European Journal of Internal Medicine最新文献

{"title":"In ageing research the slope matters","authors":"Jan Frederic Weller , Liesbeth C. de Wreede , Kevin Roedl , Frederik Peters , Maximilian Christopeit","doi":"10.1016/j.ejim.2025.07.012","DOIUrl":"10.1016/j.ejim.2025.07.012","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"139 ","pages":"Article 106416"},"PeriodicalIF":6.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660957","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 micro- and nanoplastics on gastrointestinal diseases: Recent advances","authors":"Haonan Zhao ,&nbsp;Guo Lin ,&nbsp;Yuhang Yin ,&nbsp;Qinke Wu ,&nbsp;Yan Wang ,&nbsp;Ning Tang ,&nbsp;Xingshun Qi","doi":"10.1016/j.ejim.2025.07.015","DOIUrl":"10.1016/j.ejim.2025.07.015","url":null,"abstract":"<div><div>Micro- and nanoplastics (MNPs) are ubiquitous contaminants increasingly recognized for their potential to adversely affect gastrointestinal (GI) health. This review provides a comprehensive overview regarding the impact of MNPs exposure on GI diseases, especially their toxicological mechanisms, such as oxidative stress, inflammation, apoptosis, gut microbiota dysbiosis, and intestinal barrier dysfunction. Excessive reactive oxygen species production and persistent GI inflammation triggered by MNPs exposure drive epithelial cell apoptosis and compromise the intestinal barrier. Meanwhile, MNPs-induced gut microbiota dysbiosis further exacerbate intestinal inflammation and barrier dysfunction. Through these interconnected pathways, chronic MNPs exposure may be associated with the occurrence and progression of GI diseases, including gastritis, gastric cancer, inflammatory bowel disease, and colorectal cancer. However, there are very limited human evidence, and the long-term impacts of low-dose, chronic MNPs exposure have not been sufficiently explored. Future research should address these uncertainties through longitudinal epidemiological studies, advanced experimental models, and standardized MNPs detection methods, to refine risk assessment and guide evidence-based policies that safeguard human health.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"139 ","pages":"Article 106419"},"PeriodicalIF":6.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700172","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":"Lipoprotein (a): A new target for pharmacological research and an option for treatment","authors":"Angela Pirillo ,&nbsp;Alberico L. Catapano","doi":"10.1016/j.ejim.2025.07.021","DOIUrl":"10.1016/j.ejim.2025.07.021","url":null,"abstract":"<div><div>Lipoprotein(a) [Lp(a)] is increasingly recognised as a crucial and independent risk factor for atherosclerotic cardiovascular disease (ASCVD), calcific aortic valve stenosis (AVS), and possibly heart failure and peripheral artery disease. Lp(a) consists of an LDL-like particle covalently bound to apolipoprotein(a) [apo(a)], a highly polymorphic protein encoded by the <em>LPA</em> gene. The Lp(a) level in plasma is predominantly genetically determined and remains stable throughout life, relatively unaffected by lifestyle, comorbidities or standard lipid-lowering therapies. Elevated Lp(a) levels are associated with a higher risk of ASCVD, particularly in individuals with familial hypercholesterolaemia or smaller apo(a) isoforms. Despite its clinical relevance, Lp(a) is rarely measured in daily clinical practice, although most guidelines recommend at least one lifetime measurement. Novel RNA-based therapies, including antisense oligonucleotides (pelacarsen) and small interfering RNAs (olpasiran, lepodisiran, zerlasiran)—have shown the potential to reduce Lp(a) levels by &gt;80 %. The small oral molecule muvalaplin also shows promise in inhibiting Lp(a) formation. Large-scale clinical trials are underway to assess the effects of Lp(a)-lowering therapies on cardiovascular outcomes. Measurement of Lp(a) and characterisation of the isoforms remain a challenge, and standardisation of assays is still a matter of debate. As new therapeutic options are developed that specifically target Lp(a), the inclusion of Lp(a) in cardiovascular risk assessment could improve stratification and lead to targeted interventions, particularly in high-risk populations. The growing body of genetic, epidemiological and clinical evidence makes Lp(a) a critical target in cardiovascular research and therapy.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"139 ","pages":"Article 106425"},"PeriodicalIF":6.