European Journal of Internal Medicine最新文献_第7页

Refining metabolic health assessment in inflammatory bowel disease risk prediction. 完善炎症性肠病风险预测中的代谢健康评估。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-29 DOI: 10.1016/j.ejim.2024.10.020

Yinfang Wu, Weixing Xu

引用次数: 0

Clinically relevant bleeding according to location of metastases in cancer-associated thrombosis. 根据癌症相关血栓的转移位置确定临床相关出血。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-28 DOI: 10.1016/j.ejim.2024.10.019

Victor Garcia-Garcia, Maria Barca-Hernando, Sergio Lopez-Ruz, Carmen Rosa-Linares, Teresa Elias-Hernandez, Remedios Otero-Candelera, Henry Andrade-Ruiz, Luis Jara-Palomares

{"title":"Clinically relevant bleeding according to location of metastases in cancer-associated thrombosis.","authors":"Victor Garcia-Garcia, Maria Barca-Hernando, Sergio Lopez-Ruz, Carmen Rosa-Linares, Teresa Elias-Hernandez, Remedios Otero-Candelera, Henry Andrade-Ruiz, Luis Jara-Palomares","doi":"10.1016/j.ejim.2024.10.019","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.019","url":null,"abstract":"Background: Patients with cancer-associated thrombosis (CAT) face a heightened risk of clinically relevant bleeding (CRB). However, the relationship between these risks and the location of metastasis remains unclear.Methods: A single-center, non-interventional study of consecutive patients was conducted between 2007 and 2022, involving patients with CAT (n = 1,277). Our primary objectives were: 1) To estimate the rate of CRB based on metastasis location. 2) To assess the long-term risk of CRB.Results: Over a median follow-up of 14.2 months, 144 CRB were observed. The most frequent cancers were colon (19.2 %), lung (16.1 %), and breast (12.4 %). Fifty-two per-cent had metastases. Compared to patients without metastases, metastasis locations associated with CRB were lung metastases (rate 10.0 per 100 patients/year; 95 % confidence interval [CI] 6.6 to 14.6; risk ratio [RR]: 2; 95 % CI: 1.3-3.1), liver metastases (rate 10.1 per 100 patients/year; 95 % CI 6.5-14.9; RR: 2.0; 95 % CI: 1.3-3.2) and adenopathy metastases (rate 11.9 per 100 patients/year; 95 % CI 6.8-19.3; RR: 2.4; 95 % CI: 1.4-4.1). Multivariate analysis of variables associated to CRB at long term follow-up included ECOG > 1 (HR 3.0, 95 % CI 1.7-5.3), bladder cancer (HR 2.5, 95 % CI 1.3-4.8), prostate cancer (HR 2.2, 95 % CI 1.1-4.8) and lung metastases (HR 2.1, 95 % CI 1.3-3.6).Conclusions: The bleeding rate seem differ depending on the location of metastasis. Additionally, lung metastasis was found to be associated with a long-term risk of CRB. These findings may justify the use of low dose of anticoagulation, although clinical trials need to demonstrate the efficacy and safety of this strategy.","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548727","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}

引用次数: 0

Two recent European guidelines on hypertension. 欧洲最近的两份高血压指南。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-27 DOI: 10.1016/j.ejim.2024.10.011

Paolo Verdecchia, Fabio Angeli, Giacomo Pucci, Giovanni de Simone, Gianpaolo Reboldi

引用次数: 0

Elevated blood pressure and hypertension in older persons: A comment on the recent ESC guidelines. 老年人血压升高和高血压：对近期ESC指南的评论。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-23 DOI: 10.1016/j.ejim.2024.10.013

Giulia Rivasi, Enrico Brunetti, Roberto Presta, Niccolò Marchionni, Giovambattista Desideri, Mario Bo

引用次数: 0

Treat the patient, not the disease: The embolic stroke of undetermined source as an opportunity to optimize cardiovascular prevention in a holistic approach. 治疗病人，而不是治疗疾病：来源不明的栓塞性中风是以整体方法优化心血管预防的契机。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-23 DOI: 10.1016/j.ejim.2024.10.012

