Clinics (Sao Paulo, Brazil)最新文献

{"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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of transcutaneous vagus nerve stimulation on motor function in older adults: a randomized crossover study.","authors":"Silvia Ataides Alves Santana, Fernando Zanela da Silva Arêas, Sandy Daniely Alves Santana, Taize Iolanda de Souza Ferreira, Maycon Pelosato Duarte, Francisdeise Suave Santos, Leila Dutra de Oliveira, Cassia da Luz Goulart, Fernando Fonseca de Almeida Val, Guilherme Peixoto Tinoco Areas","doi":"10.1016/j.clinsp.2026.101141","DOIUrl":"10.1016/j.clinsp.2026.101141","url":null,"abstract":"<p><strong>Background: </strong>Aging is associated with declines in gait performance and autonomic regulation, increasing the risk of functional limitations. Auricular transcutaneous Vagus Nerve Stimulation (tVNS) is a promising non-pharmacological intervention, but its acute effects on gait in older adults remain unclear. This study investigates whether acute tVNS can improve gait performance and autonomic function in healthy community-dwelling older women.</p><p><strong>Methods: </strong>A prospective, randomized, blinded, crossover trial was conducted with 17 healthy older women (≥60-years). Participants received active tVNS (left ear, 25 Hz, 500 μs, 30-min) and sham stimulation (right earlobe), separated by a 24-hour washout period. The primary outcome was the distance covered on the 6-Minute Walk Test (6MWT). Heart Rate Variability (HRV) was assessed as a key secondary outcome.</p><p><strong>Findings: </strong>Active tVNS significantly increased the resting Inter-Beat Interval (IBI, p = 0.008) and reduced heart rate (p = 0.03), indicating enhanced parasympathetic modulation. Sympathetic activity (LF and LF/HF ratio) decreased following active stimulation. Although absolute 6MWT distance did not significantly change (p = 0.07), the predicted walking distance improved significantly with active tVNS compared to sham (p < 0.01; Cohen's d = 0.65; mean difference -7.2%). Other clinical parameters remained unchanged.</p><p><strong>Interpretation: </strong>This first randomized crossover trial investigating the acute effects of transcutaneous vagus nerve stimulation in healthy older women demonstrated enhanced parasympathetic modulation and improved performance relative to predicted walking capacity. However, the primary outcome, absolute 6-minute walk distance, did not reach statistical significance. These findings should therefore be considered preliminary and hypothesis-generating, supporting the need for larger trials to determine the long-term clinical relevance of tVNS in older populations.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101141"},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a low-dose gonadotropin protocol for controlled ovarian stimulation at a University Assisted Reproduction Center.","authors":"Mayra Satiko Lemos Nakano, Edmund Chada Baracat, José Maria Soares Júnior, Henrique Penna Fazão, Tatiana Carvalho de Souza Bonetti, Pedro Augusto Araújo Monteleone","doi":"10.1016/j.clinsp.2026.101178","DOIUrl":"10.1016/j.clinsp.2026.101178","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the effectiveness of a low-dose gonadotropin protocol for Controlled Ovarian Stimulation (COS) in In Vitro Fertilization (IVF) for patients with a good prognosis attending a public health university care center.</p><p><strong>Study design: </strong>A randomized, non-inferiority, single-blind clinical trial. This study included 90 couples undergoing IVF cycles. Patients were randomized to receive either the regular-dose (REG-DOSE, n = 46) or low-dose (LOW-DOSE, n = 44) gonadotropin protocol. The REG-DOSE group received menotropin (225 IU/day), while the LOW-DOSE group received the combination of clomiphene citrate (Clomid®) and menotropin (150 IU/day). The primary outcome was the number of blastocysts available for transfer.</p><p><strong>Results: </strong>The REG-DOSE and LOW-DOSE groups had similar blastocyst development rates (49.9% and 54.8%; p = 0.463). The secondary outcomes measured, such as ongoing pregnancy rates after the first embryo transfer (23.7% and 26.5%; p = 0.729) and the cumulative clinical pregnancy rates (34% and 30%; p = 0.726), respectively, were also comparable.</p><p><strong>Conclusions: </strong>Results provide strong evidence that low-dose gonadotropin protocols for COS in good prognosis IVF patients yield comparable clinical outcomes to regular-dose protocols, with the added benefit of reduced treatment costs. These results support the clinical equivalence of low-dose protocols in selected patients and highlight their potential to reduce costs and increase access to IVF, particularly in public healthcare systems.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101178"},"PeriodicalIF":2.