Rdzanek A, Piasecki A, Lin J
… +21 more, Tomaniak M, Królikowska M, Matsko P, Markiewicz A, Janiel M, Pędzich E, Kapłon Cieślicka A, Ostrowska E, Pawłowicz P, Trębacz J, Gałąska R, Stokłosa P, Stefaniak S, Chmielecki M, Denti P, Gackowski A, Grygier M, Pręgowski J, Grabowski M, Scisło P, Maisano F
Pol Arch Intern Med
· 2026 May · PMID 42100863
·
Publisher ↗
Tkaczyk F, Dziewierz A, Piotrowska A
… +1 more, Siudak Z
Pol Arch Intern Med
· 2026 Jun · PMID 42089118
·
Publisher ↗
INTRODUCTION: Erectile dysfunction (ED) is common in men after myocardial infarction (MI) and is associated with poorer quality of life and systemic vascular disease. Previous studies have primarily relied on questionnai...INTRODUCTION: Erectile dysfunction (ED) is common in men after myocardial infarction (MI) and is associated with poorer quality of life and systemic vascular disease. Previous studies have primarily relied on questionnaires, rarely including objective assessment of penile hemodynamics. OBJECTIVES: We aimed to assess the quality of life in men with ED after MI treated with percutaneous coronary intervention (PCI), including routine assessment of penile hemodynamics using point‑of‑care resting Doppler ultrasonography. PATIENTS AND METHODS: This observational, cross‑sectional, single‑center study included 600 men: 400 after MI treated with PCI and 200 without a history of MI/PCI (controls). ED was assessed using the 5‑item version of the International Index of Erectile Function (IIEF‑5) questionnaire, and quality of life was assessed using the 36-item Short‑Form Health Survey, version 2 (SF‑36v2) questionnaire. Echocardiography, carotid Doppler ultrasound, and resting penile Doppler ultrasound were performed. Associations were analyzed using the Spearman correlation and multivariable linear regression. RESULTS: All patients after MI had ED. Quality of life scores were significantly lower in the MI group than in the controls globally (mean [SD] SF‑36v2 score, 121.3 [8.9] vs 134.6 [7.5]; P <0.001) and in the physical and mental components. Penile Doppler parameters differed between the groups and correlated with IIEF‑5 scores. In multivariable analysis, the strongest predictor of quality of life was erectile function (IIEF‑5), followed by left ventricular ejection fraction, body mass index, heart rate, and vascular parameters (intima‑media thickness, carotid and penile flow). CONCLUSIONS: ED severity is a major independent determinant of the quality of life in men after MI/PCI. Penile hemodynamic parameters reflect systemic vascular burden and functional status. Integrated ED assessment that includes the IIEF‑5 questionnaire and routine resting penile Doppler ultrasound may enhance risk stratification and post‑MI care.
Cosmi B, Gerotziafas G, Marschang P
… +3 more, Kozak M, Catalano M, Stanek A
Pol Arch Intern Med
· 2026 Jun · PMID 42084359
·
Publisher ↗
Venous thromboembolism (VTE) is caused by the interaction between genetic, individually acquired, and environmental factors. The aim of this narrative review is to summarize advances in the research on genetic susceptibi...Venous thromboembolism (VTE) is caused by the interaction between genetic, individually acquired, and environmental factors. The aim of this narrative review is to summarize advances in the research on genetic susceptibility to VTE and its recurrence, focusing on genome‑wide association study (GWAS)-derived polygenic risk scores (PRSs) and sequencing‑based approaches, and to discuss current barriers to their clinical implementation. Testing for the classical inherited thrombophilias, such as the deficiencies of natural anticoagulants (antithrombin, proteins C and S, the factor V Leiden variant, and the G20210A mutation of factor II) could improve risk stratification and therapeutic decision‑making in VTE, although their role in VTE management remains controversial. Over the last 2 decades, knowledge on genetic susceptibility to VTE progressed beyond the classical thrombophilias, thanks to the evolution from single‑gene Sanger sequencing to genome‑wide sequencing and next‑generation sequencing. GWASs have enabled the creation of PRSs combining the effects of multiple single‑nucleotide polymorphisms. PRSs could significantly improve VTE risk prediction beyond clinical factors. Integration of genetic and clinical data could improve predictive accuracy. In addition, combining GWAS with transcriptome‑wide association studies and Mendelian randomization has shown that genetic risk may change across different clinical presentations of VTE, and that recurrent VTE differs genetically and biologically from the initial event, being associated with genetic variants, such as those of kininogen 1 and fibrinogen. PRSs can stratify VTE risk beyond traditional factors in European‑ancestry cohorts; recurrence may have a partially distinct genetic / proteomic architecture. However, prospective clinical utility of these novel approaches to VTE risk stratification remains to be established, and integrating this advanced knowledge into clinical practice remains a future challenge in VTE management.
