Clinics最新文献

{"title":"Prevalence and related factors of irritable bowel syndrome in women with chronic pelvic pain","authors":"João Nogueira Neto ,&nbsp;Kamilly Ieda Silva Veigas ,&nbsp;Lyvia Maria Rodrigues de Sousa Gomes ,&nbsp;Leonardo Carvalho Silva ,&nbsp;Júlio Cesar Rosa e Silva ,&nbsp;Plínio da Cunha Leal","doi":"10.1016/j.clinsp.2026.100884","DOIUrl":"10.1016/j.clinsp.2026.100884","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the prevalence of Irritable Bowel Syndrome (IBS) and its related sociodemographic, nociceptive, neuropathic, nociplastic, psychosocial, and systemic factors in patients with Chronic Pelvic Pain (CPP).</div></div><div><h3>Materials and methods</h3><div>This observational, prospective, and analytical study was conducted at a Pelvic Pain Outpatient Clinic between August 2021 and March 2022 with patients diagnosed with CPP. The following instruments were applied: IBS was diagnosed using the Rome IV criteria, the Questionnaire for Chronic Pelvic Pain Assessment (QCPPA) of the International Pelvic Pain Society (IPPS), the Depression, Anxiety and Stress Scale (DASS-21), the Douleur Neuropathique 4 questionnaire (DN4), and the Central Sensitization Inventory (CSI).</div></div><div><h3>Results</h3><div>In this study, 111 women with CPP were evaluated. The prevalence of IBS was 53.15%. Patients with IBS showed significantly higher frequencies of myofascial pain (p &lt; 0.001), neuropathic pain (p = 0.026), and central sensitization (p = 0.010). Binary logistic regression identified myofascial pain (OR = 7.614; 95% CI: 2.12–22.88; p = 0.001) as an independent predictor of IBS, while infertility showed a protective association with IBS, with an adjusted odds ratio of 0.209 (95% CI: 0.048–0.915; p = 0.038).</div></div><div><h3>Conclusion</h3><div>Women with CPP have a high prevalence of IBS. In addition to the association with classic factors, this study also observed a significant association with neuropathic pain and pain centralization. A significant association with myofascial syndrome was observed, which appeared as a strong predictor of IBS in the adjusted model.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100884"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319291","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":"High prevalence of endometriosis in women with chronic pelvic pain and confirmed pelvic varicosities: a multiparametric MRI study","authors":"Mira Zlotnik ,&nbsp;Marcos de Lorenzo Messina ,&nbsp;Thiago Dieb Ristum Vieira ,&nbsp;Vinicius Bertoldi ,&nbsp;Andrei Skromov de Albuquerque ,&nbsp;Pedro Puech-Leão ,&nbsp;Edmund Chada Baracat","doi":"10.1016/j.clinsp.2026.100895","DOIUrl":"10.1016/j.clinsp.2026.100895","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic Pelvic Pain (CPP) presents significant diagnostic challenges, often involving multiple pathologies, including endometriosis and pelvic venous disorders. This study examined the prevalence of endometriosis among women with confirmed pelvic varicosities.</div></div><div><h3>Methods</h3><div>The authors performed a retrospective analysis of 52 women with CPP and pelvic varicosities who underwent multiparametric magnetic resonance venography between January 2019 and December 2023. All images were reviewed by a single experienced radiologist, blinded to clinical data and vascular findings, to identify radiological signs of endometriosis.</div></div><div><h3>Results</h3><div>Among the 52 women, 32 exhibited radiological findings consistent with endometriosis, corresponding to a prevalence of 61.5% (95% CI: 47.0%–74.5%).</div></div><div><h3>Conclusion</h3><div>This study demonstrates a high prevalence of endometriosis among women with pelvic varicosities. Multiparametric MRI proved effective as a non-invasive diagnostic modality capable of identifying both vascular and gynecologic abnormalities in a single session, supporting integrated assessment approaches for women with CPP. Limitations include the retrospective design and the lack of histological confirmation of endometriosis.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100895"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358485","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":"Obstructive sleep apnea in adults with Down syndrome: body composition, metabolic profile and cognitive status","authors":"Lígia Fidelis Ivanovic ,&nbsp;Cristiana Castanho de Almeida Rocca ,&nbsp;Rosa Hasan ,&nbsp;Pâmella Pollyanna Braga Carra Costela ,&nbsp;Geraldo Lorenzi-Filho ,&nbsp;Orestes Vicente Forlenza ,&nbsp;Milton A. Martins ,&nbsp;Patricia Zen Tempski","doi":"10.1016/j.clinsp.2026.100867","DOIUrl":"10.1016/j.clinsp.2026.100867","url":null,"abstract":"<div><h3>Context</h3><div>Down Syndrome (DS) is the main genetic cause of Intellectual Disability (ID) and is characterized by the presence of several medical comorbidities. Among these, Obstructive Sleep Apnea (OSA) stands out, with a prevalence much higher than that of the general population. The clinical impact of OSA in subjects without DS described in the literature includes increased cardiovascular, metabolic and neurocognitive risk. However, among the adult population with DS, these associations are poorly described.