Clinics最新文献

{"title":"Correlation study on different types of chronic sinusitis and eustachian tube dysfunction: analysis of prevalence and risk factors","authors":"Qihang Zhang , Qianjin Zeng , Jingtao Wang , Fu Feng , Guangke Wang","doi":"10.1016/j.clinsp.2026.100890","DOIUrl":"10.1016/j.clinsp.2026.100890","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigated the Eustachian Tube Dysfunction (ETD) prevalence and its influencing factors in Chronic Rhinosinusitis (CRS) patients undergoing Functional Endoscopic Sinus Surgery (FESS), based on postoperative histopathological subtypes. The findings may aid in the diagnosis and individualized management of CRS with comorbid ETD.</div></div><div><h3>Method</h3><div>This study included 92 patients who underwent FESS surgery for CRS and were hospitalized in the Otolaryngology Head and Neck Surgery Department of Zhengzhou University People's Hospital from January 2024 to May 2024. According to the postoperative pathological results, the patients were divided into the Chronic Rhinosinusitis without Nasal Polyps (CRSsNP) group and the Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) group. The CRSwNP group was further divided into an Eosinophilic Chronic Rhinosinusitis with Nasal Polyps (EosCRSwNP) subgroup. General information, imaging examination data, 7-item symptom score scale for eustachian tube dysfunction (Eustachian Tube Dysfunction Questionnaire-7, ETDQ-7), and eustachian tube pressure score (Eustachian Tube Score, ETS) of all included patients were collected. The prevalence of ETD in patients with different pathological types of CRS, the influencing factors of eustachian tube function in preoperative CRS patients, and the consistency of the two eustachian tube function detection methods and the test efficacy of the two eustachian tube function detection methods were analyzed.</div></div><div><h3>Results</h3><div>Correlations & Risk Factors: CRSwNP: Serum total IgE moderately correlated with preop ETDQ-7 (ρ = 0.497, p = 0.001). EosCRSwNP: Age (γ = 0.534, p < 0.01) and IgE (ρ = 0.506, p < 0.05) strongly correlated with ETDQ-7. IgE was an independent risk factor (OR = 1.010). Using the ETDQ-7 score and ETS score as the main diagnostic methods for ETD indicates that there is no statistically significant difference in the prevalence of ETD among the three groups of patients (CRSsNP, CRSwNP, and EosCRSwNP) (p > 0.05). Two types of examination methods were used to test the preoperative eustachian tube function of patients with different pathological types of CRS. The consistency degree of the results of the ETDQ-7 score and the ETS score was different. Among them, the patients in the EosCRSwNP group had the highest score, while those in the CRSsNP group had the lowest score (CRSsNP group: κ = 0.396, p < 0.01; CRSwNP group: κ = 0.421, p < 0.01; EosCRSwNP group: κ = 0.563, p < 0.01).</div></div><div><h3>Conclusion</h3><div>ETD Incidence & Correlation: ETD occurrence in CRS varies slightly by subtype but remains comparable overall. CRSwNP patients show a significant association between ETD symptoms and serum total IgE levels. The ETDQ-7 score and the ETS score, as subjective and objective methods for evaluating the function of the eustachian tube, have good consistency in results and ca","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100890"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222511","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}

