European Journal of Internal Medicine最新文献

{"title":"Prognostic value of N-terminal prohormone B-type natriuretic peptide modified by renal function in patients with acute heart failure.","authors":"Rui Zhu, Yaoyao Wang, Lili Liu, Xuejiao Liu, Zhanyuan Chen, Yu Wei, Weifeng Lin, Lihua Zhang, Guangda He, Jianfang Cai","doi":"10.1016/j.ejim.2025.06.017","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.017","url":null,"abstract":"<p><strong>Introduction: </strong>It remains unclear whether renal function and follow-up duration impact the prognostic value of N-terminal prohormone B-type natriuretic peptide (NT-proBNP) in patients with heart failure (HF).</p><p><strong>Methods: </strong>A nationwide prospective cohort study was conducted in 4907 adults hospitalized for acute HF, of whom 4766 were eligible for analysis. We used Cox regression to estimate the relative risks and Poisson regression to assess the absolute risks of adverse outcomes associated with NT-proBNP levels at admission. Effect modification by renal function was tested in both Cox and Poisson models.</p><p><strong>Results: </strong>Over a median follow-up period of 4.6 years, patients with the middle and highest NT-proBNP tertiles had hazard ratios (HRs) (95 % CI) of 1.41 (1.24-1.59) and 2.15 (1.89-2.44) for all-cause mortality, 1.59 (1.37-1.85) and 2.35 (2.01-2.74) for cardiovascular mortality, respectively, compared to those with the lowest tertile. These associations diminished over time. The associations between NT-proBNP levels and the risks of mortality (P-for-interaction < 0.01) were modified by estimated glomerular filtration rate (eGFR) levels, remaining significant yet weaker in HF patients with eGFR <30 ml/min/1.73m². The incidence rates of mortality at the same NT-proBNP level were higher in HF patients with lower eGFR (P-for-interaction < 0.05).</p><p><strong>Conclusion: </strong>NT-proBNP levels demonstrated graded associations with the risks of adverse outcomes. As eGFR reduced, its excessive relative risks attenuated, while its absolute risks increased. The associations waned over an extended follow-up period. These findings highlight the prognostic significance of NT-proBNP in patients with reduced renal function and the necessity of its dynamic monitoring.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of beta-blockers in patients with comorbid chronic obstructive pulmonary disease and cardiovascular disease.","authors":"Tejuss Kakarla, Yash Vardhan Trivedi, Parth Munjal, Avi Kumar, Rohit Jain","doi":"10.1016/j.ejim.2025.06.018","DOIUrl":"10.1016/j.ejim.2025.06.018","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Substantial variety in point of care ultrasound training across EFIM.","authors":"N Smallwood, J Neves","doi":"10.1016/j.ejim.2025.06.015","DOIUrl":"10.1016/j.ejim.2025.06.015","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure values in healthy normal weight children and adolescents in eight European countries: auscultatory and oscillometric measurements.","authors":"Lurbe E, Regueiro-Ons C, Mancia G, Düzova A, Erdine S, Herceg-Cavrak V, Kulaga Z, Litwin M, Pall D, Petricevic N, Seeman T, Simão C, Stabouli S, Redon J, González López-Valcarcel B","doi":"10.1016/j.ejim.2025.06.011","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.011","url":null,"abstract":"<p><strong>Aim: </strong>The aim of the study is to provide BP values adjusted for sex, age and height in a large sample of healthy and normal weight children and adolescents 3-17 years in eight European countries, using standardized BP measurement by oscillometric and auscultatory methods.</p><p><strong>Subjects and methods: </strong>In 38.374 children (20.189 girls) BP values were measured following the European Society of Hypertension guidelines. To derive BP percentiles the estimated influences of age and height simultaneously on BP levels were estimated.</p><p><strong>Results: </strong>The estimated BP values corresponding to 90th, 95th, and 99th systolic and diastolic percentiles according to height percentiles, age and sex were calculated. In both methods, the 90th and 95th percentiles of systolic blood pressure, tended to increase with both age and height, higher in boys than in girls without differences in diastolic blood pressure. The study illustrates the differences in 95th Blood Pressure percentile obtained by oscillometric and auscultatory methods in both sexes at the 50th height percentile. The threshold corresponding to 95th percentile at age 13 is close to 130/80 mmHg in both sexes and measurement methods at median height and at age 17 it is around 140/90 mmHg for boys.