</div></div><div><h3>Objectives</h3><div>To evaluate the presence and characterize OSA in adults with DS and its association with body composition, metabolic profile, functional and cognitive performance.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 34 persons with DS aged 18 years or over. The measurements were: anthropometry, complete Polysomnography in the Sleep laboratory (PSG), neuropsychological assessment using the Abbreviated Wechsler Intelligence Scale and NEUPSILIN Brief Assessment Instrument, biochemical assessments, and functionality scales (Barthel and Lawton). There were 30 representative PSG. Subjects with and without OSA were compared regarding clinical, anthropometric, functional (<em>n</em> = 30), and cognitive (<em>n</em> = 20) variables. Sleep changes were correlated with the variables under study.</div></div><div><h3>Results</h3><div>The frequency of OSA (apnea-hypopnea index ≥ 5 events/h) was 63 %. As compared to no OSA, OSA was associated with male sex (<em>p</em> = 0.001), greater cervical circumference (34 vs. 40 cm, <em>p</em> &lt; 0.001), greater deposition of abdominal fat (82 vs. 92 cm, <em>p</em> = 0.049), higher average levels systolic blood pressure (<em>p</em> = 0.03), higher frequency of altered fasting blood glucose or glycated hemoglobin equal to or greater than 5.7 % (<em>p</em> = 0.03) and low HDL cholesterol (<em>p</em> = 0.004). OSA was associated with worse performance in episodic and semantic verbal memory (<em>p</em> = 0.02).</div></div><div><h3>Conclusion</h3><div>Adults with DS have a high frequency of OSA, which may be related to metabolic profile and worse memory performance.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100867"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146185179","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":"Personalized sepsis mortality prediction: An interpretable machine learning nomogram","authors":"Lulu Weng ,&nbsp;Haidong Li ,&nbsp;Yonglai Lv ,&nbsp;Jiayi Luo ,&nbsp;Zhenliang Wen ,&nbsp;Jiawen Shi ,&nbsp;Li Zhong","doi":"10.1016/j.clinsp.2026.100872","DOIUrl":"10.1016/j.clinsp.2026.100872","url":null,"abstract":"<div><h3>Purpose</h3><div>Sepsis remains a major cause of mortality in ICU patients, requiring accurate prognostic tools for optimal management. This study aimed to develop and validate an interpretable machine learning-based nomogram for predicting in-hospital mortality in sepsis patients to guide clinical decision-making.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 407 adult sepsis patients from ICU admissions between January 2019 and December 2024. Patients were randomly divided into training (<em>n</em> = 284) and validation (<em>n</em> = 123) cohorts. A LASSO-based multivariate logistic regression was applied to construct a predictive nomogram.</div></div><div><h3>Results</h3><div>Seven independent predictors emerged for in-hospital mortality: age, abdominal infection, vasopressor requirement, WBC, BNP, APACHE II score, and mechanical ventilation support. The nomogram showed strong discrimination with an AUC of 0.900 in the training cohort and 0.796 in the validation cohort. Calibration curves, decision curve analysis, and SHAP interpretation confirmed good model performance and clinical utility.</div></div><div><h3>Conclusions</h3><div>The novel machine learning-based nomogram provides a practical, interpretable risk assessment tool for early mortality prediction, potentially improving patient outcomes through enhanced clinical understanding and timely interventions in critically ill sepsis patients.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100872"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204665","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":"Validation of the GALAD model for diagnosing HBV-related hepatocellular carcinoma in Chinese patients","authors":"KeCheng Li,&nbsp;Fei Xia,&nbsp;XiaoYa Wu","doi":"10.1016/j.clinsp.2026.100882","DOIUrl":"10.1016/j.clinsp.2026.100882","url":null,"abstract":"<div><h3>Background</h3><div>The GALAD model integrates serological biomarkers (AFP, AFP-L3%, DCP) with demographic factors to estimate the presence of Hepatocellular Carcinoma (HCC). However, its applicability in Chinese populations with HBV-related HCC remains underexplored. This study validated the clinical utility of GALAD in this specific population.