How Health Systems World-wide Fail Type 2 Diabetics

For over 50 years, health systems the world over have failed people with type 2 diabetes mellitus (T2DM). The WHO documents a quadrupling of people with diabetes in a 34-year period to 422 million in 2014, the overwhelming majority of whom were T2DM. This happened despite extensive scientific literature on the causes of, as well as proven treatments for, this disease. Using a health systems prism to review the extensive medical and nutritional T2DM published research, we identified three main shortcomings of health systems in T2DM: (i) failure in early detection; (ii) failure in understanding the actionable lifestyle drivers; and (iii) subsidizing the causes of the disease. Although small-scale success stories in T2DM control exist, the lack of documented evidence of any country-wide health system's successful attempt to address this epidemic is alarming. The immense and ever-growing health and economic burdens of T2DM should provide all the motivation needed for national and global efforts to counteract the political-economy constraints standing in the way of successful whole-of-system approaches to T2DM.

Application of reverse cumulative distribution curve and scaled logit model in determining optimal immunogenic dose and prediction of protection of EV71 vaccines

BACKGROUND

This study proposes the reverse cumulative distribution curve (RCDC) for optimal dose selection and a scaled logit model for estimating protection in EV71 vaccine development.

RESEARCH DESIGN AND METHODS

Data were from a phase 2 trial involving infants and young children randomized to receive either 640 U with or without adjuvant, 320 U with adjuvant, 160 U with adjuvant EV71 vaccines, or placebo. RCDCs were constructed using neutralizing antibody titers 28 days post-vaccination. Robustness of RCDC parameters was assessed via coefficient of variation for the area under the curve (AUC), the relative optimal point, median on the curve, and antibody titer of the point of maximum curvature, with geometric mean titer (GMT) as control. The scaled logit model estimated protection against EV71-associated disease for the selected optimal dose.

RESULTS

The AUC and relative optimal point demonstrated greater robustness than GMT. The 640 U with adjuvant dose had the highest AUC (0.64, 95% CI: 0.61-0.66), sum of coordinates of the relative optimal point (1.40, 95% CI: 1.34-1.43), and the highest estimated protection (93.36%, 95% CI: 79.91-97.86).

CONCLUSIONS

AUC and relative optimal point of RCDC are effective for early vaccine dose screening, with protection estimated by the scaled logit model.

An integrative approach to identifying NPC1 as a susceptibility gene for gestational diabetes mellitus

OBJECTIVE

The objective of this study was to identify a novel gene and its potential mechanisms associated with susceptibility to gestational diabetes mellitus (GDM) through an integrative approach.

METHODS

We analyzed data from genome-wide association studies (GWAS) of GDM in the FinnGen R11 dataset (16,802 GDM cases and 237,816 controls) and Genotype Tissue Expression v8 expression quantitative trait locus data. We used summary-data-based Mendelian randomization to determine associations between transcript levels and phenotypes, transcriptome-wide association studies to provide insights into gene-trait associations, multi-marker analysis of genomic annotation to perform gene-based analysis, genome-wide complex trait analysis-multivariate set-based association test-combo to determine gene prioritization, and polygenic priority scores to prioritize the causal genes to screen candidate genes. Subsequent Mendelian randomization analysis was performed to infer causality between the candidate genes and GDM and phenome-wide association study (PheWAS) analysis was used to explore the associations between selected genes and other characteristics. Furthermore, to gain a deeper understanding of the functional implications of these susceptibility genes, GeneMANIA analysis was used to determine the fundamental biological functions of the therapeutic targets and protein-protein interaction network analysis was performed to identify intracellular protein interactions.

RESULTS

We identified two novel susceptibility genes associated with GDM: NPC1 and KIAA1191. Magnetic resonance imaging revealed a strong correlation between NPC1 expression levels and a lower incidence of GDM (odds ratio: 0.922, 95% confidence interval: 0.866-0.981, p = 0.011). PheWAS at the gene level indicated that NPC1 was not associated with any other trait. The biological significance of this gene was evidenced by its strong association with sterol metabolism.

CONCLUSION

Our study identified NPC1 as a novel gene whose predicted expression level is linked to a reduced risk of GDM, providing new insights into the genetic framework of this disease.

METTL14 Mediates Glut3 m6A methylation to improve osteogenesis under oxidative stress condition

OBJECTIVES

Bone remodeling imbalance contributes to osteoporosis. Though current medications enhance osteoblast involvement in bone formation, the underlying pathways remain unclear. This study was aimed to explore the pathways involved in bone formation by osteoblasts, we investigate the protective role of glycolysis and N6-methyladenosine methylation (m6A) against oxidative stress-induced impairment of osteogenesis in MC3T3-E1 cells.

METHODS

We utilized a concentration of 200 μM hydrogen peroxide (H2O2) to establish an oxidative damage model of MC3T3-E1 cells. Subsequently, we examined the alterations in the m6A methyltransferases (METTL3, METTL14), glucose transporter proteins (GLUT1, GLUT3) and validated m6A methyltransferase overexpression in vitro and in an osteoporosis model. The osteoblast differentiation and osteogenesis-related molecules and serum bone resorption markers were measured by biochemical analysis, Alizarin Red S staining, Western blot and ELISA.

RESULTS

H2O2 treatment inhibited glycolysis and osteoblast differentiation in MC3T3-E1 cells. However, when METTL14 was overexpressed, these changes induced by H2O2 could be mitigated. Our findings indicate that METTL14 promotes GLUT3 expression via YTHDF1, leading to the modulation of various parameters in the H2O2-induced model. Similar positive effects of METTL14 on osteogenesis were observed in an ovariectomized mouse osteoporosis model.

DISCUSSION

METTL14 could serve as a potential therapeutic approach for enhancing osteoporosis treatment.

Gut-derived lactic acid enhances tryptophan to 5-hydroxytryptamine in regulation of anxiety via Akkermansia muciniphila

The gut microbiota plays a pivotal role in anxiety regulation through pathways involving neurotransmitter production, immune signaling, and metabolic interactions. Among these, gut-derived serotonin (5-hydroxytryptamine, 5-HT), synthesized from tryptophan metabolism, has been identified as a key mediator. However, it remains unclear whether specific microbial factors regulate tryptophan metabolism to influence 5-HT production and anxiety regulation. In this study, we analyzed 110 athletes undergoing closed training and found that fecal lactate levels were significantly associated with anxiety indicators. We observed a significant negative correlation between Akkermansia abundance and anxiety levels in athletes. Co-supplementation with lactate and Akkermansia muciniphila (A. muciniphila) modulated tryptophan metabolism by increasing key enzyme TPH1 and reducing IDO1, thus shifting metabolism from kynurenine (Kyn) to 5-HT. In addition, lactate enhanced the propionate production capacity of A. muciniphila, potentially contributing to anxiety reduction in mice. Taken together, these findings suggest that enteric lactate and A. muciniphila collaboratively restore the imbalance in tryptophan metabolism, leading to increased 5-HT activity and alleviating anxiety phenotypes. This study highlights the intricate interplay between gut metabolites and anxiety regulation, offering potential avenues for microbiota-targeted therapeutic strategies for anxiety.

Transcriptome-wide study of mRNAs modified by m6A RNA methylation in the testis development of dairy goats

N6-methyladenosine (m6A) is an important epigenetic modification in RNA, playing a crucial role in regulating the production and aging of animal testicular sperm. This study extracted mRNA from the testicular tissue of male goats before and after sexual maturity, generating a methylation map through preliminary experiments and methylation immunoprecipitation sequencing. The results showed that during the development of dairy goats, the expression levels of marker genes related to testicular development and methylation-related enzymes changed significantly. A total of 36,602 peaks and 11,223 genes were identified in the two groups, including 2989 differential peaks (427 upregulated and 2562 downregulated) and 1457 differentially expressed genes (833 upregulated and 624 downregulated). The abundance of m6A was positively correlated with gene expression levels. This study reports for the first time the mRNA profiles of m6A modifications across the entire transcriptome during testicular development in Guanzhong dairy goats, providing a new perspective for genetic improvement in goats.

Stemness regulation in prostate cancer: prostate cancer stem cells and targeted therapy

BACKGROUND

Increasing evidence indicates that cancer stem cells (CSCs) and cancer stem-like cells form a special subpopulation of cells that are ubiquitous in tumors. These cells exhibit similar characteristics to those of normal stem cells in tissues; moreover, they are capable of self-renewal and differentiation, as well as high tumorigenicity and drug resistance. In prostate cancer (PCa), it is difficult to kill these cells using androgen signaling inhibitors and chemotherapy drugs. Consequently, the residual prostate cancer stem cells (PCSCs) mediate tumor recurrence and progression.

OBJECTIVE

This review aims to provide a comprehensive and up-to-date overview of PCSCs, with a particular emphasis on potential therapeutic strategies targeting these cells.

