Uncovering the subtle relationship between vitamin D and kidney stones: a cross-sectional NHANES-based study

OBJECTIVE

This study investigated the potential correlation between serum vitamin D levels and the risk of kidney stones. To this end, the National Health and Nutrition Examination Survey (NHANES) database resources from 2007 to 2018 were utilized. The influence of other demographic characteristics, lifestyle habits, and chronic diseases on this relationship was also assessed.

METHODS

This study included 59,842 participants from the NHANES survey, and after exclusions, 24,323 individuals with complete data were analyzed. Logistic regression modeling assessed odds ratios (OR) and 95% confidence intervals (CI) between vitamin D levels and kidney stone risk, and multivariable adjustment models were constructed to control for potential confounders. To investigate the dose-response relationship between vitamin D and kidney stones, restricted cubic spline (RCS) modeling was employed. Subgroup and interaction analyses were also conducted.

RESULTS

The preliminary analyses indicated a statistically significant positive correlation between vitamin D levels and kidney stone risk before adjustment for potential confounding variables (OR = 1.01, P < 0.001). However, after gradual adjustment for age, gender, race, and multiple lifestyle and chronic diseases, this association became non-significant (OR = 1.00, P = 0.186). Furthermore, RCS analyses demonstrated that the non-linear relationship between vitamin D levels and kidney stone risk was no longer statistically significant after adjustment for confounders. In the subgroup analyses, only slight statistical associations were observed in the subgroups of vigorous exercise and those with diabetes, with no significant differences in the remaining subgroups.

CONCLUSION

The present study indicates that serum vitamin D level is not an independent predictor of kidney stone risk. Rather, its effect may be co-regulated by multiple confounding factors. Further research is required to elucidate the precise mechanisms through which vitamin D contributes to kidney stone formation and to consider the combined effects of genetic polymorphisms, dose effects, and other factors.

Special Issue "Molecular Insights into the Role of Exercise in Disease and Health"

Regular physical activity is a fundamental determinant of overall health and a key factor in mitigating the risk of numerous pathological conditions [...].

Age and Sex Differences in Efficacy of Treatments for Type 2 Diabetes: A Network Meta-Analysis

Importance

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors improve hyperglycemia, and SGLT2 inhibitors and GLP-1 receptor agonists reduce the risk of major adverse cardiovascular events (MACEs) among individuals with type 2 diabetes. It is not clear whether efficacy varies by age or sex.

Objective

To assess whether age or sex are associated with differences in the efficacy of SGLT2 inhibitors, GLP-1 receptor agonists, and DPP4 inhibitors.

Data Sources and Study Selection

The MEDLINE and Embase databases and US and Chinese clinical trial registries were searched for articles published from inception to November 2022; in August 2024, the search was updated to capture the trial results. Two reviewers screened for randomized clinical trials of SGLT2 inhibitors, GLP-1 receptor agonists, or DPP4 inhibitors vs a placebo or active comparator in adults with type 2 diabetes.

Data Extraction and Synthesis

Individual participant data and aggregate data were used to estimate age × treatment interactions and sex × treatment interactions in multilevel network meta-regression models.

Main Outcome and Measures

Hemoglobin A1c (HbA1c) and MACEs.

Results

Of the 601 eligible trials identified (592 trials with 309 503 participants reported HbA1c; mean age, 58.9 [SD, 10.8] years; 42.3% were female and 23 trials with 168 489 participants reported MACEs; mean age, 64.0 [SD, 8.6] years; 35.3% were female), individual participant data were obtained for 103 trials (103 reported HbA1c and 6 reported MACEs). The use of SGLT2 inhibitors (vs placebo) was associated with less HbA1c lowering with increasing age for monotherapy (absolute reduction [AR], 0.24% [95% credible interval {CrI}, 0.10% to 0.38%] per 30-year increment in age), for dual therapy (AR, 0.17% [95% CrI, 0.10% to 0.24%]), and for triple therapy (AR, 0.25% [95% CrI, 0.20% to 0.30%]). The use of GLP-1 receptor agonists was associated with greater HbA1c lowering with increasing age for monotherapy (AR, -0.18% [95% CrI, -0.31% to -0.05%] per 30-year increment in age) and for dual therapy (AR, -0.24% [95% CrI, -0.40% to -0.07%]), but not for triple therapy (AR, 0.04% [95% CrI, -0.02% to 0.11%]). The use of DPP4 inhibitors was associated with slightly better HbA1c lowering in older people for dual therapy (AR, -0.09% [95% CrI, -0.15% to -0.03%] per 30-year increment in age), but not for monotherapy (AR, -0.08% [95% CrI, -0.18% to 0.01%]) or triple therapy (AR, -0.01% [95% CrI, -0.06% to 0.05%]). The relative reduction in MACEs with use of SGLT2 inhibitors was greater in older vs younger participants per 30-year increment in age (hazard ratio, 0.76 [95% CrI, 0.62 to 0.93]), and the relative reduction in MACEs with use of GLP-1 receptor agonists was less in older vs younger participants (hazard ratio, 1.47 [95% CrI, 1.07 to 2.02]). There was no consistent evidence for sex × treatment interactions with use of SGLT2 inhibitors and GLP-1 receptor agonists.

Conclusions and Relevance

The SGLT2 inhibitors and GLP-1 receptor agonists were associated with lower risk of MACEs. Analysis of age × treatment interactions suggested that SGLT2 inhibitors were more cardioprotective in older than in younger people despite smaller reductions in HbA1c; GLP-1 receptor agonists were more cardioprotective in younger people.

The prognostic significance of stress hyperglycemia ratio in evaluating all-cause and cardiovascular mortality risk among individuals across stages 0-3 of cardiovascular-kidney-metabolic syndrome: evidence from two cohort studies

BACKGROUND

The American Heart Association (AHA) proposed the concept of cardiovascular-kidney-metabolic (CKM) syndrome, underscoring the interconnectedness of cardiovascular, renal, and metabolic diseases. The stress hyperglycemia ratio (SHR) represents an innovative indicator that quantifies blood glucose fluctuations in patients experiencing acute or subacute stress, correlating with detrimental clinical effects. Nevertheless, the prognostic significance of SHR within individuals diagnosed with CKM syndrome in stages 0 to 3, particularly with respect to all-cause or cardiovascular disease (CVD) mortality risks, has not been fully understood yet.

METHODS

The current study analyzed data from 9647 participants with CKM syndrome, covering stages 0 to 3, based on the NHANES (National Health and Nutrition Examination Survey) collected from 2007 to 2018. In this study, the primary exposure variable was the SHR, computed as fasting plasma glucose divided by (1.59 * HbA1c - 2.59). The main endpoints of study were all-cause mortality as well as CVD mortality, with death registration data sourced through December 31, 2019. The CHARLS database (China Health and Retirement Longitudinal Study) was utilized as validation to enhance the reliability of the findings.

RESULTS

This study included 9647 NHANES participants, who were followed for a median duration of 6.80 years. During this period, 630 all-cause mortality cases and 135 CVD-related deaths in total were recorded. After full adjustment for covariates, our results displayed a robust positive association of SHR with all-cause mortality (Hazard ratio [HR] = 1.09, 95% Confidence interval [CI] 1.04-1.13). However, the SHR exhibited no significant relationship with CVD mortality (HR = 1.00, 95% CI 0.91-1.11). The mediation analysis results suggested that the relationship between SHR and all-cause mortality risk is partially mediated by RDW, albumin, and RAR. Specifically, the mediating effects were - 17.0% (95% CI - 46.7%, - 8.7%), - 10.1% (95% CI - 23.9%, - 4.7%), and - 23.3% (95% CI - 49.0%, - 13.0%), respectively. Additionally, analyses of the CHARLS database indicated a significant positive correlation between SHR and all-cause mortality among individuals diagnosed with CKM across stages 0-3 during the follow-up period from 2011 to 2020.

