Development of ratiometric fluorescent probe based on copper nanoclusters and rhodamine B for the detection of 3-nitrotyrosine

3-nitrotyrosine (3-NT) serves as a definitive biomarker of oxidative stress and assumes an essential role in the pathogenesis of diseases, so its detection is crucial for the diagnosis of diseases. Herein, we constructed a dual-emission ratiometric fluorescence probe with copper nanoclusters (CuNCs) and rhodamine B (RhB) as the response and reference signals. In the presence of 3-NT, the fluorescence intensity of CuNCs was significantly quenched through static quenching effect (SQE) and inner filter effect (IFE), whereas the fluorescence intensity of RhB kept unchanged. Notably, the sensor achieves high stability, sensitivity, and selectivity for 3-NT detection. Moreover, a portable sensing platform integrated with a 3D printer and a smartphone was constructed to fulfill the need for convenient measurement. The sensor was subsequently employed to determine 3-NT in both human serum and urine specimens, yielding results that were deemed satisfactory. The probe holds broad application potential and provides some ideas for the fluorescence detection of other biomarkers.

The effect of vitamin D supplementation on endothelial function: An umbrella review of interventional meta-analyses

AIMS

There is no consensus in the existing literature regarding the effect of vitamin D supplementation on endothelial function. This umbrella review aimed to assess meta-analyses of randomized controlled trials (RCTs) conducted in this field.

DATA SYNTHESIS

We systematically searched English-language databases, including PubMed, Embase, Scopus, and Web of Science, up to January 2024. Flow-Mediated Dilation (FMD), Pulse Wave Velocity (PWV), and Augmentation Index (AIx) were the primary endpoints evaluated. A total of 16 meta-analyses were included in the review. The results indicated that vitamin D supplementation significantly improved FMD as assessed by Standardized Mean Difference (SMD) (SMD = 0.72, 95 % CI: 0.34, 1.11; p < 0.001; I2 = 79.4 %, p < 0.001) and Weighted Mean Difference (WMD) (WMD = 1.91; 95 % CI: 0.66, 3.16; p = 0.003; I2 = 94.5 %, p < 0.001). PWV also showed a modest but significant improvement (SMD = -0.06, 95 % CI: -0.12, -0.00; p = 0.03; I2 = 0.0 %, p = 0.66). However, vitamin D had no significant impact on AIx based on SMD (SMD = -0.03, 95 % CI: -0.13, 0.06; p = 0.48; I2 = 0.0 %, p = 0.49) or WMD (WMD = 0.02, 95 % CI: -2.22, 2.25; p = 0.98; I2 = 29.2 %, p = 0.23).

CONCLUSION

These findings suggest that vitamin D supplementation may be a beneficial intervention for improving endothelial function, particularly in populations with low FMD. The effects on PWV were modest, while AIx remained unaffected.

REGISTRATION NUMBER

PROSPERO, CRD42024451215.

Assessing the relationship between short-term blood pressure variability and glycation profile in young and middle-aged nondiabetic hypertensive individuals

INTRODUCTION

Elevated short-term blood pressure (BP) variability (BPV) has been associated with a poorer cardiovascular prognosis. The glycation profile is related to BPV in diabetic and prediabetic individuals. However, little is known about the relationship between glycation levels and BPV in hypertensive patients with optimal glycemic control.

OBJECTIVES

This observational study aimed to elucidate the relationship between glycated hemoglobin (HbA1c) levels and short-term BPV in young and middle-aged hypertensive patients over 18 years with HbA1c levels below 5.7%.

METHODS

We collected and analyzed data on 24-h ambulatory BP monitoring, demographic, epidemiological, clinical, and laboratory variables from 143 hypertensive patients. BPV was measured as the standard deviation (SD) and average real variability (ARV) in millimeters of mercury, as well as the dimensionless coefficient of variation (CV).

RESULTS

Depending on the index, each one unit increase in nighttime SD and CV indices was associated with a 17-24% higher likelihood of elevated HbA1c levels (higher than 5.2%). Regarding BPV dipping, each 1% decrease in nighttime SD and CV dipping was associated with a 10-20% higher risk of increased HbA1c levels. Additionally, each 1% decrease in nighttime ARV DBP dipping was also associated with a 10% higher risk of elevated HbA1c levels. A one-standardized-unit increase in the overall combined BPV index, as a pooled measure of BPV, was associated with a 45% higher likelihood of raised HbA1c levels.

CONCLUSION

Even within the optimal range, elevated HbA1c levels may reflect an underlying increase in BPV, which may be particularly relevant given the prognostic implications of short-term BPV.

Antithrombotic Therapy in Acute Coronary Syndrome Patients with End-Stage Renal Disease: Navigating Efficacy and Safety

Cardiovascular disease is the primary cause of mortality and morbidity in patients with chronic kidney disease (CKD), particularly those with end-stage renal disease (ESRD) undergoing hemodialysis. This paper examines the challenges of managing acute coronary syndrome (ACS) in ESRD patients, focusing on the delicate balance between thrombotic and bleeding risks. The review explores the mechanisms underlying the increased thrombotic risk in ESRD, including elevated platelet aggregation, endothelial dysfunction, and alterations in coagulation factors. Paradoxically, ESRD patients also exhibit higher bleeding tendencies due to platelet dysfunction and other uremia-related factors. The efficacy and safety of various antiplatelet therapies, including aspirin and P2Y12 inhibitors, are evaluated in this population. While potent P2Y12 inhibitors such as ticagrelor and prasugrel have demonstrated potential in reducing ischemic events, they are associated with an increased bleeding risk. The optimal duration of anti-platelet therapy (DAPT) in ESRD patients remains controversial, with studies suggesting potential benefits of prolonged DAPT but also increased bleeding risk. This review underscores the necessity for further research and patient inclusion in clinical trials to establish evidence-based guidelines for tailoring antithrombotic therapy in this high-risk population.

Copeptin as a New Blood-Based Marker for Differential Diagnosis in Stroke Patients

Diagnosis in stroke patients is based mainly on clinical and radiological findings; therefore, there is a need for serological markers that can orient the clinician. Copeptin is a new blood marker for diagnosis and prognosis in several neurological conditions, such as ischemic stroke, hemorrhagic stroke, aneurysmal subarachnoid hemorrhage, and multiple sclerosis. The aim of our study was to highlight the diagnostic value of copeptin in differentiating between stroke subtypes and stroke mimics. We performed a literature review by searching the PubMed and Scopus databases for papers with the following keywords: "stroke AND copeptin AND differential". The PRISMA criteria were used. We identified 29 papers that met the criteria. We analyzed only original research articles, excluding reviews and only including those in English. Some studies did not find any significant differences between cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage, but one study demonstrated significant correlations. All studies agreed that copeptin levels can help in differentiating stroke patients from stroke-free patients. Copeptin levels were correlated with prognostic scales For stroke mimics, copeptin levels were extremely broad and for vestibular disorders; it was shown that a normal level of copeptin excludes stroke. Copeptin is a new blood marker that can help clinicians in the acute neurological field. It may help in diagnosing stroke, in differentiating between stroke subtypes and stroke mimics, and in evaluating the prognosis of these patients, but further studies are needed.

Effects of obesity on aging brain and cognitive decline: A cohort study from the UK Biobank

Objective

To investigate the impact of obesity on brain structure and cognition using large neuroimaging and genetic data.

Methods

Associations between body mass index (BMI), gray matter volume (GMV), whiter matter hyper-intensities (WMH), and fluid intelligence score (FIS) were estimated in 30283 participants from the UK Biobank. Longitudinal data analysis was conducted. Genome-wide association studies were applied to explore the genetic loci associations among BMI, GMV, WMH, and FIS. Mendelian Randomization analyses were applied to further estimate the effects of obesity on changes in the brain and cognition.

Results

The observational analysis revealed that BMI was negatively associated with GMV (r = -0.15, p < 1 × 10-24) and positively associated with WMH (r = 0.08, p < 1 × 10-16). The change in BMI was negatively associated with the change in GMV (r = -0.04, p < 5 × 10-5). Genetic overlap was observed among BMI, GMV, and FIS at SBK1 (rs2726032), SGF29 (rs17707300), TUFM (rs3088215), AKAP6 (rs1051695), IL27 (rs4788084), and SPI1 (rs3740689 and rs935914). The MR analysis provided evidence that higher BMI was associated with lower GMV (β=-1119.12, p = 5.77 ×10-6), higher WMH (β=42.76, p = 6.37 ×10-4), and lower FIS (β=-0.081, p = 1.92 ×10-23).

Conclusions

The phenotypic and genetic association between obesity and aging brain and cognitive decline suggested that weight control could be a promising strategy for slowing the aging brain.

Contrast-Induced Nephropathy (CIN) After Invasive Treatment of Acute Coronary Syndromes-Predictors, Short and Long-Term Outcome

Background/Objectives: Contrast-induced nephropathy (CIN) is a well-documented complication following coronary angiography and percutaneous coronary intervention (PCI). This study aims to evaluate the predictors of CIN and its effect on outcomes in patients with acute coronary syndrome (ACS). Methods: A retrospective study included 1579 patients who underwent coronary angiography or PCI. Results: The overall incidence of in-hospital CIN was 6.8%, with the highest incidence in the group with eGFR <30 mL/min/1.73 m2 at 21.6%. Non-radial vascular access was an independent predictor of CIN occurrence (OR = 2.06 [1.37-3.08]; p < 0.001). The risk of death within 30 days was influenced by history of stroke (OR = 4.94 [1.58-15.51]; p = 0.006), glucose level on admission (per 10-unit increase) (OR = 1.07 [1.04-1.1]; p < 0.001), occurrence of CIN (OR = 5.64 [2.49-12.79]; p < 0.001), and hemoglobin level (OR = 0.77 [0.65-0.92]; p = 0.003). The risk of death within 365 days was increased by age (OR = 1.05 [1.02-1.07]; p < 0.001), history of stroke (OR = 2.45 [1.02-5.89]; p = 0.046), glucose levels on admission (per 10-unit increase) (OR = 1.05 [1.03-1.08]; p < 0.001), occurrence of CIN (OR = 2.62 [1.42-4.84]; p = 0.002), and hemoglobin concentration (OR = 0.78 [0.7-0.88]; p = 0.003). An independent predictor of hospitalization for acute or exacerbation of chronic renal failure was baseline creatinine concentration (OR = 3.44 [2.4-4.93]; p < 0.001). Conclusions: The incidence of CIN is significant, particularly in patients with severe pre-existing renal impairment. Non-radial vascular access is an independent predictor of CIN. The occurrence of CIN is a strong independent predictor of both short-term and long-term mortality.

