Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2024.100548
Arthur Paredes Gatti , Matheus Trovão Ribeiro , Flávio Hojaij
Introduction
The Marginal Mandibular Nerve (MMN), despite being didactically described as being a unique branch of the other branches of the Facial Nerve, has in practice an abundant anatomical variation. Both in relation to its ramifications and the positioning of these in relation to the lower edge of the mandible, as well as its anastomoses along its path, play a fundamental role in the surgical strategy during the approach of this cervicofacial site, and can generate, as underestimated its characteristics, inadvertent injuries and motor consequences to the patient.
Objective
To analyze the types of anatomical variations of the MMN in relation to its position, ramification, and distance from reference points, as well as its incidence that could imply technical difficulties in surgery.
Methods
A systematic review was conducted in the literature in search of anatomical studies, in vivo or in cadavers, between 1981 and 2024, which described the quantification of the MMN branches, their positioning and peculiarities in relation to anastomoses with other peripheral nerves.
Results
511 hemifaces were studied, with the identification of 290 cases of single nerve, 160 cases of double branch, 54 cases of triple branch, and 7 cases of quadruple branch. Of the 456 nerves that were possible to study, the average distance when superior to the lower limit of the mandible was 1.61 cm, while its lower analysis was 2.53 cm. The branches presented different proportions of presentation in relation to this reference point depending on how many branches it had, being more common to remain below it. Anastomoses were identified between the MMN and the buccal and cervical branch of the Facial Nerve, as well as with the Trigeminal Nerve.
Conclusion
The varied presentations of the MMN, both in its anatomical positioning and in the number of branches leads us to question whether the surgical thinking when performing an exploration in this site may not be the reason whythe authors verify several motor complaints superior to described injuries.
{"title":"Anatomical variations of the marginal mandibular nerve","authors":"Arthur Paredes Gatti , Matheus Trovão Ribeiro , Flávio Hojaij","doi":"10.1016/j.clinsp.2024.100548","DOIUrl":"10.1016/j.clinsp.2024.100548","url":null,"abstract":"<div><h3>Introduction</h3><div>The Marginal Mandibular Nerve (MMN), despite being didactically described as being a unique branch of the other branches of the Facial Nerve, has in practice an abundant anatomical variation. Both in relation to its ramifications and the positioning of these in relation to the lower edge of the mandible, as well as its anastomoses along its path, play a fundamental role in the surgical strategy during the approach of this cervicofacial site, and can generate, as underestimated its characteristics, inadvertent injuries and motor consequences to the patient.</div></div><div><h3>Objective</h3><div>To analyze the types of anatomical variations of the MMN in relation to its position, ramification, and distance from reference points, as well as its incidence that could imply technical difficulties in surgery.</div></div><div><h3>Methods</h3><div>A systematic review was conducted in the literature in search of anatomical studies, in vivo or in cadavers, between 1981 and 2024, which described the quantification of the MMN branches, their positioning and peculiarities in relation to anastomoses with other peripheral nerves.</div></div><div><h3>Results</h3><div>511 hemifaces were studied, with the identification of 290 cases of single nerve, 160 cases of double branch, 54 cases of triple branch, and 7 cases of quadruple branch. Of the 456 nerves that were possible to study, the average distance when superior to the lower limit of the mandible was 1.61 cm, while its lower analysis was 2.53 cm. The branches presented different proportions of presentation in relation to this reference point depending on how many branches it had, being more common to remain below it. Anastomoses were identified between the MMN and the buccal and cervical branch of the Facial Nerve, as well as with the Trigeminal Nerve.</div></div><div><h3>Conclusion</h3><div>The varied presentations of the MMN, both in its anatomical positioning and in the number of branches leads us to question whether the surgical thinking when performing an exploration in this site may not be the reason whythe authors verify several motor complaints superior to described injuries.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100548"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784317","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}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2024.100566
Clara Lucato dos Santos , Indyanara Inacio Barreto , Ana Carolina Furian da Silva , Juliana Firmino Batista Soriano , Jeferson de Lima Silva Castro , Luca Schiliró Tristão , Wanderley Marques Bernardo
Introduction
Autism Spectrum Disorder (ASD) is a neurodevelopment spectrum characterized by persistent deficits in social communication and interpersonal interaction, along with restricted and repetitive patterns of behavior, interest, or activities. The appropriate screening and diagnosis must be realized to improve the children's prognosis. Moreover, appropriate treatments are necessary to promote better social integration and development. In this scenario, this systematic review aims to evaluate the impacts of behavioral therapies applied in healthcare settings for patients with ASD.
Methods
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 behavioral therapy. The studies were assessed qualitatively.
