Clinics (Sao Paulo, Brazil)最新文献

{"title":"A multimodal MRI radiomics sonata for differentiating small renal masses: a two-center retrospective study.","authors":"Chao Fang, Li Tian, Ming Gao, Xiaohui Duan, Qi Liu, Zixin Xu, Junjiong Zheng, Yushu Chen, Ming Huang, Xu Chen, Wei Jiang, Jianqiu Kong, Wen Dong","doi":"10.1016/j.clinsp.2026.101212","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101212","url":null,"abstract":"<p><strong>Background: </strong>Accurately distinguishing benign from malignant small renal masses (SRMs) is crucial to avoid unnecessary surgeries, yet reliable preoperative diagnostic tools remain limited.</p><p><strong>Methods: </strong>A total of 189 patients with SRMs from two hospitals (2018-2022) were enrolled. Clinical data and MRI features were analyzed by two radiologists. Radiomics features were automatically extracted from manually segmented ROIs using dedicated software. Significant features were selected via univariate analysis, multivariate regression, and Lasso to develop three models: radiomics, clinical, and combined nomogram. Diagnostic performance was evaluated using the Area Under the receiver operating characteristic Curve (AUC).</p><p><strong>Results: </strong>The radiomics-clinical nomogram was constructed using T2WI signal intensity (p < 0.001), pseudocapsule (p = 0.001), and radiomics score (Rad-score, p = 0.001) via multivariate logistic regression. In the training set, the nomogram achieved an AUC of 0.962 (95% CI: 0.931-0.993), outperforming both the radiomics model (AUC = 0.918, 95% CI: 0.862-0.974) and the clinical model (AUC = 0.856, 95% CI: 0.780-0.933). Favorable performance was observed in the internal validation set (nomogram: AUC = 0.981, 95% CI: 0.944-1.000; radiomics model: AUC = 0.912, 95% CI: 0.750-1.000; clinical model: AUC = 0.844, 95% CI: 0.578-1.000) and external validation set (nomogram: AUC = 0.971, 95% CI: 0.886-1.000; radiomics model: AUC = 0.928, 95% CI: 0.841-0.989; clinical model: AUC = 0.916,95% CI: 0.760-0.976).</p><p><strong>Conclusion: </strong>All three models enable effective and non-invasive preoperative differentiation of benign from malignant SRMs, with the radiomics-clinical nomogram exhibiting the highest diagnostic accuracy, supporting its potential as a valuable clinical tool.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101212"},"PeriodicalIF":2.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut mycobiome in the spectrum of Metabolic-dysfunction Associated Steatotic Liver Disease (MASLD): from MASH to hepatocellular carcinoma.","authors":"Cássio Marques Perlin, Melina Belén Keingeski, Bruno de Souza Basso, Beatriz Garcia Mendes, Julliane Dutra Medeiros, Francis Moreira Borges, Bernd Schnabl, Mário Reis Álvares-da-Silva","doi":"10.1016/j.clinsp.2026.101200","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101200","url":null,"abstract":"<p><p>Gut Microbiome (GM) dysbiosis is associated with the development and progression of Metabolic-dysfunction Associated Steatotic Liver Disease (MASLD) and steatohepatitis (MASH). Human GM contains bacteria, fungi, archaea, and viruses. Gut mycobiome (GMyco) is still poorly studied in patients with MASLD. Herein we investigated GMyco composition at different MASLD stages.</p><p><strong>Methods: </strong>23 patients were recruited: controls (n = 5); MASH (n = 6); cirrhosis (n = 7); and Hepatocellular Carcinoma (HCC) (n = 5). Stool samples were collected and stored in -80 °C for subsequent DNA extraction and profiled by 18S rRNA sequencing. The single sequence variants obtained were inferred with DADA2 and classified with SILVA v138. Diversity metrics (Simpson; Bray-Curtis PERMANOVA) and DESeq2 with BH FDR were used for statistical analysis.</p><p><strong>Results: </strong>Among 23 participants, 73.9% were women, and the average BMI was 30.7 kg/m². Current alcohol use was reported in 17.4%, and chronic medication use in 56.5% of individuals. MASH patients showed greater gut mycobiota alpha diversity compared with controls (p < 0.05). Controls exhibited higher relative abundance of the phylum Ascomycota, whereas Basidiomycota predominated in MASH. At the family level, Aspergillaceae was more abundant in controls, Malasseziaceae and Sporidiobolaceae in cirrhosis, and Saccharomycetaceae in HCC. Differential abundance analysis identified three ASVs differing between groups, with one ASV (genus Naganishia) homogeneously distributed in MASH and absent in controls.