Bridging approaches to facilitate innovation: building an approach for heated tobacco products from case studies in the food and drug domains a comparative review

An increasing number of heated tobacco products (HTPs) have been commercialized in several countries over the last decade. To benefit public health, these products should have a lower health risk profile than cigarettes. This includes the need to be sufficiently acceptable to adults who smoke so that a reasonable proportion of those who do not want to quit smoking are persuaded to switch completely. Additionally, the product should not increase the likelihood of non-smokers starting to use tobacco or smokers increasing their total consumption of tobacco products. Part of this process involves iterative development of new product versions, leveraging lessons learned from consumer experiences with marketed products, and applying novel technologies to improve the consumer product offering. Risk assessment for these products may include pre-clinical quality, analytical and toxicity evaluations, pre-market clinical studies, and post-market surveillance studies. In recent years, approaches to bridge the assessment for modified or new products to data generated for reference products by comparing their equivalence were proposed. Here, we review the approaches taken for such bridging studies and relate them to product comparability and bridging approaches established in a diverse range of consumer and pharmaceutical products. This leads to a proposal for a logical, stepwise, and tiered bridging approach to effectively manage the introduction of new HTPs through scientific substantiation and have potential to increase the public health benefit by reducing risk and improving product acceptability for adult smokers without attracting non-smokers by new innovations.

Retinal Vessel Flicker Light Responsiveness and Its Relation to Analysis Protocols and Static and Metabolic Data in Healthy Subjects

Background: The aim of this study was to assess the agreement between different analysis protocols for the determination of retinal vessel dilation response to flicker light (FL) and its relation to static and metabolic parameters of retinal vessels in healthy subjects. Methods: In total, 24 right eyes of 24 healthy controls (mean age: 36.04 ± SD 14.4 years) who underwent dynamic and static retinal diameter and oxygen saturation measurements on a Retinal Vessel Analyzer (RVA, Imedos, Jena, Germany) were included. Using repeated video analyses, responses to FL were measured with RVA. These measurements were conducted at three specific retinal locations: within the superotemporal area-within a distance of less than one optic disk (OD) diameter to optic nerve head (ONH) (group 1); greater than one OD diameter to ONH (group 2); and areas near the ONH within the VesselMap region (group 3). For comparability, the static and oxygen saturation parameters were also calculated in the superotemporal peripapillary area using the VesselMap tool of the RVA and were evaluated in relation to the corresponding dynamic area (group 3). Results: In all groups, the vascular FL response of arteries was less pronounced compared to venules (p = 0.0014). Even though FL responses (mean ± SD: FL-A; FL-V) in group 1 were more pronounced (3.36 ± 2.31; 4.42 ± 1.69) compared to those in group 2 (2.97 ± 2.40; 4.08 ± 1.55) and group 3 (2.84 ± 2.29; 4.21 ± 2.03), they did not reach statistically significant values. The mean flicker response of venules (VDil) in all groups showed negative correlations to the corresponding static parameter: central retinal venous equivalent (CRV) (r = -0.0437; p = 0.015). The mean flicker response of arteries (ADil) in all groups showed negative correlations to the corresponding metabolic parameter: arterio-venous oxygen extraction fraction (r = -0.101; p = 0.041). Conclusions: Our study confirms that the flicker light response, despite slight variations in its duration and location, allows for reliable measurements, proving the Retinal Vessel Analyzer to be a valuable diagnostic tool. Furthermore, we were able to highlight the relationship between the dynamic and metabolic components of retinal supply, which enables early diagnosis concerning the development of diseases within this spectrum.

Renal and Safety Outcomes of SGLT2 Inhibitors in Patients with Type 2 Diabetes: A Nationwide Observational Cohort Study

Background/Objectives: Evidence on the renal benefits and safety of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the Asia region is still lacking. This study aimed to evaluate the renal and safety outcomes of SGLT2is compared with dipeptidyl peptidase-4 inhibitors (DPP4i) using real-world data. Methods: A retrospective cohort study was conducted using the nationwide claims data in Republic of Korea. We evaluated kidney outcomes (any new-onset kidney events, acute kidney injury (AKI), chronic kidney disease (CKD), and kidney failure) as primary outcomes and safety outcomes (infection, hemodynamic adverse events, and fracture). Propensity score matching was used to adjust confounders, and the hazard ratios were calculated using the Cox proportional hazards model. Results: The study included 13,649 patients in the SGLT2i group and 35,043 in the DPP4i group after the matching. The SGLT2i group had a lower risk of kidney diseases, AKI, and CKD (HR 0.88 [0.61-0.74]) than the DPP4i group. For secondary outcomes, the risk of genital infection was higher (HR 2.38 [2.12-2.68]), and the risk of hyperkalemia was lower in the SGLT2i group than in the DPP4i group (HRs 0.49 [0.36-0.67]). Conclusions: The SGLT2 inhibitors had a lower risk of new-onset kidney outcomes and CKD than the DPP4 inhibitors. A high incidence of genital infection and a low incidence of hyperkalemia were shown in the SGLT2 inhibitor.

Establishment and validation of a clinical prediction model for in-stent restenosis after intracranial and extracranial stent implantation

Objective

This study aims to analyze the risk factors for in-stent restenosis in patients who have undergone successful cerebral artery stent implantation and to develop a nomogram-based predictive model.

Methods

We utilized data retrospectively collected from 488 patients at Hebei Provincial People's Hospital between April 2019 and March 2024. After applying the inclusion criteria, 390 patients were further analyzed and divided into a training group (n = 274) and a validation group (n = 116). In the training group, we used univariate and multivariate logistic regression to identify independent risk factors for stroke recurrence and then created a nomogram. The nomogram's discrimination and calibration were assessed by examining various metrics, including the concordance index (C-index), the area under the Receiver Operating Characteristic (ROC) curve (AUC), and calibration plots. Decision curve analysis (DCA) was employed to evaluate the clinical utility of the nomogram by quantifying the net benefit for patients at different probability thresholds.

Results

The nomogram for predicting in-stent restenosis in patients undergoing cerebral artery stenting included seven variables: triglyceride-glucose index (TyG), presence of Diabetes Mellitus, postoperative dual antiplatelet therapy, body mass index (BMI), and preoperative MRS score. The C-index (0.807 for the training cohort and 0.804 for the validation cohort) indicated satisfactory discriminative ability of the nomogram. Furthermore, DCA indicated a clinical net benefit from the nomogram.

Conclusion

The predictive model constructed includes six predictive factors: TyG, presence of Diabetes Mellitus, postoperative dual antiplatelet therapy, BMI, and preoperative MRS score. The model demonstrates good predictive ability and can be utilized to predict ischemic stroke recurrence in patients with symptomatic ICAS after successful stent placement.

Endocrinological toxicities related to immunotherapy combinations for advanced renal cell carcinoma: Practical expert-based management recommendations

Nowadays immune-based combinations are the standard first-line treatment for metastatic renal cell carcinoma and involve the use of either two immunotherapy agents or an immunotherapeutic drug associated with a tyrosine kinase inhibitor. Treatment-related toxicity is the primary cause of drug discontinuation or dose reduction. A thorough understanding of the prevention and management of adverse events of the immune-based combinations is critical to ensure the success of treatment. Endocrinological toxicities during treatment with immune-based combinations are frequent and often manageable. However, in some cases, diagnosis can be complex, and the treatment requires multidisciplinary discussion. In addition, it is often challenging to determine which agent in the combination is responsible for a specific toxicity. In this review, we analyze the evidence regarding treatment-related endocrinopathies in renal cell carcinoma first-line therapy. We also discuss monitoring strategies to diagnose endocrinological adverse events and provide some practical tools for their daily management.

Association of Endothelial Nitric Oxide Synthase and Angiotensin-Converting Enzyme Genes Polymorphism With In-Sent Restenosis of Bare Metal Stents vs Drug-Eluting Stents in Egyptians

Despite its unequivocal superiority compared with balloon angioplasty, coronary stenting did not abolish restenosis. We aimed to evaluate the associations between a common single nucleotide polymorphism occurring in endothelial nitric oxide synthase (eNOS) and angiotensin-converting enzyme (ACE) genes and the risk of in-stent restenosis (ISR) of bare metal stents vs drug-eluting stents (BMS vs DES) implanted in Egyptian patients. Two hundred patients who had coronary stenting were divided into group I (n = 98) who received a BMS and group II (n = 102) who received a DES. eNOS and ACE genes polymorphism were analyzed by polymerase chain reaction (PCR). We found that the GA and AA genotypes of the eNOS gene were associated with the ISR with both BMS and DES. However, the ACE gene was not associated with ISR. We concluded that eNOS gene polymorphism is associated with ISR. Hypertension, stent length, and AA genotype of the eNOS gene were found to be independent predictors of the occurrence of ISR after both BMS and DES use.

Association between fetal sex and metabolic syndrome in women aged 40 years and older: the REACTION study

Introduction

This study aimed to investigate whether fetal sex influences the risk of metabolic syndrome (MetS) in women in China.

Materials and Methods

A cohort of 3,758 Chinese women, each having given birth to only one child and aged 40 years or older, was included in the study. Registry data on all pregnancies and miscarriages were collected for each participant. This retrospective cohort study aimed to determine whether fetal sex was associated with metabolic syndrome. MetS was defined as meeting at least three of the following five criteria: impaired insulin metabolism, reduced glucose tolerance, hypertension, dyslipidemia, and large waist circumference.

Results

Among the 3,758 women aged 40 years and older in Luzhou City, 1,018 (27.1%) developed MetS. Mothers who had carried a male fetus had higher triglyceride (TG) and total cholesterol (TC) levels and a greater prevalence of diabetes than those who had carried a female fetus (P < 0.05). Although the incidence of MetS was higher in women who had carried a male fetus than in those who had carried a female fetus, the difference was not statistically significant (P > 0.05). Notably, MetS was significantly less prevalent in premenopausal women than in postmenopausal women, irrespective of fetal sex (P < 0.05). In the postmenopausal subgroup, the incidence of MetS was significantly higher in women who had carried a male fetus compared to those who had carried a female fetus (P < 0.05).

Conclusions

Our study found no significant association between fetal sex and MetS in Chinese women aged 40 years and older. However, among postmenopausal women, the incidence of MetS was significantly higher in those who had carried a male fetus. Greater attention should be given to postmenopausal women with a history of carrying a male fetus, and early preventive measures should be implemented to reduce the risk of related chronic diseases.