CONCLUSIONS

An increased SHR value is positively associated with an elevated likelihood of all-cause mortality within individuals diagnosed with CKM syndrome across stages 0-3, yet it shows no significant association with CVD mortality. SHR is an important tool for predicting long-term adverse outcomes in this population. Cardiovascular-kidney-metabolic (CKM) syndrome emphasizes the interconnectedness of cardiovascular, kidney, and metabolic diseases. The stress hyperglycemia ratio (SHR) is a novel marker reflecting stress-induced glucose fluctuations, but its prognostic value in individuals with CKM syndrome (stages 0-3) remains uncertain. This study explores the association between SHR and all-cause and cardiovascular disease (CVD) mortality in this population. Our findings indicate that SHR is significantly associated with an increased risk of all-cause mortality (HR = 1.09, 95% CI 1.04-1.13), but not with CVD mortality (HR = 1.00, 95% CI: 0.91-1.11). Mediation analysis results suggested that the relationship between SHR and all-cause mortality risk is partially mediated by RDW, albumin, and RAR. Specifically, the mediating effects were - 17.0% (95% CI - 46.7%, - 8.7%), - 10.1% (95% CI - 23.9%, - 4.7%), and - 23.3% (95% CI - 49.0%, - 13.0%), respectively. Validation using the CHARLS database supports these findings. These results suggest that SHR could serve as a prognostic biomarker for long-term mortality risk in CKM patients, offering potential clinical utility in risk stratification and management.

The clinical efficacy of proprioceptive neuromuscular facilitation technique in the treatment of scapulohumeral periarthritis: a systematic review and meta-analysis

BACKGROUND

Scapulohumeral periarthritis (SP) is a disease caused by chronic inflammation of the shoulder soft tissue area, which is characterized by shoulder pain and limited mobility. Due to the long course of disease, it often has a great impact on the life and work of patients.

OBJECTIVES

The purpose of this study was to systematically evaluate the effect of proprioceptive neuromuscular facilitation (PNF) stretching technique in the treatment of SP.

METHODS

A systematic search of 10 databases such as China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database, Weipu, Wanfang, PubMed, Embase, Web of Science, Cochrane Library, Clinical Trials, and China Clinical Trial Registry Platform was performed. The retrieval time was from inception to January 2024. Two researchers screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality.Revman5.3 software was used for meta-analysis, and only descriptive analysis was performed on the outcome indicators of the number of literature ≤ 2.

RESULTS

A total of 12 articles were included, including 968 patients. The results of Meta-analysis showed that PNF technique could reduce pain intensity ((Visual analog scale (VAS) score (SMD = -0.67, 95% CI [-1.18, -0.15], P = 0.03), Japanese Orthopaedic Association (JOA) score (subjective pain score standard) (SMD = 0.79, 95% CI [0.23,1.35], P < 0.01)), improve the shoulder function of patients (SMD = 1.13, 95% CI [0.96,1.31], P < 0.01), and improve the patient's daily living ability (SMD = 1.06, 95% CI [0.77,1.34], P < 0.01). The results of descriptive analysis showed that the PNF technique could improve the psychological state of patients with scapulohumeral periarthritis to a certain extent.

CONCLUSION

The PNF technique can help patients with scapulohumeral periarthritis to relieve pain, improve shoulder function, and strengthen daily living ability. In addition, a good psychological state is conducive to better recovery of patients ' health. In clinical work, medical staff should pay attention to the psychological state of patients with SP.

CLINICAL TRIAL NUMBER

Not applicable.

Prevalence and Associated Factors of Dynapenia, Pre-Sarcopenia, and Sarcopenia in Korean Adults: A Cross-Sectional Epidemiological Study

Background and Objectives: This study examined the prevalence and risk factors of dynapenia, pre-sarcopenia, and sarcopenia among Korean adults using nationally representative data. Materials and Methods: A cross-sectional analysis was conducted using the 2022-2023 Korea National Health and Nutrition Examination Survey (KNHANES). Participants aged 20 years and older with available muscle strength and body composition measurements were included. Handgrip strength and skeletal muscle mass (measured via bioelectrical impedance analysis) were used to classify participants based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Logistic regression analysis identified associated risk factors. Results: The prevalence of pre-sarcopenia, dynapenia, and sarcopenia was 9.6%, 3.4%, and 1.6%, respectively. Pre-sarcopenia was most common across all age groups, while sarcopenia was primarily observed in older adults (p < 0.001). Age was a key predictor for all three conditions (p < 0.001), with sex differences-men had a higher prevalence of pre-sarcopenia (p = 0.014), whereas women showed higher rates of dynapenia (p = 0.003) and sarcopenia (p = 0.008). Low physical activity (p < 0.001), high stress (p = 0.021), and smoking (p = 0.012) were also significant risk factors. Conclusions: These findings highlight the importance of early identification and targeted interventions to prevent muscle deterioration. Public health strategies focusing on lifestyle modifications and sex-specific approaches may help mitigate the burden of sarcopenia and its related health complications in aging populations.

The Effectiveness of an Electronic Decision Support Algorithm to Optimize Recommendations of SGLT2i and GLP-1RA in Patients with Type 2 Diabetes upon Discharge from Internal Medicine Wards

Background/Objectives: Despite the established cardiovascular benefit of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs), these medications are under-prescribed in patients with type 2 diabetes. Our study aims to examine the effectiveness of a clinical decision support system (CDSS) in improving the recommendation rate of SGLT2i and GLP-1RA upon discharge. Methods: We developed an algorithm to automatically recommend SGLT2is and GLP-1RAs for eligible patients with type 2 diabetes upon discharge, based on current guidelines. Data were collected from electronic medical records of all eligible patients ≥18 years old hospitalized in one of five internal medicine wards at Beilinson Hospital. The primary outcome was to evaluate the rate of physician recommendation of SGLT2is and GLP-1RAs at discharge, before and after algorithm implementation. Results: Our study included 1318 patients in the pre-algorithm group and 970 in the post-algorithm group. The recommendation rate of SGLT2is and GLP-1RAs was 8.5% in the pre-algorithm group and 22.7% in the post-algorithm. The odds ratio (OR) of recommendation in the post- vs. pre-algorithm group was 3.151 (95% CI: 2.467-4.025, p < 0.0001). Recommendation rates increased in all subgroups analyzed, notably in patients hospitalized due to heart failure (recommendation rate pre-algorithm: 14.6% vs. post-algorithm: 49.02%). Conclusions: This study demonstrates the benefit of a CDSS in improving the recommendation rate of SGLT2is and GLP-1RAs in patients with type 2 diabetes upon discharge from hospitalization. Future studies should assess the impact of the algorithm on recommendation rates in other wards, medication utilization, and long-term outcomes.

Health outcomes of sarcopenia: a consensus report by the outcome working group of the Global Leadership Initiative in Sarcopenia (GLIS)

The Global Leadership Initiative in Sarcopenia (GLIS) aims to standardize the definition and diagnostic criteria for sarcopenia into one unifying, common classification. Among other actions to achieve this objective, the GLIS has organized three different working groups (WGs), with the WG on outcomes of sarcopenia focusing on reporting its health outcomes to be measured in clinical practice once a diagnosis has been established. This includes sarcopenia definitions that better predict health outcomes, the preferred tools for measuring these outcomes, and the cutoffs defining normal and abnormal values. The present article synthesizes discussions and conclusions from this WG, composed of 13 key opinion leaders from different continents worldwide. Results rely on systematic reviews, meta-analyses, and relevant cohort studies in the field. With a high level of evidence, sarcopenia is significantly associated with a reduced quality of life, a higher risk of falls and fractures and a higher risk of mortality. Sarcopenia has been moderately associated with a higher risk of reduced instrumental activities of daily living (IADL). However, the GLIS WG found only inconclusive level of evidence to support associations between sarcopenia and higher risks of hospitalization, nursing home admission, mobility impairments, and reduced basic activities of daily living (ADL). This limitation underscores the scarcity of longitudinal studies, highlighting a barrier to understanding its progression and implications over time.

