Clinics (Sao Paulo, Brazil)最新文献

{"title":"Impact of expiratory muscle strength training on swallowing function in Parkinson's disease: insights from high-resolution videomanometry.","authors":"Fernanda Cristina de Oliveira Rocha, Charles Henrique Dias Marques, Eponina Maria Oliveira Lemme, Luiz João Abrahão-Júnior","doi":"10.1016/j.clinsp.2026.101167","DOIUrl":"10.1016/j.clinsp.2026.101167","url":null,"abstract":"<p><strong>Introduction: </strong>Expiratory Muscle Strength Training (EMST) is used for the rehabilitation of oropharyngeal dysphagia in patients with Parkinson's Disease (PD).</p><p><strong>Materials & methods: </strong>Twenty individuals (16-men) with PD underwent High-Resolution Videomanometry (HRVM) before, during, and after training.</p><p><strong>Results: </strong>Participants' mean age was 68.2 ± 8.5 years, with PD staging corresponding to Hoehn and Yahr stage 2 (1.0-3.6). Maximum Expiratory Pressure (MEP) was 79.2 ± 24 cmH₂O. After training, there was an increase in laryngeal elevation and total displacement (10 mL nectar; r = 0.46, 95% CI [0.8, 8.8], p = 0.044 and r = 0.53, 95% CI [1.5, 5.9], p = 0.018, respectively). In addition, Intrabolus Pressure (IBP) increased during uncontrolled swallowing (nectar; r = 0.56, 95% CI [4.9, 18.6], p = 0.017). Moderate direct and inverse correlations were observed. A direct correlation was found between the Upper Esophageal Sphincter (UES) opening size and age (10 mL nectar; p = 0.037), and between laryngeal anteriorization and stage (10 mL nectar; p = 0.012). An inverse correlation was observed between UES opening size and MEP (10 mL pudding; p = 0.020). A direct correlation was observed between UES relaxation time and stage (10 mL nectar; p = 0.051), and between IBP during uncontrolled swallowing and stage (p = 0.008). The nadir of UES relaxation during uncontrolled swallowing showed a direct correlation with MEP (p = 0.031) and an inverse correlation with stage (p = 0.005).</p><p><strong>Conclusion: </strong>EMST influences laryngeal displacement. Disease stage, age, and MEP are relevant parameters that should be analyzed during PD rehabilitation. HRVM is a comprehensive tool for evaluating the impacts of EMST both during execution and on swallowing function in patients with PD.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101167"},"PeriodicalIF":2.4,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13636329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067101","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":"Clinical features of acute-onset autoimmune hepatitis: a systematic review and meta-analysis.","authors":"Xiaotian Dong, Jinhua Zhang, Yufan Guan, Jiaze An","doi":"10.1016/j.clinsp.2026.101118","DOIUrl":"10.1016/j.clinsp.2026.101118","url":null,"abstract":"<p><strong>Background and aims: </strong>Autoimmune Hepatitis (AIH), a rare chronic progressive inflammatory disease of the liver, and acute-onset AIH usually lack typical manifestations and have a poor prognosis. Hence, we have systematically examined all accessible data on the clinical features of acute-onset AIH to aid clinicians in deepening their understanding of the disease.</p><p><strong>Methods: </strong>Eligible studies were gathered from a computer search of literature published from the inception of the database to June 2024 in PubMed and CNKI. Data on basic features, clinical manifestations, laboratory examinations, clinical outcomes, and pathological results were collected as relevant outcomes.</p><p><strong>Results: </strong>Thirty-two retrospective studies encompassing 2,561 patients, and four cohort studies involving 419 patients were ultimately included. Approximately 31% of AIH patients present with acute disease onset, with 58% being acute non-severe, 25% acute severe, and 17% commencing with fulminant liver failure. Patients with acute-onset AIH tend to be younger (OR = 0.25, 95% CI: -0.449 to -0.057) and exhibit a diminishing female predilection that increases with severity compared to the more chronic classic AIH (OR = 0.65, 95% CI: 0.569‒0.727). The presence of comorbid extrahepatic autoimmune disease showed a potential protective effect when compared with C-AIH (OR = 0.63, 95% CI: 0.455‒0.874).