Pub Date : 2026-01-01DOI: 10.1016/j.clinsp.2025.100858
Selçuk Akan , Mehtap Balaban , Ahmet Kor , Bahadir Erturk
Background
Fibromyalgia (FM) is a chronic, non-inflammatory syndrome characterized by widespread body pain, fatigue, sleep disturbances, impaired cognitive function and anxiety. Peripheral and central sensitization are thought to cause chronic pain in this disorder, which impairs quality of life. No specific laboratory test, radiographic method, or biomarker has been identified for diagnosis. As its physiopathology is not fully understood, no specific treatment has been identified. At this stage, studies are needed to facilitate diagnosis and guide treatment.
Methods
Eighty-nine women with FM and 36 healthy controls were enrolled in this cross-sectional, case-controlled, single-centre study. FM-related measurements (number of tender points, myalgic score, pain Visual Analogue Scale [VAS]) were recorded. All participants underwent an analysis of trapezius muscle thickness and elasticity. Skin and subcutaneous tissue thickness, and hypodermis thickness were measured by using B-mode Ultrasonography (USG) and tension (compression) Sonoelastography (SEL).
Results
Skin thickness was lower in FM patients than in healthy controls (p < 0.01). Both trapezius muscle thickness and elastography scores were higher in the FM group compared to controls (p < 0.05 and p < 0.001, respectively). A significant correlation was found between VAS score and elastography scores (r = 0.661, p < 0.001); however, there was no significant correlation between VAS score and trapezius or skin thickness.
Conclusion
Patients with FM have lower skin thickness and higher trapezius muscle thickness and elastography scores than healthy controls. The thinner skin thickness in FM compared to controls may represent a potentially important factor in the pathophysiological mechanism of peripheral sensitization.
{"title":"Skin layer thickness, muscle elasticity and their effects on pain level in fibromyalgia patients","authors":"Selçuk Akan , Mehtap Balaban , Ahmet Kor , Bahadir Erturk","doi":"10.1016/j.clinsp.2025.100858","DOIUrl":"10.1016/j.clinsp.2025.100858","url":null,"abstract":"<div><h3>Background</h3><div>Fibromyalgia (FM) is a chronic, non-inflammatory syndrome characterized by widespread body pain, fatigue, sleep disturbances, impaired cognitive function and anxiety. Peripheral and central sensitization are thought to cause chronic pain in this disorder, which impairs quality of life. No specific laboratory test, radiographic method, or biomarker has been identified for diagnosis. As its physiopathology is not fully understood, no specific treatment has been identified. At this stage, studies are needed to facilitate diagnosis and guide treatment.</div></div><div><h3>Methods</h3><div>Eighty-nine women with FM and 36 healthy controls were enrolled in this cross-sectional, case-controlled, single-centre study. FM-related measurements (number of tender points, myalgic score, pain Visual Analogue Scale [VAS]) were recorded. All participants underwent an analysis of trapezius muscle thickness and elasticity. Skin and subcutaneous tissue thickness, and hypodermis thickness were measured by using B-mode Ultrasonography (USG) and tension (compression) Sonoelastography (SEL).</div></div><div><h3>Results</h3><div>Skin thickness was lower in FM patients than in healthy controls (<em>p</em> < 0.01). Both trapezius muscle thickness and elastography scores were higher in the FM group compared to controls (<em>p</em> < 0.05 and <em>p</em> < 0.001, respectively). A significant correlation was found between VAS score and elastography scores (<em>r</em> = 0.661, <em>p</em> < 0.001); however, there was no significant correlation between VAS score and trapezius or skin thickness.</div></div><div><h3>Conclusion</h3><div>Patients with FM have lower skin thickness and higher trapezius muscle thickness and elastography scores than healthy controls. The thinner skin thickness in FM compared to controls may represent a potentially important factor in the pathophysiological mechanism of peripheral sensitization.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100858"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.clinsp.2025.100852
You Wen Lin , Qing Zhang , Ying Sheng Xu , Ting Qu
<div><h3>Objective</h3><div>Arteriovenous Fistula (AVF) is the preferred vascular access for patients with Chronic Kidney Disease Stage G5 (CKDG5). Normal AVF function is an important prerequisite for hemodialysis, and there are few reports of studies predicting the factors affecting dysfunctional AVF. The aim of this study was to investigate the expression of Chitosanase-3-Like protein-1 (CHI3L1) in AVFs from patients with end-stage renal disease and to analyze the potential mechanism of its role in AVF dysfunction.</div></div><div><h3>Methods</h3><div>CKDG5 patients who underwent AVF surgery at our institution from January 2020 to September 2023 were prospectively collected. The general clinical data and laboratory data were collected in detail, and the occurrence of postoperative dysfunctional AVF was recorded. Then, the optimal diagnostic threshold of serum CHI3L1 was observed by the Receiver Operating Characteristic (ROC) curve. Kaplan-Meier survival curve and Log-rank test were used for survival analysis. Multi-factor backward logic analysis was used to screen baseline clinical factors and construct prediction Model 1. Subsequently, serum CHI3L1 was combined with baseline clinical factors to construct Prediction Model 2. The predictive value of the two models was evaluated by the ROC curve and the Area Under the Curve (AUC).</div></div><div><h3>Results</h3><div>A total of 152 CKDG5 patients who underwent AVF surgery were continuously included. They were divided into a normal AVF group (<em>n</em> = 64) and a dysfunctional AVF group (<em>n</em> = 88). Gender, age, body mass index, primary disease, diameter of cephalic vein, diameter of radial artery, follow-up time, and levels of Ca, K, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, white blood cell count, platelets, fasting blood glucose, and hemoglobin in both groups were not statistically significant between the two groups (<em>p</em> > 0.05). Systolic blood pressure, diastolic blood pressure, parathyroid hormone, serum albumin, and CHI3L1 were increased, whereas serum phosphorus level was decreased in CKDG5 patients with dysfunctional AVF (<em>p</em> < 0.05). The AUC of serum CHI3L1 was 0.797 (95% CI 0.728‒0.866, <em>p</em> < 0.001), the optimal cut-off value was 148.0 ng/mL, the sensitivity was 62.5%, and the specificity was 84.38%. The primary fluency rate in the high serum CHI3L1 level group was significantly lower than that in the low serum CHI3L1 level group (<em>p</em> < 0.001). Multifactorial logistic regression analysis showed that elevated serum CHI3L1 was an independent risk factor for postoperative dysfunctional AVF. The predictive value of the CHI3L1-containing predictive Model 2 was higher, with a net benefit at threshold probabilities of 0.2‒0.9 for its clinical decision curve.</div></div><div><h3>Conclusion</h3><div>This study proposes a risk prediction model of serum CHI3L1 combined with clinical risk factors, which can be