Optimizing SGLT2 inhibitor and GLP-1 RA prescribing in high-risk patients with diabetes: a Department of Veterans Affairs quality improvement intervention

INTRODUCTION

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium glucose cotransporter-2 (SGLT2) inhibitors have dramatic clinical benefits, but many appropriate patients do not receive them. We developed a quality improvement (QI) intervention to increase the adoption of these drugs in patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), and/or heart failure (HF). The purpose of this study was to examine whether the intervention increased the use of SGLT2 inhibitors and GLP-1 RAs.

METHODS

The intervention included: (1) education, academic detailing (1:1 pharmacist to clinician coaching), and audit and feedback directed at providers and allied health professionals at the Veterans Affairs Ann Arbor Healthcare System (VAAAHS); (2) outreach and inreach to patients with T2D and ASCVD, CKD, and/or HF who were not on GLP-1 RAs or SGLT2 inhibitors at baseline. Patients were identified and outcomes evaluated using existing VA national reports. We performed a difference-in-difference analysis of the change in GLP-1 RA and SGLT2 inhibitor prescribing rates before, during, and after the intervention, comparing rates in VAAAHS to rates in the same VA region (called a Veterans Integrated Service Network (VISN)) and the VA nationally to determine whether the rates of prescribing increased faster in VAAAHS than the VISN or VA nationally.

RESULTS

Home telehealth nurses and clinical pharmacy practitioners (CPPs) provided outreach to 445 patients; 48% (n = 215) of whom initiated SGLT2 inhibitors or GLP-1 RAs. Four CPPs provided 101 academic detailing sessions to 72 providers. Prior to the intervention, the prescribing rate was 22.7% in VAAAHS, 20.3% in the VISN 10 region, and 18.7% in VA nationally. At the end of the 12-month intervention, the prescribing rate had increased to 37.9% in VAAAHS, 28.4% in the VISN 10 region, and 26.5% in VA nationally. Six-months post-intervention, the prescribing rate continued to increase to 42.4% in VAAAHS, 32.2% in the VISN 10 region, and 30.2% in VA nationally. The rate of prescribing growth in VAAAHS was significantly faster than in the VISN or VA nationally (p < 0.001).

CONCLUSION

Our multidisciplinary QI intervention increased SGLT2 inhibitor and GLP-1 RA prescribing approximately 8% points faster than the national average.

Identification of the relationship between 1400 blood metabolites and urolithiasis: A bidirectional Mendelian randomization study

Relationships between blood metabolites and urolithiasis have been identified in few previous observational studies, and causality remains uncertain. We tried to examine whether blood metabolites were causally associated with upper and lower urinary stones in this bidirectional Mendelian randomization (MR) study. The causal relationship between 1400 blood metabolites and upper and lower urinary stones was investigated using genome-wide association study data. The primary analysis for causality analysis was the inverse variance weighted method, with 4 other methods used as complementary analyses. Intersection was then conducted to show the shared metabolites between upper and lower urinary tract stones, followed by the MR-Egger intercept test, Cochran Q test, leave-one-out analysis, MR-PRESSO and the linkage disequilibrium score regressions. The metabolic pathway analysis was conducted to identify potential metabolic pathways. Lastly, reverse MR analyses were also performed. We identified 15 metabolites as potential causal predictors of urinary stones in forward MR analyses. These metabolites consisted of 1 azole, 2 carbohydrates, 6 lipids, 1 nucleotide, 1 peptide, 1 urea, and 3 metabolites with unknown chemical properties. Additionally, urinary stones were found to be significantly associated with some of the above metabolites in reverse MR analyses. Metabolic pathway analysis identified several pathways that may be implicated in the development of urolithiasis. This MR study has established a causal relationship between 12 blood metabolites and the risk of upper and lower urinary tract stones. The identification of these blood metabolites provides valuable insights into early screening, prevention, and treatment of urolithiasis.

A meta-analysis on the risk of esophageal cancer in type 2 diabetes patients treated with GLP-1 receptor agonists

Objective

To evaluate the association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) treatment and the risk of esophageal cancer in adults with type 2 diabetes mellitus (T2DM) or obesity through a comprehensive meta-analysis.

Methods

A systematic computerized searches and collection of eligible randomized controlled trials (RCTs) was performed to compare the risk of esophageal cancer between GLP-1 RA and control agents. The bias risks and quality of the studies were evaluated, and a meta-analysis was conducted using Stata 18.0 and R 4.0.2 statistical software.

Results

The meta-analysis included data from six studies involving 13,391 participants. The pooled relative risk (RR) of esophageal cancer in patients using GLP-1 RAs compared to control agents was 0.46 (95% CI 0.13-1.59; p=0.725; I²=0%). Subgroup analyses stratified by age groups, intervention durations, BMI categories, and indications for T2DM or obesity treatment more often indicated no association between GLP-1 RAs use and increased risk of esophageal cancer.

Conclusions

GLP-1 RAs did not increase the incidence of esophageal neoplasms, and there were not probably significant within-class differences in T2DM or obesity treatment. This finding supports the safety of GLP-1 RAs as a therapeutic option for the clinical management of T2DM.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024543945.

Nutritional knowledge, insulin resistance, and the risk of orthorexia nervosa: a comparative cross-sectional study among polish women

Background

The global rise in insulin resistance has led to an increased emphasis on dietary modifications as a primary strategy for its management. While such interventions are essential for improving metabolic health, they can also contribute to heightened nutritional knowledge. However, this increased focus on diet may inadvertently lead to the development of disordered eating patterns, including orthorexia nervosa. This study aimed to determine the level of nutritional knowledge regarding proper eating habits among women with insulin resistance and to assess the relationship between this knowledge and the risk of developing orthorexia nervosa.

Methods

The study was using the Computer-Assisted Web Interview method, involving 133 female participants from a primary care clinic in Katowice, Poland. Of these, 101 women had a medically confirmed diagnosis of insulin resistance, and 32 were healthy controls. Data were collected using an online survey, which included a demographic section, a 15-item questionnaire to assess nutritional knowledge, and the ORTO-15 tool to evaluate orthorexia nervosa risk.

Results

Women with insulin resistance had significantly higher Body Mass Index values and demonstrated greater nutritional knowledge than their healthy counterparts. However, 56.44% of women with insulin resistance were at risk of orthorexia nervosa, compared to 15.63% of the control group. Increased dietary knowledge in women with insulin resistance was also associated with a higher risk of developing orthorexic behavior.

Conclusion

The findings indicate that while women with insulin resistance benefit from improved nutritional knowledge in managing their condition, this knowledge may simultaneously increase their risk of developing orthorexia nervosa. Balancing the promotion of healthy eating habits with strategies that prevent the emergence of distorted eating behaviors is crucial. Future interventions should emphasize flexibility, psychological support, and individualized guidance to ensure both metabolic and mental well-being.

Association between the stress hyperglycemia ratio and all-cause mortality in critically ill patients with T2DM: a retrospective study

Background

Previous studies have shown a significant correlation between the stress-hyperglycemia ratio (SHR) and mortality. However, it is unknown whether the SHR has the same predictive value in severely ill patients. The main purpose of this research was to investigate the association between the SHR and all-cause mortality in critically ill patients with T2DM.

Methods

The data used in this study were derived from the Medical Information Mart for Intensive Care (MIMIC-IV) database. The primary outcome was 180-day mortality and the secondary outcomes were 28-day, 90-day and 365-day mortality. The main analytical methods included: Kaplan-Meier survival analysis, the COX proportional hazards model and restricted cubic splines.

Results

A total of 993 patients were included. The 28-day, 90-day, 180-day, and 365-day mortalities reached 10.4%, 14.4%, 16.7% and 19.0%, respectively. Multivariate Cox proportional hazards analysis revealed that the elevated SHR was significantly related to 28-day, 90-day and 180-day all-cause mortality even after cofounder adjustment. Restricted cubic spline analysis revealed a nonlinear association between the SHR and the risk of 28-day (p for nonlinear=0.014), 90-day (p for nonlinear=0.007), 180-day (p for nonlinear=0.001) and 365-day (p for nonlinear=0.003) all-cause mortality.

