Wiligórska N, Zalewska J, Nowicki M
… +9 more, Michałowska I, Gołębiewski S, Wojtkowska I, Sumiński A, Kowalik I, Soćko G, Januszewicz A, Witkowski A, Kądziela J
Pol Arch Intern Med
· 2026 May · PMID 41842830
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INTRODUCTION: Extracoronary vascular abnormalities (EVAs) have been found in patients with spontaneous coronary artery dissection (SCAD), suggesting that SCAD may reflect systemic vascular disease. OBJECTIVE: The aim of...INTRODUCTION: Extracoronary vascular abnormalities (EVAs) have been found in patients with spontaneous coronary artery dissection (SCAD), suggesting that SCAD may reflect systemic vascular disease. OBJECTIVE: The aim of this study was to assess the prevalence and characteristics of EVAs in SCAD survivors. PATIENTS AND METHODS: A total of 109 consecutive patients with a history of SCAD underwent head‑to‑ pelvis computed tomography angiography for EVA screening. EVAs were defined as the presence of fibromuscular dysplasia (FMD), aneurysm, or cervical dissections. RESULTS: EVAs were identified in 47.7% of the cohort. The prevalence of FMD was 32.1%, aneurysms were observed in 23.2% of the patients, and dissections of cervical arteries in 5.5%, while 9.3% of the patients presented with both FMD and aneurysms. FMD predominantly affected the renal (20.3%) and cervical (15.6%) arteries, while aneurysms were most commonly detected in the renal and splenic arteries (7.3% each). Multisite FMD was present in 8.3% of the patients. Aneurysms in more than 1 vascular bed were found in 4.6% of the cases. Cervical FMD was associated with migraine headaches in 58.8% of the patients and was clinically silent in 41.2%. All aneurysms were silent, however, 3 patients (12%) with intracerebral aneurysms required intravascular treatment due to a risk of rupture. In FMD patients, higher prevalence of type 2a SCAD (65.7% vs 43.1%; P = 0.03) and pregnancy‑ associated SCAD (17.6% vs 4.2%; P = 0.03) was observed. The patients with type 2a SCAD had a 2.5‑ fold higher likelihood of having FMD (odds ratio, 2.53; 95% CI, 1.09-5.87; P = 0.03). CONCLUSIONS: This study showed a significant prevalence of EVAs in SCAD survivors, with silent aneurysms being more common than previously reported.
Procyk G, Tyrna P, Młynarczuk-Biały I
… +4 more, Budzianowski J, Olasińska-Wiśniewska A, Kochman J, Gąsecka A
Pol Arch Intern Med
· 2026 Apr · PMID 41841810
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INTRODUCTION: Severe aortic stenosis (AS) can be treated with transcatheter aortic valve implantation (TAVI). There is emerging evidence suggesting that high lipoprotein(a) (Lp[a]) levels may be associated with worse out...INTRODUCTION: Severe aortic stenosis (AS) can be treated with transcatheter aortic valve implantation (TAVI). There is emerging evidence suggesting that high lipoprotein(a) (Lp[a]) levels may be associated with worse outcomes after TAVI. OBJECTIVES: We aimed to compare major adverse cardiac and cerebrovascular events (MACCEs) within 12 months after TAVI and long‑term survival in patients with high and low Lp(a) levels. PATIENTS AND METHODS: In this prospective, multicenter cohort study we included patients with severe AS qualified for TAVI with stored plasma available for Lp(a) measurement. The patients were stratified into high- and low‑Lp(a) groups (cutoff, 30 mg/dl). Two primary end points were 12‑month MACCE and long‑term overall survival. Secondary end points were individual components of MACCE. RESULTS: Between November 2018 and September 2021, TAVI was performed across 3 clinical sites; stored plasma was available for Lp(a) level measurement in 82 patients. We observed no difference in MACCE occurrence in the high- and low‑Lp(a) groups. In unadjusted analyses, the patients with elevated Lp(a) levels had worse long‑term survival during median follow‑up of 2.8 years (log‑rank P = 0.045) but this difference lost significance after adjustments for age and sex in a Cox regression model (hazard ratio, 2.85; 95% CI, 0.85-9.55; P = 0.054). None of the secondary end points differed significantly between the groups. CONCLUSIONS: The patients with elevated Lp(a) level had a comparable risk of 12‑month MACCE after TAVI to those with low Lp(a) level but might have worse long‑term survival. Long‑term findings should be considered exploratory and require further confirmation.
