Investigación Clínica

Tabla de Contenido

Elena Ryder — 2026-05-30

La reemergencia de la fiebre amarilla en Venezuela.

Nereida Valero-Cedeño — 2026-05-30

The reemergence of yellow fever in Venezuela poses a critical threat to the region’s health security. After years of control, the persistent crisis has shifted surveillance from proactive to reactive. As of May 2026, official public health agencies report at least 40 human cases and 21 confirmed deaths, corresponding to a case fatality rate exceeding 50%. In addition to the inherent predisposing factors of arboviruses, increasing human mobility without adequate protection in jungle areas and the accumulation of susceptible, unvaccinated individuals are identified as key determinants. The epidemiological impact shows a notable demographic bias, predominantly affecting young men of working age (57.5% of cases), which exacerbates the socioeconomic consequences of this outbreak. Furthermore, ongoing enzootic and epizootic circulation of the virus, both in known hotspots and in border areas and regions previously considered low-risk, indicates a high potential for expansion. Under the One Health approach, given active viral circulation, it is imperative to reinstate vaccination protocols to close susceptibility gaps in rural and peri-urban regions that have not yet
achieved the recommended immunization coverage, thereby completely blocking transmission and preventing the urban cycle. Similarly, it is necessary to optimize diagnostic turnaround times, strengthen entomological and ecological surveillance, bolster international cooperation to reduce the risk of spread to neighboring countries, provide timely alerts about epizootics, and issue travel protection recommendations.

Expressions of Lipocalin-2 in nasal tissues and secretions of patients with chronic rhinosinusitis with nasal polyps and correlations with inflammatory factors.

Yang Li — 2026-05-30

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disease of the upper airway. Lipocalin-2, an inflammation-related glycoprotein involved in innate immune regulation, has been linked to several chronic inflammatory disorders, but its role in CRSwNP remains unclear. This study aimed to examine the expression of Lipocalin-2 in nasal tissues and secretions of CRSwNP patients and its relationship with inflammatory factors. Seventy patients diagnosed with CRSwNP between January 2023 and January 2025 were enrolled in the case group, while 60 patients with simple nasal septal deviation served as controls. NP tissues and nasal secretions were collected from CRSwNP patients, whereas inferior turbinate mucosal tissues and nasal secretions were obtained from controls. Levels of Lipocalin-2, interleukin-5 (IL -5), IL -6, and tumor necrosis factor-alpha (TNF-α) were measured and analyzed. Compared with controls, CRSwNP patients showed significantly higher levels of Lipocalin-2 and inflammatory cytokines in nasal secretions (p<0.05). Stratification based on Visual Analog Scale (VAS) scores and computed tomog- raphy Lund-Mackay (CT L -M) scores indicated that these markers were notably higher in the moderate-to-severe group than in the mild disease group (p< 0.05). Lipocalin-2 was positively correlated with IL -5, IL -6, TNF-α, as well as VAS, Lund-Kennedy endoscopy, and CT L -M scores (all p<0.05). In summary, Lipocalin-2 is highly expressed in nasal polyp tissues and secretions of CRSwNP patients and closely associated with inflammatory cytokine levels and clinical severity, implying its potential as a biomarker for disease activity in CRSwNP.

The effect of vitamin D3 combined with traction on the treatment of lumbar disc herniation.

Yina Yin — 2026-05-30

This study examined the clinical effectiveness of vitamin D₃ combined with traction therapy in patients with lumbar disc herniation. It included 112 patients who received conservative rehabilitation at our hospital from January 2021 to December 2023. Participants were randomly assigned to two groups: one received supine mechanical traction, and the other received the same traction plus oral vitamin D₃ for 4 weeks. The study compared clinical outcomes and quality of life between the groups. Results showed that both groups experienced improvements in pain and lumbar spine function. However, the combined treatment group showed significantly better outcomes than the traction-only group. Inflammation and pain markers decreased significantly, and 25(OH)D₃ levels increased notably in both groups, with greater improvements in the combined treatment group. Additionally, negative mood and quality of life improved more in the combined group. There was no significant difference in the measured indicators between the one-month follow-up and the one-month treatment. In conclusion, vitamin D₃ combined with traction therapy can effectively enhance short-term clinical outcomes and quality of life for patients with lumbar disc herniation.

Comparative efficacy of octreotide and somatostatin in acute pancreatitis: a controlled trial of inflammatory markers and hospital length of stay.

