Clinics最新文献

{"title":"Can elastography predict early allograft dysfunction or loss after liver transplantation? A prospective study of diagnostic accuracy","authors":"Guilherme Marques Andrade ,&nbsp;Luiz Marcelo Sá Malbouisson ,&nbsp;Denise Paranaguá Vezozzo ,&nbsp;Wellington Andraus ,&nbsp;Paula Sepulveda Mesquita ,&nbsp;Luiz Augusto Carneiro D'Albuquerque ,&nbsp;Alberto Queiroz Farias ,&nbsp;Flair José Carrilho","doi":"10.1016/j.clinsp.2025.100634","DOIUrl":"10.1016/j.clinsp.2025.100634","url":null,"abstract":"<div><h3>Introduction</h3><div>The imbalance between the demand for liver transplants and the shortage of donors can be addressed by expanding the donor pool, including using extended criteria donors. This strategy may reduce waiting time and list mortality but can increase poor graft function rates, affecting short-term outcomes. Tools to predict and diagnose Early Allograft Dysfunction (EAD) are crucial. Elastography for Liver Stiffness Measurement (LSM) may predict EAD and graft loss early post-transplant.</div></div><div><h3>Methods</h3><div>In this prospective observational study, the authors assessed the diagnostic accuracy of elastography for predicting EAD or loss in liver transplant recipients admitted to the ICU of Hospital das Clínicas, Universidade de São Paulo, from 2016 to 2018. Patients underwent daily LSM from ICU admission to day 7 post-transplant. EAD was defined by Olthoff et al.'s criteria, and allograft loss was defined by the need for retransplantation or death within 180 days.</div></div><div><h3>Results</h3><div>EAD developed in 27 patients (44.3 %). The median LSM was 2.12 m/s (IQR 1.87–2.67 m/s) for the EAD group and 1.70 m/s (IQR 1.55–1.90 m/s) for the non-EAD group. For predicting EAD, elastography on day 1 had a c-statistic of 0.83, sensitivity 41 %, specificity 97 %, and accuracy 83 % at a cutoff of 2.39 m/s. For predicting early allograft loss, the c-statistic was 0.93, with a sensitivity 76 %, specificity 100 %, and accuracy 93 % at a cutoff of 2.25 m/s on day 1.</div></div><div><h3>Conclusion</h3><div>Elastography demonstrated robust performance in predicting EAD and early graft loss post-transplant, outperforming traditional prognostic scores. Further multicenter studies are needed to confirm these findings.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100634"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895582","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":"Construction and validation of a nomogram for detecting chronic kidney disease in patients with nonalcoholic fatty liver disease: Insights from the NHANES database","authors":"Dazhang Deng ,&nbsp;Yutong Xie ,&nbsp;Ya Wang ,&nbsp;Wanhan Song ,&nbsp;Yuguo Liu ,&nbsp;Bin Liu ,&nbsp;Honghui Guo","doi":"10.1016/j.clinsp.2025.100686","DOIUrl":"10.1016/j.clinsp.2025.100686","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Fatty liver disease is often associated with renal impairment in many patients. Early detection and prompt intervention are crucial for improving patient quality of life and reducing mortality rates. This study aimed to develop and validate a nomogram for detecting the risk of Chronic Kidney Disease (CKD) comorbidity in adults with Nonalcoholic Fatty Liver Disease (NAFLD) in the United States.</div></div><div><h3>Methods</h3><div>From the NHANES (2017‒2020) database, the authors enrolled 2848 NAFLD participants, of whom 633 also had CKD. The authors employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression to identify variables with predictive value. The overlapping features were selected to construct a predictive model, which was presented as a nomogram. The effectiveness of the nomogram was evaluated using Receiver Operating Characteristic (ROC) curves, calibration plots, and decision curve analysis.</div></div><div><h3>Results</h3><div>Six indicators were included in the model: age, systolic blood pressure, serum albumin, high-sensitivity C-reactive protein, total cholesterol, and triglycerides. The area under the curve of the nomogram for predicting CKD in the training set was 0.772, with a 95 % Confidence Interval (95 % CI) of 0.746 to 0.797. In the validation set, the area under the curve was 0.722, with a 95 % CI of 0.680 to 0.763. The calibration curve analyses demonstrated that the prediction outcomes of the model aligned well with the actual outcomes, indicating good clinical applicability.