</div></div><div><h3>Methods</h3><div>A retrospective cohort study enrolled 217 HBV-related HCC patients, 210 patients with benign Liver disease without cirrhosis, 247 Cirrhosis patients, and 220 healthy controls. Serum levels of AFP, AFP-L3%, and DCP were measured. Receiver Operating Characteristic (ROC) curve analysis assessed diagnostic performance, and the Hosmer-Lemeshow test evaluated model calibration. Serum levels of AFP, AFP-L3%, and DCP were measured. Receiver Operating Characteristic (ROC) curve analysis assessed diagnostic performance, and the Hosmer-Lemeshow test evaluated model calibration.</div></div><div><h3>Results</h3><div>GALAD demonstrated superior diagnostic performance, with an Area Under the Curve (AUC) of 0.942. At an optimal cutoff of 1.89, sensitivity and specificity were 89.91 % and 81.51 %, respectively. The model showed excellent calibration (χ² = 8.934, p &gt; 0.05), confirming its reliability for Chinese HBV-related HCC patients.</div></div><div><h3>Conclusion</h3><div>The GALAD model outperforms individual biomarkers in diagnosing HBV-related HCC in the Chinese population, highlighting its potential utility in clinical practice. This cost-effective tool holds particular promise for the tertiary prevention of HBV-related HCC, especially in resource-limited settings.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100882"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222490","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":"Melatonin's oncostatic effects in experimental breast cancer: A systematic review of dose-response and apoptotic mechanisms in animal models","authors":"Mayara Souza Alves ,&nbsp;Luciana Lamarão Damous ,&nbsp;Isaque da Silva Ferreira ,&nbsp;Cecília da Silva Ferreira ,&nbsp;Isabel Cristina Esposito Sorpreso ,&nbsp;José Cipolla-Neto ,&nbsp;Edmund Chada Baracat ,&nbsp;José Maria Soares Jr.","doi":"10.1016/j.clinsp.2026.100888","DOIUrl":"10.1016/j.clinsp.2026.100888","url":null,"abstract":"<div><div>Breast cancer remains a major health concern for women because of its prevalence and high morbidity and mortality rates. Metastasis represents the most severe prognosis, and many studies have been conducted to understand the mechanisms involved in cell migration and the factors influencing this process.</div></div><div><h3>Objectives</h3><div>To evaluate the effects of melatonin on breast cancer cells through a systematic literature review.</div></div><div><h3>Method</h3><div>Systematic review of the literature was carried out through PubMed, Embase and Web of Science as scientific search platforms using Population, Intervention, Comparison, and Outcome (PICO) with the keywords (P) “rat” or “murine”; (I) “melatonin’’, “pineal’’ and “indolamine’’; (C) “breast cancer model’’, “mammary cancer model’’ and “breast tissue’’ and (O) “proliferation” and “cell migration.” The inclusion criteria were full-text, open-access articles in Portuguese, English, or Spanish that focused on the antioxidant and proapoptotic actions of melatonin on breast cancer cells. The exclusion criteria were articles published &gt;20-years ago, those with missing methodological information, and those not describing the dosage and specificity of the research product used. The findings of each included study were structured in tables with details about the sample size, dose of melatonin, and route of administration. The quality of evidence was assessed using the Cochrane risk-of-bias tool. This study was registered in PROSPERO (n° CRD42025635531).</div></div><div><h3>Results</h3><div>A total of 257 articles were selected from the databases; 25 were read in full, resulting in 10 articles selected for this systematic review, with a total population of 756 animals studied. From the studies analyzed, six showed a reduction in tumors in correlation with the apoptosis process. This review shows that melatonin can inhibit tumorigenesis in three studies with the lowest risk of bias, which reinforces the oncostatic action of melatonin. However, several studies have combined other substances to evaluate their oncostatic action, making it difficult to infer the mechanisms involved. Further studies are necessary to elucidate the mechanisms through which melatonin acts in mammary carcinogenesis.</div></div><div><h3>Conclusion</h3><div>The literature shows that in animal models of breast tumors, high doses of melatonin can induce tumor reduction by cell death through apoptosis. However, further studies are required to understand the mechanisms by which this hormone acts in mammary carcinogenesis.