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719011","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 climate crisis in clinical practice: Addressing air pollution, heat, and microplastics","authors":"Elizabeth Cerceo (Professor of Medicine)","doi":"10.1016/j.ejim.2025.07.031","DOIUrl":"10.1016/j.ejim.2025.07.031","url":null,"abstract":"<div><div>Climate change and environmental degradation are among the most pressing public health crises of our time, driving a wide range of health outcomes that disproportionately affect vulnerable populations. From air pollution to extreme heat, infectious diseases to microplastics, the threats are widespread, systemic, and growing. While planetary health encompasses many and multifaceted health impacts, this review will focus more specifically on three of the direct consequences of fossil fuels, namely air pollution, extreme heat as a result of global warming, and microplastics as a product of petrochemicals. As trusted professionals, physicians must be equipped to recognize, treat, and advocate against the environmental determinants of disease, both to improve patient outcomes and to foster systemic resilience.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"139 ","pages":"Article 106435"},"PeriodicalIF":6.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790633","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 effects of sleep improving interventions in medical hospital wards: the WEsleep study - A randomized clinical trial","authors":"C.J. de Gans ,&nbsp;A.J.G. Meewisse ,&nbsp;E.S. van den Ende ,&nbsp;M.L. van Zuylen ,&nbsp;P.W.B. Nanayakkara ,&nbsp;J. Hermanides ,&nbsp;D.J. Stenvers","doi":"10.1016/j.ejim.2025.04.015","DOIUrl":"10.1016/j.ejim.2025.04.015","url":null,"abstract":"<div><h3>Objective</h3><div>Hospitalized patients often experience disturbed sleep, affecting general health. While some randomized studies have assessed individual non-pharmacological interventions, none have evaluated approaches that combine multiple strategies to improve sleep. This study aimed to assess the effects of a multicomponent sleep-enhancing protocol in hospitalized medical patients.</div></div><div><h3>Methods</h3><div>The WEsleep cluster randomized controlled trial was conducted between July 2023 and March 2024 across six medical departments in a large Dutch academic hospital. Adult medical patients who were able to provide informed consent and were expected to stay at least two nights were eligible for inclusion. The multicomponent intervention included delaying early morning nursing rounds, training healthcare professionals, optimizing sleep-disturbing medication timing, offering earplugs and eye masks, and conducting evening sleep rounds. The primary outcome was sleep quality on the second night, assessed with the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcomes included sleep quantity, 30-day mortality, delirium incidence, and use of sleep-enhancing tools.</div></div><div><h3>Results</h3><div>Data from 291 patients were analyzed. The intervention group reported better sleep quality, with a median RCSQ score of 66.6 (IQR 44.3–78.9), compared to 55.7 (IQR 38.2–74.3) in the control group (<em>p</em> = 0.033). No significant differences were observed in sleep quantity, 30-day mortality or delirium incidence. Protocol adherence ranged from 42 % to 73 %.</div></div><div><h3>Conclusions</h3><div>This study provides a valuable roadmap for hospitals aiming to enhance patient care through improved sleep management. A multicomponent intervention can lead to significantly better sleep quality in medical wards, highlighting the potential of structured, non-pharmacological strategies in routine hospital care.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"139 ","pages":"Article 106308"},"PeriodicalIF":6.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993077","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":"Hyponatremia and mortality: Marker of disease or modifiable risk? Rethinking causality in large-scale observational research","authors":"Xin Xia ,&nbsp;Tao Zhang ,&nbsp;Kai Zhao ,&nbsp;Kun Huang","doi":"10.1016/j.ejim.2025.04.031","DOIUrl":"10.1016/j.ejim.2025.04.031","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"139 ","pages":"Article 106324"},"PeriodicalIF":6.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037543","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":"Oral semaglutide in HFpEF: Real-world evidence and causal considerations","authors":"Victoria Catalán ,&nbsp;Gema Frühbeck ,&nbsp;Javier Gómez-Ambrosi","doi":"10.1016/j.ejim.2025.07.024","DOIUrl":"10.1016/j.ejim.2025.07.024","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"139 ","pages":"Article 106428"},"PeriodicalIF":6.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735053","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":"Constrictive pericarditis and tuberculosis: A second look","authors":"Abraham J. Beun ,&nbsp;Maria Gabrovska ,&nbsp;Rakan Nasreddine","doi":"10.1016/j.ejim.2025.06.031","DOIUrl":"10.1016/j.ejim.2025.06.031","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"139 ","pages":"Article 106402"},"PeriodicalIF":6.