{"title":"Systematic review of the efficacy and safety of lenvatinib vs. sorafenib as first-line treatments for hepatocellular carcinoma","authors":"Wentao Bo ,&nbsp;Zhenguo Wang ,&nbsp;Xiuhua Dong ,&nbsp;Jing Zou","doi":"10.1016/j.clinsp.2026.100869","DOIUrl":"10.1016/j.clinsp.2026.100869","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to explore the efficacy and safety of lenvatinib and sorafenib as first-line treatments for hepatocellular carcinoma.</div></div><div><h3>Method</h3><div>The authors searched PubMed, Web of Science, Cochrane, CNKI, Wanfang, and other databases and compared the clinical efficacy of lenvatinib and sorafenib as first-line treatments for hepatocellular carcinoma. Two participants screened the literature, collated the data, and evaluated the literature according to the inclusion and exclusion criteria. RevMan 5.4 software was used for meta-analysis of the included studies.</div></div><div><h3>Results</h3><div>Ten studies were included in the meta-analysis. The results of the meta-analysis showed that, in terms of efficacy, compared with sorafenib, lenvatinib prolongs PFS in patients with hepatocellular carcinoma (HR = 85.50, 95 % CI: 38.53‒189.73, <em>p</em> &lt; 0.00001) and OS (HR = 36.73, 95 % CI: 20.28–66.52, <em>p</em> &lt; 0.00001), and the differences were statistically significant. In terms of safety, the risk of toxicities in the lenvatinib group at any level of gastrointestinal toxicities, metabolism/nutrition toxicities, hematological toxicities, Renal/Urinary, Vascular toxicities, and endocrine toxicities was significantly higher in the lenvatinib group than in the sorafenib group. The risks of metabolism/nutrition toxicities, renal/urinary toxicities, and vascular toxicities above grade III were significantly higher than those in the sorafenib group. The Skin/Subcutaneous Tissue toxicities of any grade and above were significantly lower than those in the sorafenib group.</div></div><div><h3>Conclusions</h3><div>As a first-line treatment for hepatocellular carcinoma, lenvatinib can prolong PFS and OS and improve the clinical benefit rate and quality of life of patients. The increased risk of specific adverse events with lenvatinib requires diligent clinical oversight.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100869"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260571","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}

{"title":"Effect of Δ9-tetrahydrocannabinol and cannabidiol on myofascial pain modulation in patients with temporomandibular disorder: a prospective crossover study","authors":"Francisco Gomes Bonetto Schinko ,&nbsp;Luiz Renato Paranhos ,&nbsp;Lucas Gonçalves de Sousa ,&nbsp;Gabriel Phelipe de Paula Santos ,&nbsp;Sigmar de Mello Rode ,&nbsp;Antonio Sergio Guimarães ,&nbsp;Juliana Cama Ramacciato","doi":"10.1016/j.clinsp.2026.100885","DOIUrl":"10.1016/j.clinsp.2026.100885","url":null,"abstract":"<div><h3>Background</h3><div>Temporomandibular Disorder (TMD) often causes chronic orofacial pain and functional limitations, with conventional treatments providing suboptimal results. Phytocannabinoids such as Δ9-Tetrahydrocannabinol (Δ9-THC) and Cannabidiol (CBD) have analgesic and anti-inflammatory properties, but evidence in TMD is scarce.</div></div><div><h3>Objective</h3><div>To evaluate the efficacy of Δ9-THC/CBD therapy in reducing pain and improving mandibular function in TMD patients.</div></div><div><h3>Methods</h3><div>Twenty adults with chronic myofascial pain (DC/TMD diagnosis) participated in a blinded, crossover, non-randomized study. Participants underwent two consecutive 90-day phases: placebo followed by Δ9-THC/CBD therapy (1:1 ratio, starting with a dose of 2 mg/day in the first week, gradually adjusting an increase of 2 mg/week until reaching 10 mg/day in the fifth week, sublingually), without washout. Outcomes included pain intensity (VAS), muscle sensitivity (algometry), mandibular function (mouth opening, protrusion, laterality) and pain sensitivity (allodynia/hyperalgesia). Data were analyzed using linear mixed models for repeated measures.</div></div><div><h3>Results</h3><div>Δ9-THC/CBD improved all outcomes versus baseline and post-placebo (<em>p</em> &lt; 0.001; Cohen’s <em>d</em> &gt; 0.8). Mouth opening increased from 45.9 mm to 49.9 mm; VAS pain decreased from 7.35 to 3.50. Functional pain dropped by ∼90%, with near elimination of allodynia and hyperalgesia. Placebo effects were minimal.</div></div><div><h3>Conclusion</h3><div>Δ9-THC/CBD therapy provided substantial analgesic and functional benefits in TMD patients, supporting its potential as a therapeutic alternative. Larger randomized studies are recommended to validate these findings and explore underlying mechanisms.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100885"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147314561","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}