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100888"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147314515","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":"Inequalities in mammograms and cervical biopsies provision in the public and private sectors of the Brazilian healthcare system and the availability of gynecology and obstetrics specialists","authors":"Ivan Wilson Hossni Dias ,&nbsp;Edmund Chada Baracat ,&nbsp;Alicia Matijasevich ,&nbsp;César Eduardo Fernandes ,&nbsp;Cristiane de Jesus Almeida ,&nbsp;Paola Soledad Mosquera ,&nbsp;Mário César Scheffer","doi":"10.1016/j.clinsp.2026.100876","DOIUrl":"10.1016/j.clinsp.2026.100876","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the provision of mammograms and cervical biopsies in Brazil’s public and private healthcare sectors and the availability of gynecologists and obstetricians<em>.</em></div></div><div><h3>Methods</h3><div>This ecological study included specialists in gynecology and obstetrics, as well as data on mammograms and cervical biopsy procedures performed in 2024 through the Brazilian Unified Health System (SUS) and private health insurance plans. For each state, ratios of specialist availability and the rate of procedures per 100,000 women were calculated. Sensitivity analysis was performed to calculate the ratio of procedures in women of different age groups, and Spearman’s correlation coefficient was used to assess the association between specialist availability and the rate of procedures performed.</div></div><div><h3>Results</h3><div>In 2024, health insurance plans performed 15,510.88 mammograms per 100,000 women, almost triple the SUS rate (5,733.93). The private sector performed 426.28 cervical biopsies per 100,000 women, while the public sector conducted only 85.24. The total provision of mammograms varied from 12,691.29 per 100,000 women in São Paulo to 2,702.91 in Pará. For cervical biopsies, the provision ranged from 348.94 per 100,000 women in São Paulo to 21.18 in Roraima. Correlation analysis showed a positive association between specialist availability and procedure volume (mammograms: <em>r</em> = 0.74; biopsies: <em>r</em> = 0.39; p &lt; 0.001), which remained consistent after sensitivity analysis.</div></div><div><h3>Conclusion</h3><div>Separate indicators for procedure provision and specialist availability effectively identified regional disparities. These findings can guide policymakers in reducing inequalities in access to early breast and cervical cancer diagnosis.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100876"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367835","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":"Diagnostic accuracy of the World Health Organization ICOPE screening tool in Brazilian older adults: a cross-sectional study","authors":"Lívia Maria do Nascimento ,&nbsp;Thainá Gabrielle Camargo da Cruz ,&nbsp;Juliana Fernanda de Lima e Silva ,&nbsp;Letícia Prado Silva ,&nbsp;Beatriz Bigatão Inácio ,&nbsp;Marcos Eduardo Scheicher","doi":"10.1016/j.clinsp.2026.100915","DOIUrl":"10.1016/j.clinsp.2026.100915","url":null,"abstract":"<div><h3>Objectives</h3><div>Evaluate the performance of diagnostic measures (sensitivity and specificity) of the Intrinsic Capacity (IC) construct by domain and by age group.</div></div><div><h3>Study design</h3><div>164 elderly individuals were assessed in the 5 domains of IC (cognition, psychological, vitality, locomotion, and sensory) and for Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), frailty, and urinary incontinence. One-way ANOVA, <em>t</em>-test, or Mann-Whitney test were used for quantitative variables, and chi-square test for qualitative variables. The sensitivity and specificity were evaluated using the ROC curve.</div></div><div><h3>Results</h3><div>Decline in IC was older, worse ADL, IADL, and mental function, low gait speed, higher depression scores, frailty, and urinary incontinence. The full version and the cognitive, psychological, locomotion, and sensory domains demonstrated moderate performance, while the vitality showed poor performance. The age-stratified analysis indicated that among participants aged 60–69 years, the cognitive, vitality, locomotion, and sensory domains showed poor performance, while the psychological domain demonstrated good performance. In the 70–79-year group, all domains showed moderate performance. In individuals aged ≥ 80-years, the cognitive, psychological, vitality, and locomotion domains demonstrated moderate performance, whereas the sensory domain showed good performance.</div></div><div><h3>Conclusions</h3><div>Full IC construct and most domains showed moderate performance, with the exception of vitality (poor performance). When analyzed by domain and age group, performance varied across domains, ranging from poor to moderate, with the sensory domain showing the best results in the oldest group. Furthermore, the intrinsic capacity construct remains a useful screening approach for identifying older adults at risk of frailty.