European Journal of Internal Medicine最新文献

{"title":"Bedside CEUS: A feasible option to consider","authors":"Andrea Boccatonda, Alice Brighenti, Valeria Tiraferri, Rossella Loiacono, Carla Serra","doi":"10.1016/j.ejim.2025.02.001","DOIUrl":"10.1016/j.ejim.2025.02.001","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"136 ","pages":"Pages 146-147"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371131","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 ,&nbsp;Carmen Beato Zambrano ,&nbsp;Elena Brozos Vázquez ,&nbsp;Ignacio García Escobar ,&nbsp;Andrés Muñoz Martín","doi":"10.1016/j.ejim.2025.04.004","DOIUrl":"10.1016/j.ejim.2025.04.004","url":null,"abstract":"<div><div>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.</div><div>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 <em>ALK</em> (30–40 %) and <em>ROS1</em> 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 (<em>KRAS</em>/<em>BRAF^V600E</em>) and antiangiogenic therapies may elevate thrombotic risk, warranting further study.</div><div>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 <em>STK11</em> mutations influence VTE risk across tumor types, while others like <em>KRAS, MET</em> and <em>BRCA</em> 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.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"136 ","pages":"Pages 19-26"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","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":"Tecovirimat and mpox: A regulatory balancing act between hope, hurdles, and high-risk populations","authors":"John G. Rizk ,&nbsp;Giuseppe Lippi ,&nbsp;Brandon M. Henry ,&nbsp;Kin Israel Notarte ,&nbsp;Youssef Rizk","doi":"10.1016/j.ejim.2025.01.031","DOIUrl":"10.1016/j.ejim.2025.01.031","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"136 ","pages":"Pages 144-145"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191208","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 febrile woman with gas collection in the right upper abdomen","authors":"Shinji Yoshida ,&nbsp;Junpei Komagamine","doi":"10.1016/j.ejim.2025.03.024","DOIUrl":"10.1016/j.ejim.2025.03.024","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"136 ","pages":"Pages 119-120"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722471","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 ,&nbsp;Frank-Peter Stephan ,&nbsp;Florian N. Riede ,&nbsp;Annette Christine Mettler ,&nbsp;Gilles Dutilh ,&nbsp;Gioele Capoferri ,&nbsp;Tito Bosia ,&nbsp;Christian Sticherling ,&nbsp;Roland Bingisser ,&nbsp;Christian H. Nickel","doi":"10.1016/j.ejim.2025.03.038","DOIUrl":"10.1016/j.ejim.2025.03.038","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the diagnostic accuracy of ECG readings in detecting hyperkalemia and predicting outcome in the ED.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>We studied 1608 patients, thereof 805 served as normokalemic control patients.</div><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"136 ","pages":"Pages 56-62"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","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":"Cerebral small vessel disease and cognitive dysfunction in relation to central systolic blood pressure","authors":"Zhongping Yu ,&nbsp;Zihao Chen ,&nbsp;Chang Chen ,&nbsp;Jiale Huang ,&nbsp;Xin He ,&nbsp;Jingjing Zhao ,&nbsp;Wenqing Li ,&nbsp;Cuiping Zhao ,&nbsp;Jiangui He ,&nbsp;Yugang Dong ,&nbsp;Chen Liu ,&nbsp;Fang-Fei Wei","doi":"10.1016/j.ejim.2025.04.033","DOIUrl":"10.1016/j.ejim.2025.04.033","url":null,"abstract":"<div><h3>Background</h3><div>Higher blood pressure (BP) is closely associated with cerebral small vessel disease (CSVD) and poor cognition. However, little is known about the association of CSVD and cognitive dysfunction with central BP.</div></div><div><h3>Methods</h3><div>In 1447 participants (59.3 % women; mean age, 76.0 years) enrolled in the Atherosclerosis Risk in Communities (ARIC) study, we investigated the associations of MRI-defined CSVD, characterized by log-transformed white matter hyperintensity volumes (log-WMHv), and the presence of lacunar infarct, lobar and subcortical microhemorrhages, and cognitive function determined by the Mini Mental State Examination score with per 1-SD increment in central systolic BP (cSBP) derived by applanation tonometry. The model performance was assessed by the area under the receiver operating characteristic curve (AUC).</div></div><div><h3>Results</h3><div>After adjusted for potential confounders, cSBP was associated with log-WMHv (<em>β</em>, 0.031; <em>p</em> = 0.003) and lobar (OR, 1.58; <em>p</em> &lt; 0.001) and subcortical microhemorrhages (OR, 1.20; <em>p</em> = 0.011). Adding cSBP to the base model enhanced the model performance for the risk of lobar microhemorrhages (<em>p</em> = 0.042), while AUC did not statistically increase with the addition of peripheral SBP (<em>p</em> = 0.49). Irrespective of adjustments, the associations of cSBP with CSVD markers and cognitive dysfunction were much stronger for Blacks compared with Whites. Incorporating cSBP into the base model significantly improved AUC from 0.63 to 0.68 (<em>p</em> = 0.042) for subcortical microhemorrhages in Blacks.</div></div><div><h3>Conclusion</h3><div>cSBP was associated with CSVD and cognition impairment. Our observations highlight that cSBP may help further investigation for the prevention strategies of CSVD.