Results
Randomized clinical trials and observational studies demonstrated improvements in cognitive and verbal components of patients who received behavioral therapies in therapeutic settings. These results indicate a positive impact of both cognitive-behavioral therapy and ESDM on the development of patients’ skills. Among the cognitive-behavioral therapies, the one based on the MASSI protocol did not impact the reduction of anxious symptoms. As for cognitive-behavioral therapy, one study demonstrated that the Behavioral Intervention for Anxiety in Children with Autism (BIACA), when compared to the Coping Cat protocol, improves cognition and reduces anxiety symptoms. Despite these results, further randomized clinical trials comparing behavioral therapies with one another are needed.
Conclusion
In the context of behavioral therapy within a healthcare setting, the Early Start Denver Model (ESDM) showed improvements in the cognitive, verbal, and social aspects of the evaluated patients. Improvement in scores sometimes is achieved independently of the group and related to the time of interventions.
{"title":"Behavioral therapies for the treatment of autism spectrum disorder: A systematic review","authors":"Clara Lucato dos Santos , Indyanara Inacio Barreto , Ana Carolina Furian da Silva , Juliana Firmino Batista Soriano , Jeferson de Lima Silva Castro , Luca Schiliró Tristão , Wanderley Marques Bernardo","doi":"10.1016/j.clinsp.2024.100566","DOIUrl":"10.1016/j.clinsp.2024.100566","url":null,"abstract":"<div><h3>Introduction</h3><div>Autism Spectrum Disorder (ASD) is a neurodevelopment spectrum characterized by persistent deficits in social communication and interpersonal interaction, along with restricted and repetitive patterns of behavior, interest, or activities. The appropriate screening and diagnosis must be realized to improve the children's prognosis. Moreover, appropriate treatments are necessary to promote better social integration and development. In this scenario, this systematic review aims to evaluate the impacts of behavioral therapies applied in healthcare settings for patients with ASD.</div></div><div><h3>Methods</h3><div>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 behavioral therapy. The studies were assessed qualitatively.</div></div><div><h3>Results</h3><div>Randomized clinical trials and observational studies demonstrated improvements in cognitive and verbal components of patients who received behavioral therapies in therapeutic settings. These results indicate a positive impact of both cognitive-behavioral therapy and ESDM on the development of patients’ skills. Among the cognitive-behavioral therapies, the one based on the MASSI protocol did not impact the reduction of anxious symptoms. As for cognitive-behavioral therapy, one study demonstrated that the Behavioral Intervention for Anxiety in Children with Autism (BIACA), when compared to the Coping Cat protocol, improves cognition and reduces anxiety symptoms. Despite these results, further randomized clinical trials comparing behavioral therapies with one another are needed.</div></div><div><h3>Conclusion</h3><div>In the context of behavioral therapy within a healthcare setting, the Early Start Denver Model (ESDM) showed improvements in the cognitive, verbal, and social aspects of the evaluated patients. Improvement in scores sometimes is achieved independently of the group and related to the time of interventions.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100566"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892623","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}
People Living with Human Immunodeficiency Virus (PLHIV) appear to be at a higher risk of developing sarcopenia. Various factors seem to influence the risk of sarcopenia, and its prevalence may differ depending on the screening tool used. This study aimed to (i) Screen the risk of sarcopenia in PLHIV using the SARC-F and SARCCalf and identify associated factors; (ii) Analyze the agreement between the instruments in PLHIV.
Methods
Cross-sectional study including PLHIV taking antiretroviral therapy. The authors assessed sarcopenia risk using the SARC-F and SARCCalf tools with ≥4 and ≥11 cutoff points, respectively, and a wide spectrum of variables was analyzed.
Results
Participated 76 patients (44.9 ± 12.7 years). Sarcopenia risk, according to the SARC-F, was 27.6 % and was associated with socioeconomic status (p = 0.004), smoking (p = 0.001), disease status (p < 0.001), opportunistic infections (p = 0.001), CD4 T-cell count (p < 0.001), Handgrip Strength (HGS) (p < 0.001), and Gait Speed (GS) (p = 0,001). Using the SARCCalf, sarcopenia risk was 36.8 % and was associated with work activity (p = 0.029), socioeconomic status (p = 0.004), smoking (p = 0.009), disease status (p < 0.001), opportunistic infections (p = 0.015), CD4 T-cell count (p = 0.002), HGS (p = 0.001), Appendicular Skeletal Muscle Mass Index (ASMMI) (p = 0.009), and GS (p < 0.001). The agreement between tools was moderate (k = 0.49).
