European Journal of Internal Medicine最新文献

英文中文

A woman with unconsciousness and tachycardia after drug overdose. 一名妇女服药过量后出现昏迷和心动过速。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ejim.2024.11.008

Minori Kuromiya, Junpei Komagamine

引用次数: 0

Hemiatrophy of the face and limb 面部和肢体的半萎缩。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ejim.2024.11.027

Jiahao Wei, Xi Liu, Lifen Chen

引用次数: 0

Immune heterogeneity associated with disease severity and activity in eosinophilic granulomatosis with polyangiitis patients 嗜酸性粒细胞肉芽肿伴多血管炎患者的免疫异质性与疾病严重程度和活动性有关。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ejim.2024.08.003

Lijuan Hua, Mengyao Guo, Wenxue Bai, Dongyuan Wang, Min Xie

引用次数: 0

Risk factors for community-acquired acute kidney injury: Challenges and perspectives 社区获得性急性肾损伤的危险因素：挑战和观点。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ejim.2024.11.023

Elisa Russo , Francesca Cappadona , Pasquale Esposito

引用次数: 0

A bibliometric analysis of awake prone positioning for non-intubated patients 非插管患者清醒俯卧位的文献计量分析。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ejim.2024.08.023

Hong Li, Yun Peng, Xixi Wan, Jiming Cai

引用次数: 0

Prospective study of risk factors for community-acquired acute kidney injury 社区获得性急性肾损伤风险因素的前瞻性研究。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ejim.2024.09.016

Telma H Ragnarsdotttir , Margret Kristjansdottir , Gisli Gislason , Vicente Sanchez-Brunete , Margret O Tomasdottir , Olafur H Samuelsson , Runolfur Palsson , Olafur S Indridason

Background and hypothesis

Causes and risk factors for community-acquired acute kidney injury (CA-AKI) have not been thoroughly studied. The aim of this study was to examine the risk factors for CA-AKI.

Methods

In this prospective study, we examined serum creatinine from all individuals visiting a university hospital's emergency department (ED) over an 11-month period for the presence of AKI defined according to the KDIGO criteria. Patients with AKI were invited to participate. Randomly selected controls (1:2) were paired according to age, sex, and date of admission. Participants answered questions about their medical history and medication use, including over-the-counter (OTC) drugs. Conditional logistic regression was used to identify factors associated with AKI.

Results

Of 602 AKI cases identified, 512 participated in the study. AKI cases were significantly more likely than controls to have used nonsteroidal anti-inflammatory drugs (NSAIDs) (26.0 % vs 18.0 %, p = 0,001) in the week preceding the ED visit, particularly OTC NSAIDs (23.3 % vs 15.9 %, p < 0.001). AKI was associated with a recent history of vomiting (OR 2.52 [95 %CI 1.87–3.39]), diarrhea (1.30 [1.00–1.70]) and urinary retention (1.92 [1.36–2.72]), use of non-selective NSAIDs (1.84, [1.37–2.48]), RAAS blockers (1.63 [1.21–2.19]), and diuretics (1.53 [1.13–2.08]), and a history of diabetes (1.42 [1.04–1.94]), CKD (1.36 [1.01–1.83]) and smoking (1.72 [1.24–2.37]).

Conclusions

Events in the setting of acute illness and medication use, including OTC NSAIDs, may play a greater role in the development of CA-AKI than comorbid conditions. Frequent use of OTC NSAIDs is a concern and should be addressed in view of serious adverse effects.

背景与假设：社区获得性急性肾损伤（CA-AKI）的原因和风险因素尚未得到深入研究。本研究旨在探讨社区获得性急性肾损伤的风险因素：在这项前瞻性研究中，我们检查了一家大学医院急诊科（ED）在 11 个月内所有就诊者的血清肌酐，以确定是否存在根据 KDIGO 标准定义的 AKI。AKI患者受邀参加。随机抽取的对照组（1:2）根据年龄、性别和入院日期配对。参与者回答了有关病史和用药（包括非处方药）的问题。条件逻辑回归用于确定与 AKI 相关的因素：在602例AKI病例中，有512例参与了研究。与对照组相比，AKI 病例在急诊室就诊前一周使用非甾体类抗炎药（NSAIDs）（26.0% vs 18.0%，p = 0,001）的几率明显更高，尤其是非处方药 NSAIDs（23.3% vs 15.9%，p < 0.001）。AKI 与近期的呕吐（OR 2.52 [95 %CI 1.87-3.39]）、腹泻（1.30 [1.00-1.70] ）和尿潴留（1.92 [1.36-2.72] ）病史、使用非选择性非甾体抗炎药（1.84, [1.1.53[1.13-2.08]），以及糖尿病史（1.42[1.04-1.94]）、慢性肾脏病史（1.36[1.01-1.83]）和吸烟史（1.72[1.24-2.37]）：结论：与合并症相比，急性病和用药（包括非处方药非甾体抗炎药）在 CA-AKI 的发病中可能起更大的作用。频繁使用非处方药物非甾体抗炎药令人担忧，鉴于其严重的不良反应，应引起重视。

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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 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-01 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

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.

