Impact of sodium-glucose cotransporter-2 inhibitors on aging biomarkers and plasma ceramide levels in type 2 diabetes: beyond glycemic control

BACKGROUND

Aging is a complex biological process marked by the decline of physiological functions and heightened susceptibility to chronic illnesses, notably cardiometabolic disorders. Ceramides (Cer) are lipid derivatives linked to aging and metabolic diseases. Sodium-Glucose Cotransporter-2 inhibitors (SGLT2i), widely used in managing type 2 diabetes, have an unclear impact on aging biomarkers and Cer profiles.

OBJECTIVE

This study explored the association between SGLT2i use, plasma Cer levels (CerC16:0, CerC18:0, CerC22:0, CerC24:0, and CerC24:1), and aging biomarkers-Human Insulin-Like Growth Factor 1 (IGF-1), mammalian target of rapamycin (mTOR), 5-Methylcytosine (5MC), and Human H2AFX (Histone H2AX) in patients with type 2 diabetes mellitus (T2DM).

METHODS

In this retrospective study, 95 participants were divided into three groups: patients on SGLT2i (n = 34), patients on non-SGLT2i anti-diabetic treatments (n = 36), and healthy controls (n = 25). Plasma Cer and aging biomarkers were quantified using Liquid Chromatography with tandem mass spectrometry (LC-MS-MS) and ELISA, respectively. Principal component analysis (PCA) assessed group-based clustering, while ANCOVA evaluated group differences with confounder adjustment.

RESULTS

SGLT2i-treated patients showed significantly lower CerC16:0, CerC22:0, and CerC24:1 levels (p < 0.01) and decreased 5MC and H2AX (p < 0.05) compared to non-SGLT2i patients. IGF-1 was significantly elevated in the SGLT2i group (p < 0.01), suggesting a possible protective effect on metabolic health. PCA distinguished control from diabetic groups but revealed overlap between SGLT2i and non-SGLT2i groups.

CONCLUSION

Beyond glucose control, SGLT2i may improve plasma Cer and aging markers in diabetic patients, supporting their broader therapeutic potential in aging and age-related diseases. Further large-scale studies are warranted to confirm these effects and underlying mechanisms.

Warburg effect in malign thyroid tissue evidenced using FTIR spectroscopy

BACKGROUND/OBJECTIVES

Thyroid cancer is the most common endocrine malignancy; the clinical approach of nodular thyroid involves ultrasonography (USG) TI-RADS classification, clinical symptoms, and biopsies according to the Bethesda System, highlighting that biomarkers also support diagnosis. The main objective of this research is to compare the chemometric changes by Fourier transform infrared (FTIR) spectroscopy analysis between benign tumor (BT) vs. malignant neoplasm (MN) and thyroid pathology (TP) vs. healthy tissue (HT).

METHODS

Biopsies of thyroid nodular disease were obtained and analyzed by ATR-FTIR spectroscopy; thereafter, BT and MN biomolecular compounds were compared, as well as TP vs HT. Prior biopsies, laboratory blood tests, USG TI-RADS classification, and thyroid cytopathology report (BETHESDA classifier) were obtained.

RESULTS

Laboratory blood tests showed that glucose and urea levels were similar in BT and MN, but in MN, the creatinine increased, and the albumin decreased compared to BT, with no differences in thyroid hormones. About the TI-RADS scoring system in the MN group, 52 % were unknown, followed by 4 (30 %). However, no significant differences in the size of the tumors were shown. The most reported Bethesda for BT was I, followed by IV and V. Contrary for the MN was VI, followed by V. The FTIR analysis showed shifts in all the analyzed biomolecules, highlighting the evidence of the Warburg effect on MN. Moreover, an increase in protein vs. lipid and protein vs. DNA (1650/1453 and 1550/1082 ratios) was observed, as well as decreased levels of DNA content about proteins and lipids (1550/1082 and 1082/1453 ratios). Besides, structural changes related to lipids (2962 cm-1, 2877 cm-1), fatty acids (1401 cm-1), amide III (1317 cm-1), and nucleic acid (1239 cm-1) were found on TP in comparison to HT. In this sense, TP showed decreased levels in proteins vs DNA and increased levels of DNA compared to lipids CH2.

CONCLUSIONS

Metabolic alteration in MN was evidenced, reflecting the "Warburg effect," with a significant decrease in lipids and DNA compared to protein content. In the same way, structural changes related to lipids, fatty acids, amide III, and nucleic acids were found in TP compared to HT. However, more studies are needed.

Screening accuracy of Single-Point Insulin Sensitivity Estimator (SPISE) for metabolic syndrome: a systematic review and meta-analysis

BACKGROUND

Metabolic syndrome (MetS) is a multifactorial condition linked to increased risk of cardiovascular disease and type 2 diabetes. The Single-Point Insulin Sensitivity Estimator (SPISE), a non-invasive index calculated via 600 × HDL-C^0.185 / (TG^0.2 × BMI^1.338), offers a practical alternative. This systematic review and meta-analysis aim to evaluate the accuracy of SPISE as an indicator for MetS.

METHODS

We conducted a systematic review and meta-analysis following PRISMA guidelines. We searched databases such as MEDLINE, Scopus, Web of Science, and Embase, focusing on studies evaluating SPISE's screening accuracy for MetS. Eligible studies were observational, reporting mean SPISE values and its predictive performance. Meta-analyses were performed using Hedges' g standardized mean differences (SMD) and pooled area under the curve (AUC) estimates.

RESULTS

Seven studies comprising 12,919 participants were included, with an age range of 9.2 ± 2.1 to 52.4 ± 11.0. Individuals with MetS had significantly lower SPISE scores than controls (SMD = -0.94, 95% CI: -1.25 to -0.63). The pooled AUC for SPISE as a predictor of MetS was 0.86 (95% CI: 0.83 to 0.90), surpassing other insulin resistance indices like HOMA-IR and the triglyceride/HDL-C ratio. Meta-regression showed that systolic and diastolic blood pressure were potential sources of heterogeneity and age, gender, BMI, waist circumference, fasting blood glucose, triglyceride, and HDL did not contribute to heterogeneity.

CONCLUSIONS

SPISE is a highly accurate and non-invasive tool for predicting MetS, potentially outperforming traditional indices like HOMA-IR. Its ease of use and precision make it a valuable clinical screening tool, especially in diverse populations.

Targeting Immune Cell Metabolism: A Promising Therapeutic Approach for Cardiovascular Disease

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality globally. Recent groundbreaking preclinical and clinical research underscores the pivotal role of metabolite remodelling in the pathology of CVD. This metabolic transformation not only directly fuels the progression of CVD but also profoundly influences the immune response within the cardiovascular system. In this review, we focused on the complex interactions between cardiovascular metabolic alterations and immune responses during the course of CVD. Furthermore, we explore the potential therapeutic interventions that could be developed based on the understanding of metabolic alterations and immune dysregulation in CVD. By targeting these metabolic and immunological pathways, novel strategies for the prevention and treatment of CVDs might be developed to improve patient outcomes and reduce the global burden of this disease.

Pseudo-Malabsorption in High Dose Levothyroxine-Resistant Hypothyroidism

A 38-year-old woman was diagnosed with hypothyroidism during pregnancy at age 35 years and started on levothyroxine (LT4). Despite increasing the dose to 400 μg/day and adding liothyronine, her thyroid function did not improve, leading to hospitalization. Upon admission, her thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4) levels were 255 μIU/mL (255 mIU/L) (reference range [RR]: 0.35---4.94 μIU/mL; 0.35---4.94 mIU/L), 3.42 pg/mL (5.27 pmol/L) (RR: 1.71-3.71 pg/mL; 2.63-5.70 pmol/L), and 0.153 ng/dL (1.97 pmol/L) (RR: 0.70-1.48 ng/dL; 9.01-19.05 pmol/L), respectively. She reported good adherence to medication and not consuming interfering food or medication. Endoscopic examination revealed no malabsorption. A 1000-μg oral LT4 loading test showed an increase in free T4 level from 0.787 (10.1 pmol/L) to 2.40 ng/dL (30.9 pmol/L), indicating pseudo-malabsorption. After presenting the loading test results, she admitted to nonadherence. A multidisciplinary team intervened, conducting individual counseling and simplifying treatment. Post-discharge, with LT4 200 μg/day, her TSH, free T3, and free T4 levels improved to 0.496 μIU/mL (0.496 mIU/L), 5.23 pg/mL (8.05 pmol/L), and 2.19 ng/dL (28.2 pmol/L), respectively. When addressing treatment-resistant hypothyroidism, it is crucial to evaluate patient history and medication schedule and to check for malabsorption. Comprehensive interventions are recommended if nonadherence is suspected.

Unveiling the role of Na⁺/K⁺-ATPase pump: neurodegenerative mechanisms and therapeutic horizons

Sodium and potassium-activated adenosine 5'-triphosphatase (Na+/K+-ATPase) is a pivotal plasma membrane enzyme involved in neuronal activity and cellular homeostasis. The dysregulation of these enzymes has been implicated in a spectrum of neurodegenerative disorders like Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), and neurodevelopmental disorders including autism spectrum disorder (ASD), psychiatric disorders such as schizophrenia, and neurological problems like epilepsy. A hallmark of these disorders is the gradual loss of neuronal integrity and function, often exacerbated by protein accumulation within brain cells. This review delves into the multifaceted role of Na+/K+-ATPase dysfunction in driving oxidative stress, excitotoxicity, and neuroinflammation, contributing to synaptic and neuronal damage. Emerging therapeutic strategies, such as gene therapy and developing isoform-specific enzyme modulators, offer promising avenues for targeted interventions. Furthermore, this review highlights innovative research directions, including the role of Na⁺/K⁺-ATPase in synaptic plasticity, the identification of endogenous regulators, and its contribution to neuroinflammatory pathways. Personalized medicine and advanced gene-editing technologies are positioned as transformative tools for crafting safer and more precise therapies tailored to individual patients. This comprehensive exploration underscores the enzyme's therapeutic potential and sets the stage for developing novel targeted strategies to mitigate the burden of Na⁺/K⁺-ATPase-linked neurological disorders.