{"title":"Body composition paradox: high muscle mass and adiposity jointly predict incident chronic kidney disease in a Korean cohort","authors":"Eun Young Lee ,&nbsp;Choon Hee Chung ,&nbsp;Tae Hwa Go ,&nbsp;Sang Baek Koh ,&nbsp;Jung Ran Choi","doi":"10.1016/j.clinsp.2026.100879","DOIUrl":"10.1016/j.clinsp.2026.100879","url":null,"abstract":"<div><h3>Objective</h3><div>Diabetes, hypertension, and obesity are common traditional risk factors for Chronic Kidney Disease (CKD). In this population-based longitudinal study, the authors identified risk factors associated with CKD development.</div></div><div><h3>Method</h3><div>A total of 6,238 Korean adults aged 40- to 69-years without baseline CKD were included. Among them, 4,057 participants with baseline estimated Glomerular Filtration Rate (eGFR) measurements were analyzed. Logistic regression models were used to evaluate significant predictors of CKD.</div></div><div><h3>Results</h3><div>Over a 10-year follow-up period, CKD developed in 354 subjects (8.7 %). Leptin levels were significantly higher in participants who developed CKD compared to those who did not (8.89 ± 8.00 vs. 6.44 ± 5.52, <em>p</em> &lt; 0.001). After adjusting for confounding factors, logistic regression analysis indicated that participants in the highest quartile of muscle mass were 2.314-times more likely to develop CKD compared to those in the lowest quartile (Odds Ratio [OR = 2.314]; 95 % Confidence Interval [95 % CI: 1.372–3.902]; p = 0.014). In multivariable-adjusted models, the OR for incident CKD when comparing the lowest to the highest quartiles of body fat was 2.166 in men; however, the significance disappeared after adjusting for eGFR. Among women, higher leptin levels and lower adiponectin levels were independently associated with incident CKD (<em>p</em> = 0.003 and <em>p</em> = 0.038, respectively), regardless of traditional CKD risk factors. Furthermore, compared to subjects without CKD, those with metabolic syndrome had an OR (95 % CI) of 5.256 (2.813–9.820) for incident CKD after controlling for confounding factors.</div></div><div><h3>Conclusion</h3><div>These findings suggest that muscle mass and body fat may serve as better predictors of incident CKD.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100879"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396177","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}

{"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 ,&nbsp;Rabi’ah Al-Adawiyah Rahmat ,&nbsp;Selva Malar Munusamy ,&nbsp;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 +0.01ײ (y = CI and x = Age in years). A significant negative correlation was found between age and CI (<em>r</em> = -0.101, p &lt; 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":"2026-01-01","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}

