Internal and Emergency Medicine最新文献

Sepsis remains a leading cause of morbidity and mortality worldwide. Increasing evidence suggests that the gut microbiota, long considered a "less relevant" to human body health, it plays a crucial role in the pathophysiology of sepsis. Disruption of the host-microbe balance contributes to impaired barrier integrity, microbial translocation, and dysregulated immune responses. This perspective raises the possibility that dysbiosis is not merely a consequence of critical illness, rather an active driver of septic progression. This narrative review explores the relationship between sepsis and gut microbiome. PubMed, Scopus, and EMBASE were searched from inception to September 2025. Recent studies have highlighted the triangular interplay between the intestinal barrier, gut microbiota, and immune system. Altered microbial composition and increased permeability foster systemic inflammation and immune dysfunction. Biomarkers such as diamine oxidase and intestinal fatty acid-binding protein are emerging as promising indicators of gut injury. Experimental therapies (i.e., faecal microbiota transplantation, targeted probiotics, prebiotics, postbiotics, and personalized antibiotic regimens guided by microbial profiling) provide potential to modulate host-microbe interactions. Integration of microbiome analysis with multi-omics and advanced bioinformatics may enable stratification of septic patients by microbial signatures, paving the way for precision medicine approaches. Modulation of gut microbiota represents a novel therapeutic frontier in sepsis. Conceptualizing sepsis as a disease of disrupted host-microbe symbiosis may unravel new diagnostic and therapeutic strategies. Future research should aim at prioritizing high-quality trials, innovative designs, and equitable implementation to target microbiota to improve survival and recovery in patients with sepsis.

Background: Anemia is a global health issue, especially in resource-limited areas, where traditional hemoglobin (Hb) testing is invasive and costly. This study aimed to develop an electrocardiogram-hemoglobin (ECG-Hb) deep learning model (DLM) for detecting anemia and assess its impact on all-cause mortality and new-onset heart failure.

Methods: This retrospective study analyzed ECGs and corresponding Hb levels from two hospitals. The DLM was trained on 388,166 ECGs from 187,202 patients and tested on 24,279 and 29,247 patients in internal and external sets, respectively. Anemia was defined as moderate (Hb ≤ 10 g/dL) or severe (Hb ≤ 8 g/dL). Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, and an 8-year follow-up assessed mortality and heart failure risk with Cox regression.

Results: The areas under the ROC curves (AUCs) for detecting moderate-to-severe anemia were 0.8545 (internal) and 0.8243 (external), with sensitivities of 65.9% and 71.0%, and specificities of 84.8% and 77.4%, respectively. ECG-Hb performed better in detecting severe anemia (AUC = 0.9038/0.8766) than in mild anemia. Pearson correlations between ECG-Hb and Hb were 0.56 (internal) and 0.53 (external). Key ECG features, including heart rate variability, significantly influenced ECG-Hb. Patients with severely low ECG-Hb had higher risks of mortality (hazard ratio [HR]: 1.71, 95% confidence interval [CI]: 1.42-2.06) and heart failure (HR: 2.47, 95% CI: 2.07-2.94) compared to those with standard ECG-Hb levels.

Conclusion: The ECG-Hb DLM offers strong diagnostic and prognostic potential for anemia and cardiovascular risks, making it a valuable, non-invasive screening tool in low-resource settings.

Plasma leakage is a hallmark of severe dengue and a major contributor to morbidity and mortality, yet early identification remains difficult, particularly in resource-limited settings. This single-centre retrospective study evaluated the diagnostic accuracy of the neutrophil-to-lymphocyte ratio (NLR) in predicting plasma leakage amongst 507 adults with laboratory-confirmed dengue admitted between January 2022 and December 2023. Plasma leakage was defined sonographically. We assessed NLR trends from illness days 1 to 11 and constructed a bivariate plot of absolute neutrophil and lymphocyte counts to visualise immune dynamics. Ninety-nine patients (19.5%) developed plasma leakage. NLR values differed significantly between groups on days 2-8. Admission NLR showed modest performance (AUROC 0.626), with high sensitivity (87.9%) but low specificity (33.8%). The highest accuracy occurred on day 2 (AUROC 0.923). Whilst NLR alone is insufficient as a diagnostic tool, early phase measurements and visual frameworks of immune cell trajectories may enhance risk stratification for plasma leakage in dengue.

This cross-sectional observational study assessed exposure to a selected combustible cigarette (CC) smoke constituent and biomarkers of potential harm (BoPH) in healthy adults who exclusively used a heated tobacco product (direct heating tobacco system, platform 3, generation 3, version a [DT3.0a] group, n = 304), smoked CC (CC group, n = 102), or had never smoked CC (NS group, n = 102), to evaluate biomarker profiles relevant to health risks associated with smoking. Relative to the CC group, exposure to 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone was 39.1% lower in the DT3.0a group (p < 0.01), and several BoPH were lower in the DT3.0a group, including 2,3-dinor-thromboxane-B2 (- 19.4%, p = 0.04), 11-dehydrothromboxane-B2 (- 10.2%, p = 0.25), 8-epi-prostaglandin-F2α (- 7.2%, p = 0.42), and white blood cell count (- 11.6%, p = 0.05). Relative to the CC group, high-density lipoprotein cholesterol was 32.0% higher in the DT3.0a group (p < 0.01) with pulmonary function parameters also being higher, although the differences were not statistically significant. For these biomarkers, the NS group exhibited trends similar to those observed in the DT3.0a group. In contrast to previous findings, soluble intercellular adhesion molecule-1 levels were similar between the CC and NS groups and highest in the DT3.0a group, suggesting that further assessments may be more appropriate in the context of change in values. Except for this point, the DT3.0a group showed BoPH profiles trending in the direction toward those of the NS group, suggesting that the health risks associated with smoking are potentially lower in DT3.0a use compared to CC smoking.Trial Registration : Prior to the recruitment, the study was registered at the UMIN Clinical Trials Registry on December 27, 2022(UMIN000049840).

ST-segment elevation myocardial infarction (STEMI) remains a condition with high morbidity despite advancements in treatment. Physical examination for heart failure and identification of mechanical complications can be inconsistent. Point-of-care ultrasound (POCUS) has proven valuable in acute cardiovascular care. We developed the Focused Assessment in STEMI (FASTEMI) protocol to enhance early evaluation, identify complications, and guide management. This single-center prospective cohort study included patients with presumed STEMI between June 2023 and June 2024. The FASTEMI protocol was performed upon admission and comprised lung ultrasound to assess congestion, and cardiac ultrasound to evaluate ventricular function, detect mechanical complications, measure left-ventricular outflow tract velocity-time integral, and assess the inferior vena cava. A total of 214 patients had a confirmed diagnosis of STEMI, whereas 17 were diagnosed with other conditions. FASTEMI altered diagnosis or management in 33 cases (14%) (CI 95% = 11.2 - 20.9). Identification of left ventricular (OR 1.26, 95% CI = 1.11-1.43; p < 0.001), right ventricular (OR 1.3, 95% CI = 1.04-1.75; p < 0.001), and biventricular dysfunction (OR 1.96, 95% CI 1.14-3.38; p < 0.001) were associated with in-hospital mortality. A normal FASTEMI exam had a 97% negative predictive value for mortality and did not delay door-to-balloon time. FASTEMI enhances early diagnosis, risk stratification, and management of STEMI. It enables rapid identification of complications, optimizes individualized treatment, and provides prognostic information without prolonging door-to-balloon time. Its feasibility supports its role as an adjunctive bedside tool.