Conclusion

SHR is significantly associated with 28-day, 90-day and 180-day all-cause mortality in critically ill patients with T2DM. This may help us identify patients at higher risk of death early.

Beyond Compliance: The Role of Self-Efficacy in Foot Care and Self-Management Among Patients With Type 1 Diabetes

Background: Effective self-management behaviors are crucial for diabetes management. This study examines the mediating role of self-efficacy in the relationship between compliance dimensions and self-management activities in patients with Type 1 diabetes. Methods: The current study explores a baseline analysis from a randomized controlled trial but the intervention's effectiveness is not reported here; the analysis focuses on elucidating potential mediating factors at baseline. The study investigated the relationships between seven compliance dimensions (treatment effort, intention, adaptability, integration, adherence, commitment, and indecisiveness) and six self-management activities (diet, exercise, smoking cessation, blood sugar monitoring, and foot care) through the potential mechanism of self-efficacy. Results: The analysis revealed an indirect association between three compliance dimensions (treatment effort, intention, and commitment) and foot care behavior, mediated by self-efficacy. Additionally, self-efficacy was identified as an indirect mechanism influencing the association between commitment and adaptability with dietary behaviors. Conclusions: This study highlights the importance of self-efficacy in promoting self-management behaviors in chronic conditions. By targeting specific compliance dimensions that influence self-efficacy, healthcare professionals can potentially improve patient self-management. Trial Registration: Iranian Registry of Clinical Trials number: IRCT20221029056335N1.

Predictive ability of visit-to-visit glucose variability on diabetes complications

BACKGROUND

Identification of prognostic factors for diabetes complications are crucial. Glucose variability (GV) and its association with diabetes have been studied extensively but the inclusion of measures of glucose variability (GVs) in prognostic models is largely lacking. This study aims to assess which GVs (i.e., coefficient of variation (CV), standard deviation (SD), and time-varying) are better in predicting diabetic complications, including cardiovascular disease (CVD), diabetic retinopathy (DR), and chronic kidney disease (CKD). The model performance between traditional statistical models (adjusting for covariates) and machine learning (ML) models were compared.

METHODS

A retrospective cohort of type 2 diabetes (T2D) patients between 2010 and 2019 in Ramathibodi Hospital was created. Complete case analyses were used. Three GVs using HbA1c and fasting plasma glucose (FPG) were considered including CV, SD, and time-varying. Cox proportional hazard regression, ML random survival forest (RSF) and left-truncated, right-censored (LTRC) survival forest were compared in two different data formats (baseline and longitudinal datasets). Adjusted hazard ratios with 95% confidence intervals were used to report the association between three GVs and diabetes complications. Model performance was evaluated using C-statistics along with feature importance in ML models.

RESULTS

A total of 40,662 T2D patients, mostly female (61.7%), with mean age of 57.2 years were included. After adjusting for covariates, HbA1c-CV, HbA1c-SD, FPG-CV and FPG-SD were all associated with CVD, DR and CKD, whereas time-varying HbA1c and FPG were associated with DR and CKD only. The CPH and RSF for DR (C-indices: 0.748-0.758 and 0.774-0.787) and CKD models (C-indices: 0.734-0.750 and 0.724-0.740) had modestly better performance than CVD models (C-indices: 0.703-0.730 and 0.698-0.727). Based on RSF feature importance, FPG GV measures ranked higher than HbA1c GV, and both GVs were the most important for DR prediction. Both traditional and ML models had similar performance.

CONCLUSIONS

We found that GVs based on HbA1c and FPG had comparable performance. Thus, FPG GV may be used as a potential monitoring parameter when HbA1c is unavailable or less accessible.

Sarcopenia: how to determine and manage

BACKGROUND

Understanding sarcopenia is becoming increasingly important as society ages. This comprehensive review covers the definition, epidemiology, causes, pathogenesis, diagnosis, prevention, management, and future directions for the management of sarcopenia, and the major issues related to sarcopenia in the knee joint.

MAIN TEXT

Sarcopenia, a condition related to aging, is characterized by decreased muscle mass and strength, which significantly affects physical function. Its prevalence may vary by region and age, with reports of up to 50% prevalence in the elderly population. The potential causes of sarcopenia include neurodegeneration, poor nutrition, changes in hormonal effects, elevated levels of proinflammatory cytokines, and reduced activation of muscle satellite cells. Various pathogeneses, such as apoptosis, proteolysis, and inhibition of the signaling for increasing muscle mass, contribute to the development of sarcopenia. Generally, the diagnostic criteria for sarcopenia are based on reduced muscle mass, reduced muscle strength, and decreased physical performance, and can be assessed using various equipment and clinical tests. A healthy lifestyle consisting of a balanced diet, sufficient protein intake, and regular exercise is recommended to prevent sarcopenia. The management of sarcopenia involves resistance exercise, proper nutrition, and deprescribing from polypharmacy. In the future, pharmacological treatment and personalized nutrition may become alternative management options for sarcopenia. Finally, since sarcopenia can be associated with knee osteoarthritis and poor outcomes after total knee arthroplasty, appropriate management of sarcopenia is important for physicians treating knee-related conditions.

CONCLUSIONS

Sarcopenia is a significant pathological condition that needs to be recognized, especially in the older population. Although sarcopenia is common as aging occurs, it can be prevented by a healthy lifestyle. Currently, there are no approved drugs for sarcopenia; however, resistance exercise and proper nutritional supplementation are essential methods for managing sarcopenic conditions. Given its diverse causes, a personalized approach may be necessary to effectively manage sarcopenia. Finally, appropriate management of sarcopenia can contribute to the prevention and effective treatment of knee osteoarthritis.

Novel Identification of CD74 as a Biomarker for Diagnosing and Prognosing Sepsis Patients

Purpose

Sepsis, a life-threatening inflammatory condition due to an imbalanced response to infections, has been a major concern. Necroptosis, a newly discovered programmed cell death form, plays a crucial role in various inflammatory diseases. Our study aims to identify necroptosis - related genes (NRGs) and explore their potential for sepsis diagnosis.

Patients and methods

We used weighted gene co-expression network analysis to identify gene modules associated with sepsis. Cox regression and Kaplan-Meier methods were employed to assess the diagnostic and prognostic value of these genes. Single-cell and immune infiltration analyses were carried out to explore the immune environment in sepsis. Plasma CD74 protein levels were quantified in our samples, and relevant clinical data from electronic patient records were analyzed for correlation.

Results

CD74 was identified through the intersection of the hub genes of sepsis and NRGs related modules. Septic patients had lower CD74 expression compared to healthy controls. The CD74-based diagnostic model showed better performance in the training dataset (AUC, 0.79 [95% CI, 0.75-0.84]), was cross-validated in external datasets, and demonstrated better performances than other published diagnostic models. Pathway analysis and single-cell profiling supported further exploration of CD74-related inflammation and immune response in sepsis.

Conclusion

This study presents the first quantitative assessment of human plasma CD74 in sepsis patients. CD74 levels were significantly lower in the sepsis cohort. CD74 warrants further exploration as a potential prognostic and therapeutic target for sepsis.

Lower body mass index is associated with the achievement of target LDL in patients using PCSK9 inhibitors in Taiwan

OBJECTIVE

Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are a standard therapy for patients who respond poorly to or cannot tolerate statins. However, identifying responders to PCSK9 inhibitors remains unclear. This study investigates the characteristics of patients who achieve target LDL-C reduction (< 70 mg/dl) after PCSK9 inhibitor therapy.

METHODS

A multicenter, retrospective cohort study included patients initiating PCSK9 inhibitors at 11 teaching hospitals in Taiwan (2017-2021). Baseline characteristics, lipid-lowering therapies, and lipid profile changes were analyzed.

