Clinics最新文献_第10页

IF 2.7 4区医学 Q2 Medicine

Clinics

Pub Date : 2024-01-01 DOI: 10.1016/j.clinsp.2024.100324

Isis Danyelle Dias Custódio , Fernanda Silva Mazzutti Nunes , Mariana Tavares Miranda Lima , Kamila Pires de Carvalho , Andressa Miranda Machado , Paula Philbert Lajolo , Carlos Eduardo Paiva , Yara Cristina de Paiva Maia

Introduction

Instruments to manage adverse effects of endocrine therapy with Aromatase inhibitors (AI) may improve adherence and persistence to treatment and Health-Related Quality of Life (HRQL). The 31-item Cervantes Scale (CS-31) is an HRQL questionnaire with particularities of the perimenopausal and postmenopausal period that could be an appropriate instrument to assess HRQL in Breast Cancer (BC) survivors.

Objective

This study aimed to perform additional validation of the CS-31 for BC survivors undergoing adjuvant endocrine therapy.

Methods

This prospective study was performed at three time points named T0, T1, and T2: initial, intermediate, and final follow-up period, respectively, totaling 24 months of follow-up. At each time point, the participants completed the CS-31, Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F), and Hospital Anxiety and Depression Scale (HADS). The internal consistency, construct validity, responsiveness analyses, and known-group validity of CS-31 were evaluated.

Results

This study included 89 postmenopausal women diagnosed with hormone receptor-positive early BC in adjuvant endocrine therapy with AI. The internal consistency was good (Cronbach's alpha = 0.89). Construct validity received a positive rating, with 100% of results consistent with prior hypotheses. A prospective improvement in HRQL was identified for the CS-31 Global Score and FACIT-F Total Score and for most of their domains. Furthermore, women with anxiety and depression by HADS presented worse HRQL by CS-31.

Conclusion

The authors identified that the CS-31 seems to be appropriate for use in oncology medical routine and may help to monitor adverse effects and HRQL of BC survivors during adjuvant endocrine therapy.

导言：使用芳香化酶抑制剂（AI）控制内分泌治疗的不良反应可提高治疗的依从性和持久性，并改善与健康相关的生活质量（HRQL）。31项塞万提斯量表（CS-31）是一种具有围绝经期和绝经后特点的HRQL问卷，可作为评估乳腺癌（BC）幸存者HRQL的合适工具。在每个时间点，参与者都填写了 CS-31、慢性疾病治疗功能评估--疲劳（FACIT-F）和医院焦虑抑郁量表（HADS）。结果这项研究纳入了89名绝经后妇女，她们被诊断为激素受体阳性早期BC，正在接受AI辅助内分泌治疗。内部一致性良好（Cronbach's alpha = 0.89）。结构效度得到了肯定的评价，100% 的结果与之前的假设一致。CS-31 总分和 FACIT-F 总分及其大部分领域的 HRQL 均有预期改善。此外，根据 HADS 测量，患有焦虑症和抑郁症的女性在 CS-31 中的 HRQL 更差。结论：作者认为 CS-31 似乎适合用于肿瘤医疗常规，可帮助监测 BC 幸存者在辅助内分泌治疗期间的不良反应和 HRQL。

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引用次数: 0

Blood transfusion is correlated with elevated adult all-cause mortality and cardiovascular mortality in the United States: NHANES 1999 to 2018 population-based matched propensity score study 输血与美国成人全因死亡率和心血管死亡率升高有关：NHANES 1999 年至 2018 年基于人口的匹配倾向得分研究

IF 2.7 4区医学 Q2 Medicine

Clinics

Pub Date : 2024-01-01 DOI: 10.1016/j.clinsp.2024.100379

Jie Shi , Min Meng , Rina Sa , Lijun Yu , Yali Lu , Bei Gao

Background and aims

The association of blood transfusion with an increase in medium- and short-term mortality in specific populations has been confirmed. However, the correlation between blood transfusion and long-term mortality in the general population remains unclear. This cohort study evaluated the correlation between blood transfusion and overall and cause-specific mortality in the general American adult population.

Methods

The authors utilized 10 sets of 2-year cycle data (1999–2018) from the National Health and Nutrition Examination Survey on the outcomes of adults who did and did not receive blood transfusions. Propensity score-matching (1:1) was performed based on age, sex, race, education level, marital status, poverty-income ratio, arteriosclerotic cardiovascular disease, cancer, anemia, hypertension, and diabetes status. After controlling for demographic characteristics and clinical risk factors, Cox regression analysis was performed to evaluate the correlation between blood transfusion and all-cause and cause-specific mortality.