</div></div><div><h3>Conclusions</h3><div>The nomogram demonstrated excellent performance and has the potential to serve as an auxiliary tool for detecting CKD in NAFLD patients.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100686"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912824","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":"Can proton pump inhibitors increase the risk of sudden unexpected death in Parkinson's disease (SUDPAR)?","authors":"Francisco Sandro Menezes-Rodrigues ,&nbsp;Fernando Sabia Tallo ,&nbsp;Afonso Caricati-Neto ,&nbsp;Josef Finsterer ,&nbsp;Carla Alessandra Scorza ,&nbsp;Fulvio Alexandre Scorza","doi":"10.1016/j.clinsp.2025.100721","DOIUrl":"10.1016/j.clinsp.2025.100721","url":null,"abstract":"","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100721"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750104","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":"Incidence of mycobacteria in pulmonary granulomatous lesions","authors":"Sibele Inácio Meireles,&nbsp;Mariana Vargas Cruz,&nbsp;Gustavo Palmer Irffi,&nbsp;Leonardo Abreu Testagrossa","doi":"10.1016/j.clinsp.2024.100564","DOIUrl":"10.1016/j.clinsp.2024.100564","url":null,"abstract":"<div><div>Mycobacteria infections are caused by species of the <em>Mycobacterium tuberculosis</em> complex (MTB) and other species called Non-Tuberculosis Mycobacteria (NTM). Identification of mycobacteria species is very important to define treatment and it can be achieved by direct culture. However, the lack of clear protocols regarding the use of culture or molecular tests on specimens diagnosed with granulomatous lesions causes delays in the diagnosis of the etiological agents and, consequently, the definition of the right treatment. This work aimed to characterize the incidence of mycobacteria species in pulmonary granulomatous lesions and the contribution of Polymerase Chain Reaction (PCR) in Formalin-Fixed Paraffin-Embedded Tissue (FFPE), direct culture, and Ziehl-Neelsen histological stain to the diagnosis. The authors performed an observational, centralized, and retrospective study in a cohort of 336 cases with pulmonary granulomatous lesions. Mycobacteria were detected by ZNS in 54/323 (16.72 %) and by direct culture in 40/198 (20.20 %). MTB DNA was detected by PCR in 10/57 (17.54 %). Mycobacterial culture results revealed MTB in 26/40 (65.00 %), whereas NTM was detected in 13/40 (32.50 %). NTM was represented by <em>M. avium</em> (<em>n</em> = 4), <em>M. intracellulare</em> (<em>n</em> = 3), <em>M. kansasii</em> (<em>n</em> = 3), <em>M. colombiense</em> (<em>n</em> = 1), <em>M. paraffinicum</em> (<em>n</em> = 1), and <em>M. abscessus</em> subsp. <em>massiliense</em> (<em>n</em> = 1). In conclusion, this study demonstrated that mycobacteria are detected in 16.72 % to 20.20 % of pulmonary granulomatous lesions. Moreover, MTB and NTM were detected in these lesions. The use of different methods for mycobacteria detection, in addition to culture, is complementary and contributes to fastening and increasing the detection of mycobacteria in these lesions.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100564"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892641","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":"Ascending to Q1: A critical analysis of clinics journal's editorial trajectory and future challenges","authors":"José Maria Soares-Júnior,&nbsp;Fauze Maluf-Filho","doi":"10.1016/j.clinsp.2025.100722","DOIUrl":"10.1016/j.clinsp.2025.100722","url":null,"abstract":"","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100722"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769536","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":"Corrigendum to “Exploration of the mechanism underlying the therapeutic effect of electroacupuncture at chengshan acupoint on post-hemorrhoidectomy anal pain: Insights from the mAChRs/IP3-Ca2+-CaM signaling pathway” [CLINSP 79 (2024) 10048]","authors":"Yang Song ,&nbsp;Yang Wang ,&nbsp;Ming Li ,&nbsp;Yujuan Wang ,&nbsp;Tianshu Xu","doi":"10.1016/j.clinsp.2024.100568","DOIUrl":"10.1016/j.clinsp.2024.100568","url":null,"abstract":"","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100568"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945850","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":"Efficacy and safety of a modified DVD regimen followed by lenalidomide for the treatment of Newly Diagnosed Multiple Myeloma","authors":"Zhichao Li ,&nbsp;Wenhao Zhang ,&nbsp;Fang Huang ,&nbsp;Siguo Hao","doi":"10.1016/j.clinsp.2025.100575","DOIUrl":"10.1016/j.clinsp.2025.100575","url":null,"abstract":"<div><h3>Background</h3><div>The common drugs used for the treatment of Newly Diagnosed Multiple Myeloma (NDMM) include bortezomib and lenalidomide, but the adverse effects of lenalidomide cannot be ignored, especially when it is used in the initial therapy.