</p><p><strong>Conclusions: </strong>The gut mycobiota profile varied across the MASLD spectrum, with stage-specific enrichment of certain taxa despite overall similarity in community structure. Basidiomycetes ‒ notably Malassezia and Naganishia ‒ were more abundant in MASH, while Saccharomyces dominated in advanced stages. These findings suggest that distinct fungal signatures accompany disease progression and may serve as potential biological markers in MASLD.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101200"},"PeriodicalIF":2.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amyloidosis and risk of psychiatric disorders-insights from a real-world nationwide registry.","authors":"Wei-Syun Hu, Po-Hsiang Liao, Cheng-Li Lin, Chih-Yang Huang","doi":"10.1016/j.clinsp.2026.101208","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101208","url":null,"abstract":"<p><strong>Objective: </strong>This is a National Health Insurance (NHI) database research investigating the association between amyloidosis and psychiatric disorders risk.</p><p><strong>Methods: </strong>The amyloidosis cohort was identified from insured individuals with amyloidosis, who were newly diagnosed from 2009 to 2019. Both cohorts were followed up and the subsequent psychiatric disorder was the major outcome event for the research. The multivariable model were used to examine the effect of amyloidosis and risk factor on the risk of developing psychiatric disorder.</p><p><strong>Results: </strong>The psychiatric disorder incidence was higher in the amyloidosis than in the comparison cohort (11.3 vs. 10.3 per 1000 person-years, crude HR = 1.10, 95% CI 1.02-1.19), with adjusted HR (aHR) of 1.26 (95% CI 1.16-1.36). After controlling for the confounders, amyloidosis cohort had a 1.38- fold higher risk of senile and pre-senile organic psychotic conditions (95% CI 1.22‒1.57), 1.26-fold higher risk of bipolar affective disorder (95% CI 1.10‒1.45), and 1.16-fold higher risk of other organic psychotic conditions than comparison cohort (95% CI 1.01-1.32).</p><p><strong>Conclusions: </strong>The authors found that compared to a matched amyloidosis naïve cohort, psychiatric disorders risk was significantly higher in patients with amyloidosis. Among different psychiatric disorders, risks of senile and pre-senile organic psychotic conditions, bipolar affective disorder and other organic psychotic conditions were higher among people with amyloidosis.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101208"},"PeriodicalIF":2.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prestin as a potential biomarker in peripheral blood: differential expression across hearing loss subtypes and acute inner ear injury.","authors":"Xuan Sun, Dian Wang, Yahan Zhao, Zhenghan Zhu, Lingxiang Hu, Yi Li","doi":"10.1016/j.clinsp.2026.101143","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101143","url":null,"abstract":"<p><strong>Objective: </strong>This exploratory study investigated peripheral blood Prestin levels across different hearing loss subtypes to evaluate its potential as a biomarker for inner ear injury.</p><p><strong>Methods: </strong>Plasma Prestin levels were measured via ELISA in 100 age-matched participants, comprising a healthy control group (HCG, n = 23) and patients with conductive (CHLG, n = 29) and unilateral sudden sensorineural hearing loss (USSNHLG, n = 48). Associations with hearing loss subtypes, initial audiogram configurations, and treatment outcomes were analyzed.</p><p><strong>Results: </strong>Overall, Prestin levels varied significantly across the three groups (P < 0.001). Following Dunn's test with Bonferroni correction, Prestin levels in the USSNHLG were significantly higher than those in the HCG (P = 0.019), whereas levels in the CHLG were significantly lower than those in the HCG (P = 0.014). Within the USSNHLG, no statistically significant differences in Prestin levels were observed among patients with different therapeutic outcomes (P = 0.102).</p><p><strong>Conclusions: </strong>The present findings confirm that acute inner ear injury (USSNHL) is associated with significantly elevated peripheral blood Prestin levels, whereas persistently reduced acoustic input (CHL) is associated with decreased levels. However, current data do not support baseline Prestin as a prognostic indicator for USSNHL. Future multicenter studies with strict clinical stratification are required to fully establish its clinical utility.