Conclusion
Sarcopenia risk, as determined by both tools, was higher in low-income PLHIV with opportunistic infections, CD4 T-cell count ≤ 200 cells/mm3, low HGS, and low GS, and lower in asymptomatic and non-smoking individuals. The authors recommend investigating these factors in hospital and outpatient settings. The SARCCalf proved to be more appropriate for screening sarcopenia risk in PLHIV.
{"title":"Agreement analysis and associated factors of SARC-F and SARC-CALF in screening of risk sarcopenia in people living with human immunodeficiency virus","authors":"Lara Cristina Vieira , Jaine Alves Ximenez , Maria Claudia Bernardes Spexoto","doi":"10.1016/j.clinsp.2024.100565","DOIUrl":"10.1016/j.clinsp.2024.100565","url":null,"abstract":"<div><h3>Introduction</h3><div>People Living with Human Immunodeficiency Virus (PLHIV) appear to be at a higher risk of developing sarcopenia. Various factors seem to influence the risk of sarcopenia, and its prevalence may differ depending on the screening tool used. This study aimed to (i) Screen the risk of sarcopenia in PLHIV using the SARC-F and SARC<img>Calf and identify associated factors; (ii) Analyze the agreement between the instruments in PLHIV.</div></div><div><h3>Methods</h3><div>Cross-sectional study including PLHIV taking antiretroviral therapy. The authors assessed sarcopenia risk using the SARC-F and SARC<img>Calf tools with ≥4 and ≥11 cutoff points, respectively, and a wide spectrum of variables was analyzed.</div></div><div><h3>Results</h3><div>Participated 76 patients (44.9 ± 12.7 years). Sarcopenia risk, according to the SARC-F, was 27.6 % and was associated with socioeconomic status (<em>p</em> = 0.004), smoking (<em>p</em> = 0.001), disease status (<em>p</em> < 0.001), opportunistic infections (<em>p</em> = 0.001), CD4 T-cell count (<em>p</em> < 0.001), Handgrip Strength (HGS) (<em>p</em> < 0.001), and Gait Speed (GS) (<em>p</em> = 0,001). Using the SARC<img>Calf, sarcopenia risk was 36.8 % and was associated with work activity (<em>p</em> = 0.029), socioeconomic status (<em>p</em> = 0.004), smoking (<em>p</em> = 0.009), disease status (<em>p</em> < 0.001), opportunistic infections (<em>p</em> = 0.015), CD4 T-cell count (<em>p</em> = 0.002), HGS (<em>p</em> = 0.001), Appendicular Skeletal Muscle Mass Index (ASMMI) (<em>p</em> = 0.009), and GS (<em>p</em> < 0.001). The agreement between tools was moderate (<em>k</em> = 0.49).</div></div><div><h3>Conclusion</h3><div>Sarcopenia risk, as determined by both tools, was higher in low-income PLHIV with opportunistic infections, CD4 T-cell count ≤ 200 cells/mm<sup>3</sup>, low HGS, and low GS, and lower in asymptomatic and non-smoking individuals. The authors recommend investigating these factors in hospital and outpatient settings. The SARC<img>Calf proved to be more appropriate for screening sarcopenia risk in PLHIV.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100565"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926505","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}
The OSCE has been a robust tool for assessing clinical skills in medical education, adaptable across various clinical domains and stages. The COVID-19 pandemic, however, posed significant challenges to traditional assessment methods. This led to the development of the OSVE as an alternative.
Objective
This study aimed to correlate OSVE results with MCT scores and Grade Point Average (GPA) of clerkship.
Methods
This cross-sectional study involved 129 clerkships. It compared two OSVEs and two MCTs, covering content from the 5th and 6th years of the curriculum, against final graduation grades.
Results
The score of GPA was 8.13 ± 0.43. The authors compared OSVE-5th (7.13 ± 0.93) and OSVE-6th (7.23 ± 0.83, NS), MCT-5th (7.08 ± 0.91) vs. MCT-6th (7.68 ± 1.21, p < 0.001), OSVE-5th (7.13 ± 0.93) and MCT-5th (7.08 ± 0.91, NS), OSVE-6th (7.23 ± 0.83) and MCT-6th (7.68 ± 1.21, p < 0.001) OSVE-5th (7.13 ± 0.93) and MCT-6th (7.68 ± 1.21, p < 0.001), OSVE-6th (7.23 ± 0.83) and MCT-5th (7.08 ± 0.91, NS), OSVE-5th (7.13 ± 0.93) and GPA (8.13 ± 0.43, p < 0.001), OSVE-6th (7.23 ± 0.83) and GPA (8.13 ± 0.43, p < 0.001), MCT-5th (7.08 ± 0.91) and GPA (8.13 ± 0.43, p < 0.001), and MCT-6th (7.68 ± 1.21) and GPA (8.13 ± 0.43, p < 0.001). There were positive correlations between OSVE-5th and OSVE-6th (R = 0.418, p < 0.05), OSVE-5th and MCT-5th (R = 0.475, p < 0.05), MCT-5th, OSVE-6th and MCT-6th (R = 0,180, p < 0.05), MCT-6th (R = 0.227, p < 0.05), with OSVE-6th and MCT-5th (R = 0.478, p < 0.05), OSVE-5th and GPA (R = 0.481, p < 0.05), OSVE-6th and GPA (R = 0,439, p < 0.05), MCT-5th and GPA (R = 0.681, p < 0.05) and MCT-6th and GPA (R = 0.195, p < 0.05), no correlation was found between OSVE-6th and MCT-6th (R = 0.070, NS).
