European Journal of Internal Medicine最新文献

{"title":"The impact of sensitization patterns on COPD severity and exacerbations: Insights from a case-control and longitudinal study.","authors":"Meropi Karakioulaki, Caroline Maria Berkemeier, Leticia Grize, Ingmar Heijnen, Stergios A Polyzos, Antonis Goulas, Michael Tamm, Daiana Stolz","doi":"10.1016/j.ejim.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.001","url":null,"abstract":"<p><strong>Background: </strong>Total Immunoglobulin E (tIgE) and allergen-specific IgE (sIgE) have been linked to asthma in numerous studies, with emerging evidence suggesting IgE sensitization influences chronic obstructive pulmonary disease (COPD) onset and severity. This study explores whether (a) serum tIgE and sIgE profiles differ among COPD, asthma, and controls (case-control substudy) and (b) tIgE and 300 individual sIgE levels correlate with disease severity and outcomes in 343 COPD patients (longitudinal substudy).</p><p><strong>Methods: </strong>The case-control substudy measured tIgE and sIgE in 122 participants (76 COPD, 19 asthma, 27 controls). The longitudinal substudy analyzed tIgE and 300 sIgE in 343 COPD patients, examining links to disease severity and outcomes. Atopy was defined as tIgE>20 kUA/L, while skin-sensitization was determined by skin prick test positivity.</p><p><strong>Results: </strong>No significant tIgE differences were observed among asthma, COPD, and controls, however asthma and COPD patients showed distinct sIgE patterns for various allergens. Atopic men reported fewer urgent visits for acute exacerbations of COPD (ECOPD) than non-atopic men (79.07 % vs.91.33 %, p = 0.007), while skin-sensitized women experienced more severe ECOPD than non-skin-sensitized women (46.43 % vs. 24.36 %, p = 0.028). Exacerbation etiology was not associated with atopic or skin-sensitization profiles. Fungal sensitization correlated with older age (p = 0.032), worse 6-minute walking test outcomes (p = 0.007), and reduced diffusion capacity (DLCO/VA %, p = 0.006).</p><p><strong>Conclusion: </strong>While atopic profiles are similar across groups, asthma features higher aeroallergen sIgE. Skin-sensitization and atopy may influence lung function and symptom severity in COPD but are differently associated with ECOPD between sexes and are not linked to the etiology of ECOPD.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054703","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":"The role of achieving blood pressure targets in renal protection: Insights from the VALUE trial.","authors":"Yong Wang, Mingzhu Jiang, Wei Zhou","doi":"10.1016/j.ejim.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.007","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004122","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":"Cancer genetic profile and risk of thrombosis.","authors":"Francisco J Pelegrín-Mateo, Carmen Beato Zambrano, Elena Brozos Vázquez, Ignacio García Escobar, Andrés Muñoz Martín","doi":"10.1016/j.ejim.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.004","url":null,"abstract":"<p><p>Cancer-associated thrombosis (CAT) remains a leading cause of morbidity and mortality among oncology patients, with an incidence influenced by tumor type, stage, treatment, and molecular characteristics. This review explores the molecular determinants of venous thromboembolism (VTE) in cancer, emphasizing its pathophysiology and association with specific oncogenic alterations. Certain molecular profiles exhibit heightened VTE risk. In lung cancer, due to hypercoagulability mechanisms linked to tissue factor overexpression, an increased incidence of VTE has been reported in populations with ALK (30-40 %) and ROS1 rearrangements (34.7-46.6 %). In gastrointestinal cancers, while pancreatic adenocarcinoma has the highest VTE rates (up to 22 %), KRAS mutations seem to be implicated but not conclusively validated. Similarly, colorectal cancer mutations (KRAS/BRAF^V600E) and antiangiogenic therapies may elevate thrombotic risk, warranting further study. High-grade gliomas, particularly glioblastomas, present VTE rates up to 30 %, driven by podoplanin-induced platelet aggregation. IDH1 mutations inversely correlate with thrombosis, highlighting its protective role. Emerging evidence suggests that agnostic biomarkers such as STK11 mutations influence VTE risk across tumor types, while others like KRAS, MET and BRCA mutations show inconclusive results. Large-scale validation studies are imperative to integrate molecular profiles into clinical practice. Until then, management decisions should be individualized, balancing the thrombotic risks with oncologic considerations.