European Journal of Internal Medicine最新文献

英文中文

Navigating the challenges: Would onboarding bootcamps enhance comfort and wellbeing of residents in medicine? 迎接挑战：入职训练营能否提高住院医师的舒适度和幸福感？

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.05.008

引用次数: 0

Unmasking eosinophilic granulomatosis with polyangiitis (EGPA) 揭开嗜酸性粒细胞肉芽肿伴多血管炎（EGPA）的神秘面纱。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.08.009

Luca Moroni , Gabriele Gallina , Lorenzo Dagna

引用次数: 0

Multi-organ abnormalities assessed by a single MRI scan in individuals with blood cancer 通过一次磁共振成像扫描评估血癌患者的多器官异常情况

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.05.025

Background

During the COVID-19 pandemic individuals with all blood cancers were classified as clinically vulnerable and at high risk of complications and death. Our study sought to determine if individuals with specific blood cancers were at a heightened risk of longer term organ impairment, secondary to SARS-CoV-2 infection.

Methods

We set up a prospective observational study, utilising quantitative multi-parametric MRI to determine organ health over time in patients with specific blood cancers who had recovered from COVID-19.

Results

Multi-organ abnormality was more prevalent in blood cancer patients than in healthy controls (42 % vs 6 % p < 0.001) but comparable to the long COVID controls (42 % vs 33 %, p > 0.05). At 6 month follow up scans, organ abnormalities persisted in most individuals with blood cancer (71 % ≥1 organ and 52 % multi-organ).

Conclusion

A multi-organ MRI platform offers the capacity to accurately evaluate organ health dynamically in blood cancers and detect asymptomatic organ impairment. The application of multi-organ MRI could aid early detection and longitudinal monitoring of organ impairment, potentially guiding more personalised treatment strategies and improving clinical outcomes in many rare diseases.

背景在 COVID-19 大流行期间，患有所有血癌的人都被列为临床易感人群，并面临并发症和死亡的高风险。我们的研究旨在确定特定血癌患者是否因感染 SARS-CoV-2 而面临更高的器官长期受损风险。方法我们建立了一项前瞻性观察研究，利用定量多参数磁共振成像来确定从 COVID-19 中康复的特定血癌患者的器官健康状况。结果与健康对照组相比，血癌患者的多器官异常发生率更高（42% vs 6% p <0.001），但与长期COVID对照组相当（42% vs 33%, p >0.05）。在 6 个月的随访扫描中，大多数血癌患者的器官仍存在异常（≥1 个器官的占 71%，多个器官的占 52%）。多器官磁共振成像的应用有助于早期检测和纵向监测器官损伤，有可能指导更个性化的治疗策略，改善许多罕见病的临床预后。

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引用次数: 0

Beta-cell function and glucose metabolism in patients with chronic pancreatitis 慢性胰腺炎患者的β细胞功能和葡萄糖代谢。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.06.007

Aims

Chronic pancreatitis (CP) is – along with acute pancreatitis - the most frequent cause of diabetes of the exocrine pancreas (DEP). Although insulin deficiency is widely accepted as the major feature of DEP, it is still unclear whether diabetes associated with CP is characterized by additional or different functional defects of the insulin secretory machinery. To identify possible functional defects specifically induced by CP, we performed a cross-sectional study in individuals with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and diabetes mellitus (DM) comparing patients with and without CP (CP vs. NCP).

Methods

We administered an oral glucose tolerance test (OGTT) to all participants and, according to their glucose tolerance, classified them as NGT, IGT and DM. Insulin sensitivity and beta-cell functional parameters were derived from OGTT, hyperglycemic clamp and hyperinsulinemic euglycemic clamp.

Results

Studying 146 subjects, we found that beta-cell function and insulin secretion were significantly lower in CP compared to NCP patients. However, when we classified the subjects according to OGTT-derived glucose tolerance, we found no differences in beta-cell function or in insulin sensitivity between CP and NCP with the same glucose tolerance status. Of note, we found that arginine-stimulated insulin secretion is reduced only in subjects with CP and DM compared to NCP subjects with DM.

Conclusions

Patients with CP had no specific alterations in insulin secretion and beta-cell function. However, in patients diagnosed with diabetes, we found a lower arginine-stimulated insulin secretion, a marker of reduced functional mass.

目的：慢性胰腺炎（CP）与急性胰腺炎一样，是胰腺外分泌糖尿病（DEP）最常见的病因。尽管胰岛素缺乏被广泛认为是胰腺外分泌糖尿病的主要特征，但与慢性胰腺炎相关的糖尿病是否以胰岛素分泌机制的额外或不同功能缺陷为特征仍不清楚。为了确定 CP 可能诱发的特殊功能缺陷，我们对糖耐量正常（NGT）、糖耐量受损（IGT）和糖尿病（DM）患者进行了一项横断面研究，比较了有 CP 和无 CP 患者（CP vs. NCP）：我们对所有参与者进行了口服葡萄糖耐量试验（OGTT），并根据他们的葡萄糖耐量将他们分为 NGT、IGT 和 DM。从 OGTT、高血糖钳夹和高胰岛素血糖钳夹中得出胰岛素敏感性和β细胞功能参数：在对 146 名受试者进行研究后，我们发现 CP 患者的 beta 细胞功能和胰岛素分泌明显低于 NCP 患者。然而，当我们根据 OGTT 导出的葡萄糖耐量对受试者进行分类时，我们发现在葡萄糖耐量状态相同的 CP 和 NCP 之间，β 细胞功能或胰岛素敏感性没有差异。值得注意的是，我们发现与患有 DM 的 NCP 受试者相比，只有患有 CP 和 DM 的受试者精氨酸刺激的胰岛素分泌减少：CP患者的胰岛素分泌和β细胞功能没有特殊改变。然而，在确诊为糖尿病的患者中，我们发现精氨酸刺激的胰岛素分泌较低，而这是功能质量降低的标志。

