IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics

Pub Date : 2025-05-08 eCollection Date: 2025-01-01 DOI: 10.1016/j.clinsp.2025.100674

Xin Liu, Yan Lou, Zhiyong Chang, Changyuan Gu, Bin Du, Guangquan Sun

Objective: To explore the association of obesity comprehensively defined by Body Mass Index (BMI) and Body Fat percentage (BF%) with osteopenia.

Methods: In this cross-sectional study, data of adult men and postmenopausal women aged ≥ 50 years old were obtained from the National Health and Nutrition Examination Surveys (NHANES) database. Weighted logistic regression analysis was conducted to investigate the association of BF% obesity with osteopenia in participants who had different gender and BMI obesity conditions. The association of obesity comprehensively evaluated by BMI and BF% with osteopenia was also explored in the total population and in gender subgroups.

Results: Among 1720 eligible subjects, 1054 had osteopenia. Multivariate analysis suggested that in males, BMI obesity combined with BF% obesity was associated with higher osteopenia odds compared to BMI obesity only (Odds Ratio [OR = 4.01], 95% Confidence Interval [95% CI 1.43‒11.27]). Compared to participants with both BMI and BF% obesity, those with BMI obesity have lower osteopenia odds (OR = 0.46, 95% CI 0.28‒0.76), whereas those with BF% obesity have higher odds of osteopenia (OR = 2.03, 95% CI 1.35‒3.05, p = 0.002). In females, compared to BMI obesity combined with BF% obesity, BF% obesity (OR = 3.37, 95% CI 1.47‒7.73) or non-obesity (OR = 2.11, 95% CI 1.18‒3.75) was respectively associated with higher osteopenia odds. In males, BMI obesity was linked to lower osteopenia odds compared to both BMI and BF% obesity (OR = 0.25, 95% CI 0.10‒0.62).

Conclusions: The comprehensively assessed obesity by BMI and BF% may be more meaningful in the evaluation of potential osteopenia risk, as well as further prevention and intervention of osteoporosis.

目的：探讨体重指数（BMI）和体脂率（BF%）综合定义的肥胖与骨质减少的关系。方法：在这项横断面研究中，年龄≥50岁的成年男性和绝经后女性的数据来自国家健康和营养检查调查（NHANES）数据库。采用加权logistic回归分析来调查不同性别和BMI肥胖状况的参与者中BF%肥胖与骨质减少的关系。通过BMI和BF%综合评价的肥胖与骨质减少的关系也在总人口和性别亚组中进行了探讨。结果：在1720名符合条件的受试者中，1054名患有骨质减少症。多因素分析表明，在男性中，BMI肥胖合并BF%肥胖与骨质减少的几率比仅BMI肥胖高（优势比[OR = 4.01]， 95%可信区间[95% CI 1.43-11.27]）。与BMI和BF%肥胖的参与者相比，BMI肥胖者骨质减少的几率较低（OR = 0.46, 95% CI 0.28-0.76），而BF%肥胖者骨质减少的几率较高（OR = 2.03, 95% CI 1.35-3.05, p = 0.002）。在女性中，与BMI肥胖合并BF%肥胖相比，BF%肥胖（OR = 3.37, 95% CI 1.47-7.73）或非肥胖（OR = 2.11, 95% CI 1.18-3.75）分别与较高的骨质减少率相关。在男性中，与BMI和BF%肥胖相比，BMI肥胖与骨质减少的几率较低相关（OR = 0.25, 95% CI 0.10-0.62）。结论：BMI和BF%综合评价肥胖对潜在骨质减少风险的评价，以及骨质疏松的进一步预防和干预可能更有意义。

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引用次数: 0

Risk factors for the growth of ground-glass nodules in the lungs: A systematic review and meta-analysis. 肺毛玻璃结节生长的危险因素：系统回顾和荟萃分析。

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics

Pub Date : 2025-05-07 eCollection Date: 2025-01-01 DOI: 10.1016/j.clinsp.2025.100669

Qianfang Yang, Fan Wang, Hongxin Cao

Objective: The growth of ground-glass nodules in the lungs is an independent risk factor for the occurrence of lung cancer, which provides the basic conditions for the occurrence of lung cancer. However, risk factors for the growth of ground-glass nodules in the lungs have not been fully identified. The purpose of this meta-analysis was to assess risk factors for the growth of ground-glass nodules in the lungs.

