European Journal of Internal Medicine最新文献

{"title":"Atypical and fatal presentation of acute liver failure","authors":"Ana Pérez González , Javier Martín López , Jesus Rivera-Esteban","doi":"10.1016/j.ejim.2025.05.036","DOIUrl":"10.1016/j.ejim.2025.05.036","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"140 ","pages":"Article 106371"},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217441","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":"Senolytic therapies for cardiovascular aging: tackling fibrosis and metabolic dysfunction","authors":"Sandra Atlante ,&nbsp;Michela Gottardi Zamperla ,&nbsp;Luca Cis ,&nbsp;Antonella Farsetti ,&nbsp;Carlo Gaetano","doi":"10.1016/j.ejim.2025.07.009","DOIUrl":"10.1016/j.ejim.2025.07.009","url":null,"abstract":"<div><div>Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality, with aging as a critical risk factor. Cellular senescence, marked by irreversible cell cycle arrest and a pro-inflammatory secretory phenotype, drives age-related cardiovascular pathologies, including vascular dysfunction, atherosclerosis, cardiac fibrosis, and metabolic disturbances. Senolytics—agents that selectively eliminate senescent cells—represent a promising therapeutic strategy. This review explores the role of senescence in CVD and evaluates senolytics potential to improve vascular function, reduce fibrosis, and address CVD-related metabolic and immune dysfunctions. Preclinical studies have shown promising results in improving heart function, particularly in the treatment of heart failure, in post-myocardial infarction recovery, and cardiac transplantation. The interplay between senescence and immunosenescence in CVD is also examined, highlighting the potential of senolytics to rejuvenate immune responses and attenuate chronic inflammation. Furthermore, the review discusses the role of senolytics in addressing metabolic syndrome, a significant contributor to CVD, by alleviating systemic inflammation and insulin resistance.</div><div>While clinical data remain limited, early-phase trials and strong preclinical evidence provide a compelling rationale for further investigating senolytics in cardiovascular contexts. In this light, the review concludes by emphasizing the challenges and the need for extended preclinical and clinical studies to establish the efficacy, safety, dose, and long-term effects of senolytics and to exploit them as a transformative approach in cardiovascular medicine.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"140 ","pages":"Article 106413"},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651112","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":"Prognostic value of N-terminal prohormone B-type natriuretic peptide modified by renal function in patients with acute heart failure","authors":"Rui Zhu ,&nbsp;Yaoyao Wang ,&nbsp;Lili Liu ,&nbsp;Xuejiao Liu ,&nbsp;Zhanyuan Chen ,&nbsp;Yu Wei ,&nbsp;Weifeng Lin ,&nbsp;Lihua Zhang ,&nbsp;Guangda He ,&nbsp;Jianfang Cai","doi":"10.1016/j.ejim.2025.06.017","DOIUrl":"10.1016/j.ejim.2025.06.017","url":null,"abstract":"<div><h3>Introduction</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 &lt; 0.01) were modified by estimated glomerular filtration rate (eGFR) levels, remaining significant yet weaker in HF patients with eGFR &lt;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 &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"140 ","pages":"Article 106388"},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","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":"Stroke prevention in atrial fibrillation patients with end-stage renal disease: how far from Ithaca after a long Odyssey?","authors":"Davide Antonio Mei ,&nbsp;Francesco Tritto ,&nbsp;Jacopo Francesco Imberti ,&nbsp;Marco Vitolo ,&nbsp;Giuseppe Boriani","doi":"10.1016/j.ejim.2025.106455","DOIUrl":"10.1016/j.ejim.2025.106455","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"140 ","pages":"Article 106455"},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805214","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":"A person-centred clinical approach to the multimorbid patient with COPD","authors":"Bartolome R. Celli ,&nbsp;Leonardo M. Fabbri ,&nbsp;Abebaw M. Yohannes ,&nbsp;Nathaniel M. Hawkins ,&nbsp;Gerard J. Criner ,&nbsp;Jessica Bon ,&nbsp;Marc Humbert ,&nbsp;Christine R. Jenkins ,&nbsp;Leonardo Pantoni ,&nbsp;Alberto Papi ,&nbsp;Jennifer K. Quint ,&nbsp;Sanjay Sethi ,&nbsp;Daiana Stolz ,&nbsp;Alvar Agusti ,&nbsp;Don D. Sin","doi":"10.1016/j.ejim.2025.07.020","DOIUrl":"10.1016/j.ejim.2025.07.020","url":null,"abstract":"<div><div>Most patients with a chronic disease are multimorbid. This is particularly important in patients with chronic obstructive pulmonary