Conclusions
The correlations between the assessments revealed mild to moderate, suggesting that the assessments can be used interchangeably in the context of formative assessment. These results indicate the feasibility of using both OSVE and multiple-choice tests as effective tools to enhance intern training and monitoring.
{"title":"OSVE or multiple-choice test: Is that a relevant question?","authors":"Francine Jomara Lopes , Renato Fraga Righetti , Matheus Belloni Torsani , Gustavo Silva Azevedo , Fernando Mauad Sacramento , Iolanda de Fátima Lopes Calvo Tibério","doi":"10.1016/j.clinsp.2024.100519","DOIUrl":"10.1016/j.clinsp.2024.100519","url":null,"abstract":"<div><h3>Introduction</h3><div>The OSCE has been a robust tool for assessing clinical skills in medical education, adaptable across various clinical domains and stages. The COVID-19 pandemic, however, posed significant challenges to traditional assessment methods. This led to the development of the OSVE as an alternative.</div></div><div><h3>Objective</h3><div>This study aimed to correlate OSVE results with MCT scores and Grade Point Average (GPA) of clerkship.</div></div><div><h3>Methods</h3><div>This cross-sectional study involved 129 clerkships. It compared two OSVEs and two MCTs, covering content from the 5th and 6th years of the curriculum, against final graduation grades.</div></div><div><h3>Results</h3><div>The score of GPA was 8.13 ± 0.43. The authors compared OSVE-5th (7.13 ± 0.93) and OSVE-6th (7.23 ± 0.83, NS), MCT-5th (7.08 ± 0.91) vs. MCT-6th (7.68 ± 1.21, <em>p</em> < 0.001), OSVE-5th (7.13 ± 0.93) and MCT-5th (7.08 ± 0.91, NS), OSVE-6th (7.23 ± 0.83) and MCT-6th (7.68 ± 1.21, <em>p</em> < 0.001) OSVE-5th (7.13 ± 0.93) and MCT-6th (7.68 ± 1.21, <em>p</em> < 0.001), OSVE-6th (7.23 ± 0.83) and MCT-5th (7.08 ± 0.91, NS), OSVE-5th (7.13 ± 0.93) and GPA (8.13 ± 0.43, <em>p</em> < 0.001), OSVE-6th (7.23 ± 0.83) and GPA (8.13 ± 0.43, <em>p</em> < 0.001), MCT-5th (7.08 ± 0.91) and GPA (8.13 ± 0.43, <em>p</em> < 0.001), and MCT-6th (7.68 ± 1.21) and GPA (8.13 ± 0.43, <em>p</em> < 0.001). There were positive correlations between OSVE-5th and OSVE-6th (<em>R</em> = 0.418, <em>p</em> < 0.05), OSVE-5th and MCT-5th (<em>R</em> = 0.475, <em>p</em> < 0.05), MCT-5th, OSVE-6th and MCT-6th (<em>R</em> = 0,180, <em>p</em> < 0.05), MCT-6th (<em>R</em> = 0.227, <em>p</em> < 0.05), with OSVE-6th and MCT-5th (<em>R</em> = 0.478, <em>p</em> < 0.05), OSVE-5th and GPA (<em>R</em> = 0.481, <em>p</em> < 0.05), OSVE-6th and GPA (<em>R</em> = 0,439, <em>p</em> < 0.05), MCT-5th and GPA (<em>R</em> = 0.681, <em>p</em> < 0.05) and MCT-6th and GPA (<em>R</em> = 0.195, <em>p</em> < 0.05), no correlation was found between OSVE-6th and MCT-6th (<em>R</em> = 0.070, NS).</div></div><div><h3>Conclusions</h3><div>The correlations between the assessments revealed mild to moderate, suggesting that the assessments can be used interchangeably in the context of formative assessment. These results indicate the feasibility of using both OSVE and multiple-choice tests as effective tools to enhance intern training and monitoring<strong>.</strong></div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100519"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045925","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}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100588
Ruzheng Lin , Ying Chen , Kai Liu
Introduction
Inflammation is hypothesized to be a pivotal factor influencing muscle function, with C-Reactive Protein (CRP) serving as a common biomarker of inflammation. However, the literature pertaining to the relationship between CRP and muscle mass remains scant, particularly among representative adult populations in the United States. The present study aimed to delve into the association between serum CRP levels and muscle mass among American adults, leveraging data from the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2006.