George Ntaios, Mayank Dalakoti

{"title":"Treat the patient, not the disease: The embolic stroke of undetermined source as an opportunity to optimize cardiovascular prevention in a holistic approach.","authors":"George Ntaios, Mayank Dalakoti","doi":"10.1016/j.ejim.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.012","url":null,"abstract":"For any physician treating a patient with a medical condition of unclear etiology, the differential diagnosis aims to identify the actual most probable cause among various potential etiologies, in order to tailor treatment options. In patients with embolic stroke of undetermined source (ESUS), this can be challenging due to the frequent presence of multiple potential embolic sources, raising difficulties to identify the most likely cause. Additionally, despite targeted preventive measures for the presumed embolic source, patients may remain at risk for stroke and cardiovascular events due to other unrecognized or underestimated pathologies. The multi-level complexity and multimorbidity typically associated with ESUS, represents a challenge that requires broad knowledge of the cardiovascular pathophysiology, deep expertise of the available diagnostic and therapeutic options, and interdisciplinary approach. At the same time, it is an ideal opportunity to assess thoroughly the overall cardiovascular status of the patient, which in turn can allow us to optimize therapeutic and preventive strategies in a holistic approach, and prevent future strokes, cardiovascular events and disability through different parallel pathways. In this context, rather than narrowing our perspective on identifying the specific embolic source presumed to be the most likely cause of ESUS, it is crucial to shift our focus from the disease to the patient, and evaluate the overall cardiovascular profile by assessing the risk of all cardiovascular comorbidities present, no matter if causally associated with ESUS or not. In order to bring across these points and more, this article is centred around a clinical case that serves as a starting point to illustrate the holistic approach to the management of patients with ESUS. After all, this is the beauty, the magic and the art of Internal Medicine: to treat the patient, not the disease, the system or the organ.","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512195","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}

引用次数: 0

Chronic obstructive pulmonary disease's eosinophilic phenotype: Clinical characteristics, biomarkers and biotherapy. 慢性阻塞性肺病的嗜酸性粒细胞表型：临床特征、生物标志物和生物疗法。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-22 DOI: 10.1016/j.ejim.2024.10.015

Mauro Maniscalco, Claudio Candia, Pasquale Ambrosino, Antonio Iovine, Salvatore Fuschillo

{"title":"Chronic obstructive pulmonary disease's eosinophilic phenotype: Clinical characteristics, biomarkers and biotherapy.","authors":"Mauro Maniscalco, Claudio Candia, Pasquale Ambrosino, Antonio Iovine, Salvatore Fuschillo","doi":"10.1016/j.ejim.2024.10.015","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.015","url":null,"abstract":"COPD is a chronic, heterogeneous inflammatory disorder of the airways with persistent and poorly reversible airflow limitation, causing symptoms such as cough, shortness of breath, and sputum production. Despite optimal treatment, some patients remain symptomatic due to the disease's heterogeneity, manifesting in various phenotypes. One notable phenotype involves eosinophilic inflammation, with a variable prevalence. Identifying eosinophilic phenotypes is crucial for tailored therapeutic strategies, as they respond favorably to corticosteroids and potentially biologics. Recent advances in both clinical trials and spontaneous research have helped understand the biological and clinical characteristics of this phenotype, although no universal consensus has been reached yet on the definition of the cut-off values of the eosinophil peripheral blood count. Moreover, there is evidence of novel emerging biomarkers which might go beyond the sole eosinophil count, while significant advancements in terms of pharmacological treatment have been made, with dupilumab being the first biological drug being licensed for COPD patients with elevated circulating eosinophils in the stable phase. In light of the above, although several papers have been written on the relationship between eosinophils and COPD, in the present work we endeavored to summarize and discuss the pivotal literature findings regarding the eosinophilic COPD in order to help define the biological and clinical features of this peculiar phenotype, with particular attention to the use of established and emerging biomarkers, as well as current and future therapeutic perspectives.","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512192","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}

引用次数: 0

Systolic blood pressure, a predictor of mortality and life expectancy following heart failure hospitalization, 2010-2023. 2010-2023 年心力衰竭住院后死亡率和预期寿命的预测指标--收缩压。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-21 DOI: 10.1016/j.ejim.2024.10.004

Mohammed Yousufuddin, Zeliang Ma, Ebrahim Barkoudah, Muhammad Waqas Tahir, Meltiady Issa, Zhen Wang, Fatmaelzahraa Badr, Ibrahim A Gomaa, Sara Aboelmaaty, Ahmed A Al-Anii, Sarah L Gerard, Ahmed D Abdalrhim, Sumit Bhagra, Arshad Jahangir, Rehan Qayyum, Gregg C Fonarow, Mohamad H Yamani