{"title":"Predictive value of serum chitinase 3-like 1 for dysfunctional autogenous arteriovenous fistulas in patients with chronic kidney disease stage G5","authors":"You Wen Lin , Qing Zhang , Ying Sheng Xu , Ting Qu","doi":"10.1016/j.clinsp.2025.100852","DOIUrl":"10.1016/j.clinsp.2025.100852","url":null,"abstract":"<div><h3>Objective</h3><div>Arteriovenous Fistula (AVF) is the preferred vascular access for patients with Chronic Kidney Disease Stage G5 (CKDG5). Normal AVF function is an important prerequisite for hemodialysis, and there are few reports of studies predicting the factors affecting dysfunctional AVF. The aim of this study was to investigate the expression of Chitosanase-3-Like protein-1 (CHI3L1) in AVFs from patients with end-stage renal disease and to analyze the potential mechanism of its role in AVF dysfunction.</div></div><div><h3>Methods</h3><div>CKDG5 patients who underwent AVF surgery at our institution from January 2020 to September 2023 were prospectively collected. The general clinical data and laboratory data were collected in detail, and the occurrence of postoperative dysfunctional AVF was recorded. Then, the optimal diagnostic threshold of serum CHI3L1 was observed by the Receiver Operating Characteristic (ROC) curve. Kaplan-Meier survival curve and Log-rank test were used for survival analysis. Multi-factor backward logic analysis was used to screen baseline clinical factors and construct prediction Model 1. Subsequently, serum CHI3L1 was combined with baseline clinical factors to construct Prediction Model 2. The predictive value of the two models was evaluated by the ROC curve and the Area Under the Curve (AUC).</div></div><div><h3>Results</h3><div>A total of 152 CKDG5 patients who underwent AVF surgery were continuously included. They were divided into a normal AVF group (<em>n</em> = 64) and a dysfunctional AVF group (<em>n</em> = 88). Gender, age, body mass index, primary disease, diameter of cephalic vein, diameter of radial artery, follow-up time, and levels of Ca, K, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, white blood cell count, platelets, fasting blood glucose, and hemoglobin in both groups were not statistically significant between the two groups (<em>p</em> > 0.05). Systolic blood pressure, diastolic blood pressure, parathyroid hormone, serum albumin, and CHI3L1 were increased, whereas serum phosphorus level was decreased in CKDG5 patients with dysfunctional AVF (<em>p</em> < 0.05). The AUC of serum CHI3L1 was 0.797 (95% CI 0.728‒0.866, <em>p</em> < 0.001), the optimal cut-off value was 148.0 ng/mL, the sensitivity was 62.5%, and the specificity was 84.38%. The primary fluency rate in the high serum CHI3L1 level group was significantly lower than that in the low serum CHI3L1 level group (<em>p</em> < 0.001). Multifactorial logistic regression analysis showed that elevated serum CHI3L1 was an independent risk factor for postoperative dysfunctional AVF. The predictive value of the CHI3L1-containing predictive Model 2 was higher, with a net benefit at threshold probabilities of 0.2‒0.9 for its clinical decision curve.</div></div><div><h3>Conclusion</h3><div>This study proposes a risk prediction model of serum CHI3L1 combined with clinical risk factors, which can be","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100852"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.clinsp.2025.100856
Lucas José da Costa , Vinicius Ruiz Uemoto , Mariana FN de Marchi , Renato de Aguiar Hortegal , Renata Valeri de Freitas
Objective
To assess whether electrocardiographic markers of Global Electrical Heterogeneity (GEH) improve the identification of patients requiring tertiary care, either alone or combined with an explainable machine learning model, compared with standard ECG features and clinical risk factors in a real-world tertiary cardiology population.
Methods
Patients were forwarded to a specific evaluation in a cardiology-specialized hospital performed an ECG and data collection. A series of follow-up attendances occurred in periods of 6-months, 12-months and 15-months to check for cardiovascular-related events (mortality or new nonfatal cardiovascular events (Stroke, MI, PCI, CS), as identified during 1-year phone follow-ups. The first attendance ECG was measured by a specialist and processed in order to obtain the Global Electric Heterogeneity (GEH) using the Kors Matriz. The ECG measurements, GEH parameters, and risk factors were combined for training multiple instances of XGBoost decision tree models. Each instance was optimized for the AUCPR, and the instance with the highest AUC was chosen as representative of the model. The importance of each parameter for the winner tree model was compared to better understand the improvement from using GEH parameters.
Results
GEH parameters were statistically significant in this population (p < 0.001), particularly the QRST angle and SVG magnitude. The combined model integrating GEH, standard ECG features, and clinical risk factors achieved the best performance, with a sensitivity of 94.1 %, specificity of 30.8 %, AUC of 67.6 %, and F2 score of 0.62. SVG feature importance and SHAP analyses were consistent with the statistical findings, indicating that the model's decision patterns align with clinically relevant information and reinforce the role of GEH features. The modeling approach was carefully designed to prevent overfitting, ensure generalizability, and facilitate implementation through its decision tree architecture.