Results

The study included 48,004 adult participants. The risk of all-cause mortality increased by 101 % with blood transfusion, and the risk of cardiovascular mortality increased by 165 %. After propensity score-matching, 6,116 pairs of cases were retained, and the risk of all-cause mortality increased by 84 % with blood transfusion, and the risk of cardiovascular mortality increased by 137 %. The sensitivity analysis results were robust.

Conclusions

In the general American population, blood transfusion significantly impacts long-term all-cause and cardiovascular mortality and may be an unacknowledged risk factor for death. Thus, the effective management of blood transfusion in the general population may be beneficial.

背景和目的在特定人群中，输血与中期和短期死亡率增加之间的关系已得到证实。然而，输血与普通人群长期死亡率之间的相关性仍不清楚。这项队列研究评估了输血与美国成年人总体死亡率和特定病因死亡率之间的相关性。方法作者利用全国健康与营养调查（National Health and Nutrition Examination Survey）中的 10 组 2 年周期数据（1999-2018 年），对接受和未接受输血的成年人的结果进行了分析。根据年龄、性别、种族、教育水平、婚姻状况、贫困收入比、动脉硬化性心血管疾病、癌症、贫血、高血压和糖尿病状况进行倾向得分匹配（1:1）。在控制了人口统计学特征和临床风险因素后，进行了 Cox 回归分析，以评估输血与全因死亡率和特定病因死亡率之间的相关性。输血导致全因死亡的风险增加了 101%，导致心血管死亡的风险增加了 165%。经过倾向评分匹配后，保留了 6,116 对病例，输血导致全因死亡的风险增加了 84%，心血管死亡的风险增加了 137%。结论在美国普通人群中，输血对长期全因死亡率和心血管死亡率有显著影响，可能是一个不为人知的死亡风险因素。因此，在普通人群中有效管理输血可能是有益的。

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引用次数: 0

Noninvasive assessment of liver fibrosis can predict clinical outcomes at late follow-up after a sustained virological response in HCV patients? 肝纤维化的无创评估能否预测 HCV 患者持续病毒学应答后后期随访的临床结果？

IF 2.7 4区医学 Q2 Medicine

Clinics

Pub Date : 2024-01-01 DOI: 10.1016/j.clinsp.2024.100381

Taisa Grotta Ragazzo , Patricia Momoyo Yoshimura Zitelli , Daniel F. Mazo , Claudia P. Oliveira , Flait José Carrilho , Mário Guimarães Pessoa

Objectives

The primary objective was to evaluate Liver-Related Events (LREs), including hepatic decompensation (ascites, hemorrhagic varices and encephalopathy) and Hepatocellular Carcinoma (HCC), as well as changes in liver stiffness during the follow-up period among patients who achieved a Sustained Virological Response (SVR) after treatment for chronic Hepatitis C Virus (HCV) infection.

Methods

A total of 218 patients with HCV were treated, and those who achieved an SVR were followed up for 3-years. Transient Elastography (TE) using FibroScan® was performed at various time points: before treatment, at the end of treatment, at 6-months post-treatment, at 1-year post-treatment, at 2-years post-treatment, and at 3-years post-treatment.

Results

At 6-months post-treatment, a Liver Stiffness Measurement (LSM) cutoff of > 19 KPa was identified, leading to a 14.5-fold increase in the hazard of negative outcomes, including decompensation and/or HCC. The analysis of relative changes in liver stiffness between pre-treatment and 6-months posttreatment revealed that a reduction in LSM of -10 % was associated with a -12 % decrease in the hazard of decompensation and/or HCC, with this trend continuing as the LSM reduction reached -40 %, resulting in a -41 % hazard of decompensation and/or HCC. Conversely, an increase in the relative change during this period, such as an LSM increase of +10 %, led to a + 14 % increase in the hazard of decompensation. In cases where this relative change in LSM was +50 %, the hazard of decompensation increased to +92.

Conclusion

Transient elastography using FibroScan® can be a good tool for monitoring HCV patients with SVR after treatment to predict LREs in the long term.

