Clinics (Sao Paulo, Brazil)最新文献

{"title":"Identification of biomarkers related to lymph node metastasis and prognosis in thyroid cancer based on integrated bioinformatics exploration.","authors":"Xuejian Hu, Dan Ge, Xiaolan Ma, Yan Yang","doi":"10.1016/j.clinsp.2026.101201","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101201","url":null,"abstract":"<p><strong>Objective: </strong>Thyroid Carcinoma (THCA) is a common endocrine malignancy, and Lymph Node Metastasis (LNM) is a critical determinant of poor prognosis. This study aimed to identify LNM-related biomarkers and establish a prognostic model for THCA patients using integrated bioinformatics approaches.</p><p><strong>Methods: </strong>Clinical data from SEER were analyzed to identify prognostic factors in THCA. Transcriptomic data from TCGA were used to identify differentially expressed genes between LNM and non-LNM samples. Survival analysis, machine learning (Boruta and LASSO), and functional enrichment were applied to screen candidate biomarkers. Immune infiltration and a ceRNA network were also explored.</p><p><strong>Results: </strong>Six independent prognostic factors were identified from SEER (n = 38,955): age, gender, marital status, race, pathologic T-stage, and pathologic M-stage. A nomogram incorporating these factors showed good predictive performance (AUC = 0.744). Transcriptomic analysis revealed 332 LNM-related genes. Through integrative machine learning, six biomarkers ‒ CLDN10, OTOS, NEXMIF, ACOT6, ASXL3, and SLC4A4 ‒ were selected. These genes were predominantly enriched in immune response and metabolic pathways. M0 macrophages and resting dendritic cells showed significant abundance differences between LNM and NLNM samples, with CLDN10 positively correlated with resting dendritic cells (R = 0.47, adjusted p < 0.01). A ceRNA network involving 14 miRNAs and 4 lncRNAs was constructed, with hsa-miR-15a-5p predicted to regulate SLC4A4, ASXL3, and NEXMIF.</p><p><strong>Conclusion: </strong>We identified six candidate LNM-related biomarkers and clinical factors associated with THCA prognosis. These findings provide a basis for further investigation into LNM mechanisms and may offer new perspectives for prognostic assessment, though independent validation is required.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101201"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198802","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":"Aerosolized prostaglandin E₁ improves oxygenation during one-lung ventilation: A dose-finding randomized controlled trial.","authors":"Pengxin Li, Xinyang Hu, Pengyi Li, Lingxi Xing, Qiang Wang, Lianbing Gu, Chunpei Wu","doi":"10.1016/j.clinsp.2026.101203","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101203","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to investigate the effects of varying doses of aerosolized Prostaglandin E&lt;sub&gt;1&lt;/sub&gt; (PGE&lt;sub&gt;1&lt;/sub&gt;) on oxygenation and intrapulmonary shunt fraction (Qs/Qt) during One-Lung Ventilation (OLV) under 60% Fraction of Inspired Oxygen (FiO&lt;sub&gt;2&lt;/sub&gt;). Secondary objectives included evaluating the impact on intraoperative hypoxemia, postoperative Clinical Pulmonary Infection Score (CPIS), and Postoperative Pulmonary Complications (PPCs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A prospective, single center, randomized, double-blind, controlled trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study was conducted at a single academic medical center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;A total of 160 patients aged 65‒84 years, with American Society of Anesthesiologists (ASA) physical status II or III and Body Mass Index (BMI) &lt; 30 kg/m&lt;sup&gt;2&lt;/sup&gt;, undergoing elective esophageal cancer surgery were enrolled. Patients with certain comorbidities, respiratory diseases, or contraindications to PGE&lt;sub&gt;1&lt;/sub&gt; were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Patients were randomly assigned to one of four groups: Group L ‒ Received 0.1 μg/kg PGE&lt;sub&gt;1&lt;/sub&gt; nebulization; Group M ‒ Received 0.2 μg/kg PGE&lt;sub&gt;1&lt;/sub&gt; nebulization; Group H ‒ Received 0.3 μg/kg PGE&lt;sub&gt;1&lt;/sub&gt; nebulization; Group C (control) ‒ Received normal saline nebulization. Nebulization was performed for 10-minutes via a modified breathing circuit into the ventilated lung before initiating OLV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Arterial blood gas parameters (arterial partial pressure of oxygen, PaO&lt;sub&gt;2&lt;/sub&gt;; arterial oxygen saturation, SaO&lt;sub&gt;2&lt;/sub&gt;; arterial partial pressure of carbon dioxide, PaCO&lt;sub&gt;2&lt;/sub&gt;), hemodynamic variables (Mean Arterial Pressure [MAP]; Heart Rate [HR]), respiratory mechanics (Peak airway pressure [Ppeak]; dynamic lung compliance [Cdyn]), PaO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; ratio, and Qs/Qt were recorded at multiple time points during OLV. The incidence of intraoperative hypoxemia and hypotension, PPCs within 7-days, and CPIS on postoperative day-2 