Conclusion
VCG-derived features may improve the identification of patients requiring tertiary care, either alone or integrated into an explainable and robust machine learning model trained on real-world data. Its clinical value will ultimately depend on prospective validation and seamless integration within existing care pathways.
{"title":"Enhancing tertiary cardiology triage with vectorcardiographic features: a machine learning approach using real-world data","authors":"Lucas José da Costa , Vinicius Ruiz Uemoto , Mariana FN de Marchi , Renato de Aguiar Hortegal , Renata Valeri de Freitas","doi":"10.1016/j.clinsp.2025.100856","DOIUrl":"10.1016/j.clinsp.2025.100856","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether electrocardiographic markers of Global Electrical Heterogeneity (GEH) improve the identification of patients requiring tertiary care, either alone or combined with an explainable machine learning model, compared with standard ECG features and clinical risk factors in a real-world tertiary cardiology population.</div></div><div><h3>Methods</h3><div>Patients were forwarded to a specific evaluation in a cardiology-specialized hospital performed an ECG and data collection. A series of follow-up attendances occurred in periods of 6-months, 12-months and 15-months to check for cardiovascular-related events (mortality or new nonfatal cardiovascular events (Stroke, MI, PCI, CS), as identified during 1-year phone follow-ups. The first attendance ECG was measured by a specialist and processed in order to obtain the Global Electric Heterogeneity (GEH) using the Kors Matriz. The ECG measurements, GEH parameters, and risk factors were combined for training multiple instances of XGBoost decision tree models. Each instance was optimized for the AUCPR, and the instance with the highest AUC was chosen as representative of the model. The importance of each parameter for the winner tree model was compared to better understand the improvement from using GEH parameters.</div></div><div><h3>Results</h3><div>GEH parameters were statistically significant in this population (<em>p</em> < 0.001), particularly the QRST angle and SVG magnitude. The combined model integrating GEH, standard ECG features, and clinical risk factors achieved the best performance, with a sensitivity of 94.1 %, specificity of 30.8 %, AUC of 67.6 %, and F2 score of 0.62. SVG feature importance and SHAP analyses were consistent with the statistical findings, indicating that the model's decision patterns align with clinically relevant information and reinforce the role of GEH features. The modeling approach was carefully designed to prevent overfitting, ensure generalizability, and facilitate implementation through its decision tree architecture.</div></div><div><h3>Conclusion</h3><div>VCG-derived features may improve the identification of patients requiring tertiary care, either alone or integrated into an explainable and robust machine learning model trained on real-world data. Its clinical value will ultimately depend on prospective validation and seamless integration within existing care pathways.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100856"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.clinsp.2025.100857
Lia V. Steuer , Clara R. Doria , Matheus S. França , Paula S. Marra , Sebastian D. Cordoba , Luisa F.C. Forero , Ricardo N. Machado , Sylvia C.L. Farhat , Gleice Clemente , Vitória Curi , Claudio A. Len , Luciana M. Carvalho , Francisco H.R. Gomes , Virginia P.L. Ferriani , Rozana G. de Almeida , Flavio R. Sztajnbok , Lucia M.A. Campos , Adriana M. Elias , Verena A. Balbi , Nadia E. Aikawa , Clovis A.A. Silva
Objective
To evaluate the risk factors associated with the presence of Painful Subcutaneous Edema (PSE) in children and adolescents with Immunoglobulin A Vasculitis (IgAV).
Methods
A multicenter study evaluated 686 patients (≤ 18 years-old) at first 3-months after diagnosis. IgAV patients with PSE were compared to those without PSE.
Results
PSE was found in 219/686 (31.9 %). The sites were lower limbs 192/215 (89.3 %) and upper limbs 85/215 (39.5 %). Persistent PSE (≥ 6-weeks of duration) was found in 4/215 (2 %), and recurrent PSE was found in 7/217 (3 %). The median age at diagnosis was significantly lower in PSE patients compared to those without [5.0 (3.4) vs. 6.3 (4.3) years, p = 0.001]. Increased CRP was significantly higher in IgAV with PSE compared to without PSE (52.6 % vs. 41.1 %, p = 0.03), likewise thrombocytosis (> 400.000 mm3) (43.8 % vs. 35.1 %, p = 0.04). Although associated with higher inflammatory markers, PSE was not linked to more severe outcomes. Logistic regression demonstrated that age at diagnosis was inversely associated with PSE (OR = 0.986; 95 % CI 0.981‒0.992; p < 0.001).
Conclusion
PSE occurred in approximately one-third-of IgAV patients at disease onset and was diagnosed predominantly at an early age, with a more inflammatory presentation at onset. However, in spite of the higher levels of inflammatory markers, PSE was not linked to more severe outcomes.
