Revista clinica espanola最新文献

英文中文

Comentario al artículo especial «Utilidad de la ecografía a pie de cama (POCUS) en el paciente hospitalizado con síndrome confusional agudo de etiología no aclarada» 对一篇专题文章“卧床超声（POCUS）在病因不明的急性混淆综合征住院患者中的效用”的评论

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rce.2025.502334

J.A. Mariz

引用次数: 0

La contribución del PET/MRI en la diferenciación entre nódulos benignos y malignos en incidentalomas tiroideos detectados en imágenes FDG PET/CT PET/MRI对FDG PET/CT成像中发现的甲状腺结节良性和恶性的区别的贡献

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rce.2025.502333

A. Nazari , S. Sager , S. Schenke , L.U. Beşli , C. Samancı , T. Öztürk , H.B. Sayman

Introduction and objectives

Incidentalomas of the thyroid gland are frequently observed in oncological patients undergoing FDG PET/CT imaging for staging or treatment response assessment. This study aims to investigate the utility of SUVmax and ADC values measured by PET/MRI in distinguishing between benign and malignant thyroid nodules.

Materials and methods

We selected 108 patients (72 females, 36 males; mean age 54 ± 12 years) who underwent routine oncological FDG PET/CT scans for staging or treatment response assessment, with nodule sizes greater than 1 cm. A one-bed neck PET/MRI scan followed the whole-body PET/CT. SUVmax values were measured, and ADC maps were created using DWI with b factors of 50 and 1000 s/mm². SUVmax and ADC values were correlated with FNAC results.

Results

FNAC results revealed 76 (70.4%) benign and 32 (29.6%) malignant nodules among the 108 patients. The mean SUVmax of malignant nodules was significantly higher than that of benign nodules (10.6 ± 8.3 vs. 5.94 ± 5.2; P<.001). Similarly, the mean ADC value was lower in malignant nodules compared to benign ones (1.4 ± 0.6 × 10^-3 mm²/s vs. 1.8 ± 0.4 × 10^-3 mm²/s; P<.001). A significant but weak correlation was found between FNAC results and mean SUVmax (r = 0.335), as well as a significant weak negative correlation with mean ADC values (r = −0.355). Using a cut-off value of 6 for SUVmax and 1.56 × 10^-3 mm²/s for ADC, the sensitivity, specificity, and accuracy for SUVmax were 68.7, 73.6, and 72.1%, respectively, while for ADC, they were 71.8, 69.7, and 70.4%, respectively. The PET/MRI system demonstrated a relative sensitivity, specificity, accuracy, PPV, and NPV of 90.62, 51.32, 62.96, 43.94, and 92.86%.

Conclusion

This study is one of the first in the literature to explore the use of FDG PET/MRI, a single-stop device, in distinguishing between benign and malignant thyroid nodules with high sensitivity and NPV.

简介和目的在接受FDG PET/CT成像进行分期或治疗反应评估的肿瘤患者中经常观察到甲状腺偶发瘤。本研究旨在探讨PET/MRI测量的SUVmax和ADC值在区分良性和恶性甲状腺结节中的应用。材料与方法选择108例患者，其中女性72例，男性36例；平均年龄54±12岁)，接受常规肿瘤FDG PET/CT扫描进行分期或治疗反应评估，结节大小大于1cm。全身PET/CT扫描后进行单床颈部PET/MRI扫描。测量SUVmax值，并使用b因子为50和1000 s/mm2的DWI创建ADC图。SUVmax和ADC值与FNAC结果相关。结果fnac结果显示，108例患者中良性结节76例（70.4%），恶性结节32例（29.6%）。恶性结节的平均SUVmax明显高于良性结节(10.6±8.3 vs. 5.94±5.2；术;措施)。同样，恶性结节的平均ADC值低于良性结节（1.4±0.6 × 10-3 mm2/s vs 1.8±0.4 × 10-3 mm2/s）；术;措施)。FNAC结果与平均SUVmax呈显著的弱相关（r = 0.335），与平均ADC值呈显著的弱负相关（r = - 0.355）。SUVmax的临界值为6，ADC的临界值为1.56 × 10-3 mm2/s， SUVmax的敏感性、特异性和准确性分别为68.7、73.6和72.1%，而ADC的敏感性、特异性和准确性分别为71.8、69.7和70.4%。PET/MRI系统的相对灵敏度、特异性、准确性、PPV和NPV分别为90.62%、51.32%、62.96%、43.94%和92.86%。结论本研究是文献中首次探索使用FDG PET/MRI这种单次停止装置来区分高灵敏度和NPV的甲状腺结节良恶性。