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategic considerations for advancing research in intradural extramedullary cervical schwannomas: a call for a multicenter registry.","authors":"Ilker Sengul, Demet Sengul","doi":"10.1016/j.clinsp.2026.101130","DOIUrl":"10.1016/j.clinsp.2026.101130","url":null,"abstract":"","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101130"},"PeriodicalIF":2.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between systemic inflammation and long-term mortality in emergency department patients with severe hypertension.","authors":"Byungwoo Yoo, Byung Sik Kim, Hyun-Jin Kim, Jeong-Hun Shin","doi":"10.1016/j.clinsp.2026.101186","DOIUrl":"10.1016/j.clinsp.2026.101186","url":null,"abstract":"<p><strong>Background: </strong>The prognostic role of systemic inflammatory indicators in patients with severe hypertension remains unclear. This study evaluated the associations between several inflammatory markers, including Neutrophil-to-Lymphocyte Ratio (NLR), Lymphocyte-to-Monocyte Ratio (LMR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), C-Reactive Protein (CRP) level, and long-term mortality.</p><p><strong>Methods: </strong>This retrospective cohort included 5,320 adult patients presenting to the emergency department with severe hypertension (systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg) between 2016 and 2019. All patients underwent complete blood counts and CRP testing. Patients were categorized into tertiles for each inflammatory marker.</p><p><strong>Results: </strong>Higher tertiles of NLR, PLR, SII, and CRP were associated with increased 3-year all-cause mortality, while higher LMR was associated with lower mortality. Adjusted hazard ratios (95% Confidence Intervals) comparing the highest to lowest tertiles were: NLR 1.61 (1.35-1.92), LMR 0.71 (0.60-0.85), PLR 1.22 (1.03-1.44), SII 1.57 (1.33-1.86), and CRP 2.21 (1.84-2.65). Dose-response analyses revealed linear associations between NLR and SII, an inverse J-shaped pattern for LMR, a J-shaped curve for PLR, and a nonlinear positive association for CRP. CRP showed the highest discriminatory performance among the evaluated markers.</p><p><strong>Conclusion: </strong>Systemic inflammatory indicators were associated with long-term mortality in patients with severe hypertension. These findings suggest that inflammatory markers may provide prognostic information in this population, although their role in risk stratification and follow-up planning requires further evaluation.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101186"},"PeriodicalIF":2.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Report-based frequency of retrodiscal tissue rupture in routine temporomandibular joint MRI reports: a retrospective cohort study.","authors":"Nataliia Savychuk, Vasyl Pekhno, Roman Osnach, Vitalii Bida","doi":"10.1016/j.clinsp.2026.101128","DOIUrl":"10.1016/j.clinsp.2026.101128","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify the report-based frequency and laterality of retrodiscal tissue rupture documented in routine temporomandibular joint MRI reports in a selected clinical cohort.</p><p><strong>Study design: </strong>Retrospective cohort study based on routine clinical TMJ MRI reports. After eligibility verification of the initial de-identified archive, two records were excluded because they did not represent eligible patient-level TMJ MRI examinations: one was a non-TMJ examination and one was a non-patient/non-case document. The final analytic dataset comprised 285 patients and 570 joints.</p><p><strong>Results: </strong>Report-documented retrodiscal tissue rupture was identified in 254 of 570 joints (44.56%; 95% CI 40.53-48.66). Report-documented absence of rupture was recorded in 124-joints (21.75%), whereas 192-joints (33.68%) had unknown or indeterminate report status. At the patient level, rupture in at least one joint occurred in 158 of 285 patients (55.44%; 95% CI 49.63-61.10), including bilateral report-documented rupture in 96 patients (33.68%; 95% CI 28.45-39.36). In paired laterality testing restricted to patients with fully known bilateral report status (n = 168), no statistically detectable imbalance between right-only and left-only report-documented rupture was observed (exact McNemar p = 0.377; discordant pairs: right-only 19, left-only 13). Valid age data were available for 265 of 285 patients (92.98%); age-related findings were interpreted descriptively.</p><p><strong>Conclusions: </strong>Report-documented retrodiscal tissue rupture was frequent in this selected referred TMJ MRI cohort and was often bilateral. Laterality and age-related findings should be interpreted cautiously because the study was retrospective, report-based, and affected by unknown/indeterminate report status, incomplete age data, and absence of standardized clinical correlation.