目的主要目的是评估肝脏相关事件（LRE），包括肝功能失代偿（腹水、出血性静脉曲张和脑病）和肝细胞癌（HCC），以及慢性丙型肝炎病毒（HCV）感染治疗后获得持续病毒学应答（SVR）的患者在随访期间肝脏硬度的变化。方法共对218名HCV患者进行了治疗，并对获得SVR的患者进行了为期3年的随访。结果治疗后6个月时，肝脏硬度测量（LSM）的临界值为> 19 KPa，导致肝功能失代偿和/或肝癌等不良后果的风险增加了14.5倍。对治疗前和治疗后6个月之间肝脏僵硬度相对变化的分析表明，LSM降低-10%与失代偿和/或HCC风险降低-12%相关，当LSM降低到-40%时，这一趋势仍在继续，导致失代偿和/或HCC风险降低-41%。相反，在此期间相对变化的增加，如 LSM 增加 +10%，则导致失代偿危险增加 +14%。结论使用 FibroScan® 进行瞬态弹性成像是监测治疗后 SVR 的 HCV 患者以预测长期 LRE 的良好工具。

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引用次数: 0

A meta-analysis on the efficacy of endoscopic ultrasonography for treatment of pancreatic cancer 关于内镜超声造影治疗胰腺癌疗效的荟萃分析

IF 2.7 4区医学 Q2 Medicine

Clinics

Pub Date : 2024-01-01 DOI: 10.1016/j.clinsp.2024.100348

Min Xuan, Na Li, Chunyan Wu

Objective

This study aimed to systematically evaluate the efficacy and safety of Endoscopic Ultrasonography (EUS) for the treatment of pancreatic cancer.

Methods

The PubMed, Embase, Web of Science, and Google Scholar databases were searched from the inception of the databases to June 2022. RevMan 5.3.0 software was utilized for data analysis. In total, 13 self-descriptive studies, which enrolled 382 patients, were finally included.

Results

It was revealed that EUS for the treatment of pancreatic cancer exhibited a lower incidence of adverse reactions (Relative Risk Ration [RR = 0.23], 95 % Confidence interval [95 % CI 0.23–0.23]), a higher success rate (RR = 0.90, 95 % CI 0.90–0.90), and a low failure rate (RR = 0.06, 95 % CI 0.06–0.06). Moreover, EUS-guided Celiac Plexus Neurolysis (EUS-CPN) not only significantly relieved pancreatic cancer patients’ pain (RR = 0.83, 95 % CI 0.83–0.83), but also significantly eliminated pain in some patients (RR = 0.09, 95 % CI 0.09–0.09). The effects of EUS on pancreatic cancer treatment were satisfactory, and few adverse reactions were found.

Conclusion

Owing to the restricted sample size in this meta-analysis, primarily consisting of descriptive studies, it was imperative to conduct more rigorously designed, multi-center, long-term follow-up, larger sample, and Randomized Controlled Trials (RCTs) to validate the findings.

方法检索PubMed、Embase、Web of Science和Google Scholar数据库，检索时间从数据库建立之初至2022年6月。使用RevMan 5.3.0软件进行数据分析。结果显示，EUS 治疗胰腺癌的不良反应发生率较低（相对风险系数 [RR = 0.23]，95 % 置信区间 [95 % CI 0.23-0.23]），成功率较高（RR = 0.90，95 % CI 0.90-0.90），失败率较低（RR = 0.06，95 % CI 0.06-0.06）。此外，EUS引导下的腹腔神经丛神经切断术（EUS-CPN）不仅能显著缓解胰腺癌患者的疼痛（RR = 0.83，95 % CI 0.83-0.83），还能明显消除部分患者的疼痛（RR = 0.09，95 % CI 0.09-0.09）。结论由于该荟萃分析的样本量有限，且主要由描述性研究组成，因此必须开展设计更严谨、多中心、长期随访、样本量更大的随机对照试验（RCT）来验证研究结果。

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引用次数: 0

Polidocanol-foam treatment of varicose veins: Quality-of-life impact compared to conventional surgery 波利多卡醇泡沫治疗静脉曲张：与传统手术相比对生活质量的影响

IF 2.7 4区医学 Q2 Medicine

Clinics

Pub Date : 2024-01-01 DOI: 10.1016/j.clinsp.2024.100346

Lissa Severo Sakugawa , Felipe Soares Oliveira Portela , Andressa Cristina Sposato Louzada , Maria Fernanda Cassino Portugal , Marcelo Passos Teivelis , Cynthia de Almeida Mendes , Lucas Lembrança Pinheiro , Marcelo Fiorelli Alexandrino da Silva , Alexandre Fioranelli , Nelson Wolosker

Background and objective

Lower limb varicose veins are a prevalent disease associated with several available treatment options, including conventional surgery and polidocanol foam sclerotherapy. However, few studies have analyzed therapeutic modality outcomes based on Patient-Reported Outcome Measures (PROMs). This large sample-size study was designed to evaluate the outcomes of polidocanol foam sclerotherapy compared to conventional surgery based on an analysis of PROMs.