Methods
A cohort of 13,518 participants, representative of the US adult population, underwent dual-energy X-Ray Absorptiometry (DXA) to assess Appendicular Skeletal Muscle Mass (ASM) and had their CRP levels measured. Muscle mass was defined using ASM adjusted by Body Mass Index (ASM/BMI) criteria. Employing weighted logistic regression models, restricted cubic spline analysis, and subgroup analyses, the authors examined the association between serum CRP and low muscle mass.
Results
After meticulously adjusting for various covariates, the present findings revealed a positive association between serum CRP levels and the risk of low muscle mass in American adults (OR = 1.07, 95 % CI 1.01‒1.14, p = 0.016). Notably, an inverse J-shaped relationship was observed, with serum CRP inflection points of 0.273 mg/dL for the overall population, 0.172 mg/dL for males, and 0.296 mg/dL for females. Subgroup analysis further demonstrated that factors such as gender, race, educational level, smoking status, congestive heart failure, stroke, renal weakness/failure, coronary heart disease, diabetes, hypertension, vigorous physical activity, moderate physical activity, and muscle strengthening activities did not significantly impact this positive correlation (all p for interaction values > 0.05).
Conclusions
This nationally representative cross-sectional study provides robust evidence of an inverse J-shaped association between serum CRP levels and the risk of low muscle mass in adults in the United States, with a critical inflection point of 0.273 mg/dL. These findings may inform future research and clinical strategies aimed at mitigating the negative effects of inflammation on muscle mass and function in the adult population.
简介：炎症被认为是影响肌肉功能的关键因素，c反应蛋白（CRP）是炎症的常见生物标志物。然而，有关CRP与肌肉质量之间关系的文献仍然很少，特别是在美国具有代表性的成年人群体中。本研究旨在深入研究美国成年人血清CRP水平与肌肉质量之间的关系，利用1999年至2006年进行的国家健康与营养检查调查（NHANES）的数据。方法：一组13518名参与者，代表美国成年人口，接受双能x射线吸收仪（DXA）评估阑尾骨骼肌质量（ASM），并测量CRP水平。肌肉质量由体质指数（ASM/BMI）标准调整的ASM定义。采用加权逻辑回归模型、受限三次样条分析和亚组分析，作者检验了血清CRP与低肌肉质量之间的关系。结果：在仔细调整各种协变量后，目前的研究结果显示血清CRP水平与美国成年人低肌肉质量风险呈正相关（OR = 1.07, 95% CI 1.01-1.14, p = 0.016）。值得注意的是，观察到一个反j型关系，血清CRP拐点在总体人群中为0.273 mg/dL，男性为0.172 mg/dL，女性为0.296 mg/dL。亚组分析进一步表明，性别、种族、受教育程度、吸烟状况、充血性心力衰竭、中风、肾衰竭/肾功能衰竭、冠心病、糖尿病、高血压、剧烈体育活动、中度体育活动和肌肉强化活动等因素对这种正相关性没有显著影响（相互作用值均为0.05）。结论：这项具有全国代表性的横断面研究提供了强有力的证据，证明血清CRP水平与美国成年人低肌肉质量风险之间存在负j型关联，其临界拐点为0.273 mg/dL。这些发现可能为未来的研究和临床策略提供信息，旨在减轻炎症对成人肌肉质量和功能的负面影响。
{"title":"Association between serum C-reactive protein and low muscle mass among US adults: Results from NHANES 1999 to 2006","authors":"Ruzheng Lin , Ying Chen , Kai Liu","doi":"10.1016/j.clinsp.2025.100588","DOIUrl":"10.1016/j.clinsp.2025.100588","url":null,"abstract":"<div><h3>Introduction</h3><div>Inflammation is hypothesized to be a pivotal factor influencing muscle function, with C-Reactive Protein (CRP) serving as a common biomarker of inflammation. However, the literature pertaining to the relationship between CRP and muscle mass remains scant, particularly among representative adult populations in the United States. The present study aimed to delve into the association between serum CRP levels and muscle mass among American adults, leveraging data from the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2006.</div></div><div><h3>Methods</h3><div>A cohort of 13,518 participants, representative of the US adult population, underwent dual-energy X-Ray Absorptiometry (DXA) to assess Appendicular Skeletal Muscle Mass (ASM) and had their CRP levels measured. Muscle mass was defined using ASM adjusted by Body Mass Index (ASM/BMI) criteria. Employing weighted logistic regression models, restricted cubic spline analysis, and subgroup analyses, the authors examined the association between serum CRP and low muscle mass.