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101143"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progesterone receptor variants and hormone therapy use in postmenopausal endometrial polyps: a case-control study.","authors":"Milton Wajman, Marcos Tcherniakovsky, Marina Martinelli Sonnenfeld, Marta Maria Arcoverde Cavalcanti Meniconi, Marília Franco de Oliveira, Thomas Moscovitz, Rogers Camargo Mariano da Silva, César Eduardo Fernandes, Emerson de Oliveira","doi":"10.1016/j.clinsp.2026.101216","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101216","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether Progesterone Receptor (PGR) variants +331G/A (rs10895068) and V660L (rs1042838, a PROGINS proxy) are associated with Endometrial Polyps (EP) in postmenopausal women undergoing hysteroscopy.</p><p><strong>Methods: </strong>This exploratory case-control study included 236 histopathologically confirmed EP cases and 73 hysteroscopy-negative controls from the same institution and period, unmatched. All eligible hysteroscopy-negative women during the study period were included, with no declinations. Genotyping of +331G/A and V660L was performed by PCR-HRM. Genetic comparisons used two-sided tests and multivariable logistic regression, with minimum detectable odds ratios estimated for 80% power at α = 0.05. Hormone Therapy (HT) and tamoxifen use were recorded as binary variables reflecting current use at hysteroscopy.</p><p><strong>Results: </strong>Genotype distributions did not differ between groups for +331G/A (p = 0.245) or V660L (p = 0.435); call rates were 100% for both variants. Neither +331G/A nor V660L carrier status was significantly associated with EP after adjustment (aOR = 0.43, 95% CI 0.17-1.09, p = 0.074; and aOR = 0.59, 95% CI 0.31-1.11, p = 0.100, respectively). Current HT use was inversely associated with EP (aOR = 0.15, 95% CI 0.06-0.40; p < 0.001), though regimen data were unavailable. Genetic associations remained non-significant in the model excluding HT.</p><p><strong>Conclusion: </strong>Neither PGR variant was significantly associated with EP. The sample could detect only relatively large effects, so smaller genetic associations cannot be excluded. The inverse association with binary HT exposure is hypothesis-generating rather than causal, given incomplete exposure characterization and the possibility of selection or residual confounding.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101216"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune parameters in hospitalized COVID-19 patients during SARS-CoV2 delta and omicron waves.","authors":"Geraldo S Magalhães, Sarah N C Gimenes, Bianca C L F Távora, José A Portes Junior, Paula A L Calabria, Leonel I Montealegre-Sanchez, Sandra C Sampaio Vessoni, Eduardo Massad, Celina A Lamas, Sergio S Muller, Tania Regina Tozetto-Mendoza, Maria Cássia Mendes-Correa, Carlos R R Carvalho, Eliana L Faquim-Mauro","doi":"10.1016/j.clinsp.2026.101213","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101213","url":null,"abstract":"<p><p>Understanding immune mechanisms associated with COVID-19 severity remains important for interpreting clinical outcomes. We investigated virological and immunological profiles in 39-patients hospitalized with COVID-19 at InCor Hospital during the Delta and Omicron waves and included 28-non-hospitalized individuals with moderate COVID-19 as a comparator group for cytokine analyses. SARS-CoV-2 infection was confirmed by RT-PCR from nasopharyngeal swabs, and viral variants were identified by next-generation sequencing. RNAemia was assessed by RT-PCR and analyzed as a binary variable. Serum cytokines were quantified by cytometric bead array, while humoral responses were evaluated by anti-Spike RBD IgG levels using CLIA and a Wuhan-Hu-1-based pseudovirus neutralization assay. RNAemia was more frequent in ICU-admitted patients than in non-ICU patients, supporting an association with disease severity. Cytokine profiling showed increased IL-6, IL-8, TNF, IL-17 A and IL-10 levels in hospitalized patients compared with moderate COVID-19 individuals, but did not distinguish recovered from deceased patients. Neutralizing antibody titers measured against a Wuhan-Hu-1 spike pseudovirus were significantly higher in recovered individuals than decease patients, underscoring the relevance of antibody functionality. These data emphasize the relevance of viral dissemination and functional humoral immunity as potential biomarkers for COVID-19 progression and outcome, with RNAemia and neutralizing antibody levels showing a stronger exploratory association in this cohort.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101213"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food intolerance/malabsorption in Hashimoto's thyroiditis.","authors":"Wolfgang J Schnedl, Simon Michaelis, Michael Schenk, Dietmar Enko, Sandra J Holasek","doi":"10.1016/j.clinsp.2026.101168","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101168","url":null,"abstract":"<p><strong>Context: </strong>The clinical significance of the interaction between the gastrointestinal system and the thyroid gland remains unclear. Moreover, a correlation between food intolerance/malabsorption, and thyroid disease, including Hashimoto's thyroiditis, awaits elucidation.