</p><p><strong>Conclusions: </strong>About 30% of patients with AIH exhibit an acute disease onset, understanding its proportion and clinical features aids clinicians in making timely diagnoses to prevent severe consequences. However, in existing studies, the results of laboratory tests and histologic examinations of A-AIH are influenced by AC-AIH to varying degrees, which somewhat restricts the clinicians' understanding.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101118"},"PeriodicalIF":2.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043334","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":"Noninvasive ventilation use and ICU mortality in COVID-19-related acute respiratory failure: a retrospective cohort study.","authors":"Josehélen Martini, Francisco Xavier de Araujo, Gabriela Machado Costa, Camilo Corbellini, Erika Meléndez-Oliva, Eleuterio A Sánchez-Romero, Rob Sillevis, Juan Nicolás Cuenca-Zaldívar, Viviane Martins Corrêa Boniatti","doi":"10.1016/j.clinsp.2026.101159","DOIUrl":"10.1016/j.clinsp.2026.101159","url":null,"abstract":"<p><strong>Background: </strong>Acute hypoxemic respiratory failure is a severe complication of Coronavirus Disease 2019 (COVID-19) frequently requiring Intensive Care Unit (ICU) admission. The association between Noninvasive Ventilation (NIV) and outcomes in critically ill patients remains uncertain.</p><p><strong>Objective: </strong>To evaluate the association between NIV use and clinical outcomes in patients with COVID-19-related acute respiratory failure.</p><p><strong>Methods: </strong>This retrospective cohort study included adults with confirmed COVID-19 admitted to the ICU of a tertiary hospital in Porto Alegre, Brazil, between March and August 2021. Patients were categorized according to two periods with different NIV implementation strategies. Survival was evaluated using Kaplan-Meier analysis, and ICU mortality predictors were assessed using multivariable Cox regression.</p><p><strong>Results: </strong>A total of 296 patients were included. NIV use increased between periods (2.4%vs. 77.8%; p < 0.001). The overall intubation rate was 90.5%, with no significant differences between periods (p = 0.139). Patients admitted during the second period had more severe hypoxemia and higher crude ICU mortality (58.5%vs. 43.2%; p = 0.013). In the multivariable Cox model, absence of NIV use was associated with a lower adjusted hazard of ICU mortality compared with NIV use (HR = 0.383; 95% CI 0.158-0.929; p = 0.034).</p><p><strong>Conclusions: </strong>NIV use increased markedly but was not associated with lower intubation rates. Patients receiving NIV had higher observed adjusted mortality; however, this association should not be interpreted as evidence of harm from NIV and likely reflects confounding by indication and treatment selection, as NIV was preferentially used in patients with more severe respiratory failure. Prospective studies are needed to clarify the role of NIV in critically ill patients with COVID-19.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101159"},"PeriodicalIF":2.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032930","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":"A pioneering transition program for adults with phenylketonuria - initial findings from a single-center one-year experience from Poland.","authors":"Michal Kania, Martyna Pietruś, Łukasz Pawliński, Karolina Orchel-Szastak, Przemko Kwinta, Maciej T Małecki","doi":"10.1016/j.clinsp.2026.101162","DOIUrl":"10.1016/j.clinsp.2026.101162","url":null,"abstract":"<p><p>Background In August 2024, at the University Hospital in Krakow, we initiated, for the first time in Poland, the transition of individuals with hyperphenylalaninemia to the adult metabolic center. We evaluated the experience and outcomes during the first year of this transition program. Methods We included 120 adults with hyperphenylalaninemia who were followed between August 1st, 2024, and July 31st, 2025, in the Outpatient Metabolic Clinic at the University Hospital in Krakow, Poland. Results The mean age of individuals was 31.77±10.80 years (range 18‒68); 69 (57.5%) were females. The majority, 101 (84.2%), were individuals with classic Phenylketonuria (PKU). Twenty (17.7%) individuals were off-diet, and a further 38 (33.6%) reported poor adherence. Participants were followed for a median of 5.6 (3.5‒7.7) months. The mean DBS Phe concentration from the 5-year period preceding the transition was 717.00±350.40 µmoL/L, with a mean percentage of results > 600 µmoL/L of 57.0 ± 41.4%. The mean Phe concentration during the follow-up period was 689.40±373.20 µmoL/L, with 55.5 ± 44.2% of Phe measurements exceeding the target value of 600 µmoL/L, revealing no significant change (p = 0.868 and 0.754, respectively). Seven (26.9%) children of transitioned individuals showed symptoms of maternal PKU. Conclusions The initially poor Phe control in the cohort studied remained unchanged after transferring to the adult center, emphasizing that maintaining a restrictive diet in adults with PKU is challenging. Alarmingly high prevalence of unplanned pregnancies and maternal PKU highlights critical reproductive health concerns in this population. A longer follow-up is needed to assess the impact of the transition on the metabolic control of Phe.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101162"},"PeriodicalIF":2.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043302","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":"Machine learning identification of biomarkers for vascular endothelial damage in obstructive sleep apnea.","authors":"Tiantian Su, Song Shi","doi":"10.1016/j.clinsp.2026.101165","DOIUrl":"10.1016/j.clinsp.2026.101165","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Obstructive Sleep Apnea (OSA) is a common sleep disorder that, if left untreated, may lead to chronic damage to multiple organs. The purpose of this study is to use machine learning methods to identify biomarkers associated with Vascular Endothelial Damage (VED), providing insights for early diagnosis and targeted therapy of OSA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The authors conducted a differential expression analysis on the dataset GSE75097 to obtain Differentially Expressed Genes (DEGs), and obtained 1577 VED-Related Genes (VEDRGs) from the GeneCards database. The intersection genes of the two were defined as the differentially expressed VED-Related Genes (DE-VEDRGs). Functional and pathway enrichment analyses were conducted on them. Then, the authors adopted a combination of three machine learning algorithms to screen the Feature DE-VEDRGs (FDE-VEDRGs) of OSA. Furthermore, the authors conducted differential, correlation, and ROC curve analyses on FDE-VEDRGs, and performed Gene Set Enrichment Analysis (GSEA) and Gene Set Variation Analysis (GSVA) on these genes. Ultimately, an immune cell infiltration analysis was conducted between OSA and Primarily Snore (PS) samples, and the relationship between the expressions of FDE-VEDRGs and the levels of immune cell infiltrations was evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 40 DE-VEDRGs were identified. These genes were involved in biological functions such as wound healing, small GTPase-mediated signal transduction, collagen-containing extracellular matrix, apical part of the cell, enzyme inhibitor activity, and growth factor receptor binding. The main pathways included Proteoglycans in cancer, Lipid and atherosclerosis, MicroRNAs in cancer, AGE-RAGE and PI3K-Akt signaling pathways, Apoptosis, etc. Six FDE-VEDRGs of OSA, namely F2RL2, SLC12A1, TGFB2, SPP1, PLAUR and MMP3, were identified, and their expression differences and correlations were explained. Furthermore, GSEA and GSVA analyses revealed significant differences in function and pathway enrichment between the high- and low- expression groups of MMP3, PLAUR, and SPP1. Finally, the analysis of immune cell infiltration indicated that compared with the PS group, the proportion of NK cell activation and macrophage M2 in the OSA group was significantly decreased, while the proportion of neutrophils was significantly increased. The correlation matrix shows the correlation between each FDE-VEDRG and each type of immune-infiltrating cells. The six-gene logistic model showed