Medicina clinica (English ed.)最新文献

英文中文

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-01-30 DOI: 10.1016/j.medcle.2026.107230

Carlos Rodrigo

引用次数: 0

Intensive versus standard blood pressure control in patients with and without type 2 diabetes: A systematic review and meta-analysis 2型糖尿病患者与非2型糖尿病患者的强化与标准血压控制：一项系统综述和荟萃分析

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-18 DOI: 10.1016/j.medcle.2026.107318

João Victor de Oliveira Ramos , João Vitor Andrade Fernandes , Flávia Maria Camilo Madruga de Oliveira Lima , José Lucas Toscano Matias , Fabyan Esberard de Lima Beltrão , Marcelo Dantas Tavares de Melo

Background

The optimal intensity of blood pressure (BP) control in patients with and without type 2 diabetes mellitus (T2D) remains unclear.

Objectives

We performed a systematic review and meta-analysis of randomized controlled trials comparing intensive versus standard BP control, stratified by T2D status.

Methods

Primary outcomes were all-cause mortality and serious adverse events (SAEs); secondary outcomes included death from cardiovascular causes and occurrence of myocardial infarction (MI) and stroke. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using DerSimonian–Laird random-effects models. Heterogeneity was assessed with the I² statistic, and leave-one-out sensitivity analyses were conducted for all outcomes.

Results

Six trials comprising 41,210 participants were included. Intensive BP control significantly reduced death from cardiovascular causes (OR 0.72; 95% CI 0.56–0.93), incidence of MI (OR 0.85; 95% CI 0.74–0.97), and stroke (OR 0.78; 95% CI 0.68–0.89). The reduction in all-cause mortality was significant in patients without T2D (OR 0.73; 95% CI 0.59–0.90), but not in those with T2D (OR 0.99; 95% CI 0.85–1.14). Intensive control was associated with a non-significant increase in SAEs overall (OR 1.15; 95% CI 0.90–1.46), with higher estimates in patients with T2D.

Conclusions

Intensive BP control reduces cardiovascular events and mortality in non-diabetic patients. In those with T2D, benefits are attenuated and may be counterbalanced by safety concerns. BP targets should be individualized based on diabetes status and clinical context.

背景：2型糖尿病（T2D）患者和非2型糖尿病患者的最佳血压（BP）控制强度尚不清楚。目的：我们对随机对照试验进行了系统回顾和荟萃分析，比较了强化与标准血压控制，并按T2D状态分层。方法主要结局为全因死亡率和严重不良事件（SAEs）；次要结局包括心血管原因死亡、心肌梗死（MI）和中风的发生。采用dersimonan - laird随机效应模型计算95%置信区间（ci）的合并优势比（ORs）。采用I2统计量评估异质性，并对所有结果进行留一敏感性分析。结果共纳入6项试验，41210名受试者。强化血压控制可显著降低心血管死亡（OR 0.72; 95% CI 0.56-0.93）、心肌梗死发生率（OR 0.85; 95% CI 0.74-0.97）和卒中发生率（OR 0.78; 95% CI 0.68-0.89）。无T2D患者的全因死亡率显著降低（OR 0.73; 95% CI 0.59-0.90），但T2D患者的全因死亡率无显著降低（OR 0.99; 95% CI 0.85-1.14）。强化控制与总体SAEs的无显著性增加相关（OR 1.15; 95% CI 0.90-1.46）， T2D患者的估计更高。结论强化血压控制可降低非糖尿病患者的心血管事件和死亡率。对于患有T2D的患者，益处减弱，可能会被安全问题所抵消。血压目标应根据糖尿病状况和临床情况个体化。

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引用次数: 0

Euthanasia in patients with cardiovascular disease in Spain 西班牙心血管疾病患者的安乐死

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-01-31 DOI: 10.1016/j.medcle.2026.107267

Alberto Alén Andrés , Manuel Martínez-Sellés

引用次数: 0

Role of point-of-care ultrasound in septic shock 即时超声在感染性休克中的作用

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-18 DOI: 10.1016/j.medcle.2026.107269