Methods: Computerized searches of the electronic databases of PubMed, Web of Science, Cochrane Library and Scopus for published studies on risk factors for the growth of ground-glass nodules in the lungs. The search time limit is from the establishment of the database to March 2024. Two review authors independently searched the studies according to the inclusion and exclusion criteria, and the quality of the selected studies was evaluated using the Newcastle-Ottawa Scale (NOS), and RevMan 5.4 software was used for meta-analysis. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42024499763).

Results: Fourteen studies involving 2059 patients were included, and 14 statistically significant risk factors were identified. The results of meta-analysis showed that age (WMD = 4.61, 95 % CI [1.73∼7.49], p = 0.002), female (OR = 0.65, 95 % CI [0.51∼0.82], p = 0.0003), history of smoking (OR = 1.76, 95 % CI [1.07∼2.92], p = 0.03), history of malignancy (OR = 1.53, 95 % CI [1.16∼2.02], p = 0.003), lesion size (≥ 8 mm) (OR = 1.19, 95 % CI [1.12∼1.26], p < 0.00001), air bronchial sign (OR = 6.09, 95 % CI [3∼12.33], p < 0.00001), lobulation sign (OR = 2.3, 95 % CI [1.58∼3.36], p < 0.00001), spiculated sign (OR = 5.56, 95 % CI [1.39∼22.3], p = 0.02), vascular bundle sign [OR = 2.54, 95 % CI [1.85∼3.48], p < 0.00001), initial diameter (≥ 8 mm) (OR = 1.89, 95 % CI [1.34∼2.67], p = 0.0003), vacuolar sign (OR = 2.62, 95 % CI [1.46∼4.69], p = 0.001), solid nodules (OR = 4.6, 95 % CI [1.96∼10.79], p = 0.0005), solid components (OR = 13.77, 95 % CI [7.08∼26.78], p < 0.00001) and nodule roundness (OR = 2.85, 95 % CI [1.19∼6.81], p = 0.02) were risk factors for the growth of ground-glass nodules in the lungs. However, pleural adhesion (p = 0.47) and pleural retraction (p = 0.07) were not statistically significant.

Conclusion: This systematic review and meta-analysis showed that there are many risk factors for the growth of ground-glass nodules in the lungs, and medical staff should identify the above risk factors as early as possible in clinical work and formulate targeted interventions for precise prevention.