METHODS

After searching in PubMed and Embase databases using 'prostate cancer' and 'cancer stem cells' as keywords, studies related were compiled and examined.

RESULTS

In this review, we detail the origin and characteristics of PCSCs, introduce the regulatory pathways closely related to CSC survival and stemness maintenance, and discuss the link between epithelial-mesenchymal transition, tumor microenvironment and tumor stemness. Furthermore, we introduce the currently available therapeutic strategies targeting CSCs, including signaling pathway inhibitors, anti-apoptotic protein inhibitors, microRNAs, nanomedicine, and immunotherapy. Lastly, we summarize the limitations of current CSC research and mention future research directions.

CONCLUSION

A deeper understanding of the regulatory network and molecular markers of PCSCs could facilitate the development of novel therapeutic strategies targeting these cells. Previous preclinical studies have demonstrated the potential of this treatment approach. In the future, this may offer alternative treatment options for PCa patients.

L3-SMI as a predictor of overall survival in oesophageal cancer patients receiving PD-1 inhibitors combined with chemotherapy

BACKGROUND

Programmed death ligand-1 (PD-1), as an immunotherapy target, has been increasingly used in tumour therapies. But as reactions and outcomes to PD-1 inhibitors combined with chemotherapy vary individually, it is primarily important to identify an ideal indicator for predicting the therapeutic effectiveness in individual patients. Oesophageal cancer (EC) patients often have difficulty eating due to tumour blockage of the oesophagus, leading to malnutrition and muscle loss. Sarcopenia is one of the influencing factors for poor prognosis in tumour patients, but its role in PD-1 inhibitors combined with chemotherapy of EC patients is not fully clarified. In this study, we aimed to explore the prognostic significance of Sarcopenia measured by CT in EC patients treated with PD-1 antibody combined with chemotherapy.

METHODS

The third lumbar skeletal muscle mass index (L3-SMI) was obtained from 83 EC patients before and 3 months after administration of PD-1 inhibitors combined with chemotherapy using conventional CT scans.

RESULTS

Baseline L3-SMI and 3-month L3-SMI values were found not suitable for predicting the overall survival (OS) of EC patients (p = 0.32 & p = 0.055). Longitudinal change in L3-SMI (ΔL3-SMI) during PD-1 inhibitors combined with chemotherapy was identified as a relevant marker of OS in univariable analysis (HR: 0.98, 95% CI: 0.96-1.00, p = 0.042) and multivariable analysis (HR: 0.96, 95% CI: 0.93-0.99, p = 0.02). L3-SMI-positive patients generally had better OS (p = 0.041).

CONCLUSION

Excessive muscle loss rather than muscle loss before and after administration of PD-1 inhibitors combined with chemotherapy is an important prognostic factor for therapeutic outcomes and OS in EC patients.

Creatine-mediated ferroptosis inhibition is involved in the intestinal radioprotection of daytime-restricted feeding

Ionizing radiation-induced intestinal injury (IRIII) is a catastrophic disease lack of sufficient medical countermeasures currently. Regulation of the gut microbiota through dietary adjustments is a potential strategy to mitigate IRIII. Time-restricted feeding (TRF) is an emerging behavioral nutrition intervention with pleiotropic health benefits. Whether this dietary pattern influences the pathogenesis of IRIII remains vague. We evaluated the impact of TRF on intestinal radiosensitivity in this study and discovered that only daytime TRF (DTRF), not nighttime TRF, could ameliorate intestinal damage in mice that received a high dose of IR. Faecal metagenomic and metabolomic studies revealed that the intestinal creatine level was increased by approximate 9 times by DTRF, to which the Bifidobacterium pseudolongum enrichment contribute. Further investigations showed that creatine could activate the energy sensor AMP-activated protein kinase in irradiated enterocytes and induce phosphorylation of acetyl-CoA carboxylase, resulting in reduced production of polyunsaturated fatty acids and reduced ferroptosis after IR. The administration of creatine mitigated IRIII and reduced bacteremia and proinflammatory responses. Blockade of creatine import compromised the ferroptosis inhibition and mitigation of DTRF on IRIII. Our study demonstrates a radioprotective dietary mode that can reshape the gut microbiota and increase intestinal creatine, which can suppress IR-induced ferroptosis, thereby providing effective countermeasures for IRIII prevention.

Evaluation of the evidence-based practices for the management of PCOS in the Latin America context: the consensus of the Latin American Association of Gynecological Endocrinology (ALEG)

OBJECTIVES

Polycystic Ovary Syndrome (PCOS) is a complex condition affecting approximately 1 in 10 women of reproductive age. However, limited data are available regarding the specific characteristics and needs of women with PCOS in Latin America. This consensus sought to evaluate the evidence-based practices for the management of PCOS for Latin American populations, consolidate regional insights, identify eventual gaps in implementation and identify key research opportunities.

METHODS

Using the Delphi strategy, experts from various Latin American countries selected and reviewed a subset of recommendations from the 2023 International Evidence-Based Guideline (EBG) for the Assessment and Management of PCOS. Virtual and in-person meetings facilitated discussions on the selected recommendations, followed by voting rounds to achieve consensus.

RESULTS

A total of 33 recommendations for PCOS diagnosis and treatment were evaluated. In the initial voting round, 25 recommendations achieved strong agreement (80%-100% support), while eight received less than 80% agreement. After further discussions on their relevance and potential to influence behavior change among health professionals and public health policies, the remaining recommendations achieved near-unanimous support in the second round.

CONCLUSIONS

This consensus underscored evidence-based practices for PCOS diagnosis and treatment deemed appropriate for the Latin American context. It also highlighted implementation barriers such as cost and accessibility, while identifying opportunities for research to improve PCOS management and address regional challenges. These findings aim to enhance clinical care and inform public health strategies tailored to the needs of Latin American women living with PCOS.

Update on the correlation between mitochondrial function and osteonecrosis of the femoral head osteocytes

Mitochondrial health is maintained in a steady state through mitochondrial dynamics and autophagy processes. Recent studies have identified healthy mitochondria as crucial regulators of cellular function and survival. This process involves adenosine triphosphate (ATP) synthesis by mitochondrial oxidative phosphorylation (OXPHOS), regulation of calcium metabolism and inflammatory responses, and intracellular oxidative stress management. In the skeletal system, they participate in the regulation of cellular behaviors and the responses of osteoblasts, osteoclasts, chondrocytes, and osteocytes to external stimuli. Indeed, mitochondrial damage or dysfunction occurs in the development of a few bone diseases. For example, mitochondrial damage may lead to an imbalance in osteoblasts and osteoclasts, resulting in osteoporosis, osteomalacia, or poor bone production, and chondrocyte death and inflammatory infiltration in osteoarthritis are the main causes of cartilage degeneration due to mitochondrial damage. However, the opposite exists for osteosarcoma, where overactive mitochondrial metabolism is able to accelerate the proliferation and migration of osteosarcoma cells, which is a major disease feature. Bone is a dynamic organ and osteocytes play a fundamental role in all regions of bone tissue and are involved in regulating bone integrity. This review examines the impact of mitochondrial physiological function on osteocyte health and summarizes the microscopic molecular mechanisms underlying its effects. It highlights that targeted therapies focusing on osteocyte mitochondria may be beneficial for osteocyte survival, providing a new insight for the diagnosis, prevention, and treatment of diseases associated with osteocyte death.

DNA-based cell typing in menstrual effluent identifies cell type variation by sample collection method: toward noninvasive biomarker development for women's health

Menstrual effluent cell profiles have potential as noninvasive biomarkers of female reproductive and gynecological health and disease. We used DNA methylation-based cell type deconvolution (methylation cytometry) to identify cell type profiles in self-collected menstrual effluent. During the second day of their menstrual cycle, healthy participants collected menstrual effluent using a vaginal swab, menstrual cup, and pad. Immune cell proportions were highest in menstrual cup samples, and epithelial cells were highest in swab samples. Our work demonstrates the feasibility and utility of menstrual effluent cell profiling in population-level research using remotely collected samples and DNA methylation.

CYP2D6 polymorphism rs1065852 significantly increases the risk of type 2 diabetes

BACKGROUND

Genetic variations within the cytochrome P450 (CYP) gene family are significant determinants of type 2 diabetes mellitus (T2DM) susceptibility. This study aimed to investigate the association between CYP2C8 and CYP2D6 gene variants and the risk of T2DM.

METHODS

We conducted a case-control study involving 512 individuals with T2DM and 515 controls. Genotyping of CYP2C8 and CYP2D6 polymorphisms was performed using the Agena MassARRAY system. Logistic regression analysis was employed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs), thereby assessing the relationship between these genetic variants and T2DM risk. Additionally, multifactor dimensionality reduction (MDR) was utilized to assess the potential interaction effects of SNPs on T2DM risk.