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引用次数: 0

Consenso de expertos sobre la enfermedad pulmonar intersticial asociada a enfermedades autoinmunes sistémicas. Resumen ejecutivo 关于与全身性自身免疫性疾病相关的间质性肺病的专家共识。执行摘要

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rce.2025.502326

A. González-García , M. Akasbi , P. Brito-Zerón , J.L. Callejas , I. Cusacovich , F. Jiménez Segovia , M. Martín Cascón , S. Prieto-González , L. Sáez Comet , C.P. Simeón , R. Solans Laque , J.S. García Morillo , en representación del grupo de Enfermedades Autoinmunes Sistémicas (GEAS) de la Sociedad Española de Medicina Interna (SEMI)

Interstitial lung disease is a frequent and potentially fatal manifestation of systemic autoimmune diseases. Early screening, diagnosis, and treatment with immunomodulators, and in some cases, antifibrotics, as well as appropriate follow-up, are essential to improving patients’ quality of life and survival. The complexity of these diseases and the limited robust evidence to guide clinical decision-making lead to significant variability in management guidelines. In this article, a group of experts in systemic autoimmune diseases has developed recommendations for the screening, diagnosis, treatment, and follow-up of interstitial lung disease, considering the latest evidence, their clinical experience, and the results of a survey conducted among specialists. The diseases included are systemic sclerosis, Sjögren's disease, idiopathic inflammatory myopathy, ANCA-associated vasculitis, sarcoidosis and systemic lupus erythematosus.

间质性肺疾病是一种常见且可能致命的系统性自身免疫性疾病。早期筛查、诊断和免疫调节剂治疗，在某些情况下使用抗纤维化药物，以及适当的随访，对于改善患者的生活质量和生存率至关重要。这些疾病的复杂性和指导临床决策的有限有力证据导致管理指南的显著差异。在这篇文章中，一组系统性自身免疫性疾病的专家考虑到最新的证据、他们的临床经验和专家调查的结果，对间质性肺疾病的筛查、诊断、治疗和随访提出了建议。这些疾病包括系统性硬化症、Sjögren病、特发性炎性肌病、anca相关血管炎、结节病和系统性红斑狼疮。

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引用次数: 0

El impacto futuro de la imagen avanzada y la inteligencia artificial en el diagnóstico e I + D de las enfermedades raras 先进成像和人工智能对罕见疾病诊断和研发的未来影响

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rce.2025.502327

M. Moreno-Higueras , G. Fatoul-del Pino , S. García-Linares , T. Martín-Noguerol

引用次数: 0

El aprendizaje asistido por pares mejora las habilidades no técnicas en la educación en fisioterapia pediátrica 同侪协助学习提高儿科物理治疗教育中的非技术技能

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rce.2025.502328

T.T. Ma , Q. Zhang , H.B. Zhao , H.X. Li

引用次数: 0

Predictores de la aparición de alteraciones radiológicas a los 12 meses tras una neumonía por COVID-19 2019年新冠肺炎后12个月内放射线变化预测

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rce.2025.502325

C. Roig-Martí , I. Pérez-Catalán , S. Folgado-Escudero , M. Varea-Villanueva , A. Navarro-Ballester , M.P. Fernández-García , A. Segura-Fábrega , M.-L. Mateu-Campos , J. Usó-Blasco , J.-M. Ramos-Rincón

Background and objective

The radiological evolution after COVID-19 pneumonia is unknown. We propose to analyze the main radiological findings one year after COVID-19 pneumonia, as well as identify possible factors that may influence it.

Material and methods

Cohort study of patients with COVID-19 pneumonia undergoing high-resolution computed tomography (HRCT) 12 months after hospital discharge. A descriptive study of the radiological findings and a multivariate analysis are carried out to identify the factors of the appearance of radiological anomalies.

Results

One hundred thirty-nine patients, with a mean age of 63 years and 66.2% male. The most frequent radiological findings were ground-glass opacities (59%), followed by bronchiectasis (42.4%), subpleural parenchymal bands (32.4%), atelectasis (13.7%), septal thickening (12.9%) and fibrotic tracts (9.4%). Male sex was associated with the presence of bronchiectasis (ORa = 3.55; P=.026), peak admission IL-6 levels > 133 ng/L with the detection of subpleural parenchymal bands (ORa = 3.58; p = 0.048) and obesity with the occurrence of atelectasis (ORa = 3.70; P=.014). Systemic corticotherapy during admission decreased the risk of fibrotic tracts (ORa = 0.02; P=.003).