目的探讨儿童和青少年免疫球蛋白A血管炎（IgAV）患者出现疼痛性皮下水肿（PSE）的相关危险因素。方法一项多中心研究对686例患者（年龄≤18岁）在诊断后3个月进行评估。将伴有PSE的IgAV患者与未伴有PSE的IgAV患者进行比较。结果686例患者中有219例（31.9%）检出spse。下肢192/215(89.3%)，上肢85/215（39.5%）。持续性PSE（持续时间≥6周）4/215例（2%），复发性PSE 7/217例（3%）。PSE患者诊断时的中位年龄明显低于无PSE患者[5.0（3.4）比6.3（4.3）岁，p = 0.001]。IgAV伴PSE患者CRP升高明显高于未伴PSE患者（52.6%比41.1%,p = 0.03），同样，血小板增多（40万mm3）（43.8%比35.1%,p = 0.04）。虽然与较高的炎症标志物相关，但PSE与更严重的结果无关。Logistic回归分析显示，诊断年龄与PSE呈负相关（OR = 0.986; 95% CI 0.981-0.992; p < 0.001）。结论：大约三分之一的IgAV患者在发病时发生pse，主要在早期诊断，发病时有更多的炎症表现。然而，尽管炎症标志物水平较高，但PSE与更严重的结果无关。
{"title":"Painful subcutaneous edema is associated with early age at disease onset in Immunoglobulin A vasculitis patients: A multicenter study","authors":"Lia V. Steuer , Clara R. Doria , Matheus S. França , Paula S. Marra , Sebastian D. Cordoba , Luisa F.C. Forero , Ricardo N. Machado , Sylvia C.L. Farhat , Gleice Clemente , Vitória Curi , Claudio A. Len , Luciana M. Carvalho , Francisco H.R. Gomes , Virginia P.L. Ferriani , Rozana G. de Almeida , Flavio R. Sztajnbok , Lucia M.A. Campos , Adriana M. Elias , Verena A. Balbi , Nadia E. Aikawa , Clovis A.A. Silva","doi":"10.1016/j.clinsp.2025.100857","DOIUrl":"10.1016/j.clinsp.2025.100857","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the risk factors associated with the presence of Painful Subcutaneous Edema (PSE) in children and adolescents with Immunoglobulin A Vasculitis (IgAV).</div></div><div><h3>Methods</h3><div>A multicenter study evaluated 686 patients (≤ 18 years-old) at first 3-months after diagnosis. IgAV patients with PSE were compared to those without PSE.</div></div><div><h3>Results</h3><div>PSE was found in 219/686 (31.9 %). The sites were lower limbs 192/215 (89.3 %) and upper limbs 85/215 (39.5 %). Persistent PSE (≥ 6-weeks of duration) was found in 4/215 (2 %), and recurrent PSE was found in 7/217 (3 %). The median age at diagnosis was significantly lower in PSE patients compared to those without [5.0 (3.4) vs. 6.3 (4.3) years, <em>p</em> = 0.001]. Increased CRP was significantly higher in IgAV with PSE compared to without PSE (52.6 % vs. 41.1 %, <em>p</em> = 0.03), likewise thrombocytosis (> 400.000 mm<sup>3</sup>) (43.8 % vs. 35.1 %, <em>p</em> = 0.04). Although associated with higher inflammatory markers, PSE was not linked to more severe outcomes. Logistic regression demonstrated that age at diagnosis was inversely associated with PSE (OR = 0.986; 95 % CI 0.981‒0.992; <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>PSE occurred in approximately one-third-of IgAV patients at disease onset and was diagnosed predominantly at an early age, with a more inflammatory presentation at onset. However, in spite of the higher levels of inflammatory markers, PSE was not linked to more severe outcomes.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100857"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-25DOI: 10.1016/j.clinsp.2025.100854
Daniel Santos Rocha Sobral Filho , Giulia Mazaro de Oliveira , Letícia Vecchi Leis , Mariana de Paiva Batista , Vanessa da Costa Miranda , Renata Colombo Bonadio , Maria del Pilar Estevez Diz , Samantha Cabral Severino da Costa
Objective
Evaluate the prognostic of the sarcomatous component (homologous vs heterologous).
Methods
This retrospective study evaluated patients with FIGO I‒IVA Uterine Carcinosarcoma (UCS) treated at a single cancer center. The endpoints were Overall Survival (OS) and Disease-Free Survival (DFS) according to the sarcomatous component. The Kaplan-Meier was used for survival analyses. Hazard Ratio (HR) and 95% Confidence Interval (95% CI) were calculated using Cox regression.
Results
61 patients with localized/locally advanced disease (34 homologous vs. 27 heterologous) were included. The most common pathological subtype was Rhabdomyosarcoma (60%) in the heterologous and endometrial stromal sarcoma (95%) in the homologous group. All patients underwent surgery. Adjuvant Chemotherapy (CT) was indicated for approximately 70%. A difference was observed between patients who did not complete adjuvant CT: 32.0% vs. 57.9% in homologous and heterologous groups, respectively (p = 0.03). The main reason for this was recurrence during treatment. Comparing homologous vs. heterologous group, median DFS was 143.2 months vs. 18.0 months (HR = 3.72, 95% CI 1.73‒8.02; p = 0.001) and median OS was 143.2 months vs. 34.4 months (HR = 2.79, 95% CI 1.27‒6.13; p = 0.001), respectively. Heterologous subtype (HR = 4.34, 95% CI 1.59‒11.85, p = 0.004) and FIGO stage III (HR = 3.33, 95% CI 1.18–9.39, p = 0.023) were associated with inferior DFS and OS, while completing adjuvant CT (HR = 0.22, 95% CI 0.07‒0.69, p = 0.009) was associated with superior outcomes.
Conclusions
The sarcomatous component has a relevant prognostic impact in localized/locally advanced UCS. The heterologous component was associated with a worse DFS and OS. Other negative prognostic factors were FIGO stage III and not completing adjuvant CT.
