Medicina clinica (English ed.)最新文献

{"title":"Severe graft-versus-host disease-like erythroderma in the setting of thymoma-associated multiorgan autoimmunity","authors":"Juan Carlos Romera Pallarés, José Francisco Orts Paco, Verónica García Yllán","doi":"10.1016/j.medcle.2026.107482","DOIUrl":"10.1016/j.medcle.2026.107482","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107482"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862048","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 serum free triiodothyronine (FT3) levels and ICU-acquired weakness: A prospective observational study","authors":"Jie Tian,&nbsp;Siyao Zeng,&nbsp;Chunming Guan,&nbsp;Haibo Li","doi":"10.1016/j.medcle.2026.107452","DOIUrl":"10.1016/j.medcle.2026.107452","url":null,"abstract":"<div><h3>Background</h3><div>Intensive care unit-acquired weakness (ICU-AW) is a common complication among critically ill patients. Existing evidence indicates that critically ill patients frequently develop low triiodothyronine syndrome (LT₃S), and this thyroid hormone imbalance may disrupt muscle metabolic pathways and thereby promote the onset and progression of ICU-AW. However, the relationship between FT₃ levels and ICU-AW remains inconclusive, and clinical research addressing this link remains limited. Accordingly, this study aims to examine the clinical relationship between FT₃ levels and ICU-AW.</div></div><div><h3>Methods</h3><div>We enrolled patients with mechanical ventilation in the ICU of the Second Affiliated Hospital of Harbin Medical University from June 2024 to December 2025, dividing them into low-T₃ group (<em>n</em> <!-->=<!--> <!-->46, FT₃ <!-->&lt;<!--> <!-->2.43<!--> <!-->pmol/L) and non-low T₃ group (<em>n</em> <!-->=<!--> <!-->33, FT₃ <!-->≥<!--> <!-->2.43<!--> <!-->pmol/L) by admission FT₃ levels. ICU-AW was defined as a Medical Research Council score<!--> <!-->≤<!--> <!-->48. We collected clinical data including demographics, comorbidities and laboratory results, compared baseline characteristics, and adopted correlation, regression and subgroup analyses to assess relevant associations.</div></div><div><h3>Results</h3><div>Among 79 patients, 58.2% had reduced admission FT₃, and its incidence decreased with increasing MRC scores. Spearman analysis showed FT₃ levels were positively correlated with MRC scores. Fully adjusted logistic regression confirmed FT₃ as a factor associated with ICU-AW (OR<!--> <!-->=<!--> <!-->0.31; 95% CI, 0.10–0.97; <em>p</em> <!-->=<!--> <!-->0.0447). ROC analysis indicated FT₃ had good discrimination for ICU-AW (AUC<!--> <!-->=<!--> <!-->0.84).</div></div><div><h3>Conclusions</h3><div>Reduced FT₃ levels are closely associated with the development of ICU-acquired weakness, with higher FT₃ levels showing a positive correlation with higher MRC scores and a negative correlation with the risk of ICU-AW.</div></div><div><h3>Trial registration</h3><div>The study has been registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2500100201, registration date: April 3, 2025). This study is a retrospective registration.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107452"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861628","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":"Clinicopathologic spectrum and prognostic determinants in biopsy-proven thrombotic microangiopathy","authors":"Taha Enes Cetin,&nbsp;Veysel Baran Tomar,&nbsp;Yagmur Eken,&nbsp;Betul Ogut,&nbsp;Ipek Isik Gonul,&nbsp;Ozant Helvaci,&nbsp;Ulver Derici,&nbsp;Galip Guz,&nbsp;Omer Faruk Akcay","doi":"10.1016/j.medcle.2026.107509","DOIUrl":"10.1016/j.medcle.2026.107509","url":null,"abstract":"<div><h3>Background</h3><div>Thrombotic microangiopathy (TMA) represents a heterogeneous clinicopathologic entity characterized by endothelial injury, microvascular thrombosis, and variable clinical outcomes. Data on prognostic factors in biopsy-proven TMA remain limited.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included 46 adult patients with biopsy-proven TMA diagnosed between 2000 and 2025. Demographic, clinical, laboratory, histopathologic, and genetic parameters were analyzed. The composite adverse outcome was defined as death or progression to end-stage renal disease (ESRD). Logistic regression analysis was performed to identify prognostic determinants.</div></div><div><h3>Results</h3><div>The most common etiologies were atypical hemolytic uremic syndrome (37.0%) and peripartum (pregnancy-associated) thrombotic microangiopathy (26.1%). During follow-up, 43.5% of patients progressed to end-stage renal disease or died. In univariate analyses, the presence of acute kidney injury at diagnosis (<em>p</em> <!-->=<!--> <!