were also assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;All PGE&lt;sub&gt;1&lt;/sub&gt; groups showed significantly improved PaO&lt;sub&gt;2&lt;/sub&gt;, SaO&lt;sub&gt;2&lt;/sub&gt;, and PaO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; ratio, and reduced Qs/Qt during the first 30-minutes of OLV compared to the control group. The High-dose group (H) demonstrated the greatest improvement in oxygenation. The incidence of intraoperative hypoxemia [Group L: 0/40 (0%), Group M: 0/40 (0%), Group H: 0/40 (0%), Group C: 3/40 (7.5%)] and hypotension did not differ significantly among groups; however, the hypoxemia finding was exploratory as the study was not powered for this endpoint. No significant differences were observed in PPCs incidence among groups, but group H was associated with a lower CPIS on postoperative day-2 compared to group C. Hemodynamic changes were transient and clinically manageable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/s","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101203"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198769","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 between android-to-gynoid lean mass ratio and advanced cardiovascular-kidney-metabolic syndrome, and the cross-sectional association decomposition of estimated glucose disposal rate.","authors":"Ye Zhang, Rui Zhuang, Zheng Zhuo, Chaofeng Niu, Chenxi Xu, Xuetong Wang, Bing Li, Ce Wang, Lijing Zhang, Meng Li","doi":"10.1016/j.clinsp.2026.101170","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101170","url":null,"abstract":"<p><strong>Background: </strong>The Android-to-Gynoid Lean Mass (LM) Ratio (AGLR) reflects the distribution of body LM and may influence the risk of advanced Cardiovascular-Kidney-Metabolic (CKM) syndrome. However, the extent to which Insulin Resistance (IR), as indicated by the estimated Glucose Disposal Rate (eGDR), explains the association between AGLR and advanced CKM syndrome remains unclear. This study aims to elucidate the relationship between AGLR and advanced CKM syndrome and to determine the contribution of eGDR to this association.</p><p><strong>Methods: </strong>7,399 participants from the 2003‒2006 and 2011‒2018 cycles of the National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study. The association between AGLR and advanced CKM syndrome was assessed using weighted Logistic Regression (LR) and subgroup analyses. The potential relationship was further examined using Restricted Cubic Splines (RCS). Sensitivity analyses were conducted to evaluate the robustness of the findings. Cross-sectional decomposition analysis was performed to quantify the contribution of eGDR to the observed associations.</p><p><strong>Results: </strong>Higher AGLR was associated with stage 4 of CKM syndrome (OR = 1.83, 95% CI: 1.34‒2.50, p < 0.001). For stage 3, the overall trend across quartiles was not significant, indicating a less robust association. Reverse causality cannot be excluded. RCS analysis revealed a positive linear relation (p for nonlinear = 0.681). Subgroup analyses suggested that interactions were statistically insignificant across subgroups. Cross-sectional decomposition analysis showed that eGDR statistically accounted for 33.71% of the association. Notably, given shared components and the cross-sectional design, this should not be interpreted as causal mediation.</p><p><strong>Conclusion: </strong>LM distribution is relevant to CKM syndrome progression. IR, as reflected by eGDR, may represent a key underlying pathological mechanism.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101170"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198746","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 early CD4⁺ T-lymphocyte depletion with 28 day mortality in sepsis: a retrospective single-center cohort study.","authors":"Deng Pan, Pin Peng, Yu Fang, Jun Lu, Wendi Zhang, Shanshan Hu, Minghao Fang","doi":"10.1016/j.clinsp.2026.101173","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101173","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis-induced immune dysregulation, characterized by T-cell loss, is associated with poor outcomes. This study investigated the association between early peripheral T-lymphocyte subset profiles and 28 day mortality in patients with sepsis.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, 60 critically ill patients with sepsis and 30 healthy controls were included. Patients with sepsis were classified as 28 day survivors (n = 30) or non-survivors (n = 30). Peripheral T-lymphocyte subset percentages (CD3⁺, CD4⁺, and CD8⁺) were measured by flow cytometry within 24 h of ICU admission.</p><p><strong>Results: </strong>Compared with healthy controls, patients with sepsis had lower CD3⁺ (55.23±9.15%vs. 68.12±8.04%) and CD4⁺ T-cell percentages (30.88±10.52%vs. 40.15±7.21%) and a lower CD4⁺/CD8⁺ ratio (all p < 0.001). Non-survivors had lower CD3⁺ and CD4⁺ T-cell percentages than survivors (both p < 0.001). In multivariable logistic regression, lower CD4⁺ T-cell percentage (OR = 0.85, 95% CI 0.77-0.94; p = 0.002) and higher APACHE II score (OR = 1.42, 95% CI 1.18-1.71; p < 0.001) were independently associated with 28-day mortality. Adding CD4⁺ T-cell percentage to APACHE II increased the area under the receiver operating characteristic curve from 0.86 to 0.91 (p = 0.03).