背景：射血分数保留型心力衰竭（HFpEF）患者的最佳收缩压（SBP）仍存在争议。我们旨在评估 HFpEF 患者的收缩压轨迹和预后：根据随访血压，使用潜在类别轨迹模型将醛固酮拮抗剂治疗保留心功能心衰试验（TOPCAT）的患者分为三个SBP轨迹组。主要结果是心血管死亡、心脏骤停和心衰再入院的复合结果。共纳入 3388 名患者（平均年龄 68.6 岁，48.5% 为男性）。在 6 年内，SBP 稳定轨迹组的平均 SBP 保持在 128 mmHg，SBP 下降轨迹组的平均 SBP 从 129 mmHg 下降到 125 mmHg，SBP 上升轨迹组的平均 SBP 从 132 mmHg 上升到 143 mmHg。在平均 3.4 年的随访期间，654 人出现了主要结果。与 SBP 轨迹稳定组相比，SBP 上升轨迹组和 SBP 下降轨迹组的主要和次要结果发生率均较高。经调整后，SBP下降轨迹组与所有结果的风险增加有关（危险比≥1.32），SBP上升轨迹组与全因住院和中风有关（危险比≥1.28）：结论：SBP下降或上升轨迹与HFpEF心血管事件的高风险相关，建议SBP轨迹稳定组（≈130 mmHg）的心血管事件发生率和死亡率较低。有必要进行试验以确定 HFpEF 的最佳 SBP。

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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 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ejim.2024.10.006

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

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.

目的研究布鲁氏菌病患者免疫反应蛋白的单核苷酸多态性（SNPs）携带的相关性：对符合世界卫生组织标准的布鲁氏菌病患者进行病例对照研究。通过 RFLP- PCR 进行血液基因组分析，检测 SNPs：i) TNF 基因启动子 -376 G > A (rs1800750); -308 G > A (rs 1,800,629); -238 G > A (rs361525)，ii) TLR-4 基因 -896 A > G Asp299Gly (rs4986790) 和 -1196 C > T Thr399Ile (rs4986791) 位置。对与布鲁氏菌脊柱盘炎相关的因素进行了逻辑回归分析：结果：布鲁氏杆菌病患者（n = 105）为男性（n = 67，63.8%）；平均年龄（SD）：49.51（18.31）；脊柱盘炎（n = 30），骶骨骨髓炎（n = 21）。TNF启动子区域-238的小频率A等位基因在患者中的携带率高于对照组（11.4% vs 2.6%，P < 0.001）。在包括宿主变量和TNF-238 G A-1基因型的逐步回归模型中，只有最后一个基因型与布鲁氏脊柱盘炎相关[OR 2.91 (CI95 % 1.02-8.31), p = 0.047]：在我们的队列中，布鲁氏菌病（尤其是脊柱盘炎）患者的一个 TNF SNP 可能与预后有关，但需要进一步研究其在宿主免疫反应中的确切作用。

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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 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-01 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

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.

背景：治疗住院急性失代偿性心力衰竭（ADHF）患者的最佳收缩压（SBP）目标尚不明确：方法：我们分析了 14,611 名急性失代偿性心力衰竭（ADHF）患者的医疗记录：我们分析了 17 家医院（2010-2022 年）14,611 名急性失代偿性心力衰竭住院患者的医疗记录，这些患者的随访至 2023 年 5 月。敏感性分析包括出院后 30 天内测量 SBP 的 10,515 名患者：结果：出院 SBP 患者在 30 天、180 天、1 年和 3 年后的死亡率均较高：在住院的 ADHF 患者中，SBP

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引用次数: 0

Clinical significance of the anti-Nucleolar Organizer Region 90 antibodies (NOR90) in systemic sclerosis 系统性硬化症患者抗核极组织区 90 抗体（NOR90）的临床意义。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.ejim.2024.09.011

Wanyi Lin , Chenhan Jia , Hanlin Yin , Liangjing Lu

引用次数: 0

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