Clinics最新文献

{"title":"Associations of obesity defined comprehensively by body mass index and body fat percentage with osteopenia.","authors":"Xin Liu, Yan Lou, Zhiyong Chang, Changyuan Gu, Bin Du, Guangquan Sun","doi":"10.1016/j.clinsp.2025.100674","DOIUrl":"10.1016/j.clinsp.2025.100674","url":null,"abstract":"<p><strong>Objective: </strong>To explore the association of obesity comprehensively defined by Body Mass Index (BMI) and Body Fat percentage (BF%) with osteopenia.</p><p><strong>Methods: </strong>In this cross-sectional study, data of adult men and postmenopausal women aged ≥ 50 years old were obtained from the National Health and Nutrition Examination Surveys (NHANES) database. Weighted logistic regression analysis was conducted to investigate the association of BF% obesity with osteopenia in participants who had different gender and BMI obesity conditions. The association of obesity comprehensively evaluated by BMI and BF% with osteopenia was also explored in the total population and in gender subgroups.</p><p><strong>Results: </strong>Among 1720 eligible subjects, 1054 had osteopenia. Multivariate analysis suggested that in males, BMI obesity combined with BF% obesity was associated with higher osteopenia odds compared to BMI obesity only (Odds Ratio [OR = 4.01], 95% Confidence Interval [95% CI 1.43‒11.27]). Compared to participants with both BMI and BF% obesity, those with BMI obesity have lower osteopenia odds (OR = 0.46, 95% CI 0.28‒0.76), whereas those with BF% obesity have higher odds of osteopenia (OR = 2.03, 95% CI 1.35‒3.05, p = 0.002). In females, compared to BMI obesity combined with BF% obesity, BF% obesity (OR = 3.37, 95% CI 1.47‒7.73) or non-obesity (OR = 2.11, 95% CI 1.18‒3.75) was respectively associated with higher osteopenia odds. In males, BMI obesity was linked to lower osteopenia odds compared to both BMI and BF% obesity (OR = 0.25, 95% CI 0.10‒0.62).</p><p><strong>Conclusions: </strong>The comprehensively assessed obesity by BMI and BF% may be more meaningful in the evaluation of potential osteopenia risk, as well as further prevention and intervention of osteoporosis.</p>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"100674"},"PeriodicalIF":2.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for the growth of ground-glass nodules in the lungs: A systematic review and meta-analysis.","authors":"Qianfang Yang, Fan Wang, Hongxin Cao","doi":"10.1016/j.clinsp.2025.100669","DOIUrl":"10.1016/j.clinsp.2025.100669","url":null,"abstract":"<p><strong>Objective: </strong>The growth of ground-glass nodules in the lungs is an independent risk factor for the occurrence of lung cancer, which provides the basic conditions for the occurrence of lung cancer. However, risk factors for the growth of ground-glass nodules in the lungs have not been fully identified. The purpose of this meta-analysis was to assess risk factors for the growth of ground-glass nodules in the lungs.</p><p><strong>Methods: </strong>Computerized searches of the electronic databases of PubMed, Web of Science, Cochrane Library and Scopus for published studies on risk factors for the growth of ground-glass nodules in the lungs. The search time limit is from the establishment of the database to March 2024. Two review authors independently searched the studies according to the inclusion and exclusion criteria, and the quality of the selected studies was evaluated using the Newcastle-Ottawa Scale (NOS), and RevMan 5.4 software was used for meta-analysis. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42024499763).</p><p><strong>Results: </strong>Fourteen studies involving 2059 patients were included, and 14 statistically significant risk factors were identified. The results of meta-analysis showed that age (WMD = 4.61, 95 % CI [1.73∼7.49], p = 0.002), female (OR = 0.65, 95 % CI [0.51∼0.82], p = 0.0003), history of smoking (OR = 1.76, 95 % CI [1.07∼2.92], p = 0.03), history of malignancy (OR = 1.53, 95 % CI [1.16∼2.02], p = 0.003), lesion size (≥ 8 mm) (OR = 1.19, 95 % CI [1.12∼1.26], p < 0.00001), air bronchial sign (OR = 6.09, 95 % CI [3∼12.33], p < 0.00001), lobulation sign (OR = 2.3, 95 % CI [1.58∼3.36], p < 0.00001), spiculated sign (OR = 5.56, 95 % CI [1.39∼22.3], p = 0.02), vascular bundle sign [OR = 2.54, 95 % CI [1.85∼3.48], p < 0.00001), initial diameter (≥ 8 mm) (OR = 1.89, 95 % CI [1.34∼2.67], p = 0.0003), vacuolar sign (OR = 2.62, 95 % CI [1.46∼4.69], p = 0.001), solid nodules (OR = 4.6, 95 % CI [1.96∼10.79], p = 0.0005), solid components (OR = 13.77, 95 % CI [7.08∼26.78], p < 0.00001) and nodule roundness (OR = 2.85, 95 % CI [1.19∼6.81], p = 0.02) were risk factors for the growth of ground-glass nodules in the lungs. However, pleural adhesion (p = 0.47) and pleural retraction (p = 0.07) were not statistically significant.