Internal and Emergency Medicine最新文献

We investigated the interplay of cardiovascular autonomic and inflammatory profiles in persons with extreme longevity (PEL), their direct offsprings (DO), and a group of controls matched for age and sex with the DO. Cardiac autonomic control was assessed through the heart rate variability (HRV) using spectral and symbolic analysis. The plasma concentration and gene expression of interleukin (IL)-10, IL-6, and TNF-α were quantified. In PEL, the sympatho-vagal is shifted to a vagal predominance and both pro- and anti-inflammatory circulation cytokines are increased compared to DO and controls. Also, no differences were found in HRV between DO and controls. These preliminary results suggest that environmental factors, at least in our small sample, may overcome the impact of heritability on cardiac autonomic control and inflammatory circulation cytokines.

The purpose is to analyze the prevalence of intestinal infection in patients with pneumonia in intensive care units (ICU) and the impact of intestinal infection on the prognosis of patients with pneumonia, so as to explore the bidirectional association between pneumonia and intestinal infection. The study aims to investigate the correlation between the occurrence of pneumonia and intestinal infection among patients in the ICU, utilizing the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, as well as the impact of intestinal infection on the prognosis of pneumonia patients. The enrolled patients were first divided into pneumonia group and non-pneumonia group, and the primary outcome was that patients developed intestinal infection. Multivariate logistic regression was used to elucidate the association between pneumonia and the prevalence of intestinal infection, and propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) were used to validate our findings. We then divided patients with pneumonia into two groups according to whether they were complicated by intestinal infection, and analyzed the effect of intestinal infection on 28-day mortality, length of ICU stay, and length of hospital stay in patients with pneumonia. This study included 50,920 patients, of which 7493 were diagnosed with pneumonia. Compared with non-pneumonia patients, the incidence of intestinal infection in pneumonia patients was significantly increased [OR 1.58 (95% CI 1.34-1.85; P < 0.001)]. Cox proportional hazards regression model showed no significant effect of co-infection on 28-day mortality in patients with pneumonia (P = 0.223). Patients in the intestinal infection group exhibited a longer length stay in ICU and hospital than those without intestinal infection (P < 0.001). In the ICU, patients with pneumonia were more likely linked to intestinal infection. In addition, the presence of concurrent intestinal infections can prolong both ICU and hospital stays for pneumonia patients.

Digoxin is commonly used to treat acute heart failure (AHF), especially in patients with concurrent atrial fibrillation (AF). Nonetheless, there is little consensus about in which patients digoxin should be given, the proper time for digoxin initiation, and whether digoxin initiation is associated with improved outcomes. We investigated factors related to digoxin initiation after an episode of AHF and whether patients receiving digoxin presented better short-term outcomes. We analyzed digoxin-naïve AHF patients from a Spanish and Swiss database, who were dichotomized into cohorts based on their receipt of digoxin treatment at discharge. The relationship between digoxin initiation and 23 additional patient covariates, including chronic treatment, was investigated, as well as its association with 90-day combined adverse events (defined as all-cause death or AHF hospitalization). Of 13,105 patients (10,600/2505 from the Spanish/Swiss cohorts, respectively), the median (interquartile range) age was 83 (74.87) years, and 51% were women. Of these, 484 (3.7%) received digoxin at discharge, which was associated with AF, female sex, left ventricular ejection fraction (LVEF) < 50%, and coming from the Spanish cohort. Parameters inversely associated with receiving digoxin at discharge included some chronic treatments, diabetes mellitus (DM), and chronic kidney disease (CKD). Digoxin initiation was not association with 90-day adverse events, adjusted hazard ratio (aHR) = 0.939 (0.769-1.146), but there was an interaction for CKD, aHR = 1.390 (0.831-2.325) vs. 0.854 (0.682-1.183), p = 0.039, and for cohort pertinence, with higher risk in the Swiss cohort; aHR = 1.405 (0.827-2.386) vs. 0.862 (0.689-1.077), p = 0.046. Digoxin initiation after an AHF episode was more frequent in the Spanish cohort and was associated with certain patient characteristics (AF, female sex, reduced LVEF, no DM, no CKD), but had no effect on 90-day outcomes.