Conclusions

Lung damage persists with high frequency one year after COVID-19 pneumonia. Male sex, high peak admission IL-6 levels and obesity were risk factors for radiological abnormalities while systemic corticosteroid therapy decreased the occurrence of fibrotic tracts 12 months after hospital admission.

背景与目的新型冠状病毒肺炎后影像学进展尚不清楚。我们建议分析COVID-19肺炎一年后的主要影像学表现，并确定可能影响其的因素。材料与方法对COVID-19肺炎患者出院后12个月行高分辨率计算机断层扫描（HRCT）的简短研究。对放射学结果进行描述性研究，并进行多变量分析，以确定放射学异常出现的因素。结果139例患者，平均年龄63岁，男性占66.2%。最常见的影像学表现为毛玻璃混浊（59%），其次是支气管扩张（42.4%）、胸膜下实质带（32.4%）、肺不张（13.7%）、间隔增厚（12.9%）和纤维化束（9.4%）。男性与支气管扩张相关(ORa = 3.55；P= 0.026)，峰值入院IL-6水平>；133 ng/L胸膜下实质带检测(ORa = 3.58；p = 0.048)，肥胖与肺不张的发生相关(ORa = 3.70；P = .014)。入院时全身皮质治疗可降低纤维化束的风险(ORa = 0.02；P = .003)。结论新型冠状病毒肺炎后1年肺损伤发生率较高。男性、入院时峰值IL-6水平和肥胖是放射学异常的危险因素，而全身皮质类固醇治疗可减少住院后12个月纤维化束的发生。

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引用次数: 0

En respuesta al artículo de Ivars N, et al. «Características clínicas, manejo en urgencias y mortalidad de los episodios de insuficiencia cardiaca aguda en pacientes con enfermedad pulmonar obstructiva crónica» 对Ivars N等人的文章“慢性阻塞性肺病患者急性心力衰竭发作的临床特征、急诊管理和死亡率”的回应

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-06-01 DOI: 10.1016/j.rce.2025.502298

A. Gil-Rodrigo , M.-J. Luque-Hernández , L. Cuesta-García , C. Martínez-Buendía

引用次数: 0

Sobre la dificultad del diagnóstico clínico de insuficiencia cardíaca aguda en urgencias 在紧急情况下对急性心力衰竭进行临床诊断的困难

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-06-01 DOI: 10.1016/j.rce.2025.502301

Ò. Miró , N. Ivars , P. Llorens

引用次数: 0

Uso de SCORE2 en la evaluación y control del riesgo cardiovascular en una cohorte de individuos aparentemente sanos 在一组看似健康的人群中使用SCORE2来评估和控制心血管风险

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-06-01 DOI: 10.1016/j.rce.2025.502302

J. Campos , A. Figueiredo , J. Silva , L. Azevedo , I. Ribeiro , M. Miranda , H. Gomes

Introduction and objectives

Cardiovascular risk estimation is an essential step in reducing the onset of adverse cardiovascular events. It helps to identify healthy patients who will benefit most from treatment for atherosclerotic risk factors. The authors pretend to assess the Cardiovascular risk in an apparently healthy Portuguese population and evaluate the degree of control of LDL-cholesterol.

Materials and methods

This cross-sectional study assessed the cardiovascular risk level in a Portuguese population aged 40 to 69 years, using the Systematic Coronary Risk Evaluation 2 algorithm. This research received no specific funding.

Results

12076 apparently healthy patients were included, median age of 53.8 ± 8.03 (min. 40; max. 69), 58.7% women and 41.3% men. Based on the Systematic Coronary Risk Evaluation 2 calculation, 59.5% of patients belonged to the low moderate risk, 35.1% to the high risk group, and 5.4% to the very high risk group.

Based on cardiovascular risk stratification, 64.6%, 94.1%, and 98.5% of the patients with low-moderate, high, and very high cardiovascular risk were above the LDL-cholesterol target, respectively. Of those with high and very high cardiovascular risk, 94.7% were above LDL-cholesterol goal in spite that 35.9% were under statin treatment.

Conclusion

In this real-life setting study, over a third of the population had high and very high cardiovascular risk, of which 94.7% were above the LDL-cholesterol goal. The study highlights that a large part of apparently healthy patients could benefit from a therapeutic intervention to reduce the risk of the onset of adverse cardiovascular events.