Methods

This was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with either polidocanol foam sclerotherapy (57 patients, 90 legs) or conventional surgery (148 patients, 236 legs). Patients were preoperatively assessed and re-evaluated 30 days after the procedure using the Venous Disease Severity Score (VCSS) and specific venous disease quality-of-life questionnaires (VEINES-QoL/Sym).

Results

Both treatments significantly improved VCSS and VEINES results 30 days after the procedure (p < 0.05). However, surgery promoted greater improvements in VCSS (on average 4.02-points improvement, p < 0.001), VEINES-QoL (average 8-points improvement, p < 0.001), and VEINES-Sym (average 11.66 points improvement, p < 0.001) than did sclerotherapy. Postoperative pain and aesthetic concerns about the legs were the domains of the questionnaires in which the results varied the most between the treatment modalities, with worse results for sclerotherapy.

Conclusion

Both polidocanol foam sclerotherapy and conventional surgery positively impact patients’ quality of life after 30 days, but the improvement is more significant for patients who undergo conventional surgery.

背景和目的下肢静脉曲张是一种常见疾病，有多种治疗方法可供选择，包括传统手术和多发性泡沫硬化剂注射疗法。然而，很少有研究根据患者报告结果指标（PROMs）来分析治疗方法的效果。这是一项前瞻性、观察性和定性研究，共有 205 名患者接受了静脉曲张治疗，其中有 57 名患者接受了泡沫硬化剂治疗（90 条腿），有 148 名患者接受了传统手术治疗（236 条腿）。术前对患者进行评估，术后 30 天使用静脉疾病严重程度评分（VCSS）和特定静脉疾病生活质量问卷（VEINES-QoL/Sym）对患者进行重新评估。结果两种治疗方法都能显著改善术后 30 天的 VCSS 和 VEINES 结果（p <0.05）。然而，与硬化疗法相比，手术对 VCSS（平均改善 4.02 分，p < 0.001）、VEINES-QoL（平均改善 8 分，p < 0.001）和 VEINES-Sym （平均改善 11.66 分，p < 0.001）的改善更大。术后疼痛和对腿部美观的担忧是两种治疗方式的问卷调查中结果差异最大的领域，硬化剂治疗的结果更差。结论聚多巴胺醇泡沫硬化剂治疗和传统手术都会对患者 30 天后的生活质量产生积极影响，但接受传统手术的患者的生活质量改善更为显著。

{"title":"Polidocanol-foam treatment of varicose veins: Quality-of-life impact compared to conventional surgery","authors":"Lissa Severo Sakugawa , Felipe Soares Oliveira Portela , Andressa Cristina Sposato Louzada , Maria Fernanda Cassino Portugal , Marcelo Passos Teivelis , Cynthia de Almeida Mendes , Lucas Lembrança Pinheiro , Marcelo Fiorelli Alexandrino da Silva , Alexandre Fioranelli , Nelson Wolosker","doi":"10.1016/j.clinsp.2024.100346","DOIUrl":"https://doi.org/10.1016/j.clinsp.2024.100346","url":null,"abstract":"<div><h3>Background and objective</h3><p>Lower limb varicose veins are a prevalent disease associated with several available treatment options, including conventional surgery and polidocanol foam sclerotherapy. However, few studies have analyzed therapeutic modality outcomes based on Patient-Reported Outcome Measures (PROMs). This large sample-size study was designed to evaluate the outcomes of polidocanol foam sclerotherapy compared to conventional surgery based on an analysis of PROMs.</p></div><div><h3>Methods</h3><p>This was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with either polidocanol foam sclerotherapy (57 patients, 90 legs) or conventional surgery (148 patients, 236 legs). Patients were preoperatively assessed and re-evaluated 30 days after the procedure using the Venous Disease Severity Score (VCSS) and specific venous disease quality-of-life questionnaires (VEINES-QoL/Sym).</p></div><div><h3>Results</h3><p>Both treatments significantly improved VCSS and VEINES results 30 days after the procedure (p < 0.05). However, surgery promoted greater improvements in VCSS (on average 4.02-points improvement, p < 0.001), VEINES-QoL (average 8-points improvement, p < 0.001), and VEINES-Sym (average 11.66 points improvement, p < 0.001) than did sclerotherapy. Postoperative pain and aesthetic concerns about the legs were the domains of the questionnaires in which the results varied the most between the treatment modalities, with worse results for sclerotherapy.</p></div><div><h3>Conclusion</h3><p>Both polidocanol foam sclerotherapy and conventional surgery positively impact patients’ quality of life after 30 days, but the improvement is more significant for patients who undergo conventional surgery.</p></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1807593224000231/pdfft?md5=87e1389e2bde56a8f984546259378c90&pid=1-s2.0-S1807593224000231-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140344783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Screening and diagnostic tools for autism spectrum disorder: Systematic review and meta-analysis 自闭症谱系障碍的筛查和诊断工具：系统回顾和荟萃分析