</div></div><div><h3>Methods</h3><div>This retrospective study evaluated the efficacy and safety of a modified DVD regimen (pegylated liposomal doxorubicin, bortezomib, and dexamethasone) followed by lenalidomide in the treatment of NDMM. A total of 40 NDMM patients were treated with a reduced dose of pegylated liposomal doxorubicin (20 mg/m²) on day 1, subcutaneous bortezomib (1.3 mg/m²) on days 1, 4, 8, and 11, and dexamethasone (20 mg) on days 1, 2, 3, 4, 8, 9, 11, and 12 (20 days for each course). When patients failed to achieve partial or better response after 2 courses of treatment, a regimen containing lenalidomide was administered. After the induction therapy, 15 eligible patients received Peripheral Blood Stem Cells (PBSC) mobilization and transplantation followed by maintenance therapy with lenalidomide.</div></div><div><h3>Results</h3><div>The response rate (≥ very good partial response) was 55% and 80% after 2 and 4 courses, respectively. The 18-month Progression Free Survival (PFS) and Overall Survival (OS) were 78.6% and 83.4%, respectively. Grade 3 or 4 hematologic toxicity occurred in less than 10% of patients. In addition, all 15 transplant-eligible patients successfully mobilized PBSC (median CD34⁺cells = 4.59 × 10⁶/kg) and underwent autologous PSBC transplantation.</div></div><div><h3>Conclusions</h3><div>This study suggests that the modified DVD regimen followed by lenalidomide is an effective and well-tolerated regimen, and has little influence on the PBSC collection and transplantation for patients with NDMM.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100575"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051941","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":"Metabolomics in juvenile idiopathic arthritis: A distinct profile in patients under methotrexate","authors":"Renato B. Tomioka ,&nbsp;Gabriela R.V. Ferreira ,&nbsp;Nadia E. Aikawa ,&nbsp;Gustavo A.R. Maciel ,&nbsp;José M. Soares Junior ,&nbsp;Edmund C. Baracat ,&nbsp;Eloisa Bonfá ,&nbsp;Ismael Dale Cotrim Guerreiro da Silva ,&nbsp;Clovis Almeida da Silva","doi":"10.1016/j.clinsp.2024.100522","DOIUrl":"10.1016/j.clinsp.2024.100522","url":null,"abstract":"<div><div>The objective of the present study was to evaluate biochemical quantitative metabolites in peripheral blood serum samples of Juvenile Idiopathic Arthritis (JIA) patients and healthy controls. A cross-sectional study included 33 post-pubertal JIA (21 without and 12 with Methotrexate (MTX) women and 28 age-matched healthy controls. Metabolomic analyses based on targeted electrospray ionization tandem mass spectrometry were used to identify possible biochemical pathway modifications in serum from JIA patients. The mean current age (<em>p</em> = 0.065) was similar in JIA patients and healthy controls. Current MTX use in all subtypes of JIA patients was associated with an increase in concentrations of free carnitine [21.74 (12.7‒35.2) vs. 27.49 (14.5‒41.3) µM/L, <em>p</em> = 0.02], suggesting an enhanced mitochondrial metabolism and intestinal absorptive function. In contrast, a decreased mitochondrial metabolism was observed in polyarticular and systemic JIA subtypes, with a decrease of several acylcarnitines’ concentrations (<em>p</em> &lt; 0.05). In conclusion, the present study identified a distinctive pattern of serum metabolic signatures in JIA patients under MTX therapy. Our findings indicate that MTX use is associated with a more efficient mitochondrial function.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100522"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063990","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":"Outcomes of Susanna UF implants in refractory congenital glaucoma","authors":"Aline Domingos Pinto Ruppert,&nbsp;Nara Gravina Ogata,&nbsp;Leopoldo Ernesto Oiticica Barbosa,&nbsp;Paulo Silas Neroni Stina,&nbsp;Marcus Vinícius Takatsu,&nbsp;Ernst Werner Oltrogge,&nbsp;Marcelo Hatanaka","doi":"10.1016/j.clinsp.2025.100619","DOIUrl":"10.1016/j.clinsp.2025.100619","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the success and complication rates of the Susanna UF Glaucoma Drainage Device (SUFGDD) in treating refractory primary congenital glaucoma.