Rusinek D, Pfeifer A, Krajewska J
… +9 more, Zebracka-Gala J, Kowalska M, Student S, Zembala-Nozynska E, Chmielik E, Jarzab B, Cieslicka M, Czarniecka A, Oczko-Wojciechowska M
Pol Arch Intern Med
· 2026 Apr · PMID 41841562
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INTRODUCTION: Despite extensive research, no independent molecular markers have been identified that could optimize the treatment of patients with papillary thyroid carcinoma (PTC). Proper recurrence risk stratification...INTRODUCTION: Despite extensive research, no independent molecular markers have been identified that could optimize the treatment of patients with papillary thyroid carcinoma (PTC). Proper recurrence risk stratification is crucial for further clinical management and determining the extent of treatment aggressiveness. OBJECTIVES: We focused on the TERT promoter (TERTp) variants, identified in previous research as a poor prognostic factor in patients with PTC, with the aim to analyze the clinical utility of TERTp variants in risk‑stratification of PTC patients. PATIENTS AND METHODS: We analyzed a set of 188 PTCs for BRAF V600E and TERTp variants to investigate the associations of TERTp variants with clinical factors and their impact on time‑to‑progression. RESULTS: Key observations included an association between the co‑occurrence of BRAF V600E and TERTp variants and persistent disease, poorer response to treatment, and recurrences, as compared with PTCs without these alterations. The results also suggest that the presence of TERTp variants is associated with a shorter time‑to‑relapse. CONCLUSIONS: Detection of TERTp variants should be considered in routine diagnostic procedures, as this would significantly improve patient classification into risk groups.
Pol Arch Intern Med
· 2026 Apr · PMID 41841349
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The new resuscitation guidelines of the European Resuscitation Council were published in October 2025. The aim of the guidelines is to sustainably improve the survival rate after cardiac arrest through structured and evi...The new resuscitation guidelines of the European Resuscitation Council were published in October 2025. The aim of the guidelines is to sustainably improve the survival rate after cardiac arrest through structured and evidence‑based care systems. The latest update brings about some important changes and innovations. In this review, we highlighted the new recommendations, especially in the chapters on adult advanced life support, post‑resuscitation care, and the role of systems in saving lives. The importance of the first 3-5 minutes after cardiac arrest has been further strengthened. The most relevant updates include, among others, the need for lay people to be educated in cardiopulmonary resuscitation (CPR) by physicians, the role of the dispatch center in helping the caller identify cardiac arrest and ventilation failure, identification of the intravenous access as superior to other routes of drug administration, highlighting the possibility of vector change in defibrillation, importance of provider experience in the context of point‑of‑care ultrasound use, and the role of sedation during CPR.
Pol Arch Intern Med
· 2026 May · PMID 41817218
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Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare, autoimmunologic diseases that can manifest as a vital organ- and / or life‑threatening disorder. They are classified as small‑ves...Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare, autoimmunologic diseases that can manifest as a vital organ- and / or life‑threatening disorder. They are classified as small‑vessel vasculitis. Inflammatory infiltrations cause destruction and necrosis of the vessel wall, as well as occlusion of the vessel lumen; thus, organs supplied by these vessels become ischemic and damaged. According to the 2012 Revised International Chapel Hill Consensus Conference Nomenclature, AAV comprises 3 distinct diseases, but this review focuses on granulomatosis with polyangiitis and microscopic polyangiitis. Quick diagnosis and prompt initiation of intensive immunosuppressive therapy are crucial to prevent an unfavorable outcome in patients with AAV. Recent years have brought development in therapeutic strategies, new immunosuppressive agents, and future perspectives. Our review starts with the description of current diagnostic and long‑term follow‑up strategies, including the role of ANCA, immunoglobulin G, and CD19/CD20 cell monitoring, as well as remission assessment. The following sections present possible induction and maintenance therapies, including cyclophosphamide, rituximab, glucocorticoids, avacopan, and therapeutic plasma exchange, based on current recommendations ofthe European Alliance of Associations for Rheumatology, Kidney Disease: Improving Global Outcomes, and British Society of Rheumatology, as well as results of recent randomized controlled trials and real‑world data. These therapies are particularly relevant for specific clinical conditions, such as rapidly progressive glomerulonephritis and / or pulmonary hemorrhage. We describe in detail a new, promising molecule, avacopan, which acts by blocking the C5a receptor on neutrophils and other cell types. Avacopan is currently approved by the Food and Drug Administration and the European Medicines Agency but rigorous liver function monitoring-specifically the activity of alanine aminotransferase and aspartate aminotransferase and bilirubin level-before and during the treatment course is required to ensure the safe delivery of this steroid-sparing therapy. Recently, in April 2026 the Food and Drug Administration proposed to withdraw approval for avacopan due to, among others, a lack of substantial evidence of effectiveness for the drug.