Marta Torres-Arrese , Gonzalo García-Casasola , Rafael Blancas

Sepsis and septic shock are critical medical emergencies with high rates of morbidity and mortality. Point-of-care ultrasound (POCUS) has been demonstrated to be a vital instrument in the management of these patients, facilitating dynamic haemodynamic assessment and prompting immediate clinical decision-making. POCUS has been demonstrated to facilitate early identification of shock type, assessment of fluid response, and detection of infectious foci in unstable patients. It is evident that ultrasound protocols, including RUSH and VExUS, offer a systematic approach to the assessment of perfusion, venous congestion, and fluid overload. Recent studies have validated the usefulness of parameters such as left ventricular outflow tract velocity time integral (LVOT-VTI) and inferior vena cava (IVC) collapse to predict fluid response. However, it is imperative that its limitations be considered in the clinical context. In the context of etiological diagnosis, the use of pulmonary ultrasound has been shown to be superior to radiography in terms of the detection of pneumonia and pleural effusions. Concurrently, the use of abdominal and cardiac ultrasound has been demonstrated to enhance the identification of urological infections, biliary infections, abscesses, and indications of endocarditis. Despite its dependence on the operator, the extant evidence supports the systematic use of POCUS in the comprehensive assessment of the septic patient, being crucial for targeted and personalised resuscitation. Further research is necessary to standardise its application and demonstrate its benefits in clinical outcomes.

脓毒症和脓毒性休克是严重的医疗紧急情况，具有高发病率和死亡率。即时超声（POCUS）已被证明是管理这些患者的重要工具，促进动态血流动力学评估和促进即时临床决策。POCUS已被证明有助于休克类型的早期识别，液体反应的评估，以及不稳定患者的感染病灶的检测。很明显，包括RUSH和VExUS在内的超声方案提供了一种系统的方法来评估灌注、静脉充血和液体过载。最近的研究证实了左心室流出道速度时间积分（LVOT-VTI）和下腔静脉（IVC）塌陷等参数对预测液体反应的有效性。然而，在临床背景下考虑其局限性是必要的。在病因诊断的背景下，在肺炎和胸腔积液的检测方面，肺部超声的使用已被证明优于x线摄影。同时，腹部和心脏超声的使用已被证明可以增强对泌尿系统感染、胆道感染、脓肿和心内膜炎适应症的识别。尽管POCUS依赖于操作人员，但现有的证据支持在脓毒症患者的综合评估中系统地使用POCUS，这对于有针对性和个性化的复苏至关重要。需要进一步的研究来规范其应用并证明其在临床结果中的益处。

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引用次数: 0

Basic principles of ultrasound applied to infectious diseases 应用于传染病的超声基本原理

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-18 DOI: 10.1016/j.medcle.2026.107248

Alejandro Díez-Vidal , Costantino Caroselli , Yale Tung-Chen

Point-of-care ultrasound (POCUS) is an increasingly valuable diagnostic tool in infectious diseases, offering real-time, bedside imaging without radiation. It enables the detection of key findings such as fluid collections, lung consolidations, abscesses, and cardiac involvement, supporting rapid diagnosis, targeted interventions, and improved outcomes. This article reviews the fundamental physical principles of ultrasound – wave propagation, acoustic impedance, resolution, and artifacts – along with technical aspects like image acquisition, probe selection, and optimization strategies. Typical sonographic appearances of pus, effusions, and vegetations are discussed, with emphasis on key interpretative elements. POCUS is presented as a clinical extension of the physical exam, enhancing bedside assessment and decision-making. Despite its many advantages, safe and effective use requires appropriate training and awareness of its limitations. This review supports the integration of point-of-care ultrasound into the diagnostic and therapeutic approach to infectious disease management.