前言和目的心血管风险评估是减少心血管不良事件发生的重要步骤。它有助于确定健康患者谁将受益于治疗动脉粥样硬化的危险因素。作者假装在一个表面上健康的葡萄牙人群中评估心血管风险，并评估低密度脂蛋白胆固醇的控制程度。材料和方法本横断面研究使用系统性冠状动脉风险评估2算法评估了40 - 69岁葡萄牙人群的心血管风险水平。这项研究没有得到特别的资助。结果纳入表面健康患者12076例，中位年龄53.8±8.03 (min. 40；max。69)，女性58.7%，男性41.3%。根据系统冠状动脉风险评估2计算，59.5%的患者属于低中度危险，35.1%属于高危组，5.4%属于非常高危组。根据心血管风险分层，低、中、高、极高心血管风险患者的ldl -胆固醇高于目标的比例分别为64.6%、94.1%和98.5%。在心血管风险高和非常高的患者中，尽管35.9%的患者接受了他汀类药物治疗，但仍有94.7%的患者ldl -胆固醇水平高于目标。在这项现实生活环境的研究中，超过三分之一的人群有高和非常高的心血管风险，其中94.7%的人高于低密度脂蛋白胆固醇的目标。该研究强调，很大一部分表面上健康的患者可以从治疗干预中获益，以降低不良心血管事件发生的风险。

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引用次数: 0

¿Es segura y eficaz la hospitalización a domicilio de los pacientes agudos que ingresan por infección? 急性感染住院患者在家住院是否安全有效？

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-06-01 DOI: 10.1016/j.rce.2025.502308

L. Moreno Núñez , C. Garmendia Fernández , M. Ruiz Muñoz , J. Collado Álvarez , C. Jimeno Griño , Á. Prieto Callejero , E. Pérez Fernández , I. González Anglada

Introduction

Home hospitalization (HH) is a safe, effective and more efficient modality of care than conventional hospitalization (CH). There is little scientific evidence comparing these two models of hospitalization in patients admitted from the Emergency Department (ED) for infection.

Material and methods

Retrospective cohort study between October 1 and December 15, 2023 of patients admitted from the ED for infection. Two cohorts were analyzed, the first one, patients admitted to CH in Internal Medicine, Geriatrics or Infectious Diseases units and the second one, patients admitted to HH. Patients with hemodynamic instability, those who died in the first 48 hours of admission, S. aureus bacteremia, catheter-associated bacteremia, osteoarticular infection, meningitis, diverticulitis, fever without focus, and infections with undrained focus were excluded.

Results

257 patients were analyzed, 151 in CH and 106 in HH. The median duration of antibiotherapy was 9 days in HC vs 7 in HH (p < 0.001), the mean length of stay was longer in CH vs HH (6 vs 4; p = 0.007). More laboratory tests were performed in CH vs HH (3 vs 1, p < 0.001), radiographs (11% vs 0%), ultrasound (12% vs 2%) and computed axial tomography (13% vs 3%, p < 0.001). Patients admitted to CH had more confusional syndrome than those admitted to HH (15% vs 2%; p < 0.001). There were no differences in mortality or readmissions. In the multivariate linear regression analysis, patients admitted to HH shortened their hospital stay by 1 day (95% CI: -2.2– -0.185) compared to those admitted to CH.

Conclusion

Patients admitted for infection in HH from the ED have a shorter hospital stay than patients admitted to CH.

家庭住院（HH）是一种比传统住院（CH）更安全、有效和高效的护理方式。很少有科学证据比较这两种住院模式的患者从急诊科（ED）入院感染。材料与方法回顾性队列研究于2023年10月1日至12月15日在急诊科因感染入院的患者。对两个队列进行分析，第一个队列是在内科、老年科或传染病科住院的CH患者，第二个队列是在HH住院的患者。排除有血流动力学不稳定、入院前48小时内死亡、金黄色葡萄球菌菌血症、导管相关性菌血症、骨关节感染、脑膜炎、憩室炎、无病灶发热和病灶不排水感染的患者。结果共分析257例患者，其中CH 151例，HH 106例。抗生素治疗的中位持续时间HC为9天，HH为7天(p <；0.001)， CH组比HH组的平均住院时间更长(6 vs 4；p = 0.007)。在CH和HH中进行了更多的实验室测试(3 vs 1, p <；0.001)， x线片（11% vs 0%），超声（12% vs 2%）和计算机轴位断层扫描（13% vs 3%）， p <；0.001)。入院的CH患者比入院的HH患者有更多的混淆综合征(15% vs 2%；p & lt;0.001)。死亡率和再入院率没有差异。在多元线性回归分析中，HH患者的住院时间比CH患者缩短了1天（95% CI: -2.2 - -0.185）。结论急诊HH感染患者的住院时间比CH患者短。

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