目的：肺内磨玻璃结节生长是肺癌发生的独立危险因素，为肺癌的发生提供了基础条件。然而，肺毛玻璃结节生长的危险因素尚未完全确定。本荟萃分析的目的是评估肺毛玻璃结节生长的危险因素。方法：计算机检索PubMed、Web of Science、Cochrane Library、Scopus等电子数据库中已发表的肺毛玻璃结节生长危险因素的相关研究。检索时限为数据库建立至2024年3月。两位综述作者根据纳入和排除标准独立检索研究，采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale， NOS）评价入选研究的质量，采用RevMan 5.4软件进行meta分析。本综述已在国际前瞻性系统综述注册（PROSPERO）（标识符CRD42024499763）中注册。结果：共纳入14项研究，共2059例患者，共发现14项具有统计学意义的危险因素。荟萃分析的结果显示,年龄(大规模杀伤性武器= 4.61,95% CI 1.73∼7.49,p = 0.002),女(OR = 0.65, 95% CI 0.51∼0.82,p = 0.0003),吸烟史(OR = 1.76, 95% CI 1.07∼2.92,p = 0.03),恶性肿瘤史(OR = 1.53, 95% CI 1.16∼2.02,p = 0.003),病灶大小(≥8毫米)(OR = 1.19, 95% CI 1.12∼1.26,p < 0.00001),空气支气管标志(OR = 6.09, 95% CI 12.33[3∼),p < 0.00001),分成小裂片符号(OR = 2.3, 95% CI 1.58∼3.36,p < 0.00001),针状的符号(或= 5.56,95% CI 1.39∼22.3,p = 0.02),维管束(OR = 2.54, 95% CI 1.85∼3.48,p < 0.00001),初始直径(≥8毫米)(OR = 1.89, 95% CI 1.34∼2.67,p = 0.0003),空泡的迹象(OR = 2.62, 95% CI 1.46∼4.69,p = 0.001),固体结节(OR = 4.6, 95% CI 1.96∼10.79,p = 0.0005),固态组件(OR = 13.77, 95% CI 7.08∼26.78,p < 0.00001)和结节圆度(OR = 2.85, 95% CI 1.19∼6.81,p = 0.02)的风险因素是毛玻璃肺部结节的增长。然而，胸膜粘连（p = 0.47）和胸膜缩回（p = 0.07）无统计学意义。结论：本系统综述和荟萃分析显示，肺部磨玻璃结节生长的危险因素较多，医务人员在临床工作中应尽早识别上述危险因素，并制定有针对性的干预措施，进行精准预防。

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引用次数: 0

Extracellular vesicles as cancer biomarkers and drug delivery strategies in clinical settings: Advances, perspectives, and challenges. 细胞外囊泡作为癌症生物标志物和临床药物递送策略：进展、观点和挑战。

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics

Pub Date : 2025-05-01 eCollection Date: 2025-01-01 DOI: 10.1016/j.clinsp.2025.100635

Raphaela Rebeca Silveira Assunção, Nathalia Leal Santos, Luciana Nogueira de Sousa Andrade

Cancer is a leading cause of death worldwide, and despite the introduction of new therapeutic approaches for advanced cases aimed at improving patient survival, only a subset of patients benefits from a complete response. In this context, there is a growing need for new cancer biomarkers and therapeutic strategies, and the use of Extracellular Vesicles (EVs) has been widely explored in various approaches. As circulating lipid-bilayer particles carrying a variety of biological information from tumor cells, EVs can be employed as good biomarkers of diagnosis, prognosis, therapy evaluation, and as adjuvants in cancer treatment. In this review, we provide a brief overview of the different types of EVs and their biogenesis and discuss how tumor-derived EV cargo can serve as a potential biomarker in clinical settings through liquid biopsy. We also highlight recent advances in EV nanoengineering and their potential as adjuvants in cancer treatment. Finally, we discuss the key unknowns, gaps, and bottlenecks that must be addressed to fully integrate EVs into precision oncology.

癌症是世界范围内的主要死亡原因，尽管针对晚期病例引入了旨在提高患者生存率的新治疗方法，但只有一小部分患者从完全缓解中受益。在这种背景下，人们对新的癌症生物标志物和治疗策略的需求日益增长，细胞外囊泡（EVs）的使用已经在各种方法中得到了广泛的探索。ev作为一种循环脂质双分子层颗粒，携带着来自肿瘤细胞的多种生物信息，可作为诊断、预后、治疗评价的良好生物标志物，并可作为肿瘤治疗的辅助剂。在这篇综述中，我们简要概述了不同类型的EV及其生物发生，并讨论了肿瘤来源的EV货物如何通过液体活检在临床环境中作为潜在的生物标志物。我们还强调了EV纳米工程的最新进展及其在癌症治疗中作为佐剂的潜力。最后，我们讨论了将电动汽车完全整合到精准肿瘤学中必须解决的关键未知数、差距和瓶颈。

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引用次数: 0

Minimally invasive radical prostatectomy versus open radical prostatectomy: A systematic review and meta-analysis of randomized control trials. 微创根治性前列腺切除术与开放式根治性前列腺切除术：随机对照试验的系统回顾和荟萃分析。