即时超声（POCUS）是一种越来越有价值的传染病诊断工具，提供实时、无辐射的床边成像。它能够检测关键发现，如液体收集、肺实变、脓肿和心脏受累，支持快速诊断、有针对性的干预和改善结果。本文回顾了超声波传播、声阻抗、分辨率和伪影的基本物理原理，以及图像采集、探头选择和优化策略等技术方面的内容。讨论了脓、积液和植被的典型超声表现，并强调了关键的解释因素。POCUS作为身体检查的临床延伸，加强了床边评估和决策。尽管它有许多优点，但安全有效的使用需要适当的培训和对其局限性的认识。本综述支持将即时超声纳入传染病管理的诊断和治疗方法。

引用次数: 0

Metabolic index a non-invasive predictive marker of liver steatosis in patients with non-alcoholic fatty liver disease 代谢指数：非酒精性脂肪性肝病患者肝脏脂肪变性的无创预测指标

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-04 DOI: 10.1016/j.medcle.2026.107268

Julio Lara-Riegos , Luis Alberto Chi-Cervera , Iaarah Montalvo-Gordon , Hugo Azcorra-Pérez , Julio Torres-Romero , Víctor Arana-Argáez , Mario Ramírez-Camacho , María Eugenia Icaza-Chávez

Introduction and objectives

Determining insulin resistance (IR) is essential to identify subjects at risk for non-alcoholic fatty liver disease (NAFLD). A particular area of interest is the ability to detect patients with NAFLD using non-invasive biomarkers. This study aimed to evaluate the sensitivity, specificity, and predictive value of the metabolic index for detecting NAFLD.

Materials and methods

A retrospective study was conducted in adults of both sexes eligible for inclusion were adults of both sexes aged 18–85 years with and without NAFLD. Liver steatosis was measured using the controlled attenuation parameter (CAP) through FibroScan®. The metabolic index was calculated using the formula: Fasting Glucose × TG/HDL-C2. The study was carried out at the Gastrointestinal and Liver Specialty Clinic in Yucatán, Mexico, between January 2014 and November 2020, using a convenience sampling method. In a total of 138 subjects (32 healthy and 106 patients with NAFLD), anthropometric measures and laboratory tests were obtained to determine levels of triglycerides (TG), glucose (G), total cholesterol (TC), HDL-C, LDL-C, AST, and ALT.

Results

The metabolic index showed a specificity of 90,6% (95% CI [80,5–100]), sensitivity of 64.2% (95% CI [55–73,3]), a positive predictive value of 95,8%, a negative predictive value of 43,3%, a positive likelihood ratio of 6,83, and a negative likelihood ratio of 0,40 for detecting NAFLD.

Conclusion

The metabolic index showed high specificity for detecting NAFLD and could be used in adult patients with suspected NAFLD seen in primary health care.

前言和目的测定胰岛素抵抗（IR）对于识别非酒精性脂肪性肝病（NAFLD）的风险至关重要。一个特别感兴趣的领域是使用非侵入性生物标志物检测NAFLD患者的能力。本研究旨在评价代谢指标检测NAFLD的敏感性、特异性和预测价值。材料和方法回顾性研究纳入年龄在18-85岁的成人，不论有无NAFLD。通过FibroScan®使用控制衰减参数（CAP）测量肝脏脂肪变性。代谢指数计算公式为：空腹葡萄糖× TG/HDL-C2。该研究于2014年1月至2020年11月在墨西哥Yucatán的胃肠道和肝脏专科诊所进行，采用了方便的抽样方法。在138名受试者（32名健康受试者和106名NAFLD患者）中，通过人体测量和实验室检查，测定了甘油三酯（TG）、葡萄糖(G)、总胆固醇（TC）、HDL-C、LDL-C、AST和alt的水平。结果代谢指数的特异性为906% (95% CI[80,5 - 100])，敏感性为64.2% (95% CI[55 - 73,3])，阳性预测值为95.8%，阴性预测值为43.3%，阳性似然比为6.83。检测NAFLD的负似然比为0.40。结论代谢指标检测NAFLD具有较高的特异性，可用于初级卫生保健中疑似NAFLD的成人患者。

