Internal and Emergency Medicine最新文献

Point-of-care ultrasound (PoCUS) has emerged as a critical tool for diagnosing intrauterine pregnancy (IUP) in symptomatic first-trimester patients, particularly in emergency settings. This meta-analysis aims to evaluate the test characteristics of PoCUS in diagnosing IUP. As a secondary objective, this study will also examine the accuracy of PoCUS in detecting fetal cardiac activity (FCA). This systematic review and meta-analysis was conducted following the PRISMA-DTA guidelines with the protocol registered in PROSPERO (ID: CRD42024596206). We performed a comprehensive search of PubMed, Scopus, Web of Science, Cochrane Library and Google Scholar up to November 2024, identifying studies that compared PoCUS to reference standards for IUP diagnosis. Seven studies (n = 1716) were included in the meta-analysis. Two independent reviewers performed study selection, data extraction, and quality assessment using the QUADAS-2 tool. A bivariate random-effects model was used to pool the diagnostic accuracy metrics. In this meta-analysis, PoCUS demonstrated a pooled sensitivity of 86.3% (95% CI: 75.6%-92.8%, I² = 89.8%) and a specificity of 98.2% (95% CI: 86.6%-99.8%, I² = 72.6%) for the identification of IUP. Sensitivity analysis showed a significant decrease in heterogeneity for specificity (from 72.6% to 0%), along with a slight increase in sensitivity (88.5%). The pooled positive likelihood ratio was 39.01 (95% CI: 16.00-95.1), and the negative likelihood ratio was 0.10 (95% CI: 0.05-0.21). Moreover, subgroup analysis revealed higher sensitivity (92%) in studies using transvaginal ultrasound as the reference standard. In addition, PoCUS demonstrated high specificity (100%) and variable sensitivity (81-96%) for identifying FCA across three studies, but the limited number of studies prevented further meta-analysis. PoCUS is highly effective for diagnosing IUP in symptomatic first-trimester patients, allowing for the ruling out of ectopic pregnancy. However, when PoCUS is negative or indeterminate, follow-up strategies such as serial β-hCG, repeat ultrasound, or clinical reassessment remain essential to ensure diagnostic safety.

Smoke inhalation is a leading cause of fire-related deaths, primarily due to toxic gases like carbon monoxide (CO) and hydrogen cyanide (HCN). Both gases often coexist in fire victims, but while CO poisoning is commonly recognized in emergency settings, HCN intoxication is often underdiagnosed, partly due to the lack of rapid diagnostic tools and the overlapping clinical presentation with CO poisoning. Diagnosis must therefore rely on presumptive clinical suspicion based on clinical and laboratory findings. Early recognition is crucial for initiating appropriate treatment. The objective of the study was to describe the prevalence and clinical characteristics of presumptive HCN poisoning among fire victims, using clinical and analytical criteria. This study also aims to evaluate the overlap with CO poisoning and discuss surrogate markers that may aid in clinical suspicion. A retrospective observational study over 10 years was conducted at a tertiary-care hospital emergency department. Fire victims were identified through electronic records, and those with arterial blood gas analysis were included. Presumptive HCN diagnosis was established according to predefined criteria, including the presence of neurological or cardiovascular symptoms, carboxyhemoglobin > 15%, or lactate > 7.5 mmol/L. These criteria, while based on literature, are also commonly associated with severe CO poisoning. Therefore, the diagnosis of HCN poisoning remains non-confirmatory. Out of 172 patients, 26.2% had CO poisoning and 8.1% met criteria for presumptive HCN poisoning, all of whom also had CO intoxication. The presence of nasal soot was associated with a high negative predictive value, but failed to identify positive cases, suggesting its utility primarily as a tool to rule out HCN intoxication. Neurological symptoms were common, but frequently unrecognized. Only 42.9% of HCN intoxications were correctly identified in the emergency department, with a significant number of cases missed, particularly those with neurological signs. No patients had lactate > 7.5 mmol/L, although HCN-intoxicated patients showed higher mean levels than other groups. Among the correctly diagnosed, all received hydroxocobalamin, while undiagnosed patients did not. One patient, who was not given hydroxocobalamin, died with concurrent presumptive HCN poisoning. It is unknown whether this contributed to his death. HCN poisoning remains underrecognized in fire victims. Because confirmatory testing is lacking, diagnosis must be considered presumptive based on predefined criteria. Clinical signs traditionally used for CO severity may also suggest possible HCN exposure, but their specificity is limited and must be interpreted with caution. The absence of airway soot may help rule out HCN poisoning. Our findings underscore the importance of clinical vigilance in the absence of confirmatory testing.