Ultrasound has become an increasingly valuable tool for the assessment of body composition, offering several applications and indications in clinical practice. Ultrasound allows bedside evaluation of muscle mass, fat compartments, and extravascular water, providing a cost-effective, portable, and accessible alternative to traditional methods, such as Dual-energy X-ray Absorptiometry (DEXA), Bioelectrical Impedance Analysis (BIA), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). It is particularly useful in evaluating conditions, such as malnutrition, sarcopenia, and sarcopenic obesity, which require poor muscle mass to establish a diagnosis. The potential uses of ultrasound in body composition assessment include measurement of muscle thickness, cross-sectional area, pennation angle, and echo-intensity, which are indicative of muscle health. Additionally, ultrasound can be used to evaluate various fat compartments, including visceral, subcutaneous, and ectopic fat, which are important for understanding metabolic health and cardiovascular risk. However, the widespread adoption of ultrasound is challenged by the lack of standardized measurements and the absence of ultrasound measures in the validated diagnostic criteria. This article reviews the current applications of ultrasound in body composition assessment, highlighting the recent advancements and the correlation between ultrasound parameters and clinical outcomes. It discusses the advantages of ultrasound while also addressing its limitations, such as the need for standardized protocols and cut-off points. By providing a comprehensive update based on recent publications, this article aims to enhance the clinical utility of ultrasound in assessing and monitoring body composition and pave the way for future research in this field.

Heart failure is a multifaceted clinical syndrome, with obesity identified as a significant modifiable risk factor. This study employed a two-sample Mendelian randomization (MR) design, incorporating obesity data across life stages, to elucidate the causal link between obesity and heart failure. Data on heart failure from the 2023 Finngen database and genetic predictors of obesity from the IEU OpenGWAS project were analyzed using the IVW method, MR-Egger regression, weighted median, simple mode, weighted mode, and scatter plots. Heterogeneity was assessed with Cochran's Q test, and horizontal pleiotropy with MR-Egger intercept test. Sensitivity to single-nucleotide polymorphisms (SNPs) was tested via leave-one-out analysis, and funnel plots were utilized for visual inspection of horizontal pleiotropy. Statistical powers were also calculated. The MR analysis findings indicate a significant relationship between birth weight and the likelihood of developing heart failure (Odds Ratio [OR] 1.134, 95% Confidence Interval [CI] 1.033-1.245, P = 0.008). In addition, a heightened childhood BMI was found to be a significant predictor of heart failure risk (OR 1.307, 95% CI 1.144-1.494, P = 8.51E-05), as was childhood obesity (OR 1.123, 95% CI 1.074-1.173, P = 2.37E-07). Furthermore, adult BMI sex-combined exhibited a strong correlation with the risk of heart failure (OR 2.365, 95% CI 2.128-2.629, P = 1.91E-57). Sensitivity analyses provided further support for the reliability of these results, with no significant indication of horizontal pleiotropy observed. This study shows that obesity, including childhood obesity, is linked to a higher risk of heart failure. These findings highlight the urgent need for early weight management interventions in public health and clinical settings to reduce heart failure rates.

Peripheral artery disease (PAD) remains underdiagnosed in patients with coronary artery disease (CAD) and barriers persist to measure screening PAD in routine clinical practice. We assessed the prevalence of PAD in patients with CAD in Italian primary care setting using an easy automatic instrument to measure ankle brachial pressure index (ABI). A multicenter, observational study was conducted with 32 General Practitioners (GPs). Prevalence of PAD was calculated dividing the number of patients with abnormal ABI value, or with symptoms associated with PAD or history of lower limb revascularization procedures, over the total number of patients included in the study. Incidence of major CV clinical events and all-cause death was also evaluated at 12 months in both CAD and CAD + PAD groups. In total, 713 CAD patients were included in the study, 148 (20.8%) patients had also PAD, asymptomatic in nearly 15% of them (106). The 35.4% of patients had ABI value ≤ 0.9 and 46.0% > 1.3 ABI. A significantly higher incidence of major CV events and all-cause death was seen in patients with PAD than in those without. Over 80% of patients received the therapy for secondary CV prevention and difference was seen between groups. Our findings showed that the use of an easy automatic instrument to measure ABI, easily managed by nurses, allowed to detect PAD in a relevant proportion of CAD patients who otherwise would not have been recognized. This encourages performing PAD screening in primary care setting to optimize the management of major CV risk factors associated with PAD. NCTumber: NCT03921905.