目的评价同种异体肉瘤的预后。方法回顾性研究在单一癌症中心治疗的FIGO I-IVA子宫癌肉瘤（UCS）患者。终点是根据肉瘤成分的总生存期（OS）和无病生存期（DFS）。Kaplan-Meier法用于生存分析。采用Cox回归计算风险比（HR）和95%置信区间（95% CI）。结果纳入61例局部/局部晚期疾病患者（34例同源对照27例异源）。异体组中最常见的病理亚型为横纹肌肉瘤（60%），同源组中最常见的病理亚型为子宫内膜间质肉瘤（95%）。所有患者均接受手术治疗。辅助化疗（CT）约占70%。未完成辅助CT的患者在同源组和异体组的差异分别为32.0%和57.9% （p = 0.03）。主要原因是治疗期间复发。同源组和异源组比较，中位DFS分别为143.2个月和18.0个月（HR = 3.72, 95% CI 1.73-8.02, p = 0.001），中位OS分别为143.2个月和34.4个月（HR = 2.79, 95% CI 1.27-6.13, p = 0.001）。异源亚型（HR = 4.34, 95% CI 1.59-11.85, p = 0.004）和FIGO III期（HR = 3.33, 95% CI 1.18-9.39, p = 0.023）与较差的DFS和OS相关，而完成辅助CT （HR = 0.22, 95% CI 0.07-0.69, p = 0.009）与较好的结果相关。结论肉瘤成分对局部/局部晚期UCS的预后有一定影响。异种成分与较差的DFS和OS相关。其他不良预后因素为FIGO III期和未完成辅助CT。
{"title":"Prognostic impact of sarcomatous component in patients with localized and locally advanced uterine carcinosarcoma: a retrospective study in Latin America","authors":"Daniel Santos Rocha Sobral Filho , Giulia Mazaro de Oliveira , Letícia Vecchi Leis , Mariana de Paiva Batista , Vanessa da Costa Miranda , Renata Colombo Bonadio , Maria del Pilar Estevez Diz , Samantha Cabral Severino da Costa","doi":"10.1016/j.clinsp.2025.100854","DOIUrl":"10.1016/j.clinsp.2025.100854","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate the prognostic of the sarcomatous component (homologous vs heterologous).</div></div><div><h3>Methods</h3><div>This retrospective study evaluated patients with FIGO I‒IVA Uterine Carcinosarcoma (UCS) treated at a single cancer center. The endpoints were Overall Survival (OS) and Disease-Free Survival (DFS) according to the sarcomatous component. The Kaplan-Meier was used for survival analyses. Hazard Ratio (HR) and 95% Confidence Interval (95% CI) were calculated using Cox regression.</div></div><div><h3>Results</h3><div>61 patients with localized/locally advanced disease (34 homologous vs. 27 heterologous) were included. The most common pathological subtype was Rhabdomyosarcoma (60%) in the heterologous and endometrial stromal sarcoma (95%) in the homologous group. All patients underwent surgery. Adjuvant Chemotherapy (CT) was indicated for approximately 70%. A difference was observed between patients who did not complete adjuvant CT: 32.0% vs. 57.9% in homologous and heterologous groups, respectively (p = 0.03). The main reason for this was recurrence during treatment. Comparing homologous vs. heterologous group, median DFS was 143.2 months vs. 18.0 months (HR = 3.72, 95% CI 1.73‒8.02; p = 0.001) and median OS was 143.2 months vs. 34.4 months (HR = 2.79, 95% CI 1.27‒6.13; p = 0.001), respectively. Heterologous subtype (HR = 4.34, 95% CI 1.59‒11.85, p = 0.004) and FIGO stage III (HR = 3.33, 95% CI 1.18–9.39, p = 0.023) were associated with inferior DFS and OS, while completing adjuvant CT (HR = 0.22, 95% CI 0.07‒0.69, p = 0.009) was associated with superior outcomes.</div></div><div><h3>Conclusions</h3><div>The sarcomatous component has a relevant prognostic impact in localized/locally advanced UCS. The heterologous component was associated with a worse DFS and OS. Other negative prognostic factors were FIGO stage III and not completing adjuvant CT.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100854"},"PeriodicalIF":2.4,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-21DOI: 10.1016/j.clinsp.2025.100851
Willian das Neves, Thomás Giollo Rivelli, Eduardo Furquim Simão, Marco Aurélio Vamondes Kulcsar, Gilberto de Castro Junior
Introduction
Over 90% of Head and Neck Cancers are Squamous Cell Carcinoma (HNSCC). HNSCC patients with no evidence of disease after treatment completion usually present a high frequency of late treatment-related toxicities. Here, we aimed to evaluate the prevalence of cachexia among head and neck squamous cell carcinoma patients treated with cisplatin-based chemoradiation with curative intent and presenting no evidence of disease. We hypothesize that even patients post long-term follow-up and curative-intention treatment present a high frequency of cancer cachexia.
Materials and methods
This cross-sectional observational study included 120 patients with HNSCC who had previously received definitive or adjuvant chemoradiation. Eligible patients were in regular follow-up for at least 2-years, with no evidence of disease. We assessed clinical characteristics, body composition, muscle strength, nutritional status, and blood tests. The primary outcome was the prevalence of cachexia, and the secondary outcome was an association between cachexia and self-reported dysphagia.
Results
Using two different diagnostic criteria (Fearon and Evans criteria), we found that 20.7% and 8.6% of patients presented cancer cachexia after more than two years of follow-up after curative chemoradiation treatment. As expected, cachectic patients presented lower mid-arm muscle circumference, with dysphagia in 73%. In addition, in cachectic patients diagnosed according to Evans's cancer cachexia criteria, we found lower muscle strength levels. There is no association between dysphagia and cancer cachexia, regardless of the diagnostic criteria.
Conclusion
In long-term follow-up, head and neck squamous cell carcinoma patients with no evidence of disease frequently present with cachexia after curative chemoradiation.