Advances in flavonoid bioactivity in chronic diseases and bioavailability: transporters and enzymes

Flavonoids, abundant in the human diet, have been extensively studied for their therapeutic bioactivities. Recent research has made significantly advances in our understanding of the biological activities of flavonoids, demonstrating their therapeutic effects for various chronic diseases. However, the generally low bioavailability of flavonoids limits their effectiveness. Therefore, it is essential to explore the pharmacokinetics of flavonoids, paying particular attention to the roles of transporters and metabolizing enzymes. This paper reviews recent studies on the bioactivity of flavonoids, highlighting the importance of transporters and metabolic enzymes in their pharmacokinetics.

The associations between circulating amino acids and arterial aneurysms and dissection: A bidirectional Mendelian randomization study

Background

Circulating amino acid levels can be altered in arterial aneurysms and dissection, but the relationships between them is unclear. The present study investigated the causal relationship between circulating amino acid levels and arterial aneurysms and dissection via bidirectional two-sample Mendelian randomization (MR).

Methods

A bidirectional two-sample MR analysis was used. Forward analysis was performed with amino acid levels as the exposure and arterial aneurysms and dissection as outcomes. Reverse analysis was performed with arterial aneurysms and dissection as exposures and circulating amino acid levels as outcomes. MR data were analyzed using five analytical methods: the inverse-variance weighted (IVW), MR‒Egger, weighted median, simple, and weighted methods. IVW was used as the main analytical method, and the other methods were used for supplementary analyses. Heterogeneity was assessed using Cochran's Q test, and horizontal pleiotropy was assessed using intercepts from MR‒Egger regression. The genome-wide association study (GWAS) data for circulating amino acids were obtained from the IEU open GWAS database and the GWAS Catalog database. The GWAS data for arterial aneurysms and dissection were obtained from the Finngen consortium database version R10.

Results

The tyrosine level was negatively correlated with other aneurysms (P = 0.00211, OR: 0.57, 95 % CI: 0.40, 0.82). Aortic dissection decreased the circulating glycine level (P = 0.00168, OR: 0.98, 95 % CI: 0.98, 0.99).

Conclusion

Through bidirectional MR analysis, we found that tyrosine level was negatively correlated with other aneurysms and that aortic dissection reduced circulating glycine. Our findings support a possible interaction between circulating amino acid levels and arterial aneurysms and dissection.

New insights into diabetes-induced cardiac pathology

Individuals with diabetes have an elevated risk of heart disease, and there is a significant clinical need for evidence-based treatments. Heart disease in diabetes manifests as a distinct cardiopathology, with cardiac structural and functional remodeling underlying increased susceptibility to cardiac dysfunction and arrhythmias. An understanding of the mechanisms associated with cardiac vulnerability in diabetes is incomplete, but recent studies have advanced new insights into the roles of metabolic disturbances, gene dysregulation and epicardial adipose influence. This perspective article highlights these three promising new developments in proposed mechanisms, and discusses exciting advances in cardiac-targeting for potential treatment of diabetic heart disease.

Natural History of NAA15 -Related Neurodevelopmental Disorder Through Adolescence

The NatA N-terminal acetyltransferase complex is composed of the NAA10 catalytic subunit and the auxiliary subunits NAA15 and HYPK. While those with variants in the enzymatic subunit develop Ogden Syndrome, individuals with variants in the NAA15 coding region develop NAA15-related neurodevelopmental syndrome, which presents with a wide array of manifestations that affect the heart, brain, musculoskeletal system, and behavioral and cognitive development. We tracked a cohort of 27 participants (9 females and 18 males) with pathogenic NAA15 variants over time and administered the Vineland-3 assessment to assess their adaptive functioning. We found that this cohort performed significantly worse compared to the normalized Vineland values. On average, females performed better than males, and they performed significantly better on the motor domain and fine motor sub-domain portions of the assessment. Over time, females showed a significant decrease in adaptive functioning, primarily in the daily living skills and motor domains. Males (after excluding one outlier) showed a moderate positive correlation between age and adaptive behavior composite (ABC) standard score. Despite a similar etiology caused by dysfunction in the NatA complex, NAA15-related neurodevelopmental disorder appears to have a weaker effect on adaptive behavior than Ogden Syndrome. However, these differences are based on comparisons to similar literature, as opposed to head-to-head testing. Lastly, comparisons between probands with loss of function variants in NAA15 and those with missense variants showed no significant differences in adaptive behavior metrics. Ultimately, additional longitudinal data should be collected to determine the validity of the between sex differences and to better understand the change in adaptive behavioral outcomes of individuals with NAA15-neurodevelopmental disorder as they age.

Molecular basis of cardioprotective effects of methanol extract of Ficus exasperata in diabetic Wistar rats

Cardiovascular complications are a significant concern in diabetes mellitus. Ficus exasperata Vahl leaf has been traditionally used for diabetes management, yet its impact on cardiovascular biomarkers in diabetic conditions remains unexplored. This study evaluated the effects of methanol extract of Ficus exasperata (MEFE) on antioxidant defense, oxidative stress markers, ion transport enzymes, inflammatory mediators, and cardiovascular gene expression in diabetic Wistar rats. Twenty Wistar rats were divided into four groups (n = 5): control, diabetic untreated, diabetes + MEFE (200 mg/kg), and diabetes + insulin (0.3 IU). Diabetes was induced with alloxan monohydrate (150 mg/kg), and treatments were administered orally for 28 days. Antioxidant enzyme activities (Glutathione peroxidase (GPx), Glutathione reductase (GR), Superoxide dismutase (SOD), Catalase, malondialdehyde and 8-hydroxy-2'-deoxyguanosine), Cardiac biomarkers (Na+/K+ ATPase, Ca2+ ATPase, Creatinine kinase-myocardial band (CK-MB), Troponin I, Troponin T, and Lactatate dehydrogenase), and gene expression of CRP, ACE, P-Selectin, and eNOS were evaluated. Data were analyzed using one-way analysis of variance, expressed as mean ± SEM, and p < 0.05 was considered statistically significant. The diabetic group treated with MEFE (200 mg/kg) significantly increased Ca²⁺ ATPase, SOD, and glutathione reductase activities compared to diabetic untreated. However, malondialdehyde and 8-OHdG levels decreased significantly in diabetes+MEFE (200 mg/kg) compared to diabetes untreated. CK-MB levels increased significantly in diabetes+MEFE (200 mg/kg) compared to diabetic untreated. MEFE reduced ACE and P-selectin expression in diabetes+MEFE (200 mg/kg) compared to diabetic untreated, indicating potential antihypertensive and anti-thrombotic effects. However, it increased CRP levels compared to control, suggesting an inflammatory response. MEFE significantly reduced eNOS expression compared to diabetic untreated, suggesting impaired vascular function. These findings suggest that while Ficus exasperata has some beneficial effects, its impact on inflammatory and cardiac biomarkers necessitates further research to fully understand its therapeutic potential and safety.

Nonlinear relationship between serum high sensitivity C reactive protein to high density lipoprotein cholesterol ratio with non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) has become an increasing public health concern. We examined the association between serum high-sensitivity C-reactive protein(hs-CRP)to high-density lipoprotein cholesterol (HDL-C) ratio (HCHR) and the prevalence of NAFLD, extent of hepatic steatosis and fibrosis in the general US population. This cross-sectional analysis included 4039 adult participants from the 2017 to 2018 National Health and Nutrition Examination Survey. Multivariable logistic regression and multivariable linear regression analyses were used to assess the association between HCHR levels and NAFLD, fatty liver degree, and liver fibrosis. Generalized additive models examined the nonlinear relationship between the HCHR and NAFLD. In the three models, HCHR was positively associated with NAFLD, model 1 (OR  1.315, 95% CI 1.273, 1.359), model 2 (OR 1.364, 95% CI 1.317, 1.412) and model 3 (OR  1.120, 95% CI 1.074, 1.168). Stratified analyses showed that the association was more prominent in women, those younger than 40 years, Mexican-Americans, and those with a 25-30 kg/m2 BMI. Nonlinear association analysis revealed a threshold effect between HCHR and NAFLD, with a threshold inflection point of 2.598. We also found a significant link between HCHR and liver steatosis and the risk of liver fibrosis. In the US adult population, the increased risk of NAFLD, liver fibrosis, and severity of hepatic steatosis are independently associated with increased HCHR, and the HCHR may serve as a potential marker for NAFLD and liver fibrosis.