RESULTS

The study found a strong correlation between rs1065852 and increased risk of T2DM in overall (A vs. G: OR = 1.22, 95% CI: 1.03-1.45, p = .024; AA vs. GG: OR = 1.46, 95% CI: 1.04-2.06, p = .031; AA-AG vs. GG: OR = 1.36, 95% CI: 1.04-1.79, p = .026; additive: OR = 1.21, 95% CI: 1.02-1.44, p = .027), males and age < 59 subgroups. However, there is no significant association between the CYP2C8 polymorphisms (rs1934953, rs1934951, rs2275620 and rs17110453) and T2DM risk. MDR analysis results showed that the best model was the one locus model (rs1065852, testing accuracy = 0.534; OR = 1.39; 95% CI: 1.05-1.85; p = .023; CVC = 10/10), indicating that rs1065852 is an independent risk factor for T2DM.

CONCLUSIONS

This study suggests that rs1065852 (CYP2D6) is an independent risk factor for T2DM. Further research is warranted to validate these results and explore their clinical implications.

Atorvastatin enhances LDL receptor-mediated LDL-C uptake and modulates PCSK9 protein expression in pancreatic β-cells

Statins are widely used to treat hyperlipidemia and atherosclerotic cardiovascular diseases (ACVD) by significantly lowering low-density lipoprotein cholesterol (LDL-C) levels. However, their use has been associated with an increased risk of type 2 diabetes (T2D), a paradox given their lipid-lowering benefits. This study investigates the role of LDL receptors (LDLR) and proprotein convertase subtilisin/kexin type 9 (PCSK9) in the diabetogenic effects of atorvastatin on pancreatic β-cells. Using the MIN6 pancreatic β-cell line, we assessed the impact of atorvastatin on LDL-C uptake, PCSK9 expression, glucose-stimulated insulin release (GSIR), and cell proliferation. Cellular cholesterol assays, EdU labeling, Dil-LDL uptake, western blot analysis, reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and ELISA, were employed to measure relevant biomarkers and cellular responses. Male C57BL/6j mice were treated with atorvastatin to validate in vitro findings. Atorvastatin enhances LDL-C uptake by upregulating LDLR on the cell surface, without causing excess cholesterol accumulation. Additionally, atorvastatin suppresses PCSK9 expression, which is crucial for LDLR degradation. Interestingly, atorvastatin, combined with exogenous LDL-C, impairs glucose-stimulated insulin release (GSIR) but promotes cell proliferation, highlighting a potential mechanism for statin-associated diabetes. Oral administration of atorvastatin in mice reduced plasma PCSK9 and insulin levels, supporting the in vitro findings. These results indicate that while atorvastatin effectively lowers circulating cholesterol, it may adversely affect pancreatic β-cell function by modulating LDLR and LDL-C uptake, thereby increasing the risk of T2D. This study highlights the importance of further research to develop strategies mitigating the diabetogenic effects of statins while maintaining their cardiovascular benefits.

Frequency of ischemic cardiac events in patients receiving long-term multikinase inhibitor: A report of three cases

Objective

To investigate the incidence and characteristics of ischemic cardiac events, specifically major adverse cardiac events (MACE), in patients undergoing long-term treatment with multikinase inhibitors (MKIs) such as lenvatinib and sorafenib.

Methods

A single-center retrospective analysis was conducted on 41 patients treated with lenvatinib or sorafenib for more than one year at our institution from 2015 to 2022. Patient records were reviewed to collect data on demographics, cancer type, cardiovascular risk factors, MKI treatment duration, and MACE incidence. MACE events, defined as acute heart failure, fatal arrhythmia, acute myocardial infarction, and coronary revascularization, were analyzed to determine potential correlations with MKI therapy.

Results

Among the 41 patients, three (7.3%) developed MACE, presenting as acute heart failure, fatal arrhythmia, and acute myocardial infarction, all associated with significant coronary artery stenosis. Notably, none of these patients had a prior history of cardiovascular disease. Despite variations in clinical presentation, all cases suggested a link between long-term MKI administration and accelerated coronary atherosclerosis. Factors involved in atherosclerosis were significantly older and tended to be more hypertensive in the non-MACE group.

Conclusions

Long-term MKI therapy may increase the risk of severe ischemic cardiac events, likely due to accelerated atherosclerosis. Clinicians and oncology nurses should monitor patients closely for early signs of angina, especially in an outpatient setting, to prevent acute cardiac events. Further large-scale studies are warranted to establish a clearer causal relationship between MKI therapy and cardiovascular risks.

Chronic stress resulting from stressful life events and its role in the onset of primary Sjögren's syndrome: a comparative analysis using the modified Holmes-Rahe stress scale

Recent years brought considerable attention to the connection between chronic stress and the development of autoimmune diseases. However, little is still known about the impact of prolonged stress reactions on the onset and course of primary Sjögren Syndrome (pSS). This study aimed to seek for associations between chronic stress, resulting from stressful life events, and pSS. In the study, 50 patients with diagnosed pSS, as well as 50 control patients with osteoarthritis underwent an assessment. Modified Holmes-Rahe (H-R) stress scale was used in order to evaluate the impact of stressful events within 12 months prior to the diagnosis. Patients with pSS had a significantly higher total score on H-R stress scale within one-year preceding the disease diagnosis (152 ± 66.3 vs 50 ± 54.6; p <  0.001). Additionally, the pSS patients more commonly than the controls reported a subjectively perceived correlation between stressful events and the occurrence of disease symptoms (50% vs 12%; p <  0.001). Moreover, the H-R score at the time of the assessment correlated with the disease activity. The results support the view that pSS belongs to the group of diseases which pathogenesis is closely related to stressful life events. The novelty of this work lies in focus on both the correlation of stress on the onset of autoimmune disease as well as the activity of previously diagnosed disorder. Our data contributes to finding evidence-based medicine (EBM) arguments to what has until recently been merely a thematic observation-the harmfulness of negative stress on individual's health status.

Hypertension modifies the association between serum Klotho and chronic kidney disease in US adults with diabetes: a cross-sectional study of the NHANES 2007-2016

CONTEXT

The association between serum soluble Klotho (sKlotho) and chronic kidney disease (CKD) in individuals with diabetes mellitus (DM) remains controversial, and the influence of hypertension on this association is inconclusive.

OBJECTIVE

This study aims to investigate the joint association of sKlotho and hypertension with CKD prevalence in adults with DM.

METHODS

This cross-sectional study included 3,302 adults with DM from the National Health and Nutrition Examination Survey (2007-2016). Multivariate logistic regression analysis stratified by hypertension was used to assess the association between sKlotho and CKD prevalence. Moreover, the interaction between hypertension and sKlotho on CKD was evaluated.

RESULTS

Among individuals with DM, a significant association between sKlotho levels and CKD prevalence was observed only in those with hypertension. CKD prevalence was significantly lower in individuals with high sKlotho (≥ 806 pg/mL) than in those with low sKlotho (< 806 pg/mL) [adjusted OR = 0.54 (95% CI: 0.41-0.72); p < 0.001]. Moreover, a significant interaction between hypertension and sKlotho on CKD prevalence was observed among adults with DM [Multiplicative scale: OR = 0.65 (95% CI: 0.42-0.99); RERI = -0.80 (95% CI: -1.49 to -0.10); AP = -0.51 (95% CI: -0.90 to -0.12); SI = 0.44 (95% CI: 0.30-0.66)].

CONCLUSIONS

Among DM adults, hypertension modified the association between sKlotho levels and CKD prevalence. Both additive and multiplicative interactions were observed between hypertension and sKlotho levels on CKD. The causalities between hypertension, Klotho, and CKD in diabetic patients need further exploration, and underlying mechanisms warrants elucidation.

Gut microbiota and microbial metabolites for osteoporosis

Osteoporosis is an age-related bone metabolic disease. As an essential endocrine organ, the skeletal system is intricately connected with extraosseous organs. The crosstalk between bones and other organs supports this view. In recent years, the link between the gut microecology and bone metabolism has become an important research topic, both in preclinical studies and in clinical trials. Many studies have shown that skeletal changes are accompanied by changes in the composition and structure of the gut microbiota (GM). At the same time, natural or artificial interventions targeting the GM can subsequently affect bone metabolism. Moreover, microbiome-related metabolites may have important effects on bone metabolism. We aim to review the relationships among the GM, microbial metabolites, and bone metabolism and to summarize the potential mechanisms involved and the theory of the gut‒bone axis. We also describe existing bottlenecks in laboratory studies, as well as existing challenges in clinical settings, and propose possible future research directions.

Dysregulated serum levels of kisspeptin, NKB, GABA in women with polycystic ovary syndrome and their association with hormonal profiles

INTRODUCTION

The clinical study aimed to evaluate the levels of serum kisspeptin, NKB, and GABA in Chinese patients with polycystic ovary syndrome (PCOS) and explore their association with hormonal profiles, as well as the relationship between these levels in PCOS patients and controls.