</div></div><div><h3>Results</h3><div>After meticulously adjusting for various covariates, the present findings revealed a positive association between serum CRP levels and the risk of low muscle mass in American adults (OR = 1.07, 95 % CI 1.01‒1.14, <em>p</em> = 0.016). Notably, an inverse J-shaped relationship was observed, with serum CRP inflection points of 0.273 mg/dL for the overall population, 0.172 mg/dL for males, and 0.296 mg/dL for females. Subgroup analysis further demonstrated that factors such as gender, race, educational level, smoking status, congestive heart failure, stroke, renal weakness/failure, coronary heart disease, diabetes, hypertension, vigorous physical activity, moderate physical activity, and muscle strengthening activities did not significantly impact this positive correlation (all p for interaction values > 0.05).</div></div><div><h3>Conclusions</h3><div>This nationally representative cross-sectional study provides robust evidence of an inverse J-shaped association between serum CRP levels and the risk of low muscle mass in adults in the United States, with a critical inflection point of 0.273 mg/dL. These findings may inform future research and clinical strategies aimed at mitigating the negative effects of inflammation on muscle mass and function in the adult population.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100588"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078788","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}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100626
Rafael André da Silva , João Vitor Ferreira de Lima , Raquel Fink Lins e Silva de Macedo , Monielle Sant'Ana , Cristiane Damas Gil , M. Natalia Vergara
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Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100593
Karine Rodrigues da Luz , Jamil Natour , Marcelo de Medeiros Pinheiro , Giovanna S. Petterle , Marla Francisca dos Santos , Artur da Rocha Correa Fernandes , Rita Nely Vilar Furtado
Objective
This study aimed to determine whether ultrasound measurements of the hands could predict treatment failure in treatment-naive women with early rheumatoid arthritis.
Method
In a prospective case-control study, 48 women underwent blind assessments four times over 48-weeks, considering three failure stages: failure 1 (methotrexate), failure 2 (leflunomide), and failure 3 (adalimumab). Bilateral ultrasound exams evaluated wrist, 2nd, and 3rd Metacarpophalangeal Joints (MCPs), and Proximal Interphalangeal Joints (PIPs) for inflammatory indicators (synovial and tenosynovial proliferation using grayscale and Power Doppler [PD]) and joint damage (bone erosion and cartilage damage).
Results
The study involved 48 women, aged 47.7 ± 11.6 years, with an average disease duration of 7.5 ± 3.5 months. Of these, 41 (85.41 %) experienced failure 1, 25 (52 %) experienced failure 2, and 5 (10.5%) experienced failure 3. Predictors for failure 1 included PD/Q10 total score > 2.5 (OR = 18.00), PD/SQ10 total score > 5.0 (OR = 23.2), PD/Q MCP score > 1.5 (OR = 14.58), and PD/SQ MCP score > 3.0 (OR = 35). For failure 2, predictors encompassed PD/Q10 total score > 4.5 (OR = 4.81), PD/SQ10 total score > 9.5 (OR = 4.81), PD/Q MCP score > 2.5 (OR = 4.92), PD/SQ MCP score >5.0 (OR = 6.22), and PD/Q PIP score > 1.5 (OR = 6.66). In relation to failure 3, a PD/Q wrist score > 2.5 (AUC = 0.79; p = 0.035) was indicative.
Conclusions
Power Doppler proved to be a predictive indicator for treatment failure in early rheumatoid arthritis among treatment-naive women. It emerged as a predictor for both the initial and 2nd DMARD treatments, as well as the 1st immunobiological treatment, based on hand joint assessments.