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561834","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":"Identification of risk factors for permanent visual loss in patients with giant cell arteritis","authors":"Roser Solans-Laqué ,&nbsp;Begoña de Escalante-Yanguela ,&nbsp;Eva Fonseca ,&nbsp;Guadalupe Fraile ,&nbsp;Ferran Martínez-Valle ,&nbsp;Luis Caminal ,&nbsp;Manuel Monteagudo ,&nbsp;Mercedes Pérez-Conesa ,&nbsp;Borja Gracia-Tello ,&nbsp;Monica Abdilla ,&nbsp;Sergio Prieto-González ,&nbsp;Aleida Martínez-Zapico ,&nbsp;Borja de Miguel-Campo ,&nbsp;Jaume Mestre-Torres ,&nbsp;REVAS-Registry, from the Systemic Autoimmune Diseases Study Group (GEAS) of the Spanish Society of Internal Medicine (SEMI)","doi":"10.1016/j.ejim.2025.06.001","DOIUrl":"10.1016/j.ejim.2025.06.001","url":null,"abstract":"<div><h3>Objectives</h3><div>permanent visual loss (PVL) is the most frequent ischemic complication of GCA. We aimed to evaluate whether clinical signs, symptoms, and blood test abnormalities at GCA diagnosis can predict PVL.</div></div><div><h3>Patients and methods</h3><div>retrospective, multicenter study of patients with biopsy-proven GCA. The whole cohort was randomly split into a derivation and a validation dataset. Multivariable logistic regression (MVLR) was used to develop a prediction model and a predictive score. The model's performance was determined through the area under the curve (AUC).</div></div><div><h3>Results</h3><div>620 patients were included, 397 in the derivation cohort. PVL occurred in 20.3%. MVLR showed that <span><em>amaurosis fugax</em></span> (OR 5.86, 95%CI 3.41-10.07, <em>p</em>&lt;0.001), jaw claudication (OR 2.48, 95%CI 1.51-4.07, <em>p</em>&lt;0.001), and increasing age (OR 1.09, 95%CI 1.05-1.14, <em>p</em>&lt;0.001) were independently associated to PVL. Fever was the only independent protective factor (OR 0.45, 95%CI 0.25-0.84, <em>p</em>=0.01). The optimum cut-off for age as a PVL predictor was 78 years (OR 2.4, 95%CI 1.62-3.59, <em>p</em>&lt;0.001). No laboratory variables were independently associated with PVL. Our model showed an AUC 0.80 (95%CI 0.76-0.85) and good internal validity (AUC 0.82, 95%CI 0.76-0.87). A predictive risk score with a sensitivity of 64.9%, a specificity of 82.0%, and positive and negative predictive values of 46.4% and 90.01% is proposed.</div></div><div><h3>Conclusions</h3><div>The risk of developing PVL at GCA diagnosis may be estimated upon a detailed patient evaluation, including temporal arteries. <em>Amaurosis fugax</em>, jaw claudication, and older age can predict PVL. Fever is a protective factor. Inflammatory markers do not differentiate patients at risk of developing PVL.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"139 ","pages":"Article 106372"},"PeriodicalIF":6.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303513","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":"Hypochloremia in chronic and acute heart failure scenarios: Prevalence and risk factors","authors":"Pau Llàcer ,&nbsp;Marta Cobo Marcos ,&nbsp;François Croset ,&nbsp;Isabel Zegrí-Reiriz ,&nbsp;Rafael de la Espriella ,&nbsp;Jara Gayán Ordás ,&nbsp;Aleix Fort ,&nbsp;Jorge Rubio-Gracia ,&nbsp;Zorba Blázquez-Bermejo ,&nbsp;Ana Méndez ,&nbsp;Adriana Rodríguez ,&nbsp;Pedro Caravaca-Pérez ,&nbsp;Josep Comín-Colet ,&nbsp;Jose Luis Morales-Rull ,&nbsp;Luis Manzano ,&nbsp;Julio Núñez","doi":"10.1016/j.ejim.2025.05.022","DOIUrl":"10.1016/j.ejim.2025.05.022","url":null,"abstract":"<div><h3>Aims</h3><div>Chloride plays a key role in maintaining volume homeostasis. Low plasmatic chloride levels are associated with diuretic resistance and worse outcomes in patients with heart failure (HF). This study focused on determining the prevalence and factors related to hypochloremia in patients with heart failure (HF) in chronic and acute settings.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of three cohorts: chronic HF patients from the Spanish Cardiorenal Registry, ambulatory patients with worsening heart failure (WHF) from the SALT-HF trial, and inpatient WHF admitted in a teaching-level center in Spain. Multivariate linear regression analyses were employed to identify factors associated with chloremia.</div></div><div><h3>Results</h3><div>The chronic HF cohort included 845 patients [median age 75 years, 38 % female, 62.7 % presenting with a left ventricular ejection fraction (LVEF)≤40 %]. The prevalence of hypochloremia was 5.5 %. The second cohort (ambulatory WHF) comprised 148 participants (median age 80 years, 30 % female, 50 % displaying LVEF ≥ 50 %). Here, hypochloremia was observed in 11 % of the sample. The third cohort (inpatient WHF) enrolled 427 patients (median age 87 years, 64 % female, 82 % with LVEF≥50 %). This group showed a hypochloremia prevalence of 24 %. Multivariate analysis identified lower plasma sodium, loop diuretic treatment, and higher CA125 as common factors independently related to lower chloride levels in the three cohorts.</div></div><div><h3>Conclusions</h3><div>Prevalence of hypochloremia in HF differ across clinical status. Lower chloride is associated with lower sodium levels, prior loop diuretic and thiazide treatment, and higher CA125 values.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"139 ","pages":"Article 106357"},"PeriodicalIF":6.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276506","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}