IGF-1 contributes to cardiovascular protection in obesity by upregulating Na+/K+-ATPase activity and modulating key signaling pathways in rats on a high-fat diet

This study examined the ability of insulin-like growth factor-1 (IGF-1) to improve the expression and function of cardiac sodium/potassium adenosine triphosphatase (Na+/K+-ATPase) and reduce heart hypertrophy in obese rats. Adult male Wistar rats received a standard diet or a high-fat (HF) diet for 12 weeks. A bolus injection of IGF-1 (50 μg/kg, i.p.) was administered to half of the HF rats 24 hours before euthanasia. IGF-1 treatment increased: the activity of Na+/K+-ATPase and expression of phosphorylated and total Na+/K+-ATPase α1 subunit, the phosphorylation of IGF-1 receptor β /insulin receptor β at Tyr1131/Tyr1146, insulin receptor substrate-1 (IRS-1) at Tyr1222, mammalian target of rapamycin (mTOR) at Ser2481, protein kinase B (Akt) at Ser473 and the expression of type-2 angiotensin II (AngII) receptor (AT2R). Conversely, IGF-1 reduced the levels of IRS-1 phosphorylated at Ser307, mTOR at Ser2448, ribosomal protein p70 S6 kinase (S6K) at Thr421/Ser424, and the expression of type-1 Ang II receptor (AT1R) in the heart, as well as the serum levels of Ang II in obese rats. IGF-1 treatment reduced cardiac mass and elevated mRNA expression of the α-myosin heavy chain (MHC), and the α/β MHC ratio in the hearts of obese rats. The results of this study suggest that the administration of IGF-1 to obese rats reduces the adverse effects of HF diet, potentially by lowering Ang II-mediated activation of mTOR/S6K and enhancing the IRS-1/Akt pathway, which promotes Na+/K+-ATPase activity in the heart and diminishes cardiac hypertrophy.

Levothyroxine therapy in thyroidectomized patients: ongoing challenges and controversies

This mini-review provides an update on the challenges and controversies surrounding levothyroxine therapy in thyroidectomized patients, following an extensive review on dosing strategies and available formulations. Despite efforts to establish an ideal dosage adjustment method, achieving optimal thyroid hormone replacement remains complex due to interindividual variations in the hypothalamic-pituitary-thyroid axis and the pharmacokinetic and pharmacodynamic limitations of exogenous levothyroxine. Additionally, this review highlights the importance of evaluating the risk-benefit ratio of levothyroxine therapy, particularly in the setting of TSH suppression, focusing on its effects on quality of life, bone metabolism, and cardiac rhythm. Levothyroxine-induced subclinical hyperthyroidism may contribute to an increased risk of atrial fibrillation and alterations in bone mineral density, with implications that remain a subject of debate. Given the incomplete replication of endogenous thyroid hormone action by levothyroxine monotherapy, a tailored therapeutic approach is crucial. Despite ongoing research, the optimal management of thyroidectomized patients continues to be an open issue.

Neutrophil Percentage-to-Albumin Ratio and Neutrophil-to-Albumin Ratio as novel biomarkers for non-alcoholic fatty liver disease: a systematic review and meta-analysis

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is a major global health concern, with rising prevalence linked to obesity, insulin resistance, and metabolic syndrome. Timely and accurate identification of individuals at risk is crucial for improving outcomes. Recently, systemic inflammatory and nutritional markers such as the Neutrophil Percentage-to-Albumin Ratio (NPAR) and the Neutrophil-to-Albumin Ratio (NAR) have emerged as promising non-invasive biomarkers for NAFLD. Both ratios reflect inflammation and hepatic nutritional status, offering potential utility in predicting disease presence and progression. This systematic review and meta-analysis aimed to evaluate the diagnostic value of NPAR and NAR in patients with NAFLD.

METHODS

A comprehensive search was performed across databases including PubMed, Embase, Scopus, and Web of Science from inception to December 28, 2024. Data extraction was carried out using a standardized form, and the methodological quality of included studies was assessed using the Newcastle-Ottawa Scale. Statistical analyses were performed using STATA version 18, employing a random-effects model.

RESULTS

The meta-analysis demonstrated that both the Neutrophil Percentage-to-Albumin Ratio (NPAR) and the Neutrophil-to-Albumin Ratio (NAR) were significantly higher in patients with NAFLD compared to healthy individuals. NPAR showed a standardized mean difference (SMD) of 0.28 (95% CI: 0.22-0.35, P < 0.01), while NAR had a higher effect size with an SMD of 0.69 (95% CI: 0.44-0.93, P < 0.01). The pooled diagnostic performance of NPAR yielded a sensitivity of 69.5% (95% CI: 56.3-82.6%), specificity of 63.1% (95% CI: 46.6-70.0%), and an area under the curve (AUC) of 76.05% (95% CI: 66.3-85.7%). For NAR, the pooled sensitivity was 65.0% (95% CI: 49.0-82.0%), specificity was 63.0% (95% CI: 47.0-79.0%), and AUC was 69.0% (95% CI: 48.0-89.0%).

CONCLUSION

In conclusion, both NPAR and NAR were found to be elevated in individuals with NAFLD, supporting their potential as non-invasive and accessible biomarkers. These ratios reflect key aspects of systemic inflammation and nutritional status, offering clinical value in early detection and risk stratification. However, given the limited number of studies available-particularly for NAR-further research is needed to confirm these findings, establish standardized thresholds, and assess their performance across diverse populations and clinical settings.

CLINICAL TRIAL NUMBER

Not applicable.

Exploring the causal relationship between Hashimoto thyroiditis and metabolic-associated fatty liver disease: A Mendelian randomization study

This study aims to investigate the possible causal link between Hashimoto thyroiditis (HT), an autoimmune disorder, and metabolic-associated fatty liver disease (MAFLD), previously referred to as nonalcoholic fatty liver disease (NAFLD), a common metabolic condition. Using genome-wide association study data from large European populations, we performed a bidirectional Mendelian randomization (MR) analysis. We identified single nucleotide polymorphisms strongly associated with HT and MAFLD/NAFLD, which we used as instrumental variables to probe the causal relationship between these 2 conditions. The forward MR analysis, using the inverse variance weighted method, showed that HT may increase the risk of MAFLD/NAFLD (odds ratio = 1.065, 95% confidence intervals: 1.014-1.119, P = .011). However, the reverse MR analysis did not establish a significant causal effect of MAFLD/NAFLD on HT (P > .05). Sensitivity analyses were carried out to assess potential heterogeneity or pleiotropy, and the results supported the robustness of our findings, indicating no significant concerns. These results suggest that HT may be a risk factor for the development of MAFLD/NAFLD. The bidirectional MR study revealed an elevated risk of MAFLD/NAFLD in individuals with HT, but no causal relationship was found from MAFLD/NAFLD to HT in the opposite direction. This understanding could assist healthcare professionals in improving their comprehension and management of both HT and MAFLD/NAFLD, leading to more comprehensive clinical guidance for patients and promoting the development of interdisciplinary treatment strategies.

Influence of concomitant mitral valve intervention on clinical outcomes during atrial myxoma surgery

IntroductionThe aim of this study was to examine whether concomitant mitral valve intervention affected the clinical outcomes in patients undergoing atrial myxoma surgery.Materials and MethodsWe included a total of 97 patients who underwent surgery for atrial myxoma between February 1990 and July 2024 in this study. Among them, 19 patients underwent concomitant mitral valve intervention and these patients comprised the mitral valve group while remaining 78 patients comprised the myxoma-alone group. Preoperative clinical characteristics, operative data, postoperative outcomes and complications of the patients were retrospectively reviewed, and compared between the groups.ResultsThere were no significant differences between the groups in terms of preoperative basic demographic and clinical characteristics, except for the mean diameter of mass and frequency of atrial fibrillation. In the postoperative period, only new-onset atrial fibrillation rate was significantly greater in the mitral valve group than in the myxoma-alone group. In terms of other postoperative outcomes and complications, no significant differences were found between the groups and both groups were statistically similar. During the postoperative period, no valve-related adverse event occurred in patients undergoing mitral valve replacement. In eight of nine patients undergoing mitral valve repair for moderate or severe mitral regurgitation, absent or mild mitral regurgitation was observed. In one patient undergoing mitral valve repair for severe mitral regurgitation, the regurgitation regressed to moderate and this patient was followed asymptomatically with medical treatment.ConclusionOur study demonstrated that concomitant mitral valve intervention did not significantly affect the clinical outcomes in patients undergoing atrial myxoma surgery.

Hypothyroidism: playing the cardiometabolic risk concerto

BACKGROUND

Thyroid hormones influence the function of essentially every system of the body, including the cardiovascular and metabolic system. Thyroid hormone replacement with levothyroxine (LT4) is the mainstay of pharmacological management for people with (especially clinically overt) hypothyroidism, and it is important to ensure the cardiovascular and metabolic safety of this treatment. This is especially so as in hypothyroidism, cardiometabolic risk factors and cardiovascular disease are highly prevalent conditions and will often coexist in an individual patient. Accordingly, we have reviewed the cardiometabolic consequences of hypothyroidism and intervention with thyroid hormone replacement.

MAIN BODY

Numerous observational studies and meta-analyses have described multiple potentially adverse cardiometabolic consequences of hypothyroidism, including exacerbation of cardiovascular and metabolic risk factors (especially dyslipidaemia), functional impairment of the heart and vasculature (including accelerated atherosclerosis) and increased risk of advanced cardiovascular outcomes. LT4 usually improves cardiometabolic risk factors in people with hypothyroidism and some (but not all) studies have reported improved vascular and cardiac function in LT4-treated populations. Observational data have suggested the possibility of improved cardiometabolic outcomes with LT4 treatment, particularly in younger people with hypothyroidism, although data from randomised, controlled trials are needed here. Importantly, LT4 (with or without additional triiodothyronine) appears to be safe from a cardiovascular perspective, as long as overtreatment and iatrogenic thyrotoxicosis are avoided.

CONCLUSIONS

Overall, the current evidence base supports intervention with LT4 to protect the cardiometabolic health of people with hypothyroidism who require thyroid hormone replacement, although more data on long-term clinical outcomes are needed.