Denegri A, Pruc M, Kozyra P
… +3 more, El-Menyar A, Szarpak L, Siudak Z
Pol Arch Intern Med
· 2026 Jun · PMID 42084149
·
Publisher ↗
Potassium‑competitive acid blockers (P‑CABs) are the first mechanistically distinct oral acid suppressants to challenge proton pump inhibitors (PPIs) in routine practice. By reversibly inhibiting gastric H+/K+-adenosinet...Potassium‑competitive acid blockers (P‑CABs) are the first mechanistically distinct oral acid suppressants to challenge proton pump inhibitors (PPIs) in routine practice. By reversibly inhibiting gastric H+/K+-adenosinetriphosphatase without requiring acid activation, they provide rapid onset of action, durable 24‑hour acid control, and decreased dependence on meal timing and CYP2C19 variability. These pharmacologic features are clinically relevant in acid‑related disorders, but the clinical evidence is not uniform across individual compounds. Within the class, the most extensive efficacy and safety data have been collected for vonoprazan, whereas newer agents, including zastaprazan, remain supported by a more limited evidence base. In erosive esophagitis, randomized trials indicate that P‑CABs are effective acid suppressants, but compound‑specific conclusions are more appropriate than broad assumptions of interchangeable class effects. For zastaprazan specifically, phase 3 data show that 20 mg is noninferior to esomeprazole 40 mg at week 8, with higher week 4 healing rates in a predominantly low‑grade population. In contrast, no clinical trials have directly evaluated any P‑CAB for stress ulcer prophylaxis in critically ill adults. Current intensive care unit guidelines continue to support PPIs or histamine‑2 receptor antagonists in patients at a high risk of stress‑related gastrointestinal bleeding, and pantoprazole remains the best‑established benchmark. This review integrates mechanistic, pharmacokinetic, efficacy, safety, regulatory, and guideline data relevant to P‑CABs, with particular attention to zastaprazan, while distinguishing compound‑specific findings from broader class‑level considerations.
Wroński J, Adamska A, Urba J
… +2 more, Foryś A, Kudraszewska E
Pol Arch Intern Med
· 2026 May · PMID 42059890
·
Publisher ↗
INTRODUCTION: SAPHO syndrome is a rare autoimmune / autoinflammatory disorder with no approved therapies or standardized management guidelines. Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsD...INTRODUCTION: SAPHO syndrome is a rare autoimmune / autoinflammatory disorder with no approved therapies or standardized management guidelines. Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) are increasingly used off‑label. OBJECTIVES: This review aimed to systematically evaluate the evidence for the efficacy of b/tsDMARDs in SAPHO. PATIENTS AND METHODS: A PRISMA‑guided search of PubMed database was conducted through March 31, 2025. Studies of any design reporting outcomes of b/tsDMARDs in patients with SAPHO fulfilling the modified Kahn criteria were included. Exclusion criteria were non‑English language, inaccessible full text, and insufficient treatment details. Data on patient characteristics, drug class, follow‑up duration, and treatment response were extracted. As all the included studies were case reports or case series, the risk of bias was not assessed. Treatment responses were summarized using descriptive statistics. RESULTS: Of 1610 screened records, 106 studies comprising 385 instances of b/tsDMARD use met the inclusion criteria; no randomized controlled trials were identified. Tumor necrosis factor inhibitors (TNFis) were used in 203 patients, with complete skeletal and skin responses in 81% and 72%, respectively. The use of Janus kinase inhibitors (JAKis) in 77 patients was associated with complete response rates of 89% (skeletal) and 94% (skin). Other b/tsDMARD classes-including interleukin 17 (IL‑17), IL‑23, IL‑1, and IL‑6 inhibitors, as well as phosphodiesterase‑4 inhibitors-demonstrated variable and generally lower efficacy. CONCLUSIONS: Evidence for b/tsDMARD efficacy in SAPHO remains limited to low‑quality, uncontrolled studies with substantial heterogeneity and probable publication bias. TNFis and JAKis are among the most consistently effective therapies reported in the available literature, but high‑quality research, including randomized trials or prospective registries, is urgently needed to inform evidence‑based management.
Pol Arch Intern Med
· 2026 May · PMID 42047305
·
Publisher ↗
Neutrophil extracellular traps (NETs) are increasingly recognized as key mediators in the development of venous thromboembolism (VTE). Animal models and in vitro studies showed that NETs form a prothrombotic scaffold tha...Neutrophil extracellular traps (NETs) are increasingly recognized as key mediators in the development of venous thromboembolism (VTE). Animal models and in vitro studies showed that NETs form a prothrombotic scaffold that supports platelet adhesion and aggregation, promotes activation of blood coagulation, and accelerates thrombin generation, leading to the formation of compact fibrin networks that exhibit increased resistance to fibrinolysis. Although clinical data remain limited, available studies support the translational relevance of these mechanisms in VTE. Elevated levels of circulating markers related to NETs formation (NETosis), such as citrullinated histone H3 (citH3), cell‑free DNA, and neutrophil protein-DNA complexes, have been detected in patients with acute deep vein thrombosis and correlated with disease severity and unfavorable outcomes. In acute pulmonary embolism (PE), elevated citH3 level on admission predicted PE‑related death. Higher concentrations of NET‑related proteins have also been linked to post‑thrombotic syndrome and chronic thromboembolic pulmonary hypertension. Recent data suggest an association between enhanced NETosis and elevated levels of factor XI. From a clinical perspective, enhanced NETosis can be implicated in suboptimal effects of anticoagulant therapy in VTE, especially in cancer or septic patients. Despite the fact that attenuation of NETosis is an attractive goal in VTE, at present, no therapeutic strategies targeting NETosis, NETs degradation, or inhibition of NETosis‑associated pathways are available. This review summarizes the current knowledge on the mechanisms linking NETs with thrombosis. It also discusses the utility of available methods for the quantification of NET-related markers in patients and clinical implications of NET‑mediated venous thrombosis and its sequelae.