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics

Pub Date : 2025-04-27 eCollection Date: 2025-01-01 DOI: 10.1016/j.clinsp.2025.100636

Caio Felipe Araujo Matalani, Mateus Silva Santos Costa, Marcelo Ribeiro da Rocha, Roberto Iglesias Lopes, Thalita Bento Talizin, José Bessa Júnior, William Carlos Nahas, Leopoldo Alves Ribeiro-Filho, Caio Vinicius Suartz

Objective: To evaluate the comparative outcomes of Minimally Invasive Radical Prostatectomy (MIRP) versus Open Radical Prostatectomy (ORP) to treat localized prostate cancer, using only Randomized Controlled Trials (RCTs) to ensure high-quality evidence.

Method: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, focusing solely on RCTs comparing MIRP (robot-assisted or laparoscopic surgery) and ORP. Literature searches across multiple databases, including Cochrane Library, Medline, Embase, Lilacs, Scopus, Web of Science, NIH, Clinical Trials, and EU Clinical Trials Register, identified studies meeting predefined PICOT criteria. Four RCTs met inclusion criteria ‒ two representing the same cohort of patients ‒ and were analyzed for perioperative, functional, and oncologic outcomes. Quality assessment utilized the ROB-2 tool to gauge the risk of bias.

Results: Three RCTs encompassing 1051 patients were analyzed. MIRP demonstrated statistically significant benefits over ORP in terms of reduced perioperative blood loss (Standardized Mean Difference [SMD = -3.058], p = 0.006), lower transfusion rates (Odds Ratio [OR = 0.137]; p = 0.009), and fewer overall complications (OR = 0.465; p = 0001). However, no significant differences were found in long-term oncologic and functional outcomes, including urinary continence and erectile function. Positive surgical margins and additional treatments also did not differ significantly between groups.

Conclusion: This systematic review and meta-analysis of RCTs indicated that MIRP offers perioperative advantages over ORP, supporting its role as a safe and effective option for localized prostate cancer.

目的：评价微创根治性前列腺切除术（MIRP）与开放式根治性前列腺切除术（ORP）治疗局限性前列腺癌的比较效果，仅采用随机对照试验（rct）来确保高质量的证据。方法：根据PRISMA指南进行系统回顾和荟萃分析，仅关注比较MIRP（机器人辅助或腹腔镜手术）和ORP的随机对照试验。文献检索跨越多个数据库，包括Cochrane Library， Medline, Embase, Lilacs, Scopus, Web of Science， NIH， Clinical Trials和EU Clinical Trials Register，确定了符合预定义PICOT标准的研究。四项rct符合纳入标准，其中两项代表相同的患者队列，并对围手术期、功能和肿瘤预后进行分析。质量评估采用rob2工具评估偏倚风险。结果：共分析了3项rct，共1051例患者。与ORP相比，MIRP在减少围手术期失血量（标准化平均差[SMD = -3.058], p = 0.006）、降低输血率(优势比[OR = 0.137]；p = 0.009)，总并发症较少(OR = 0.465；P = 0001)。然而，在长期肿瘤和功能结果（包括尿失禁和勃起功能）方面没有发现显著差异。阳性手术切缘和额外治疗在两组之间也没有显著差异。结论：本系统综述和荟萃分析的随机对照试验表明，MIRP比ORP具有围手术期优势，支持其作为局部前列腺癌安全有效的选择。

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引用次数: 0

Comment on: "Comparison of endoscopic submucosal dissection and transanal endoscopic surgery for the treatment of rectal neoplasia: A systematic review and meta-analysis". 评论：“内镜下粘膜剥离术与经肛门内镜手术治疗直肠肿瘤的比较：一项系统综述和荟萃分析”。

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics

Pub Date : 2025-04-24 eCollection Date: 2025-01-01 DOI: 10.1016/j.clinsp.2025.100663