RESULTS

Among 211 patients (mean age 57.2 ± 13.1 years, 72.0% male), 73.5% used alirocumab and 26.5% used evolocumab. More than half had coronary artery disease and/or hypertension. Of these, 120 patients achieved the LDL-C target. Target achievers had a lower baseline BMI (25.8 ± 3.7 vs. 27.4 ± 4.5 kg/m2, P = 0.028) and a higher incidence of myocardial infarction and anti-platelet use compared to non-achievers. Baseline cholesterol and LDL-C levels were similar, but target achievers experienced greater LDL-C reductions (- 71.5; IQR - 81.8, - 62.2 vs. - 29.4; IQR - 38, - 10.5 mg/dl, P < 0.001), as well as decreases in triglycerides and increases in HDL-C. Glucose levels and liver enzymes did not differ significantly. Logistic regression revealed BMI as the only independent predictor of LDL-C target achievement (odds ratio: 0.899, 95% CI 0.821-0.984, P = 0.021).

CONCLUSIONS

Lower BMI at baseline was associated with a higher likelihood of achieving LDL-C < 70 mg/dl after 12 weeks of PCSK9 inhibitor therapy. These findings support personalized strategies for optimizing cholesterol management in statin-intolerant patients while further investigations are required.

Stress hyperglycemia in acute pancreatitis: From mechanisms to prognostic implications

Acute pancreatitis (AP) is an inflammatory reaction of the pancreas. When the disease is severe, it is often accompanied by destruction of the pancreatic islets, resulting in dysfunction of the endocrine system of the pancreas. Stress hyperglycemia is a transient increase in glucose during a critical illness, and its possible mechanism is related to abnormal glucose metabolism and insulin resistance due to the increased release of counterregulatory hormones and cytokines, such as glucagon, cortisol, and catecholamines. Numerous studies have shown that stress hyperglycemia is strongly associated with morbidity, mortality, and increased risk of post-acute pancreatitis diabetes in AP patients. Therefore, stress hyperglycemia may be a significant independent risk factor for poor clinical outcomes and prognosis in patients with AP. This article reviews the clinical features, risk factors, and mechanisms of action of stress hyperglycemia in AP and its influence on adverse clinical outcomes and the prognosis of inpatients with AP. For AP patients with stress hyperglycemia, it is necessary to comprehensively consider their blood glucose levels, daily habits, and complications to develop an appropriate treatment plan for hyperglycemia. Limited evidence indicates that in the case of acute hyperglycemia in critically ill patients, especially during the first 3 days of hospitalization, insulin therapy should not be undertaken if the blood glucose level does not exceed 10 mmol/L. However, some important questions related to clinical practice remain to be answered. More clinical trials and studies are needed in the future to provide a sufficient basis for clinical practice.

SGLT2 Inhibitors and the Risk of Urogenital Infections: A Concise Review

Diabetes mellitus has become a major public health problem due to aspects such as an alarming increase in prevalence, the morbidity and mortality associated with its complications and, not least, the economic burden. SGLT2 inhibitors are a relatively new but valuable class of drugs that demonstrated multifaceted effects in addition to hypoglycemic action. Moreover, these drugs demonstrated cardiovascular and renal benefits, even in individuals without diabetes, being recommended by current guidelines to patients with a history of cardiovascular disease, or at high risk for it, as well as to patients with chronic kidney disease. The prescription of this class of drugs is limited by the risk of urogenital infections, despite their multiple demonstrated benefits. Data regarding the prevalence of SGLT2 inhibitors associated with urogenital infections depend on several factors related to the study carried out and to other additional conditions that could precipitate such infections. While SGLT2 inhibitors have a well-established association with the risk of genital infections, the association with urinary tract infections remains controversial and uncertain. This review will be focused on urogenital infections associated with the administration of SGLT2 inhibitors, highlighting their prevalence, risk factors, mechanisms involved, clinical relevance and particularities of management.

Application of Mendelian randomized analysis method in Vitamin D research: A 10-year bibliometric analysis

Vitamin D is an open-cyclic steroidal trace organic compound that plays a crucial role in human metabolism and nutritional health. In recent years, Mendelian randomization (MR) has emerged as a widely adopted method for analyzing causal relationships, particularly in studying the association between Vitamin D and related diseases. However, no bibliometric analyses have been conducted to explore the research hotspots and trends regarding Vitamin D status in MR studies. This study utilized the Web of Science Core Collection as a source database and retrieved articles on Vitamin D status in MR published from 2014 to 2024. Bibliometric and visualization analyses utilized VOSviewer, Microsoft Excel 2021, and Scimago Graphica. An in-depth analysis of country or region, authors, journals, keywords, and references were performed to provide insights into the content related to the field. A total of 186 documents authored by 1122 contributors across 30 countries were identified. China and the University of Bristol had the highest publication counts, with 94 and 19 articles, respectively. The nutrients published the largest number of articles, and J Brent Richards was the largest contributors. The most frequently used keywords included "Mendelian randomization," "Vitamin D," "25-hydroxyVitamin D," "obesity," and "Type 2 Diabetes." The current research focuses on using MR methods to explore the associations between Vitamin D status and metabolic, cardiovascular, immune skin, psychiatric and neurological diseases. The related research in this field will continue to increase in the next few years, which is a promising research prospect in this field. This study systematically reviews the literature from the past decade, revealing research hotspots and trends in the field of Vitamin D status within MR studies. This information will provide a strong reference for readers and researchers.

Expression and clinical significance of serum lncRNA H19 in patients with metabolic dysfunction-associated fatty liver disease

Long non-coding RNA H19 (lncRNA H19) plays an important role in lipid metabolism, however, its relationship with metabolic dysfunction-associated fatty liver disease (MAFLD) remains unclear. The aim of this study is to investigate the expression and clinical significance of serum lncRNA H19 in patients with MAFLD. This study enrolled patients with MAFLD and a control group of healthy subjects from January 2023 to March 2024. The serum levels of lncRNA H19 were quantified using real-time quantitative polymerase chain reaction. The serum levels of lncRNA H19 in patients with MAFLD were significantly higher compared to the control group (P < .05). Moreover, there was a positive correlation between serum lncRNA H19 and body mass index, triglyceride, total cholesterol (TC), low-density lipoprotein cholesterol, fasting blood glucose and uric acid (all P < .05). Conversely, a negative correlation was observed between serum lncRNA H19 and high-density lipoprotein cholesterol (HDL-C; P = .009). Additionally, significant positive associations were found between serum lncRNA H19 and alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase and liver stiffness measurement(all P < .05). The optimal cutoff value of serum lncRNA H19 for diagnosing MAFLD was 1.15, with an area under the curve of the receiver operating characteristic curve of 0.83, and the sensitivity and specificity were observed to be 87.7% and 72.5%, respectively. The lncRNA H19 exhibits associations with metabolic risk factors, liver function, and liver fibrosis, and can serve as a potential diagnostic biomarker for MAFLD.

Association between prebiotic, probiotic consumption and hyperuricemia in U.S. adults: a cross-sectional study from NHANES 2011-2018

Aim

This study aims to provide evidence for an association between the consumption of prebiotics and probiotics and hyperuricemia in U.S. adults.

Methods

A total of 7,176 adults who participated in the National Health and Nutrition Examination Survey (NHANES) during 2011-2018 were included in the study. First, the baseline characteristics of the data were described for the weighted data, using the presence or absence of hyperuricemia as the classification criterion. Second, binary logistic regression analyses were performed to establish crude models and regression models adjusted for relevant covariates, and odds ratios (OR) and 95% confidence intervals (95% CI) were calculated to explore the relationship between prebiotics, probiotic intake, and hyperuricemia. Subsequently, receiver operating characteristic (ROC) curves were plotted to assess probiotic consumption's role in the hyperuricemia prediction model. Finally, subgroup analyses were performed.

Results

Participants who consumed probiotics had a lower prevalence of hyperuricemia than those who did not (3.48% vs. 6.25%, p = 0.082). In logistic regression analyses, prebiotics' effect on hyperuricemia was insignificant (p > 0.05), regardless of whether covariates were considered. In contrast, the crude model for probiotics and the adjusted model 1, which was constructed by adjusting for age, sex, and ethnicity, showed ORs less than 1 (crude model: OR = 0.54, 95% CI [0.34, 0.83], p = 0.008; adjusted model 1: OR = 0.54, 95% CI [0.34, 0.83], p = 0.008). The predictive model, including age, sex, race, body mass index (BMI), hypertension, chronic kidney disease, and probiotics, had 76.7% sensitivity and 68.0% specificity with an area under the ROC curve of 0.7886 for detecting hyperuricemia in US adults.