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis showed that there are many risk factors for the growth of ground-glass nodules in the lungs, and medical staff should identify the above risk factors as early as possible in clinical work and formulate targeted interventions for precise prevention.</p>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"100669"},"PeriodicalIF":2.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracellular vesicles as cancer biomarkers and drug delivery strategies in clinical settings: Advances, perspectives, and challenges.","authors":"Raphaela Rebeca Silveira Assunção, Nathalia Leal Santos, Luciana Nogueira de Sousa Andrade","doi":"10.1016/j.clinsp.2025.100635","DOIUrl":"10.1016/j.clinsp.2025.100635","url":null,"abstract":"<p><p>Cancer is a leading cause of death worldwide, and despite the introduction of new therapeutic approaches for advanced cases aimed at improving patient survival, only a subset of patients benefits from a complete response. In this context, there is a growing need for new cancer biomarkers and therapeutic strategies, and the use of Extracellular Vesicles (EVs) has been widely explored in various approaches. As circulating lipid-bilayer particles carrying a variety of biological information from tumor cells, EVs can be employed as good biomarkers of diagnosis, prognosis, therapy evaluation, and as adjuvants in cancer treatment. In this review, we provide a brief overview of the different types of EVs and their biogenesis and discuss how tumor-derived EV cargo can serve as a potential biomarker in clinical settings through liquid biopsy. We also highlight recent advances in EV nanoengineering and their potential as adjuvants in cancer treatment. Finally, we discuss the key unknowns, gaps, and bottlenecks that must be addressed to fully integrate EVs into precision oncology.</p>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"100635"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive radical prostatectomy versus open radical prostatectomy: A systematic review and meta-analysis of randomized control trials.","authors":"Caio Felipe Araujo Matalani, Mateus Silva Santos Costa, Marcelo Ribeiro da Rocha, Roberto Iglesias Lopes, Thalita Bento Talizin, José Bessa Júnior, William Carlos Nahas, Leopoldo Alves Ribeiro-Filho, Caio Vinicius Suartz","doi":"10.1016/j.clinsp.2025.100636","DOIUrl":"https://doi.org/10.1016/j.clinsp.2025.100636","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the comparative outcomes of Minimally Invasive Radical Prostatectomy (MIRP) versus Open Radical Prostatectomy (ORP) to treat localized prostate cancer, using only Randomized Controlled Trials (RCTs) to ensure high-quality evidence.</p><p><strong>Method: </strong>A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, focusing solely on RCTs comparing MIRP (robot-assisted or laparoscopic surgery) and ORP. Literature searches across multiple databases, including Cochrane Library, Medline, Embase, Lilacs, Scopus, Web of Science, NIH, Clinical Trials, and EU Clinical Trials Register, identified studies meeting predefined PICOT criteria. Four RCTs met inclusion criteria ‒ two representing the same cohort of patients ‒ and were analyzed for perioperative, functional, and oncologic outcomes. Quality assessment utilized the ROB-2 tool to gauge the risk of bias.</p><p><strong>Results: </strong>Three RCTs encompassing 1051 patients were analyzed. MIRP demonstrated statistically significant benefits over ORP in terms of reduced perioperative blood loss (Standardized Mean Difference [SMD = -3.058], p = 0.006), lower transfusion rates (Odds Ratio [OR = 0.137]; p = 0.009), and fewer overall complications (OR = 0.465; p = 0001). However, no significant differences were found in long-term oncologic and functional outcomes, including urinary continence and erectile function. Positive surgical margins and additional treatments also did not differ significantly between groups.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis of RCTs indicated that MIRP offers perioperative advantages over ORP, supporting its role as a safe and effective option for localized prostate cancer.