-->0.017) and lower estimated glomerular filtration rate (eGFR) (<em>p</em> <!-->=<!--> <!-->0.016) were associated with poorer outcomes. In contrast, both early treatment response within the first week (<em>p</em> <!-->=<!--> <!-->0.004) and peripartum TMA (<em>p</em> <!-->=<!--> <!-->0.042) were associated with more favorable outcomes. Notably, early treatment response remained significantly associated with improved outcomes in multivariate analyses (odds ratio [OR]<!--> <!-->=<!--> <!-->0.15; 95% confidence interval [CI], 0.03–0.75; <em>p</em> <!-->=<!--> <!-->0.021). Complement gene variants were identified in 5 of 10 tested patients, supporting a potential role for complement dysregulation in the pathogenesis of TMA.</div></div><div><h3>Conclusions</h3><div>Early on-treatment response may serve as a dynamic prognostic marker reflecting short-term disease trajectory in biopsy-proven TMA. These findings highlight the potential importance of timely recognition and close monitoring of treatment response in patients with biopsy-proven TMA.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107509"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861629","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":"The need for kidney biopsy in suspected primary membranous nephropathy with typical clinical presentation and positive anti-PLA2R antibodies","authors":"Martín Rodolfo Cheballier,&nbsp;Pehuén Fernández,&nbsp;Juan Pablo Maldonado,&nbsp;Greta Schwarz,&nbsp;Pablo Luján,&nbsp;Marco Mazzotta,&nbsp;Emanuel José Saad,&nbsp;Javier de Arteaga,&nbsp;Walter Douthat,&nbsp;Jorge de la Fuente,&nbsp;Carlos Chiurchiu","doi":"10.1016/j.medcle.2026.107511","DOIUrl":"10.1016/j.medcle.2026.107511","url":null,"abstract":"<div><h3>Introduction</h3><div>According to KDIGO guidelines, in patients with nephrotic syndrome without atypical features (estimated glomerular filtration rate &lt; 60 mL/min/1.73 m², rapid decline in kidney function, or significant hematuria), without suspicion of secondary causes or diabetes mellitus, and with the presence of anti–phospholipase A2 receptor antibodies (anti-PLA2R), a kidney biopsy is not required to confirm the diagnosis of primary membranous nephropathy (PMN). The aim of this study was to evaluate the diagnostic utility of anti-PLA2R for predicting PMN.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study including adult patients with suspected nephrotic syndrome in whom serum anti-PLA2R was measured and who subsequently underwent a kidney biopsy between January 1, 2019, and December 31, 2022, at our institution.</div></div><div><h3>Results</h3><div>A total of 44 patients were included; 17 had positive anti-PLA2R and 27 were anti-PLA2R negative. All patients with positive anti-PLA2R were diagnosed with PMN on kidney biopsy (100%; n = 17). Among anti-PLA2R–negative patients (n = 27), 13 (48.1%) had membranous nephropathy, of whom 9 were classified as PMN. Using a cutoff value &gt;20 RU/mL, anti-PLA2R showed a specificity and positive predictive value of 100% for the diagnosis of PMN, with a sensitivity of 56.7% and a negative predictive value of 51.9%.</div></div><div><h3>Conclusion</h3><div>Measurement of anti-PLA2R demonstrates high diagnostic accuracy for PMN in our setting and may allow kidney biopsy to be avoided in a selected subgroup of patients with a typical clinical presentation, thereby optimizing resources and reducing invasive procedures. Larger local studies are needed to confirm these findings.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107511"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861631","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":"Diagnostic challenges of Paederus dermatitis: A case series in military personnel","authors":"Enrique Gallego-Colón,&nbsp;Luis Casaseca Moreno","doi":"10.1016/j.medcle.2026.107506","DOIUrl":"10.1016/j.medcle.2026.107506","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107506"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861669","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":"Cellular intraosseous schwannoma mimicking aneurysmal bone cyst","authors":"Yuanxing Zhong,&nbsp;Xiequan Hu","doi":"10.1016/j.medcle.2026.107459","DOIUrl":"10.1016/j.medcle.2026.107459","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107459"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861711","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":"A case of thrombotic microangiopathy during tislelizumab therapy for lung cancer","authors":"Nannan Zhang,&nbsp;Yumeng Zou","doi":"10.1016/j.medcle.2026.107473","DOIUrl":"10.1016/j.medcle.2026.107473","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107473"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862047","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":"Frailty