{"title":"Head and neck cancer patients present late cancer cachexia two years after curative chemoradiotherapy","authors":"Willian das Neves, Thomás Giollo Rivelli, Eduardo Furquim Simão, Marco Aurélio Vamondes Kulcsar, Gilberto de Castro Junior","doi":"10.1016/j.clinsp.2025.100851","DOIUrl":"10.1016/j.clinsp.2025.100851","url":null,"abstract":"<div><h3>Introduction</h3><div>Over 90% of Head and Neck Cancers are Squamous Cell Carcinoma (HNSCC). HNSCC patients with no evidence of disease after treatment completion usually present a high frequency of late treatment-related toxicities. Here, we aimed to evaluate the prevalence of cachexia among head and neck squamous cell carcinoma patients treated with cisplatin-based chemoradiation with curative intent and presenting no evidence of disease. We hypothesize that even patients post long-term follow-up and curative-intention treatment present a high frequency of cancer cachexia.</div></div><div><h3>Materials and methods</h3><div>This cross-sectional observational study included 120 patients with HNSCC who had previously received definitive or adjuvant chemoradiation. Eligible patients were in regular follow-up for at least 2-years, with no evidence of disease. We assessed clinical characteristics, body composition, muscle strength, nutritional status, and blood tests. The primary outcome was the prevalence of cachexia, and the secondary outcome was an association between cachexia and self-reported dysphagia.</div></div><div><h3>Results</h3><div>Using two different diagnostic criteria (Fearon and Evans criteria), we found that 20.7% and 8.6% of patients presented cancer cachexia after more than two years of follow-up after curative chemoradiation treatment. As expected, cachectic patients presented lower mid-arm muscle circumference, with dysphagia in 73%. In addition, in cachectic patients diagnosed according to Evans's cancer cachexia criteria, we found lower muscle strength levels. There is no association between dysphagia and cancer cachexia, regardless of the diagnostic criteria.</div></div><div><h3>Conclusion</h3><div>In long-term follow-up, head and neck squamous cell carcinoma patients with no evidence of disease frequently present with cachexia after curative chemoradiation.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100851"},"PeriodicalIF":2.4,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-21DOI: 10.1016/j.clinsp.2025.100848
Antonio Silvinato , Clara Lucato dos Santos , Eliane Amorim , Idevaldo Floriano , Luís Eduardo Miranda Paciência , Luca Schiliró Tristão , Wanderley Marques Bernardo
Objective: To assess the diagnostic and prognostic accuracy of C-Reactive Protein (CRP) in adult patients with suspected or confirmed sepsis.
Methods: A systematic review and meta-analysis were conducted using the Medline, Embase, and Google Scholar databases, without language or time restrictions. Studies involving adults at risk for, suspected of, or diagnosed with sepsis who underwent CRP measurement and reported diagnostic or prognostic accuracy data were eligible. Both cross-sectional and cohort studies were included. Risk of bias was evaluated with the QUADAS-2 tool, and the quality of evidence was graded using the GRADE approach.
Results: A total of 3599 records were screened, and 22 studies (13,083 patients) met the inclusion criteria, 16 assessing diagnostic accuracy and 6 evaluating prognostic value. In the diagnostic meta-analysis, the pooled sensitivity was 83 % (95 % CI 75 %–89 %) and specificity was 56 % (95 % CI 41 %–69 %), with high heterogeneity (I2 = 80.1 %) and a false-positive rate of 44.3 % (95 % CI 30.9 %‒58.6 %). In the prognostic analysis for mortality, the pooled sensitivity was 81 % (95 % CI 70 %–89 %) and the specificity was 77 % (95 % CI 64 %–86 %), with high heterogeneity (I2 = 65.9 %) and a false-positive rate of 22.8 % (95 % CI 13.6 %–35.6 %). Most studies presented a moderate to high risk of bias, and the overall quality of the evidence was rated as low.
Conclusions: Current evidence reveals high diagnostic uncertainty and limited prognostic accuracy of CRP in adults with sepsis. The low specificity and high error rates restrict the clinical utility of CRP for diagnostic or prognostic decision-making in sepsis management.
{"title":"C-reactive protein in adult sepsis: systematic review and meta-analysis","authors":"Antonio Silvinato , Clara Lucato dos Santos , Eliane Amorim , Idevaldo Floriano , Luís Eduardo Miranda Paciência , Luca Schiliró Tristão , Wanderley Marques Bernardo","doi":"10.1016/j.clinsp.2025.100848","DOIUrl":"10.1016/j.clinsp.2025.100848","url":null,"abstract":"<div><div><em>Objective</em>: To assess the diagnostic and prognostic accuracy of C-Reactive Protein (CRP) in adult patients with suspected or confirmed sepsis.</div><div><em>Methods</em>: A systematic review and meta-analysis were conducted using the Medline, Embase, and Google Scholar databases, without language or time restrictions. Studies involving adults at risk for, suspected of, or diagnosed with sepsis who underwent CRP measurement and reported diagnostic or prognostic accuracy data were eligible. Both cross-sectional and cohort studies were included. Risk of bias was evaluated with the QUADAS-2 tool, and the quality of evidence was graded using the GRADE approach.</div><div><em>Results</em>: A total of 3599 records were screened, and 22 studies (13,083 patients) met the inclusion criteria, 16 assessing diagnostic accuracy and 6 evaluating prognostic value. In the diagnostic meta-analysis, the pooled sensitivity was 83 % (95 % CI 75 %–89 %) and specificity was 56 % (95 % CI 41 %–69 %), with high heterogeneity (I<sup>2</sup> = 80.1 %) and a false-positive rate of 44.3 % (95 % CI 30.9 %‒58.6 %). In the prognostic analysis for mortality, the pooled sensitivity was 81 % (95 % CI 70 %–89 %) and the specificity was 77 % (95 % CI 64 %–86 %), with high heterogeneity (I<sup>2</sup> = 65.9 %) and a false-positive rate of 22.8 % (95 % CI 13.6 %–35.6 %). Most studies presented a moderate to high risk of bias, and the overall quality of the evidence was rated as low.</div><div><em>Conclusions</em>: Current evidence reveals high diagnostic uncertainty and limited prognostic accuracy of CRP in adults with sepsis. The low specificity and high error rates restrict the clinical utility of CRP for diagnostic or prognostic decision-making in sepsis management.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100848"},"PeriodicalIF":2.4,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.clinsp.2025.100855
Sharifah Nabilah Syed Mohd Hamdan , Rabi’ah Al-Adawiyah Rahmat , Selva Malar Munusamy , Norliza Ibrahim
Objective
Population-specific Cephalic Index (CI) classifications are lacking for Malaysian subadults. This study aimed to develop a new CI classification and determine the prevalence of deformational brachycephaly using Computed Tomography (CT) images.
Methods
A total of 520 CT images from subadults aged 0- to 20-years were included in the study. Two cranial measurements were obtained: the maximum Cephalic Length (CL) and the maximum Cephalic Width (CW), derived from axial CT images. The CI was subsequently calculated using the formula: CW/CL × 100. In addition, a simple linear regression analysis was performed to evaluate the relationship between CI and age.