{"title":"Power Doppler in hand joints predicts therapeutic failure in treatment-naive women with early rheumatoid arthritis: A prospective study","authors":"Karine Rodrigues da Luz , Jamil Natour , Marcelo de Medeiros Pinheiro , Giovanna S. Petterle , Marla Francisca dos Santos , Artur da Rocha Correa Fernandes , Rita Nely Vilar Furtado","doi":"10.1016/j.clinsp.2025.100593","DOIUrl":"10.1016/j.clinsp.2025.100593","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to determine whether ultrasound measurements of the hands could predict treatment failure in treatment-naive women with early rheumatoid arthritis.</div></div><div><h3>Method</h3><div>In a prospective case-control study, 48 women underwent blind assessments four times over 48-weeks, considering three failure stages: failure 1 (methotrexate), failure 2 (leflunomide), and failure 3 (adalimumab). Bilateral ultrasound exams evaluated wrist, 2nd, and 3rd Metacarpophalangeal Joints (MCPs), and Proximal Interphalangeal Joints (PIPs) for inflammatory indicators (synovial and tenosynovial proliferation using grayscale and Power Doppler [PD]) and joint damage (bone erosion and cartilage damage).</div></div><div><h3>Results</h3><div>The study involved 48 women, aged 47.7 ± 11.6 years, with an average disease duration of 7.5 ± 3.5 months. Of these, 41 (85.41 %) experienced failure 1, 25 (52 %) experienced failure 2, and 5 (10.5%) experienced failure 3. Predictors for failure 1 included PD/Q10 total score > 2.5 (OR = 18.00), PD/SQ10 total score > 5.0 (OR = 23.2), PD/Q MCP score > 1.5 (OR = 14.58), and PD/SQ MCP score > 3.0 (OR = 35). For failure 2, predictors encompassed PD/Q10 total score > 4.5 (OR = 4.81), PD/SQ10 total score > 9.5 (OR = 4.81), PD/Q MCP score > 2.5 (OR = 4.92), PD/SQ MCP score >5.0 (OR = 6.22), and PD/Q PIP score > 1.5 (OR = 6.66). In relation to failure 3, a PD/Q wrist score > 2.5 (AUC = 0.79; <em>p</em> = 0.035) was indicative.</div></div><div><h3>Conclusions</h3><div>Power Doppler proved to be a predictive indicator for treatment failure in early rheumatoid arthritis among treatment-naive women. It emerged as a predictor for both the initial and 2nd DMARD treatments, as well as the 1st immunobiological treatment, based on hand joint assessments.</div></div><div><h3>Trial registration</h3><div>Clinical trials.gov NCT04752748.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100593"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526995","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}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100641
Yan Liu, Hongyao Cui, Chuan Sun
Background
Gastric Cancer (GC) remains a leading global cause of cancer mortality, underscoring the urgent need for advanced prognostic tools. This study aimed to construct and evaluate a prognostic risk signature based on Supramolecular Polymer-Related Genes (SPRGs) in gastric cancer.
Methods
The authors downloaded data from TCGA-STAD, GEO, and CCLE databases for patients with GC and validation cohorts. Through consensus clustering, Cox proportional hazards models, LASSO Cox regression, and nomogram development, the authors identified and constructed a GC Prognostic risk Index (SPI). Additionally, the authors conducted drug sensitivity analysis and immune landscape assessment. Functional evaluations were conducted through colony formation, transwell invasion, and wound healing assays.
Results
The authors identified that 182 SPRGs were significantly upregulated and 226 were downregulated in gastric cancer. Consensus clustering revealed two molecular subtypes, with cluster 1 having significantly lower overall survival compared to cluster 2. SPI effectively distinguished high-risk and low-risk patients across all cohorts. Furthermore, SPI was associated with tumor stage, lymph node metastasis, and tumor size, and could predict drug sensitivity in GC patients. Immune landscape analysis showed higher infiltration of naïve B cells, M2 macrophages, and activated NK cells in high-SPI patients. A nomogram model for GC prognosis using SPI and patient age was developed. KLC1 knockdown significantly suppressed GC cell proliferation, while markedly attenuating metastatic potential and invasion capacity.
Conclusion
This study constructed a prognostic risk signature based on SPRGs in gastric cancer, which is closely related to clinical pathological features, drug sensitivity, and immune landscape, providing new insights for personalized treatment.