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020153","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":"Excess risk or misestimated baseline? Reconsidering relative survival in the oldest ICU patients.","authors":"Juan Ye, Kun Huang","doi":"10.1016/j.ejim.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.005","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006625","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":"Performance and costs of rule-out protocols for acute aortic syndromes: analysis of pooled prospective cohorts.","authors":"Paolo Bima, Peiman Nazerian, Christian Mueller, Matteo Castelli, Elisa Capretti, Alexandre de Matos Soeiro, Alessandro Cipriano, Giorgio Costantino, Simone Vanni, Bernd A Leidel, Beat A Kaufmann, Adi Osman, Marcello Candelli, Nicolò Capsoni, Wilhelm Behringer, Giovanni Ascione, Tatiana de Carvalho Andreucci Torres Leal, Lorenzo Ghiadoni, Emanuele Pivetta, Enrico Lupia, Fulvio Morello","doi":"10.1016/j.ejim.2025.03.039","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.03.039","url":null,"abstract":"<p><strong>Background: </strong>Acute aortic syndromes (AAS) are deadly conditions causing unspecific symptoms, such as chest/abdominal/back pain, syncope and neurological deficit. They are diagnosed with computed tomography angiography (CTA), but the patient selection is challenging. To support physicians and standardize management, protocols combining a clinical score with D-dimer (DD) have been developed. However, direct comparison of their diagnostic performance and cost-effectiveness is lacking.</p><p><strong>Methods: </strong>We used individual patient data from 3 prospective diagnostic studies of patients with suspected AAS, enrolled in 12 centers from 5 countries. Diagnostic accuracy, failure rate and costs were calculated for 5 protocols, applying 3 scores (aortic dissection detection [ADD], AORTAs and Canadian) and 2 DD thresholds (500 ng/mL [DD₅₀₀], age-adjusted [DD_age]). Costs were estimated using Italian and German reimbursements.</p><p><strong>Results: </strong>Among 4907 patients, 506 (10.3 %) had an AAS. The sensitivity of the diagnostic protocols ranged from 97.6 % for Canadian/DD₅₀₀ to 99.4 % for AORTAs/DD₅₀₀ or DD_age (P = 0.022). The specificity was lowest for AORTAs/DD₅₀₀ (46.8 %; P < 0.001 vs AORTAs/DD₅₀₀) and highest for ADD/DD_age (61.5 %; P < 0.001). The number of potential AAS misses was 4-fold higher with Canadian/DD₅₀₀ vs AORTAs/DD₅₀₀ or DD_age. The net clinical benefit was highest for ADD/DD_age. All protocols reduced CTA exams and costs over a CTA-to-all strategy. Numbers of predicted CTA exams and costs per 100 patients were lowest for ADD/DD_age (447 CTAs, 34,366 EUR) and highest (579 CTAs, 43,628 EUR) for AORTAs/DD₅₀₀.</p><p><strong>Conclusions: </strong>Guideline-compliant clinical score/DD based protocols are highly sensitive. Differences in specificity and efficiency are present. Data may guide decision-making based on policies and resources.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994354","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":"Diagnostic accuracy of emergency department ECGs in hyperkalemia detection: A cross-sectional study.","authors":"Luca Ünlü, Frank-Peter Stephan, Florian N Riede, Annette Christine Mettler, Gilles Dutilh, Gioele Capoferri, Tito Bosia, Christian Sticherling, Roland Bingisser, Christian H Nickel","doi":"10.1016/j.ejim.2025.03.038","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.03.038","url":null,"abstract":"<p><strong>Objective: </strong>To assess the diagnostic accuracy of ECG readings in detecting hyperkalemia and predicting outcome in the ED.