Qunchao Zhu — 2026-05-31

Acute pancreatitis is an acute pancreatic injury with multiple etiologies. Octreotide and somatostatin are commonly used treatments, but their clinical efficacy remains controversial. This study compares their effects on inflammatory markers and hospital length of stay. One hundred and twenty patients with acute pancreatitis admitted to The First People’s Hospital of Jiashan between January 2022 and December 2024 were retrospectively included and divided into two groups based on treatment modality, namely the control group (somatostatin treatment) and the experimental group (octreotide treatment), with 60 cases in each group. Serum amylase (AMY), serum lipase (LPS), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), white blood cell count (WBC), serum albumin (ALB) content, procalcitonin (PCT), hos- pital stay duration, and the incidence of adverse reactions were assessed in both groups. Baseline data for the two groups were comparable, with no statistically significant differences (p>0.05). After seven days of medication, compared with the control group, patients in the experimental group had lower AMY, LPS, CRP, IL-6, TNF-α, WBC, and PCT (p<0.05), a shorter hospital stay (p=0.011), and a lower incidence of adverse reactions (p=0.007). ALB levels in the experimental group were significantly higher than those in the control group (p=0.039). Compared with somatostatin, octreotide shows superior therapeutic effects in acute pancreatitis, alleviating inflammation more effectively, promoting recovery, improving clinical outcomes, and shortening hospital stay. These findings provide a scientific basis for optimizing clinical medication.

Predictive value of carotid atherosclerotic plaques assesment, in combination with glycosylated hemoglobin A1c and C-reactive protein levels, for disease progression in young patients with acute ischemic stroke.

Shuting Jiang — 2026-05-31

This study evaluated the predictive significance of combining carotid atherosclerotic plaques assesment with glycosylated hemoglobin A1c (HbA1c) and C-reactive protein (CRP) levels for disease progression in young acute ischemic stroke (AIS) patients. A total of 130 subjects were evenly recruited, comprising young patients with AIS admitted between January 2015 and March 2025 (case group) and healthy individuals undergoing physical examinations during the same period (control group). Comparisons were conducted on the incidence rate of carotid atherosclerotic plaques and serum HbA1c and CRP levels. The case group was categorized into mildmoderate and severe groups according to the National Institute of Health Stroke Scale (NIHSS) score. Significant differences were observed between the severe and mildmoderate groups in NIHSS scores, carotid atherosclerotic plaque incidence, and serum levels of HbA1c and CRP (p<0.05). Increased serum HbA1c levels, elevated CRP levels, and presence of carotid atherosclerotic plaques functioned as risk factors for AIS progression in young patients (odds ratio>1, p<0.05). Serum HbA1c and CRP levels, along with the presence of carotid atherosclerotic plaques, showed a positive correlation with NIHSS scores (r>0, p<0.05). The areas under the ROC curves of serum HbA1c and CRP levels, carotid athero- sclerotic plaques and their combination for assessing AIS progression in young patients were 0.810, 0.823, 0.781, and 0.905, respectively. Elevated HbA1c, CRP, and the presence of carotid plaques are associated with AIS severity in young patients. Combined detection improves predictive accuracy, suggesting clinical utility for risk stratification.

Ensayo no aleatorizado de una intervención con terapia de la risa y su efecto en la calidad de vida de personas mayores residentes en centros gerontológicos.

Jairo L. Cardona — 2026-05-31

The rise in older adults experiencing deterioration in quality of life and mental health underscores the need to deepen our understanding of the effects of complementary therapies on this population. Therefore, this study aimed to describe changes in quality-of-life scores following laughter therapy among adults residing in gerontological centers. An exploratory quasi-experimental study was conducted with 25 volunteers aged 60 and older. The SF-12 survey, which assesses physical and mental health dimensions, was administered before and after eight laughter therapy sessions. Statistically significant improvements were observed in the total quality-of-life score after completing the therapy sessions (p = 0.001), particularly in the mental health dimension (p = 0.001), whereas changes in the physical health dimension were not significant (p = 0.281). By sociodemographic variables, those who benefited most were women, those over 80 years of age, single individuals, and those with a monetary income. Regarding education and the type of institution (private or public), all groups improved their quality-of-life scores. In conclusion, laughter therapy applied to older adult residents in nursing homes significantly increases quality-of-life scores in the mental health dimension and on the total scale.

Impact of plasma adsorption volumes (5 L vs. 6 L) on the prognosis of patients with liver failure.