IF 2.7 4区医学 Q2 Medicine

Clinics

Pub Date : 2024-01-01 DOI: 10.1016/j.clinsp.2023.100323

Clara Lucato dos Santos , Indyanara Inacio Barreto , Idevaldo Floriano , Luca Schiliró Tristão , Antonio Silvinato , Wanderley Marques Bernardo

Introduction

Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental disorder, with main manifestations related to communication, social interaction, and behavioral patterns. The slight dynamics of change in the child over time require that the onset of clinical manifestations presented by the child be more valued, with the aim of stabilizing the condition. Faced with a variety of methods for diagnosing ASD, the question arises as to which method should be used. This systematic review aims to recommend the best tools to perform screening and diagnosis.

Methodology

This systematic review followed the PRISMA guidelines. The databases MEDLINE, Embase, CENTRAL (Cochrane), and Lilacs were accessed, and gray and manual searches were performed. The search strategy was created with terms referring to autism and the diagnosis/broad filter. The studies were qualitatively evaluated and quantitatively. Statistical analysis was performed using Meta-diSc-2.0 software, the confidence interval was 95 %.

Results

The M-CHAT-R/F tool demonstrated a sensitivity of 78 % (95 % CI 0.57‒0.91) and specificity of 0.98 (95 % CI 0.88–1.00). The diagnostic tools demonstrated sensitivity and specificity respectively of: ADOS, sensitivity of 87 % (95 % CI 0.79‒0.92) and specificity 75 % (95 % CI 0.73‒0.78); ADI-R demonstrated test sensitivity of 77 % (95 % CI 0.56‒0.90) and specificity 68 % (95 % CI 0.52‒0.81), CARS test sensitivity was 89 % (95 % CI 0.78‒0.95) and specificity 79 % (95 % CI 0.65‒0.88).

Conclusion

It is mandatory to apply a screening test, the most recommended being the M-CHAT-R/F. For diagnosis CARS and ADOS are the most recommended tools.

导言自闭症谱系障碍（ASD）是一种异质性神经发育障碍，主要表现与沟通、社会交往和行为模式有关。随着时间的推移，患儿会发生细微的动态变化，这就要求我们更加重视患儿开始出现的临床表现，以稳定病情。面对各种各样的 ASD 诊断方法，问题是应该使用哪种方法。本系统综述旨在推荐进行筛查和诊断的最佳工具。访问了 MEDLINE、Embase、CENTRAL（Cochrane）和 Lilacs 等数据库，并进行了灰色检索和人工检索。使用自闭症术语和诊断/宽泛过滤器创建了检索策略。对研究进行了定性和定量评估。结果M-CHAT-R/F工具的灵敏度为78%（95% CI 0.57-0.91），特异度为0.98（95% CI 0.88-1.00）。诊断工具的灵敏度和特异性分别为ADOS 的灵敏度为 87 % (95 % CI 0.79-0.92)，特异度为 75 % (95 % CI 0.73-0.78)；ADI-R 的测试灵敏度为 77 % (95 % CI 0.56-0.90)，特异度为 68 % (95 % CI 0.52-0.81)；CARS 的测试灵敏度为 89 % (95 % CI 0.78-0.95)，特异度为 79 % (95 % CI 0.65-0.88)。在诊断方面，CARS 和 ADOS 是最值得推荐的工具。

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引用次数: 0

FOXO3a deregulation in uterine smooth muscle tumors 子宫平滑肌瘤中的 FOXO3a 基因失调

IF 2.7 4区医学 Q2 Medicine

Clinics

Pub Date : 2024-01-01 DOI: 10.1016/j.clinsp.2024.100350

Thais Gomes de Almeida , Anamaria Ritti Ricci , Laura Gonzalez dos Anjos , Jose Maria Soares Junior , Gustavo Arantes Rosa Maciel , Edmund Chada Baracat , Katia Candido Carvalho

Objective

The present study aimed to investigate FOXO3a deregulation in Uterine Smooth Muscle Tumors (USMT) and its potential association with cancer development and prognosis.