</div></div><div><h3>Patients and methods</h3><div>In this prospective non-comparative clinical trial, patients with refractory primary congenital glaucoma, under 18-years-old, who had unsuccessful prior glaucoma surgeries, underwent standardized SUFGDD implant surgery. All procedures were performed by a single surgeon (A.D.P.R.). Pre and postoperative intraocular pressure (IOP), number of antiglaucoma eye drops, surgical complications, and any subsequent related events were recorded. Success criteria were defined as follows: (I) IOP ≥ 5 and ≤ 21 mmHg; (II) IOP ≥ 5 and ≤ 18 mmHg. Each group was further categorized as absolute success (without medication) or qualified success (including those with medication).</div></div><div><h3>Results</h3><div>The study included 45 eyes from 31 patients, with an average age of 6.14 ± 5.02 years (range: 9 months‒18 years). The mean follow-up time was 37.78 ± 10.44 months. Mean IOP decreased from 28.18 ± 5.69 mmHg to 14.73 ± 2.90 mmHg (<em>p</em> &lt; 0.05). The average number of antiglaucoma medications was reduced from 2.96 ± 0.74 to 1.40 ± 1.23 (<em>p</em> &lt; 0.05). At 36-months postoperatively, the qualified success rates for criteria I and II were 93.3 % and 77.8 %, respectively. Seven eyes (15.6 %) experienced complications, all of which required reoperation; six cases were successfully managed, while one case resulted in permanent vision loss due to endophthalmitis. There were no significant associations between complications and analyzed risk factors (e.g., number of previous surgeries, age at surgery, past glaucoma surgeries, preoperative IOP, and number of preoperative eye drops). However, an association was observed between the occurrence of complications and surgical failure in the qualified success group for criterion II (HR = 6.50; 95 % CI 1.20‒31.35; <em>p</em> = 0.029).</div></div><div><h3>Conclusion</h3><div>In this studied cohort, SUFGDD achieved qualified success rates of 93.3 % and 77.8 %, for criteria I and II, respectively, at 36-months, with a complication rate of 15.6 %.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100619"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895580","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":"The impact of early morphine administration on septic patients with pre-existing chronic heart failure","authors":"Zhi-Ye Zou,&nbsp;Shui-Qing Gui","doi":"10.1016/j.clinsp.2025.100655","DOIUrl":"10.1016/j.clinsp.2025.100655","url":null,"abstract":"<div><h3>Background</h3><div>The use, timing, and dosage of morphine in septic patients with a history of Chronic Heart Failure (CHF) are poorly studied, and it is still unclear if morphine administration affects sepsis survival. This study aims to elucidate the relationship between early morphine administration and 30-day mortality among septic patients with a history of CHF.</div></div><div><h3>Methods</h3><div>Utilizing data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, this retrospective cohort study focuses on septic patients with CHF. The authors investigated the effects of early morphine administration (within 24 h of ICU admission) on 30-day mortality, employing Cox proportional hazards modeling and Propensity Score Matching (PSM) for analysis.</div></div><div><h3>Results</h3><div>The authors analyzed 7424 adult septic patients with CHF, among whom 6495 received early morphine and 929 were managed without morphine. The early morphine group exhibited a significantly lower 30-day mortality rate compared to the nonmorphine group (post-matched 16.4 % vs. 25.7 %, Absolute Risk Reduction (ARR) 9.3 % (95 % Confidence Interval [95 % CI 5.1–13.6], p &lt; 0.001). Among septic patients with CHF, early morphine administration was associated with a reduction in 30-day death in all adjusted variables (HR = 0.539‒0.735, p &lt; 0.001). After PSM, only &lt;15 mg of morphine was correlated to a lower 30-day mortality rate (HR = 0.233, 95 % CI 0.086–0.632, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>This investigation reveals a significant association between the early administration of morphine and reduced risk-adjusted 30-day mortality in septic patients with CHF.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100655"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869817","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}