{"title":"Systolic blood pressure, a predictor of mortality and life expectancy following heart failure hospitalization, 2010-2023.","authors":"Mohammed Yousufuddin, Zeliang Ma, Ebrahim Barkoudah, Muhammad Waqas Tahir, Meltiady Issa, Zhen Wang, Fatmaelzahraa Badr, Ibrahim A Gomaa, Sara Aboelmaaty, Ahmed A Al-Anii, Sarah L Gerard, Ahmed D Abdalrhim, Sumit Bhagra, Arshad Jahangir, Rehan Qayyum, Gregg C Fonarow, Mohamad H Yamani","doi":"10.1016/j.ejim.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.004","url":null,"abstract":"Background: Optimal systolic blood pressure (SBP) targets for the treatment of hospitalized acute decompensated heart failure (ADHF) patients are not known.Objectives: To investigate the association between SBP <130 mmHg at discharge or within 30 days and all-cause mortality or years of life lost (YLL) after ADHF hospitalization.Methods: We analyzed medical records of 14,611 adults who survived ADHF hospitalization at 17 hospitals (2010-2022) with follow-up until May 2023. Sensitivity analysis included 10,515 patients with post-discharge SBP measured within 30 days.Results: Mortality rates at 30 days, 180 days, 1 year, and 3 years were higher in patients with discharge SBP <130 mmHg (6.9 %, 21.1 %, 29.1 %, and 45.1 %) vs. SBP ≥130 mmHg (4.8 %, 16.0 %, 23.6 %, and 40.3 %). Hazard ratios (HR) for mortality were consistently higher in patients with discharge SBP <130 at 1.30 (95 % CI, 1.11-1.52), 1.45 (95 % CI, 1.33-1.58), 1.40 (95 % CI, 1.30-1.51), 1.31 (95 % CI, 1.23-1.38) at these intervals. The average YLL per deceased individual was 1-2 years greater in the discharge SBP <130 group (incidence rate ratios, 1.004 to 1.230). Restricted cubic spline analysis showed that HR for mortality shifted toward better outcomes at discharge SBP ≥130 Sensitivity analysis supported these findings.Conclusion: In hospitalized ADHF patients, SBP <130 mmHg at discharge or within 30 days post-discharge was linked to higher mortality and YLL, while SBP ≥130 mmHg or improvement to ≥130 mmHg post-discharge led to better short and long-term outcomes. Further research is needed to understand the mechanisms and benefits of SBP optimization.","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512194","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}

引用次数: 0

Association between trajectory of systolic blood pressure and outcomes in heart failure patients with preserved ejection fraction (HFpEF). 射血分数保留型心力衰竭（HFpEF）患者收缩压变化轨迹与预后之间的关系。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-17 DOI: 10.1016/j.ejim.2024.09.003

Xiao Liu, Hong Pan, Yuan Jiang, Yue Wang, Ayiguli Abudukeremu, Zhengyu Cao, Maoxiong Wu, Wanbing He, Minghai Zhang, Zhiwei Yan, Qingyuan Gao, Wengen Zhu, Haifeng Zhang, Yuling Zhang, Yangxin Chen, Jingfeng Wang

{"title":"Association between trajectory of systolic blood pressure and outcomes in heart failure patients with preserved ejection fraction (HFpEF).","authors":"Xiao Liu, Hong Pan, Yuan Jiang, Yue Wang, Ayiguli Abudukeremu, Zhengyu Cao, Maoxiong Wu, Wanbing He, Minghai Zhang, Zhiwei Yan, Qingyuan Gao, Wengen Zhu, Haifeng Zhang, Yuling Zhang, Yangxin Chen, Jingfeng Wang","doi":"10.1016/j.ejim.2024.09.003","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.09.003","url":null,"abstract":"Background: The optimal systolic blood pressure (SBP) in heart failure patients with preserved ejection fraction (HFpEF) remains controversial. We aim to assess the SBP trajectory and prognosis in HFpEF.Methods and results: Patients from Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT) were classified into three SBP trajectory groups according to the follow-up blood pressure using a latent category trajectory model. The primary outcome was composite of cardiovascular death, cardiac arrest, and hospital readmission for heart failure. A total of 3388 patients (mean age 68.6 years, 48.5 % men) were included. Mean SBP maintained 128 mmHg in the stable SBP trajectory group, declined from 129 to 125 mmHg in the decreasing SBP trajectory group and rose from 132 to 143 mmHg in the increasing SBP trajectory group within 6 years. During a mean follow-up of 3.4 years, 654 individuals had a primary outcome. Incidence for both primary and secondary outcomes were higher in increasing SBP trajectory group and decreasing SBP trajectory group compared with stable SBP trajectory group. After adjustments, the decreasing SBP trajectory group was associated with increased risk of all outcomes (hazard ratio ≥1.32), the increasing SBP trajectory group was associated with all-cause hospitalization and stroke (hazard ratio ≥ 1.28).Conclusion: The decreasing or increasing SBP trajectory is associated with a high risk of cardiovascular events in HFpEF, suggesting a stable SBP trajectory group (≈130 mmHg) have lower incidence of cardiovascular events and mortality. Trials are necessary to determine the optimal SBP in HFpEF.","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479683","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}