</p><p><strong>Objectives: </strong>This study set out with the objective of identifying food intolerance/malabsorption, including Fructose Malabsorption (FM), Histamine Intolerance (HIT), and Lactose Intolerance (LIT), in patients presenting with abdominal symptoms within the Irritable Bowel Syndrome (IBS) spectrum who had also Hashimoto's thyroiditis.</p><p><strong>Methods: </strong>In this retrospective study, 221 patients with Hashimoto's thyroiditis, defined by elevated Thyroid Peroxidase Antibodies (TPO-Ab), were included. A subgroup of 50 abdominal asymptomatic Hashimoto's patients served as controls. Among 171 patients with abdominal symptoms FM and LIT were diagnosed using hydrogen breath tests, while HIT was defined by reduced serum diamine oxidase levels in combination with clinical response to a histamine-reduced diet.</p><p><strong>Results: </strong>Twenty-two were identified with FM, 40 with HIT and 42 with LIT; 19 had both LIT and FM, 31 had LIT and HIT, and 17 had LIT, FM, and HIT. However, there were no statistically significant differences in TSH or TPO-Ab levels between patients with FM, HIT, LIT, or their combinations (p = 0.739 and p = 0.460, respectively). Thyroid function and TPO-Ab levels were similar between symptomatic and asymptomatic patients.</p><p><strong>Conclusion: </strong>In summary, this study assumes that food intolerance/malabsorption, including FM, HIT, and LIT, may coexist in patients with Hashimoto's thyroiditis who present with IBS-spectrum abdominal symptoms.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101168"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of endoscopic management failure in benign non-caustic esophageal strictures: a retrospective cohort study.","authors":"Ilan David Friedmann, Sergio Szachnowicz, André Fonseca Duarte, Fauze Maluf-Filho, Rubens Sallum, Ulysses Ribeiro, Paulo Herman","doi":"10.1016/j.clinsp.2026.101174","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101174","url":null,"abstract":"<p><strong>Background: </strong>Benign Non-caustic Esophageal Strictures (BNES) often require repeated endoscopic dilations, yet a substantial proportion of patients remain refractory and ultimately require esophagectomy. Identifying predictors of endoscopic failure is essential for risk stratification and timely referral to alternative therapies. This study aimed to identify factors associated with endoscopic treatment failure leading to esophagectomy in patients with BNES.</p><p><strong>Methods: </strong>This retrospective cohort study included 51 patients with BNES treated at a single tertiary center from January 2004 to March 2026. Patients with caustic, malignant, or post-esophagectomy anastomotic strictures were excluded. Treatment consisted of balloon or bougie dilation. Endoscopic failure was defined as the need for esophagectomy due to persistent or recurrent dysphagia despite treatment. Multivariable logistic regression was performed to identify independent predictors of failure.</p><p><strong>Results: </strong>Of 51 patients, 18 (35.3%) required esophagectomy. Failure was associated with non-GERD etiology (p < 0.001), absence of hiatal hernia (p = 0.001), segmental strictures (p = 0.016), and a higher number of dilations (p = 0.026). In multivariable analysis, non-GERD etiology (OR = 7.45, p = 0.034) and absence of hiatal hernia (OR = 8.28, p = 0.016) were independent predictors. In a secondary model, absence of hiatal hernia (OR = 17.02, p = 0.011) and number of dilations (OR = 1.08 per session, p = 0.028) remained significant. Among endoscopically managed patients, 33.3% had persistent symptoms.</p><p><strong>Conclusions: </strong>One-third of BNES patients required esophagectomy. Non-GERD etiology, absence of hiatal hernia, and increasing dilation burden independently predict endoscopic failure and may support earlier consideration of surgical management.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101174"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of peripheral CD4⁺/CD8⁺ T-cell ratio with SYNTAX score and coronary stenosis severity in patients with coronary artery disease.","authors":"Wenhao Li, Chunzi Jin, Meina Piao, Xiang Li, Guangming Jin","doi":"10.1016/j.clinsp.2026.101211","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101211","url":null,"abstract":"<p><strong>Background: </strong>Coronary Artery Disease (CAD) is characterized by chronic immune-inflammatory activation. The relationship between the peripheral CD4+/CD8+ T-cell ratio and coronary stenosis severity remains unclear. We investigated its association with SYNTAX score and potential as a complementary marker.