Xin Zhang — 2026-05-31

Plasma adsorption (PA) is used to improve outcomes in liver fail- ure (LF). Data on adsorption capacity and its relationship to patient outcomes are limited. This single-center retrospective study included patients with LF who received PA at the First Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou City, China, between October 2020 and October 2022, and examined the impact of adsorption volume (5 L vs. 6 L) on prognosis. The study included 230 PA treatments, of which nine were excluded due to missing data. The 5L column was used in 60 patients (118 treatments, 47 male), and the 6L column was used in 50 patients (103 treatments, 31 male). Treatment effectiveness was evaluated using length of hospital stay, liver transplantation, death, and improvement in disease-related symptoms. In both groups, PA increased white blood cells (WBC), international normalized ratio (INR), activated partial thromboplastin time (APTT), and prothrombin time (PT) but decreased hemoglobin, total bile acids, total bilirubin, and fibrinogen (all p<0.05). Plate- let levels decreased after 6L PA (p=0.033) but not after 5L PA (p=0.116). After PA, the 6L group had lower WBC than the 5L group (p=0.003), but there were no significant differences in the other parameters. The 5L and 6L columns did not differ significantly in hospital stay duration, liver transplantation, mortality, or symptom improvement. However, the 5L column significantly reduced platelet destruction, shortened treatment time, and reduced the occurrence of complications, particularly thrombocytopenia-related risks. Hence, the results indicate that the 5L volume would be preferable clinically.

Orientin attenuates pulmonary fibrosis via TGF-β1/suppressor of mother against decapentaplegic 3 (Smad3) pathway.

Yijin Liu — 2026-05-31

Orientin, a natural flavonoid found in many medicinal plants, can improve lung injury through anti-inflammatory and antioxidant effects, but its role in pulmonary fibrosis (PF) remains unstudied. Human Fetal Lung 1 (HFL1) cells were stimulated with transforming growth factor-β1 (TGF-β1), and a single intratracheal bleomycin instillation in mice was used to establish a PF mouse model. Orientin, the TGF-β1/suppressor of mother against decapentaplegic 3 (Smad3) pathway agonist SRI-011381, and the inhibitor SB431542 were used for intervention. The proliferation and migration were evaluated using the Cell Counting Kit-8 (CCK-8), Edu staining (evaluated proliferative activity) and a scratch-healing assay. Fibers in HFL1 cells were detected by Sirius red staining. Inflammation and fibrosis in lung tissue were assessed by pathological staining and enzyme-linked immunosorbent assay (ELISA). PF and TGF-β1/Smad3 path- way protein expressions were evaluated by Western blot. Orientin significantly reduced TGF-β1, p-Smad3, alpha-smooth muscle actin (α-SMA), Collagen I, and matrix metallopeptidase (MMP)-2 levels. After Orientin treatment, the Edu pos- itive cells, cell proliferation and migration were significantly reduced, and the number of red-stained collagen fibers was significantly reduced. After Orientin treatment, alveolar cavity collapse, inflammatory cell infiltration, and collagen fiber hyperplasia of mice were alleviated, and the contents of Hydroxyproline (HYP) and inflammatory factors in the alveolar lavage fluid were significantly reduced. SRI-011381 attenuated the effect of Orientin on the intervention, and inflammation and fibrosis levels were markedly increased. SB431542 enhanced the intervention effect of Orientin. Orientin inhibited TGF-β1/Smad3 signaling, inhibited fibroblast-to-myofibroblast transition (FMT) and extracellular matrix (ECM) production, and alleviated inflammatory and fibrotic damage.

Circulating white blood cells and risk of tonsillar and base of tongue squamous cell carcinoma: A retrospective and mendelian randomization study.

Changyu Zhu — 2026-05-31

This study aimed to investigate the relationship between circulating white blood cells (cWBC) and the risk of tonsillar and base of tongue squamous cell carcinoma (TSCC/BOT SCC) using retrospective clinical data and Mendelian randomization (MR) analysis. A retrospective cohort of 239 TSCC/ BOT SCC patients was analyzed for cWBC subtypes and their association with clinicopathological variables, stratified by human papillomavirus (HPV) status. Blood tests, tumor staging, and immunological markers were included. For cau- sal inference, MR analysis was performed using genome-wide association study (GWAS) data on cWBC from the Blood Cell Consortium (UK Biobank) and TSCC/BOT SCC outcome data from the FinnGen consortium. Single-nucleotide polymorphisms (SNPs) were chosen based on genome-wide significance (p<5 ×10⁻⁸), low linkage disequilibrium (r² < 0.001), and F-statistic >10. The inverse-variance weighted (IVW) method was used as the primary MR approach, supplemented by MR-Egger, weighted median, and weighted mode analyses. The retrospective analysis showed significant differences in cWBC subtypes by gender, age, lifestyle factors, and HPV status. Notably, neutrophils (cNEU) and monocytes (cMON) were strongly associated with tumor stage and immune markers. MR analysis confirmed a causal link between total cWBC count and TSCC/BOT SCC risk (OR=1.516, p=0.005), with no evidence of heterogeneity or pleiotropy. No causal relationship was identified for cWBC subtypes or other head and neck squamous cell carcinoma (HNSCC) sites. This study provides the first comprehensive evidence supporting a causal role of elevated cWBC in the development of TSCC/BOT SCC. These findings indicate that cWBC may serve as a potential biomarker and therapeutic target in HPV-related or unrelated TSCC/BOT SCC.