METHODS

From December 2022 to December 2023, medical records of 60 individuals diagnosed with PCOS and 32 healthy subjects were obtained. Serum kisspeptin, NKB and GABA levels were quantified using enzyme-linked immunosorbent assay (ELISA) kits. To assess the correlation, either Pearson's or Spearman's analytical method was employed between serum kisspeptin, NKB, and GABA levels and hormonal profiles.

RESULTS

The results showed that serum kisspeptin and NKB levels were significantly lower in PCOS patients (p﹤.05), while GABA levels were elevated compared to those in the control group (p﹤.05). In PCOS patients, kisspeptin was notably positive-correlated with LH and LH/FSH (p﹤.05), but no significant correlation was found between NKB, GABA, and hormonal profiles. In PCOS, GABA levels had a strong positive correlation with NKB levels (r = 0.613, p = .000), but this was not observed in the control group. In control patients, kisspeptin levels were positively associated with NKB (r = 0.475, p = .011), strongly negatively correlated with GABA levels (r = -0.773, p = .000), but these were not observed in the PCOS group.

CONCLUSION

The study concluded that patients with PCOS have dysregulated levels of serum kisspeptin, NKB, and GABA and that they may have paradoxical effects under physiological and pathological situations.

Correlation between conventional and unconventional lipid parameters with the risk of progression of renal function decline: insights from the China Health and Retirement Longitudinal Study 2011-2015

BACKGROUND

This study aimed to evaluate the association between conventional and unconventional lipid parameters and the risk of future chronic kidney disease (CKD) and progression of renal function decline.

METHODS

Data from 4,542 participants who were free of CKD at baseline were analyzed using information from the China Health and Retirement Longitudinal Study (2011-2015). The follow-up period was four years. The primary endpoints were incident CKD and rapid progression of renal function decline. The associations between lipid parameters and the risk of CKD and rapid progression of renal function decline were assessed using restricted cubic splines (RCS) and logistic regression analysis.

RESULTS

Logistic regression analysis showed that high-density lipoprotein cholesterol (HDL-C) was negatively associated with CKD risk, while remnant cholesterol (RC) and the atherogenic index of plasma (AIP) were positively associated. Triglycerides (TG), RC, and AIP were positively correlated with rapid renal function decline, whereas low-density lipoprotein cholesterol (LDL-C) and HDL-C were negatively correlated. Among these parameters, AIP was the most strongly associated with CKD [adjusted odds ratio (OR) (95% CI): 2.091 (1.199, 3.649), p = 0.009] and rapid progression of renal function decline [adjusted OR (95% CI): 3.996 (2.632, 6.068), p < 0.001].

CONCLUSION

LDL-C and HDL-C were negatively associated with rapid progression of renal function decline, while TG, RC, and AIP were positively associated with this outcome. Among the lipid parameters examined, AIP was the most strongly associated with CKD and rapid progression of renal function decline.

Awareness, burden and treatment of uterine fibroids: a web-based Italian survey

Uterine fibroids (UFs) are the most common benign tumors in women of reproductive age and one of the leading causes of hysterectomy in Italy. This survey aimed to report how Italian women perceive and approach UFs, in order to raise healthcare professionals (HCPs)', institutions' and women's awareness of UFs and their treatment options. 1508 Italian women aged 30-50 years completed a web-based survey, answering a structured questionnaire focused on UF prevalence, symptomatology and impact, management and awareness. UF self-reported prevalence was 28.8%. Most UF-diagnosed women had symptom(s) before diagnosis (79.0%), and more than a half of UF-diagnosed participants were symptomatic post-diagnosis (55.8%). The most common symptoms after diagnosis were heavy menstrual bleeding (73.1%), dysmenorrhea (50.4%) and pelvic pain (36.8%). UFs negatively affected the quality of life of most symptomatic women, as well as sexuality and employment. Private gynecologists were the key reference HCPs for consultation and UF diagnosis. The most common UF treatments for symptomatic women were surgery (49.2%), followed by oral contraceptives (39.3%). Surgery was also performed for 22.9% of asymptomatic participants. UF-diagnosed participants were not involved in therapeutic choices in 37.6% of cases. Women's knowledge about UFs was mostly superficial (58.7% of all participants), with gynecologists and family/friends as main information sources. Patient-physician communication was rather unsatisfactory, especially about UF therapeutic options and disease impact on sexuality, fertility and lifestyle. This survey highlights that there is still a need to promote patient's knowledge about UFs and empowerment in treatment decision.

Glucocorticoid receptor epigenetic activity in the heart

The glucocorticoid receptor (GR) is a critical nuclear receptor that regulates gene expression in diverse tissues, including the heart, where it plays a key role in maintaining cardiovascular health. GR signaling influences essential processes within cardiomyocytes, including hypertrophy, calcium handling, and metabolic balance, all of which are vital for proper cardiac function. Dysregulation of GR activity has been implicated in various cardiovascular diseases (CVDs), highlighting the potential of GR as a therapeutic target. Remarkably, recent insights into GR's epigenetic regulation and its interaction with circadian rhythms reveal opportunities to optimize therapeutic strategies by aligning glucocorticoid administration with circadian timing. In this review, we provide an overview of the glucocorticoid receptor's role in cardiac physiology, detailing its genomic and non-genomic pathways, interactions with epigenetic and circadian regulatory mechanisms, and implications for cardiovascular disease. By dissecting these molecular interactions, this review outlines the potential of epigenetically informed and circadian-timed interventions that could change the current paradigms of CVD treatments in favor of precise and effective therapies.

Effect of curcumin on methotrexate-induced ovarian damage and follicle reserve in rats: the role of PARP-1 and P53

BACKGROUND

Methotrexate (MTX) is an agent used in the treatment of many neoplastic and non-neoplastic diseases and is known to cause oxidative damage in normal tissues. Curcumin (Cur) is a natural polyphenol compound with powerful antioxidant and antiapoptotic effects. In this study we investigate the effects of Cur on MTX-induced ovarian damage.

MATERIALS AND METHODS

Thirty-two young adult female Wistar albino rats were divided into four groups: (1) Control (n = 8): only vehicle group, (2) Cur (n = 8): Cur-only group (200 mg/kg/day), (3) MTX (n = 8): MTX-only group (0.35 mg/kg/day), (4) MTX+Cur (n = 8): The group was given MTX (0.35 mg/kg/day) and Cur (200 mg/kg/day) for 28 days. Then, SOD, CAT, MDA, AMH levels were measured using ELISA kits. Follicle count was performed on H&E stained slides. In addition, the expressions of P53 and PARP-1 were analysed by immunohistochemistry.

RESULTS

MDA levels were seen to be higher in the MTX group than in the MTX+Cur group (p < 0.05). Cur treatment lowered MDA levels and increased SOD and CAT levels (p < 0.05 for all). In the MTX+Cur group, atretic follicle count decreased (p < 0,05), however, primordial follicle count increased (p < 0,01). Secondary follicle count and AMH levels were higher in MTX-treated groups (p < 0,05 and p < 0,01, respectively). Expressions of p53 and Poly [ADP-ribose] polymerase 1 (PARP-1) increased significantly in the MTX group compared to the other groups (p < 0,05).

CONCLUSION

Cur pretreatment prior to MTX administration may be an effective option in preserving the ovarian follicle pool by regulating P53 and PARP-1 expressions with its antioxidant effect.

Improvement of endocrine and metabolic conditions in patients with polycystic ovary syndrome through acupuncture and its combined therapies: a systematic review and meta-analysis

BACKGROUND

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder among women of reproductive age that significantly impacts their reproductive health. Acupuncture and its combined therapies may have beneficial effects on the endocrine and metabolic states of women with PCOS. This systematic review and meta-analysis evaluated the treatment effects and potential mechanisms of acupuncture and its combined therapies compared to oral metformin in treating PCOS patients.

METHODS

The evaluation focused on three sets of outcomes: hormonal indicators, metabolic indicators, and body weight indicators. Studies that involved additional therapies beyond the specified interventions or included patients with other diseases were excluded. Additionally, data mining methods were used, including frequency statistics to analyze the frequency of acupuncture points and the meridians involved, and the Apriori algorithm to perform association rule analysis for the most effective interventions.

RESULTS

The study included 46 articles (51 studies) involving six interventions: acupuncture combined with metformin, acupuncture treatment, acupuncture with Chinese herbal medicine and metformin, acupuncture with Chinese herbal medicine, acupuncture combined with cupping, and auricular acupuncture combined with metformin showed significant improvements in all evaluated indicators. Data mining revealed the Stomach meridian of foot yangming was the most frequently used, and the most commonly used combination of points included CV4, SP6, and ST36.

CONCLUSIONS

This study suggests that acupuncture and its combined therapies may benefit PCOS. However, risk of bias and heterogeneity observed were noted. Future high-quality, rigorously designed randomized controlled trials are needed to confirm these findings and provide stronger clinical recommendations for acupuncture in PCOS treatment.