</p><p><strong>Conclusion: </strong>Early reduction in peripheral CD4⁺ T-cell percentage was independently associated with 28 day mortality in this selected cohort. CD4⁺ T-cell assessment may provide incremental prognostic information beyond APACHE II, but external validation in larger prospective cohorts is required.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101173"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198809","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":"Chest pain in the emergency room: value of the new HEAR score identifying patients with low risk of acute coronary syndrome without troponin testing.","authors":"Thibaut Pommier, Eddy Portella, Pierre Guilleminot, Adrien Goldstein, Gabriel Laurent, Charles Guenancia, Patrick Ray","doi":"10.1016/j.clinsp.2026.101214","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101214","url":null,"abstract":"<p><strong>Background: </strong>Chest pain is a frequent reason for Emergency Department (ED) visits, although only a minority of patients ultimately present an Acute Coronary Syndrome (ACS). Current diagnostic strategies rely heavily on troponin testing, but a new clinical tool requiring no blood sampling, the HEAR score, has recently been proposed. This study aimed to evaluate the performance of the HEAR score for identifying low-risk patients presenting with chest pain, using 45-day Major Adverse Cardiovascular Events (MACE) as the primary outcome.</p><p><strong>Methods: </strong>All patients presenting with chest pain to the ED of Dijon University Hospital in 2019 were retrospectively analyzed in this single-center study. Patients were stratified as \"low risk\" (HEAR < 2) or \"high risk\" (HEAR ≥ 2). Outcomes assessed at 45-days included MACE (defined as a composite of all-cause death, non-fatal myocardial infarction, and urgent coronary revascularization) and recurrence of ED consultation for chest pain.</p><p><strong>Results: </strong>Among 2177 patients presenting with chest pain, 1807 met inclusion criteria. Of these, 653 (36%) were classified as low risk (HEAR < 2). At 45-days, 22 (3%) low-risk patients reconsulted for chest pain compared with 64 (6%) in the high-risk group (p = 0.037). No MACE was identified among low-risk patients within the available follow-up data. The negative predictive value of a HEAR score < 2 was 100% (95% CI: 99.5%-100%), with an upper 95% confidence bound for the event rate of 0.46%.</p><p><strong>Conclusion: </strong>A HEAR score < 2 identifies a substantial proportion of ED chest pain patients at very low risk of short-term adverse cardiovascular events. However, given the limitations of retrospective follow-up and potential under-ascertainment of events, these findings should be considered hypothesis-generating. The HEAR score may contribute to early clinical risk stratification rather than replace troponin-based strategies.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101214"},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198824","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":"Determinants of parliamentary health funding allocation in Brazil: A national cross-sectional study.","authors":"Mariana G Magon, Marcio R Facanali, José Maria Soares, Sarah Emmely Fazanaro, Everson L A Artifon","doi":"10.1016/j.clinsp.2026.101198","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101198","url":null,"abstract":"<p><p>Parliamentary amendments are an important mechanism for health resource allocation in Brazil, but little is known about the characteristics of actors involved in mobilizing these resources. This national cross-sectional web-based survey included 276 respondents, each reporting on the usual amendment allocation pattern of a parliamentary office in 2025. The outcome was categorized as higher-magnitude (> BRL 1,000,000; n = 124) or lower-magnitude (≤ BRL 1,000,000; n = 152). Associations with individual, institutional, political, and allocation-related variables were examined using multivariable logistic regression with backward selection based on the Akaike information criterion. Higher-magnitude allocations were associated with relevance attributed to party affiliation (adjusted Odds Ratio [aOR = 2.80], 95% Confidence Interval [95% CI 1.46-5.55]), prioritization of capital investment (aOR = 1.79, 95% CI 1.07-3.02), and representation by a professional advisory intermediary (aOR = 1.94, 95% CI 1.16-3.29). Extroverted personality profile (aOR = 0.36, 95% CI 0.15-0.81), an advisory position within the parliamentary office (aOR = 0.51, 95% CI 0.28-0.92), and prioritization of higher-complexity care (aOR = 0.58, 95% CI 0.34-0.97) were inversely associated with higher-magnitude allocation. The final model showed moderate apparent discrimination (AUC = 0.716). Reported amendment magnitude was associated with political alignment, allocation strategy, and intermediary characteristics. These exploratory findings should be interpreted in light of the cross-sectional design, purposive sampling, and respondent-reported outcome.