Astapczyk R, Niemczuk M, Kurek K
… +7 more, Daniluk J, Kostrzewska M, Wasielica-Berger J, Rogalski P, Jurkowska G, Dąbrowski A, Świdnicka-Siergiejko AK
Pol Arch Intern Med
· 2026 Apr · PMID 41817000
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INTRODUCTION: Patients with troublesome reflux‑like symptoms, in whom routine empirical proton pump inhibitor (PPI) therapy is often unsatisfactory, present a therapeutic challenge and are frequently referred for gastroe...INTRODUCTION: Patients with troublesome reflux‑like symptoms, in whom routine empirical proton pump inhibitor (PPI) therapy is often unsatisfactory, present a therapeutic challenge and are frequently referred for gastroenterological evaluation to confirm a diagnosis of gastroesophageal reflux disease (GERD). OBJECTIVES: We aimed to determine the prevalence of objectively confirmed GERD (diagnosed according to the Lyon Consensus 2.0 criteria) in patients with typical and / or atypical troublesome reflux‑like symptoms who did not respond or partially responded to PPI therapy, and were referred for esophageal pH‑impedance monitoring. PATIENTS AND METHODS: This was a retrospective study analyzing pH‑impedance monitoring results of 500 patients who previously underwent endoscopy. A conclusive GERD diagnosis was defined as an acid exposure time (AET) greater than 6%, or 4%-6% with supporting evidence (number of reflux episodes >80/d, and / or mean nocturnal basal impedance <1500 Ω, and / or a positive reflux-symptom association). RESULTS: Of the 500 patients analyzed, 477 reported symptoms, which were categorized as follows: isolated typical (n = 49; 10.3%), both typical and atypical (n = 206; 43.2%), and isolated atypical (n = 222; 46.5%). AET greater than 6% was found in 12 (24.5%), 41 (19.9%), and 27 patients (12.2%) in each group, respectively. The inclusion of supportive evidence for patients with AET of 4%-6% increased the number of GERD diagnoses in each group to 23 (46.9%), 68 (33%), and 40 (18%), respectively. When endoscopy findings were factored in, the prevalence of GERD in the whole study population increased from 27% (n = 135) to 29.6% (n = 148). Among the 161 individuals reporting heartburn, 41.6% met the criteria of functional heartburn. CONCLUSIONS: Only 29.6% of the patients referred for GERD evaluation fulfilled the objective diagnostic criteria for the disease. GERD was present in about half of the patients with isolated typical symptoms, one‑third of those with both typical and atypical symptoms, and fewer than one‑fifth of those with isolated atypical symptoms.
Drożdż G, Doroszko A, Banasiak W
… +3 more, Sobieszczanska M, Ptaszkowski K, Jagielski D
Pol Arch Intern Med
· 2026 Apr · PMID 41811213
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INTRODUCTION: As the global population ages and the use of cardiac implantable electronic devices (CIEDs) increases, transvenous lead extraction (TLE) is being performed more frequently in elderly patients. Concerns rema...INTRODUCTION: As the global population ages and the use of cardiac implantable electronic devices (CIEDs) increases, transvenous lead extraction (TLE) is being performed more frequently in elderly patients. Concerns remain regarding its safety and efficacy in octogenarians, and age‑specific recommendations are limited. OBJECTIVES: We aimed to assess procedural success, complication rates, and mortality associated with TLE in patients aged 80 years or older in comparison with younger individuals. PATIENTS AND METHODS: A systematic search of PubMed, Cochrane CENTRAL, SciELO, and ScienceDirect was conducted up to December 2024. Studies reporting TLE outcomes in octogenarians and younger patients were included according to predefined criteria. A meta‑analysis was performed to compare procedural success, complications, and mortality between the age groups. RESULTS: Seventeen studies including 15 984 patients were analyzed. Complete lead extraction success was 96.7% in octogenarians and 96.2% in the patients aged below 80 years. No significant differences were observed in major or minor procedural complications. In‑hospital mortality was low and comparable between the groups. Although long‑term mortality was higher in the octogenarians, this reflected greater baseline comorbidity and frailty rather than increased procedural risk. None of the included studies demonstrated higher periprocedural danger of TLE in elderly patients. CONCLUSIONS: TLE is safe and effective in patients aged 80 years and older, with outcomes comparable to younger individuals. Advanced age alone should not preclude referral for lead extraction.