Conclusion

These results suggest that probiotic consumption may reduce the incidence of hyperuricemia in the US adult population, but prebiotics have not shown the same effect.

An update on current type 2 diabetes mellitus (T2DM) druggable targets and drugs targeting them

Type 2 diabetes mellitus (T2DM) is characterized by hyperglycemia and affects millions of people globally. Even after advancement and development in medical science, it is a big task to achieve victory over type 2 diabetes mellitus (T2DM). T2DM can be a reason for fatal events like stroke, cardiac failure, nephropathy, and retinopathy. Many advanced antidiabetic drugs have been introduced in the market in the past two decades, leading researchers to hunt for new target proteins and their potential modulators that can help develop newer antidiabetic drugs. This review article comprises a broad literature of the latest developments in the management of T2DM concerning new target proteins, their inhibitors, or drugs from the clinical arena employed for the successful management of symptoms of T2DM using mono, dual, or triple combination medication therapy. The review categorizes antidiabetic drugs into three general classes that include conventional drug targets, currently explored targets, and upcoming emerging targets. The review aims to merge information on the medicines affecting these targets, their mechanisms, followed by the chemical structures, and recent advancements.

Correlation of the lipid complex marker hs-CRP/HDL-C ratio with hyperuricaemia: a cross-sectional retrospective study from NHANES 2015-2018

the high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) ratio and hyperuricemia among the population of the United States, the ratio still has predictive value for cardiovascular disease in middle age. Methods 4,780 adult participators from the National Health and Nutrition Examination Survey (NHANES) were involved in this research. Through the NHANES laboratory testing, all biochemical indications were discovered. In order to observe the differences in indications, propensity score methods were used to match age and sex confounders.The relationship between hs-CRP/HDL-C ratio and hyperuricemia was explored using propensity matching and weighted multivariate logistic regression analysis, with the potential nonlinear relationship between hs-CRP/HDL-C ratio and hyperuricemia was investigated using a restricted cubic spline test. Results Sex, age, hypercholesterolaemia, diabetes, fasting glucose, cholesterol, high and low density lipoprotein, did not differ statistically significantly (P > 0.05); however, uric acid, triglycerides, high-density lipoprotein, CRP/HDL ratio, C-reactive protein, ethnicity, and hypertriglyceridemia differed (P < 0.05). In a weighted multifactor model, the relative odds ratio for hyperuricemia increased by 0.383 times at the second quintile (OR = 1.383, 95%CI(1.382-1.385), P < 0.001), 2.001 times at the third quintile (OR = 3.001, 95%CI (2.998-3.005), P < 0.001), and 2.533 times at the fourth quintile (OR = 3.533, 95%CI (3.529-3.538), P < 0.001). In the univariate and multivariate models, the restricted cubic spline test demonstrated a nonlinear correlation between the CRP/HDL ratio and hyperuricaemia, with a growing "log-function" shaped trend (P for overall < 0.001). Conclusion The hs-CRP/HDL-C ratio is significantly positively correlated with hyperuricemia among American adults. Maintaining the ideal hs-CRP/HDL-C ratio may contribute to reducing the burden of hyperuricemia.

Semaglutide as a GLP-1 Agonist: A Breakthrough in Obesity Treatment

This review addresses the role of semaglutide (SMG), a GLP-1 receptor agonist, in the treatment of obesity and its related comorbidities. Originally developed for type 2 diabetes (DM2), SMG has shown significant efficacy in weight reduction, with superior results compared to other treatments in the same class. Its effects include appetite suppression, increased satiety, and improvements in cardiovascular, renal, and metabolic parameters. Studies such as SUSTAIN, PIONEER, and STEP highlight its superiority compared to other GLP-1 receptor agonists and anti-obesity drugs. The oral formulation showed promising initial results, with higher doses (50 mg) showing weight losses comparable to those of subcutaneous administration. Despite its benefits, there are challenges, such as weight regain after cessation of treatment, gastrointestinal adverse effects, and variability of response. Future studies should explore strategies to mitigate these effects, identify predictive factors of efficacy, and expand therapeutic indications to other conditions related to obesity and insulin resistance. The constant innovation in this class of drugs reinforces the potential of SMG to transform treatment protocols for chronic weight-related diseases.

Roles of extracellular vesicles from different origins in metabolic-associated fatty liver disease: progress and perspectives

Metabolic-Associated Fatty Liver Disease (MAFLD) is the most common chronic liver disease worldwide, associated with systemic metabolic dysregulation. It can progress from simple hepatic steatosis (MAFL) to more severe conditions like Metabolic-Associated Steatohepatitis (MASH), fibrosis, cirrhosis, and Hepatocellular Carcinoma (HCC). There is a critical lack of reliable non-invasive diagnostic methods and effective pharmaceutical treatments for MAFLD/MASH, emphasizing the need for further research. Extracellular vesicles (EVs) are nanoscale structures that play important roles in cell signaling by delivering bioactive molecules. However, there is a significant gap in literature regarding the roles of EVs from hosts, plants, and microbiota in MAFLD. This review explores the potential of EVs from various sources-host, plants, and microbiota-as biomarkers, therapeutic agents, drug carriers, and treatment targets for MAFLD. Firstly, the roles of host-derived extracellular vesicles (EVs) in MAFLD, with a focus on cell-type specific EVs and their components-proteins, miRNAs, and lipids-for disease diagnosis and monitoring were discussed. Moreover, it highlighted the therapeutic potential of mesenchymal stem cell (MSC)-derived EVs in reducing lipid accumulation and liver injury, and immune cell-derived EVs in mitigating inflammation and fibrosis. The review also discussed the use of host-derived EVs as drug carriers and therapeutic targets due to their ability to deliver bioactive molecules that impact disease mechanisms. Additionally, it summarized research on plant-derived EVs, which help reduce liver lipid accumulation, inflammation, and enhance gut barrier function in MAFLD. Also, the review explored microbial-derived EVs as novel therapeutic targets, particularly in relation to insulin resistance, liver inflammation, and dysfunction in MAFLD. Overall, by exploring the diverse roles of EVs from host, plant, and microbiota sources in MAFLD, this review offers valuable insights into their potential as non-invasive biomarkers and novel therapeutic strategies, which could pave the way for more effective diagnostic and treatment options for this increasingly prevalent liver disease. Notably, the challenges of translating EVs into clinical practice were also thoroughly discussed, aiming to provide possible directions and strategies for future research.

Association between skeletal muscle mass and the prognosis of patients undergoing percutaneous coronary intervention: a retrospective study

BACKGROUND

The predicted skeletal muscle mass index (pSMI) is a proven and reliable index that reflects muscle mass; however, its ability to predict major adverse cardiovascular events (MACES) in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains uncertain.

METHODS

A total of 1340 enrolled patients were ultimately included in the study and stratified according to the pSMI tertiles. The primary endpoint was a complex set of MACEs, including all-cause mortality, nonfatal myocardial infarction, and unplanned revascularization. The Kaplan‒Meier method was used to generate a cumulative incidence curve of MACEs and secondary endpoint events of all-cause mortality. Due to the competing risk relationship between all-cause mortality and cardiovascular mortality, non-fatal myocardial infarction, and unplanned revascularization events, a competing risk model was employed to analyze the cumulative event incidence curves of competing risk events.The restricted cubic spline analysis was conducted to examine the linear association between pSMI and the incidence of MACE. A univariate and multivariate Cox regression model was utilized to identify predictors of MACEs. The predictive value of the pSMI was evaluated by determining the area under the ROC curve.