{"title":"The supramolecular polymer-related signature predicts prognosis and indicates immune microenvironment infiltration in gastric cancer","authors":"Yan Liu, Hongyao Cui, Chuan Sun","doi":"10.1016/j.clinsp.2025.100641","DOIUrl":"10.1016/j.clinsp.2025.100641","url":null,"abstract":"<div><h3>Background</h3><div>Gastric Cancer (GC) remains a leading global cause of cancer mortality, underscoring the urgent need for advanced prognostic tools. This study aimed to construct and evaluate a prognostic risk signature based on Supramolecular Polymer-Related Genes (SPRGs) in gastric cancer.</div></div><div><h3>Methods</h3><div>The authors downloaded data from TCGA-STAD, GEO, and CCLE databases for patients with GC and validation cohorts. Through consensus clustering, Cox proportional hazards models, LASSO Cox regression, and nomogram development, the authors identified and constructed a GC Prognostic risk Index (SPI). Additionally, the authors conducted drug sensitivity analysis and immune landscape assessment. Functional evaluations were conducted through colony formation, transwell invasion, and wound healing assays.</div></div><div><h3>Results</h3><div>The authors identified that 182 SPRGs were significantly upregulated and 226 were downregulated in gastric cancer. Consensus clustering revealed two molecular subtypes, with cluster 1 having significantly lower overall survival compared to cluster 2. SPI effectively distinguished high-risk and low-risk patients across all cohorts. Furthermore, SPI was associated with tumor stage, lymph node metastasis, and tumor size, and could predict drug sensitivity in GC patients. Immune landscape analysis showed higher infiltration of naïve B cells, M2 macrophages, and activated NK cells in high-SPI patients. A nomogram model for GC prognosis using SPI and patient age was developed. KLC1 knockdown significantly suppressed GC cell proliferation, while markedly attenuating metastatic potential and invasion capacity.</div></div><div><h3>Conclusion</h3><div>This study constructed a prognostic risk signature based on SPRGs in gastric cancer, which is closely related to clinical pathological features, drug sensitivity, and immune landscape, providing new insights for personalized treatment.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100641"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824422","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 : 2025-01-01DOI: 10.1016/j.clinsp.2025.100611
DanYang Gu , YuHao Wu , ZhengHua Ding , Yang Dai
Background
Acute Obstructive Septic Cholangitis (AOSC) is a serious infectious disease of the biliary system. It is prone to develop into septic shock without prompt management.
Methods
Bile was collected from 71 AOSC patients (45 AOSC without septic shock, 26 AOSC with septic shock) during biliary drainage and on days 1 and 3 postoperatively. The levels of High Mobility Group Protein 1 (HMGB1), Interleukin (IL)-1, IL-6, and Tumor Necrosis Factor alpha (TNF-α) were measured. The differences in the levels of biliary factors and their correlation with clinical biochemical indicators were assessed in the two groups.
Results
HMGB1 gradually decreased in both groups in the postoperative period. Intraoperative levels of biliary HMGB1 were significantly higher in patients with AOSC with septic shock. TNF-α and HMGB1 decreased slowly in patients with AOSC with septic shock on postoperative days 1 and 3, and the levels of the factors decreased less. Biliary HMGB1 levels were negatively correlated with white blood cell count and positively correlated with blood urea nitrogen, blood creatinine, procalcitonin, and C-reactive protein. A bile HMGB1 level of 1108.3 pg/mL was the cut-off value to differentiate patients with AOSC with or without septic shock.
Conclusion
Biliary HMGB1 levels are elevated in patients with AOSC with septic shock and decrease slowly in the postoperative period. This suggests that HMGB1 is of considerable importance as a potential therapeutic target in the pathogenesis of septic shock in AOSC patients.
{"title":"Biliary HMGB1 levels and biochemical indices in the assessment of acute obstructive septic cholangitis combined with septic shock","authors":"DanYang Gu , YuHao Wu , ZhengHua Ding , Yang Dai","doi":"10.1016/j.clinsp.2025.100611","DOIUrl":"10.1016/j.clinsp.2025.100611","url":null,"abstract":"<div><h3>Background</h3><div>Acute Obstructive Septic Cholangitis (AOSC) is a serious infectious disease of the biliary system. It is prone to develop into septic shock without prompt management.</div></div><div><h3>Methods</h3><div>Bile was collected from 71 AOSC patients (45 AOSC without septic shock, 26 AOSC with septic shock) during biliary drainage and on days 1 and 3 postoperatively. The levels of High Mobility Group Protein 1 (HMGB1), Interleukin (IL)-1, IL-6, and Tumor Necrosis Factor alpha (TNF-α) were measured. The differences in the levels of biliary factors and their correlation with clinical biochemical indicators were assessed in the two groups.</div></div><div><h3>Results</h3><div>HMGB1 gradually decreased in both groups in the postoperative period. Intraoperative levels of biliary HMGB1 were significantly higher in patients with AOSC with septic shock. TNF-α and HMGB1 decreased slowly in patients with AOSC with septic shock on postoperative days 1 and 3, and the levels of the factors decreased less. Biliary HMGB1 levels were negatively correlated with white blood cell count and positively correlated with blood urea nitrogen, blood creatinine, procalcitonin, and C-reactive protein. A bile HMGB1 level of 1108.3 pg/mL was the cut-off value to differentiate patients with AOSC with or without septic shock.</div></div><div><h3>Conclusion</h3><div>Biliary HMGB1 levels are elevated in patients with AOSC with septic shock and decrease slowly in the postoperative period. This suggests that HMGB1 is of considerable importance as a potential therapeutic target in the pathogenesis of septic shock in AOSC patients.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100611"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548775","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}
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