Umbilical Cord-Derived Mesenchymal Stem Cells Infusion in Type 2 Diabetes Mellitus Patients: A Retrospective Cytopeutics' Registry Study

Background

Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, leading to elevated blood glucose levels. Cellular therapies offer promise for improving hyperglycemia in T2DM. This retrospective study aimed to assess the clinical effectiveness of intravenous allogeneic umbilical cord-derived mesenchymal stem cells (UC-MSCs) infusion in T2DM patients through various clinical evaluations, focusing on systemic inflammation, metabolic dysfunction, and insulin resistance.

Methods

The data from a total of 218 T2DM patients who attended for follow-up after 6 months, and 83 patients after 12 months after receiving 50-100×10⁶ allogeneic UC-MSCs were analyzed. Blood and urine samples were collected at baseline and follow-up. Key evaluations included changes in anthropometry, diabetes indices, lipids, liver, renal, hormonal, and inflammatory markers.

Results

All patients demonstrated satisfactory outcomes, without adverse effects. Significant reductions in HbA1c levels were observed at 6-months (p<0.001) and 12-months (p=0.016). Insulin (p=0.048) and HOMA-IR (p=0.007) levels significantly reduced within 6-months, with same trend at 12-months. ALT and GGT levels significantly decreased (p<0.05), indicating a reduction in liver inflammation. hs-CRP level among patients with higher inflammation were also reduced at 6-months (p=0.073) and significantly at 12-months (p=0.016). Testosterone (p=0.050) and estradiol (p=0.043) levels increased in males and females, respectively, during 12-month follow-up. Additionally, estimated glomerular filtration rate (eGFR) and creatinine levels improved in stage 2 chronic kidney disease (CKD) at 6- and 12-month (p<0.05), indicating recovered renal function for those in early stage of CKD.

Conclusion

Allogeneic UC-MSCs infusion is safe for patients with T2DM and is associated with overall health outcomes, with sustained benefits up to 12 months. Notably, the treatment significantly improved metabolic indices including glycemic control, liver and renal profile and systemic subclinical inflammation. These findings provide a basis for further exploration of UC-MSCs in managing T2DM in proper randomized control trial, by addressing both metabolic dysregulation and inflammation.

Comparisons of various insulin resistance indices for new-onset metabolic syndrome before midlife: The CHIEF cohort study, 2014-2020

BACKGROUND

Some non-insulin-based insulin resistance (IR) indices have been found to be associated with metabolic syndrome (MetS); however, few cohort studies have compared the capacities of these indices for predicting incident MetS in young adults.

AIM

To investigate the associations of various non-insulin-based IR (NI-IR) indices with new-onset MetS in young military personnel.

METHODS

A total of 2890 armed forces personnel in Taiwan who were aged 18-39 years and did not have MetS at baseline were followed to monitor the incidence of new-onset MetS from 2014 to the end of 2020. Six NI-IR indices, including the metabolic score for IR (METS-IR), triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio, TG glucose (TyG) index, Zhejiang University (ZJU) index, total cholesterol (TC)-to-HDL-C ratio, and alanine transaminase (ALT)-to-aspartate transaminase (AST) ratio, were defined according to specific criteria. Incident MetS was identified on the basis of each annual health examination using the International Diabetes Federation criteria. Multiple Cox regression analyses were conducted, adjusting for age, sex, waist circumference, smoking status, alcohol consumption status, and physical activity, to assess the associations of the NI-IR indices with incident MetS. The area under the receiver operating characteristic curve (AUROC) was used to compare the capacities of these NI-IR indices for predicting new-onset MetS.

RESULTS

During a median follow-up of 5.8 years, there were 673 patients with new-onset MetS (23%). All six of the NI-IR indices were significantly and positively associated with incident MetS. In the entire cohort, the greatest AUROC was found for the METS-IR [0.782; 95% confidence interval (CI): 0.762-0.801; all P values compared to the other NI-IR indices < 0.05], followed by the TG/HDL-C ratio (0.752; 95%CI: 0.731-0.772), ZJU index (0.743; 95%CI: 0.722-0.764), TyG index (0.734; 95%CI: 0.713-0.756), TC/HDL-C ratio (0.731; 95%CI: 0.709-0.752), and then the ALT/AST ratio (0.734; 95%CI: 0.713-0.756).

CONCLUSION

This study suggests that almost all the NI-IR indices are associated with the development of MetS in military young adults. The METS-IR is the strongest predictor of new-onset MetS before midlife.

Phloretin and Enalapril co-administration ameliorates hyperglycemia mediated exacerbation of myocardial injury in rats

Hyperglycemia exacerbates myocardial injury by amplifying oxidative stress, inflammation and apoptosis. This study explores the therapeutic potential of phloretin and enalapril co-administration in mitigating hyperglycemia-exacerbated myocardial damage. Using network pharmacology, 47 therapeutic targets and 10 hub genes, including albumin, insulin, prostaglandin endoperoxide synthase 2, matrix metallopeptidase 9, caspase3, tumor protein p53, insulin like growth factor 1, transforming growth factor beta 1, matrix metallopeptidase 2 and glycogen synthase kinase 3, were identified as critical to the drugs' synergistic action. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses highlighted key pathways, such as Interleukin-17 (IL-17), Advanced Glycation End Product-Receptor for Advanced Glycation End Products (AGE-RAGE), Mitogen activated protein kinase (MAPK), Phosphatidylinositol 3-kinase-protein kinase B (PI3K-Akt), Tumor necrosis factor (TNF) and Forkhead box O (FoxO), involved in angiogenesis, glucose metabolism, oxidative stress regulation and inflammation. Molecular docking confirmed strong affinities of phloretin and enalapril for key targets like insulin (INS), matrix metallopeptidase 9 (MMP9), prostaglandin endoperoxide synthase 2 (PTGS2) and insulin like growth factor 1 (IGF1). In-vivo studies using hyperglycemic rats with isoproterenol-induced myocardial ischemia validated the therapeutic efficacy of the combination. Co-treatment significantly enhanced antioxidant enzyme levels, reduced myocardial injury markers and improved histopathological features. These findings demonstrate the synergistic cardioprotective effects of phloretin and enalapril, offering a promising strategy for managing hyperglycemia and cardiac injury. The study provides a foundation for further preclinical and clinical evaluations to optimize the use of this combination in cardiovascular therapies.

Beyond obesity: lean metabolic dysfunction-associated steatohepatitis from unveiling molecular pathogenesis to therapeutic advancement

Nonalcoholic fatty liver disease (NAFLD), now known by the name of metabolic dysfunction-associated fatty liver disease (MAFLD), with increased global incidence, has been recognized as a significant metabolic disorder. NAFLD includes a spectrum liver disease from hepatocellular fat accumulation (isolated steatosis) to an advanced form of liver injury known as nonalcoholic steatohepatitis (NASH), which refers to distinct histologic features, including hepatocellular steatosis and injury, necroinflammation, and eventually fibrosis. Nonobese or lean individuals associated with metabolic dysregulation usually demonstrated diverse risk factors compared to obese MAFLD. The presence of normal range body mass index (BMI) and excess visceral adiposity with increased cardiometabolic and renal comorbidities, along with sarcopenia, has been evidenced to be associated with lean MASH. Genetic predispositions accompanying lifestyle and environmental factors contribute to disease initiation and progression. The genetic influence in pathophysiology indicated the significant contributions of the following genes: PNPLA3, TM6SF2, APOB, LIPA, MBOAT7, and HSD17B13, and the impact of their disease-specific variants in the development of obesity-independent MASH. The epigenetic modifications exhibited differential DNA methylation patterns in the genes involved in lipid metabolism, particularly hypomethylation of PEMT. Diet-induced and genetic animal models of lean MASH, including Slc: Wistar/ST rats, PPAR-α, PTEN, and MAT1A knockout mice models, are indicated to be pivotal in the exploration of disease progression and observing the effect of therapeutic interventions. This comprehensive review comprises the molecular and genetic pathophysiology, molecular diagnostics, and therapeutic aspects of lean MASH to enunciate a diagnostic approach that combines detailed clinical phenotyping regarding genomic analysis.

The status of studies on the mechanism of microcirculatory dysfunction in the process of diabetic kidney injury

Diabetic nephropathy (DN) is one of the most common and serious microvascular complications of diabetes mellitus (DM) and is the main cause of end-stage renal disease. Endothelial dysfunction caused by persistent hyperglycemia occurs at the initial stage of vascular disease. Moreover, persistent hyperglycemia is also a critical factor causing renal microcirculatory dysfunction. In recent years, many studies have confirmed that chronic hypoxia caused by microcirculatory dysfunction is one of the main mechanisms of kidney injury in patients with DM. Similarly, microcirculatory dysfunction damages renal tissue through interactions with other pathophysiological processes, thereby promoting the occurrence and development of DN. Thus, this article reviews the pathogenesis of renal microcirculatory dysfunction in DM and its interaction with stress, energy metabolism, and immunologic inflammation. Furthermore, a new idea was proposed to analyze the mechanism of kidney injury in DM from the perspective of microcirculatory dysfunction.

The Current Understanding of the Molecular Pathogenesis of Papillary Thyroid Cancer

The thyroid is a vital endocrine organ that regulates metabolism, heart rate, respiration, digestion, body temperature, brain development, skin and bone maintenance, and reproduction and fertility. Thyroid cancer (TC) is the most common endocrine malignancy, with an estimate of 44,020 new cases in 2025. Incidence has been increasing, most notably at 4-5% per year in young adults. Papillary thyroid cancer (PTC), the most common TC subtype, accounts for approximately 80% of newly diagnosed TC cases. Furthermore, 2290 deaths are expected from the disease in 2025, with survival at over 98% with treatment. However, as PTC occurs most frequently in young women, recurrences are frequent and the 10-year disease-specific survival rate for advanced PTC is less than 50%. This narrative review aims to describe the current understanding of the thyroid gland, the incidence and subtypes of thyroid cancer, and specifically the diagnosis, prognosis, treatment, and recurrence of PTC. This is supplemented by the role of molecular pathways and biomarkers in PTC.