Methods

The authors analyzed gene and protein expression profiles of FOXO3a in 56 uterine Leiomyosarcomas (LMS), 119 leiomyomas (comprising conventional and unusual leiomyomas), and 20 Myometrium (MM) samples. The authors used techniques such as Immunohistochemistry (IHC), FISH/CISH, and qRT-PCR for the present analyses. Additionally, the authors conducted an in-silico analysis to understand the interaction network involving FOXO3a and its correlated genes.

Results

This investigation revealed distinct expression patterns of the FOXO3a gene and protein, including both normal and phosphorylated forms. Expression levels were notably elevated in LMS, and Unusual Leiomyomas (ULM) compared to conventional Leiomyomas (LM) and Myometrium (MM) samples. This upregulation was significantly associated with metastasis and Overall Survival (OS) in LMS patients. Intriguingly, FOXO3a deregulation did not seem to be influenced by EGF/HER-2 signaling, as there were minimal levels of EGF and VEGF expression detected, and HER-2 and EGFR were negative in the analyzed samples. In the examination of miRNAs, the authors observed upregulation of miR-96-5p and miR-155-5p, which are known negative regulators of FOXO3a, in LMS samples. Conversely, the tumor suppressor miR-let7c-5p was downregulated.

Conclusions

In summary, the outcomes of the present study suggest that the imbalance in FOXO3a within Uterine Smooth Muscle Tumors might arise from both protein phosphorylation and miRNA activity. FOXO3a could emerge as a promising therapeutic target for individuals with Unusual Leiomyomas and Leiomyosarcomas (ULM and LMS), offering novel directions for treatment strategies.

本研究旨在探讨子宫平滑肌瘤（USMT）中 FOXO3a 的失调及其与癌症发展和预后的潜在关联。方法：作者分析了 56 例子宫线肉瘤（LMS）、119 例子宫肌瘤（包括常规和异常子宫肌瘤）和 20 例子宫肌瘤（MM）样本中 FOXO3a 的基因和蛋白表达谱。作者采用免疫组织化学（IHC）、FISH/CISH 和 qRT-PCR 等技术进行了分析。此外，作者还进行了体内分析，以了解涉及 FOXO3a 及其相关基因的相互作用网络。结果这项研究揭示了 FOXO3a 基因和蛋白的不同表达模式，包括正常和磷酸化形式。与传统的子宫肌瘤（LM）和子宫肌层（MM）样本相比，LMS和异常子宫肌瘤（ULM）的表达水平明显升高。这种上调与LMS患者的转移和总生存期（OS）明显相关。耐人寻味的是，FOXO3a 的失调似乎不受 EGF/HER-2 信号转导的影响，因为在分析样本中检测到的 EGF 和 VEGF 表达水平极低，而且 HER-2 和 EGFR 均为阴性。在对 miRNA 的研究中，作者观察到 miR-96-5p 和 miR-155-5p 在 LMS 样本中上调，它们是已知的 FOXO3a 负调控因子。结论综上所述，本研究结果表明，子宫平滑肌瘤中 FOXO3a 的失衡可能源于蛋白质磷酸化和 miRNA 活性。FOXO3a 可能会成为异常子宫肌瘤和子宫平滑肌肉瘤（ULM 和 LMS）患者的一个有希望的治疗靶点，为治疗策略提供新的方向。

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引用次数: 0

Toll-like receptor signaling pathway involved in pathogenesis of thromboangiitis obliterans through activating of NF-κB 通过激活 NF-κB 参与血栓闭塞性脉管炎发病机制的 Toll 样受体信号通路

IF 2.7 4区医学 Q2 Medicine

Clinics

Pub Date : 2024-01-01 DOI: 10.1016/j.clinsp.2024.100357

Facai Guo , Yan Bi , Jiangyan Yin , Yi Guo

Objectives

The pathogenic mechanisms of Thromboangiitis Obliterans (TAO) are not entirely known and autoimmune inflammation plays a vital role in the initiation and continuance of TAO activity. The authors investigated in this study the role of the TLR signaling pathway in the pathogenesis of TAO.

