Clinics最新文献

{"title":"Evaluation of optimal dosage combinations of oral midazolam and esketamine for pediatric preoperative sedation: A randomized, double-blind clinical trial","authors":"Hongfei Xiong ,&nbsp;Yingxue Xu ,&nbsp;Jing Liu ,&nbsp;Guangbo Liu ,&nbsp;Yunyun Zhang ,&nbsp;Ziwen Wei ,&nbsp;Wenwen Liang ,&nbsp;Xuemei Zhao ,&nbsp;Siyuan Li ,&nbsp;Gang Xiao ,&nbsp;Rongliang Xue","doi":"10.1016/j.clinsp.2026.100921","DOIUrl":"10.1016/j.clinsp.2026.100921","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy and safety of combinations of oral midazolam and esketamine for pediatric preoperative sedation.</div></div><div><h3>Intervention</h3><div>Children aged 1‒6-years undergoing elective surgery were assigned to Group A (0.62 mg/kg midazolam and 2.05 mg/kg esketamine), Group B (0.41 mg/kg midazolam and 4.1 mg/kg esketamine), and Group C (0.21 mg/kg midazolam and 6.16 mg/kg esketamine). The combination was administered orally before anesthesia induction.</div></div><div><h3>Outcomes</h3><div>Primary outcome was sedation success, defined as a modified Ramsay sedation score ≥3a, low parent-child separation anxiety, and acceptance of the face mask for inhalation induction. Secondary outcomes included parental satisfaction, occurrence of Adverse Events (AE), and recovery times.</div></div><div><h3>Results</h3><div>The sedation success rate in Group B was 71.8%, which was significantly higher than Group A (53.5%, <em>p</em> &lt; 0.05) but not Group C (68.2%, <em>p</em> &gt; 0.05). There was no difference in the sedation success rate between Group A and Group C (<em>p</em> &gt; 0.05). The overall incidence rate of AE in Group C was 25.90%, which was significantly higher than that in Group A (2.30%) and Group B (4.70%) (<em>p</em> &lt; 0.05). No significant differences in sedation success rates were observed between genders within each group (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>The combination of 0.41 mg/kg midazolam and 4.1 mg/kg esketamine provided the most effective sedation with the fewest adverse events in pediatric patients. This regimen may reduce rescue sedation needs and improve perioperative flow.</div></div><div><h3>Trial registration</h3><div><span><span>http://www.chictr.org.cn</span><svg><path></path></svg></span> (ChiCTR2400080633; date of first registration: February 4th, 2024).</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100921"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577560","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":"Cardiometabolic index as a predictor of sarcopenia in U.S. adults aged 20–59: results from a cross-sectional study","authors":"Ji Li,&nbsp;Shou-Jun Bai","doi":"10.1016/j.clinsp.2026.100912","DOIUrl":"10.1016/j.clinsp.2026.100912","url":null,"abstract":"<div><h3>Background</h3><div>Sarcopenia, characterized by progressive loss of skeletal muscle mass and strength with pathophysiological changes that may originate in early life, and the Cardiometabolic Index (CMI) ‒ a reliable marker for lipid metabolic dysfunction and central adiposity ‒ have associations that are insufficiently studied. This study aimed to investigate the association between CMI and sarcopenia in U.S. adults aged 20–59 and to evaluate the predictive value of CMI for sarcopenia.</div></div><div><h3>Methods</h3><div>Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2011–2018, which initially encompassed 39,156 participants, the authors applied age-based screening and exclusion of cases with missing data, resulting in a final analytical cohort of 4784 participants for statistical analysis. Sarcopenia was defined per the Foundation for the National Institutes of Health (FNIH) criteria: Appendicular Lean Mass (ALM) adjusted for BMI &lt; 0.512 in men and &lt; 0.461 in women. CMI was calculated as [triglycerides (mg/dL) / high-density lipoprotein cholesterol (mg/dL)] × [waist circumference (cm) / height (m)] / body mass index (kg/m²). Multivariate logistic regression, subgroup analysis (sex, age, race and clinical conditions), Generalized Additive Models (GAM), piecewise regression, Propensity Score Matching (PSM), Inverse Probability Weighting (IPW), and Receiver Operating Characteristic (ROC) curves were employed. Analyses were adjusted for three categories of confounders: sociodemographic factors, behavioral factors, and clinical factors.