</p>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"100636"},"PeriodicalIF":2.2,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12059318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: \"Comparison of endoscopic submucosal dissection and transanal endoscopic surgery for the treatment of rectal neoplasia: A systematic review and meta-analysis\".","authors":"Wensi Ouyang, Guimei Guo","doi":"10.1016/j.clinsp.2025.100663","DOIUrl":"https://doi.org/10.1016/j.clinsp.2025.100663","url":null,"abstract":"","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"100663"},"PeriodicalIF":2.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12051704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"Pembrolizumab in gestational trophoblastic neoplasia: systematic review and meta-analysis with sub-group analysis of potential prognostic factors\".","authors":"Shubham Kumar, Rachana Mehta, Ranjana Sah","doi":"10.1016/j.clinsp.2025.100651","DOIUrl":"https://doi.org/10.1016/j.clinsp.2025.100651","url":null,"abstract":"","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"100651"},"PeriodicalIF":2.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between decreased p53 expression, elevated serum CagA levels, and oral squamous cell carcinoma","authors":"Minxiao Lin ,&nbsp;Jing Wang ,&nbsp;Xiaowu Yao","doi":"10.1016/j.clinsp.2025.100632","DOIUrl":"10.1016/j.clinsp.2025.100632","url":null,"abstract":"<div><h3>Objective</h3><div>p53 is a key tumor suppressor, aCnd loss of p53 function promotes the progression of many cancers. <em>Helicobacter Pylori</em> (HP) is mainly involved in the progression of gastric carcinoma, but its role in Oral Squamous Cell Carcinoma (OSCC) is controversial. The primary objectives of this study were to investigate the expression levels of p53 in OSCC tissues and to examine the serum levels of CagA in OSCC patients. Additionally, the authors aimed to explore the potential association between p53 expression and CagA levels in OSCC.</div></div><div><h3>Method</h3><div>A total of 65 patients diagnosed with OSCC and 42 healthy volunteers were recruited in this study. The clinical pathological parameters of all patients were collected. Reverse transcription-quantitative polymerase chain reaction was performed to detect the expression of p53 in tissues. Receiver Operating Characteristics Curve (ROC) analysis was used to assess the sensitivity of p53 for the diagnosis of OSCC. The concentration of Cytotoxin-Associated gene A (CagA) in serum was assessed by enzyme-linked immuno sorbent assay.</div></div><div><h3>Results</h3><div>The results indicated that the p53 expression in oral mucosal tissues was downregulated while the concentration of CagA in serum was increased in OSCC patients. Besides, p53 expression was correlated with tumor stage. OSCC patients showed a higher HP positive rate than in healthy people.</div></div><div><h3>Conclusions</h3><div>In conclusion, this study demonstrated that decreased p53 expression and elevated serum CagA levels might be correlated with OSCC progression and diagnosis.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100632"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in kidney and lung status in an animal model of brain death","authors":"Marina Vidal-dos-Santos ,&nbsp;Roberto Armstrong-Jr ,&nbsp;Maryna van Zil ,&nbsp;Fernanda Yamamoto Ricardo-da-Silva ,&nbsp;Lucas Ferreira da Anunciação ,&nbsp;Mayara Munhoz de Assis Ramos ,&nbsp;Cristiano de Jesus Correia ,&nbsp;Petra J. Ottens ,&nbsp;Luiz Felipe Pinho Moreira ,&nbsp;Henri G.D. Leuvenink ,&nbsp;Ana Cristina Breithaupt-Faloppa","doi":"10.1016/j.clinsp.2025.100623","DOIUrl":"10.1016/j.clinsp.2025.100623","url":null,"abstract":"<div><h3>Background</h3><div>In transplantation, sex-mismatched procedures correlate with poorer outcomes. Previous research has indicated that females respond worst to Brain Death (BD) and that organ damage varies with the speed of BD induction. The authors aimed to investigate the effects of slow BD-induction on lung and kidney responses in male and female rats.</div></div><div><h3>Methods</h3><div>Males and female rats were subjected to slow induction of BD and kept for 4h. Blood gas samples were taken at 0 h and 4h. At 4 h, blood, urine and tissue samples were collected. IL-1β was measured in plasma, lung homogenate and lung culture. IL-6 was quantified in plasma, lung culture, and kidney homogenate. Leukocyte infiltration/activation was evaluated. Biochemical analyses of creatinine were performed in the plasma. Naïve animals were used as controls.