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引用次数: 0

Gastroparesis after lung transplant: An underestimated factor in chronic graft dysfunction 肺移植后胃轻瘫：慢性移植物功能障碍的一个被低估的因素

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-01-31 DOI: 10.1016/j.medcle.2026.107253

Myrian González Álvarez , Ana Latorre Díez , Irvin Aníbal Castellanos Girón

引用次数: 0

Challenges of real data studies: Causality, intervention and reproducibility 真实数据研究的挑战：因果关系、干预和可重复性

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-06 DOI: 10.1016/j.medcle.2026.107292

Inmaculada Arostegui , Josep Roma Millan , Nora Amama-BenHassun , Erik Cobo Valeri

引用次数: 0

Impact of the initiation of flash glucose monitoring (FGM) on glycemic control parameters in adult patients with type 2 diabetes mellitus 启动瞬时血糖监测（FGM）对成人2型糖尿病患者血糖控制参数的影响

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-01-31 DOI: 10.1016/j.medcle.2026.107255

Carmela Manrique Mutiozábal , Amaia Legarreta Alday , Zuria Alba Muñoz , Eunate Sánchez Uribe , Ainara Deusto Puertas , Santos Zorrozúa Borja , Maria Luisa Antuñano López , Teresa Ruiz de Azúa Arteche , Estela Benito Martínez , Ester Caballero Renilla , Maite Guimón Bardesi

Introduction

The effective implementation of the FGM contributes to achieving glycemic control, reducing hypoglycemic and hyperglycemic decompensations as well as enhancing patient self-management and improving their perception of quality of life. The aim of our study was to evaluate the glycemic control in type 2 diabetes patients after having implemented FGM in clinical practice.

Material and methods

Current patients with type 2 diabetes treated in our unit were monitored (FGM). A Structured Therapeutic Education Program was carried out and glycemic control variables were compared at the start and after 3 months of treatment.

Results

A total of 36 patients were included (mean age of 67.8 ± 12.4 years, 36.11% female, diabetes duration 21.5 ± 2.12 years and a previous median glycated hemoglobine of 7.55%). Comparing the baseline data and the measures at 3 months, it was found a decrease in both glucose management indicator (GMI) (0.15% [0.40;0.30], P, 537) and the coefficient of variation (CV) (1,42 ± 4,66%, P, 07), as well as an increase in time in range (TIR) (3,44 ± 14.72%, P, 169). Furthermore, a decrease in time in hyperglycemia > 250 mg/dl was observed (2,00% [−6,50;0,00] P, 001).

Conclusion

FGM has led to a favorable advance in the management and glycemic control in patients with type 2 diabetes.

女性生殖器切割的有效实施有助于实现血糖控制，减少低血糖和高血糖失代偿，增强患者自我管理，提高他们对生活质量的感知。本研究的目的是评估2型糖尿病患者在临床实践中实施女性生殖器切割后的血糖控制情况。材料与方法对我院目前收治的2型糖尿病患者进行FGM监测。进行了结构化治疗教育计划，并在治疗开始和治疗3个月后比较血糖控制变量。结果共纳入36例患者（平均年龄67.8±12.4岁，女性36.11%，糖尿病病程21.5±2.12年，既往糖化血红蛋白中位数为7.55%）。将基线数据与3个月时的测量数据进行比较，发现血糖管理指标（GMI）（0.15% [0.40;0.30]， P, 537）和变异系数（CV）（1,42±4,66%，P, 07）下降，时间范围（TIR）（3,44±14.72%，P, 169）增加。此外，观察到高血糖≤250 mg/dl的时间缩短（2,00% [- 6,50;0,00]P, 001）。结论女性生殖器切割对2型糖尿病患者的治疗和血糖控制有良好的促进作用。

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Late pulmonary metastasis of pheochromocytoma 嗜铬细胞瘤晚期肺转移

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-04 DOI: 10.1016/j.medcle.2026.107276

Pablo Andrés Ordóñez Lozano , Olalla García Rodríguez , Andrea Carilla Sanromán

引用次数: 0

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