</div></div><div><h3>Results</h3><div>Among the 4784 participants, 425 (8.88%) had sarcopenia. Descriptive analysis showed that the median CMI of sarcopenia participants was higher (0.82 vs. 0.43; <em>p</em> &lt; 0.001) compared with non-sarcopenia participants, and they had unfavorable demographic/clinical characteristics (e.g., older age, higher prevalence of diabetes). In the full sample, after adjusting for all confounding factors, Elevated CMI correlated with an increased odds of presenting sarcopenia (Odds Ratio [OR = 1.39], 95% CI = 1.05–1.91, <em>p</em> = 0.005). The multi-dimensional model incorporating CMI demonstrated superior predictive ability (AUC = 0.819). GAM revealed a non-linear association with a threshold of 0.899, which was strongest in males, individuals aged 20–39 years, non-Hispanic Blacks, those with hypertension, and non-obese or non-diabetic individuals.</div></div><div><h3>Conclusion</h3><div>Cardiometabolic Index (CMI) has a non-linear positive association with sarcopenia in U.S. young and middle-aged adults, with a threshold of 0.899. The multi-dimensional predictive model incorporating CMI demonstrates superior performance in assessing odds of presenting sarcopenia compared to traditional anthropometric indicators, indicating its potential as a novel clinical biomarker for such evaluations.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100912"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597519","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":"Causal associations between ankylosing spondylitis and cardiovascular disease: a mendelian randomization analysis","authors":"Lei Zhou ,&nbsp;Yong Tang ,&nbsp;Jihong Jiang","doi":"10.1016/j.clinsp.2026.100918","DOIUrl":"10.1016/j.clinsp.2026.100918","url":null,"abstract":"<div><h3>Background</h3><div>Accumulating evidence suggests an association between Ankylosing Spondylitis (AS) and Cardiovascular Disease (CVD), yet the causal effects of AS on different CVD types remain unclear. This study aimed to determine the associations between AS and CVD using two-sample Mendelian Randomization (MR) analysis.</div></div><div><h3>Methods</h3><div>The genetically predicted causal relationships between AS and six common cardiovascular and cerebrovascular diseases (hypertension, atrial fibrillation, acute myocardial infarction, coronary atherosclerosis, angina, and heart failure) were evaluated using MR analysis. Data originated from Genome-Wide Association Studies (GWAS). Single Nucleotide Polymorphisms (SNPs; <em>p</em> &lt; 5 × 10^–8, <em>r</em>² &lt; 0.01) were selected as Instrumental Variables (IVs) for MR analysis. The primary outcome for causal inference was the Inverse Variance-Weighted (IVW) method, complemented by other methods (MR Egger, weighted median, simple mode, weighted mode). All results were presented as Odds Ratios (ORs). Heterogeneity and pleiotropy analyses were performed to ensure result stability and reliability.</div></div><div><h3>Results</h3><div>MR results provided positive causal evidence for AS on hypertension (OR = 1.0143; 95% CI: 1.0038‒1.0248, <em>p</em> = 7.269 × 10^–3) and heart failure (OR = 1.0128; 95% CI: 1.0037‒1.0217, <em>p</em> = 5.76 × 10^–3). Conversely, none of the IVW methods indicated causal effects for AS on the other four diseases. Sensitivity analyses supported the robustness of the results.</div></div><div><h3>Conclusion</h3><div>This study indicates that ankylosing spondylitis has positive causal effects on hypertension and heart failure.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100918"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617284","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":"Feasibility of robotic telesurgery over wired and private 5 G networks within Brazil’s public health system (SUS): a pilot study","authors":"Everson L.A. Artifon ,&nbsp;Felipe Kfouri ,&nbsp;Jose Pinhata Otoch ,&nbsp;Luiz P. Kowalski ,&nbsp;William Nahas ,&nbsp;Gustavo Ebaid ,&nbsp;Paulo Pego-Fernandes ,&nbsp;Edmund C. Baracat ,&nbsp;José Maria Soares Júnior ,&nbsp;Ulysses Ribeiro Jr. ,&nbsp;Marcos Samano ,&nbsp;Ricardo Terra ,&nbsp;Pedro Nabuco ,&nbsp;Marco A.V. Kulcsar ,&nbsp;Gabriel dos Anjos ,&nbsp;Eduardo Motta ,&nbsp;Ricardo Zugaib Abdalla ,&nbsp;Sergio Damous ,&nbsp;Alessandro Belon ,&nbsp;Giovanni G. Cerri","doi":"10.1016/j.clinsp.2026.100926","DOIUrl":"10.1016/j.clinsp.2026.100926","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the feasibility and performance of a robotic telesurgery platform operating within the Brazilian Unified Health System (SUS) infrastructure in a dry lab environment under wired and private 5 G network conditions.