A Comprehensive Review of Selenium as a Key Regulator in Thyroid Health

Selenium (Se) is an essential trace element crucial for thyroid function, participating in the production and metabolism of thyroid hormones and the immune system. It engages in synthesizing selenoproteins, which are essential for antioxidant defense and regulating thyroid hormone levels. It is crucial to convert thyroxine (T4) into the active thyroid hormone triiodothyronine (T3) via deiodinase activity and safeguard thyroid cells from oxidative damage. Therefore, thyroid dysfunction, including abnormalities in thyroid hormone synthesis and the emergence of autoimmune thyroid conditions such as Graves' disease and Hashimoto's thyroiditis, has been linked to Se deficiency. When evaluating the benefits of Se supplementation, it is crucial to recognize that excessive mineral intake may be detrimental and result in adverse consequences, including gastrointestinal disturbances and neurological problems. The effectiveness of Se-based therapies is influenced by individual characteristics, including hereditary anomalies in thyroid function and Se metabolism. Further research should be performed on personalized Se supplementation approaches using genetics and nanotechnology to optimize the bioavailability and efficacy of the supplements. This study aims to thoroughly examine Se's role in thyroid health and how its therapeutic use in thyroid-related diseases may be optimized via appropriate dosing.

Molecular Mechanisms of Type 2 Diabetes-Related Heart Disease and Therapeutic Insights

Type 2 diabetes is a significant risk factor for cardiovascular disease, particularly coronary heart disease, heart failure, and diabetic cardiomyopathy. Diabetic cardiomyopathy, characterized by heart dysfunction in the absence of coronary artery disease or hypertension, is triggered by various mechanisms, including hyperinsulinemia, insulin resistance, and inflammation. At the cellular level, increased insulin resistance leads to an imbalance in lipid and glucose metabolism, causing oxidative stress, mitochondrial dysfunction, and excess production of reactive oxygen species (ROS). This disrupts normal heart function, leading to fibrosis, hypertrophy, and cardiac remodeling. In diabetic patients, the excessive accumulation of fatty acids, advanced glycation end products (AGEs), and other metabolic disturbances further contribute to endothelial dysfunction and inflammatory responses. This inflammatory environment promotes structural damage, apoptosis, and calcium-handling abnormalities, resulting in heart failure. Additionally, diabetes increases the risk of arrhythmias, such as atrial fibrillation, which worsens cardiac outcomes. New insights into these molecular mechanisms have led to improvements in diabetes management, focusing on mitigating complications and understanding the cellular processes involved. Recent therapeutic advances, such as SGLT-2 inhibitors, have shown promise in addressing the energy imbalance and cardiac dysfunction seen in diabetic cardiomyopathy, offering new hope for better cardiovascular outcomes.

TRPV2 mediates stress resilience in mouse cardiomyocytes

The heart dynamically compensates for haemodynamic stress, but how this resilience forms during cardiac growth is not clear. Using a temporally inducible, cardiac-specific knockout in mice we show that the Transient receptor potential vanilloid family 2 (TRPV2) channel is crucial for the maturation of cardiomyocyte stress resilience. TRPV2 defects in growing hearts lead to small morphology, abnormal intercalated discs, weak contractility, and low expression of serum response factor and Insulin-like growth factor-1 (IGF-1) signalling. Individual cardiomyocytes of TRPV2-deficient hearts show reduced contractility with abnormal Ca2+ handling. In cultured neonatal cardiomyocytes, mechanical Ca2+ response, excitation-contraction coupling, sarcoplasmic reticulum Ca2+ content, actin formation, nuclear localisation of Myocyte enhancer factor 2c, and IGF-1 expression require TRPV2. TRPV2-deficient hearts show a defective response to dobutamine stress and no compensatory hypertrophic response to phenylephrine administration, but no stress response to pressure overload. These data suggest TRPV2 mediates the maturation of cardiomyocyte stress resilience, and will advance therapeutic interventions and drug discovery for heart disease.

Trends in Hyperinsulinemia and Insulin Resistance Among Nondiabetic US Adults, NHANES, 1999-2018

Introduction: Hyperinsulinemia and insulin resistance are strong predictors of cardiometabolic diseases, which disproportionately affect individuals across gender, racial/ethnic, and socioeconomic groups. We aim to estimate and test the temporal trends in the prevalence of hyperinsulinemia and insulin resistance (IR) by sociodemographic groups among nondiabetic adults in the United States from 1999 to 2018. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. We fitted linear and joinpoint logistic regression models to test the sample weighted and age-standardized time trends for linear and nonlinear trends in the prevalence of hyperinsulinemia and IR, respectively. Results: We included 17,310 nondiabetic men and nonpregnant women aged 20 years or older. The age-standardized prevalence of hyperinsulinemia increased from 28.2% in 1999-2000 to 41.4% in 2017-2018, with IR prevalence similarly rising from 24.8% in 1999-2000 to 38.4% in 2017-2018. Across the entire period examined, individuals who were male; non-Hispanic Black; Hispanic; or had a lower educational level or lower family income consistently had a higher prevalence of hyperinsulinemia and IR than other groups. We found increasing temporal trends in the prevalence of hyperinsulinemia and IR for all the sociodemographic subgroups, at least in some periods from 1999 to 2018. Conclusions: There was an increased age-standardized prevalence of hyperinsulinemia and IR among nondiabetic adults in the US across each defined sociodemographic group from 1999 to 2018. The difference in prevalence across subgroups underscores the need for designing personalized and targeted interventions to address disparities.

Alginate nanoparticles loaded with enriched polyphenols of Desmodium gangeticum alleviates diabetes induced oxidative and inflammatory stress in Rin-5F cells via GLUT2/IRS-1/NF-κB pathway

This study aimed to evaluate the effect of enriched polyphenols-loaded alginate nanoparticles (EP-loaded AlgNP) on streptozotocin (STZ)-induced Rin-5F cells. The alginate nanoparticles of enriched polyphenols from Desmodium gangeticum leaves were synthesised by ionic-gelation process using sodium alginate as biopolymer. The nanoparticles were characterized in terms of their size, morphology using HR-TEM, FESEM, Zeta potential, and FTIR. Our findings showed that the formulated EP-loaded AlgNP exhibited spherical particles (<100 nm) with a zeta potential of -48.8 mV. The total polyphenol content (TPC) and the biological activities of EP-loaded AlgNP showed significant stability throughout 12-months compared to EP (p < 0.05). The EP-loaded AlgNP at pH 7.4 showed optimal TPC release and followed Korsmeyer-Peppas model. The bio-accessibility of EP-loaded AlgNP was also enhanced under simulated gastrointestinal condition. In vitro experiments revealed that EP-loaded AlgNP enhanced insulin secretion impaired by STZ and improved the cell viability. Further, it mitigated oxidative stress by suppressing activation of NF-κB and upregulated mRNA expression of insulin signaling molecules like IR, IRS-1, and GLUT 2 in STZ-induced RIN-5F cells (p < 0.0001). Overall, the synthesis of EP-loaded AlgNP could be a promising approach and might be an effective therapeutic option for treating diabetes.

Non-coding RNAs modulate pyroptosis in diabetic cardiomyopathy: A comprehensive review

Diabetic cardiomyopathy (DCM) is a leading cause of heart failure (HF) among individuals with diabetes, presenting a significant medical challenge due to its complex pathophysiology and the lack of targeted therapies. Pyroptosis, a pro-inflammatory form of programmed cell death (PCD), is the predominant mode of cell death in the primary resident cells involved in DCM. It has been reported to be critical in DCM's onset, progression, and pathogenesis. Non-coding RNAs (ncRNAs), diverse transcripts lacking protein-coding potential, are essential for cellular physiology and the progression of various diseases. Increasing evidence indicates that ncRNAs are pivotal in the pathogenesis of DCM by regulating pyroptosis. This observation suggests that targeting the regulation of pyroptosis by ncRNAs may offer a novel therapeutic approach for DCM. However, a comprehensive review of this topic is currently lacking. Our objective is to elucidate the regulatory role of ncRNAs in pyroptosis associated with DCM and to elucidate the relationships among these factors. Additionally, we explored how ncRNAs influence pyroptosis and contribute to the pathophysiology of DCM. By doing so, we aim to identify new research targets for the clinical diagnosis and treatment of DCM.

Study on the Molecular Mechanism of XiaoXianXiong Decoction in the Treatment of Atherosclerosis Based on UHPLC-Q Exactive Focus MS/MS, Network Pharmacology, and Experimental Validation

Atherosclerosis (AS), a leading pathological basis of severe cardiovascular diseases, poses a significant threat to human health. XiaoXianXiong Decoction (XXXD), a classical traditional Chinese medicine (TCM) prescription, has demonstrated promising effects in the treatment of AS. To investigate the underlying mechanism of XXXD in treatment with AS, we used UHPLC-Q Focus MS/MS, network pharmacology and in vivo validation methods. The results showed that 59 chemical components of XXXD were identified. Network pharmacology showed that 11 key compounds, 10 key targets and five key signaling pathways involved in the therapeutic effects of XXXD on AS. Experimental verification confirmed that XXXD significantly improved dyslipidemia, lipid accumulation and pathological changes in the aorta during AS. These effects were linked to the inhibition of the PI3K/AKT signaling pathway, down-regulation of PI3K, HRAS, EGF, CREB and up-regulation of NOS3 expression. This work may provide a theoretical basis for further research on the molecular mechanisms for XXXD in AS treatment.