RESULTS

During a median follow-up of 31.38 months, 217 patients developed MACEs. The Kaplan-Meier survival curve showed the lowest risk of MACEs and all-cause mortality in the high pSMI group(log-rank test, P < 0.05). After adjusting for competing risk factors for all-cause death, the cumulative events of cardiac death in the T3 group were lower than other two groups (Gray's test, P < 0.001), with no significant difference in the cumulative incidence of non-fatal myocardial infarction and unplanned revascularization between the pSMI groups (Gray's test, P > 0.05). The adjusted hazard ratio (HR) for the incidence of MACEs in the highest pSMI tertile was 0.335(95% CI 0.182-0.615; P < 0.001), as shown by multivariable Cox regression analysis. Subgroup analysis revealed that the pSMI was negatively correlated with the incidence of MACEs in a population of nonelderly individuals, and those without heart failure (all P < 0.05). Both the univariate and fully adjusted restriction cubic spline (RCS) curves showed a linear relationship between the pSMI and MACEs. In addition, the inclusion of the pSMI in the basic risk prediction model improved prognostic prediction (the area under the ROC curve increased from 0.647 to 0.682, P = 0.033).

CONCLUSION

In patients with CAD undergoing PCI, the pSMI is a protective factor and potentially simple method for assessing the risk of MACEs independently.

CLINICAL TRIAL NUMBER

Not applicable.

Clinical Guidelines of the Russian Society for the Study of the Liver, Russian Gastroenterological Association, Russian Society for the Prevention of Non-Communicable Diseases, Russian Association of Endocrinologists, Russian Scientific Medical Society of Therapists, National Society of Preventive Cardiology, Russian Association of Gerontologists and Geriatricians on Non-Alcoholic Fatty Liver Disease

Aim. The clinical guidelines are intended to provide information support for making decisions by gastroenterologists, general practitioners and internists that will improve the quality of medical care for patients with non-alcoholic fatty liver disease, taking into account the latest clinical data and principles of evidence-based medicine. Key points. Clinical guidelines contain information about current views on etiology, risk factors and pathogenesis of nonalcoholic fatty liver disease, peculiarities of its clinical course. Also given recommendations provide information on current methods of laboratory and instrumental diagnostics, invasive and non-invasive tools for nonalcoholic fatty liver disease and its clinical phenotypes assessment, approaches to its treatment, considering the presence of comorbidities, features of dispensary monitoring and prophylaxis. The information is illustrated with algorithms of differential diagnosis and physician's actions. In addition, there is information for the patient and criteria for assessing the quality of medical care. Conclusion. Awareness of specialists in the issues of diagnosis, treatment and follow-up of patients with nonalcoholic fatty liver disease contributes to the timely diagnosis and initiation of treatment, which in the long term will significantly affect their prognosis and quality of life.

Clinical Utilization and Performance of Bempedoic Acid in an Italian Real-World Setting: Insight from Campania Region

Background/Objectives: Bempedoic acid (BA) is a novel lipid-lowering agent that reduces low-density lipoprotein cholesterol (LDL-c) and cardiovascular events. Limited real-world data on its effectiveness and safety are available. This study aimed to evaluate the utilization and clinical performance of BA in routine clinical practice. Moreover, an explorative pharmacoeconomic analysis was performed. Methods: We prospectively enrolled consecutive patients with dyslipidemia who started 180 mg BA, alone or with 10 mg ezetimibe, across five outpatient clinics in Campania Region, Italy from September to December 2023. Clinical and laboratory assessments, including lipid profile, hepatic function, and creatine phosphokinase levels, were performed at baseline and at least after one month follow-up. Side effects were recorded. Results: 111 patients (age 65 ± 9 years, 61% male) were included. At BA initiation, 70.3% were on maximally tolerated statin dosage and ezetimibe, 16.2% on ezetimibe alone, and 13.5% on PCSK9 inhibitors due to statin intolerance. BA significantly reduced LDL-c serum levels (89.9 ± 33.0 vs. 56 ± 27.6 mg/dL; p < 0.0001), with 46% achieving therapeutic targets. LDL-c decreased by 28% in patients on intensive statins/ezetimibe and by 45% in statin-intolerant patients, with reduced healthcare costs. Side effects were infrequent (10%) and reversible. Adherence was 99%, and persistence 90%. Conclusions: In our clinical pratice, BA was primarily used in high-risk patients with dyslipidemia who failed to reach LDL-c therapeutic target with statins/ezetimibe, and to a lesser extent, in statin-intolerant individuals. BA treatment enabled 54% to reach LDL-c therapeutic target. BA was well tolerated, and showed high adherence and persistence, contributing to cost savings.

Perioperative Considerations of Novel Antidiabetic Agents in Heart Failure Patients Undergoing Cardiac Surgery

Diabetes mellitus (DM) is a major risk factor for cardiovascular disease, including heart failure (HF). A high proportion of DM patients eventually require cardiac surgery. While the traditional approach to DM therapy focuses on tight glucose control with insulin and oral hypoglycemic agents, novel antidiabetic drugs have emerged over the past two decades that offer not only improved glycemic control but also cardiovascular and renal protection, such as benefits in HF management. The aim of this review is to examine and evaluate the perioperative risk and benefits of novel antidiabetic agents in HF treatment for both DM and non-DM patients undergoing cardiac surgery. We specifically studied glucagon-like peptide-1 receptor agonists (GLP-1RAs), dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium-glucose cotransporter 2 inhibitors (SGLT2is). Although studies on novel antidiabetic therapy in cardiac surgeries were limited, the results showed all three agents to be safe for use in the perioperative period, with SLGT2i demonstrating the most benefits in HF management for those with or without DM and kidney impairment undergoing cardiac surgery. Future research on larger study populations and using a more rigorous study design is necessary in bridging current knowledge to improve patient outcomes.

Association between hs-CRP/HDL with type 2 diabetes mellitus in middle-aged and elderly people: a cross-sectional study from CHARLS

Background

Research into the relationship between the ratio of high-sensitivity C-reactive protein (hs-CRP) and high-density lipoprotein cholesterol (HDL-C) concerning type 2 diabetes mellitus (T2DM) is still scarce. The hs-CRP/HDL ratio could be an important biomarker for evaluating the risk of developing diabetes. This study primarily aims to investigate the association between hs-CRP/HDL ratios and the incidence of T2DM within a defined population.

Methods

This analysis was conducted using data from 9,381 participants aged 45 and older, obtained during the 2011 wave of the China Health and Retirement Longitudinal Study (CHARLS). The study evaluated the association between the hs-CRP/HDL ratio and the risk of developing type 2 diabetes mellitus (T2DM) employing multivariate logistic regression, subgroup analyses, smooth curve fitting, and threshold effect analysis.

Results

The overall prevalence of T2DM within the study population was found to be 16.3%, with 46.1% of cases occurring in men and 53.9% in women. Participants diagnosed with T2DM demonstrated a mean hs-CRP/HDL ratio that was 1.2 times higher than that of individuals without diabetes. The adjusted odds ratio (OR) for T2DM associated with hs-CRP/HDL levels was determined to be 0.75 (95% CI: 0.64-0.87). Additionally, a significant interaction was identified between hs-CRP/HDL ratios and variables such as sex and smoking in relation to T2DM risk (P < 0.05). Further subgroup analyses examining factors like age, education, marital status, hukou status, and drinking habits did not reveal any significant interactions (all P values for interaction were >0.05).

Conclusions

The results highlight a robust association between the hs-CRP/HDL ratio and the likelihood of developing T2DM, indicating its potential as a predictive biomarker for the condition. Additional research is required to clarify the relationship between hs-CRP/HDL ratios and the incidence of T2DM.

Paeonol ameliorates ferroptosis and inflammation in chondrocytes through AMPK/Nrf2/GPX4 pathway

Introduction

Chondrocyte ferroptosis is an important component of the pathogenesis of osteoarthritis. Paeonol, the main pharmacologically active ingredient of the Paeonia suffruticosa Andrews, is a natural radical scavenger with potent biological activities, including antioxidant, anti-inflammatory, and cartilage protection effects. However, the molecular mechanisms underlying its role in regulating chondrocytes ferroptosis remain unclear.