Methods

First, the authors detected the expressions of MyD88, TRIF and NF-κB in vascular walls of 46 patients with TAO and 32 patients with trauma and osteosarcoma by western blot assay. Second, the authors detected the cellular localization of MyD88, TRIF and NF-κB in vascular walls of patients with TAO by immunofluorescent assay.

Results

The protein expressions of MyD88, TRIF and NF-κB were much higher in vascular walls of TAO patients (p < 0.05). Higher expressions of MyD88 and NF-κB were detected both on vascular endothelial and vascular smooth muscle cells of TAO patients. However, higher expression of TRIF was just detected on vascular smooth muscle cells of TAO patients.

Conclusions

These dates suggest that the TLR signaling pathway might play an important role in the pathogenesis of TAO, it might induce vasospasm, vasculitis and thrombogenesis to lead to the pathogenesis and progression of TAO.

目的血栓闭塞性脉管炎（TAO）的发病机制尚不完全清楚，而自身免疫性炎症在TAO活动的开始和持续中起着至关重要的作用。作者在本研究中探讨了 TLR 信号通路在 TAO 发病机制中的作用。方法首先，作者通过 Western 印迹检测了 46 名 TAO 患者和 32 名外伤及骨肉瘤患者血管壁中 MyD88、TRIF 和 NF-κB 的表达。其次，作者通过免疫荧光法检测了MyD88、TRIF和NF-κB在TAO患者血管壁中的细胞定位。在 TAO 患者的血管内皮细胞和血管平滑肌细胞中均检测到 MyD88 和 NF-κB 的较高表达。结论这些研究结果表明，TLR信号通路可能在TAO的发病机制中发挥重要作用，它可能诱导血管痉挛、血管炎和血栓形成，从而导致TAO的发病和进展。

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引用次数: 0

Correlation between islet α cell function and peripheral neuropathy in patients with type 2 diabetes mellitus 2 型糖尿病患者胰岛 α 细胞功能与周围神经病变之间的相关性

IF 2.2 4区医学 Q2 Medicine

Clinics

Pub Date : 2024-01-01 DOI: 10.1016/j.clinsp.2024.100392

Yurou Cao , Xueqin Wang

Background

This study explored the correlation between pancreatic islet α cell function, as reflected by the plasma glucagon levels, and Diabetic Peripheral Neuropathy (DPN) in patients with Type 2 Diabetes Mellitus (T2DM).

Methods

A total of 358 patients with T2DM were retrospectively enrolled in this study and divided into the Non-DPN (NDPN) group (n = 220) and the DPN group (n = 138). All patients underwent an oral glucose tolerance test to detect levels of blood glucose, insulin and glucagon, and the Area Under the Curve (AUC) for Glucagon (AUCglu) was used to estimate the overall glucagon level. The Peripheral Nerve Conduction Velocity (PNCV), Amplitude (PNCA) and Latency (PNCL) were obtained with electromyography, and their Z scores were calculated.

Results

There were significant differences regarding the age, disease duration, serum levels of alanine aminotransferase, aspartate aminotransferase, urea nitrogen, high-density lipoprotein, and 2h-C peptide between these two groups (p < 0.05). The NDPN group had higher glucagon levels at 30, 60 and 120 min and AUCglu (p < 0.05). The Z-scores of PNCV and PNCA showed an increasing trend (p < 0.05), while the Z-score of PNCL showed a decreasing trend (p < 0.05). The glucagon levels were positively correlated with PNCV and PNCA, but negatively correlated with PNCL, with Gluca30min having the strongest correlation (p < 0.05). Gluca30min was independently related to PNCV, PNCL, PNCA and DPN, respectively (p < 0.05). The function of pancreatic α islet cells, as reflected by the plasma glucagon level, is closely related to the occurrence of DPN in T2DM patients.

Conclusion

Gluca30min may be a potentially valuable independent predictor for the occurrence of DPN.