Discovery and development of steroidal enzyme inhibitors as anti-cancer drugs: state-of-the-art and future perspectives

Steroidal compounds have emerged as effective therapeutic agents in oncology. Beyond natural-occurring and synthetic steroids that act as cytotoxic anti-tumoral agents, steroidal derivatives can be designed to mime the endogenous substrates of key metabolic enzymes in steroidogenesis, thus reducing the circulating levels of relevant oestrogenic and androgenic hormones responsible for cancer survival and proliferation. Therefore, enzyme inhibition represents an intriguing endocrine approach for the treatment of hormone-dependent tumours, such as breast and prostate cancer, with well-known approved drugs and several pre-clinical and clinical candidates under investigation. This review summarises the key advancements over the past decade (2014-2024) in the development of steroidal enzyme inhibitors endowed with anticancer activity, illustrating their mechanisms of action, therapeutic potential, drug design approaches, and current clinical applications. Furthermore, we discuss challenges related to drug resistance, off-target effects, and future strategies to optimise their efficacy in oncology.

Role of oxysterol 4β-hydroxycholesterol and liver X receptor alleles in pre-eclampsia

BACKGROUND

Liver X receptors (LXRs) are expressed in placenta and may be associated with pre-eclampsia (PE). Oxysterols act as agonists for LXRs. We recently proposed a new blood pressure-regulating circuit with oxysterol 4β-hydroxycholesterol (4βHC) acting as a hypotensive factor via LXRs.

MATERIALS AND METHODS

This study investigated the association between maternal plasma 4βHC, blood pressure (BP) indices, placental expression of LXR target genes, and patient characteristics using data from the Finnish Genetics of Pre-Eclampsia Consortium (FINNPEC) cohort. Plasma samples of 144 women with PE and 38 healthy pregnant controls as well as 44 PE and 40 control placental samples were available. In addition, genetic data from the FinnGen project was utilized to explore the associations of LXR alleles with PE and pregnancy hypertension.

RESULTS

There were no significant associations between 4βHC and BP or maternal and perinatal characteristics in FINNPEC cohort. However, plasma 4βHC was inversely correlated with the maternal body mass index. There were no associations with the genetic variants of LXRs with PE in FinnGen. LXR target genes APOD, SCARB1, TGM2, and LPCAT3 were expressed differently between PE and normal pregnancies in placental samples of FINNPEC.

CONCLUSIONS

Our results demonstrate that plasma 4βHC and genetic LXR variants do not play a major role in PE and BP regulation during pregnancy. However, key LXR target genes involved in lipid metabolism were expressed differently in normal and PE pregnancies. Further research is needed to understand the complexities of oxysterols, LXRs, and their potential contributions to placental function and pregnancy outcomes.

Inhibition of hepatic gluconeogenesis in type 2 diabetes by metformin: complementary role of nitric oxide

Metformin is the first-line treatment for type 2 diabetes mellitus. Type 2 diabetes mellitus is associated with decreased nitric oxide bioavailability, which has significant metabolic implications, including enhanced insulin secretion and peripheral glucose utilization. Similar to metformin, nitric oxide also inhibits hepatic glucose production, mainly by suppressing gluconeogenesis. This review explores the combined effects of metformin and nitric oxide on hepatic gluconeogenesis and proposes the potential of a hybrid metformin-nitric oxide drug for managing type 2 diabetes mellitus. Both metformin and nitric oxide inhibit gluconeogenesis through overlapping and distinct mechanisms. In hepatic gluconeogenesis, mitochondrial oxaloacetate is exported to the cytoplasm via various pathways, including the malate, direct, aspartate, and fumarate pathways. The effects of nitric oxide and metformin on the exportation of oxaloacetate are complementary; nitric oxide primarily inhibits the malate pathway, while metformin strongly inhibits the fumarate and aspartate pathways. Furthermore, metformin effectively blocks gluconeogenesis from lactate, glycerol, and glutamine, whereas nitric oxide mainly inhibits alanine-induced gluconeogenesis. Additionally, nitric oxide contributes to the adenosine monophosphate-activated protein kinase-dependent inhibition of gluconeogenesis induced by metformin. The combined use of metformin and nitric oxide offers the potential to mitigate common side effects. For example, lactic acidosis, a known side effect of metformin, is linked to nitric oxide deficiency, while the oxidative and nitrosative stress caused by nitric oxide could be counterbalanced by metformin's enhancement of glutathione. Metformin also amplifies nitric oxide -induced activation of adenosine monophosphate-activated protein kinase. In conclusion, a metformin-nitric oxide hybrid drug can benefit patients with type 2 diabetes mellitus by enhancing the inhibition of hepatic gluconeogenesis, decreasing the required dose of metformin for maintaining optimal glycemia, and lowering the incidence of metformin-associated lactic acidosis.

Gut microbiota alterations induced by Roux-en-Y gastric bypass result in glucose-lowering by enhancing intestinal glucose excretion

Roux-en-Y gastric bypass (RYGB) results in glucose-lowering in patients with type 2 diabetes mellitus (T2DM) and may be associated with increased intestinal glucose excretion. However, the contribution of intestinal glucose excretion to glycemic control after RYGB and its underlying mechanisms are not fully elucidated. Here, we confirmed that intestinal glucose excretion significantly increased in obese rats after RYGB, which was negatively correlated with postoperative blood glucose levels. Moreover, we also found that the contribution of Biliopancreatic limb length, an important factor affecting glycemic control after RYGB, to the improvement of glucose metabolism after RYGB attributed to the enhancement of intestinal glucose excretion. Subsequently, we further determined through multiple animal models that intestinal glucose excretion is physiological rather than pathological and plays a crucial role in maintaining glucose homeostasis in the body. Finally, we employed germ-free mice colonized with fecal samples from patients and rats to demonstrate that enhanced intestinal glucose excretion after RYGB is directly modulated by the surgery-induced changes in the gut microbiota. These results indicated that the gut microbiota plays a direct causal role in the hypoglycemic effect of RYGB by promoting intestinal glucose excretion, which may provide new insights for developing gut microbiota-based therapies for T2DM.

Using network pharmacology and molecular docking technology, proteomics and experiments were used to verify the effect of Yigu decoction (YGD) on the expression of key genes in osteoporotic mice

BACKGROUND

Yigu decoction (YGD) is a traditional Chinese medicine prescription for the treatment of osteoporosis, although many clinical studies have confirmed its anti-OP effect, but the specific mechanism is still not completely clear.

METHODS

In this study, through the methods of network pharmacology and molecular docking, the material basis and action target of YGD in preventing and treating OP were analyzed, and the potential target and mechanism of YGD in preventing and treating OP were clarified by TMT quantitative protein and experiment.

RESULTS

Network pharmacology and molecular docking revealed that the active components of YGD were mainly stigmasterol and flavonoids. Molecular docking mainly studied the strong binding ability of stigmasterol to the target. Animal proteomics verified the related mechanism of YGD in preventing and treating OP. Based on the KEGG enrichment of network pharmacology and histology, our animal experiments in vivo verified that YGD may play a role in the treatment of OP by mediating hif1- α/vegf/glut1 signal pathway.

CONCLUSIONS

YGD prevention and treatment of OP may be achieved by interfering with multiple targets. This study confirmed that it may promote osteoblast proliferation and protect osteoblast function by up-regulating the expression of proteins related to HIF signal pathway.

Pyridine indole hybrids as novel potent CYP17A1 inhibitors

Prostate cancer (PCa) is one of the most prevalent malignancies affecting men worldwide, and androgen deprivation therapy (ADT) is a primary treatment approach. CYP17A1 inhibitors like abiraterone target the steroidogenic pathway to reduce androgen levels, but their clinical efficacy is limited by drug resistance and adverse effects. This study reports the synthesis and evaluation of novel CYP17A1 inhibitors derived from a previously identified hit compound. Several analogs were synthesised, including an unexpected di-cyano derivative, which demonstrated increased potency against CYP17A1 compared to abiraterone. Biological assays revealed that these compounds significantly inhibited CYP17A1 enzymatic activity and altered steroid biosynthesis. Among the newly synthesised inhibitors, compound 11 showed the highest potency (IC50 = 4 nM) and the related compound 14 presented a template for further development. A combined docking and molecular dynamics approach was used to identify the possible target binding modes of the compounds.