</p><p><strong>Methods: </strong>A retrospective cross-sectional analysis was conducted on ED patients, including patients with confirmed hyperkalemia (≥ 5 mmol/l) and a normokalemic control group. The predictive value of ECG readings for the detection of hyperkalemia was studied. For this purpose, the subjective probability of hyperkalemia was rated from 0-100 (Hyperkalemia Probability Scoring) by two attending acute care physicians. Logistic regression and ROC analysis were used to assess predictive power and sensitivity/specificity of Hyperkalemia Probability Scorings. Prediction of 7-day adverse outcomes (ICU admission, hemodialysis, in-hospital mortality) based on Hyperkalemia Probability Scorings was analyzed.</p><p><strong>Results: </strong>We studied 1608 patients, thereof 805 served as normokalemic control patients. Sensitivity and specificity of ECG readings for hyperkalemia detection were 0.47 and 0.76 for cardiologist 1, and 0.39 and 0.81 for cardiologist 2. The AUC was 0.63 (95 % CI 0.60-0.65) and 0.61 (95 % CI 0.59-0.63) for the respective cardiologists. With a Hyperkalemia Probability Scoring of 100 compared to 0, the Odds Ratios (ORs) of diagnosing hyperkalemia were 8.2 (95 % CI 5.3-12.6) and 9.1 (95 % CI 5.8-14.7), while the ORs for 7-day adverse outcomes were 2.14 (95 % CI 1.34-3.38) and 2.22 (95 % CI 1.39-3.49) respectively.</p><p><strong>Conclusion: </strong>The ECG is not an accurate tool for ruling-in or ruling-out hyperkalemia in ED patients. Higher Hyperkalemia Probability Scorings are associated with 7-day adverse outcomes.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024112","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":"Isolated joint involvement in Whipple's disease: a cohort study.","authors":"Victor Eiferman, Alice Chanteloup, Jean Christophe Lagier, Xavier Puéchal","doi":"10.1016/j.ejim.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.003","url":null,"abstract":"<p><strong>Background: </strong>To analyse the joint manifestations of Whipple's disease and compare clinical isolated joint involvement (CIJI) with systemic joint involvement (SJI).</p><p><strong>Methods: </strong>A cohort study included patients diagnosed with Whipple's disease and joint involvement at two expert centres. Patients were divided according to their clinical presentation at diagnosis: those with CIJI and those with SJI.</p><p><strong>Results: </strong>Of the 60 patients, 17 (28 %) exhibited CIJI. Both groups were predominantly middle-aged men (75 %) with a median time to diagnosis of six (2-11) years. Joint involvement was similar, with initial episodic migratory arthritis (91 %) predominantly affecting large joints and lasting 2-7 days. Saliva and stool PCR tests were positive in 59 % and 75 % of CIJI patients, respectively, compared to 91 % and 88 % in the SJI group (P = 0 02 and P = 0 24, respectively). In CIJI patients, duodenal PCR was negative in 65 % of cases and PAS staining consistently negative. Synovial fluid PCR was positive in 100 % of CIJI and 89 % of SJI patients. Treatment with doxycycline and hydroxychloroquine, initiated in 52 (88 %) patients, resulted in resolution of joint symptoms within ten (7-15) days in all but one patient, who had destructive arthritis.</p><p><strong>Conclusion: </strong>Whipple's disease can present with isolated articular forms. Joint involvement is usually inaugural and stereotypical, with little difference between the CIJI and SJI groups. The diagnosis should be considered in cases with the typical pattern of recurrent intermittent large joint arthritis with elevated acute phase reactants, particularly in middle-aged men. Synovial fluid PCR is a valuable diagnostic tool. Doxycycline and hydroxychloroquine resulted in dramatic improvement.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052231","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":"Serum interleukin-18 levels are specifically elevated in auto-inflammatory diseases involving the pyrin inflammasome: A study on 516 patients.","authors":"Inès Elhani, Laure Calas, Farah Bejar, Bruno Fautrel, Laurence Pieroni, Véronique Hentgen, Philippe Mertz, Stéphane Mitrovic, Marion Delplanque, Léa Savey, Sophie Georgin-Lavialle","doi":"10.1016/j.ejim.