{"title":"Associations of physical activity, sleep with functional disability in Chinese older adults: a five-year prospective study","authors":"Xuewei Zhao ,&nbsp;Jiani Zeng ,&nbsp;Lijuan Zhang ,&nbsp;Haibo Zhang ,&nbsp;Jingjing Huang ,&nbsp;Lei Jiang ,&nbsp;Jun Zhao","doi":"10.1016/j.clinsp.2026.100863","DOIUrl":"10.1016/j.clinsp.2026.100863","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the associations of Physical Activity (PA) and sleep with functional disability among older adults.</div></div><div><h3>Method</h3><div>A total of 1927 participants were enrolled from the China Health and Retirement Longitudinal Study (CHARLS) between 2015 and 2020. Activities of Daily Living (ADL) were used to assess functional status. Sleep consisted of nighttime sleep (healthy sleep, or unhealthy sleep) and daytime nap sleeping (extended, moderate, short, or none), and PA was classified as sufficient or insufficient. Effects of sleep and PA on ADL Disability (ADLD) among the elderly were examined using logistic regression analysis, with Odds Ratios (ORs) and 95% Confidence Intervals (95% CIs) calculated.</div></div><div><h3>Results</h3><div>After a follow-up of 5-years, healthy nighttime sleep was linked to a decreased odds of ADLD (OR = 0.77, 95% CI: 0.60‒0.98). In participants with sufficient PA, healthy nighttime sleep was linked to the odds of ADLD (OR = 0.68, 95% CI: 0.52‒0.90). No multiplicative interaction of PA and nighttime sleeping was found. Moreover, the association between healthy nighttime sleep and decreased risk of ADLD was consistent in females (OR = 0.64, 95% CI: 0.45‒0.91) and those with complications (OR = 0.63, 95%CI: 0.46‒0.87).</div></div><div><h3>Conclusion</h3><div>Healthy nighttime sleep may be beneficial for preventing ADLD in older people. The benefits of sufficient PA with healthy sleep on reducing the risk of ADLD remain uncertain.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100863"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146185063","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}

{"title":"Moderate and vigorous aerobic exercise enhances inhibitory control, but not working memory or cognitive flexibility, up to the second ventilatory threshold: a randomized crossover trial","authors":"Marcelo Hiro Akiyoshi Ichige,&nbsp;Paulo Roberto Santos-Silva,&nbsp;Julia Maria D’Andrea Greve","doi":"10.1016/j.clinsp.2026.100896","DOIUrl":"10.1016/j.clinsp.2026.100896","url":null,"abstract":"<div><h3>Introduction</h3><div>The effects of acute physical exercise on executive functions remain controversial, partly due to inconsistencies in how exercise intensity is measured. This study investigated the impact of moderate and vigorous aerobic exercise on three core components of executive function: inhibitory control, working memory, and cognitive flexibility. Exercise intensity was rigorously defined using a combination of heart rate reserve, ventilatory thresholds, and rate of perceived exertion.</div></div><div><h3>Method</h3><div>Twenty-six physically active adults completed three separate sessions in a randomized order: Rest (REST), Moderate-intensity exercise (MOD), and Vigorous-Intensity exercise (VIG). Cognitive performance was assessed during each condition using the Go/No-Go test (inhibitory control), the 2-back test (working memory), and the Multitasking test (cognitive flexibility).</div></div><div><h3>Results</h3><div>Inhibitory control improved significantly during exercise. Response Times (RT) on the Go/No-Go test were reduced in both MOD (<em>p</em> = 0.038) and VIG (<em>p</em> = 0.003) compared with REST, without changes in accuracy. In contrast, working memory and cognitive flexibility showed no significant differences across conditions.</div></div><div><h3>Conclusions</h3><div>Acute moderate and vigorous aerobic exercise, up to the second ventilatory threshold, selectively enhances inhibitory control by reducing RT, with no detectable effects on working memory or cognitive flexibility. By integrating multiple physiological and perceptual markers of intensity, this study provides a rigorous evaluation of the acute cognitive effects of aerobic exercise.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100896"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147314191","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}

{"title":"Painful subcutaneous edema is associated with early age at disease onset in Immunoglobulin A vasculitis patients: A multicenter study","authors":"Lia V. Steuer ,&nbsp;Clara R. Doria ,&nbsp;Matheus S. França ,&nbsp;Paula S. Marra ,&nbsp;Sebastian D. Cordoba ,&nbsp;Luisa F.C. Forero ,&nbsp;Ricardo N. Machado ,&nbsp;Sylvia C.L. Farhat ,&nbsp;Gleice Clemente ,&nbsp;Vitória Curi ,&nbsp;Claudio A. Len ,&nbsp;Luciana M. Carvalho ,&nbsp;Francisco H.R. Gomes ,&nbsp;Virginia P.L. Ferriani ,&nbsp;Rozana G. de Almeida ,&nbsp;Flavio R. Sztajnbok ,&nbsp;Lucia M.A. Campos ,&nbsp;Adriana M. Elias ,&nbsp;Verena A. Balbi ,&nbsp;Nadia E. Aikawa ,&nbsp;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 (&gt; 400.000 mm³) (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> &lt; 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}