Tetramethylpyrazine Confers Protection Against Oxidative Stress and NLRP3-Dependent Pyroptosis in Rats with Endometriosis

Tetramethylpyrazine (TMP) has been confirmed to suppress inflammation in endometriosis (EMs). Herein, this study investigated whether and how TMP affected NLRP3 inflammasomes and oxidative stress in EMs. After establishment of an EMs rat model, rats were treated with different concentrations of TMP. The size of endometriotic lesions and the latency and frequency of torsion in rats were recorded, followed by the measurement of relevant indicators (TNF-α, IL-6, IL-2, IL-10, MDA, SOD, GSH, CAT, ROS, NLRP3, ASC, GSDMD, caspase-1, Nrf2, and HO-1). The study experimentally determined that TMP treatment markedly decreased the size of endometriotic lesions and improved torsion in rats with EMs. The levels of inflammatory proteins, oxidative stress markers, NLRP3 inflammasome, and pyroptotic proteins were elevated in rats with EMs, all of which were reversed upon TMP treatment. Additionally, the activities of SOD, GSH, and CAT were lowered in rats with EMs, which were partly abrogated by TMP treatment. Furthermore, the downregulation of Nrf2 and HO-1 was counteracted by TMP treatment. To sum up, TMP represses excessive oxidative stress, NLRP3 inflammasome activation, and pyroptosis in rats with EMs. Additionally, TMP may activate the Nrf2/HO-1 pathway.

Improved insulin sensitivity and reproductive profile in overweight/obese PCOS patients undergoing integrative treatment with carnitines, L-arginine, L-cysteine and myo-inositol

OBJECTIVE

To evaluate the effects of a combination of carnitines, L-arginine, L-cysteine and myo-inositol on metabolic and reproductive parameters in PCOS overweight/obese patients.

METHODS

This was a retrospective study analyzing information of a group of PCOS (n = 25) overweight/obesity patients, not requiring hormonal treatment, selected from the database of the ambulatory clinic of the Gynecological Endocrinology Center at the University of Modena and Reggio Emilia, Modena, Italy. The hormonal profile, routine exams and insulin and C-peptide response to oral glucose tolerance test (OGTT) were evaluated before and after 12 weeks of a daily oral complementary treatment with L-carnitine (500 mg), acetyl-L-carnitine (250 mg), L-arginine (500 mg), L-cysteine (100 mg) and myo-inositol (1 gr). The hepatic insulin extraction index was also calculated.

RESULTS

The mix of complementary substances significantly improved metabolic parameters, homeostatic model assessment for insulin resistance index values and gonadotropin plasma levels. Glucose, C-peptide and insulin response to OGTT was significantly reduced as well as the hepatic insulin extraction index.

CONCLUSION

The administration of a combination of carnitines, L-arginine, L-cysteine and myoinositol improved gonadotropin plasma levels and insulin sensitivity in overweight/obese PCOS patients and restored hepatic clearance of insulin as demonstrated by the decreased hepatic insulin extraction index.

Signalling pathways in a nutshell: from pathogenesis to therapeutical implications in prostate cancer

From tumorigenesis to the establishment of local or metastatic high-grade tumours, an integral part of the cellular lifespan relies on various signalling pathways. Particular pathways that allow cells to proliferate by creating a network of new blood vessels have been documented, whereas other pathways are primarily involved with a migration to distant body parts, partially through the process of epithelial-mesenchymal transition (EMT). This review will discuss the different signalling pathways, such as TGF-β, Cripto-1, Wnt pathways, Hedgehog, Notch and NF-κB pathways, and how they promote tumour initiation and progression by influencing diverse cellular processes and EMT in general and in benign and malignant prostate tumours. This review will discuss only the critical pathways. Therefore, many other types of signalling pathways which are related to prostate cancer will not be discussed. Possibilities for further investigation will be mentioned, as many underlying mechanisms involved in these pathways have potential as targets in future tumour therapy. This review will also introduce some novel clinical trials relating to the inhibition of signalling pathways and their clinical outcomes.

Post sleeve gastrectomy-enriched gut commensal Clostridia promotes secondary bile acid increase and weight loss

The gut microbiome is altered after bariatric surgery and is associated with weight loss. However, the commensal bacteria involved and the underlying mechanism remain to be determined. We performed shotgun metagenomic sequencing in obese subjects before and longitudinally after sleeve gastrectomy (SG), and found a significant enrichment in microbial species in Clostridia and bile acid metabolizing genes after SG treatment. Bile acid profiling further revealed decreased primary bile acids (PBAs) and increased conjugated secondary bile acids (C-SBAs) after SG. Specifically, glycodeoxycholic acid (GDCA) and taurodeoxycholic acid (TDCA) were increased at different follow-ups after SG, and were associated with the increased abundance of Clostridia and body weight reduction. Fecal microbiome transplantation with post-SG feces increased SBA levels, and alleviated body weight gain in the recipient mice. Furthermore, both Clostridia-enriched spore-forming bacteria and GDCA supplementation increased the expression of genes responsible for lipolysis and fatty acid oxidation in adipose tissue and reduced adiposity via Takeda G-protein-coupled receptor 5 (TGR5) signaling. Our findings reveal post-SG gut microbiome and C-SBAs as contributory to SG-induced weight loss, in part via TGR5 signaling, and suggest SBA-producing gut microbes as a potential therapeutic target for obesity intervention.

Evolving perspectives on evaluating obesity: from traditional methods to cutting-edge techniques

Objective: This review examines the evolution of obesity evaluation methods, from traditional anthropometric indices to advanced imaging techniques, focusing on their clinical utility, limitations, and potential for personalized assessment of visceral adiposity and associated metabolic risks.

Methods: A comprehensive analysis of existing literature was conducted, encompassing anthropometric indices (BMI, WC, WHR, WHtR, NC), lipid-related metrics (LAP, VAI, CVAI, mBMI), and imaging technologies (3D scanning, BIA, ultrasound, DXA, CT, MRI). The study highlights the biological roles of white, brown, and beige adipocytes, emphasizing visceral adipose tissue (VAT) as a critical mediator of metabolic diseases.

Conclusion: Although BMI and other anthropometric measurements are still included in the guidelines, indicators that incorporate lipid metabolism information can more accurately reflect the relationship between metabolic diseases and visceral obesity. At the same time, the use of more modern medical equipment, such as ultrasound, X-rays, and CT scans, allows for a more intuitive assessment of the extent of visceral obesity.

Association between hemoglobin glycation index and poor prognosis in patients with AKI: a retrospective cohort analysis of the MIMIC-IV database

BACKGROUND

There have been no investigations on the relationship between hemoglobin glycation index (HGI) and poor prognosis in patients with acute kidney injury (AKI).

METHODS

Patients were enrolled from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The HGI was calculated using a linear regression model fitted to glycosylated hemoglobin and fasting plasma glucose (FPG). Kaplan-Meier survival analysis and Cox proportional hazards regression analysis were performed based on HGI quartiles to determine the independent association between HGI and mortality risk. A restricted cubic spline (RCS) was employed to assess the potential nonlinear relationship between HGI and mortality risk. A two-piecewise linear regression model was developed to identify the threshold effect. Additionally, a linear regression model was applied to evaluate the association between HGI and the length of hospital stays.

RESULTS

A total of 3684 patients with AKI were included in this study. Among them, 486 patients died within 28 days, and 673 patients died within 90 days. Multivariate Cox regression analysis identified HGI as an independent risk factor for both 28-day mortality (hazard ratio [HR], 1.65 [95% CI 1.26 to 2.16], p < 0.001) and 90-day mortality (HR, 1.45 [95% CI 1.16 to 1.82], p < 0.001) in AKI. The RCS analysis revealed a significant L-shaped association between HGI and both 28-day (nonlinear p < 0.001) and 90-day mortality (nonlinear p < 0.001). For 28-day mortality, the inflection point was 1.09 (HR = 0.72, 95% CI: 0.65 to 0.805). For 90-day mortality, the inflection point was 1.14 (HR = 0.76, 95% CI: 0.69 to 0.84). Notably, the association between HGI and outcomes was more significant in nondiabetic patients (p < 0.05). Additionally, HGI was found to be significantly and inversely associated with the length of hospital stays.

CONCLUSION

In patients with AKI, a low HGI is an independent risk factor for 28-day and 90-day mortality, exhibiting an L-shaped association. HGI may serve as a potential predictor of mortality risk.

Research progress and application prospects of animal models of group B Coxsackievirus infections

Group B Coxsackieviruses (CVBs) consist of six serotypes, CVB1 to CVB6, which can clinically affect the heart, brain, liver, pancreas and other organs, causing myocarditis, encephalitis, myelitis, pancreatitis, hand-foot-and-mouth disease (HFMD) and other diseases, and can even lead to death. CVBs are widespread globally and highly contagious. However, there are currently no approved CVB vaccines or effective treatments. The construction and optimization of animal models will aid in the in-depth understanding of CVB infections and its pathogenesis, providing essential tools for the exploration of vaccine development and antiviral therapies. This paper reviews the latest research progress and application prospects of CVB animal models.

Addressing Factors that Impact Sexual Well-Being and Intimacy in IBD Patients

PURPOSE OF REVIEW

This review details the pathophysiologic mechanisms from medical, surgical to psychosocial factors that illustrate how and why sexual health and intimacy are impacted in IBD.