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101198"},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198749","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":"Earlier onset of type 2 diabetes mellitus as a risk factor for Irvine-Gass syndrome.","authors":"Yingxia Yin, Yu Du, Junyi Wang, Wan Lu, Shancheng Si","doi":"10.1016/j.clinsp.2026.101204","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101204","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between age at type 2 diabetes mellitus (T2DM) onset and the risk of Irvine-Gass Syndrome (IGS) following uneventful phacoemulsification with intraocular lens implantation (PEI).</p><p><strong>Methods: </strong>This retrospective case-control study analyzed 190 participants (39 IGS, 151 non-IGS) who underwent uneventful PEI. Comprehensive demographic, systemic, and perioperative data were collected. Statistical analyses included between-group comparisons, logistic regression, and Receiver Operating Characteristic (ROC) curve analysis to identify independent IGS predictors and determine optimal risk-stratification thresholds.</p><p><strong>Results: </strong>While overall T2DM prevalence was comparable between groups (p = 0.168), IGS patients had significantly earlier diabetes onset (49.05±8.61 vs. 59.23±10.65 years, p < 0.001). Multivariable analysis confirmed younger T2DM onset age as an independent IGS predictor (OR = 1.094 per year decrease, 95% Confidence Interval [95% CI 1.015‒1.179], p = 0.019). ROC analysis identified T2DM onset age ≤ 55.5-years as the optimal predictive threshold (Area Under the ROC Curve [AUROC = 0.774], sensitivity = 73.7%, specificity = 78.9%). Participants stratified by this threshold showed significantly different IGS incidence (non-diabetic: 15.32%; younger-onset T2DM: 56.67%; older-onset T2DM: 10.20%; p < 0.001). Younger-onset T2DM patients had approximately 5.5-fold higher IGS odds versus non-diabetics (adjusted OR = 5.499, 95% CI 2.104‒14.373, p = 0.001).</p><p><strong>Conclusions: </strong>Earlier T2DM onset (≤ 55.5-years) is a strong independent risk factor for IGS following uneventful PEI. This threshold provides a clinically useful tool for preoperative risk stratification, particularly valuable for identifying high-risk diabetic patients who may benefit from enhanced perioperative monitoring and management.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101204"},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187435","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":"In-laboratory polysomnography as the reference standard in sleep research: a bibliometric overview of human studies.","authors":"Panpan Liu, Mingzhu He, Wenlong Xing, Guiqing Zhang, Shangli Zhang","doi":"10.1016/j.clinsp.2026.101157","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101157","url":null,"abstract":"<p><strong>Background: </strong>In-laboratory attended Polysomnography (PSG) is the reference standard for objective sleep assessment. Although portable and wearable sleep technologies have advanced, the evolution of PSG research over the past decade has not been systematically characterized.</p><p><strong>Methods: </strong>Bibliometric data from the Web of Science Core Collection (2015-2025) were retrieved using a search strategy focused on in-laboratory, full-night PSG studies, yielding 462 publications for analysis. VOSviewer, CiteSpace, and Microsoft Excel were used to conduct visual and quantitative analyses of publication trends, country- and institution-level co-authorship, journal distribution, author keywords, and keywords bursts.</p><p><strong>Results: </strong>Annual publications exhibited a steady increase, with the United States and China as the leading contributors. Prominent institutions included Eindhoven University of Technology and Seoul National University. PSG research was predominantly published in specialized sleep medicine journals. Keyword analysis revealed a stable thematic core encompassing sleep monitoring, sleep staging, and sleep apnea, alongside emerging trends in machine learning, wearable devices, and brain modeling.</p><p><strong>Conclusion: </strong>Within the corpus of included in-laboratory PSG studies, research outputs demonstrated a sustained trajectory, exhibiting a pattern of parallel development between clinical applications and technical refinement. While PSG remains a foundational methodological pillar in this specific domain, its evolving integration with advanced computational methods underscores a continued commitment to bridging clinical relevance and technological progress within PSG-focused research.