The aim is to investigate the value and mechanism of action of LINC00963 in septic cardiomyopathy (SCM). A total of 85 patients with cardiomyopathy (control group) and 108 SCM patients were enrolled. An in vitro model was created by treating cardiomyocytes with 1 μg/mL of LPS. A sepsis mouse model was created using cecal ligation and puncture (CLP). Cox analysis was used to identify factors independently influencing mortality. Kaplan-Meier curves were used to record patient prognosis. RT-qPCR was used to detect gene expression. CCK8 and flow cytometry were employed to evaluate cell function. ELISA was used to detect inflammatory factor expression. Dual luciferase reporter and RIP validation were employed to confirm gene-targeted interactions. Upregulation of LINC00963 was observed in serum from patients with septic cardiomyopathy, heart tissue from septic mice, and LPS-infected cardiomyocytes, while miR-98-5p was downregulated. Patients with high LINC00963 expression had lower survival rates and were more likely to experience fatal outcomes. Both LINC00963 and BNP/NT-proBNP were both independent factors influencing patient mortality, and it was predicted that miR-98-5p was a target gene of LINC00963. Following si-LINC00963 transfection, apoptosis was reduced and inflammatory levels decreased in cardiomyocytes and myocardial tissue from sepsis-induced mice, and miR-98-5p was downregulated. However, the use of a miR-98-5p inhibitor reversed the cellular functional and inflammatory changes induced by LINC00963 knockdown. Knocking down LINC00963 reduces apoptosis and inflammation levels, and promotes cell proliferation by targeting miR-98-5p. This reduces the damage caused by sepsis to cardiomyocytes.

Hyponatremia is the most common electrolyte disorder. Accurate assessment of extracellular fluid volume status (hypovolemic, euvolemic, or hypervolemic) is essential for determining the underlying etiology and guiding treatment. Point-of-care ultrasound (PoCUS) has emerged as a complementary bedside tool to objectively assess volume status in hyponatremia. We systematically reviewed the relevant literature up to June 2025. The aim of this systematic review was to evaluate the role of PoCUS in the assessment and management of hyponatremia. The evidence suggests that combined lung, cardiac, and abdominal PoCUS (including the venous excess ultrasound score, VExUS) helps overcome the limitations of physical examination. PoCUS leads to a more accurate etiologic diagnosis and optimized treatment. PoCUS also aids in monitoring treatment response, enabling real-time adjustment of diuretics or fluids based on serial examinations. Its role may be limited by operator dependency and inability to detect non-ultrasound-revealed pathologies such as hypothyroidism. Integrating bedside ultrasound into hyponatremia management improves volume assessment accuracy and supports a more individualized approach. Although current evidence is mainly derived from small studies and case series, findings consistently support using PoCUS as an adjunct to traditional evaluation.

Venous congestion is a major contributor to morbidity and mortality in several clinical settings. Relying on traditional methods for bedside evaluation of congestion often leads to inadequate decongestion and increased hospital readmissions. The Venous Excess Ultrasound Score (VExUS) was introduced by Beaubien-Souligny to improve assessment of systemic congestion by integrating inferior vena cava size and Doppler patterns from hepatic, portal, and intrarenal veins. This review aims to describe how to perform VExUS and summarize the current state of evidence based on original data studies either supporting its clinical use or recognizing limitations. Most of the knowledge regarding VExUS comes from studies assessing its prognostic role in predicting death, re-hospitalization, and acute kidney injury. VExUS proved to be a valuable prognostic tool in cardiologic settings such as patients admitted in intensive care unit after cardiac surgery and those hospitalized for heart failure; conversely its predictive performance is less consistent in more heterogeneous populations where patients are less prone to develop venous congestion. Importantly limited evidence supports VExUS utility in guiding management strategies. Further research is needed to establish whether the integration of a VExUS-guided decongestive diuretic therapy improves outcomes across different clinical settings. Moreover, concerns regarding its complexity, redundancy with single-site Doppler indices, and the absence of validation in broader populations have been raised.

Cardiac implantable electronic device (CIED) implantation is a minor surgical procedure, with a low complication incidence. Neoplasm occurrence at the CIED pocket is a rare event, and sporadic cases are reported without a comprehensive evaluation. This hybrid study aims to fill this gap through a three-part approach: a new case report, a scoping review with individual patient data (IPD) analysis, and a clinical survey. In March 2024, a male patient with a history of high-grade urothelial cancer referred to our Department with a mass at the CIED pocket. Incisional biopsy confirmed the diagnosis of high-grade urothelial carcinoma. The patient died after 4 months. Through our scoping review and IPD analysis, we collected 56 patients affected by primary neoplasms [40 (71.4%)] and metastasis [16 (28.6%)] at the CIED pocket. Among the primary neoplasms, adenocarcinoma (12; 30.0%) was most frequent in females, while sarcoma (10; 25.0%) was predominant in males. On the other hand, metastasis types were represented by breast cancer (3; 18.8%) in females, and myeloma (2; 13.3%) and melanoma (2; 13.3%) in males. The clinical survey showed data from 471 patients who underwent CIED implantation. No primary neoplasm or metastasis developed at the CIED pocket, also in subjects with history of cancer. Although rare, both primary and metastatic neoplasms may occur at the site of CIED implantation. Vigilant monitoring of CIED patients is essential, particularly when changes at the pocket site arise. Early biopsy and oncologic assessment should be considered in such cases to enable timely diagnosis and intervention.

Background The objective of this study was to ascertain whether cardiometabolic index(CMI), visceral adiposity index (VAI), dysfunctional adiposity index (DAI), and body adiposity index (BAI) are superior predictors of future hypertension risk when compared with conventional indicators such as waist circumference(WC), body mass index (BMI) and waist-to-height ratio(WHtR).