</p><p><strong>Methods: </strong>CD4+ and CD8+ T-cell counts were measured by flow cytometry in 297 patients with CAD and 181 controls. Coronary stenosis was assessed by angiography and SYNTAX score. Multivariable linear regression was used for SYNTAX score, and logistic regression for moderate-to-severe stenosis (SYNTAX > 23). Models were adjusted for age, sex, BMI, hypertension, diabetes, smoking, HbA1c, hs-CRP, creatinine, and medications. Benjamini-Hochberg FDR was applied. ROC analysis assessed incremental value beyond risk factors.</p><p><strong>Results: </strong>CD4+ counts and the CD4+/CD8+ ratio were higher, and CD8+ counts lower, in CAD patients, especially in acute coronary syndromes. In unadjusted analyses, SYNTAX score correlated positively with CD4+ count and the CD4+/CD8+ ratio and negatively with CD8+ count (weak to moderate). After adjustment, the CD4+/CD8+ ratio remained independently associated with SYNTAX score (β = 4.88, 95% CI 1.42-8.30, p = 0.006). For SYNTAX > 23, the ratio showed limited discrimination (AUC = 0.598, 95% CI 0.526-0.670; sensitivity 0.587, specificity 0.552 at cutoff 1.90). Adding the ratio to conventional risk factors showed no substantial incremental value (ΔAUC = 0.010, DeLong p = 0.43, NRI = 0.082, IDI = 0.006).</p><p><strong>Conclusions: </strong>Peripheral T-cell imbalance is associated with greater angiographic coronary complexity in CAD. However, the CD4+/CD8+ ratio has limited discriminatory ability and should be considered a complementary candidate marker, not a standalone diagnostic or predictive tool. Larger prospective multicenter studies are required.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101211"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological trend comparison and incidence prediction for elderly lung cancer in 204 countries and territories: a retrospective study.","authors":"Songjing Chen, Sizhu Wu","doi":"10.1016/j.clinsp.2026.101161","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101161","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer is widely prevalent worldwide at present, especially in the elderly population aged over 65-years. It is essential to timely understand epidemiological trends of elderly lung cancer and project the future incidence in global and regions, which could be conducive to reducing the incidence and mortality of lung cancer.</p><p><strong>Methods: </strong>We stratified the large-scale population through ages, genders, regions and countries and territories. Lung cancer incidence, mortality and Disability Adjusted Life Years (DALYs), with 95% uncertainty intervals, were separately computed in global, regional and national levels. Average Annual Percentage Changes (AAPCs) were calculated through join point regression model to assess the temporal trend of each year. We employed Deep Neural Networks (DNN) for predicting the global and regional incidence of lung cancer to 2050 by gender, age and socio-demographic index.</p><p><strong>Results: </strong>Lung cancer incidence, mortality and DALYs for the elderly people were derived in the global and Socio-Demographic Index (SDI) levels, regional levels and national levels through the stratification of age and gender. We predicted lung cancer incidence of the elderly through DNN model by the year of 2050. Lung cancer incidence of the elderly men was decreased nearly 11% from 1990 to 2021 globally, with the AAPC value of -0.36% (95% CI -0.42% ‒ -0.30%). Elderly lung cancer incidence in high SDI region had significant drop of 21% from 1990 to 2021. The prediction indicated the decline trend in incidence of elderly lung cancer worldwide. Elderly lung cancer incidence in the high SDI region would have obviously decrease by 2050, whereas the high-middle SDI region would have highest lung cancer incidence in the elderly than other SDI regions by 2050.</p><p><strong>Conclusions: </strong>This research analysed the epidemiological trends of lung cancer for the elderly in global, regional and national levels and predicted the incidence trend of elderly lung cancer by the year of 2050. The findings could illuminate the trend of incidence, mortality and DALYs for elderly lung cancer and contribute to lung cancer early diagnosis and treatment in the elderly.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101161"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}