The Supporting Role of Hyperbaric Oxygen Therapy in Atopic Dermatitis Treatment

Over the past decades, atopic diseases have emerged as a growing global health concern. The Global Report on Atopic Dermatitis 2022 estimated that approximately 223 million people worldwide were living with atopic dermatitis in 2022, with around 43 million being children or adolescents. The financial burden associated with the treatment of this condition poses a significant challenge for both healthcare systems and patients. The current therapeutic approach for atopic diseases primarily focuses on symptomatic management, aiming to mitigate the effects of an overactive immune system. The most widely used treatments include topical or systemic corticosteroids, which suppress inflammation, and emollients, which help restore the skin barrier function. However, prolonged corticosteroid use is associated with adverse effects, including impaired immune response and reduced ability to combat external and internal threats. Consequently, there is a growing interest in developing alternative therapeutic strategies for managing atopic dermatitis. Among these emerging treatments, hyperbaric oxygen therapy (HBOT) appears particularly promising. HBOT has a beneficial effect on the vascular and immune systems, which results in improved functioning of tissues and organs. This therapy has demonstrated efficacy in promoting wound healing, particularly in conditions such as thermal burns and diabetic foot ulcers. Given these properties, HBOT is being tested as a potential adjunctive therapy for atopic dermatitis and other allergy-related diseases. In this paper, we present the current state of knowledge regarding the application of HBOT in the treatment of atopic and immune-mediated conditions, with a focus on its immunomodulatory and regenerative effects.

The role of gut microbiota and bacterial translocation in the pathogenesis and management of type 2 diabetes mellitus: Mechanisms, impacts, and dietary therapeutic strategies

PURPOSE OF REVIEW

The influence of gut microbiota on Type 2 Diabetes Mellitus (T2DM) is an emerging area of research. This review investigates the relationship between gut microbiota dysbiosis, bacterial translocation, and T2DM. It aims to elucidate how microbial imbalances contribute to the progression of T2DM through bacterial translocation and to evaluate dietary and therapeutic strategies to manage these effects.

RECENT FINDINGS

Recent studies highlight that dysbiosis in T2DM patients often leads to increased systemic inflammation, impaired glucose metabolism, and disrupted gut barrier integrity. These disruptions promote elevated levels of harmful bacterial components, such as lipopolysaccharides, in the bloodstream. This, in turn, is linked to worsening insulin resistance and metabolic dysfunction. Advances in molecular methods and biomarkers have provided deeper insights into bacterial translocation and its impact on diabetes. Dietary interventions, including nutraceutical agents, high-fiber and low-glycemic index diets, as well as the use of probiotics and prebiotics, have shown promise in restoring gut health and mitigating bacterial translocation.

CONCLUSION

Maintaining a balanced gut microbiota and intestinal barrier integrity is crucial for managing T2DM. Therapeutic strategies, including dietary modifications and nutraceuticals, have demonstrated potential in reducing bacterial translocation and systemic inflammation. Continued research is needed to refine these approaches and explore novel treatment modalities for improving metabolic health in T2DM patients.

Comparison of the Effect of Omega-3 vs. MCT Supplementation on Iron-Related Indices in Patients Undergoing Dialysis

Chronic kidney disease (CKD), characterized by progressive kidney failure, significantly increases mortality and comorbidity risks such as anemia. This study contrasts the impacts of omega-3 and medium-chain triglycerides (MCT) oil on levels of iron, ferritin, total iron-binding capacity (TIBC), hemoglobin (Hb), and transferrin saturation in patients with CKD undergoing dialysis. This interventional trial was conducted on 120 patients with CKD undergoing dialysis in Rasht, Iran. For 8 weeks, the omega-3 group was orally administered three 1000-mg capsules of omega-3 fatty acid supplement, and the MCT group was administered three 1000-mg capsules containing MCT oil daily. Serum concentrations of ferritin, iron, TIBC, Hb, and transferrin saturation were assessed pre-intervention and after the intervention. There was a significant increase in serum iron levels in the MCT group compared to the omega-3 group (103.72 ± 57.8 vs. 77.48±40.13; P = 0.031). No effect was found regarding other iron-related factors such as TIBC, Hb, transferrin saturation, and ferritin levels. The results of our study indicated that taking MCT oil increased serum iron levels compared to omega-3 supplementation in patients with CKD undergoing dialysis. Further research is needed to better understand the potential benefits of MCT oils in patients with CKD.

Aqueous Vernonia amygdalina leaf extract in drinking water mitigates aflatoxin B1 toxicity in broilers: effects on performance, biomarker analysis, and liver histology

This study evaluated aqueous Vernonia amygdalina leaf extract in drinking water as a mitigation strategy against Aflatoxin B1-induced toxicity in broilers, focusing on performance, haematology, serum biochemistry, pro-inflammatory cytokines, cellular stress markers, and liver histology. Two hundred and forty (240) day-old chicks (mixed sex), of the Cobb 500 breed were divided into four groups: control (CONT), AFB1-exposed (AFLB1), and two treatment groups (VE1AF and VE2AF) receiving 0.5 mg/kg AFB1 and Vernonia amygdalina aqueous extract at 1 g/L and 2 g/L, respectively. At 42 days, VE1AF and VE2AF chickens showed higher (P < 0.05) final weights and weight gains than CONT and AFLB1 groups. The red blood cells, packed cell volume, haemoglobin, and white blood cell counts were higher (P < 0.05) in CONT, VE1AF, and VE2AF groups compared to AFLB1. Mean cell volume, and mean cell haemaoglobin were higher (P < 0.05) in AFLB1 and VE2AF. Serum analysis revealed lower (P < 0.05) total protein, globulin, and albumin in AFLB1, which were restored by the extract. The tumor necrosis factor-α, interleukin-6, interleukin-1β, and interferon-γ, were elevated (P < 0.05) in AFLB1 but reduced in VE1AF and VE2AF. The heat shock protein 70, 8-hydroxy-2'-deoxyguanosine and adiponectin levels were higher (P < 0.05) in AFLB1, but were normalized by the extract in VE1AF and VE2AF. Leptin and triiodothyronine levels were significantly (P < 0.05) better in VE1AF and VE2AF, compared to AFLB1. Liver histology showed reduced inflammation in VE1AF and VE2AF, with near-normal hepatic architecture. In conclusion, Vernonia amygdalina leaf extract effectively counteracts AFB1 toxicity, enhancing overall health and performance in broiler chickens.

Central Hypothyroidism: Advances in Etiology, Diagnostic Challenges, Therapeutic Targets, and Associated Risks

OBJECTIVE

Central hypothyroidism is a rare disorder resulting from impaired thyroid hormone production due to deficiencies in TSH secretion from the pituitary or TRH secretion from the hypothalamus. This review aims to summarize recent advances in the etiology, diagnosis, and treatment of central hypothyroidism, with an emphasis on diagnostic and therapeutic challenges.

METHODS

A comprehensive review of the literature was conducted, focusing on genetic and acquired causes, particularly those related to hypothalamic-pituitary tumors and the effects of surgical and radiotherapeutic interventions. Diagnostic approaches and treatment strategies, including levothyroxine therapy and monitoring, are analyzed.

RESULTS

Early diagnosis requires simultaneous measurement of free T4 and TSH to prevent neurological sequelae, especially in congenital cases. Central hypothyroidism is associated with risks such as growth and developmental impairment, as well as metabolic and cardiovascular disturbances. Levothyroxine therapy is crucial for correcting hormonal deficits and improving patient outcomes; however, careful dosing is necessary to avoid potential complications, particularly in vulnerable populations.

CONCLUSIONS

Personalized treatment and continuous monitoring are essential to optimize clinical outcomes and enhance the quality of life in affected individuals. A thorough understanding of central hypothyroidism's etiology and management is necessary to improve early detection and therapeutic strategies.

Nonlinear association between triglyceride-glucose index and 28-day mortality in intensive care units: a multi-center retrospective cohort study

Background

The triglyceride-glucose (TyG) index, derived from the calculation of two biomarkers, fasting plasma glucose and triglyceride levels, is a reliable indicator of insulin resistance and has been demonstrated to be associated with the adverse clinical outcomes of patients in the intensive care unit (ICU). This study aims to investigate the relationship between the TyG index and the 28-day all-cause mortality of these patients during their ICU stay.

Methods

This study employed a multicenter retrospective cohort design, analyzing data from 18,883 ICU patients in the eICU database. We calculated the TyG index for each patient and assessed its association with 28-day all-cause mortality. The Cox proportional hazards model was utilized for analysis, adjusting for various clinical and laboratory variables to control for confounding factors. We performed sensitivity analyses, subgroup analyses, and interaction analyses to evaluate the robustness of the results.

Results

The study identified a significant positive correlation between the TyG index and 28-day all-cause mortality. Specifically, each one-unit increase in the TyG index corresponded to a 58% increase in mortality risk (HR=1.58, 95% CI: 1.25-2.00, P=0.0001). Additionally, the analysis revealed a non-linear threshold effect of the TyG index on mortality, with a cutoff point at 8.82; mortality was lower below this value and significantly increased above it. Sensitivity and subgroup analyses indicated robust findings, while E-value analysis suggested resilience against unmeasured confounding.

Conclusion

This study establishes the TyG index as an independent predictor of 28-day all-cause mortality in critically ill patients, highlighting its potential value in clinical management and risk assessment. By recognizing the non-linear effect of the TyG index, clinicians can more effectively adjust treatment strategies to reduce mortality among high-risk patients.