Material and methods: This is a post hoc analysis of the MONICA protocol. We selected 597 patients based on inclusions criteria. Data collection began in 1992, and follow-up was conducted on the same group of participants in 2007. The study collected anthropometric indexes and biochemical data.

Results: After adjusting for confounding factors using multivariate Cox regression analysis, the following results were observed: CMI [HR: 1.754 (1.240-2.480); P = 0.001], VAI [HR: 1.533 (1.074-2.187); P = 0.018], DAI [HR: 1.382 (0.982-1.945); P = 0.064], BAI [HR: 2.791 (1.790-4.352); P < 0.001], WC [HR: 2.234 (1.510-3.307); P < 0.001], WHtR [HR: 2.303 (1.589-3.339); P < 0.001], and BMI [HR: 2.488 (1.778-3.561); P < 0.001] were all significantly associated with the incidence of hypertension. ROC curve analysis showed that the area under the curve (AUC) for WC product was the highest (0.649, 95% CI: 0.605-0.693), followed by BMI (0.648, 95% CI: 0.603-0.692), WHtR (0.646, 95% CI: 0.601-0.690), and then by CMI (0.603, 95% CI: 0.557-0.649).

Conclusions: Although the CMI, VAI, DAI and BAI can all be utilised as independent predictors of hypertension, the predictive discriminatory power of these novel indicators for hypertension remains inferior to that of traditional indicators such as WC, BMI and WHtR.

Advanced lung disease, cardiovascular disease (CVD), infections, malignancies, and thromboembolic disease (TED) determine the mortality of patients with sarcoidosis. Our objective was to evaluate the main causes of admission and in-hospital mortality in patients with sarcoidosis in Spain. A retrospective and observational analysis of the National Registry of Hospital Discharges (RAE-CMBD) of patients admitted with a diagnosis of sarcoidosis between 2016 and 2021 was performed. A total of 18,887 admissions of patients with sarcoidosis were identified. The main causes of admission were infection (21%), sarcoidosis itself (16.4%), CVD (12.7%), and malignancies (7.1%). Overall, 892 (4.7%) patients died, mainly from infection (32.1%), CVD (16.3%) and neoplasms (12.4%), with case fatality rates of 7.2%, 6% and 8.3%, respectively. Factors associated with higher in-hospital mortality were Charlson comorbidity index (OR 1.30 95%CI 1.27-1.34), sarcoidosis pulmonary involvement (OR = 1.20, 95%CI 1.04-1.38), pulmonary fibrosis (OR 2.07; 95%CI 1.52-2.81) and CVD (OR 1.56; 95%CI 1.26-1.95), infection (OR 2.37; 95%CI 1.97-2.84), malignancies (OR 1.77; 95%CI 1.38-2.27) and TE-related admissions (OR 2.1, 95%CI 1.21-3.76). The main determinants of hospital admissions and mortality in patients with sarcoidosis are infections, CVD, neoplasm, VTE, pulmonary fibrosis, and a high comorbidity burden. While sarcoidosis itself is a common cause of admission, it is rarely the cause of death. Prevention of infections, VTE, and neoplasm, along with control of cardiovascular risk factors, may help reduce mortality in these patients.

This study aims to develop a predictive model based on the triglyceride-glucose (TyG) index to assess in-hospital mortality risk in older acute myocardial infarction (AMI) patients with multimorbidity. This retrospective study included 479 patients aged ≥ 65 years with AMI and multimorbidity, hospitalized at Qilu Hospital of Shandong University from September 2017 to March 2022. Patients were randomly divided into a training set (n = 384) and an internal validation set (n = 95). In addition, 90 patients admitted after April 2022 were included as an external validation set. Univariate Cox regression and least absolute shrinkage and selection operator regression were employed to select potential predictive variables, and a predictive model was constructed using Cox regression. Model performance was assessed using receiver operating characteristic (ROC) curves, concordance (C)-index, time-dependent ROC curves, calibration plots, and decision curve analysis (DCA). The predictive performance of the TyG-incorporated model was compared with models excluding TyG, as well as the global registry of acute coronary events and thrombolysis in myocardial infarction risk scores. During an average hospitalization of 9.8 days, 7.85% of patients experienced all-cause mortality. Key predictors included the TyG index, occupation, ≥ 2 Killip classification, hepatic insufficiency, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, Nicorandil and white blood cell. The TyG-incorporated model demonstrated superior predictive performance, with C-index values of 0.93 (95% CI 0.89, 0.97; P < 0.001) in the training set, 0.85 (95% CI 0.74, 0.96; P < 0.001) in the internal validation set, and 0.89 (95% CI 0.81, 0.97; P < 0.001) in the external validation set, indicating high predictive accuracy. Calibration plots demonstrated good model calibration, and DCA results indicated superior clinical applicability of the model. The predictive model based on the TyG index provides an effective tool for assessing in-hospital mortality risk in older AMI patients with multimorbidity, demonstrating strong predictive performance and significant clinical value.