moderate discriminative ability in the discovery dataset (AUC = 0.78) and consistent performance in two external datasets (AUC = 0.75 and 0.72), suggesting potential predictive value that warrants further validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study identified several candidate vascular endothelial damage-related genes in OSA using integrative bioinformatics and machine learning analyses. These findings may provide potential bi","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101165"},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043354","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":"Lipids, lipid-modifying drug targets with venous thromboembolism: a mendelian randomization study.","authors":"Liuyan Nie, Yongmei Han, Fenping Zheng","doi":"10.1016/j.clinsp.2026.101163","DOIUrl":"10.1016/j.clinsp.2026.101163","url":null,"abstract":"<p><strong>Background: </strong>The role of lipid-lowering therapies (e.g., statins) during anticoagulation for Venous Thromboembolism (VTE) remains unclear. This study investigated the causal role of lipid traits in VTE and evaluated lipid-lowering drug targets using a Mendelian Randomization (MR) approach.</p><p><strong>Methods: </strong>Genetic variants associated with lipid traits and lipid-lowering drug targets were extracted from the Global Lipids Genetics Consortium GWAS. Summary statistics for VTE, Deep Vein Thrombosis (DVT), and Pulmonary Embolism (PE) were obtained from UK Biobank. For associated targets, expression quantitative trait loci data were analyzed using summary-data-based MR. Colocalization analysis assessed shared genetic signals, and molecular docking explored plausible ligand-target binding poses.</p><p><strong>Results: </strong>Higher triglyceride levels were associated with lower VTE (OR = 0.998, 95% CI: 0.996‒1.000, p = 0.035) and DVT risks (OR = 0.998, 95% CI: 0.997‒1.000, p = 0.012). Genetic mimicry of Lipoprotein Lipase (LPL) enhancement was nominally associated with lower VTE odds (OR = 0.997, 95% CI: 0.995‒1.000, p = 0.02) and with lower PE odds after Bonferroni correction (OR = 0.996, 95% CI: 0.994‒0.998, p = 5.29E-06), but not DVT. LPL expression in whole blood showed a significant MR association with PE (OR = 1.001, 95% CI: 1.000‒1.002, p = 0.039) and moderate colocalization (PP.H4 = 0.68). Molecular docking predicted plausible active-site or allosteric binding poses for three LPL agonists (binding energies ≤ -6.8 kcal/mol).</p><p><strong>Conclusions: </strong>Genetically proxied LPL enhancement was nominally associated with modestly lower composite VTE risk and was associated with lower PE risk after multiple-testing correction, although no association was observed for DVT. These findings support a potential role for LPL-related pathways in VTE biology and warrant independent genetic and functional validation before clinical translation.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101163"},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208397","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":"Inspiratory muscle strength and post-liver transplantation outcomes: safety of measurement in the ICU ‒ an observational study.","authors":"Rayssa Pistilli Duarte, Rodrigo Marques Tonella, Ligia Dos Santos Roceto Ratti, Lilian Elisabete Bernardes Delazari, Gabriela Maria de Oliveira, Leticia de Souza Campos Assis, Mariana Bueno da Rosa, Edmilson Florêncio Pinto Junior, Enrico de Francisco Magnani, Ilka de Fátima Santana Ferreira Boin","doi":"10.1016/j.clinsp.2026.101079","DOIUrl":"10.1016/j.clinsp.2026.101079","url":null,"abstract":"<p><strong>Objective: </strong>Assess respiratory muscle strength and hemodynamic responses in the early postoperative period after Liver Transplantation (LT) and to analyze their associations with clinical outcomes.</p><p><strong>Patients and methods: </strong>A prospective and observational study included adult LT recipients admitted to the Intensive Care Unit (ICU) of the Clinical Hospital of the University of Campinas. Inspiratory muscle strength was assessed during the first three postoperative days using a digital Manovacuometer and POWERbreathe® device. Hemodynamic and respiratory parameters were continuously monitored. Statistical analyses included repeated-measures ANOVA, Wilcoxon tests, correlation analyses (p < 0.05), linear mixed models for respiratory variables, and multiple linear regression to examine the directionality of associations.