背景本研究探讨了血浆胰高血糖素水平所反映的胰岛α细胞功能与2型糖尿病（T2DM）患者糖尿病周围神经病变（DPN）之间的相关性。方法本研究回顾性纳入了358名T2DM患者，并将其分为非DPN（NDPN）组（n = 220）和DPN组（n = 138）。所有患者都接受了口服葡萄糖耐量试验，以检测血糖、胰岛素和胰高血糖素的水平，并用胰高血糖素的曲线下面积（AUC）（AUCglu）来估算胰高血糖素的总体水平。结果两组患者的年龄、病程、血清丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、尿素氮、高密度脂蛋白和 2h-C 肽水平差异显著（p < 0.05）。NDPN 组在 30、60 和 120 分钟的胰高血糖素水平和 AUCglu 水平更高（p < 0.05）。PNCV 和 PNCA 的 Z 值呈上升趋势（p < 0.05），而 PNCL 的 Z 值呈下降趋势（p < 0.05）。胰高血糖素水平与 PNCV 和 PNCA 呈正相关，但与 PNCL 呈负相关，其中 Gluca30min 的相关性最强（p < 0.05）。Gluca30min 分别与 PNCV、PNCL、PNCA 和 DPN 独立相关（p < 0.05）。血浆胰高血糖素水平所反映的胰腺α胰岛细胞的功能与 T2DM 患者 DPN 的发生密切相关。

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引用次数: 0

Clinical research of fibroscan ‒ TE-CAP at noninvasive diagnosis of hepatic steatosis in children 纤维扫描 - TE-CAP 在无创诊断儿童肝脂肪变性方面的临床研究

IF 2.7 4区医学 Q2 Medicine

Clinics

Pub Date : 2024-01-01 DOI: 10.1016/j.clinsp.2024.100387

Shuangzhen Jia , Jianli Zhou , Qiao Zhang , Shaoming Zhou , Zhaoxia Wang , Xiaolin Ye , Jie Wu

Background & aims

The authors assess the diagnostic accuracy of the Transient Elastography-Controlled Attenuation Parameter (TE-CAP) in children of Southern China.

Methods

105 obese or overweight children and adolescents were enrolled in the diagnostic test of TE-CAP assessment of hepatic steatosis using MRI-PDFF. Hepatic steatosis grades S0-S3 were classified. Statistical correlation, agreement and consistency between methods were evaluated. The diagnostic efficiency of TE-CAP was evaluated. The authors used the cutoff value of TE-CAP to detect hepatic steatosis in another 356 children.

Results

The Area Under Curve (AUC) of TE-CAP for grade ≥ S1, ≥ S2, and ≥ S3 steatosis were 0.975, 0.984, and 0.997, respectively. For detecting ≥ S1 steatosis, TE-CAP had a sensitivity of 96 % and a specificity of 97 %. For detecting ≥ S2 steatosis, TE-CAP had a sensitivity of 97 % and a specificity of 93 %. For detecting ≥ S3 steatosis, TE-CAP had a sensitivity of 1 and a specificity of 94 %. TE-CAP and MRI-PDFF had a linear correlation (r = 0. 0.87, p < 0.001). The hepatic steatosis was identified in 40.2 % (143/356) of children in which the obesity and overweight were 69.8 % (113/162) and 40.0 % (18/45).

Conclusion

TE-CAP showed excellent diagnostic accuracy in pediatric hepatic steatosis.

背景& 目的作者评估了瞬态弹性成像-控制衰减参数（TE-CAP）在中国南方儿童中的诊断准确性。方法105名肥胖或超重的儿童和青少年参加了使用MRI-PDFF评估肝脏脂肪变性的TE-CAP诊断测试。肝脏脂肪变性分为 S0 至 S3 级。评估了各种方法之间的统计相关性、一致性和连贯性。评估了 TE-CAP 的诊断效率。结果TE-CAP检测≥S1、≥S2和≥S3级脂肪变性的曲线下面积（AUC）分别为0.975、0.984和0.997。对于检测≥ S1 脂肪变性，TE-CAP 的灵敏度为 96%，特异性为 97%。对于检测≥ S2 脂肪变性，TE-CAP 的灵敏度为 97%，特异度为 93%。对于检测≥ S3 脂肪变性，TE-CAP 的灵敏度为 1，特异性为 94%。TE-CAP 和 MRI-PDFF 呈线性相关（r = 0. 0.87，p < 0.001）。40.2%的儿童（143/356）发现了肝脂肪变性，其中肥胖和超重的比例分别为 69.8%（113/162）和 40.0%（18/45）。

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引用次数: 0