We investigated the risk of cardiovascular events, all-cause mortality, and liver-related mortality according to the presence of metabolic syndrome (MetS) and fatty liver index (FLI). In this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2009 to 2012. Nonalcoholic fatty liver disease (NAFLD) was defined as FLI ≥ 60. Risk of all-cause mortality, liver-related mortality, and major adverse cardiovascular events (MACE) including myocardial infarction (MI), stroke, heart failure (HF), and cardiovascular disease (CVD)-related mortality was assessed according to the presence of MetS and FLI among adults (aged 40 to 80 years) who underwent health examinations (n = 769,422). During a median 8.59 years of follow up, 44,356 (5.8%) cases of MACE, 24,429 (3.2%) cases of all-cause mortality, and 1114 (0.1%) cases of liver-related mortality were detected in the entire cohort. When the FLI < 30 without MetS group was set as a reference, the FLI ≥ 60 with MetS group had the highest risk of MACE (adjusted hazard ratio [aHR] 2.05, 95% confidence interval [CI] 1.98-2.13) and all-cause mortality (aHR 1.96, 95% CI 1.86-2.07). The risk of liver-related mortality (aHR 10.71, 95% CI 8.05-14.25) was highest in the FLI ≥ 60 without MetS group. The FLI ≥ 60 with MetS group had a higher risk of MACE (aHR 1.39, 95%CI 1.28-1.51), a lower risk of liver-related mortality (aHR 0.44, 95%CI 0.33-0.59), and no significant difference in all-cause mortality compared with the FLI ≥ 60 without MetS group. The FLI ≥ 60 with MetS group was associated with the highest risk of MACE and the FLI ≥ 60 without MetS group had the highest risk liver-related mortality, but there was no significant difference in all-cause mortality between two groups. In conclusion, as FLI levels increase, the risk of MACE increases, and the risk increases additively in the presence of MetS. The risk of liver-related mortality increases with higher FLI levels, the effect of high FLI on increased risk is more significant in groups without MetS compared to those with MetS.

Cardiac rupture (CR) is fatal mechanical complication of ST-segment elevation myocardial infarction (STEMI). We systematically analyzed the clinical features of STEMI patients with CR, as well as predictors and treatments associated with risk of CR in contemporary era. In this nationwide database, 49,284 patients admitted within 48 h after STEMI were enrolled, and were stratified according to CR status. We analyzed patients' clinical characteristics, case fatality rate, and independent correlates of CR. A total of 188 (0.38%) patients had CR, of which 42.6% died during hospitalization. Older age, female gender, higher heart rate, history of diabetes, and worse cardiac function were risk factors of CR in patients with STEMI, while a previous history of myocardial infarction was associated with a reduced risk of CR. CR patients were less likely to undergo primary percutaneous coronary intervention (PCI). After adjustment, primary PCI was associated with 56% decreased risk of CR (OR 0.44, 95% CI 0.29-0.67). This result was consistent in the propensity-score matching analysis and inverse probability of treatment weighting analysis. CR was associated with high in-hospital mortality among STEMI patients. Multiple factors were associated with CR occurrence, primary PCI was associated with lower risk of CR, indicating that early intervention targeting the risk factors and implementation of primary PCI may improve its prognosis. Clinical trial registration ClinicalTrials.gov; Number: NCT02306616; URL: www.clinicaltrials.gov.