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引用次数: 0

Internal medicine in the 21st century: Back to the future 21 世纪的内科医学：回到未来。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.07.038

Ricardo Gómez-Huelgas , George N. Dalekos , Dror Dicker , Nicola Montano

Healthcare systems face multiple challenges arising from demographic factors (population aging) and epidemiological factors (rise of chronic diseases and patients with multimorbidity) as well as threats to their financial sustainability when maintaining equitable access to medical and technological advances. Current healthcare models, based on specialized medical care, lead to fragmented care that can be harmful to the patient and is inefficient for the system due to the overuse of redundant, low-value medical acts. Internal medicine is the hospital-centered general medical specialty par excellence, providing a comprehensive and holistic vision that is centered on the patient and not on the disease. Internists should be the leading physicians in the hospital setting for complex patients with or those with an uncertain diagnosis. Internists must play a key role, as hospitalists do, in the continued care of acute patients hospitalized for medical or surgical diseases, establishing shared care models in multidisciplinary teams. Likewise, to guarantee continuity of care for chronic patients, internists must establish mechanisms for collaboration with primary care and nursing, participating in the development of new out-of-hospital care models that use the available technological resources. Internal medicine should play a leading role in graduate and postgraduate medical education to promote a holistic vision among medical students and residents in medical subspecialties.

医疗保健系统面临着人口因素（人口老龄化）和流行病因素（慢性病和多发病患者的增加）带来的多重挑战，以及在保持公平获得医疗和技术进步的同时对其财务可持续性的威胁。目前的医疗保健模式以专科医疗保健为基础，导致医疗保健分散，由于过度使用多余、低价值的医疗行为，可能对患者造成伤害，对医疗系统来说也是低效的。内科是以医院为中心的卓越的全科医学专科，提供以病人而非疾病为中心的综合全面的医疗服务。对于诊断复杂或诊断不明确的病人，内科医生应成为医院的主要医生。内科医生必须像住院医生一样，在内科或外科急症住院病人的持续护理中发挥关键作用，在多学科团队中建立共同护理模式。同样，为了保证对慢性病患者的持续护理，内科医生必须建立与初级保健和护理的合作机制，参与开发新的院外护理模式，利用现有的技术资源。内科应在研究生和研究生医学教育中发挥主导作用，在医学亚专科的医学生和住院医师中推广整体观念。

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引用次数: 0

Diagnostic challenge of hemoptysis in a hemodialysis patient 血液透析患者咯血的诊断难题。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.07.022

Fullana Martin , Aliaga Leandro , Verni Giuliana

引用次数: 0

Exploring Cardiovascular Risk Factors and Atherosclerosis in Rheumatoid Arthritis 探索类风湿关节炎的心血管风险因素和动脉粥样硬化。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.07.016

Alexandros A. Drosos, Aliki A. Venetsanopoulou, Eleftherios Pelechas, Paraskevi V. Voulgari

Rheumatoid arthritis (RA) is a chronic inflammatory disease mainly affecting the peripheral diarthrodial joints symmetrically and also presenting many extra-articular manifestations. Morbidity and mortality in RA patients are higher compared to the general population. Cardiovascular (CV) disease is one of the most common causes of death in these patients. Classical or traditional risk factors for atherosclerosis development occur more frequently in RA patients compared to those without this condition. Studies have showed that RA patients often present comorbidities such as hypertension, dyslipidemia, diabetes mellitus and obesity. However, the high incidence of CV events occurring in RA patients is not explained by the presence of traditional risk factors. Systemic inflammation, as it is expressed with the presence of proinflammatory cytokines and increased acute phase reactants, may contribute to the development of premature atherosclerosis in these patients. In this review, we explore the risk factors for CV disease, the generation of dyslipidemia, the lipid paradox and the role of systemic inflammation in the atherosclerotic process in RA. We discuss also the role of early therapeutic intervention that suppresses inflammation which may have beneficial effects on CV disease in RA patients.

类风湿性关节炎（RA）是一种慢性炎症性疾病，主要累及对称性外周二关节，也有许多关节外表现。与普通人群相比，RA 患者的发病率和死亡率较高。心血管疾病是这些患者最常见的死因之一。与无动脉粥样硬化的患者相比，RA 患者更容易出现动脉粥样硬化的经典或传统风险因素。研究表明，RA 患者通常伴有高血压、血脂异常、糖尿病和肥胖等合并症。然而，传统风险因素的存在并不能解释 RA 患者心血管事件高发的原因。全身炎症表现为促炎细胞因子的存在和急性期反应物的增加，这可能会导致这些患者过早发生动脉粥样硬化。在这篇综述中，我们探讨了心血管疾病的危险因素、血脂异常的产生、血脂悖论以及全身炎症在 RA 动脉粥样硬化过程中的作用。我们还讨论了抑制炎症的早期治疗干预的作用，这可能会对 RA 患者的心血管疾病产生有益的影响。

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引用次数: 0

Treatment of systemic lupus erythematosus in real life. 在现实生活中治疗系统性红斑狼疮。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.09.019

Giuseppe Barilaro, Ricard Cervera

引用次数: 0

Deprescribing in reflex syncope 在反射性晕厥中取消处方。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.08.019

Alessandra Fusco , Monica Solbiati , Giorgio Costantino

引用次数: 0

The association between long-acting muscarinic antagonist-based therapy and the risk of urinary tract infection in patients with chronic obstructive pulmonary disease 基于长效毒蕈碱拮抗剂的治疗与慢性阻塞性肺病患者尿路感染风险之间的关联。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.05.022

引用次数: 0

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