Results
The modified CI ranges for the Malaysian subadult population were defined as follows: dolichocephalic ≤ 78.8, mesocephalic 78.9–89.0, brachycephalic 89.1–94.0, and hyperbrachycephalic ≥ 94.1. The predictive equation derived was y = 87.08–0.47x +0.01×2 (y = CI and x = Age in years). A significant negative correlation was found between age and CI (r = -0.101, p < 0.001), with the index decreasing by approximately 0.026 per year. This indicates a natural trend towards a less brachycephalic head shape with maturation.
Conclusion
This new, population-specific classification provides an essential reference tool for clinicians and researchers to accurately detect, manage, and treat cranial deformities in Malaysian subadults, with significant applications in pediatrics, anthropology, and forensic medicine.
目的马来西亚亚成人缺乏人群特异性的头侧指数（CI）分类。本研究旨在建立一种新的CI分类方法，并利用计算机断层扫描（CT）图像确定变形性短头畸形的患病率。方法选取520张0 ~ 20岁亚成人CT图像。通过轴向CT图像获得两个颅测量值：最大头侧长度（CL）和最大头侧宽度（CW）。CI计算公式为：CW/CL × 100。此外，我们还进行了简单的线性回归分析来评估CI与年龄之间的关系。结果马来西亚亚成年人群的修正CI范围定义为：多头≤78.8，中头78.9-89.0，短头89.1-94.0，长头≥94.1。导出的预测方程为y = 87.08-0.47x +0.01×2 （y = CI, x = Age in years）。年龄与CI呈显著负相关（r = -0.101, p < 0.001），指数每年下降约0.026。这表明随着成熟，头的形状逐渐变短的自然趋势。结论：这种新的人群特异性分类为临床医生和研究人员准确检测、管理和治疗马来西亚亚成人颅骨畸形提供了重要的参考工具，在儿科学、人类学和法医学方面具有重要应用价值。
{"title":"New population-specific cephalic index standards for Malaysian subadults: prevalence, growth patterns, and clinical implications from a CT imaging study","authors":"Sharifah Nabilah Syed Mohd Hamdan , Rabi’ah Al-Adawiyah Rahmat , Selva Malar Munusamy , Norliza Ibrahim","doi":"10.1016/j.clinsp.2025.100855","DOIUrl":"10.1016/j.clinsp.2025.100855","url":null,"abstract":"<div><h3>Objective</h3><div>Population-specific Cephalic Index (CI) classifications are lacking for Malaysian subadults. This study aimed to develop a new CI classification and determine the prevalence of deformational brachycephaly using Computed Tomography (CT) images.</div></div><div><h3>Methods</h3><div>A total of 520 CT images from subadults aged 0- to 20-years were included in the study. Two cranial measurements were obtained: the maximum Cephalic Length (CL) and the maximum Cephalic Width (CW), derived from axial CT images. The CI was subsequently calculated using the formula: CW/CL × 100. In addition, a simple linear regression analysis was performed to evaluate the relationship between CI and age.</div></div><div><h3>Results</h3><div>The modified CI ranges for the Malaysian subadult population were defined as follows: dolichocephalic ≤ 78.8, mesocephalic 78.9–89.0, brachycephalic 89.1–94.0, and hyperbrachycephalic ≥ 94.1. The predictive equation derived was y = 87.08–0.47x +0.01×<sup>2</sup> (y = CI and x = Age in years). A significant negative correlation was found between age and CI (<em>r</em> = -0.101, p < 0.001), with the index decreasing by approximately 0.026 per year. This indicates a natural trend towards a less brachycephalic head shape with maturation.</div></div><div><h3>Conclusion</h3><div>This new, population-specific classification provides an essential reference tool for clinicians and researchers to accurately detect, manage, and treat cranial deformities in Malaysian subadults, with significant applications in pediatrics, anthropology, and forensic medicine.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100855"},"PeriodicalIF":2.4,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate and monitor, through electrophysiological assessment of hearing, the integrity of the peripheral and central auditory pathways in infants with Peri-intraventricular hemorrhage and/or Periventricular Leukomalacia (PIVH/PVL) who stayed in a Neonatal Intensive Care Unit (NICU), aiming to verify the occurrence of possible neural dysfunctions in this system.
Material and methods
This prospective longitudinal study evaluated preterm Newborns (NBs) and infants at the time of hospital discharge and after 3- and 6-months. The Study Group (SG) had 12 females and 11 males, with gestational age between 25- and 33-weeks, and a mean gestational age of 29.82-weeks at birth. The Control Group (CG) had 26 healthy NBs, distributed in 13 females and 13 males, with gestational age between 27- and 33-weeks and a mean of 30.67-weeks of gestational age at birth. All participants underwent Auditory Brainstem Response (ABR) and Cortical Auditory Evoked Potentials (CAEP) P1, N1, P2, at the time of hospital discharge, and 3- and 6-months after discharge. Each group’s results were compared using statistical tests.
Results
Evolutionary study of mean ABR and CAEP latencies in infants in the study and control group showed a similar pattern over the six months after hospital discharge.
Conclusion
The comparison of brainstem and cortical potentials showed that auditory function is symmetrical in the peripheral and central portions of the auditory pathway in both groups. The maturation of the ABR and CAEP waves in both groups developed in a very similar way over the six months after hospital discharge.
