Revista De Investigacion Clinica-Clinical and Translational Investigation最新文献

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is commonly linked to liver fibrosis, which may progress to cirrhosis. FIB-4, APRI, and NFS are used to predict fibrosis severity, but their accuracy and role in long-term outcomes remain unclear.

Objectives: This study evaluates the predictive value of these scores for fibrosis and assesses the incidence of de novo cirrhosis and survival outcomes in MASLD patients.

Methods: This retrospective, single-center study included 175 MASLD patients in our university medical center. The diagnostic performance of FIB-4, APRI, and NFS for advanced fibrosis (stage 3-4) was assessed using receiver operating characteristic (ROC) analysis. Cox regression analysis was performed to evaluate factors associated with de novo cirrhosis and survival outcomes.

Results: The mean age was 49.9±14.1 years, and 54.9% were female. The median follow-up was 78 months. ROC analysis showed FIB-4 (AUC: 0.77) was the best predictor of advanced fibrosis, followed by APRI (AUC: 0.74) and NFS (AUC: 0.74). Multivariate analysis identified fibrosis stage (HR: 3.045, p=0.001) and hypertension (HR: 4.096, p=0.047) as independent predictors of de novo cirrhosis. Age (HR: 1.070, p=0.031), albumin (HR: 15.151, p<0.001), and HbA1c (HR: 1.589, p<0.001) were independently associated with survival.

Conclusion: FIB-4 was the most accurate predictor of advanced fibrosis. Fibrosis stage and hypertension were the strongest predictors of de novo cirrhosis. These findings highlight the importance of fibrosis staging and comorbidity management in MASLD.

Background: Anemia of inflammation (AI) is a mild form of anemia. Vitamin D deficiency has been linked to an increased risk of AI. This study aims to investigate the potential molecular mechanisms underlying the protective role of vitamin D in AI.

Methods: HepG2 cells were stimulated with lipopolysaccharide (LPS) to induce an inflammatory model in vitro. Cell counting kit-8 assays were conducted to assess vitamin D's cytotoxicity to HepG2 cells. RT-qPCR analysis was conducted to evaluate hepcidin mRNA levels. A rat AI model was established by subcutaneous injection of complete Freund's adjuvant (CFA). Hematoxylin-eosin staining was performed for synovial histopathological analysis. The concentrations of inflammatory cytokines were determined by ELISA. Western blotting was used to evaluate the protein levels of hepcidin, ferroportin, and markers associated with signaling pathways.

Results: Vitamin D dose-dependently reduced hepcidin expression in LPS-treated HepG2 cells. Vitamin D inactivated NF-κB, JAK2/STAT3, and BMP6/SMAD pathways to reduce hepcidin levels in LPS-treated HepG2 cells. Vitamin D ameliorated CFA-induced synovial injury and inflammatory response in rats. Vitamin D reduced hepcidin expression and improved anemia in CFA-injected rats. Vitamin D inactivated NF-κB, JAK2/STAT3, and BMP6/SMAD pathways in the liver of CFA-injected rats.

Conclusion: Vitamin D supplementation ameliorates experimental AI by downregulating hepcidin expression through NF-κB, JAK2/STAT3, and BMP6/SMAD pathways.

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine and metabolic disorder in women of reproductive age characterized by hormonal imbalances, menstrual irregularities, and changes in ovarian morphology. Excess body fat plays a significant role in the clinical development of PCOS. The complex relationship between adiposity and PCOS involves disruptions in hormonal balance and inflammatory processes, which both contribute to the clinical and phenotypic manifestations of the syndrome. Insulin resistance is a significant factor linking adiposity and PCOS. Moreover, reduced fertility is associated with adiposity in PCOS, with obesity exacerbating anovulation. Recent studies have raised questions about the role of androgen exposure during fetal life, including genetic factors related to PCOS identified in genome-wide association studies and Mendelian randomization studies. Managing PCOS should concentrate on addressing adiposity as a crucial target, positively impacting the syndrome, particularly regarding reproductive and fertility outcomes. This review aims to understand how metabolic conditions such as obesity and insulin resistance are linked to PCOS and how early prenatal androgen exposure is involved in its etiology. Particular attention is given to its role in developmental programming, fat distribution, and fat type, as well as how these factors contribute to the onset of metabolic disturbances in adulthood.