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101128"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological and reporting concerns regarding \"Melatonin improves fertilization rate in assisted reproduction: systematic review and meta-analysis\".","authors":"Sedighe Esmaeilzadeh, Parvaneh Manabí","doi":"10.1016/j.clinsp.2026.101148","DOIUrl":"10.1016/j.clinsp.2026.101148","url":null,"abstract":"","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101148"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapy dose, recovery phase, and patient factors influencing language outcomes in post-stroke aphasia.","authors":"Laura Carbonero Sancho, Olalla Saiz-Vázquez, Juan Hilario Ortiz-Huerta, Montserrat Santamaría-Vázquez","doi":"10.1016/j.clinsp.2026.101152","DOIUrl":"10.1016/j.clinsp.2026.101152","url":null,"abstract":"<p><strong>Background: </strong>Therapy dose is increasingly recognized as an important factor influencing language recovery in post-stroke aphasia, yet evidence from routine clinical practice remains limited.</p><p><strong>Objective: </strong>To examine the relationship between total therapy dose and language outcomes, and to explore the influence of sex, recovery phase, and aphasia type.</p><p><strong>Methods: </strong>A longitudinal pre-post study was conducted with 20 adults with aphasia who received eight weeks of individualized speech-language therapy in three rehabilitation centers in Spain. Language performance was assessed with the Spanish version of the Mississippi Aphasia Screening Test (MASTsp). Statistical analyses included Wilcoxon tests, Spearman correlations, regression models, and non-parametric comparisons.</p><p><strong>Results: </strong>Participants showed significant improvement after intervention (p = 0.003). Therapy dose correlated positively with language gains (r = 0.624, p = 0.003), and receiving ≥ 20 h predicted greater improvement (p = 0.019). Sex and aphasia type did not significantly influence outcomes. Recovery phase showed a significant effect, with individuals in the acute and subacute stages improving more than those in the chronic phase (p = 0.046).</p><p><strong>Conclusions: </strong>A minimum of 20 therapy hours over eight weeks appears beneficial for language recovery in post-stroke aphasia. Recovery phase emerged as a relevant factor, while sex and aphasia type showed no measurable impact. These findings contribute practice-based evidence supporting the role of therapy dose in aphasia rehabilitation.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101152"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation and discriminatory performance of non-invasive serum fibrosis indices according to liver disease etiology using two-dimensional shear wave elastography as reference.","authors":"María Elena Galaviz-Valdez, Liliana Torres-González, José Raúl Izaguirre-García, Linda E Muñoz-Espinosa, Diana Patricia Moreno-Peña, Diana Raquel Rodríguez-Rodríguez, Idalia A Cura-Esquivel, Paula Cordero-Pérez","doi":"10.1016/j.clinsp.2026.101187","DOIUrl":"10.1016/j.clinsp.2026.101187","url":null,"abstract":"<p><strong>Background/objectives: </strong>Non-invasive serum fibrosis indices are widely used for liver fibrosis assessment; however, their correlation with liver stiffness and diagnostic performance may vary according to liver disease etiology. This study aimed to evaluate the etiology-dependent correlation between multiple serum Non-Invasive Test (NITs) indices and liver stiffness measured by two-dimensional Shear Wave Elastography (2D-SWE), and to explore their ability to discriminate patients according to 2D-SWE-based fibrosis categories.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study including 105 patients with chronic liver disease. Serum NITs indices were correlated with liver stiffness measured by 2D-SWE using Pearson or Spearman correlation Exploratory ROC curve analyses were performed to assess the ability of serum indices to discriminate 2D-SWE-based fibrosis categories by etiology.</p><p><strong>Results: </strong>Strong intercorrelations were observed among multiple serum NITs indices across all etiological groups, indicating substantial collinearity. In metabolic-associated steatotic liver disease, alcohol-related liver disease, and metabolic dysfunction-associated alcohol-related liver disease, correlations between serum indices and liver stiffness were weak to moderate. In contrast, viral hepatitis showed moderate and statistically significant correlations between several indices and 2D-SWE, with more consistent diagnostic performance in ROC analyses. Autoimmune hepatitis demonstrated an intermediate pattern, with modest but significant associations between selected indices and liver stiffness. Exploratory ROC analyses showed heterogeneous discriminatory performance across etiologies.</p><p><strong>Conclusions: </strong>Serum NITs indices exhibit high collinearity and etiology-dependent performance. Their correlation with liver stiffness and their discriminatory performance against 2D-SWE-based fibrosis categories vary according to underlying liver disease supporting the complementary rather than interchangeable use of serum indices and elastography.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101187"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}