</p><p><strong>Results: </strong>Sample consisted of 35 patients, with a median age of 59-years [IQR: 52.0-68.0] and a predominance of males (n = 26; 74.3%). The MELD mean was 18.1±7.6, SAPS3 score of 44.7±11.2, and SOFA score of 9.2±3.1, MIP increased significantly between postoperative days 1 and 3 (37.5 [32.8-53.8] vs. 49.0 [40.0-72.0] cmH₂O, p = 0.035). The S-Index showed significant negative correlations with both surgery duration (r_s = -0.52, p = 0.009) and ICU length of stay (r = -0.42, p = 0.015). No clinically relevant hemodynamic changes occurred during tests; however, there was a main effect of Time for MAP (4.079, 204.0) = 6.765, p < 0.0001) and RR (2.030, 101.5) = 3.628, p = 0.0295).</p><p><strong>Conclusions: </strong>LT patients exhibit early postoperative improvement in inspiratory muscle strength, with both assessment methods proving safe. Higher dynamic inspiratory strength is associated with shorter ICU stay and surgical duration, supporting the inclusion of routine respiratory muscle monitoring in postoperative physiotherapy protocols.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101079"},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027406","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":"Mendelian randomization analysis reveals causal links between specific immune cell phenotypes and Parkinson's disease.","authors":"Yan Su, Sheng Cai, Yang Xu, QiQi Xu, Qi Wang, XianWen Chen","doi":"10.1016/j.clinsp.2026.101164","DOIUrl":"10.1016/j.clinsp.2026.101164","url":null,"abstract":"<p><strong>Objective: </strong>Immunity and neuroinflammation are key factors in Parkinson's Disease (PD); however, detailed studies on how they are causally related to each other are lacking. This study aimed to explore the potential causal relationship between immune cells and PD.</p><p><strong>Methods: </strong>A comprehensive two-sample Mendelian Randomization (MR) analysis was conducted based on publicly available genetic data to explore the causal relationship between 731 immune cells and PD risk. Inverse Variance Weighted (IVW) served as the main technique to explore the causal relationship, along with methods such as weighted median, MR-Egger regression, simple mode, and weighted mode. Sensitivity analysis was performed to evaluate the reliability, heterogeneity, and horizontal pleiotropy of the study results.</p><p><strong>Results: </strong>A total of 18 immune cell phenotypes related to PD were identified in MR analysis, with 8 associated with risk, including 3 from the T-cells, B-cells, and Natural Killer cells (TBNK) group, 3 from the regulatory T-cell (Treg) group, and 2 from the myeloid group. There were 10 factors conferring protection against PD, with 3 associated with monocytes, 3 associated with T-cell maturation, 2 associated with Tregs, and 1 associated with myeloid cells. PD altered the phenotypic levels of two immune cell types, one from the TBNK group and one from the B-cell group.</p><p><strong>Conclusions: </strong>This study suggests a potential causal link between immune cells and PD, pinpointing specific immune cell features related to PD.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101164"},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13636344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070750","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":"Predictive value of stress-induced hyperglycemia for 28-day all-cause mortality in ICU patients with sepsis: a MIMIC-IV-based retrospective cohort study.","authors":"Jiahui Ma, Xu Wang, Yan Zhang, Chunyan Ge","doi":"10.1016/j.clinsp.2026.101123","DOIUrl":"10.1016/j.clinsp.2026.101123","url":null,"abstract":"<p><strong>Background: </strong>This study explored the link between Stress-Induced Hyperglycemia (SIH) and 28-Day All-Cause Mortality (28D-ACM) in patients with sepsis, focusing on the predictive values of stress hyperglycemia ratios 1 and 2 (SHR1 and SHR2) and Glucose Gap (GG).