Clinical Medicine最新文献_第5页

Risk factors of clonal hematopoiesis of indeterminate potential. 潜力不确定克隆造血的危险因素。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-09-01 Epub Date: 2026-08-08 DOI: 10.1016/j.clinme.2026.100635

Qiaoxue Liu, Fen Yang, Hans-Olov Adami, Yingsuo Zhao, Tove Wästerlid, Fang Fang, Qianwei Liu

{"title":"Risk factors of clonal hematopoiesis of indeterminate potential.","authors":"Qiaoxue Liu, Fen Yang, Hans-Olov Adami, Yingsuo Zhao, Tove Wästerlid, Fang Fang, Qianwei Liu","doi":"10.1016/j.clinme.2026.100635","DOIUrl":"10.1016/j.clinme.2026.100635","url":null,"abstract":"Background: Accumulating evidence demonstrates associations between clonal hematopoiesis of indeterminate potential (CHIP) and increased risks of haematological and non-haematological health outcomes. Although adverse health consequences of CHIP have become well-documented, large knowledge gaps exist regarding the aetiology of CHIP.Objective: To investigate risk factors for CHIP using large-scale phenotypic data and Mendelian randomisation analysis.Methods: We utilised rich phenotypic and genomic data from the UK Biobank (UKB) to perform a cross-sectional study to systematically investigate risk factors of CHIP, including around 460,000 participants recruited from 2006 to 2010. We used Logistic regression to estimate odds ratios (ORs) of CHIP in relation to risk factors (sociodemographic factors, lifestyle factors, history of diseases, blood cell count, blood biochemistry parameters, proteomics biomarkers and metabolomics biomarkers). In addition, we conducted Mendelian Randomisation (MR) analyses to assess causality between the studied risk factors and CHIP, using publicly available summary statistics of genome-wide association studies (GWAS).Results: We found that advanced age, smoking, history of several diseases (including breast cancer and leiomyoma of uterus), as well as several serum biomarkers (monocyte count, proteins LY75, SIGLEC6, SIRPB1 and CYB5R2) were associated with CHIP.Conclusion: Our findings expanded existing knowledge base by demonstrating novel risk factors of CHIP, especially history of several diseases and serum biomarkers. These findings advance understanding of the aetiology of CHIP.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100635"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697258","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}

引用次数: 0

Pathophysiology, workup and treatment of cancer-related ischaemic stroke. 癌症相关性缺血性脑卒中的病理生理、检查和治疗。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-09-01 Epub Date: 2026-10-15 DOI: 10.1016/j.clinme.2026.100656

Shivam Patel, Soma Sengupta, Wuwei Feng, Dylan Ryan

引用次数: 0

Neuro-oncological emergencies requiring critical care intervention. 需要重症监护干预的神经肿瘤急症。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-09-01 Epub Date: 2026-10-06 DOI: 10.1016/j.clinme.2026.100653

Joshua A Kornbluth, Jessica Wallace, David Y Hwang

引用次数: 0

The road less travelled: Why neuro-oncology matters. 少有人走过的路：为什么神经肿瘤学很重要。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-09-01 Epub Date: 2026-10-23 DOI: 10.1016/j.clinme.2026.100662

Soma Sengupta, Ponnusamy Saravanan

引用次数: 0

First report of bilateral avascular necrosis (AVN) of the femoral heads in a patient with dual factor V deficiency and factor V Leiden mutation: A unique coagulopathy intersection with therapeutic insights. 双因子V缺乏和因子V Leiden突变患者股骨头双侧缺血性坏死（AVN）的首次报道：一种独特的凝血病交叉点与治疗见解。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-09-01 Epub Date: 2026-07-15 DOI: 10.1016/j.clinme.2026.100616

Wei Li, Huibo Li, Xixi Dou, Deqiang Zheng, Chengyao Liu

引用次数: 0

Prognostic value of C-reactive protein to albumin ratio (CAR) for mortality in older adults with sepsis: Cohort study. c反应蛋白与白蛋白比（CAR）对脓毒症老年人死亡率的预后价值：队列研究

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-09-01 Epub Date: 2026-07-06 DOI: 10.1016/j.clinme.2026.100610