{"title":"Electrophysiological evaluation of the auditory pathway in newborns and infants with peri-intraventricular hemorrhage and/or periventricular leukomalacia","authors":"Rosanna Giaffredo Angrisani , Natalia Olival Balzarini , Carla Regina Tragante , Valdenise Martins Laurindo Tuma Calil , Werther Brunow de Carvalho , Carla Gentile Matas","doi":"10.1016/j.clinsp.2025.100853","DOIUrl":"10.1016/j.clinsp.2025.100853","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate and monitor, through electrophysiological assessment of hearing, the integrity of the peripheral and central auditory pathways in infants with Peri-intraventricular hemorrhage and/or Periventricular Leukomalacia (PIVH/PVL) who stayed in a Neonatal Intensive Care Unit (NICU), aiming to verify the occurrence of possible neural dysfunctions in this system.</div></div><div><h3>Material and methods</h3><div>This prospective longitudinal study evaluated preterm Newborns (NBs) and infants at the time of hospital discharge and after 3- and 6-months. The Study Group (SG) had 12 females and 11 males, with gestational age between 25- and 33-weeks, and a mean gestational age of 29.82-weeks at birth. The Control Group (CG) had 26 healthy NBs, distributed in 13 females and 13 males, with gestational age between 27- and 33-weeks and a mean of 30.67-weeks of gestational age at birth. All participants underwent Auditory Brainstem Response (ABR) and Cortical Auditory Evoked Potentials (CAEP) P1, N1, P2, at the time of hospital discharge, and 3- and 6-months after discharge. Each group’s results were compared using statistical tests.</div></div><div><h3>Results</h3><div>Evolutionary study of mean ABR and CAEP latencies in infants in the study and control group showed a similar pattern over the six months after hospital discharge.</div></div><div><h3>Conclusion</h3><div>The comparison of brainstem and cortical potentials showed that auditory function is symmetrical in the peripheral and central portions of the auditory pathway in both groups. The maturation of the ABR and CAEP waves in both groups developed in a very similar way over the six months after hospital discharge.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100853"},"PeriodicalIF":2.4,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study investigates the role of Sialic acid-binding Immunoglobulin-Like Lectin-9 (SIGLEC9), a novel immune checkpoint, in Cervical Cancer (CC) and its interaction with immune cells in the tumor microenvironment.
Methods
SIGLEC9 expression in CC was analyzed using the TNM plot, TCGA, and Human Protein Atlas databases, alongside its correlation with tumor stage. The relationship between SIGLEC9 expression and immune cell infiltration was explored using TCGA and TISIDB databases. Single-cell analysis focused on SIGLEC9 in macrophages. Protein interactions were assessed through the String, IntAct, BioGRID, and Mentha databases. MUC1 expression was validated via GEO and GEPIA databases. Immunohistochemical staining, western blot, immunofluorescence, and flow cytometry were used for verification. The prognostic significance of SIGLEC9 and SIGLEC9+ Tumor-Associated Macrophages (TAMs) was evaluated.
Results
SIGLEC9 was found to be significantly upregulated in CC, with higher levels correlating with poor prognosis. It was expressed in macrophages and T-cells, and elevated SIGLEC9+ TAMs were linked to reduced overall survival.
Conclusion
SIGLEC9 plays a crucial role in the progression and prognosis of cervical cancer through its interaction with TAMs and T-cells. These findings highlight SIGLEC9 as a potential target for new immunotherapies in CC.
目的探讨唾液酸结合免疫球蛋白样凝集素-9 （SIGLEC9）在宫颈癌（CC）中的作用及其与肿瘤微环境中免疫细胞的相互作用。方法采用TNM图、TCGA和Human Protein Atlas数据库分析ssiglec9在CC中的表达，并分析其与肿瘤分期的相关性。利用TCGA和TISIDB数据库探讨SIGLEC9表达与免疫细胞浸润的关系。单细胞分析的重点是巨噬细胞中的SIGLEC9。通过String、完好无损、BioGRID和Mentha数据库评估蛋白质相互作用。通过GEO和GEPIA数据库验证MUC1的表达。免疫组织化学染色、免疫印迹、免疫荧光和流式细胞术进行验证。评估SIGLEC9和SIGLEC9+肿瘤相关巨噬细胞（Tumor-Associated Macrophages, tam）的预后意义。结果siglec9在CC中表达显著上调，且高表达与预后不良相关。它在巨噬细胞和t细胞中表达，升高的SIGLEC9+ tam与总生存率降低有关。结论siglec9通过与TAMs和t细胞的相互作用，在宫颈癌的进展和预后中起重要作用。这些发现突出了SIGLEC9作为CC新免疫疗法的潜在靶点。
{"title":"The role of SIGLEC9 in immunosuppression and prognosis in cervical cancer","authors":"Bihui Wang , Yuejie Zhu , Zhenyu Ru , Yulian Zhang , Mingkai Yu , Pingfen Li , Manli Zhang , Jianbing Ding , Zhifang Chen","doi":"10.1016/j.clinsp.2025.100849","DOIUrl":"10.1016/j.clinsp.2025.100849","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the role of Sialic acid-binding Immunoglobulin-Like Lectin-9 (SIGLEC9), a novel immune checkpoint, in Cervical Cancer (CC) and its interaction with immune cells in the tumor microenvironment.</div></div><div><h3>Methods</h3><div>SIGLEC9 expression in CC was analyzed using the TNM plot, TCGA, and Human Protein Atlas databases, alongside its correlation with tumor stage. The relationship between SIGLEC9 expression and immune cell infiltration was explored using TCGA and TISIDB databases. Single-cell analysis focused on SIGLEC9 in macrophages. Protein interactions were assessed through the String, IntAct, BioGRID, and Mentha databases. MUC1 expression was validated via GEO and GEPIA databases. Immunohistochemical staining, western blot, immunofluorescence, and flow cytometry were used for verification. The prognostic significance of SIGLEC9 and SIGLEC9+ Tumor-Associated Macrophages (TAMs) was evaluated.</div></div><div><h3>Results</h3><div>SIGLEC9 was found to be significantly upregulated in CC, with higher levels correlating with poor prognosis. It was expressed in macrophages and T-cells, and elevated SIGLEC9+ TAMs were linked to reduced overall survival.</div></div><div><h3>Conclusion</h3><div>SIGLEC9 plays a crucial role in the progression and prognosis of cervical cancer through its interaction with TAMs and T-cells. These findings highlight SIGLEC9 as a potential target for new immunotherapies in CC.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100849"},"PeriodicalIF":2.4,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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