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.002","url":null,"abstract":"<p><p>Auto-inflammatory diseases (AIDs) are characterized by excessive activation of innate immunity. Current biomarkers, such as C-reactive protein (CRP) and serum Amyloid A (SAA), are not disease-specific and cannot reflect disease severity. Interleukin-18 (IL-18), a pro-inflammatory cytokine of the IL-1 superfamily, has been recently studied as, biomarker for AIDs; This study aims to evaluate total serum IL-18 levels in a large cohort of AID patients from the adult French national reference center for AID. We conducted a retrospective analysis of 708 IL-18 measurements from 516 patients. The highest IL-18 levels were observed in diseases involving the pyrin inflammasome, such as Familial Mediterranean fever, mevalonate kinase deficiency, CDC42-associated AID and PSTPIP1-associated AID. Receiver operating characteristic (ROC) curve analysis demonstrated an AUC of 0.87 for IL-18, with a sensitivity of 83.4 % and specificity of 76.2 % at a cut-off value of 412 pg/mL, in differentiating pyrin inflammasome-related diseases from other monogenic inflammatory diseases. Our findings suggest the utility of total serum IL-18 as a diagnostic tool, particularly for pyrin inflammasome-related AIDs, that could in the future help to personalized treatment strategies.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057216","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":"Clinical epidemiological characteristics of BRASH syndrome.","authors":"Junji Kaneyama, Yoshihito Goto, Maki Murata, Tadanobu Irie, Takashi Kawamura","doi":"10.1016/j.ejim.2025.03.032","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.03.032","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796532","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":"Intermediate Care Units in Internal Medicine.","authors":"Ciro Canetta, Silvia Accordino, Fabiola B Sozzi","doi":"10.1016/j.ejim.2025.03.033","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.03.033","url":null,"abstract":"<p><strong>Background: </strong>Intermediate Care Units (ImCU) have been historically described as an intermediate level of care between standard wards and intensive care units (ICU), and general medical ImCUs have evolved as specifically addressed to high care medical patients. The objective of this study is to explore designs, appropriateness criteria, and quality of care of general medical ImCUs.</p><p><strong>Methods: </strong>a comprehensive literature search was performed in electronic database (PubMed/Medline, Embase, Cochrane and Web of Science) up to July 30th 2024 and data about general medical ImCU denominations, settings, processes and outcomes were extracted.</p><p><strong>Results: </strong>34 studies were included in systematic analyses, the more used nomenclature was ImCU (70.6 %), followed by High Dependency Unit (20.6 %). The median number of beds was 8 [4-11], the nurse-to-patients ratio 1:3.1, and internists involved in comanagement in 40.0 %. Either a step-up from standard wards or a step-down from ICUs role were reported, with a median of 50.8 % [26.2-71.0] of patients directly admitted from Emergency Departments. The main distinctive activities were continuous monitoring and non-invasive ventilation. The median ICU transfer rate was 8.0 % [5.6-12.3], while in-ImCU and in-hospital mortality were 6.2 % [3.6-8.3] and 14.0 % [8.7-19.1], respectively.</p><p><strong>Conclusions: </strong>general medical ImCUs are being increasingly recognized as the appropriate setting for high care medical patients but present to date a wide variability of formats. Activity-based admission criteria tailored on each hospital reality could be a process model for adequate patient flow, and quality of care key indicators should consider the functional general medical ImCU role in hospital macro-systems.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789257","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}