{"title":"Monoclonal gammopathy of renal significance in western China: A large cohort study dominated by amyloidosis with distinct clinical outcomes","authors":"Junru Wang,&nbsp;Kun Peng,&nbsp;Guisen Li,&nbsp;Shasha Chen","doi":"10.1016/j.clinsp.2026.100866","DOIUrl":"10.1016/j.clinsp.2026.100866","url":null,"abstract":"<div><h3>Aim</h3><div>To characterize the epidemiology, clinicopathological features, and renal outcomes in patients with Monoclonal Gammopathy of Renal Significance (MGRS).</div></div><div><h3>Methods</h3><div>The authors conducted a retrospective analysis of all renal biopsy-confirmed MGRS cases diagnosed between 2010‒2020, with histopathological review by two independent pathologists. Post-hoc power analysis confirmed adequate statistical power (92 %).</div></div><div><h3>Results</h3><div>Among 124 histologically confirmed MGRS cases (median age 64.0-years, IQR 52.5‒68.0), renal amyloidosis predominated (75.8 %), followed by monoclonal immunoglobulin deposition disease (MIDD, 10.5 %), cryoglobulinemic GN (4.8 %), proliferative GN with monoclonal Ig deposits (PGNMID, 2.4 %), light chain proximal tubulopathy (3.2 %), and C3 glomerulopathy with monoclonal gammopathy (1.6 %). Amyloidosis patients primarily presented with nephrotic syndrome (77.7 %), while fewer exhibited acute kidney injury (3.2 %), chronic kidney disease (16.1 %), or ESRD (6.7 %). Compared to other MGRS subtypes, amyloidosis patients demonstrated significantly lower anemia rates (<em>p</em> &lt; 0.001), higher LDH (<em>p</em> = 0.035), preserved eGFR (<em>p</em> &lt; 0.001), greater proteinuria (<em>p</em> = 0.037), and hypoalbuminemia (<em>p</em> &lt; 0.001). The renal response rates were 26.1 % (Amyloidosis-Associated MGRS, MGRS-A) versus 33.3 % (Non-Amyloidosis MGRS, MGRS-NA), while hematologic responses were 8.7 % versus 0 %, respectively. Both hematologic (<em>p</em> = 0.007) and renal responses (<em>p</em> = 0.009) correlated with improved survival. MGRS-A showed inferior renal survival (<em>p</em> = 0.05). Multivariate analysis identified hypotension (<em>p</em> = 0.005), elevated creatinine (<em>p</em> = 0.002), and cardiac involvement (<em>p</em> = 0.022) as independent predictors of ESKD, while age (<em>p</em> &lt; 0.001) and cardiac involvement (<em>p</em> &lt; 0.001) predicted mortality.</div></div><div><h3>Conclusion</h3><div>MGRS represents a clinically significant cause of kidney injury in monoclonal gammopathy patients, with amyloidosis being the predominant etiology. MGRS-A portends a worse prognosis than MGRS-NA. Therapeutic responses in both hematologic and renal parameters predict survival benefits. Age and cardiac involvement emerge as key prognostic markers for both renal and patient survival.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"81 ","pages":"Article 100866"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146169009","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}

{"title":"C-reactive protein in adult sepsis: systematic review and meta-analysis","authors":"Antonio Silvinato ,&nbsp;Clara Lucato dos Santos ,&nbsp;Eliane Amorim ,&nbsp;Idevaldo Floriano ,&nbsp;Luís Eduardo Miranda Paciência ,&nbsp;Luca Schiliró Tristão ,&nbsp;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 (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.</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":"2026-01-01","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}