Background: Sepsis is a severe condition in clinical practice. Although numerous studies have reported various prognostic markers associated with sepsis, the combination of the platelet-to-albumin ratio (PLT/ALB) and the lactate dehydrogenase-to-albumin ratio (LDH/ALB) has not been thoroughly examined.

Objectives: To study the associations of both the PLT/ALB ratio and the LDH/ALB ratio with all-cause mortality during the first hospitalization for sepsis.

Methods: A retrospective study was conducted on patients with sepsis at a local medical center. The ratios of PLT/ALB and LDH/ALB at the time of the first hospital admission of the patients were collected. Statistical analysis was used to examine the relationships of the PLT/ALB and LDH/ALB ratios with mortality, as well as their ability to predict the prognosis of patients with sepsis.

Results: Cox regression revealed that high PLT/ALB and LDH/ALB independently predict mortality. ROC curve analysis revealed that the ratios of PLT/ALB and LDH/ALB exhibited satisfactory sensitivity and specificity in predicting the mortality rate of patients with sepsis, with sensitivity values of 70.50% and 66.19% and specificity values of 73.58% and 69.25%, respectively.

Conclusion: Elevated ratios of PLT/ALB and LDH/ALB in sepsis patients are associated with increased all-cause mortality and serve as reliable prognostic indicators.

Background: Atrial fibrillation (AF) increases the risk of stroke, especially in patients with previous cerebrovascular disease. This risk is significantly reduced with oral anticoagulants (OAC), with direct oral anticoagulants (DOACs) being the optimal treatment.

Objectives: To study the most used anticoagulant treatment in patients with nonvalvular AF (NVAF) with and without cerebrovascular disease in Mexico.

Methods: CARMEN-AF is a national, multicentric observational registry that includes 1423 patients with AF. Patients were recruited regardless of the anticoagulant therapy. Demographics, clinical variables, comorbidities and antithrombotic treatment were compared among patients with and without a history of cerebrovascular disease.

Results: Of the 238 patients with a previous cerebrovascular disease (average age 69±13 years; 114 women [48.5%]), 99% had a previous ischemic stroke. In this subgroup, the type of AF was permanent 43.4%, persistent 20%, and paroxysmal AF was 36.6%. Principal comorbidities were hypertension 77.9%, diabetes mellitus 29.8%, and heart failure 20%. Nearly 12.4% of patients with a history of ischemic cerebrovascular disease did not receive anticoagulant (AC) treatment. Among those who did, vitamin K antagonists (VKAs) were more commonly prescribed than DOACs (37.4% vs. 25.5%).

Conclusion: In Mexico, anticoagulation rates remain low among patients with NVAF and a history of cerebrovascular disease.

Background: The scientific meetings disseminate the results of the latest research. However, if the presented work is not published later, the information is lost.

Objective: To know and compare the fate of the abstracts produced by our nephrology community that were submitted to the Instituto Mexicano de Investigaciones Nefrológicas (IMIN) and American Society of Nephrology (ASN) meetings.

Methods: All abstracts presented by Mexican authors to the ASN from 2011 to 2019 and the IMIN from 2018 to 2019 were analyzed. We captured their publication rate, time to publication, journals, and the impact factor. Publications in both cases were analyzed through PubMed and Scopus databases.

Results: Of the 382 works submitted at ASN by Mexican authors from 2011 to 2019, 141 (36.5%; p<0.001 vs. IMIN) were published. The percentage increases if only accepted abstracts are included (141 of 265, 45%). The format of the presentation affected the final publication rate, which is 81% for free communications, 41.4% for posters, and 18.6% for non-accepted works. In contrast, of the 641 works presented from the 2018-2019 annual meetings of the IMIN, 8% (n=52) have been published.

Conclusion: The publication rate of the ASN abstracts presented by Mexico is like that seen globally for international meetings. However, the publication rate of works presented in our national meeting is very low.