disease (COPD), who on average have five other identified comorbidities that independently impact their health and increase their mortality risk. Using a modified Delphi method, we selected the 20 most important diseases associated with COPD and clustered them into five domains: mental, respiratory, cardiovascular, metabolic and multiple organs loss of tissue. We then developed a systematic approach to characterise the impact and clinical presentation of individual diseases within each cluster, and to define the priority and timing of measurement of the potential markers of disease presence and severity. Given the absence of integrated guidelines to treat multimorbid patients, we reviewed and selected individual disease guidelines or recommendations that can be accessed for specific information related to the management of each disease. In addition, we built a multimorbidity ‘Health Dashboard’ that, completed by the patient or health practitioner, can help identify the presence and severity of comorbid diseases. By using a practical comprehensive approach, it is possible to identify and characterise important comorbid diseases in patients with COPD, and to implement management tools that should help improve their outcome. This expert consensus commentary summarises patient-centred recommendations to manage comorbidities in COPD patients, aiming to improve quality-of-life and reduce disease burden through a holistic approach. Prospective pragmatic trials comparing such an approach with usual care for multimorbid patients with COPD including long-term follow-up are urgently needed.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"140 ","pages":"Article 106424"},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849496","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 secondary prevention with colchicine in patients with CAD: an updated systematic review and meta-analysis","authors":"Patrizia Boracchi ,&nbsp;Giuseppe Marano ,&nbsp;Ester Luconi ,&nbsp;Claudio Cimminiello","doi":"10.1016/j.ejim.2025.04.024","DOIUrl":"10.1016/j.ejim.2025.04.024","url":null,"abstract":"<div><div>The CLEAR SYNERGY trial failed to demonstrate any benefit of colchicine in patients with acute myocardial infarction (MI). In this meta-analysis of the randomized clinical trials (RCTs) of colchicine in coronary artery disease (CAD), we updated the estimates of effect on cardiovascular events in patients with CAD.</div><div>We searched for the largest RCTs of colchicine in CAD patients. The effect was assessed in a pooled analysis of individual events such as MI, urgent coronary revascularization (UR), stroke, cardiovascular mortality, and total mortality, for each of these endpoints using hazard ratios (HR) and their 95 % confidence intervals (CI), estimated by the Cox model. Fixed-effects or random-effects models were used. A similar approach was used for the composite of MI, UR, and cardiovascular mortality (MACE 1) and stroke, MI, total mortality (MACE 2). Safety was also assessed. Five studies were selected with a total of 18,656 patients. Colchicine reduced the risk of MI by 21 %, HR 0.79 (95 % CI: 0.68 - 0.92).Its effect was neutral on total and cardiovascular mortality. The composite endpoints MACE 1 and MACE 2 were reduced by colchicine, HR 0.81 (95 % CI: 0.68 - 0.98), and HR 0.88 (95 % CI: 0.79 - 0.98), respectively. There were no differences in non-cardiovascular mortality, cancer, and serious gastrointestinal and infectious events.</div><div>The benefit of colchicine appears attenuated compared to past analyses, but is still valuable in reducing the risk of MI and the composite of MI, UR, and cardiovascular death. The safety appears reassuring in relation to all serious adverse reactions.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"140 ","pages":"Article 106317"},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250639","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":"Role of 12-lead electrocardiogram for identifying very low mortality risk patients with non-hypotensive acute pulmonary embolism","authors":"Crhistian-Mario Oblitas ,&nbsp;Francisco Galeano-Valle ,&nbsp;Luis-Antonio Alvarez-Sala Walther ,&nbsp;Pablo Demelo-Rodríguez","doi":"10.1016/j.ejim.2025.06.002","DOIUrl":"10.1016/j.ejim.2025.06.002","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"140 ","pages":"Article 106373"},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250640","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":"Hijacked medical journals rank first via search engine optimization and threaten academic integrity","authors":"Mihály Hegedűs ,&nbsp;Mehdi Dadkhah ,&nbsp;Lóránt Dénes Dávid","doi":"10.1016/j.ejim.2025.106450","DOIUrl":"10.1016/j.ejim.2025.106450","url":null,"abstract":"<div><div>The