Prediction of cardiac autonomic dysfunction using heart rate response to deep breathing test among type 2 diabetes mellitus

BACKGROUND

Cardiac autonomic neuropathy (CAN) is an underdiagnosed complication of type 2 diabetes mellitus (T2DM) and a predictor of mortality and cardiovascular morbidity. Hence, CAN screening is essential. The objective of the study was to examine whether cardiac autonomic dysfunction can be predicted using the heart rate response to deep breathing test of cardiac autonomic reflex tests (CARTs) among type 2 diabetes mellitus.

METHODS

The study was a cross-sectional study of T2DM individuals between 40 and 65 years. Each participant underwent a heart rate (HR) response to deep breathing test (CARTs) as per standard guidelines. ANOVA F-test was used to check the difference between the CAN severity and the heart rate response to deep breathing parameters. A post-hoc (Tukey's) test was used to check which groups showed the difference.

RESULTS

Eighty-four participants were screened, of which forty-one were included in the present study. The mean age of the participants was 58.8 ± 4.0 years. The Fisher's test showed a statistically significant difference between groups for the average deep breathing difference (F(3,27) = 16.09, p < 0.001) and the respiratory sinus arrhythmia index (F(3,27) = 7.35, p < 0.001).

CONCLUSION

HR response to deep breathing can be used as a preliminary tool to screen CAN in T2DM to differentiate between normal and the other stages of CAN, which can then be followed by the gold standard tests. Further studies are required to establish HR response to deep breathing as a singular tool using regression analysis.

CLINICAL TRIALS REGISTRATION

The study was registered prospectively in the Clinical Trials Registry- India (CTRI/2023/11/060077) on 21st November 2023.

Relationship Between Stress Hyperglycemia Ratio and In-Stent Restenosis in Patients Receiving Drug-Eluting Stents

Aims/Background In-stent restenosis (ISR) is a major cause of long-term failure in coronary revascularization among patients undergoing percutaneous coronary intervention (PCI). Emerging evidence suggests that the stress hyperglycemia ratio (SHR) is a novel biomarker with potential predictive value for cardiovascular diseases. This study aimed to investigate the relationship between SHR and ISR in patients treated with drug-eluting stents (DES). Methods This retrospective study included 410 patients who underwent DES implantation at the Cardiology Department of Yixing People's Hospital between January 2015 and December 2022. All participants underwent coronary angiography (CAG) to evaluate the incidence of ISR and were categorized into two groups based on CAG results: non-ISR (n = 346) and ISR (n = 64). Laboratory parameters were evaluated prior to CAG for all participants. A restricted cubic spline (RCS) analysis was performed to evaluate the potential nonlinear associations between SHR and ISR. Multivariate logistic regression was used to identify independent risk factors for ISR, while the predictive value of SHR for ISR was assessed using receiver operating characteristic (ROC) analysis. Results RCS analysis revealed a nonlinear, J-shaped relationship between SHR and ISR (p < 0.05). Multivariate logistic regression identified SHR as an independent risk factor of ISR (odds ratio (OR) = 32.05, 95% confidence interval (CI): 6.827-150.450, p < 0.05). ROC analysis revealed that SHR had a high predictive value for ISR, with an area under the curve (AUC) of 0.81 (95% CI: 0.74-0.87, p < 0.001). The optimal SHR cutoff value was 0.87, with a sensitivity of 79.69% and a specificity of 73.41%. Conclusion Our findings identified a significant association between SHR and the risk of ISR in patients with coronary heart disease (CHD) undergoing PCI with DES implantation. SHR may serve as a valuable biomarker for predicting ISR, enabling improved risk stratification and patient management.

Proteomic Analysis and 2-Hydroxyisobutyrylation Profiling in Metabolic Syndrome Induced Restenosis

Restenosis is the primary complication following stenting for coronary and peripheral arterial disease, posing an ongoing clinical challenge. Metabolic syndrome (MetS), characterized by metabolic disturbances, has been identified as an independent predictor for postoperative restenosis in coronary and carotid arteries, potentially due to endothelial dysfunction and augmented oxidative stress in cells, while its specific regulatory mechanism is still largely unknown. Lysine 2-hydroxyisobutyrylation (Khib), a recently identified posttranslational modification, plays a crucial role in transcriptional regulation and cellular metabolism. However, there is a lack of comprehensive analysis of the proteome and Khib modifications within restenotic vessels in the context of MetS, as well as in the understanding of the associated pathophysiology. In this study, we observed a significant upregulation of Khib in restenotic arteries induced by MetS, confirmed by animal and cellular experiments. Further, using high-throughput liquid chromatography-mass spectrometry, we catalogued 15,558 Khib sites across 2568 proteins, implicating a multitude of biological functions. Analysis revealed 2007 Khib sites on 1002 proteins with considerable differential modifications which are present within the cytoplasm and nucleus. Interestingly, proteins located in the mitochondria, endoplasmic reticulum, and cell membrane also exhibit distinct expression and modification profiles to varying extents that related to vascular smooth muscle contraction, platelet activation, and the PI3K-Akt signaling pathway. Notably, the level of COL1A1 protein detected in the protein-protein interaction pathway network and the level of Khib modification are diametrically opposed, suggesting a significant role in the disease's pathogenesis. This study provides the first comprehensive proteomic and Khib modification overview of MetS-related in-stent restenosis vasculature, offering key insights to inform novel therapeutic approaches for restenosis mitigation.

The association between Glycated Hemoglobin to High Density Lipoprotein Cholesterol Ratio and risk of cardiovascular diseases caused death among adult cancer survivors: evidence from NHANES 1999-2018

BACKGROUND

The population of cancer survivors is growing markedly, facing an elevated risk of overall mortality as well as death from cardiovascular diseases (CVDs). Uncovering biomarkers that associated with CVDs among cancer survivors appears to be vital.

METHODS

We collected data from NHANES (1999-2018), focusing on cancer survivors with comprehensive Glycated Hemoglobin (GH), High Density Lipoprotein Cholesterol (HDL-C), CVDs history and survival follow-up information. We first executed test for Proportional Hazards assumptions among the variables, paving the way for constructing the COX proportional hazards model. By stratifying participants by age, we explored the association between GH/HDL-C levels and the CVDs-caused mortality risk across various age segments. Restricted cubic spline (RCS) curves were employed to detect any potential non-linear associations. When non-linear associations were identified, we proceeded with segmented analyses based on reference values to better understand the association between GH/HDL-C and the risk of CVDs-related mortality among cancer survivors. To further affirm the robustness of our findings, subgroup and sensitivity analyses were conducted.

RESULTS

A total of 3,244 eligible participants were included in this study. The GH/HDL-C levels in cancer survivors died from CVDs were markedly higher than those who survived the follow-up period. According to the results from the Proportional Hazards assumptions test, the endpoint for CVDs mortality was established at 168 months, and the subjects were classified into three age groups: <60 years, between 60 and 74 years, and ≥ 75 years. For the young cohort (< 60 years), there was no significant association between GH/HDL-C levels and CVDs mortality. However, in the 60 ~ 74 age group, a linear association was noted, with higher GH/HDL-C levels indicating a greater CVDs-related mortality risk. For cancer survivors aged 75 and older, the association appeared nonlinear, resembling a U-shaped curve, where high GH/HDL-C levels were associated with higher mortality risk above the certain reference point (4.25mmol/L^-1), while lower levels were associated with reduced risk or no significant impact.

CONCLUSION

The study highlighted that in cancer survivors, the GH/HDL-C is significantly associated with the risk of CVDs mortality. Those between 60 and 74 years old showed a straightforward increase in CVD death risk with higher GH/HDL-C levels. In individuals aged 75 and older, the association was more complex, exhibiting a non-linear U-shaped trend.

The relationship of glycosylated hemoglobin A1c and Apolipoprotein A‑1 ratio on short-term prognosis in STEMI patients following PCI: a retrospective study

The ST segment elevation myocardial infarction (STEMI) patients tend to experience cardiovascular events following percutaneous coronary intervention (PCI), and the prognosis remains suboptimal. The objective of this investigation was to examine the correlation between the ratio of glycosylated hemoglobin A1c/Apolipoprotein A1 (HbA1c/ApoA-1) and the short-term prognosis in STEMI patients following PCI. This study conducted a retrospective analysis of the clinical data of 182 patients diagnosed with STEMI following PCI and admitted to our hospital between January 2022 and June 2023. The patients were categorized into two groups based on the occurrence of major adverse cardiovascular events (MACEs), and a comparative analysis of baseline characteristics was performed. The significant correlation between HbA1c/ApoA-1 with short-term MACEs in STEMI patients post-PCI were determined through univariate and multivariate logistic regression analysis. Different models and Subgroup analysis demonstrated that HbA1c/ApoA-1 was independent risk factor for MACEs in STEMI patients post-PCI and exhibited high stability. Receiver operating characteristic (ROC) curve and area under curve (AUC) value were utilized to validate the predictive value of HbA1c/ApoA-1 in forecasting outcomes among STEMI patients post-PCI, with an AUC of 0.752 (95% CI: 0.68-0.86), sensitivity of 85.7%, and specificity of 56.8%. Restricted cubic spline (RCS) was employed to evaluate the potential non-linear relationship between HbA1c/ApoA-1 levels and MACEs in STEMI patients post-PCI. Our results demonstrated high and significant correlation between HbA1c/ApoA-1 and short-term prognosis, and indicated that HbA1c/ApoA-1 was independent risk factor for MACEs in STEMI patients following PCI and possessed significant predictive value, facilitating the early identification of high-risk cohorts and the anticipation of MACEs.