</div></div><div><h3>Results</h3><div>Males presented reduced testosterone levels after 4h. Females presented reduced progesterone, whereas estradiol remained similar at 0 h and 4h. Compared with Naive, BD-groups presented increased plasma IL-1β and IL-6. Males and females presented reduced pO₂ after BD, with females presenting even lower values at 4h. In lung tissue, males presented increased expression of IL-1β, whereas IL-1β was elevated in females in lung culture. Females presented increased cell infiltration/activation. In the kidney, males presented increased plasma creatinine, increased expression of caspase-3, and increased leukocyte migration to renal tissue than females.</div></div><div><h3>Conclusions</h3><div>The authors observed an organ and sex-dependent response to the slow-induction of BD. These results suggest that management strategies should consider the sex of the donor to achieve the best treatment, improving graft quality.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100623"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LBP and iFABP mismatch in the evaluation of intestinal barrier dysfunction due to SARS-CoV-2 infection","authors":"Hermes Vieira Barbeiro,&nbsp;Denise Frediani Barbeiro,&nbsp;Heraldo Possolo de Souza,&nbsp;Francisco Garcia Soriano,&nbsp;Marcel Cerqueira Machado,&nbsp;Ludhmila Abrahão Hajjar","doi":"10.1016/j.clinsp.2025.100642","DOIUrl":"10.1016/j.clinsp.2025.100642","url":null,"abstract":"<div><div>SARS-CoV-2 presents a hyperinflammatory scenario due to systemic inflammatory response syndrome with intense cytokine release, with consequent extrapulmonary involvement in 20 % of patients. The authors studied whether COVID-19 intestinal damage is a direct action of the virus on intestinal epithelial cells, with damage mainly at the tight junction. This is a retrospective observational study in a tertiary hospital emergency department. The authors studied 87 patients (46 patients over 61 years and 41 patients under 60 years old) with severe SARS-CoV-2 infection. The authors measured two plasma markers, LPS-Binding Protein (LBP) and ileal Fatty Acid-Binding Protein (iFABP). Furthermore, the authors evaluated the interaction between the two markers. TNF-α and IL-1 β were higher in bacterial co-infected patients and TNF-α was also higher in the older patients. Plasma iFABP levels were not statistically different in patients with bacterial co-infection; however, higher levels were found in the older population. Plasma LBP levels were higher in patients with bacterial co-infection when compared to patients without infection; however, when comparing plasma LBP levels in the older population with younger patients, no differences could be found. LBP, FABP, and cytokines can discriminate between bacterially infected patients and also discriminate elderly patients. The present study suggests that intestinal barrier dysfunction in SARS-CoV-2 infections is mainly due to damage to the intestinal tight junction complex with a disproportionately lower damage to enterocyte. In the older population, the authors also observed an increase in intestinal epithelial damage.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100642"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognition of medical error: It is not too late for an open disclosure – a narrative review","authors":"Ivan Dieb Miziara ,&nbsp;Carmen Silvia Molleis Galego Miziara","doi":"10.1016/j.clinsp.2025.100622","DOIUrl":"10.1016/j.clinsp.2025.100622","url":null,"abstract":"<div><div>A medical error is a preventable adverse effect of medical care. These errors are usually avoidable. They are a vast source of ethical, financial, and even mental problems affecting patients, physicians, and healthcare organizations. The negative impact on patients can be physical, generating sequelae or disability. It could lead to a loss of trust in the patient and his family in the doctor or the hospital where he has been treated.</div><div>On the other hand, doctors resist disclosing their errors to the patient, fearing lawsuits and financial losses. Disclosure errors are also an imperative moral duty. In this narrative review, the authors discuss obstacles that exist and prevent an adequate open disclosure, including flaws in medical education, and propose ten steps to proceed with an open disclosure if a medical error occurs.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100622"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}