Wensi Ouyang, Guimei Guo

引用次数: 0

Commentary on "Pembrolizumab in gestational trophoblastic neoplasia: systematic review and meta-analysis with sub-group analysis of potential prognostic factors". 关于“派姆单抗治疗妊娠滋养细胞瘤：系统评价和潜在预后因素亚组分析的meta分析”的评论。

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics

Pub Date : 2025-04-24 eCollection Date: 2025-01-01 DOI: 10.1016/j.clinsp.2025.100651

Shubham Kumar, Rachana Mehta, Ranjana Sah

引用次数: 0

Association between decreased p53 expression, elevated serum CagA levels, and oral squamous cell carcinoma p53表达降低、血清CagA水平升高与口腔鳞状细胞癌之间的关系

IF 2.2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics

Pub Date : 2025-01-01 DOI: 10.1016/j.clinsp.2025.100632

Minxiao Lin , Jing Wang , Xiaowu Yao

Objective

p53 is a key tumor suppressor, aCnd loss of p53 function promotes the progression of many cancers. Helicobacter Pylori (HP) is mainly involved in the progression of gastric carcinoma, but its role in Oral Squamous Cell Carcinoma (OSCC) is controversial. The primary objectives of this study were to investigate the expression levels of p53 in OSCC tissues and to examine the serum levels of CagA in OSCC patients. Additionally, the authors aimed to explore the potential association between p53 expression and CagA levels in OSCC.

Method

A total of 65 patients diagnosed with OSCC and 42 healthy volunteers were recruited in this study. The clinical pathological parameters of all patients were collected. Reverse transcription-quantitative polymerase chain reaction was performed to detect the expression of p53 in tissues. Receiver Operating Characteristics Curve (ROC) analysis was used to assess the sensitivity of p53 for the diagnosis of OSCC. The concentration of Cytotoxin-Associated gene A (CagA) in serum was assessed by enzyme-linked immuno sorbent assay.

Results

The results indicated that the p53 expression in oral mucosal tissues was downregulated while the concentration of CagA in serum was increased in OSCC patients. Besides, p53 expression was correlated with tumor stage. OSCC patients showed a higher HP positive rate than in healthy people.

Conclusions

In conclusion, this study demonstrated that decreased p53 expression and elevated serum CagA levels might be correlated with OSCC progression and diagnosis.

目的p53是一种重要的肿瘤抑制因子，p53功能的缺失促进了许多肿瘤的进展。幽门螺杆菌（HP）主要参与胃癌的进展，但其在口腔鳞状细胞癌（OSCC）中的作用仍有争议。本研究的主要目的是研究OSCC组织中p53的表达水平，并检测OSCC患者血清中CagA的水平。此外，作者旨在探讨OSCC中p53表达与CagA水平之间的潜在关联。方法本研究共招募65例OSCC患者和42名健康志愿者。收集所有患者的临床病理参数。逆转录-定量聚合酶链反应检测p53在组织中的表达。采用受试者工作特征曲线（Receiver Operating characteristic Curve， ROC）分析评估p53对OSCC诊断的敏感性。采用酶联免疫吸附法测定血清中细胞毒素相关基因A （CagA）的浓度。结果OSCC患者口腔黏膜组织中p53表达下调，血清中CagA浓度升高。p53的表达与肿瘤分期相关。OSCC患者HP阳性率高于健康人。结论本研究提示p53表达降低和血清CagA水平升高可能与OSCC的进展和诊断有关。

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引用次数: 0

Sex differences in kidney and lung status in an animal model of brain death 脑死亡动物模型中肾和肺状态的性别差异

IF 2.2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics

Pub Date : 2025-01-01 DOI: 10.1016/j.clinsp.2025.100623

Marina Vidal-dos-Santos , Roberto Armstrong-Jr , Maryna van Zil , Fernanda Yamamoto Ricardo-da-Silva , Lucas Ferreira da Anunciação , Mayara Munhoz de Assis Ramos , Cristiano de Jesus Correia , Petra J. Ottens , Luiz Felipe Pinho Moreira , Henri G.D. Leuvenink , Ana Cristina Breithaupt-Faloppa

Background

In transplantation, sex-mismatched procedures correlate with poorer outcomes. Previous research has indicated that females respond worst to Brain Death (BD) and that organ damage varies with the speed of BD induction. The authors aimed to investigate the effects of slow BD-induction on lung and kidney responses in male and female rats.