</div></div><div><h3>Methods</h3><div>Over three consecutive days, robotic surgeons performed three standardized dry lab tasks from a remote console at PROMIN‒FMUSP, with the robotic unit at HU-USP. Sessions were conducted using either a wired or a private 5 G network. Performance outcomes included task success and completion time. Connectivity metrics ‒ latency, jitter and packet loss ‒ were recorded; and per-participant mean values were used in descriptive analyses. Surgeons completed post-session assessments of perceived safety, usability, and mental workload.</div></div><div><h3>Results</h3><div>Twenty-eight robotic surgeons completed dry lab sessions (23 wired, 5 private 5 G). Task success was 100% for Task 1, 82.1% for Task 2, and 89.3% for Task 3; all failures occurred in wired sessions. Median completion times were 26 s (Task 1), 4.5 min (Task 2), and 8.5 min (Task 3). Median latency and jitter were significantly higher in 5 G than in wired sessions (latency: 32.4 vs. 12.0 ms; jitter: 30.8 vs. 6.8 ms). Median packet loss was low under both conditions (0.0% in 5 G; 0.09% in wired). Most surgeons rated the system as safe (78.6% assigned the maximum safety score) and considered it suitable for high-complexity procedures (67.9%).</div></div><div><h3>Conclusion</h3><div>Robotic telesurgery within SUS infrastructure was feasible in a simulated environment. Although the private 5 G network exhibited higher latency and jitter than the wired connection, the task completion and usability were preserved, supporting further evaluation in controlled clinical settings.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100926"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617300","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":"Lack of effect of short-term interval training on kidney function in obese adolescent females","authors":"Wissal Abassi ,&nbsp;Nejmeddine Ouerghi ,&nbsp;Omar Feki ,&nbsp;Martine Duclos ,&nbsp;Anissa Bouassida ,&nbsp;Moncef Feki ,&nbsp;Thomas Rosemann ,&nbsp;Katja Weiss ,&nbsp;Beat Knechtle","doi":"10.1016/j.clinsp.2026.100904","DOIUrl":"10.1016/j.clinsp.2026.100904","url":null,"abstract":"<div><h3>Objective</h3><div>Obesity is a major independent risk factor for chronic kidney disease. High-Intensity Interval Training (HIIT) is recognized as an interesting therapeutic strategy in managing obesity and related disorders. However, there is still a lack of knowledge about its impact on kidney function. The study aimed to evaluate the impact of the HIIT program on kidney function and erythrocyte parameters in overweight/obese women.</div></div><div><h3>Methods</h3><div>Thirty-three overweight/obese young women (age, 17.0 ± 1.15 yrs.; body mass index, 33.3 ± 4.77 kg/m²) were allocated into HIIT (<em>n</em> = 17) or control (<em>n</em> = 16) groups. The HIIT program was performed 3 times a week for nine weeks. Body composition parameters, blood creatinine, blood urea, estimated Glomerular Filtration Rate (eGFR), serum electrolytes (i.e., sodium, potassium, chloride, calcium, phosphorus, and magnesium), and red blood cell parameters (i.e., red blood cell count, hematocrit, hemoglobin and mean corpuscular volume) were collected before the start and after the completion of the training.</div></div><div><h3>Results</h3><div>Nine weeks of HIIT significantly improved (<em>p</em> &lt; 0.01) body mass index, body fat, and waist circumference, but the auhtors found no statistically significant changes in blood creatinine, urea, eGFR, and red blood cell parameters (<em>p</em> &gt; 0.05). No variable changed in the control group.</div></div><div><h3>Conclusions</h3><div>HIIT improved body composition; however, no significant changes in renal function parameters were detected in this underpowered study.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100904"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147501591","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":"Planetary health: Real challenges for elderly population","authors":"Fulvio A. Scorza ,&nbsp;Josef Finsterer ,&nbsp;Antonio-Carlos G. de Almeida ,&nbsp;Marcelo F. de Mello","doi":"10.1016/j.clinsp.2026.100911","DOIUrl":"10.1016/j.clinsp.2026.100911","url":null,"abstract":"","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100911"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518189","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":"Skin layer thickness, muscle elasticity and their effects on pain level in fibromyalgia patients","authors":"Selçuk Akan ,&nbsp;Mehtap Balaban ,&nbsp;Ahmet Kor ,&nbsp;Bahadir Erturk","doi":"10.1016/j.clinsp.2025.100858","DOIUrl":"10.1016/j.clinsp.2025.100858","url":null,"abstract":"<div><h3>Background</h3><div>Fibromyalgia (FM) is a chronic, non-inflammatory syndrome characterized by widespread body pain, fatigue, sleep disturbances, impaired cognitive function and anxiety. Peripheral and central sensitization are thought to cause chronic pain in this disorder, which impairs quality of life. No specific laboratory test, radiographic method, or biomarker has been identified for diagnosis. As its physiopathology is not fully understood, no specific treatment has been identified. At this stage, studies are needed to facilitate diagnosis and guide treatment.