Usefulness of Myocardial Injury Parameters in Predicting Prolonged Postoperative Use of Inotropes Drugs in Patients Undergoing Heart Valve Surgery

Background: Prolonged use of inotropes drugs in the early postoperative period is one of the most common complications occurring in patients undergoing heart valve surgery. Patients requiring prolonged support via inotropes drugs are significantly more likely to experience serious postoperative complications such as acute kidney injury, cardiogenic shock, multiple organ dysfunction syndrome, and death. This study assessed the usefulness of selected perioperative parameters in predicting prolonged postoperative use of inotropic drugs and cardiogenic shock and/or death in a group of patients requiring prolonged supply of inotropes drugs. Methods: This prospective study was conducted on a group of 607 patients undergoing heart valve surgery. The primary endpoint in-hospital follow-up was prolonged postoperative use of inotropes drugs. The secondary composite endpoint was cardiogenic shock requiring mechanical circulatory support (MCS) and/or death from any cause in patients with prolonged postoperative use of inotropes drugs. Results: A total of 210 patients required inotropes drugs for more than 48 h. Age (p = 0.03), preoperative atrial fibrillation (p < 0.001), preoperative NT-proBNP level (p < 0.001), Troponin T measured one day after surgery (TnT II) (p < 0.001), and the need for urgent postoperative rethoracotomy (p < 0.001) remained independent predictors of primary endpoint. Preoperative hemoglobin level (p = 0.001) and TnT II (p < 0.001) were independent predictors of death and cardiogenic shock requiring MCS. Conclusions: Patients with elevated preoperative NT-proBNP values, as well as with increasing postoperative troponin T levels, are at risk of prolonged postoperative use of inotropes drugs, a complication which is associated with a significant risk of developing further adverse consequences, such as cardiogenic shock and death.

Obesity-Related Disorders in Türkiye: A Multi Center, Retrospective, Cross-Sectional Analysis from the OBREDI-TR Study

Objectives: Obesity is a significant public health concern, as it is associated with the development of numerous chronic diseases. The prevalence of obesity and attendant diseases has been increasing over recent years. This study attempted to ascertain the frequency of chronic diseases in obese patients in Türkiye for the first time on this scale. Methods: A retrospective study was conducted, with patients admitted to the internal medicine outpatient clinics or obesity centers between December 2023 and December 2024 included in this study. Participants were recruited from seven regions, 20 provinces, and 28 centers, and the inclusion criteria were met by those aged 18 years and over with a body mass index (BMI) of 30 kg per square meter (kg/m2) or above. Their status, with respect to chronic diseases, and their anthropometric parameters were documented. Results: The total number of patients was 10,121, with a mean age of 45.2 ± 13.92. Of these, 7222 (71.35%) were female. The prevalence of type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidemia (DL), coronary artery disease (CAD), obstructive pulmonary disease (OPD), obstructive sleep apnea syndrome (OSAS), and fatty liver disease (FLD) was found to be 35.01%, 78.19%, 12.37%, 10.32%, 5.88%, and 75.12%, respectively. A subsequent analysis of the prevalence of these diseases by region revealed a statistically significant variation between regions (p < 0.001 for all regions). Conclusions: This study represents a substantial contribution to the existing body of knowledge in this field, particularly with regard to the identification of the current chronic disease rate of obese patients in Türkiye.

Modulation of the Inflammatory Response by Adenovirus 36 in Patients with Obesity and Type 2 Diabetes: A Nested Case-Control Study Within a Cohort

Human adenovirus 36 (HAdV-36) is associated with obesity, potentially by promoting adipocyte proliferation and differentiation. Although linked to increased fat storage, HAdV-36 is also correlated with improved insulin sensitivity. Given its potential role in modulating adipose tissue and promoting a less inflammatory metabolic profile, its impacts on pro- and anti-inflammatory cytokine secretion remain unclear.

METHODS

This nested case-control study compared cytokine levels (IL-10, IL-2, IL-6, IL-8, and TNF-α) between patients with and without HAdV-36 infection. A total of 76 participants were included, with 37 in the control group (HAdV-36 negative) and 39 classified as cases (HAdV-36 positive).

RESULTS

HAdV-36 seropositive individuals exhibited significantly lower IL-6 levels and higher IL-8 levels than seronegative participants. Additionally, they had lower glucose levels, suggesting a potential link between HAdV-36 and metabolic regulation.

CONCLUSIONS

These findings support the hypothesis that HAdV-36 may influence inflammatory and metabolic responses by modulating cytokine expression and glucose levels. Further research is needed to clarify the underlying mechanisms and their implications for metabolic health.

Endovascular treatment of intracranial blood blister-like aneurysms with the Willis covered stent: a case series

BACKGROUND AND PURPOSE

To evaluate the safety, feasibility, and effectiveness of the Willis covered stent (WCS) in treating blood blister-like aneurysms (BBAs).

MATERIALS AND METHODS

Twenty-one consecutive patients with BBAs treated with the WCS were identified between July 2017 and July 2022. The demographic, clinical, and angiographic data and procedural-related complications were collected from the medical records and the operative reports.

RESULTS

The present study included six men and fifteen women, with a mean age of 51.6 years (31-70 years). The immediate postoperative angiography demonstrated that the complete occlusion rate was 100%, with no endoleak. Ophthalmic artery (OA) occlusion occurred in five patients (23.8%). One patient developed delayed stent thrombosis on the third postoperative day. The mean angiographic follow-up time was 9.2 months (range 3-21 months). All twenty-one BBAs were occluded entirely, and the patency of the parent arteries was preserved. No aneurysm rupture or recurrence was found, and no retreatment was needed. Two patients developed mild to moderate asymptomatic in-stent stenosis. The clinical follow-up time was 20.0 months (range 15-33 months). Twenty patients had an mRS score of zero, and one had an mRS score of one.

CONCLUSIONS

Our series indicates that treating BBAs with WCSs was relatively safe and efficacious. However, the incidence of stent delivery failure and complications should not be neglected.

Combined action of dietary-based approaches and therapeutic agents on cholesterol metabolism and main related diseases

BACKGROUND

Dyslipidaemia is among the major causes of severe diseases and, despite being well-established, the hypocholesterolaemic therapies still face significant concerns about potential side effects (such as myopathy, myalgia, liver injury digestive problems, or mental fuzziness in some people taking statins), interaction with other drugs or specific foods. Accordingly, this review describes the latest developments in the most effective therapies to control and regulate dyslipidaemia.

SCOPE AND APPROACH

Herein, the metabolic dynamics of cholesterol and their integration with the current therapies: statins, bile acid sequestrants, fibrates, niacin, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, reconstituted high-density lipoprotein (rHDL), or anti-inflammatory and immune-modulating therapies), were compared focusing their effectiveness, patients' adhesion and typical side-effects. Likewise, the interaction of these therapies with recommended dietary habits, focusing functional foods and nutraceuticals uptake were also considered.

KEY FINDINGS AND CONCLUSIONS

Since none of the current therapeutic alternatives represent an ideal solution (mainly due to side-effects or patients' tolerance), the potential adjuvant action of selected diets (and other healthy habits) was proposed as a way to improve the cholesterol-lowering effectiveness, while reducing the adverse effects caused by dose-increase or continuous uptake of alternating therapeutic agents. In general, the relevance of well-adapted diets must be acknowledged and their potential effects must be exhorted among patients, who need to be aware of the associated multifactorial advantages.

Endothelial dysfunction in chronic kidney disease: Mechanisms, biomarkers, diagnostics, and therapeutic strategies

Endothelial cells regulate vascular tone, blood flow, coagulation, and inflammation, with heterogeneous populations serving specific roles throughout the body. In the kidney, endothelial cells maintain vascular integrity and function, contribute to filtration, and support other renal structures. Nitric oxide (NO) is a key signaling molecule that maintains vascular tone and endothelial function. It is synthesized by nitric oxide synthase (NOS) isoforms, with endothelial NOS playing a central role in vascular health. Chronic kidney disease (CKD) is characterized by reduced NO bioavailability, driven by the accumulation of endogenous NOS inhibitors such as asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA). Uremic toxins, oxidative stress, and proinflammatory cytokines contribute to a prothrombotic and proinflammatory state, contributing to endothelial dysfunction and exacerbating cardiovascular (CV) risks in CKD. Biomarkers such as ADMA, SDMA, endothelial microparticles, and soluble adhesion molecules offer insights into vascular health, while invasive or noninvasive diagnostic techniques can assess endothelial function in CKD. Effective management strategies focus on enhancing NO bioavailability, controlling oxidative stress, reducing inflammation, and optimizing dialysis to minimize uremic toxin levels. Emerging therapeutic approaches, including antioxidant therapies and endothelial progenitor cell-based interventions, show promise in preserving vascular function. A multifaceted approach to managing endothelial dysfunction is critical for mitigating CV complications and improving patient outcomes in CKD.

Estimated Glucose Disposal Rate Associated With Risk of Frailty and Likelihood of Reversion

BACKGROUND

Estimated glucose disposal rate (eGDR) is a simple and effective measure for insulin resistance, which is associated with higher risk of frailty. We aim to analyse the associations of eGDR with frailty risk and its reversibility.

METHODS

A population-based longitudinal study was conducted of 11 670 participants from the China Health and Retirement Longitudinal Study and 19 355 participants from the Health and Retirement Study. Frailty was assessed by the frailty index and reversibility was measured by transitions from frailty at baseline to non-frailty during follow-up. The eGDR was divided into Q1, Q2, Q3 and Q4 according to the quartiles. Multi-state Markov model was performed to evaluate the effects of eGDR on transitions among non-frailty, frailty and death. Cox regression model was used to estimate eGDR associated with the risk of frailty and the likelihood of reversion.

RESULTS

In Chinese population characterized by a median age of 60 years (IQR: 54-66) with 6119 women (52.43%), compared with the Q1 level of eGDR, participants exposure to Q3 and Q4 level decreased the probability of transitioning from non-frailty to frailty by 22% (HR = 0.78, 95% CI: 0.69-0.88) and 25% (HR = 0.75, 95% CI: 0.66-0.86), respectively. But its Q2, Q3 and Q4 levels increased the probability of transitioning from frailty to non-frailty by 24% (HR = 1.24, 95% CI: 1.06-1.44), 39% (HR = 1.39, 95% CI: 1.19-1.64) and 33% (HR = 1.33, 95% CI: 1.13-1.58). In American population with a median age of 63 years (IQR: 56-72) and 11 189 women (57.81%), its Q2, Q3 and Q4 levels decreased the probability of transitioning from non-frailty to frailty by 17% (HR = 0.83, 95% CI: 0.77-0.89), 24% (HR = 0.76, 95% CI: 0.70-0.82) and 46% (HR = 0.54, 95% CI: 0.49-0.59), respectively. The probability of revising frailty increased by 25% (HR = 1.25, 95% CI: 1.13-1.38), 36% (HR = 1.36, 95% CI: 1.22-1.51) and 48% (HR = 1.48, 95% CI: 1.30-1.69) for levels Q2, Q3 and Q4. As shown in the prospective analysis, increased eGDR levels from Q2 to Q4 were associated with decreased frailty risk and higher likelihood of reversion, as evidenced by the dose-response relationship revealed by restricted cubic spline analysis.