Neurotoxic effects of nanoplastics exposure on depression-like behavior and cognitive function in mice under chronic unpredictable mild stress.

Dewei Chang — 2026-05-31

The aim was to investigate the effects of gavage exposure to nanoplastics (NPs) on cognitive decline and depression-like behavior was investigated in mice subjected to chronic unpredictable mild stress (CUMS). BALB/c mice were randomly assigned to four experimental groups: Control (Ctrl), nanoplastics (NPs), Mod (subjected to CUMS), and NPs+Mod (nano- plastics + CUMS). We evaluated the role of the brain-derived neurotrophic factor (BDNF) and its receptor, the tyrosine kinase receptor B (TrkB), signaling pathway in the hippocampus of mice. Behavioral assessments included the sucrose preference test, the open field test, the forced swim test, and the Morris water maze. Nissl staining was used to assess hippocampal neuronal morphology. BDNF and TrkB mRNA levels and protein expression in the hippocampus were measured by qPCR and Western blotting, respectively. Mice in the NPs, Mod, and NPs+Mod groups showed reduced body weight, lower sucrose preference, poorer performance in the open field test, and prolonged immobility in the forced swim test. Additionally, there was a reduction in hippocampal neurons and deficits in spatial learning and memory compared with the control group. BDNF mRNA and TrkB protein levels were decreased. Compared with the Mod group, the NPs+Mod group exhibited increased depression-like behaviors and cognitive impairments, greater hippocampal neuronal damage, and further reductions in BDNF and TrkB mRNA and protein levels. In conclusion, NP exposure has neurotoxic properties that can exacerbate CUMS-induced depression-like behavior and cognitive deficits, likely by further suppressing the hippocampal BDNF/TrkB signaling pathway.

Breast papillary lesions: comparative analysis of core needle biopsy and surgical excision findings in a single-center retrospective cohort with literature review.

Tuba Devrim — 2026-05-31

This retrospective study aimed to identify histopathological and immunohistochemical predictors of malignancy requiring surgical excision among papillary breast lesions diagnosed by core-needle biopsy (CNB). Fifty- three women with CNB-diagnosed papillary breast lesions who subsequently underwent surgical excision at the İzmir Bakırçay University Çiğli Hospital be- tween January 2015 and January 2025 were included. Clinical, radiological, and pathological data were analyzed. Twenty-eight patients (52.8%) were ≤50 years of age, and 21 lesions (39.6%) were larger than 3 cm. Surgical excision revealed benign lesions in 24 cases, malignant lesions in 16 cases, and intracystic solid carcinoma or atypical ductal hyperplasia in 13 cases. The malignancy/ atypia group (45.2%) showed a significantly higher frequency of myoepithelial cell loss (p<0.001) and microcalcifications (p=0.028), and uniform, strong estrogen receptor positivity (100%) on CNB. Benign lesions were more commonly peripherally located (p=0.049). No significant associations were observed with age, Breast Imaging Reporting and Data System (BI-RADS) category, or lesion size. These findings indicate that loss of myoepithelial cells and estrogen receptor positivity are strong predictors of malignancy and support the routine incorporation of immunohistochemical evaluation into CNB-based risk stratification.

Revisión panorámica de Enterobacterales productores de carbapenemasas en Venezuela: Características microbiológicas, epidemiológicas y moleculares.

Elba Guerrero — 2026-05-31

Infections caused by carbapenem-resistant Enterobacterales, which are considered last-line antibiotics, represent a growing threat to public health. The primary resistance mechanism is carbapenemase production, and characterizing these enzymes is essential for guiding therapeutic decisions. Likewise, molecular epidemiology provides critical information for monitoring and controlling these microorganisms. In this context, we reviewed reports of carbapenemase-producing Enterobacterales in Venezuela, synthesizing available data on bacterial species, antibiotic susceptibility, resistance-conferring enzymes, associated mobile genetic elements, molecular typing, and epidemiological trends. Analysis of these studies revealed that KPC-producing Klebsiella pneumoniae has been the most frequently reported carbapenemase-producing enterobacterium, although NDM (New Delhi metallo-beta-lactamase) is on the rise, consistent with the situation in the rest of Latin America. Overall, we iden- tified a knowledge gap, especially in the molecular characterization of carbape- nem-resistant isolates, that requires systematic studies to better understand the dynamics and impact of these pathogenic agents in Venezuela.

Erratum

Elena Ryder — 2026-05-31