RECENT FINDINGS

Recent clinical surveys of practicing gastroenterologists document that clinicians should routinely address sexual health when addressing patient reported outcomes but very few actually make direct inquiry or suggest management into this important aspect of human life. Example 'patter' are suggested to clinicians to demonstrate how to introduce the subject of sexual intimacy and well-being and engender patient trust on this sensitive topic. Once specific symptomatology are elicited, then a review follows on how referral to a cadre of available multidisciplinary specialists can help directly manage the patient's concerns. Specific emphasis on addressing the sexual health in ostomate and sexual and gender minority populations is focused upon as well. Overall, this in depth review highlights a practical clinical approach to understanding how to address sexual wellbeing and human intimacy in IBD patients.

Reproductive hormone characteristics of obese Chinese patients with polycystic ovarian syndrome: a meta-analysis

The aim of this analysis is to assess the effect of obesity on reproductive hormones in Chineses patients with polycystic ovarian syndrome (PCOS). Seven databases were searched. The Newcastle-Ottawa Scale (NOS) assessed the quality of included studies. A meta-analysis was performed using random-effects model. The means and standard deviations of the outcomes were synthesized as standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs). A total of 23 studies involving 4554 patients with PCOS were included. No significant differences in follicle-stimulating hormone (FSH) (p = 0.51), estradiol (E2) (p = 0.48), and prolactin (PRL) (p = 0.46) levels were found between obese and nonobese PCOS patients. However, obese PCOS patients had significantly lower levels of luteinizing hormone (LH) (p < 0.00001), LH/FSH (p = 0.001), progesterone (P) (p = 0.009), and anti-mullerian hormone (AMH) (p = 0.001). Conversely, they exhibited significantly higher testosterone (T) (p = 0.001) levels. Obese PCOS patients exhibited lower levels of LH, LH/FSH, P, and AMH, but higher T levels compared to nonobese PCOS patients, and no significant difference were observed in FSH, E2, and PRL levels in PCOS patients with and without obesity.

Hypercaloric 16:8 time-restricted eating during 8 weeks of resistance exercise in well-trained men and women

BACKGROUND

The effectiveness and practicality of time-restricted eating (TRE) when trying to maximize muscle mass and strength is unclear. Thus, we examined the effects of a hypercaloric 16:8 TRE approach during supervised progressive resistance exercise.

METHODS

Seventeen healthy and well-trained men (n = 10) and women (n = 7) were randomly assigned to TRE or control (FED). Both groups consumed a 10% hypercaloric high-protein (2.2 g/kg/d) diet and performed supervised resistance exercise 4× per wk for 8 wk. TRE consumed all calories within an 8 h window starting at least 1 h post-exercise, while FED consumed the same number of calories throughout the day.

RESULTS

Eating windows were significantly different (TRE: 7.9 ± 0.1 h vs. FED: 13.2 ± 0.6 h). Calorie, carbohydrate, fat, and protein intake did not differ statistically between groups. Total exercise volume was significantly lower in TRE than FED (6,960 ± 287 vs. 7,334 ± 289 repetitions), as were subjective daily energy ratings (week 4 = -1.41; p = 0.04, week 8 = -1.04; p = 0.06). Both groups increased maximal upper and lower body strength (1RM) and muscular endurance (ME); however, gains in squat 1RM were 4.0 ± 1.9 kg lower in TRE (p = 0.05). Both groups increased fat-free mass similarly (TRE: 2.67 kg; FED: 1.82 kg, p = 0.04), but FED added 1.4 ± 0.6 kg more fat mass (p = 0.04). Subjective mood and sleep ratings did not change in either group.

CONCLUSIONS

16:8 TRE is viable during periods of muscle size, strength, and endurance development in well-trained young men and women when engaging in progressive resistance exercise and eating in a caloric surplus with adequate protein. However, the differences in total training volume, squat 1RM, fat mass accumulation, and energy are notable and practically relevant. These findings should be considered within the broader context of an individual's goals, lifestyle, preferences, and exercise demands.

The regulatory effect of chitooligosaccharides on islet inflammation in T2D individuals after islet cell transplantation: the mechanism behind Candida albicans abundance and macrophage polarization

Islet cell transplantation (ICT) represents a promising therapeutic approach for addressing diabetes mellitus. However, the islet inflammation during transplantation significantly reduces the surgical outcome rate, which is related to the polarization of macrophages. Chitooligosaccharides (COS) was previously reported which could modulate the immune system, alleviate inflammation, regulate gut microecology, and repair the intestinal barrier. Therefore, we hypothesized COS could relieve pancreatic inflammation by regulating macrophage polarization and gut microbiota. First, 18S rDNA gene sequencing was performed on fecal samples from the ICT population, showing abnormally increased amount of Candida albicans, possibly causing pancreatic inflammation. Functional oligosaccharides responsible for regulating macrophage polarization and inhibiting the growth of Candida albicans were screened. Afterwards, human flora-associated T2D (HMA-T2D) mouse models of gut microbiota were established, and the ability of the selected oligosaccharides were validated in vivo to alleviate inflammation and regulate gut microbiota. The results indicated that ICT significantly decreased the alpha diversity of gut fungal, altered fungal community structures, and increased Candida albicans abundance. Moreover, Candida albicans promoted M1 macrophage polarization, leading to islet inflammation. COS inhibited Candida albicans growth, suppressed the MyD88-NF-κB pathway, activated STAT6, inhibited M1, and promoted M2 macrophage polarization. Furthermore, COS-treated HMA-T2D mice displayed lower M1 macrophage differentiation and higher M2 macrophage numbers. Additionally, COS also enhanced ZO-1 and Occludin mRNA expression, reduced Candida albicans abundance, and balanced gut microecology. This study illustrated that COS modulated macrophage polarization via the MyD88/NF-κB and STAT6 pathways, repaired the intestinal barrier, and reduced Candida albicans abundance to alleviate islet inflammation.

Family size and cardiovascular disease incidence: a population-level association study

AIM

To investigate the population-level association between family size and cardiovascular disease (CVD) incidence, focusing on broad patterns rather than causal mechanisms or individual-level effects.

METHODS

Population level correlations of family size to CVD incidence were analyzed with scatter plots, simple regression, partial correlation and multivariate regression separately. Aging, economic affluence, obesity and urbanization were incorporated in models as potential confounders.

RESULTS

Globally, family size negatively correlated to CVD incidence rate. This relationship remained in partial correlation analyses when controlling for confounders. Stepwise multiple regression revealed that family size may be the most significant predictor of CVD incidence.

CONCLUSIONS

Large family size is significantly associated with lower cardiovascular disease (CVD) incidence, potentially due to biological, psychological, and social factors. However, as the data are cross-sectional, this relationship should be interpreted as correlational rather than causal. The association appears more pronounced in developing countries, where contextual factors may amplify its effects.

The association between blood-based HYAL2 methylation and early-stage lung cancer: a case-control study

BACKGROUND

Blood-based DNA methylation biomarkers have great potential for the early detection of lung cancer (LC). Here, we investigated the association between HYAL2 methylation in peripheral blood and LC.

METHODS

Matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry was performed to measure the methylation levels of 4 CpG sites in HYAL2 gene in two independent case-control studies (168 LC cases and 167 controls in Study I, 677 LC cases and 833 controls in Study II). Logistic regression adjusted for covariates was conducted for odds ratios (ORs) and 95% confidence intervals (CIs). Non-parametric tests were applied for the comparisons of stratified groups.

RESULTS

Hypomethylation of all 4 CpG sites in HYAL2 was associated with early-stage LC in the two studies (ORs range from 1.91 to 3.07 in Study I, ORs range from 1.39 to 1.86 in Study II, p < 0.05 for all). The associations were still significant for the very early-stage LC patients (stage I). Subgroup analysis indicated that the associations could be enhanced by male gender and older age. Moreover, decreased HYAL2 methylation was correlated with increased tumor size, tumor length and stage.

CONCLUSIONS

Our results suggested blood-based HYAL2 hypomethylation as a potential biomarker for LC early detection.

Timing of dietary effects on the epigenome and their potential protective effects against toxins

Exposure to toxins causes lasting damaging effects on the body. Numerous studies in humans and animals suggest that diet has the potential to modify the epigenome and these modifications can be inherited transgenerationally, but few studies investigate how diet can protect against negative effects of toxins. Potential evidence in the primary literature supports that caloric restriction, high-fat diets, high protein-to-carbohydrate ratios, and dietary supplementation protect against environmental toxins and strengthen these effects on their offspring's epigenome. Most notably, the timing when dietary interventions are given - during a parent's early development, pregnancy, and/or lifetime - result in similar transgenerational epigenetic durations. This implies the existence of multiple opportunities to strategically fortify the epigenome. This narrative review explores how to best utilize dietary modifications to modify the epigenome to protect future generations against negative health effects of persistent environmental toxins. Furthermore, by suggesting an ideal diet with specific micronutrients, macronutrients, and food groups, epigenetics can play a key role in the field of preventive medicine. Based on these findings, longitudinal research should be conducted to determine if a high protein, high-fat, and low-carbohydrate diet during a mother's puberty or pregnancy can epigenetically protect against alcohol, tobacco smoke, and air pollution across multiple generations.