Methods

Males and female rats were subjected to slow induction of BD and kept for 4h. Blood gas samples were taken at 0 h and 4h. At 4 h, blood, urine and tissue samples were collected. IL-1β was measured in plasma, lung homogenate and lung culture. IL-6 was quantified in plasma, lung culture, and kidney homogenate. Leukocyte infiltration/activation was evaluated. Biochemical analyses of creatinine were performed in the plasma. Naïve animals were used as controls.

Results

Males presented reduced testosterone levels after 4h. Females presented reduced progesterone, whereas estradiol remained similar at 0 h and 4h. Compared with Naive, BD-groups presented increased plasma IL-1β and IL-6. Males and females presented reduced pO₂ after BD, with females presenting even lower values at 4h. In lung tissue, males presented increased expression of IL-1β, whereas IL-1β was elevated in females in lung culture. Females presented increased cell infiltration/activation. In the kidney, males presented increased plasma creatinine, increased expression of caspase-3, and increased leukocyte migration to renal tissue than females.

Conclusions

The authors observed an organ and sex-dependent response to the slow-induction of BD. These results suggest that management strategies should consider the sex of the donor to achieve the best treatment, improving graft quality.

在移植中，性别不匹配的手术与较差的结果相关。先前的研究表明，女性对脑死亡（BD）的反应最差，并且器官损伤随BD诱导的速度而变化。作者旨在研究慢速bd诱导对雄性和雌性大鼠肺和肾脏反应的影响。方法将雄性大鼠和雌性大鼠缓慢诱导BD，静养4h。0h和4h采集血气样本。4 h时，采集血液、尿液和组织样本。测定血浆、肺匀浆和肺培养物中IL-1β的含量。定量血浆、肺培养和肾匀浆中的IL-6。评估白细胞浸润/活化。血浆肌酐生化分析。Naïve动物作为对照。结果4小时后，雄性小鼠睾酮水平下降。雌性在第0和第4小时出现孕酮降低，而雌二醇保持相似。与Naive相比，bd组血浆IL-1β和IL-6升高。BD后，雄性和雌性的pO2均降低，雌性在4小时时的pO2值更低。在肺组织中，雄性小鼠IL-1β表达升高，雌性小鼠IL-1β表达升高。雌性细胞浸润/活化增加。在肾脏方面，男性表现为血浆肌酐升高，caspase-3表达增加，白细胞向肾组织的迁移比女性增加。结论：作者观察到对慢速诱导BD的器官和性别依赖性反应。这些结果表明，管理策略应考虑供体的性别，以达到最佳治疗，提高移植物质量。

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引用次数: 0

LBP and iFABP mismatch in the evaluation of intestinal barrier dysfunction due to SARS-CoV-2 infection LBP和iFABP不匹配评价SARS-CoV-2感染引起的肠道屏障功能障碍

IF 2.2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics

Pub Date : 2025-01-01 DOI: 10.1016/j.clinsp.2025.100642

Hermes Vieira Barbeiro, Denise Frediani Barbeiro, Heraldo Possolo de Souza, Francisco Garcia Soriano, Marcel Cerqueira Machado, Ludhmila Abrahão Hajjar