Geng T, Chen L, Cai Z
… +9 more, Gao L, Geng L, Zhang H, Huang J, Cheng J, Xing L, Wang X, Zhang Q, Li J
Pol Arch Intern Med
· 2026 Apr · PMID 41778767
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INTRODUCTION: Chronic coronary syndrome (CCS) refers to a spectrum of clinical manifestations of coronary artery disease, excluding acute coronary syndrome (ACS), which is characterized by acute thrombosis. Identifying r...INTRODUCTION: Chronic coronary syndrome (CCS) refers to a spectrum of clinical manifestations of coronary artery disease, excluding acute coronary syndrome (ACS), which is characterized by acute thrombosis. Identifying risk factors associated with plaque stability is crucial for preventing progression of CCS to ACS. OBJECTIVES: This study aimed to explore the associations between serum copper levels and high‑risk plaque (HRP) in patients with CCS, and to evaluate the potential of serum copper level as a novel diagnostic biomarker for HRP. PATIENTS AND METHODS: In this cross‑sectional study, 80 CCS patients undergoing coronary angiography were enrolled. Plaque characteristics were systematically assessed using optical coherence tomography (OCT), and inflammatory parameters and serum copper concentrations were measured. Logistic regression models were employed to examine the association between variables and HRP. Receiver operating characteristic analysis was used to evaluate the discriminatory performance of biomarkers. RESULTS: HRP was detected in 39 patients (48.8%). Serum copper levels were significantly higher in the HRP group than in the stable plaque group. Copper levels correlated positively with interleukin 6 (IL‑6) and matrix metalloproteinase‑9, and inversely with IL‑10 levels. Serum copper level was an independent predictor of HRP and showed good discriminatory ability. A biomarker panel combining serum copper, low‑density lipoprotein cholesterol (LDL‑C), and IL‑6 achieved an area under the curve of 0.864, which was significantly superior to any single biomarker alone. CONCLUSIONS: Elevated serum copper level is independently associated with OCT‑defined HRP in CCS patients. A combined model incorporating copper, LDL‑C, and IL‑6 significantly improves the noninvasive identification of HRP, suggesting a potential multimarker strategy for risk stratification in CCS.
Pol Arch Intern Med
· 2026 Mar · PMID 41757837
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Clinical research published in internal medicine journals relies heavily on statistical analysis and quantitative inference, making the quality of statistical reporting and statistical peer review central to the credibil...Clinical research published in internal medicine journals relies heavily on statistical analysis and quantitative inference, making the quality of statistical reporting and statistical peer review central to the credibility of this literature. Despite long‑standing methodological recommendations, the quality of statistical analyses and reporting in medical journals remains suboptimal, and the proportion of manuscripts undergoing formal statistical review has not improved over recent decades. At the same time, generative artificial intelligence (AI) tools have been increasingly adopted in biomedical research, raising expectations that they may support statistical analysis and elements of the peer review process. This narrative review synthesizes evidence published between 2023 and 2025 on the use of AI‑assisted tools in statistical analysis and statistical review within medical research. The reviewed studies show that large language models can support selected tasks, including generation of analytical code, reproduction of simple statistical procedures, preliminary selection of statistical tests, and detection of certain formal statistical errors. However, AI performance is highly variable and frequently limited by incomplete consideration of statistical assumptions and reduced reliability in complex analytical scenarios. Current generative AI tools should not be regarded as fully autonomous instruments for statistical analysis or statistical peer review. Their effective use depends on statistical expertise, independent validation, and contextual judgment by human users. The review discusses implications for statistical practice and statistical review in internal medicine, a research setting characterized by heterogeneous observational data, multimorbidity, and frequent use of nonrandomized study designs, including pragmatic clinical trials.