rise of questionable journals poses a significant threat to academic integrity, resulting in substantial waste of institutional and university resources. This commentary analysis focuses on six hijacked medical journals, a specific type of questionable publication. We utilized Semrush, an online Search Engine Optimization auditing platform, to analyse our data, which revealed that hijacked journals disseminate their content through search engines. Specifically, searches for certain medical keywords return hijacked medical journals’ content among the top 20 results. Evidence from both previous research and the current study suggests that hijacked journals leverage various channels for content dissemination, including artificial intelligence chatbots, citation databases, spam emails, and search engines. Raising awareness about this issue is crucial to mitigating the immediate harm caused by these journals. Furthermore, long-term solutions will necessitate advancements in technological development to combat this evolving problem effectively.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"140 ","pages":"Article 106450"},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876527","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":"Gamma-glutamyltransferase independently predicts mortality and heart failure hospitalization in cardiac transthyretin amyloidosis","authors":"Alberto Aimo ,&nbsp;Vincenzo Castiglione ,&nbsp;Daniela Tomasoni ,&nbsp;Giovanni Battista Bonfioli ,&nbsp;Giorgia Panichella ,&nbsp;Giulio Sinigiani ,&nbsp;Alessandro Lupi ,&nbsp;Aldostefano Porcari ,&nbsp;Navneet Kaur ,&nbsp;Marco Merlo ,&nbsp;Alberto Cipriani ,&nbsp;Gianfranco Sinagra ,&nbsp;Maria Franzini ,&nbsp;Giuseppe Vergaro ,&nbsp;Michele Emdin","doi":"10.1016/j.ejim.2025.06.009","DOIUrl":"10.1016/j.ejim.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Transthyretin cardiac amyloidosis<span> (ATTR-CA) is a leading cause of heart failure (HF). Although transthyretin is synthesized in the liver, overt liver disease is uncommon in ATTR-CA. We characterised hepatic involvement in patients with ATTR-CA, and identified the correlates and prognostic value of elevated gamma-glutamyl transferase (GGT), the most prominently deranged biomarker.</span></div></div><div><h3>Methods</h3><div>We examined 528 patients from four centers, using scintigraphy, cardiovascular magnetic resonance, and circulating biomarkers to assess liver function. The primary endpoint was all-cause mortality; secondary endpoints included HF hospitalization alone or combined with all-cause mortality.</div></div><div><h3>Results</h3><div>The cohort comprised predominantly older men (86 % male; median age 81 years). Scintigraphy showed no abnormal hepatic uptake, but liver extracellular volume was elevated (median 0.69; clinically significant cutoff 0.40). Median GGT was 49 U/L, with 48 % exceeding sex-specific upper reference limits. By comparison, elevated aspartate and alanine transaminases, total bilirubin, and alkaline phosphatase were observed in 26 %, 9 %, 33 %, and 1 % of patients, respectively. Patients with GGT ≥82 U/L displayed indicators of more advanced cardiac disease, hepatic injury, and venous congestion. During a median follow-up of 2.6 years, 39 % died and 33 % were hospitalized for HF. In multivariable analysis, GGT remained predictive of all-cause mortality and HF hospitalization beyond the National Amyloidosis Centre score (hazard ratio [HR] 1.15, 95 % confidence interval [CI] 1.01–1.31; <em>p</em> = 0.045, and HR 1.17, 95 % CI 1.03–1.32; <em>p</em> = 0.016, respectively).</div></div><div><h3>Conclusions</h3><div>Elevated GGT is associated with greater disease severity and predicts worse outcomes in ATTR-CA. GGT measurement may improve risk stratification and guide treatment decision-making.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"140 ","pages":"Article 106380"},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287013","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":"Corrigendum to “Telemedicine in Internal Medicine: a statement by the European Federation of Internal Medicine” [European Journal of Internal Medicine 112C (2023) 138-139]","authors":"Filomena Pietrantonio ,&nbsp;Sebastian Kuhn ,&nbsp;Kati Kärberg ,&nbsp;Tiffany Leung ,&nbsp;Ismael Said-Criado ,&nbsp;on behalf of the EFIM Telemedicine, Innovative Technologies and Digital Health Working Group","doi":"10.1016/j.ejim.2025.07.008","DOIUrl":"10.1016/j.ejim.2025.07.008","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"140 ","pages":"Article 106412"},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769241","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}