SARS-CoV-2 presents a hyperinflammatory scenario due to systemic inflammatory response syndrome with intense cytokine release, with consequent extrapulmonary involvement in 20 % of patients. The authors studied whether COVID-19 intestinal damage is a direct action of the virus on intestinal epithelial cells, with damage mainly at the tight junction. This is a retrospective observational study in a tertiary hospital emergency department. The authors studied 87 patients (46 patients over 61 years and 41 patients under 60 years old) with severe SARS-CoV-2 infection. The authors measured two plasma markers, LPS-Binding Protein (LBP) and ileal Fatty Acid-Binding Protein (iFABP). Furthermore, the authors evaluated the interaction between the two markers. TNF-α and IL-1 β were higher in bacterial co-infected patients and TNF-α was also higher in the older patients. Plasma iFABP levels were not statistically different in patients with bacterial co-infection; however, higher levels were found in the older population. Plasma LBP levels were higher in patients with bacterial co-infection when compared to patients without infection; however, when comparing plasma LBP levels in the older population with younger patients, no differences could be found. LBP, FABP, and cytokines can discriminate between bacterially infected patients and also discriminate elderly patients. The present study suggests that intestinal barrier dysfunction in SARS-CoV-2 infections is mainly due to damage to the intestinal tight junction complex with a disproportionately lower damage to enterocyte. In the older population, the authors also observed an increase in intestinal epithelial damage.

SARS-CoV-2表现为全身炎症反应综合征，伴有强烈的细胞因子释放，导致20%的患者出现肺外受累。作者研究了COVID-19肠道损伤是否是病毒对肠上皮细胞的直接作用，主要是在紧密连接处的损伤。这是一项在三级医院急诊科进行的回顾性观察研究。作者研究了87例严重感染SARS-CoV-2的患者（46例61岁以上患者和41例60岁以下患者）。作者测定了两种血浆标志物，脂多糖结合蛋白（LBP）和回肠脂肪酸结合蛋白（iFABP）。此外，作者还评估了两种标记物之间的相互作用。细菌共感染患者TNF-α和IL-1 β较高，老年患者TNF-α也较高。合并细菌感染患者血浆iFABP水平差异无统计学意义；然而，在年龄较大的人群中发现了更高的水平。与未感染患者相比，合并细菌感染患者的血浆LBP水平更高；然而，当比较老年人群和年轻患者的血浆LBP水平时，没有发现差异。LBP、FABP和细胞因子可以区分细菌感染患者，也可以区分老年患者。目前的研究表明，SARS-CoV-2感染的肠道屏障功能障碍主要是由于肠道紧密连接复合物的损伤，而对肠细胞的损伤比例较低。在老年人群中，作者还观察到肠上皮损伤的增加。

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引用次数: 0

Recognition of medical error: It is not too late for an open disclosure – a narrative review 承认医疗错误：现在进行公开披露还为时不晚——进行叙述性回顾。

IF 2.2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics

Pub Date : 2025-01-01 DOI: 10.1016/j.clinsp.2025.100622

Ivan Dieb Miziara , Carmen Silvia Molleis Galego Miziara

A medical error is a preventable adverse effect of medical care. These errors are usually avoidable. They are a vast source of ethical, financial, and even mental problems affecting patients, physicians, and healthcare organizations. The negative impact on patients can be physical, generating sequelae or disability. It could lead to a loss of trust in the patient and his family in the doctor or the hospital where he has been treated.

On the other hand, doctors resist disclosing their errors to the patient, fearing lawsuits and financial losses. Disclosure errors are also an imperative moral duty. In this narrative review, the authors discuss obstacles that exist and prevent an adequate open disclosure, including flaws in medical education, and propose ten steps to proceed with an open disclosure if a medical error occurs.

医疗差错是一种可预防的医疗不良影响。这些错误通常是可以避免的。它们是影响患者、医生和医疗保健组织的道德、财务甚至精神问题的巨大来源。对患者的负面影响可能是身体上的，产生后遗症或残疾。这可能导致患者及其家属对医生或接受治疗的医院失去信任。另一方面，医生拒绝向病人透露他们的错误，担心诉讼和经济损失。披露错误也是一项必要的道德义务。在这篇叙述性评论中，作者讨论了存在的障碍，并阻止了充分的公开披露，包括医学教育的缺陷，并提出了在发生医疗错误时进行公开披露的十个步骤。

引用次数: 0

Clinics最新文献

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Method

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Background

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Conclusions