CONCLUSIONS

Higher levels of eGDR were associated with a reduced risk of frailty, delayed transition from non-frailty to frailty and an increased likelihood of reversion. eGDR emerges as a promising predictor for early frailty detection, prognosis assessment and a potential therapeutic target for intervention strategies.

Association of gender and metabolic factors with thyroid nodules in T2DM: a retrospective study

Aims

Sex differences in the incidence of thyroid nodules (TNs) are broadly recognized, but further analysis is lacking. Thus, the aim of this study was to evaluate the association between TNs and anthropometric parameters in type 2 diabetic males and females.

Materials and Methods

This cross-sectional study included 747 patients with type 2 diabetes mellitus (T2DM). All patients underwent clinical examination, thyroid ultrasound, laboratory tests, anthropometrics and body composition. Multivariable logistic regression assessed factors associated with TNs, and a simple nomogram was finally developed.

Results

In total, the incidence of TNs was 36.95% (276/747) and was significantly higher in females (52.75%) than in males (27.85%). Age was positively correlated with TNs risk in patients with T2DM (males: OR = 4.141, 95% CI [1.999-8.577], females: OR = 4.630, 95% CI [1.845-11.618]). Obesity (OR = 2.655, 95% CI [1.257-5.607]) and hyperuricemia (OR = 1.997, 95% CI [1.030-3.873]) were only associated with the risk of TNs independent of other risk factors in type 2 diabetic females, as well as other obesity factors such as weight, BMI, waist-hip ratio, percent body fat, visceral curve area, and upper arm circumference, but not in type 2 diabetic males. However, the diameter of the largest thyroid nodule was only related to age (R = 0.226, p < 0.01). Finally, the nomogram for evaluating TNs in female T2DM patients was established, and the C-index of the nomogram was 0.704 (95% CI [0.89-0.94]).

Conclusion

TNs occur with a significantly higher frequency in type 2 diabetic females than in males, especially those with hyperuricemia and obesity. Modifiable metabolic factors, such as obesity and hyperuricemia, are a major focus for improving TNs risk in women.

Sex-specific characterization of aortic function and inflammation in a new diet-induced mouse model of metabolic syndrome

Perivascular adipose tissue (PVAT) expansion promotes inflammation and vascular dysfunction in metabolic syndrome (MetS), but the sexual dimorphisms of PVAT are poorly understood. Using a new mouse model of diet-induced MetS, we characterized the aorta and determined the influence of PVAT on vascular function in males and females. Six-week-old C57BL/6 mice were fed either a high-fat diet (43% kcal in food) with high sugar and salt in their drinking water (10% high fructose corn syrup and 0.9% NaCl; HFSS), or a normal chow diet (NCD) for 10 weeks. The aorta was characterized at endpoint using pin myography, flow cytometry, bulk RNA-sequencing, GSEA analysis, and histology. Compared to NCD-fed mice, HFSS-fed mice displayed higher weight gain, fasting blood glucose, systolic blood pressure, aortic fibrosis, and perivascular adipocyte cross-sectional area, regardless of sex (p < .05). Circulating adiponectin levels were also higher in HFSS-fed males compared to NCD males. PVAT enhanced U46619-mediated contraction in HFSS males only. HFSS increased the expression of immune regulation genes in female PVAT and ion transport genes in male PVAT but had no effect on total numbers of immune cells in the aorta in either sex. Despite having similar effects on metabolic parameters in males and females, HFSS caused contrasting effects on vascular function with and without PVAT. These data highlight the sexual dimorphisms of PVAT in regulating the vasculature in healthy and diseased states.

The Effect of Thyroid Lobe Volume on the Common Carotid Artery Blood Flow in Thyroidectomy Position

Background/Objectives: This study investigates the effect of thyroid lobe size on common carotid artery hemodynamics during thyroidectomy. While prior research has reported reduced carotid blood flow during the procedure, the impact of thyroid size remains unclear. We hypothesized that larger thyroid lobes may influence carotid flow dynamics via external compression. Methods: Adult patients undergoing elective thyroidectomy were prospectively included. Doppler ultrasonography measured carotid artery diameters and flow characteristics at three time points: before anesthesia induction, after induction, and after surgical positioning. Regional cerebral oximetry was recorded. Each carotid artery was analyzed separately. Results: Data from 202 carotid arteries (132 patients) were analyzed. Baseline carotid diameters and flow velocities were similar between patients with normal and large thyroid lobes. Anesthesia induction reduced flow velocities in all patients. After surgical positioning, patients with large thyroid lobes had significantly increased peak systolic velocity, leading to an overestimation of carotid blood flow, when using formula-based calculations. Manually traced Velocity Time Integral confirmed the increase in peak systolic velocity and a shortened systolic/diastolic ratio in these patients. Receiver operating characteristic analysis identified a thyroid lobe volume cutoff of 19.7 mL (AUC: 0.93, Sensitivity: 85%, Specificity: 98%). Regional cerebral oxygen saturation remained unchanged (p > 0.05). Conclusions: Larger thyroid lobes are associated with altered carotid flow dynamics during thyroidectomy, emphasizing diastolic flow. While these findings provide insight into thyroid-related hemodynamic changes, their applicability to patients with pre-existing carotid stenosis or peripheral artery disease remains uncertain, as our study population did not include such cases.

A Rare Case of ST-Elevation Myocardial Infarction (STEMI) in a Paced Rhythm Meeting Full Sgarbossa Criteria in a 61-Year-Old Male With Complex Percutaneous Coronary Intervention and Post-Infarction Management Challenges

In-stent restenosis (ISR) is a common complication following stent implantation and can lead to acute coronary syndrome (ACS), particularly in patients with multiple comorbidities. This condition increases the risk of recurrent angina, myocardial infarction (MI), and the need for repeat revascularization. Although advancements in drug-eluting stents (DES), particularly second- and third-generation models, have significantly decreased the incidence of ISR to about 1-2%, it is still a major concern for high-risk individuals. Managing ACS in the presence of ISR is a complex clinical challenge, requiring careful assessment and intervention. This case report details the presentation, diagnostic challenges, and management of a 61-year-old male with a complex medical history, including atrial fibrillation, chronic obstructive pulmonary disease (COPD), prior MI, and symptomatic bradyarrhythmias treated with a permanent pacemaker. The patient presented with severe chest pain consistent with ST-elevation myocardial infarction (STEMI), later confirmed to result from ISR involving the left anterior descending (LAD) and diagonal arteries. The report highlights the critical role of emergent intervention and advanced diagnostic techniques in managing ISR-related ACS. A key aspect of this case was the use of Sgarbossa criteria to diagnose STEMI in the presence of an atrial-ventricular paced rhythm. The patient's EKG demonstrated a perfect score of 10 on the Sgarbossa scale, a rare finding indicative of a high-risk ischemic event. Emergent percutaneous coronary intervention (PCI) was performed, guided by intravascular ultrasound (IVUS), revealing near-complete ISR of the LAD and total occlusion of the first and second diagonal arteries. Successful revascularization was achieved with balloon angioplasty, stent placement, and post-dilation. Post-procedural management required a delicate balance between antithrombotic therapy and bleeding risk, leading to the initiation of dual antiplatelet therapy (DAPT) (It is not specified how long the Cardiology team was going to continue the DAPT in the records). This report underscores the importance of maintaining vigilance when encountering patients with a history of ISR and prior coronary interventions, emphasizing the need for close monitoring and aggressive management of recurrent ischemic symptoms. Furthermore, it demonstrates the diagnostic value of Sgarbossa criteria in patients with ventricular-paced rhythms and the role of multimodal imaging in guiding optimal PCI strategies. By detailing this patient's course, this report contributes to the understanding and management of ISR in complex cardiovascular cases, offering insights into optimizing outcomes for high-risk populations.

Analysis of Tryptophan Metabolic Profile Characteristics and Clinical Value in Differentiated Thyroid Cancer Patients

BACKGROUND

Differentiated thyroid cancer (DTC) is the primary subtype of thyroid cancer. Timely diagnosis and intervention are crucial for improving prognosis and survival. However, the effectiveness of existing serum markers is limited, necessitating the discovery of new biomarkers.

METHODS

This study utilized liquid chromatography-tandem mass spectrometry to analyze tryptophan metabolic profiles in serum samples from 105 DTC patients and 50 healthy controls. Independent predictors of DTC were identified through univariate intergroup comparisons and multivariate logistic regression analysis, leading to the development and validation of a new diagnostic model.

RESULTS

Significant differences were observed in 11 tryptophan metabolites between DTC patients and controls. Logistic regression identified nicotinamide, 3-hydroxyanthranilic acid, 5-hydroxytryptophan, melatonin, and indole-3-propionic acid as independent predictors. The nomogram prediction model was established based on these five metabolites, and according to the Hosmer-Lemeshow test, the model showed good fit. The five-metabolite diagnostic model demonstrated 84.8% sensitivity, 90.0% specificity, and an area under the ROC curve of 0.932. Decision curve analysis indicated that the model had significant advantages over serum thyroglobulin.

DISCUSSION

Tryptophan metabolism exhibits distinct changes in DTC patients, with specific metabolites serving as early diagnostic markers. The five-metabolite panel demonstrates potential for improving early detection and management of DTC.

Mediating role of organized sports participation on the relationship between body fatness and arterial wall thickness among adolescents: ABCD Growth Study

BACKGROUND

Participation in sports is the main manifestation/subdomain of physical exercise in adolescents and affects cardiovascular health in different ways.

OBJECTIVES

To analyze the relationship between body fatness and arterial wall thickness as well as the mediating role of sports participation in this relationship among adolescents.

METHODS

This cross-sectional study is linked to the ABCD-Growth Study conducted in Presidente Prudente, Brazil. The study sample included 402 adolescents (275 boys and 127 girls) aged 11-17 years recruited from schools (non-sport group) and sports clubs (sports group). Sex-stratified multivariate model was created using structural equation modelling (SEM) with carotid (CIMT) and femoral arterial wall thickness (FIMT) as dependent variables were assessed by an ultrasound device. Body fatness percentage (BF) as the independent variable and was assessed by whole-body dual-energy X-ray absorptiometry, and sports participation as a moderator was assessed by face-to-face interviews. The maturity offset and dyslipidemia were treated as confounders in the mediation models.