assessment and therapeutic strategies for preventing functional decline in hospitalized older adults: A narrative review of current evidence and recent advances","authors":"Mikel L. Sáez de Asteasu,&nbsp;Mikel Izquierdo,&nbsp;Fabricio Zambom-Ferraresi,&nbsp;Eduardo L. Cadore,&nbsp;Chenhui Chenhuichen,&nbsp;Nicolás Martínez-Velilla","doi":"10.1016/j.medcle.2026.107524","DOIUrl":"10.1016/j.medcle.2026.107524","url":null,"abstract":"<div><div>Hospitalization is usually linked to dramatic adverse events in older adults, including hospital-associated disability (HAD). Despite advancements in geriatric medicine to mitigate this trend, hospital models have often remained antiquated rather than being designed to minimize the risk of harm and reduce the associated burdens. The objective of this narrative review is to identify the personal and in-hospital process risk factors that may contribute to the development of HAD and determine efficacious therapeutic strategies to reverse these negative consequences. Age, sex, ethnicity, number of comorbidities, frailty, dementia, functional status at hospital admission, and polypharmacy may influence the development of HAD. Additional factors related to hospital processes, including prolonged length of hospital stay, low mobility, malnutrition, muscle function loss, social isolation, and sensory alterations, may increase the risk of HAD. Comprehensive geriatric assessment and in-hospital physical exercise appear to be effective therapeutic strategies for preventing HAD in acutely hospitalized older adults and should be part of the clinical routine. However, further research is necessary to examine the feasibility and effectiveness of new integrative care models to provide optimal and widely accessible treatments.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107524"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861638","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":"Eating disorders","authors":"Rocío Campos del Portillo,&nbsp;Elena Carrillo Lozano,&nbsp;Isabel Campos del Portillo,&nbsp;Miriam Esther Pelayo Delgado","doi":"10.1016/j.medcle.2026.107547","DOIUrl":"10.1016/j.medcle.2026.107547","url":null,"abstract":"<div><div>Eating Disorders (ED) constitute a heterogeneous set of mental illnesses characterized by the persistent presence of an altered eating behaviour that negatively impacts the nutritional, physical health, and psychosocial status of the affected individuals. The etiology is multifactorial, with potentially serious clinical implications. Their presentation is variable depending on the specific type of disorder (Anorexia Nervosa -AN-, Bulimia Nervosa -BN-, or Binge Eating Disorder -BED-), symptoms, illness duration, and severity. In AN and BN, symptoms and complications arise from malnutrition due to restrictive intake and purgative behaviors, respectively. In patients with BED, where excess weight is common, there is a risk of developing metabolic syndrome and obesity-related diseases. Treatment is multidisciplinary, comprising psychological/psychiatric, nutritional intervention, and management of intercurrent organic complications.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107547"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861524","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":"Foundations for the rational prescription of enteral medical nutrition therapy","authors":"Juan José López-Gómez,&nbsp;Daniel De Luis-Román","doi":"10.1016/j.medcle.2026.107535","DOIUrl":"10.1016/j.medcle.2026.107535","url":null,"abstract":"<div><div>Enteral nutrition consists of providing nutrients through the digestive tract, either via oral supplements or fully through nasoenteric tubes or stomas. Its use requires a comprehensive nutritional assessment that identifies nutritional status and energy-protein requirements, in addition to an evaluation of the underlying disease. The choice of formula should be understood as a prescription within the framework of medical nutrition therapy, based on clinical criteria and the available scientific evidence, given that its composition influences not only the improvement of nutritional status but may also affect disease progression. A thorough understanding of formula components is essential to select the option that best fits the patient's needs. Overall, a structured, evidence-based approach centered on an accurate nutritional diagnosis is key to optimizing clinical outcomes.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107535"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861637","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}