引用次数: 0

The assessment, interpretation and implementation of lung ultrasound examinations in Heart Failure: Current evidence and gaps in knowledge. 心力衰竭患者肺部超声检查的评估、解释和实施：当前证据和知识差距。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-17 DOI: 10.1016/j.ejim.2024.09.013

Alberto Palazzuoli, Matteo Beltrami, Nicolas Girerd, Anna Maw, Gaetano Ruocco, Elke Platz

{"title":"The assessment, interpretation and implementation of lung ultrasound examinations in Heart Failure: Current evidence and gaps in knowledge.","authors":"Alberto Palazzuoli, Matteo Beltrami, Nicolas Girerd, Anna Maw, Gaetano Ruocco, Elke Platz","doi":"10.1016/j.ejim.2024.09.013","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.09.013","url":null,"abstract":"Lung ultrasound (LUS) is a simple, fast and non-invasive tool for pulmonary congestion assessment with higher accuracy for the detection of acute heart failure (HF) compared to clinical examination and chest radiography. The integrated assessment with other ultrasound and echocardiographic parameters can lead to a better systemic and pulmonary congestion characterization. Additionally, the combination of echocardiographic and pulmonary features can identify patients at higher risk for adverse outcomes, potentially facilitating both acute and chronic HF management and prognostic stratification. However, the optimal utilization of LUS needs to be better defined both in terms of imaging method and B-line thresholds which may differ based on the clinical scenario and, potentially, the HF phenotype. Despite the extensive potential role of LUS in a wide range of HF scenarios, clinicians may be unaware of the correct technique and exam interpretation. Specifically, the interpretation of LUS findings is influenced by several factors, such as imaging protocol, type of ultrasound transducer, patient positioning, and presence of concomitant pulmonary diseases. The aim of this review is to provide a practical overview of LUS in patients with known or suspected HF with the goal of providing a practical guide for clinicians and nurses in various clinical settings.","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479708","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}

引用次数: 0

TLR4 and TNF-α single nucleotide polymorphisms in patients with brucellosis: Association with infection complications. 布鲁氏菌病患者的 TLR4 和 TNF-α 单核苷酸多态性：与感染并发症的关系

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-16 DOI: 10.1016/j.ejim.2024.10.006

Efthymia Giannitsioti, Angelos Stefos, Georgia Damoraki, Sarah Georgiadou, Maria Pavlaki, Evangelos J Giamarellos-Bourboulis, George Dalekos

{"title":"TLR4 and TNF-α single nucleotide polymorphisms in patients with brucellosis: Association with infection complications.","authors":"Efthymia Giannitsioti, Angelos Stefos, Georgia Damoraki, Sarah Georgiadou, Maria Pavlaki, Evangelos J Giamarellos-Bourboulis, George Dalekos","doi":"10.1016/j.ejim.2024.10.006","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.006","url":null,"abstract":"Objectives: To investigate associations of the carriage of single nucleotide polymorphisms (SNPs) of proteins involved in the immune response of patients with brucellosis.Methods: A case control study of patients with brucellosis upon WHO criteria. Blood genomic analysis was performed by RFLP- PCR for the detection of SNPs: i) at promoters -376 G > A (rs1800750); -308 G > A (rs 1,800,629); -238 G > A (rs361525) of the TNF gene, ii) at -896 A > G Asp299Gly (rs4986790) and -1196 C > T Thr399Ile (rs4986791) positions of the TLR-4 gene. Logistic regression analysis of factors related to brucellar spondylodiscitis was performed.Results: Patients with brucellosis (n = 105) were male (n = 67, 63.8 %); mean age (SD): 49.51(18.31); spondylodiscitis (n = 30), sacral osteomyelitis (n = 21). Carriage of the minor frequency A alleles at -238 of the promoter region of TNF was greater in patients than in controls (11.4% vs 2.6 %, p < 0.001). In a stepwise regression model including host variables and TNF-238 G A-1 genotype, only the last one was associated with brucellar spondylodiscitis [OR 2.91 (CI95 % 1.02-8.31), p = 0.047].Conclusions: In our cohort, the association of one TNF SNP of patients with brucellosis, in particular spondylodiscitis, might be prognostic whereas further investigation of the exact role in the host immune response is required.","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479710","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}

引用次数: 0