</p><p><strong>Conclusions: </strong>The progressive increment of blood pressure in children across age is largely influenced by height. In boys blood pressure values still increase after 13 years old, while in girls the BP increment after this age was lower. Differences in systolic blood pressure and diastolic blood pressure among the two used methods are minimal except in the oldest age group.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of time to first palliative care consultation in hospitalized patients with advanced or terminal illness - A retrospective analysis.","authors":"Christopher Paschen, Franziska Ecker, Patrick Haider, Claudia Wenzel, Eva Katharina Masel","doi":"10.1016/j.ejim.2025.06.013","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.013","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis and sex-related biases can affect clinical decision-making in serious illness, including the recognition of palliative needs. Such biases may influence when and how patients receive palliative care (PC). This study aimed to investigate differences in timing and frequency of PC consultations by diagnosis, comorbidities, age, and sex among hospitalized patients.</p><p><strong>Methods: </strong>This study retrospectively analyzed 918 patients (50.5 % female) who received a PC consultation during hospitalization between 2016 and 2022. Time from admission to first PC consultation was analyzed using a Cox proportional hazards model adjusted for primary diagnosis, comorbidities, age, and sex. Further analysis included number of follow-up consultations, time from primary disease onset to first PC consultation, and from consultation to discharge or death.</p><p><strong>Results: </strong>Inpatients with organ failure (HR: 0.7 [95 %-CI: 0.5-0.9]; p = 0.02) or neurological diseases (HR: 0.7 [95 %-CI: 0.5-1.0]; p = 0.03) received later PC consultations than those with solid organ tumors or hematologic malignancies. Higher comorbidity burden was associated with earlier PC consultation (HR: 1.04 [CI: 1.01-1.07]; p = 0.02), while age was not linked to consultation timing (HR: 0.997 [CI: 0.992-1.002]; p = 0.20). Women received earlier PC consultations than men (HR: 1.3 [95 %-CI: 1.1-1.4]; p < 0.001). Only 9.4 % of individuals received a follow-up consultation, with the lowest proportion in subjects with organ failure (4.7 %).</p><p><strong>Conclusions: </strong>This study highlights earlier PC consultation requests during hospitalization for individuals with malignant diseases and for women. The low rate of follow-up PC consultations indicates that the importance of regular PC involvement to improve patient's outcomes still did not permeate into clinical practice.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When inflammatory bowel disease meets pregnancy.","authors":"Shiqing Zhao, Shengpu Zhou, Junmei Wang, Yanyan Shi","doi":"10.1016/j.ejim.2025.06.014","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.014","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) is a group of chronic and relapsing inflammatory conditions that affect the gastrointestinal tract. Women of reproductive age comprise a significant proportion of patients with IBD. The management of IBD during pregnancy presents unique and complex challenges that have garnered increasing attention recently. Moreover, considerable attention has been directly toward the safety of novel treatments for IBD during pregnancy. This review summarises the complex interaction between pregnancy and IBD, the special management of IBD during pregnancy, and the effects of early life events on IBD of offspring.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term quality of life after sleeve gastrectomy vs Roux-en-Y Gastric Bypass in patients with severe obesity: Results from the SleeveBypass multicentre randomised controlled trial.","authors":"J W H 't Hart, B J Noordman, E Birnie, J F Smulders, S Nienhuijs, M Dunkelgrün, J F Zengerink, I A M Friskes, G H H Mannaerts, C Verhoef, J A Apers, L U Biter","doi":"10.1016/j.ejim.2025.06.006","DOIUrl":"10.1016/j.ejim.2025.06.006","url":null,"abstract":"<p><strong>Background: </strong>Limited information is available on long-term quality of life (QoL) outcomes after sleeve gastrectomy compared to Roux-en-Y gastric bypass.