O Jiménez-Zarazúa, B I Tolentino-Pérez, L N Vélez-Ramírez, J D Mondragón

{"title":"Prognostic value of C-reactive protein to albumin ratio (CAR) for mortality in older adults with sepsis: Cohort study.","authors":"O Jiménez-Zarazúa, B I Tolentino-Pérez, L N Vélez-Ramírez, J D Mondragón","doi":"10.1016/j.clinme.2026.100610","DOIUrl":"10.1016/j.clinme.2026.100610","url":null,"abstract":"Study objective: To evaluate the prognostic value of the C-reactive protein/albumin (CAR) for mortality in older adults with sepsis.Design and setting: Prospective observational cohort study conducted at General Hospital Zone No. 21, León, Guanajuato, Mexico (Nov 2023-Aug 2025).Participants: Consecutive patients aged >60 years with Sepsis-3-defined sepsis or septic shock, excluding those with prior ICU care, transfers, malignancies, cirrhosis, autoimmune disease, or non-septic shock.Interventions: None. The CAR and Sequential Organ Failure Assessment (SOFA) scores were measured at diagnosis and 72 h.Main outcome measures: 28-day all-cause mortality, with predictive performance assessed via area under the ROC curve (AUC).Results: CAR was higher in septic shock versus sepsis. In patients with sepsis, both initial (AUC = 0.867) and 72-h (AUC = 0.852) ratios predicted mortality better than SOFA (AUC = 0.786). In septic shock, SOFA was superior (AUC = 0.785 vs. 0.637). An initial ratio in the highest tertile independently predicted mortality (HR 2.88, 95% CI 1.15-5.19, p < 0.001).Conclusions: The CAR is a strong, independent mortality predictor in older adults with sepsis, outperforming SOFA in sepsis but not in septic shock. This simple biomarker can aid early identification of high-risk patients to guide timely intervention.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100610"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396088","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}

引用次数: 0

Letter to the Editor: 'Heart failure with preserved ejection fraction (HFpEF): Diagnosis and management for the general physician'. 关于“保留射血分数的心力衰竭（HFpEF）：普通医生的诊断和管理”的信。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-09-01 Epub Date: 2026-07-19 DOI: 10.1016/j.clinme.2026.100627

Maria Giulia Bellicini

引用次数: 0

Resident doctor workforce wellbeing worldwide: Lessons between the UK and Australia. 世界范围内住院医生的福利：英国和澳大利亚之间的经验教训。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-09-01 Epub Date: 2026-07-02 DOI: 10.1016/j.clinme.2026.100614

Neeraj B Bhala, Emily C Taylor, Andrew F Goddard, Ajay M Verma

{"title":"Resident doctor workforce wellbeing worldwide: Lessons between the UK and Australia.","authors":"Neeraj B Bhala, Emily C Taylor, Andrew F Goddard, Ajay M Verma","doi":"10.1016/j.clinme.2026.100614","DOIUrl":"10.1016/j.clinme.2026.100614","url":null,"abstract":"Healthcare systems fundamentally depend on the wellbeing and sustainability of their workforce. Physician burnout, workload strain and declining professional fulfilment are widely documented across high-income health systems. The UK and Australia share similar professional cultures and training pathways, but operate within distinct health system structures. Comparing these systems provides insight into the structural determinants of resident doctor wellbeing. Both countries face common challenges, including rising demand for care, domestic workforce shortages, and changing expectations of work-life balance. Data from both countries demonstrate persistently high levels of moral distress and intention to leave practice, alongside structural pressures including industrial action, training bottlenecks and changing workforce composition. Evidence on suicide risk further underscores the seriousness of workforce wellbeing as a public health issue. These shared outcomes highlight that structural differences do not protect resident doctors from distress. System-level reform and cultural change are essential to safeguard workforce wellbeing and health system sustainability.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100614"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374850","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}

引用次数: 0

Sink or swim: Making sense of the NICE intravenous fluid guidelines as a Foundation Year Doctor. 沉沦或游泳：作为预科医生理解NICE静脉输液指南。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-08-30 DOI: 10.1016/j.clinme.2026.100639

Talia Patel, Calum R A Heslop, Milap Rajpara, Shivaali Karelia, Rakesh Patel

引用次数: 0

The economic imperative for an AI Productivity Index in healthcare: Beyond clinical promise to fiscal accountability. 医疗保健领域人工智能生产力指数的经济必要性：从临床承诺到财政责任。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-08-20 DOI: 10.1016/j.clinme.2026.100638

Yazan A Al-Ajlouni, Basile Njei

{"title":"The economic imperative for an AI Productivity Index in healthcare: Beyond clinical promise to fiscal accountability.","authors":"Yazan A Al-Ajlouni, Basile Njei","doi":"10.1016/j.clinme.2026.100638","DOIUrl":"10.1016/j.clinme.2026.100638","url":null,"abstract":"Artificial intelligence (AI) is increasingly embedded in healthcare delivery, yet its evaluation remains dominated by technical performance metrics that inadequately capture real-world system value. Clinical accuracy is necessary but insufficient to justify adoption in resource-constrained health systems facing workforce shortages and rising demand. AI technologies compete for limited financial, technical and cognitive resources, but there is no standardised framework to assess their effects on productivity, workflow, downstream utilisation or equity. This article argues that treating clinical validity as a proxy for value risks misallocating scarce resources and undermining trust in digital transformation. We propose an AI Productivity Index to complement existing safety, efficacy and economic assessments by evaluating operational impact, implementation burden, opportunity costs and post-deployment consequences. Embedding productivity measurement into procurement and governance processes could help align AI innovation with fiscal accountability, equitable access and sustainable healthcare delivery.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100638"},"PeriodicalIF":3.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789206","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}

引用次数: 0