Exploring the interaction between the gut microbiota and cyclic adenosine monophosphate-protein kinase A signaling pathway: a potential therapeutic approach for neurodegenerative diseases

The interaction between the gut microbiota and cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA) signaling pathway in the host's central nervous system plays a crucial role in neurological diseases and enhances communication along the gut-brain axis. The gut microbiota influences the cAMP-PKA signaling pathway through its metabolites, which activates the vagus nerve and modulates the immune and neuroendocrine systems. Conversely, alterations in the cAMP-PKA signaling pathway can affect the composition of the gut microbiota, creating a dynamic network of microbial-host interactions. This reciprocal regulation affects neurodevelopment, neurotransmitter control, and behavioral traits, thus playing a role in the modulation of neurological diseases. The coordinated activity of the gut microbiota and the cAMP-PKA signaling pathway regulates processes such as amyloid-β protein aggregation, mitochondrial dysfunction, abnormal energy metabolism, microglial activation, oxidative stress, and neurotransmitter release, which collectively influence the onset and progression of neurological diseases. This study explores the complex interplay between the gut microbiota and cAMP-PKA signaling pathway, along with its implications for potential therapeutic interventions in neurological diseases. Recent pharmacological research has shown that restoring the balance between gut flora and cAMP-PKA signaling pathway may improve outcomes in neurodegenerative diseases and emotional disorders. This can be achieved through various methods such as dietary modifications, probiotic supplements, Chinese herbal extracts, combinations of Chinese herbs, and innovative dosage forms. These findings suggest that regulating the gut microbiota and cAMP-PKA signaling pathway may provide valuable evidence for developing novel therapeutic approaches for neurodegenerative diseases.

Understanding the link between type 2 diabetes mellitus and Parkinson's disease: role of brain insulin resistance

Type 2 diabetes mellitus and Parkinson's disease are chronic diseases linked to a growing pandemic that affects older adults and causes significant socio-economic burden. Epidemiological data supporting a close relationship between these two aging-related diseases have resulted in the investigation of shared pathophysiological molecular mechanisms. Impaired insulin signaling in the brain has gained increasing attention during the last decade and has been suggested to contribute to the development of Parkinson's disease through the dysregulation of several pathological processes. The contribution of type 2 diabetes mellitus and insulin resistance in neurodegeneration in Parkinson's disease, with emphasis on brain insulin resistance, is extensively discussed in this article and new therapeutic strategies targeting this pathological link are presented and reviewed.

Core-shell molecularly imprinted polymers for the monitoring of dimethyl phthalate in the children's toys1

Plastic materials contain many additives, among which plasticizers from the group of phthalates are added during the production of everyday products, including children's toys. Even if the European Union and many other regions, for example Canada and the United States, have established restrictions on phthalate esters in children's toys or food contact materials and electronic and electrical products, there is still a danger that products imported from regions where there are no such restrictions can contain these dangerous compounds belonging to the group of endocrine disruptors. The additives introduced into plastics are not chemically bound to the polymer chain, so they can easily migrate to the external environment. This paper presents the process of synthesis of the core-shell type of molecularly imprinted polymers (MIPs) toward dimethyl phthalate (DMP). The most suitable polymerization mixture, which was selected to obtain the MIP layer, was prepared from the 4:6 wt ratio of methyl methacrylate and ethylene glycol dimethacrylate in the n-octane environment and with the addition of 5 wt% of the template. This material was characterized with the highest value of DMP removal, the maximum sorption capacity of this thin layer of MIP was about 3.0 mg/L. Additionally, DMP was about 3 times and about 5 times more efficient sorbed by core-shell MIP, than diethyl phthalate (DEP) and dibutyl phthalate (DBP), respectively. The best sorbed core-shell molecularly imprinted polymer was used as a column filler for solid phase extraction and was used to identify the phthalates present from rubber duck extraction solutions, showing the presence of this compound in the analyzed samples. The method developed in this work has a low limit of detection (LOD) and a low limit of quantification (LOQ) and a wide linear range, allowing DMP to be determined at both at trace levels (0.151 mg/L) and at higher concentrations.

A remotely controlled nanotherapeutic with immunomodulatory property for MRSA-induced bone infection

Osteomyelitis is a deep bone tissue infection caused by pathogenic microorganisms, with the primary pathogen being methicillin-resistant Staphylococcus aureus (MRSA). Due to the tendency of the infection site to form biofilms that shield drugs and immune cells to kill bacteria, combined with the severe local inflammatory response causing bone tissue destruction, the treatment of osteomyelitis poses a significant challenge. Herein, we developed a remotely controlled nanotherapeutic (TLBA) with immunomodulatory to treat MRSA-induced osteomyelitis. TLBA, combined with baicalin and gold nanorods, is positively charged to actively target and penetrate biofilms. Near-infrared light (808 nm) triggers spatiotemporal, controllable drug release, while bacteria are eliminated through synergistic interaction of non-antibiotic drugs and photothermal therapy, enhancing bactericidal efficiency and minimizing drug resistance. TLBA eliminated nearly 100 % of planktonic bacteria and dispersed 90 % of biofilms under NIR light stimulation. In MRSA-induced osteomyelitis rat models, laser irradiation raised the infection site temperature to 50 °C, effectively eradicating bacteria, promoting M2 macrophage transformation, inhibiting bone inflammation, curbing bone destruction, and fostering bone tissue repair. In summary, TLBA proposes a more comprehensive treatment strategy for the two characteristic pathological changes of bacterial infection and bone tissue damage in osteomyelitis.

Simultaneous determination of multiple endocrine disrupting chemicals in human amniotic fluid samples by solid phase extraction coupled with liquid chromatography tandem mass spectrometry (LC-MS/MS)

Prenatal exposure to endocrine-disrupting chemicals (EDCs) may lead to immediate and long-term adverse health effects in the offspring. The occurrence levels of EDCs in amniotic fluid (AF) have significant influence on fetus prior to birth. In this study, an analytical method for simultaneous determination of a total of 59 widely concerned EDCs, including 11 bisphenols (BPs), 4 parabens, 11 phthalate metabolites (mPAEs), 7 organophosphate metabolites (mOPEs), 8 polycyclic aromatic hydrocarbons metabolites (OH-PAHs) and 18 perfluorinated compounds (PFASs), in human AF samples was developed employing solid phase extraction (SPE) coupled with liquid chromatography tandem mass spectrometry (LC-MS/MS). Key parameters of SPE procedures were carefully investigated. The developed method enabled the determination of 59 EDCs in a low sample volume (500 μL) with LOD and LOQ values in the range of 0.02-0.2 ng/mL and 0.07-0.66 ng/mL, respectively. The recoveries (60.95 %-144.74 %) and precisions (<44 %) were obtained. To further verify the method, AF samples from Tianjin of China were collected and analyzed. The detected concentrations of BPs, parabens, mPAEs, mOsPEs, and PFASs ranged from < LOD-60.48 ng/mL, indicating satisfying performance for field samples. Furthermore, the results of AGREEprep, ComplexGAPI and BAGI exhibited good environmental friendliness and applicability of the developed method.

Glucocorticoid receptor signaling in the brain and its involvement in cognitive function

The hypothalamic-pituitary-adrenal axis regulates the secretion of glucocorticoids in response to environmental challenges. In the brain, a nuclear receptor transcription factor, the glucocorticoid receptor, is an important component of the hypothalamic-pituitary-adrenal axis's negative feedback loop and plays a key role in regulating cognitive equilibrium and neuroplasticity. The glucocorticoid receptor influences cognitive processes, including glutamate neurotransmission, calcium signaling, and the activation of brain-derived neurotrophic factor-mediated pathways, through a combination of genomic and non-genomic mechanisms. Protein interactions within the central nervous system can alter the expression and activity of the glucocorticoid receptor, thereby affecting the hypothalamic-pituitary-adrenal axis and stress-related cognitive functions. An appropriate level of glucocorticoid receptor expression can improve cognitive function, while excessive glucocorticoid receptors or long-term exposure to glucocorticoids may lead to cognitive impairment. Patients with cognitive impairment-associated diseases, such as Alzheimer's disease, aging, depression, Parkinson's disease, Huntington's disease, stroke, and addiction, often present with dysregulation of the hypothalamic-pituitary-adrenal axis and glucocorticoid receptor expression. This review provides a comprehensive overview of the functions of the glucocorticoid receptor in the hypothalamic-pituitary-adrenal axis and cognitive activities. It emphasizes that appropriate glucocorticoid receptor signaling facilitates learning and memory, while its dysregulation can lead to cognitive impairment. This provides clues about how glucocorticoid receptor signaling can be targeted to overcome cognitive disability-related disorders.