</p><p><strong>Methods: </strong>These techniques were compared in an open-label randomised controlled trial. This paper focuses on generic health-related QoL (HRQoL) using the 36-Item Short Form Health Survey and EuroQol-5 Dimension 3-Level questionnaires and disease-specific QoL (DSQoL), using the Moorehead-Ardelt questionnaire (specifically designed for individuals with obesity to assesses self-esteem, physical activity, work performance, sexual life, eating behaviour, and social interactions)the Gastroesophageal Reflux Disease Questionnaire (GERD-Q); the Gastrointestinal Quality of Life Index (GIQLI); and the Asthma Control Questionnaire. Simple carbohydrate consumption was assessed with the Dutch Sweet Eating Questionnaire. Measurements were taken preoperatively, 2 months post-surgery, and annually up to 5 years. Analyses used a linear mixed model. Cohen's d (CD) effect sizes indicate small (0∙2), medium (0∙5), and large (0∙8) effects. Dutch Trial Register NTR4741.</p><p><strong>Findings: </strong>From 2013 until 2017, 628 patients were randomised between sleeve gastrectomy (n = 312) and Roux-en-Y gastric bypass (n = 316). Minimal follow-up was 5 years (last follow-up July 29th, 2022). Mean age was 43 [SD, 11] years; mean BMI 43∙5 [SD, 4∙7] and 81∙8 % were women. No clinically relevant differences in generic HRQoL were observed. Moorehead-Ardelt scored higher in the bypass group at 2 years (difference 0∙4, [95 % CI -0∙6 to -0∙1], P=.002, CD -0∙3), without statistically differences later on. GERD-Q scores were consistently better in the bypass group at all time points and remained higher after 5 years (difference 1∙5, [95 % CI 0∙7 to 2∙3], P<.001, CD 0∙3). GIQLI showed a statistically significant better outcome in the bypass group after 4 and 5 years (difference -4∙6, [95 % CI -8∙7 to -0∙4], P = 0.032, CD -0∙17). Sweet-eating showed no statistically significant differences over time.</p><p><strong>Conclusion: </strong>For patients living with severe obesity, sleeve gastrectomy and Roux-en-Y gastric bypass overall showed good long-term HRQoL and DSQoL outcomes. Roux-en-Y gastric bypass was associated with less GERD-related symptoms. Factors such as GERD should be considered when choosing the type of surgery.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive skin thickening in a young adult.","authors":"Thomas Didier, Sophie Leducq, Boris Laure","doi":"10.1016/j.ejim.2025.05.032","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.05.032","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point of care ultrasound: focus on evidence for a critical appraisal.","authors":"E Ceriani, R Schiavon, L La Cava, C Ruscitti, C Cogliati","doi":"10.1016/j.ejim.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.005","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) refers to a sonographic examination performed directly at the patient's bedside, integrated into clinical reasoning for diagnostic, monitoring, risk stratification, and therapeutic purposes. Its main applications in medical patients include causes of dyspnea, chest pain, abdominal pain, and shock. In dyspnea, a multiorgan POCUS approach allows for the identification of most underlying conditions. Moreover, in acute heart failure and pulmonary embolism, it aids in risk stratification. In chest pain, POCUS supports diagnosis, though in acute aortic syndromes and acute coronary syndrome, it remains part of a broader diagnostic process. For abdominal pain, it is particularly useful in detecting biliary tract diseases, ascites, acute appendicitis, and abdominal aortic aneurysm. Various POCUS protocols assist in identifying different types of shock (distributive, cardiogenic, hypovolemic, and obstructive). Most studies focus on diagnostic accuracy, highlighting valuable sensitivity and specificity in many conditions. While in many cases faster diagnosis has been shown, its efficacy in guiding treatment, reducing length of stay and the impact on mortality is much less defined. Misuse may derive from inadequate image acquisition, interpretation, and clinical integration, thus appropriate training is fundamental to ensure patient safety. Despite significant expansion in residency programs and medical schools over the past decade, barriers such as limited training access for practicing physicians, faculty availability, and longitudinal competency maintenance persist. The fragmented inclusion of POCUS in disease-specific guidelines underscores a delay in recognizing evidence in some cases, but mostly highlights the need for further research and standardization.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing unmet needs in the use of SGLT2 inhibitors in critical and acute care setting.","authors":"Damiano D'Ardes, Fabrizio Ricci, Paola Simeone, Andrea Boccatonda, Francesca Santilli","doi":"10.1016/j.ejim.2025.06.003","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.003","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}