RESULTS

In girls, body fatness was positively associated with FIMT (r = 0.210 [95%CI: 0.035; 0.372]) but not with CIMT (r= -0.148 [95%CI: -0.314; 0.027]), whereas sports participation was not associated with vascular structure. In boys, body fatness was inversely related to CIMT (r= -0.285 [95%CI: -0.390; -0.172]) and positively to FIMT (r = 0.129 [95%CI: 0.011; 0.244]), whereas sports participation was inversely related to FIMT (r= -0.142 [95%CI: -0.256; -0.024]). Among boys, sports participation mediated 7.4% of the relationship between body fatness and FIMT, and the association between body fatness and FIMT remained significant (r = 0.168 [95%CI: 0.037; 0.299]).

CONCLUSIONS

Sports participation mediates the relationship between BF and arterial thickness in adolescent boys.

From Pathophysiology to Treatment: The Role of Ferroptosis in PCOS

Polycystic ovary syndrome (PCOS) is a prevalent gynecological endocrine and metabolic disorder in women, with an incidence rate of 10-13%. The etiology of PCOS is multifaceted, involving genetic predisposition, environmental influences, lifestyle factors, and endocrine metabolic dysregulation. Iron, a critical mineral, not only plays a role in regulating female physiological functions and the progression of PCOS but also requires careful management to avoid deficiency. However, excess iron can trigger ferroptosis, a form of nonapoptotic cell death characterized by the accumulation of lipid peroxides. While numerous studies have explored ferroptosis in patients with PCOS and animal models, the precise mechanisms and therapeutic implications remain inadequately understood. This review seeks to elucidate the pathophysiology of PCOS and the contributory factors of ferroptosis. Additionally, we examine the diverse manifestations of ferroptosis in PCOS and evaluate its role. Furthermore, we introduce ferroptosis-related traditional Chinese medicines that may enhance the understanding of PCOS pathogenesis and aid in the development of targeted therapies for ferroptosis in PCOS.

Cardioprotective Effects of Dapagliflozin and Trimetazidine on Doxorubicin-Induced Cardiotoxicity in Streptozotocin-Induced Type 1 Diabetic Rats via Endoplasmic Reticulum Stress

Background/Objectives: Diabetic cardiomyopathy is a distinct myocardial dysfunction characterized by structural and functional changes in the heart that occur in diabetic patients independently of coronary artery disease or hypertension. It is closely associated with oxidative stress, inflammation, mitochondrial dysfunction, and endoplasmic reticulum (ER) stress, and contributes to progressive cardiac damage. This study aimed to evaluate the cardioprotective effects of dapagliflozin (DAPA) and trimetazidine (TMZ) in a rat model of doxorubicin-induced cardiomyopathy with streptozotocin-induced diabetes, focusing on their potential mechanisms related to ER stress. Methods: A total of 48 Sprague Dawley rats aged 6-8 weeks were randomly distributed equally into six cages. The diabetes model was induced by intraperitoneal administration of streptozotocin (STZ) and rats with blood glucose levels above 250 mg/dL were considered diabetic. For those rats with diabetes, cardiotoxicity was induced by intraperitoneal injection of 5 mg/kg/week doxorubicin (DOXO) for 4 weeks. After a cumulative dose of 20 mg/kg doxorubicin, a week break was given, followed by the administration of TMZ (10 mg/kg) and/or DAPA (10 mg/kg) to the treatment groups. Results: STZ administration caused diabetes and significant degeneration in cardiomyocytes. With the addition of DOXO (STZ + DOXO), cardiomyocyte degeneration became more severe. When the study groups were histopathologically evaluated based on parameters of degenerative cardiomyocytes, vascular congestion, and edema, it was shown that both TMZ and DAPA, whether applied alone or in combination, reduced damage in heart tissue. Both TMZ and DAPA reduced cardiomyocyte damage, and their combination provided the lowest level of damage through the reduced ER stress pathway by reducing GRP 78 and CHOP positivity. Conclusions: TMZ and DAPA reduce ER stress and have protective effects against diabetic-induced cardiotoxicity. Combination therapy or TMZ was found to be more effective than DAPA in alleviating ER stress. Combination therapy appears to carry potential effects for reducing cardiac cell damage in individuals with diabetes.

The Association of Statin Therapy with Liver and Pancreatic Fat Fraction in Type 2 Diabetes Mellitus

Background/Objectives: It has been shown that the use of statins in patients with type 2 diabetes mellitus (T2DM) worsens hyperglycemia and hemoglobin A1c levels but may help in the preservation of pancreatic β-cell function. The potential role of a high pancreatic fat fraction (PFF) in this process has not yet been clarified. This study aimed to investigate whether the liver fat fraction (LFF) and PFF in T2DM patients is affected by statin therapy. Methods: This cross-sectional study involved a total of 140 T2DM patients, including both those who were receiving (n = 70) and those who were not receiving (n = 70) statin therapy. The mapping of the LFF and PFF utilizing the IDEAL-IQ sequence was conducted in magnetic resonance imaging. Results: In T2DM patients who used statins, the median PFF was higher compared to those who did not use statins (8.4 vs. 6.2%, p = 0.021), while the median LFF was found to be similar (8.4 vs. 8.9, p = 0.572). Variations in PFF were associated with the use of various statins (non-statin group: 6.2 vs. atovastatin: 8.7 vs. rosuvastatin: 3.2 vs. pitavastatin: 9.2, p = 0.004). The multivariable regression analysis indicated that insulin usage decreased log(LFF) by a factor of 0.16-fold (ꞵ ± SE = -0.16 ± 0.05, p = 0.010), and rosuvastatin usage reduced log(PFF) by 0.16-fold (ꞵ ± SE = -0.16 ± 0.07, p = 0.025), irrespective of other risk factors. Furthermore, the use of atorvastatin (ꞵ ± SE = 0.17 ± 0.06, p = 0.011) and pitavastatin (ꞵ ± SE = 0.19 ± 0.07, p = 0.008) were independently associated with an increase in log(PFF). Conclusions: In patients with T2DM, statin use did not show a significant effect on the liver fat fraction, but it caused differences in the pancreatic fat fraction. The observation of a lower pancreatic fat fraction in patients taking a rosuvastatin and atorvastatin dose of 40 mg/day suggests that different types and doses of statins may have varying effects on pancreatic fat accumulation.

Effects of Weight Loss on Endothelium and Vascular Homeostasis: Impact on Cardiovascular Risk

Available knowledge shows that obesity is associated with an impaired endothelial function and an increase in cardiovascular risk, but the mechanisms of this association are not yet fully understood. Adipose tissue dysfunction, adipocytokines production, along with systemic inflammation and associated comorbidities (e.g., diabetes and hypertension), are regarded as the primary physiological and pathological factors. Various strategies are now available for the control of excess body weight. Dietary regimens alone, or in association with bariatric surgery when indicated, are now widely used. Of particular interest is the understanding of the effect of these interventions on endothelial homeostasis in relation to cardiovascular health. Substantial weight loss resulting from both diet and bariatric surgery decreases circulating biomarkers and improves endothelial function. Extensive clinical trials and meta-analyses show that bariatric surgery (particularly gastric bypass) has more substantial and long-lasting effect on weight loss and glucose regulation, as well as on distinct circulating biomarkers of cardiovascular risk. This review summarizes the current understanding of the distinct effects of diet-induced and surgery-induced weight loss on endothelial function, focusing on the key mechanisms involved in these effects.

CALML6 as a potential diagnostic marker for thyroid cancer promotes thyroid cancer cell proliferation via modulating the immune microenvironment

PURPOSE

CALML6 is an inflammation-related gene, and its expression may be associated with cancer. Here we evaluated the role of CALML6 expression in papillary thyroid carcinoma (PTC).

METHODS

We utilized databases such as The Cancer Genome Atlas (TCGA), Genotype-Tissue Expression Project (GTEx) and UALCAN to evaluate the relationship between CALML6 expression and clinicopathological features in thyroid cancer. Immunohistochemical assays were used to observe CALML6 expression in thyroid cancer tissues. The role of CALML6 in PTC cells was investigated using RNA interference.

RESULTS

We found CALML6 expression was lower than normal and associated with extrathyroidal extension, lymph node metastasis, pathological T stage, tall cell PTC and the expressions of immune checkpoint genes CD274 and PDCD1LG2 in THCA. Additionally, Immunohistochemical staining showed that CALML6 expression was significantly upregulated in thyroid cancer tissues. RNAi analysis showed that CALML6 knockdown significantly reduced cell growth and blocked the cell cycle of PTC cells.

CONCLUSIONS

Our results suggest that CALML6 may be a novel diagnostic marker for PTC that is closely associated with the invasive and tall cell subtypes, and it may be a potential target for immunotherapy.

Higher oxidative balance score is associated with a decreased risk of infertility: an analysis of NHANES 2013-2020

Background

Oxidative stress plays a crucial role in the female reproductive system. The oxidative balance score (OBS) is a new measure for assessing the balance between antioxidant and pro-oxidative factors in diet and lifestyle. However, limited studies have explored the relationship between OBS and infertility.

Methods

We performed a cross-sectional study including 2,664 women aged 20-45 years, based on data from the 2013-2020 National Health and Nutrition Examination Survey (NHANES). The OBS was derived from 16 dietary components and 4 lifestyle factors. We used multivariate logistic regression analysis to examine the association between OBS and infertility.

Results

The analysis revealed a significant negative association between higher OBS and infertility risk, with an odds ratio (OR) of 0.98 (95% CI, 0.95-1.00) after full adjustment. Compared to the first quartile of OBS, the second, third, and fourth quartiles showed ORs of 0.71 (95% CI, 0.45-1.11), 0.79 (95% CI, 0.51-1.22), and 0.57 (95% CI, 0.35-0.92), respectively. Similarly, women in the highest dietary OBS and lifestyle OBS quartiles had a lower infertility risk compared to those in the lowest quartiles, with ORs of 0.60 (95% CI, 0.39-0.94) and 0.54 (95% CI, 0.32-0.93), respectively. Furthermore, subgroup analysis indicated that the association between the fourth quartile of OBS and infertility remained consistent, except among women with other ethnicities-including multi-racial, and college graduate or higher.

Conclusion

These findings suggest that high dietary OBS and lifestyle OBS are associated with a lower risk of infertility.

Association between impaired brachial flow-mediated dilation and early neurological deterioration in acute ischemic stroke: a retrospective analysis

BACKGROUND

Early neurological deterioration (END) occurs in individuals who had experienced acute ischemic stroke (AIS), impacting long-term functional outcomes. We aimed to investigate the association between endothelial function, measured via flow-mediated dilation (FMD), and END in patients with AIS.