The association between long-term trajectories of insulin resistance and brain structural integrity in middle-aged and older adults

BackgroundThe triglyceride-glucose (TyG) index is considered a robust surrogate for insulin resistance (IR). The relationship between the trajectory patterns of the TyG index and subsequent brain structure changes is still unclear.ObjectiveThis study investigates the relationship between 10-year trajectories of TyG-related indices and brain structural integrity in a 10-year follow-up.MethodsThis prospective study included 898 participants (mean age 55.6 years, 34.4% males) from the community-based Shunyi Study. IR was assessed using the TyG index, TyG-body mass index (BMI) index, TyG-waist circumference index, and TyG-waist-to-height ratio (WHtR) index. The group-based trajectory model was employed to identify the 10-year trajectories. Structural brain measurements included structural changes of the whiter matter (white matter hyperintensities (WMHs), fractional anisotropy, and mean diffusivity) and gray matter (brain parenchymal fraction (BPF), cortical thickness, and hippocampal volume). General linear models were utilized to examine the association between the trajectory patterns of TyG-related indices and brain structure.ResultsThree distinct trajectories of TyG-related indices were identified from 2013 to 2023. The high-level trajectory groups of TyG-related indices exhibited a greater volume of WMHs and were more susceptible to disruptions in white matter microstructural integrity. This association was most significant for the TyG-BMI and TyG-WHtR trajectory groups. No significant correlations were found for BPF and cortical thickness among the different TyG-related indices trajectories.ConclusionsThe findings suggest that long-term IR primarily damages brain white matter rather than causing structural changes in gray matter.

ChIP-seq and RNA-seq Reveal the Involvement of Histone Lactylation Modification in Early Pregnancy with Subclinical Hypothyroidism

Subclinical hypothyroidism (SCH) is associated with multiple adverse outcomes in early pregnancy. This study aims to explore the regulatory mechanisms underlying histone lactylation modification in early pregnancy with SCH. Peripheral blood mononuclear cells were collected from early pregnant women with or without SCH. RNA sequencing (RNA-seq) and chromatin immunoprecipitation sequencing (ChIP-seq) analyses were performed to identify the transcriptional pattern and histone lactylation modification in early pregnancy with SCH. RNA-seq analysis revealed that the differentially expressed genes associated with the extracellular matrix exhibited a significant downregulation in early pregnancy with SCH (EP_SCH) compared to early pregnancy without SCH (EP), while those involved in apoptosis were significantly upregulated. In the ChIP-seq analysis, 1660 hypomodified and 766 hypermodified H3K18la-binding peaks were identified in the EP_SCH group compared to the EP group. The hypomodified genes in early pregnancy with SCH compared to its control were enriched in GO terms of apoptotic process and differentiation of immune cells. The genes with increased H3K18 lactylation in early pregnancy with SCH compared to its control were associated with the nervous system, female pregnancy, and the OXT signaling pathway. When RNA-seq data was integrated with ChIP-seq data, we found that the expression and H3K18la enrichment of KCTD7, SIPA1L2, HDAC9, BCL2L14, TXNRD1, and SGK1 were increased in early pregnancy with SCH compared to its control, which was further confirmed by RT-qPCR and ChIP-PCR analyses. This study identifies the changes in histone lactylation modification in early pregnancy with SCH. These findings provide novel insights into the regulatory mechanisms of SCH during early pregnancy.

The Pathophysiological Mechanisms and Pattern of Dyslipidemia Associated with Iodine Deficiency and Subclinical Hypothyroidism in Pregnant Normotensive and Preeclamptic Central African Women

BACKGROUND

Pregnancy simulates a metabolic syndrome-like state and predisposes to iodine deficiency and hypothyroidism through increased iodine renal loss and transplacental transfer to the fetus. Iodine deficiency is thought to predispose to dyslipidemia through elevation of serum TSH. Obesity, dyslipidemia, and hypothyroidism are established risk factors of preeclampsia. Hence, pregnant women with iodine deficiency are likely to be at increased risk of dyslipidemia and preeclampsia. We investigated the pattern of dyslipidemia among preeclamptic and normotensive pregnant women with and without iodine deficiency.

METHODS

The pathophysiological mechanisms linking iodine deficiency and dyslipidemia were delineated using bivariate correlations, logistic regression, and exploratory factor analysis of anthropometric, lipid profile, urine iodine concentration (UIC), and thyroid function data from 240 women with preeclampsia and 120 normotensive pregnant controls at term who attended Lomo Medical Centre, Democratic Republic of Congo (DRC).

RESULTS

Preeclamptic women with iodine deficiency had significantly lower HDL-C but higher triglyceride levels than those with sufficient iodine intake. Both normotensive and preeclamptic participants with elevated TSH had high serum oxidized LDL-C but low NO, p < 0.001.

CONCLUSIONS

SCH, secondary to iodine deficiency, is associated with elevated serum oxidized LDL and decreased Nitric Oxide (NO) among both normotensive and preeclamptic women, while insufficient iodine nutrition among preeclamptic women predisposes to reduced HDL-C and increased serum Triglycerides, which are risk factors of atherosclerosis and cardiovascular disease.

Perfluorooctane sulfonic acid: a possible risk factor of endothelial dysfunction based on in silico and in vitro studies

Perfluorooctane sulfonic acid (PFOS) is a fluorinated chemical utilized in a variety of industrial and household products. PFOS has been detected in human serum and is associated with multiple human adverse health effects. Epidemiological evidence has linked PFOS exposure to endothelial dysfunction, which is a key contributor to atherosclerosis. However, the underlying mechanisms of PFOS-induced endothelial dysfunction associated atherosclerosis has not been investigated. In the present study, human microvascular endothelial cells (HMEC-1) exposed to PFOS (15 μM) for 72 h, mimicking long-term exposure. We further employed integrated RNA-sequencing (RNA-seq) and transcriptomic analysis to identify differentially expressed genes (DEGs) for biological alterations: gene ontology (GO), pathway enrichment analysis (KEGG), protein-protein interaction network and modular clustering analysis. Furthermore, the Metascape database was used for disease association, tissue specificity, and transcription factor analysis. Hub genes were verified using atherosclerosis patient data sets from the GEO dataset. Alteration of hub genes in patients was then validated using immunoblotting and ELISA. Our results revealed that PFOS altered amino acid biosynthesis, lipid metabolism and induced the ER-stress response through the HRI/eIF2α/ATF4 pathway, leading to endothelial dysfunction. Interestingly, we found that PFOS induced inflammation by increasing COX-2, ICAM-1 and IL-6 expression through NF-κB and JAK2/STAT3 pathway in endothelial cells. Moreover, up-regulated C/EBPβ and ATF4 were observed in both patients and PFOS-exposed endothelium, which may use as an early biomarker and may have a potential role in PFOS-induced endothelial dysfunction. These findings provide novel insight into the underlying molecular mechanisms of PFOS-induced endothelial dysfunction associated with atherosclerosis.

Gene clusters linked to insulin resistance identified in a genome-wide study of the Taiwan Biobank population

This pioneering genome-wide association study examined surrogate markers for insulin resistance (IR) in 147,880 Taiwanese individuals using data from the Taiwan Biobank. The study focused on two IR surrogate markers: the triglyceride to high-density lipoprotein cholesterol (TG:HDL-C) ratio and the TyG index (the product of fasting plasma glucose and triglycerides). We identified genome-wide significance loci within four gene clusters: GCKR, MLXIPL, APOA5, and APOC1, uncovering 197 genes associated with IR. Transcriptome-wide association analysis revealed significant associations between these clusters and TyG, primarily in adipose tissue. Gene ontology analysis highlighted pathways related to Alzheimer's disease, glucose homeostasis, insulin resistance, and lipoprotein dynamics. The study identified sex-specific genes associated with TyG. Polygenic risk score analysis linked both IR markers to gout and hyperlipidemia. Our findings elucidate the complex relationships between IR surrogate markers, genetic predisposition, and disease phenotypes in the Taiwanese population, contributing valuable insights to the field of metabolic research.

Prevalence of and Predictive Factors for Hypothyroidism Following Hemithyroidectomy

PURPOSE

Hemithyroidectomy is an appropriate procedure that is recommended for a number of thyroid conditions to preserve the functional contralateral thyroid lobe, but patients who underwent a hemithyroidectomy still run the risk of developing hypothyroidism. This study aimed to determine the incidence of hypothyroidism following a hemithyroidectomy as well as predictive risk factors.

METHODS

A retrospective analysis was carried out on all patients who underwent hemithyroidectomy between 2016 and 2022. Age, gender, preoperative and postoperative thyroid stimulating hormone (TSH) and free thyroxin (FT4), side, and volume of the remaining lobe, as well as the histologic diagnosis, were all examined in the patients. To identify the predictors of hypothyroidism, statistical analyses, both univariate and multivariate, were conducted.

RESULTS

Out of 224 patients, 18.25% had hypothyroidism following surgery. This complication appeared within the first year in 88% of the cases. Patients with thyroiditis (P = .036), preoperative TSH levels greater than 1.72 mIU/L (P < .001), right side hemithyroidectomy (P = .017), and residual lobe volume less than 3.57 cm (P < .001) had a significantly higher risk of developing hypothyroidism.

CONCLUSION

After hemithyroidectomy, hypothyroidism is a major complication that should be carefully evaluated preoperatively based on risk factors of hypothyroidism. Furthermore, our results confirm the need for routine serum TSH monitoring for a minimum of 1 year following hemithyroidectomy.