</div></div><div><h3>Methods</h3><div>Eighty-nine women with FM and 36 healthy controls were enrolled in this cross-sectional, case-controlled, single-centre study. FM-related measurements (number of tender points, myalgic score, pain Visual Analogue Scale [VAS]) were recorded. All participants underwent an analysis of trapezius muscle thickness and elasticity. Skin and subcutaneous tissue thickness, and hypodermis thickness were measured by using B-mode Ultrasonography (USG) and tension (compression) Sonoelastography (SEL).</div></div><div><h3>Results</h3><div>Skin thickness was lower in FM patients than in healthy controls (<em>p</em> &lt; 0.01). Both trapezius muscle thickness and elastography scores were higher in the FM group compared to controls (<em>p</em> &lt; 0.05 and <em>p</em> &lt; 0.001, respectively). A significant correlation was found between VAS score and elastography scores (<em>r</em> = 0.661, <em>p</em> &lt; 0.001); however, there was no significant correlation between VAS score and trapezius or skin thickness.</div></div><div><h3>Conclusion</h3><div>Patients with FM have lower skin thickness and higher trapezius muscle thickness and elastography scores than healthy controls. The thinner skin thickness in FM compared to controls may represent a potentially important factor in the pathophysiological mechanism of peripheral sensitization.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100858"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879786","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":"Association of possible sarcopenia, sarcopenia and knee osteoarthritis among middle-aged and older adults: Evidence from the CHARLS cohort","authors":"Xilun Ma ,&nbsp;Zelong Cai ,&nbsp;Jiong Zhang ,&nbsp;Haiqi Hu ,&nbsp;Wanting Zheng ,&nbsp;Ziting Peng ,&nbsp;Haizhu Tan ,&nbsp;Ruibin Huang","doi":"10.1016/j.clinsp.2026.100949","DOIUrl":"10.1016/j.clinsp.2026.100949","url":null,"abstract":"<div><h3>Background</h3><div>Population-based studies exploring the association between sarcopenia, possible sarcopenia and Knee Osteoarthritis (KOA) ‒ particularly including the intermediate state of possible sarcopenia ‒ remain limited. The authors aimed to explore both cross-sectional and longitudinal associations between possible sarcopenia, sarcopenia, and KOA in a large cohort of Chinese adults.</div></div><div><h3>Methods</h3><div>The authors utilized data from the China Health and Retirement Longitudinal Study. After applying the exclusion criteria, a total of 5018 participants aged 45-years or older were included and followed from 2011 to 2015. Sarcopenia status was classified as non-sarcopenia, possible sarcopenia, or sarcopenia according to the Asian Working Group for Sarcopenia. Logistic regression was used to assess the associations between sarcopenia status and KOA, including associations with changes in sarcopenia status over follow-up.</div></div><div><h3>Results</h3><div>Sarcopenia and possible sarcopenia demonstrated a significant positive association with KOA, exhibiting an Odds Ratio (OR) of 1.37 (95% CI: 1.02‒1.83) and an OR of 1.55 (95% CI: 1.26‒1.91), respectively. Participants who newly developed sarcopenia had an increased likelihood of developing KOA than those who remained non-sarcopenic, with an OR of 1.72 (95% CI: 1.27‒2.32). The incidence of KOA differed significantly among the non-sarcopenia, possible sarcopenia, and sarcopenia groups, with rates of 10.0% in the non-sarcopenia group, 17.8% in the possible sarcopenia group, and 16.1% in the sarcopenia group (p<em>-</em>value &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Sarcopenia and possible sarcopenia were associated with the occurrence of KOA. Individuals who newly developed sarcopenia or possible sarcopenia were at a higher risk of developing KOA during the four-year follow-up.