METHODS

We retrospectively reviewed patients who had experienced AIS within 7 days of stroke onset and underwent FMD assessments during their hospitalization (%FMD = Peak diameter - baseline diameter)/baseline diameter x 100). END was defined as ≥ 2-point increase in the National Institutes of Health Stroke Scale total score or ≥ 1-point increase in the motor score within 72 h post-stroke. Through multivariate analysis, we examined factors associated with END and explored the relationship between FMD and END with considering stroke mechanisms.

RESULTS

Among 1,262 patients diagnosed with AIS, 184 (14.6%) experienced END. Those with END were on average older (69 ± 13 vs. 67 ± 13 years; P = 0.033), had a higher prevalence of stroke history (21.2 vs. 12.9%; P = 0.003), and lower FMD (5.0 ± 1.8 vs. 5.4 ± 2.2%; P = 0.029). Multivariate analysis revealed that a history of stroke (adjusted odds ratio [aOR] = 1.728; 95% confidence interval [CI] 1.159-2.578; P = 0.007) and low % were independently associated with END. Subgroup analysis revealed that low %FMD was significantly associated with END within the small vessel disease (SVD) category (aOR = 0.789; 95% CI 0.679-0.920; P = 0.002).

CONCLUSIONS

Impaired FMD may be associated with END, particularly within the context of SVD.

Correlation between impaired brachial flow-mediated dilation and hemorrhagic transformation after acute reperfusion therapy

OBJECTIVE

Hemorrhagic transformation (HT) represents a critical complication of reperfusion therapy, often resulting in unfavorable functional outcomes. Our objective was to explore the correlation between endothelial function, assessed through flow-mediated dilation (FMD), and the occurrence of HT in patients undergoing acute reperfusion therapy.

MATERIALS AND METHODS

In our retrospective analysis, we investigated patients with emergent large vessel occlusion (ELVO) who underwent acute reperfusion therapy and assessment through FMD, calculated as %FMD = (peak diameter - baseline diameter)/baseline diameter×100. HT was categorized according to the European Cooperative Acute Stroke Study (ECASS) definition. Through multivariate analysis, we explored factors associated with HT, considering stroke mechanisms, and delved into the relationship between FMD and HT.

RESULTS

A total of 172 patients were included in this study, with 45.3% experiencing HT. Factors associated with HT included high initial National Institute of Health Stroke Scale (NIHSS) scores [7 (5-10) vs. 10 (8-14); P <0.001], receiving tissue plasminogen activator (tPA) (21.3 vs. 39.7%; P<0.001), undergoing endovascular therapy (EVT) 10.6 vs. 26.9%; P <0.001), and impaired %FMD (6.2±2.5 vs. 4.9±1.8; P = 0.022). In a subgroup analysis of patients with cardioembolism, receiving EVT was significantly associated with HT (reference: tPA only; adjusted odds ratio [aOR] = 7.000; 95% confidence interval, 1.173-41.759; P = 0.033). In those with large artery atherosclerosis (LAA), a higher initial NIHSS score (aOR = 1.274; 1.082-1.499; P = 0.004) and impaired %FMD (aOR = 0.632; 0.402-0.995; P = 0.047) were independently associated with HT.

CONCLUSIONS

Endothelial dysfunction, indicated by impaired %FMD, emerges as a potential predictor of HT following acute reperfusion therapy, particularly in patients with LAA.

FTO rs17817449 Variant Increases the Risk of Severe Obesity in a Brazilian Cohort: A Case-Control Study

Purpose

Obesity is a complex disease caused by a combination of genetic, environmental, and epigenetic factors, and is associated with an increased risk of chronic diseases. The leptin-melanocortin pathway integrates peripheral signals about the body's energy stores with a central neuronal circuit in the hypothalamus. This pathway has been extensively studied over the years, as genetic variations in genes related to it may play a crucial role in determining an individual's susceptibility to obesity. Therefore, we analyzed the association between obesity and specific polymorphisms in leptin-melanocortin-related genes such as LEPR rs1137101, POMC rs1042571, LEP rs7799039, BDNF rs6265, FTO rs17817449, CART rs121909065, and NPY rs16147/rs5574.

Patients and Methods

The study enrolled 501 participants from Rio de Janeiro, Brazil, with obesity class II or greater (BMI ≥ 35 kg/m2) and normal weight controls (18.5≤ BMI ≤24.9 kg/m2). We collected demographic, body composition, biochemical, and genotyping data by real-time PCR, and performed logistic and linear regression analyses to investigate the association of polymorphisms with severe obesity status and obesity-related quantitative parameters.

Results

Individuals with severe obesity had significantly higher anthropometric measures, blood pressure, and biochemical levels. The FTO rs17817449 TT genotype was associated with a significantly higher risk of developing severe obesity, and distinct cytokine expression was observed across the FTO rs17817449 genotypes. The BDNF rs6265 dominant-model and NPY rs16147 CC genotypes were associated with triglyceride levels and childhood obesity, respectively. Finally, individuals with obesity were more likely to carry a greater number of risk alleles than those without obesity.

Conclusion

Our study observed an important association between FTO rs17817449 polymorphism with obesity and obesity-related traits. Additionally, BDNF rs6265 dominant-model was associated with triglyceride serum levels, and NPY rs16147 may have a role in obesity onset.

Revascularization of Chronic Total Occlusions vs. Planned Complex Percutaneous Coronary Intervention: Long-Term Outcomes and Mortality

Introduction: The number of chronic total occlusion (CTO) revascularization procedures has continuously increased, obtaining better results in recent years. However, there are few data regarding long-term outcomes and no comparisons to planned complex non-CTO percutaneous coronary intervention (PCI). Methods: We included all patients undergoing planned complex PCI. Our main objective was to compare a combined endpoint of all-cause death, myocardial infarction, and target vessel revascularization at the long-term follow-up of CTO PCI versus planned complex non-CTO PCI. We compared the groups using multivariable Cox regression and performed a propensity score matching analysis to control the baseline characteristics. We repeated the analysis for the separate components of the primary endpoint. Results: From January 2018 to June 2023, 1394 complex coronary PCIs were performed at our center. After excluding 393 non-planned cases, 201 CTO PCIs and 800 non-CTO PCIs were included. The mean follow-up was 2.5 ± 1.5 years. The composite endpoint occurred in 23 (11.6%) CTO PCIs and 219 (28.2%) planned non-CTO PCIs. The multivariable Cox regression using the CTO group as the reference showed a lower risk for the primary outcome (HR: 0.59; 95% CI 0.37-0.95; p = 0.031). After matching, a total of 195 adequately balanced pairs were obtained. The CTO group presented a lower risk for the primary combined outcome (HR: 0.46; 95% CI 0.27-0.76; p = 0.003). Conclusions: In patients undergoing planned complex PCI, those in the CTO group presented a reduced risk of all-cause death, myocardial infarction, and target vessel revascularization at the end of the follow-up.

Integrating frailty interventions into existing care models: a comprehensive approach to enhancing patient outcomes in chronic disease management

Frailty syndrome (FS) is a complex and multifaceted condition commonly observed in old adults patients with chronic diseases, often accompanied by cognitive impairments. This review explores the integration of frailty interventions into existing care models to improve patient outcomes, focusing on four key areas. First, it emphasizes the importance of comprehensive assessment tools to identify frailty and cognitive impairments early, facilitating targeted care planning. Second, it highlights the value of personalized interventions, such as dietary modifications, exercise programs, and cognitive training, tailored to individual patient needs and preferences. Third, the review underscores the critical role of multidisciplinary care teams in providing holistic and coordinated care, leveraging the expertise of diverse healthcare professionals. Finally, it examines the potential of technological innovations and caregiver support systems in enhancing frailty management and addressing the challenges posed by cognitive impairments. By integrating these approaches, this review presents a patient-centered framework aimed at mitigating the impact of frailty and improving long-term outcomes. The findings emphasize the need for a unified strategy that combines personalized care, interdisciplinary collaboration, and technological advancements to address the multifaceted challenges of frailty in chronic disease management.

Relationship of Thyroid Volume and Function with Carotid and Femoral Intima-Media Thickness in Euthyroid People Aged 18-65 Taking into Account the Impact of Diabetes, Hypertension, and Excess Body Mass

Background/Objectives: The interrelationship of thyroid volume and function with features of cardiovascular dysfunction has already been investigated but some aspects remain unclear, especially in terms of subclinical cardiovascular dysfunction in euthyroid patients. Intima-media thickness (IMT) measurement in ultrasound B-mode imaging in different vascular beds (most frequently within the common carotid artery) is one of the most important tools for the detection of subclinical atherosclerosis in both clinical practice and research. This article aimed to present the results of our research on the association between the thyroid evaluation parameters and the IMT measured in both the carotid and femoral arteries in euthyroid patients aged 18 to 65 years taking into account the influence of diabetes, hypertension, and excess body mass. Methods: We performed a retrospective cross-sectional analysis of data from patients with no thyroid disease who during planned hospitalization underwent thyroid ultrasound, determination of biochemical parameters of thyroid function, and Doppler ultrasound of carotid, vertebral, and lower extremities arteries with IMT measurement. Data from 45 people (females: 57.8%) were analyzed. Results: No significant correlations were found between biochemical parameters of thyroid function and IMT parameters. Thyroid volume was found to be significantly correlated with all parameters of the IMT within the superficial femoral artery (R = 0.407, p = 0.007 for the mean IMT calculated from the left side and the right side) and with minimal IMT within the common femoral artery taken from the left side and the right side (R = 0.342, p = 0.025). Selected IMT parameters were shown to be significantly higher in patients with arterial hypertension, diabetes, obesity, or metabolic syndrome in comparison to patients without the mentioned comorbidities. Using multiple linear regression, it was confirmed that parameters related to thyroid status do not significantly affect the IMT value. A significant effect of diabetes and, to a lesser extent, hypertension on the IMT value was confirmed, especially in the femoral arteries. Conclusions: In the population of euthyroid patients, thyroid volume correlates significantly with some parameters of femoral IMT. No significant correlations were found between thyroid biochemical parameters and IMT in both carotid and femoral arteries. A significant influence of diabetes and hypertension on the IMT value was confirmed, especially in the femoral arteries.