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"136 ","pages":"Pages 101-106"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048253","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":"Impact of L-arginine and liposomal vitamin C supplementation on quality of life and daily life activities in patients with COPD: a randomized, multicenter, single blind, placebo-controlled trial (ILDA study)","authors":"Dejan Radovanovic ,&nbsp;Juan Camilo Signorello ,&nbsp;Giuseppe Fuccia ,&nbsp;Giada Lazzaroni ,&nbsp;Fiammetta Danzo ,&nbsp;Gualtiero Maria Guandalini ,&nbsp;Federica Massaro ,&nbsp;Francesco Tursi ,&nbsp;Pierachille Santus","doi":"10.1016/j.ejim.2025.04.039","DOIUrl":"10.1016/j.ejim.2025.04.039","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic Obstructive Pulmonary Disease (COPD) patients experience limitations in activities of daily living (ADL) despite optimal inhaled treatment. L-arginine depletion is associated with poor exercise performance. Our aim was to assess whether oral L-arginine supplementation improves dyspnea and ADL in COPD patients.</div></div><div><h3>Design and Methods</h3><div>Randomized, multicenter, single blind, placebo-controlled study (NCT05412160). Stable COPD patients received L-arginine (1.66 g) plus liposomal vitamin C (500 mg) twice daily or placebo for 4 weeks. At baseline (T0) and after treatment (T1) lung function, six minutes walking test (6MWT), dyspnea and ADL perfomance, evaluated through: COPD assessment test (CAT), self-administered chronic respiratory questionnaire (CRQ-SA), Clinical COPD Questionnaire 24 h and 7 days (CCQ) and London Chest Activity of Daily Living Scale (LCADL) -were assessed. The primary endpoint was CRQ score change compared with placebo.</div></div><div><h3>Results</h3><div>150 patients were enrolled (67 % males, median FEV1 57 %predicted), with 76 receiving L-arginine. Baseline characteristics and questionnaire scores were balanced between arms. At T1, L-arginine patients demonstrated significant improvements compared to placebo in CRQ total score (median (IQR) 3.5 (0.0;6.75); <em>P</em> = 0.006), CRQ dyspnea domain (3.0 (0.0;6.0); <em>P</em> &lt; 0.001); LCADL total score (-1.0 (-3.0;0.0); <em>P</em> = 0.005); LCADL housework (-1.0 (-3.0;0.0); <em>P</em> &lt; 0.001) and LCADL free time (0.0 (-1.0;0.0); <em>P</em> = 0.003). More L-arginine patients reached the minimal clinically important difference (MCID) in CRQ dyspnea and total LCADL. Baseline CRQ dyspnea&lt;20 (OR (95 %CI): 4.296 (2.051–8.999); <em>P</em> &lt; 0.001) and a LCADL score&lt;27 (7.126 (2.729–18.609); <em>P</em> &lt; 0.001) predicted MCID response.</div></div><div><h3>Conclusion</h3><div>Oral supplementation with L-arginine added to inhaled therapy appears to improve dyspnea and ADL in COPD.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"136 ","pages":"Pages 107-116"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052229","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":"Evidence that adequate provision of vitamin D reduces cardiovascular disease risks","authors":"William B. Grant ,&nbsp;Barbara J. Boucher","doi":"10.1016/j.ejim.2025.02.037","DOIUrl":"10.1016/j.ejim.2025.02.037","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"136 ","pages":"Pages 123-124"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558705","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":"Ultra-processed foods and cardio-kidney-metabolic syndrome: A review of recent evidence","authors":"Mehmet Kanbay ,&nbsp;Lasin Ozbek ,&nbsp;Mustafa Guldan ,&nbsp;Sama Mahmoud Abdel-Rahman ,&nbsp;Arif E. Narin ,&nbsp;Alberto Ortiz","doi":"10.1016/j.ejim.2025.03.017","DOIUrl":"10.1016/j.ejim.2025.03.017","url":null,"abstract":"<div><div>The rapid increase in the consumption of ultra-processed foods (UPFs) has become a significant global public health concern. UPFs are typically high in unhealthy fats, refined sugars, sodium, and other additives while being low in proteins, fibers, and other essential nutrients. Their high glycemic index and glycemic load lead to blood sugar spikes, contributing to metabolic dysregulation. Emerging evidence links UPF intake to the development of the cardiovascular-kidney-metabolic (CKM) syndrome and a higher risk of adverse health outcomes, such as all-cause and cardiovascular mortality. The pathophysiological mechanisms likely involve chronic inflammation, oxidative stress, dysregulated lipid metabolism, insulin resistance, immune dysfunction, and gut microbiota disruption. The adverse effects are even more concerning in vulnerable populations, including individuals with chronic kidney disease, kidney failure, and the elderly. This review article explores how UPF intake contributes to chronic diseases across the CKM spectrum, including cardiovascular disease, kidney disease, obesity, and type 2 diabetes mellitus, while also exacerbating frailty and reducing quality of life. The focus goes beyond risks of individual metabolic complications to address the broader health implications of UPFs on the increased prevalence of multiple coexistent non-communicable diseases, frailty, reduced quality of life, meta-inflammation, metabolic memory, and syndemics, which are particularly critical for the aging geriatric population.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"136 ","pages":"Pages 4-18"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694322","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":"Avian flu: a swooping threat or just a volatile menace? What clinicians need to know","authors":"Fabian Patauner,&nbsp;Emanuele Durante-Mangoni,&nbsp;Lorenzo Bertolino","doi":"10.1016/j.ejim.2025.04.032","DOIUrl":"10.1016/j.ejim.2025.04.032","url":null,"abstract":"<div><div>Avian flu is a cause of emerging fears among citizens and health care providers. In this review article, we provide the practicing Internal Medicine physician with a concise update regarding epidemiology, clinical consequences and management of ‘avian flu’ possibly affecting humans.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"136 ","pages":"Pages 27-30"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052072","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}