</p><p><strong>Methods: </strong>This retrospective cohort study included ICU patients with sepsis from the MIMIC-IV database. The relationships between the three SIH metrics and 28D-ACM risk were analyzed using multivariate Cox proportional hazards models, Kaplan-Meier curves, and restricted cubic spline analysis. The predictive performances of these metrics within a basic model were assessed using the Receiver Operating Characteristic (ROC) curve and Integrated Discrimination Improvement (IDI) index.</p><p><strong>Results: </strong>The study included 12,582 ICU patients with sepsis, with a 28D-ACM rate of 13.63%. In the fully adjusted model, SHR1, SHR2, and GG were independently associated with 28D-ACM risk, with Hazard Ratios (HR) and 95% Confidence Intervals (95% CIs) of 1.158 (1.029, 1.304), 1.18 (1.046, 1.332), and 1.133 (1.008, 1.275), respectively. Increased SIH metrics correlated positively with higher mortality risk (p_trend< 0.05). The Kaplan-Meier curve indicated that higher tertiles of SHR1, SHR2, and GG resulted in increased cumulative incidence of 28D-ACM (p < 0.05). Additionally, integrating SHR1 and SHR2 enhanced the model's predictive accuracy for 28D-ACM (p < 0.05).</p><p><strong>Conclusions: </strong>SHR1, SHR2, and GG are significantly associated with 28D-ACM risk in ICU patients with sepsis. SHR1 showed statistical association with mortality and modest incremental value, but clinical utility for risk stratification is limited and needs external validation.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101123"},"PeriodicalIF":2.4,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009696","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":"Trimester-specific reference interval for glycated hemoglobin in non-diabetic pregnant women: A cross-sectional study.","authors":"Kassahun Takiso, Aster Tsegaye, Mekoya Dabulo, Abenet Woldesenbet, Abebaye Leminie","doi":"10.1016/j.clinsp.2026.101160","DOIUrl":"10.1016/j.clinsp.2026.101160","url":null,"abstract":"<p><strong>Background: </strong>Gestational Diabetes Mellitus (GDM) is a growing public health concern in Ethiopia. HbA1c is useful for assessing glycemia but is influenced by physiological changes in pregnancy. To our knowledge, no published trimester-specific HbA1c reference intervals exist for Ethiopian non-diabetic pregnant women. This limits population-specific clinical interpretation.</p><p><strong>Methods: </strong>A facility-based cross-sectional study was conducted from February to July 2025 among 424 non-diabetic pregnant women across all trimesters. Normality of HbA1c distribution was assessed using the Shapiro-Wilk and Kolmogorov-Smirnov tests; outliers were identified using Tukey's fences method. Reference intervals were determined parametrically (mean ±2SD). Differences across trimesters were tested using one-way ANOVA. Because Levene's test indicated a violation of the homogeneity of variances (p < 0.001) and group sizes were unequal, pairwise comparisons were performed using the Games-Howell post hoc test. A p-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>HbA1c showed a normal distribution across all trimesters. Reference intervals were 4.8-5.9% in the first, 4.2-5.8% in the second, and 4.5-5.9% in the third trimester. Mean HbA1c levels differed significantly between trimesters (p < 0.05). Lowest in the second trimester 5.00% (95% CI 4.93-5.07) and highest in the first trimester 5.35% (95% CI: 5.31-5.39). Games-Howell post hoc tests confirmed that all pairwise comparisons were significant (p < 0.05).</p><p><strong>Conclusion: </strong>Trimester-specific HbA1c reference intervals were defined for non-diabetic pregnant women, demonstrating measurable physiological variation across gestation. The use of locally derived thresholds could improve the accuracy of GDM screening and support more appropriate clinical interpretation.</p>","PeriodicalId":520594,"journal":{"name":"Clinics (Sao Paulo, Brazil)","volume":"81 ","pages":"101160"},"PeriodicalIF":2.4,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009686","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}