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101157"},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187491","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":"Neurodevelopmental risk in a referred sample of hospitalized children with congenital heart disease: interrelation between communication and feeding vulnerabilities.","authors":"Camila Pimentel-Piemonte, Fernanda Chiarion Sassi, Ana Paula Ritto, Gisele Chagas de Medeiros, Claudia Regina Furquim de Andrade","doi":"10.1016/j.clinsp.2026.101199","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101199","url":null,"abstract":"<p><strong>Objective: </strong>To determine the prevalence of communication developmental risk in hospitalized children with Congenital Heart Disease (CHD) and to identify clinical, surgical, and hospitalization-related factors independently associated with increased risk.</p><p><strong>Methods: </strong>This cross-sectional observational study was conducted at a tertiary pediatric cardiac center between September 2024 and April 2025. Sixty-five children referred for speech-language pathology assessment underwent communication development screening using a structured developmental observation protocol. Functional feeding status was assessed using the Pediatric Functional Oral Intake Scale. Multivariable logistic regression was used to identify factors independently associated with communication developmental risk, with Firth's penalized logistic regression performed as a sensitivity analysis given the low events-per-variable ratio.</p><p><strong>Results: </strong>Twenty-five children (38%) were classified as being at risk for delayed communication development. Hospitalization in a ward setting, compared with intensive care, was independently associated with lower odds of risk classification (adjusted OR = 0.13, 95% CI 0.02‒0.77, p = 0.025), an association confirmed by the Firth sensitivity analysis (adjusted OR = 0.18, 95% CI 0.03‒0.80, p = 0.024). Length of hospital stay, cyanotic physiology, cardiopulmonary bypass duration, and aortic cross-clamp time were not independently associated with risk. Children classified as at risk also showed significantly greater feeding restrictions.</p><p><strong>Conclusion: </strong>Communication developmental risk was common among hospitalized children with CHD. Hospitalization setting and feeding performance, rather than traditional markers of clinical severity, were associated with communication risk, suggesting a multifactorial model that integrates biological, functional, and environmental factors. These findings suggest that feeding function, alongside hospitalization setting, may help flag children at higher developmental risk before formal communication assessment is available. These exploratory findings support incorporating structured developmental surveillance into routine pediatric cardiac care.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101199"},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187461","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":"Predicting acute kidney injury in type B aortic dissection: development and validation of a clinical nomogram.","authors":"Weijian Chen, Zhengfei Li, Xiaojun Shu","doi":"10.1016/j.clinsp.2026.101209","DOIUrl":"https://doi.org/10.1016/j.clinsp.2026.101209","url":null,"abstract":"<p><strong>Objectives: </strong>Acute Kidney Injury (AKI) is a frequent and serious complication in patients with Type B Aortic Dissection (TBAD). Existing prediction models are mainly derived from type A or mixed cohorts and do not account for the distinct pathophysiology of TBAD. This study aimed to develop and validate a nomogram for individualized AKI risk prediction in TBAD patients.</p><p><strong>Methods: </strong>Data were obtained from the eICU Collaborative Research Database (eICU-CRD) and the Medical Information Mart for Intensive Care IV (MIMIC-IV). The eICU-CRD cohort was used for model development and internal validation, while MIMIC-IV served for external validation. A three-step variable selection strategy combining Least Absolute Shrinkage and Selection Operator (LASSO), univariate, and multivariate logistic regression analyses was applied. Model performance was evaluated using the Area Under the receiver operating characteristic Curve (AUC), calibration curves, and Decision Curve Analysis (DCA).</p><p><strong>Results: </strong>Six independent predictors were identified: ICU length of stay, minimum glucose, minimum sodium, maximum bicarbonate, minimum creatinine, and minimum diastolic blood pressure. The nomogram showed excellent discrimination, with AUCs of 0.926 (95% CI: 0.893-0.956), 0.922 (95% CI: 0.869-0.967), and 0.921 (95% CI: 0.895-0.944) in the training, internal validation, and external validation cohorts, respectively. Calibration analysis demonstrated good agreement, and DCA indicated clinical utility within a threshold probability range of 0-70%.</p><p><strong>Conclusions: </strong>This study developed a practical nomogram based on six readily available variables for dynamic in-hospital prediction of AKI in TBAD patients. The model may assist early risk stratification, although further prospective validation is warranted.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101209"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187459","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}