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100915"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518183","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":"Investigation of molecular immune regulation mechanisms and therapeutic target prediction in pancreatic cancer based on bioinformatics and genetics","authors":"Changjun Dong ,&nbsp;Jing Guan ,&nbsp;Linhuan Dong ,&nbsp;Yunlin Yu ,&nbsp;Xiangwei Zhang ,&nbsp;Zheng Li ,&nbsp;Xianlin Zhang ,&nbsp;Chunlin Mo","doi":"10.1016/j.clinsp.2026.100952","DOIUrl":"10.1016/j.clinsp.2026.100952","url":null,"abstract":"<div><h3>Objective</h3><div>Pancreatic Cancer (PC) is a highly aggressive malignancy with a dismal prognosis, primarily due to late-stage diagnosis and limited therapeutic options. This study aimed to identify potential biomarkers involved in PC progression and immune microenvironment modulation.</div></div><div><h3>Methods</h3><div>RNA sequencing data from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases were integrated to identify differentially expressed genes. Mendelian Randomization (MR) analysis was conducted to assess causal associations between candidate genes and PC risk. Immune cell infiltration was evaluated using the CIBERSORT algorithm, and mediation analysis explored the role of immune cells in PC progression. Validation was performed using RT-qPCR and immunohistochemistry in clinical tissue samples.</div></div><div><h3>Results</h3><div>CLIC3 and MST1R were significantly overexpressed in PC tissues and associated with advanced tumor stages. MR analysis confirmed their causal relationship with PC, with Odds Ratios of 2.36 (95% CI: 1.58–3.51) for CLIC3 and 1.30 (95% CI: 1.06–1.60) for MST1R. High expression of these genes correlated with increased M0 macrophages and decreased CD8⁺ T cells, CD4⁺ T-cells, and naïve B-cells, suggesting immune dysregulation. Mediation analysis emphasized the pivotal role of CD8⁺ cytotoxic T-cells in PC progression. Moreover, CLIC3 and MST1R were closely associated with immune checkpoint molecules CD276 and NT5E.</div></div><div><h3>Conclusions</h3><div>CLIC3 and MST1R are overexpressed and causally implicated in pancreatic cancer development and immune modulation. They represent promising biomarkers and potential therapeutic targets for precision immunotherapy in PC.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100952"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147709413","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":"Short- versus long-course antibiotic therapy in mechanically ventilated sepsis patients with pneumonia: a real-world cohort analysis","authors":"Bin Wang ,&nbsp;Shuiqing Gui ,&nbsp;Jiang Mei ,&nbsp;Zhiye Zou","doi":"10.1016/j.clinsp.2026.100932","DOIUrl":"10.1016/j.clinsp.2026.100932","url":null,"abstract":"<div><h3>Objective</h3><div>To compare outcomes of short-course versus longer-course antibiotic regimens in mechanically ventilated adult patients with sepsis due to pneumonia.</div></div><div><h3>Methods</h3><div>The authors performed a retrospective cohort study using the MIMIC-IV database (2008–2022), identifying 2590 adults meeting Sepsis-3 criteria with a primary diagnosis of pneumonia requiring invasive mechanical ventilation. Patients were stratified by antibiotic duration (short: 2‒7 days; long: 8‒14 days). Demographics, comorbidities, severity (SOFA score, PaO₂/FiO₂ ratio), and microbiology were extracted. The primary outcome was 90-day all-cause mortality. The authors used Kaplan-Meier analysis, multivariable Cox proportional hazards models, and subgroup analyses to assess the effect of treatment duration.</div></div><div><h3>Results</h3><div>The study found that overall 90-day mortality did not differ significantly (short-course ∼41.3% vs. long-course ∼41.2%; <em>p</em> = 0.98). Subgroup analyses indicated that in patients &gt; 65-years, those with severe hypoxemia (low PaO₂/FiO₂), on RRT, or infected with Staphylococcus aureus or Pseudomonas aeruginosa, shorter therapy was associated with higher mortality rates (<em>p</em> &lt; 0.05). Conversely, younger or less severely ill patients showed no significant effect of duration. These findings may reflect residual confounding.</div></div><div><h3>Conclusions</h3><div>In this observational cohort, shorter antibiotic courses were not associated with increased 90‑day mortality after adjustment. Given potential confounding and limited recurrence data, subgroup signals are hypothesis‑generating and require confirmation in randomized trials.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100932"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147656244","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}