Werel-Ołdziejewska P, Krentowska A, Orzechowska D
… +2 more, Gietka A, Kowalska I
Pol Arch Intern Med
· 2026 Jun · PMID 42024300
·
Publisher ↗
INTRODUCTION: Global rise in obesity and metabolic syndrome has increased incidence of metabolic dysfunction-associated steatotic liver disease (MASLD). Owing to its high prevalence and the emergence of new therapies, no...INTRODUCTION: Global rise in obesity and metabolic syndrome has increased incidence of metabolic dysfunction-associated steatotic liver disease (MASLD). Owing to its high prevalence and the emergence of new therapies, noninvasive tests (NITs) for liver fibrosis are becoming more widely used. OBJECTIVES: The aim of this study was to analyze and compare NIT performance in identifying fibrosis of grade F2 or greater in patients with MASLD confirmed on liver biopsy. PATIENTS AND METHODS: This study was a retrospective analysis of 134 patients. The accuracy of 9 NITs in identifying significant fibrosis was assessed, and new thresholds were proposed using the Youden index. RESULTS: The group with fibrosis grade F2 or greater (n = 52) was older (P = 0.002), had higher body mass index (P <0.001), lower platelet count (P <0.001), total cholesterol (P = 0.005) and albumin levels (P = 0.02), and higher aspartate aminotransferase activity (P = 0.003) and international normalized ratio (P = 0.02) than the group without significant fibrosis (n = 82). Areas under the receiver operating characteristic curve above 0.8 were obtained for the nonalcoholic fatty liver disease fibrosis score (0.818), Fibroscan (0.805), Hepamet score (0.803), and aspartate aminotransferase / alanine aminotransferase ratio (0.802). The highest sensitivity and negative predictive value were obtained for the Fibrosis‑4 and Hepamet score. The new optimal thresholds were lower than those previously presented in the literature, which was associated with an increase in the NIT sensitivity and negative predictive value. CONCLUSIONS: NITs for assessing liver fibrosis are useful for identifying patients with significant fibrosis, but lower thresholds should be considered. The Hepamet score might be considered an alternative tool to the Fibrosis‑4 score in ruling out significant fibrosis in clinical practice.
Croce A, Riccò A, Ornago AM
… +7 more, Ferrara MC, Soranna D, Zambon A, Pengo MF, Bilo G, Bellelli G, Parati G
Pol Arch Intern Med
· 2026 Jun · PMID 42024299
·
Publisher ↗
INTRODUCTION: Frailty is a common condition in older hypertensive adults, and it is associated with an increased risk of adverse outcomes. Blood pressure variability (BPV) is an independent cardiovascular risk factor, bu...INTRODUCTION: Frailty is a common condition in older hypertensive adults, and it is associated with an increased risk of adverse outcomes. Blood pressure variability (BPV) is an independent cardiovascular risk factor, but its relationship with frailty remains poorly understood, especially in outpatients. OBJECTIVES: We aimed to investigate the association between short‑term 24‑hour BPV and frailty in a cohort of older hypertensive outpatients. PATIENTS AND METHODS: In this cross‑sectional study, 184 hypertensive outpatients aged at least 75 years underwent frailty assessment using a 40‑item frailty accumulation index derived from comprehensive geriatric assessment and 24‑hour ambulatory BP monitoring (ABPM). The participants were categorized as nonfrail, prefrail, or frail, and short‑term BPV was quantified using multiple indices. Multiple regression analysis was used to identify associations between BPV and frailty status, and adjusted β estimates were reported. RESULTS: Mean (SD) age of the participants was 81.76 (4.32) years, and 68% were women. Of the entire group, 63 patients (34.2%) were nonfrail, 79 (42.9%) prefrail, and 42 (22.8%) frail. Frailty directly correlated with nocturnal diastolic BPV. In adjusted analyses, nocturnal diastolic BP was strongly associated with frailty (β = 0.076; P = 0.04), and systolic dipping showed a marked negative association with the frailty index (β = -0.17; P = 0.04). CONCLUSIONS: Nocturnal but not diurnal BPV is associated with frailty in older hypertensive outpatients. These findings support the potential clinical value of BPV in geriatric care as a noninvasive marker of physiological vulnerability, easy to obtain whenever ABPM is required for hypertension management. Further studies are needed to clarify causality and define the potential of BPV assessment and modulation in older patients.