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100949"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147713556","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":"External validation of a nomogram for predicting tubulointerstitial lesions in IgA nephropathy: a cross-regional study in China","authors":"Xinyu Wang ,&nbsp;Litian Pu ,&nbsp;Lu Song ,&nbsp;Jian Xu ,&nbsp;Hu Meng ,&nbsp;Meng Yang ,&nbsp;Yan Xu ,&nbsp;Qiao Wang ,&nbsp;Lijuan Sun ,&nbsp;Feifei Liu ,&nbsp;Yaling Yu ,&nbsp;Yaxi Zhao ,&nbsp;Ying Shen ,&nbsp;Qinyuan Deng","doi":"10.1016/j.clinsp.2026.100860","DOIUrl":"10.1016/j.clinsp.2026.100860","url":null,"abstract":"<div><h3>Background</h3><div>A diagnostic nomogram for predicting tubulointerstitial lesions (T1/2) in IgA Nephropathy (IgAN), developed in Guangzhou (GZ) using estimated Glomerular Filtration Rate (eGFR) and Urinary Protein Excretion (UPE), demonstrated high accuracy (AUC = 0.92) but lacked external validation.</div></div><div><h3>Methods</h3><div>The authors externally validated the nomogram in an independent cohort from Kunming (KM, n = 387; median altitude: 1,891 m), including a high-altitude subgroup (&gt; 2,000 m, n = 155). Model performance was evaluated using Receiver Operating Characteristic (ROC) curves, calibration plots, and Decision Curve Analysis (DCA). Both creatinine-based eGFR (eGFRcr) and Creatinine-Cystatin C-based eGFR (eGFRcr-cys), each combined with UPE, were assessed.</div></div><div><h3>Results</h3><div>The nomogram achieved nearly identical AUCs of 0.80 in the overall KM cohort for both eGFRcr-UPE (95% CI: 0.75–0.85) and eGFRcr-cys-UPE (95% CI: 0.74–0.85), demonstrating strong generalizability across eGFR formulas. In the high-altitude subgroup, performance significantly improved (AUC = 0.89; 95% CI: 0.83–0.95) for both models.</div></div><div><h3>Conclusion</h3><div>External validation demonstrates that the nomogram combining eGFR and UPE is feasible for non-invasive prediction of T1/2 lesions, with comparable performance between eGFRcr and eGFRcr-cys. The improved accuracy observed at high altitude suggests altitude-related influences that merit further study. Prospective studies are needed to determine its prognostic value for clinical outcomes such as CKD progression and treatment response.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100860"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260556","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":"A cross-sectional analysis of all vena cava filter placement over 9-years in Brazil: trends and mortality rates in a population of over 200 million","authors":"Clara Sanches Bueno ,&nbsp;Hedra Marques Santos ,&nbsp;Júlia Freire Castanheira ,&nbsp;Bruno Jeronimo Ponte ,&nbsp;Felipe Soares Oliveira Portela ,&nbsp;Marcelo Fiorelli Alexandrino da Silva ,&nbsp;Marcelo Passos Teivelis ,&nbsp;Alexandre Fioranelli ,&nbsp;Nelson Wolosker","doi":"10.1016/j.clinsp.2026.100874","DOIUrl":"10.1016/j.clinsp.2026.100874","url":null,"abstract":"<div><h3>Background</h3><div>Venous Thromboembolism (VTE) is a major global health concern, with Vena Cava Filters (VCFs) serving as an alternative to anticoagulation in high-risk patients. Brazil’s VCF trends remain understudied, particularly in its dual public-private healthcare system. This database study allows a broad overview of the Brazilian healthcare landscape.</div></div><div><h3>Methods</h3><div>This cross-sectional nationwide analysis used Brazilian public (SUS/TabNet) and private (ANS/D-TISS) healthcare databases (2015–2023) to assess VCF placement rates, regional disparities, and in-hospital mortality. Data included 21,630 procedures, analyzed via generalized linear models (Gamma/Poisson distributions).</div></div><div><h3>Results</h3><div>The private system performed 57% of VCFs (12,323) despite covering only 25% of the population, with a 4.25-fold higher procedure rate per capita than the public system (29.45 vs. 6.42 per-million). Women accounted for 57.8% of recipients. The Southeast region dominated (70% private, 40.5% public), while the North and Midwest had the lowest rates. Mortality rates were comparable (public 6.7% vs. private 7.4%, <em>p</em> = 0.066), peaking during COVID-19. Procedure volumes rose 140% over 9-years, contrasting with declining U.S. trends post-FDA restrictions.</div></div><div><h3>Conclusions</h3><div>Brazil’s VCF use reflects systemic disparities, with private-system overrepresentation and regional gaps. This study enables unprecedented insights into large-scale VCF implementation across diverse healthcare subsystems.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100874"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146777060","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}