Research status of subclinical hypothyroidism promoting the development and progression of cardiovascular diseases

In recent years, the incidence of cardiovascular disease (CVD) has risen steadily, significantly impacting public health. Subclinical hypothyroidism (SCH) remains a controversial risk factor for CVD. This review examines the associations between SCH and dyslipidemia, carotid intima-media thickness (C-IMT), cardiac dysfunction, and cardiovascular event risk. Evidence suggests SCH may exacerbate atherosclerosis and cardiac dysfunction through mechanisms such as increased LDL synthesis, oxidative stress, and impaired vascular endothelial function. However, the causal link between SCH and cardiovascular outcomes remains unclear due to study design heterogeneity and overreliance on TSH levels. Elevated TSH may not solely reflect thyroid dysfunction but could also indicate compensatory responses to inflammation, aging, or stress. Large-scale studies like NHANES and IPD meta-analyses show a strong association between SCH and cardiovascular risk in younger populations, which diminishes in older adults due to physiological TSH increases. The cardiovascular benefits of levothyroxine (L-T4) therapy in SCH patients are limited, especially in older individuals, where a narrow therapeutic window increases side effect risks. Studies relying solely on TSH as a diagnostic and therapeutic target have significant limitations, as TSH cannot distinguish adaptive thyroid adjustments from pathological states and overlooks the role of free thyroid hormones (FT3/FT4). Future research should integrate multi-dimensional markers (such as oxidative stress indicators, vascular elasticity measures, and thyroid antibody status) and adopt longitudinal study designs to more accurately assess the clinical significance of SCH.

The prevalence of metabolic syndrome in patients with non-alcoholic fatty liver disease in primary care clinics at King Saud University Medical City, Riyadh, Saudi Arabia

Background

Metabolic syndrome is present in a subset of individuals harboring a constellation of metabolic risk factors that heightens their likelihood of developing coronary artery disease. Non-alcoholic fatty liver disease (NAFLD) manifests through the incremental accumulation of fat within liver cells in the absence of secondary causes. NAFLD has long been recognized as the hepatic manifestation of metabolic syndrome. Our study seeks to ascertain the prevalence of metabolic syndrome among NAFLD patients at King Khalid University Hospital and to explore the factors associated with metabolic syndrome.

Method and design

We conducted a retrospective study targeting 1,173 patients diagnosed with NAFLD at King Khalid University Hospital in Riyadh, Saudi Arabia, from March 2020 to March 2021. NAFLD diagnosis was made based on ultrasonographic evidence of a fatty liver, excluding other liver ailments and alcohol intake. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) criteria, which require at least three of five metabolic risk factors to be present. Statistical analysis was performed using chi-square tests for categorical variables and independent t-tests for continuous variables, with a significance level set at p < 0.05.

Results

Out of 1173 NAFLD participants evaluated, 38.2% met the NCEP/ATPIII criteria for metabolic syndrome. Additionally, 23.8% had at least one metabolic syndrome component coinciding with their ultrasonographically confirmed NAFLD diagnosis. The incidence of NAFLD was not linked to gender. Married individuals constituted a higher percentage (42.8%) of the NAFLD cohort. Elevated blood glucose and triglyceride levels, along with reduced HDL levels, were predominantly observed among the metabolic syndrome components in NAFLD patients.

Conclusion

A significant portion of the NAFLD patient population was concurrently affected by metabolic syndrome. There exists a marked interrelationship between NAFLD and the components of metabolic syndrome. Regular metabolic disorder screenings are recommended for this patient group.

Research progress of non-coding RNA regulating the role of PANoptosis in diabetes mellitus and its complications

Diabetes is a chronic metabolic disease that is endemic worldwide and is characterized by persistent hyperglycemia accompanied by multiple severe complications, including cardiovascular disease, kidney dysfunction, neuropathy, and retinopathy. The pathogenesis of diabetes mellitus and its complications is multifactorial, involving various molecular and cellular pathways. In recent years, research has indicated that mechanisms of cell death play a significant role in the advancement of diabetes and its complications. PANoptosis is a complex phenomenon caused by three cell death pathways: programmed apoptosis, necroptosis and pyroptosis. The contribution of PANoptosis to diabetes and its complications remains incompletely understood. Non-coding RNA, an important molecule in gene expression regulation, has shown significant regulatory functions in a variety of diseases. This paper reviews the underlying mechanisms of diverse types of non-coding RNAs (including lncRNA, miRNA and circRNA) in regulating PANoptosis and their specific contributions in diabetes, aiming to explore how non-coding RNAs influence PANoptosis and their effects in diabetes.

Racial disparity in preoperative C-reactive protein level for predicting prognosis of patients with non-metastatic clear cell renal cell carcinoma: INMARC study

BACKGROUND

C-reactive protein (CRP) is a prognostic biomarker for clear cell renal cell carcinoma (ccRCC). However, there may be potential racial heterogeneity in distribution and prognostic impact of CRP level. We investigated potential racial differences in distribution and prognostic impact of preoperative CRP among Asian (AS), African American (AA), and Caucasian (CAUC) patients with non-metastatic ccRCC (nmccRCC).

METHODS

We retrospectively analyzed 1991 nmccRCC cases (AS/AA/CAUC: n = 968/223/800) undergoing nephrectomy from the international multi-institutional database. We investigated CRP distributions and optimal cut-off values for predicting recurrence-free survival (RFS) and overall survival (OS) using Cox regressions for each racial group. Subgroup analyses considered comorbidities, pathological T stage, and Fuhrman grade.

RESULTS

Preoperative CRP distributions differed significantly among the races, with median values of 0.90 mg/L (interquartile range, 0.40-2.33) for AS, 5.00 mg/L (1.98-12.20) for AA, and 3.55 mg/L (1.41-8.48) for CAUC (p < 0.01). Optimal cut-off values for RFS were 1.2 mg/L in AS, 2.8 mg/L in AA, and 1.7 mg/L in CAUC, showing C-indices of 0.77, 0.71, and 0.77, respectively. For OS, they were 1.6 mg/L in AS, 8.3 mg/L in AA, and 9.3 mg/L in CAUC, yielding C-indices of 0.77, 0.70, and 0.74, respectively. Subgroup analyses revealed varying reference ranges of CRP levels among races (1.1-2.2/2.7-5.0/1.5-3.4 mg/L for RFS, and AS/AA/CAUC: 0.9-3.0/8.0-12.7/8.0-10.4 mg/L for OS, respectively).

CONCLUSION

The preoperative CRP distributions and their optimal cut-off values for predicting patient prognosis differed significantly among the races. Using race-specific cut-off values, CRP demonstrated consistently high-prognostic accuracies, which may improve tailored patient management in nmccRCC.

Association of Polycystic Ovary Syndrome With Sensorineural Hearing Loss: A Systematic Review and Meta-analysis

OBJECTIVE

Despite certain studies indicating hearing impairments in individuals with polycystic ovary syndrome (PCOS), the correlation between PCOS and sensorineural hearing loss (SNHL) remains inconclusive. This study aimed to investigate the association between PCOS and SNHL.

DATA SOURCES

A systematic literature search was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Library from inception to June 24, 2024.

REVIEW METHODS

This meta-analysis included cross-sectional, case-control, or cohort studies examining the association between PCOS and SNHL without language or regional restrictions. Case reports, case series, animal studies, and in vitro studies were excluded. We adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and utilized the Newcastle-Ottawa Scale to assess the risk of bias in the included studies.

RESULTS

After performing the systematic review, we conducted a meta-analysis that included 489 patients from 5 studies: 349 patients with PCOS and 140 age- and sex-matched controls without PCOS. The meta-analysis compared the mean differences in frequency-specific pure-tone thresholds between patients with PCOS and matched controls, providing 95% confidence intervals for these differences. Given the expected clinical heterogeneity, we employed the DerSimonian and Laird random-effects model. Our results revealed significant hearing loss at specific frequencies (1000, 4000, 8000, 10,000, 12,000, 14,000, 16,000, 18,000, and 20,000 Hz) in the PCOS group compared to the control group (P < .05). Furthermore, the degree of hearing loss is greater at higher frequencies.

CONCLUSION

This meta-analysis demonstrated an association between PCOS and SNHL, particularly at higher frequencies.

Discipline-specific adaptation patterns in respiratory and lower limb musculotendinous structures: cyclists vs. basketball players

BACKGROUND

This study aimed at assessing how chronic exposure to specific exercise training (high-intensity intervals vs. endurance), comparing experienced basketball-players (BP, N.=16), cyclists (CY, N.=16), and non-specifically trained individuals (CN, N.=16), influences the structural and functional characteristics of both lower limb and respiratory musculotendinous structures.

METHODS

Vastus lateralis, gastrocnemius lateralis, and medialis, diaphragm muscles, as well as patellar tendon and Achilles tendon, were assessed using B-mode ultrasonography. Maximal voluntary isometric and passive torque measurements were conducted in the knee-extensors and plantar-flexors. Additionally, a subset of participants (N.=10 for each group) underwent a fatigue-inducing exercise-till-exhaustion protocol, and the strength of lower limb and respiratory muscles was evaluated immediately before and after the trial.

RESULTS

Athletes had bigger and stronger musculotendinous structures and greater endurance to fatigue than CN (P<0.05). BP had bigger plantar-flexors and diaphragm, greater fascicles length, more explosive plantar-flexors and respiratory muscles and bigger tendons than CY (P<0.05). On the other hand, CY showed greater muscle pennation angle and greater endurance to fatigue for both, lower limb, and respiratory muscles (P<0.05).

CONCLUSIONS

The present study emphasizes that chronic and specific exercise training leads to distinctive adaptations, not only in lower limb musculotendinous structures but also in other components such as respiratory muscles.