Excessive Weight Gain During Pregnancy Increased Ponoxarase 1 Level in Neonatal Cord Blood

Maternal obesity is increasingly recognized as a risk factor for adverse fetal outcomes, primarily through its association with heightened oxidative stress. This study aimed to evaluate oxidative stress markers in umbilical cord blood of neonates born to obese mothers. Sixty-three pregnant women, who were of normal weight at the start of pregnancy but classified as obese at term, were included. Umbilical cord blood samples were collected immediately post-delivery and analyzed for serum oxidative stress markers (total oxidant status (TOS), total antioxidant status (TAS), paraoxanase (PON), aryl esterase, thiol, and catalase activities). Protein interaction networks were generated using Cytoscape (v3.10.3), and the overlapping proteins were further analyzed for functional annotations with ShinyGO (0.80). The top ten significantly enriched pathways were identified with a false discovery rate (FDR) threshold of <0.05. Significant associations were found between maternal BMI change and paraoxonase 1 (PON1) levels in umbilical cord blood, while no correlation was observed with other oxidative (total oxidant status) and antioxidant markers (total antioxidant status, aryl esterase, thiol, and catalase). Additionally, the correlation analysis showed a significant relationship between BMI change and fetal gestational age, but not with other demographic or clinical features. A total of 24 common protein interactors associated with PON1, obesity, and oxidative stress were identified. Functional annotation analysis revealed significant enrichment in antioxidant and oxidoreductase activities, along with pathways involved in insulin resistance, AGE-RAGE signaling, and atherosclerosis. Maternal obesity may specifically affect PON1 activity, potentially serving as a compensatory response to oxidative stress in neonates, suggesting PON1 as a possible biomarker for oxidative stress-related metabolic disturbances in neonates of obese mothers, with implications for monitoring and managing pregnancy outcomes in obese populations.

Herbal Medicines as Complementary Therapy for Managing Complications in COVID-19 Patients with Diabetes Mellitus

Diabetes mellitus (DM) is recognized and classified as a group of conditions marked by persistent high blood glucose levels. It is also an inflammatory condition that may influence concurrent disease states, including Coronavirus Disease 2019 (COVID-19). Currently, no effective drug has been found to treat COVID-19, especially in DM patients. Many herbal medicines, such as the well-known Andrographis paniculata, have been explored as drugs and complementary therapies due to their antidiabetic, antibacterial, antiviral, anti-inflammatory, and immunomodulatory effects. This study aimed to examine the potential of herbal medicines as complementary therapy in DM patients with COVID-19 complications, drawing from in-vitro and in-vivo investigations. This study analyzed articles published within the last 15 years using keywords including "herbal medicines", "COVID-19", "Diabetes Mellitus", "antidiabetics", "antiviral", and "anti-inflammatory". The results showed that several herbal medicines could serve as complementary therapy for DM patients with COVID-19 complications. These include Andrographis paniculata, Ageratum conyzoides, Artocarpus altilis, Centella asiatica, Momordica charantia, Persea gratissima, Phyllanthus urinaria, Physalis angulata, Tinospora cordifolia, and Zingiber zerumbet. Herbal medicines may serve as a complementary therapy for DM patients with COVID-19, but these claims need experimental validation in infection models and among affected patients.

Association of the Triglyceride-Glucose Index and Obesity Indicators with Multiple Chronic Diseases: A Longitudinal Cohort Study Based on CHARLS

Objective

To explore the relationship between triglyceride glucose (TyG) and the obesity combined indexes and the occurrence of multiple chronic diseases (MCD), which will help to provide a basis for the prevention and treatment of this condition.

Methods

3037 participants in the China Health and Retirement Longitudinal Study, which was conducted from 2011 to 2015 were selected for this study. They were divided into four groups (Q1, Q2, Q3, Q4) based on the quartiles of TyG, TyG-BMI, TyGWC and TyGWHtR in the baseline data. A Cox proportional hazard model was used to analyze the risk of MCD associated with TyG and its obesity-related combined indicators. Dose-response relationships were analyzed using restricted cubic spline regression, and the predictive ability for detection of MCD was analyzed using ROC curve.

Results

At the end of the follow-up in 2015, 473 new cases of MCD were observed among the study population, with an incidence rate of 15.6%. After adjusting for confounding factors, the risk of MCD significantly increased in the Q4 TyG, TyG-BMI, TyG-WC and TyG-WHtR index groups compared to the Q1 groups (p<0.001 in all cases). A linear dose-response relationship was observed between the TyG index and the risk of MCD, indicating increased risks of CKD with higher TyG indexes. However, the TyG-BMI, TyG-WC and TyG-WHtR indexes exhibited nonlinear dose-response relationships with the risk of MCD (P-nonlinearity <0.0001 in all cases), indicating higher indexes were associated with higher risks of MCD. The areas under the ROC curves for the Cox regression models of TyG, TyG-BMI, TyG-WC and TyG-WHtR indices were 0.610, 0.590, 0.590 and 0.607, respectively.

Conclusion

The TyG, TyG-BMI, TyG-WC and TyG-WHtR indexes were found to be positively correlated with increased risk of developing MCD. Measurements and regulation of these indexes can be used to prevent and control the occurrence of MCD.

Endothelial Dysfunction and Oxidative Stress in Patients with Severe Coronary Artery Disease: Does Diabetes Play a Contributing Role?

Background and Objectives: Endothelial dysfunction (ED) and oxidative stress play major contributions in the initiation and progression of atherosclerosis. Diabetes is a pathological state associated with endothelial damage and enhanced oxidative stress. This study evaluated endothelial dysfunction and oxidative stress in patients with severe coronary artery disease (CAD) undergoing coronary artery bypass graft (CABG) surgery, comparing those with and without type 2 diabetes mellitus (T2DM). Materials and Methods: We included 84 patients with severe coronary artery disease (33 of whom had type 2 diabetes mellitus) who underwent clinical assessments, ultrasound, and coronaryangiography. The SYNTAXI score was calculated from the coronaryangiogram. Blood samples were collected to measure plasma serotonin (5-HT; SER) levels, as well as levels of superoxide dismutase 1(SOD-1) and lectin-like oxidized low-density lipoprotein receptor-1(LOX-1) to assess oxidative stress. Brachial flow-mediated dilation (FMD) was used as a surrogate for endothelial dysfunction (ED),along with serum concentrations of 5-HT. Results: The coronary atherosclerotic burden, assessed using the SYNTAX I score, was more severe in patients with CAD and associated T2DM compared to those with CAD without T2DM (30.5 (17-54) vs. 29 (17-48); p = 0.05). The SYNTAX score was found to be positively correlated with T2DM (p = 0.029; r = 0.238).ED measured by FMD was associated with T2DM (p = 0.042; r = -0.223), with lower FMD measurements in T2DM patients when compared with individuals without this pathology (2.43% (0.95-5.67) vs. 3.46% (1.02-6.75); p = 0.079). Also, in the studied population, T2DM was correlated with serum 5-HT levels (764.78 ± 201 ng/mL vs. 561.06 ± 224 ng/mL; p < 0.001; r = 0.423), with higher plasma circulating levels of 5-HT in patients with T2DM. No statistically significant differences for oxidative stress markers (SOD-1 and LOX-1) were obtained when comparing T2DM and non-T2DM patients with severe CAD. Conclusions: ED (as assessed by brachial FMD and serum 5-HT) is more severe in in diabetic patients with severe CAD scheduled for CABG surgery, while oxidative stress (as evaluated through serum SOD-1 and LOX-1 concentrations) was not influenced by the presence of T2DM in this specific population. The most important finding of the present study is that circulating 5-HT levels are markedly influenced by T2DM. 5-HT receptor-targeted therapy might be of interest in patients undergoing CABG, but further studies are needed to confirm this hypothesis.

Inflammation mediates the adverse effects of urinary phthalate exposure on metabolic disease risk: Results from NHANES 2005-2016

BACKGROUND

Phthalates are a category of chemicals commonly utilized in various industrial applications and everyday products. Their associations with health issues remains a significant concern. Although some studies have suggested associations between phthalates and metabolic diseases, the current understanding of the associations is still limited, especially the lack of effects of mixed exposure.

METHODS

This cross-sectional study included information from 9217 participants in National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016. Multivariate logistic regression was used to explore the associations between single phthalate exposure and obesity and its complications. Weighted quantile sum (WQS) regression and Quantile G-Computation (Qgcomp) models were used to further analyze the associations between mixed phthalate exposure and obesity and its complications. Mediated analysis was used to explore the mediating role of immune cells in the relationship between phthalate exposure and obesity and its complications.

RESULTS

MiBP, MCOP and MBzP were associated with an increased risk of obesity. MiBP and MCOP were associated with an increased risk of abdominal obesity. MCNP, MCOP, MEHHP, MEOHP and MECPP were positively associated with T2DM. Mixed phthalate exposure was positively associated with obesity and T2DM. Monocytes mediated the effects of MiBP, MEHP and MBzP on obesity, explaining 7.94 %, -2.32 % and 6.69% of the total effect, respectively.

CONCLUSIONS

This study revealed a significant association between mixed phthalate exposure and obesity and its complications, underlining the importance of considering the interactions of these compounds. The synergistic effects of multiple phthalates may exacerbate health risks.

Cardiometabolic Aspects of Congenital Adrenal Hyperplasia

Treatment of classic congenital adrenal hyperplasia (CAH) is directed at replacing deficient hormones and reducing androgen excess. However, even in the era of early diagnosis and lifelong hormonal substitution, the presence of CAH is still associated with numerous complications and also with increased mortality. The aim of this article was to create an authoritative and balanced review concerning cardiometabolic risk in patients with CAH. The authors searched all major databases and scanned reference lists of all potentially eligible articles to find relevant articles. The risk was compared with that in other forms of adrenal insufficiency. The reviewed articles, most of which were published recently, provided conflicting results, which can be partially explained by differences in the inclusion criteria and treatment, small sample sizes, and gene-environment interactions. However, many studies showed that the presence of CAH is associated with an increased risk of weight gain, worsening of insulin sensitivity, high blood pressure, endothelial dysfunction, early atherosclerotic changes in the vascular wall, and left ventricular diastolic dysfunction. These complications were more consistently reported in patients with classic than nonclassic CAH and were in part related to hormonal and functional abnormalities associated with this disorder and/or to the impact of overtreatment and undertreatment. An analysis of available studies suggests that individuals with classic CAH are at increased cardiometabolic risk. Excess cardiovascular and metabolic morbidity is likely multifactorial, related to glucocorticoid overtreatment, imperfect adrenal hormone replacement therapy, androgen excess, and adrenomedullary failure. Cardiometabolic effects of new therapeutic approaches require future targeted studies.