Methods

To investigate the effect of paeonol on ferroptosis and inflammation of chondrocytes through interleukin-1β (IL-1β), the proliferation activity, lipid peroxidation level, endogenous antioxidant capacity, and mitochondrial membrane potential of chondrocytes were evaluated in detail. Intracellular ferrous ion concentration was detected by FerroOrange fluorescent probe staining. Western blotting and immunofluorescence staining were used to detect biomarker proteins of ferroptosis, inflammation, and AMPK/Nrf2/GPX4 signaling pathway proteins.

Results

The results showed that paeonol significantly depressed IL-1β-induced ferroptosis and inflammation in chondrocytes. Specifically, paeonol protects cell viability, reduces lipid peroxidation damage, maintains mitochondrial function, and inhibits pro-ferroptosis and pro-inflammation biomarker proteins. In addition, the anti-inflammatory ability of paeonol was partially inhibited after the addition of ferroptosis agonist erastin, suggesting that paeonol protects against inflammatory injury in part by inhibiting ferroptosis. Further studies showed that paeonol activated AMPK phosphorylation and promoted Nrf2 nuclear translocation and Keap1 degradation. Finally, the AMPK-Nrf2-GPX4 signaling pathway was confirmed to be the underlying mechanism of paeonol against ferroptosis by the simultaneous use of the AMPK agonist and Nrf2 inhibitor.

Conclusion

These results indicate that paeonol significantly inhibits IL-1β-induced ferroptosis and inflammation in chondrocytes, and the underlying mechanism of paeonol against ferroptosis is partly through the AMPK/Nrf2/GPX4 axis.

Atherogenic index of plasma, high sensitivity C-reactive protein and incident diabetes among middle-aged and elderly adults in China: a national cohort study

BACKGROUND

The atherogenic index of plasma (AIP) and systematic inflammation, as measured by high-sensitivity C-reactive protein (hsCRP), are predictors of diabetes, but their combined impacts on incident diabetes are poorly understood. Using a nationally representative cohort in China, we aimed to investigate the association of AIP and hsCRP with incident diabetes among middle-aged and elderly adults.

METHODS

This cohort comprised 9,112 participants aged at least 45 years from 125 cities in the China Health and Retirement Longitudinal Study who were free of diabetes at baseline in 2011. Of these, 5,048 participants were followed up until 2015. The AIP was calculated as Log10[TG (mg/dL)/HDL-C(mg/dL)]. Multivariate logistic regression and linear mixed-effect (LME) models were performed to evaluate the associations of AIP, hsCRP, and incident diabetes as well as glycemic biomarkers. Receiver operating characteristic (ROC) curves were used to evaluate their diagnostic values. We conducted a mediation analysis to assess the direct and indirect associations between AIP and hsCRP with diabetes.

RESULTS

489 (9.7%) cases developed diabetes during four years. Higher levels of AIP and hsCRP were independently associated with diabetes. Compared to the lowest quartile of AIP or hsCRP, the highest quartile of AIP (adjusted odds ratio, aOR 2.53, 95% CI: 1.90-3.38) and hsCRP (aOR 2.38, 1.79-3.16) was significantly associated with incident diabetes. The joint effects showed that participants with higher levels of AIP and hsCRP had significantly higher aOR of 2.76 (2.13-3.57). The LME models showed AIP and hsCRP were related to an increased level of fasting blood glucose and glycated hemoglobin. The combination of AIP and hsCRP has better predictive efficacy (area under the curve, AUC: 0.628, 0.601-0.654) for incident diabetes than alone. Mediation analyses showed that high AIP significantly mediated 25.4% of the association between hsCRP and diabetes, and hsCRP simultaneously mediated 5.7% of the association between AIP and diabetes.

CONCLUSIONS

This cohort suggests combined effects and mutual mediation between the AIP and hsCRP on incident diabetes in China. Our findings provide clinical implications for monitoring and managing AIP and hsCRP levels to mitigate the development of diabetes.

Long-term glycemic control after sleeve gastrectomy and biliopancreatic diversion with duodenal switch in patients with type 2 diabetes mellitus

BACKGROUND AND OBJECTIVES

Long-term studies exploring factors associated with glycemic control of type 2 diabetes mellitus (T2DM) after bariatric surgery are being requested. This prospective cohort study aimed to evaluate potential predictors of long-term glycemic control 5 years after surgery.

METHODS

Patients were operated between 2002 and 2014. Data were collected prospectively in a database after obtaining written informed consent from the patients. Surgical methods were sleeve gastrectomy (SG) or biliopancreatic diversion with duodenal switch (BPDDS). Possible predictors of postoperative long-term glycemic control (HbA1c) were investigated using multiple path regression analysis, which handles missing data.

RESULTS

A total of 181 patients were included consecutively, 87 after SG and 94 after BPDDS. The follow-up rate was 124/181 (69%), 57 (66%) after SG and 67 (71%) after BPDDS. We found that 39/57 (68%) of the patients who underwent SG and 54/67 (81%) of the patients who underwent BPDDS had remission of T2DM at 5 years. Lower preoperative HbA1c (P < 0.010), higher preoperative C-peptide (P = 0.004), greater percent total weight loss (P < 0.005), and the BPDDS procedure (P < 0.001) were associated with better postoperative long-term glycemic control (explained variance = 39.4%).

CONCLUSIONS

Both procedures, especially BPDDS, were effective in achieving long-term glycemic control. Lower preoperative HbA1c, higher C-peptide levels, greater weight loss, and the BPDDS procedure were key predictors of better long-term glycemic control.

Fabry Disease: Insights into Pathophysiology and Novel Therapeutic Strategies

Fabry disease (FD) is an X-linked lysosomal storage disorder characterized by deficiency of α-galactosidase A (α-GalA), leading to the accumulation of glycosphingolipids and multi-organ dysfunction, particularly affecting the cardiovascular and renal systems. Disease-modifying treatments such as enzyme replacement therapy (ERT) and oral chaperone therapy (OCT) have limited efficacy, particularly in advanced disease, prompting a need for innovative therapeutic approaches targeting underlying molecular mechanisms beyond glycosphingolipid storage alone. Recent insights into the pathophysiology of FD highlights chronic inflammation and mitochondrial, lysosomal, and endothelial dysfunction as key mediators of disease progression. Adjunctive therapies such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and mineralocorticoid receptor antagonists (MRAs) demonstrate significant cardiovascular and renal benefits in conditions including heart failure and chronic kidney disease. These drugs also modulate pathways involved in the pathophysiology of FD, such as autophagy, oxidative stress, and pro-inflammatory cytokine signaling. While theoretical foundations support their utility, dedicated trials are necessary to confirm efficacy in the FD-specific population. This narrative review highlights the importance of expanding therapeutic strategies in FD, advocating for a multi-faceted approach involving evidence-based adjunctive treatments to improve outcomes. Tailored research focusing on diverse FD phenotypes, including females and non-classical variants of disease, will be critical to advancing care and improving outcomes in this complex disorder.

Empowering Health Care Actors to Contribute to the Implementation of Health Data Integration Platforms: Retrospective of the medEmotion Project

Health data integration platforms are vital to drive collaborative, interdisciplinary medical research projects. Developing such a platform requires input from different stakeholders. Managing these stakeholders and steering platform development is challenging, and misaligning the platform to the partners' strategies might lead to a low acceptance of the final platform. We present the medEmotion project, a collaborative effort among 7 partners from health care, academia, and industry to develop a health data integration platform for the region of Limburg in Belgium. We focus on the development process and stakeholder engagement, aiming to give practical advice for similar future efforts based on our reflections on medEmotion. We introduce Personas to paraphrase different roles that stakeholders take and Demonstrators that summarize personas' requirements with respect to the platform. Both the personas and the demonstrators serve 2 purposes. First, they are used to define technical requirements for the medEmotion platform. Second, they represent a communication vehicle that simplifies discussions among all stakeholders. Based on the personas and demonstrators, we present the medEmotion platform based on components from the Microsoft Azure cloud. The demonstrators are based on real-world use cases and showcase the utility of the platform. We reflect on the development process of medEmotion and distill takeaway messages that will be helpful for future projects. Investing in community building, stakeholder engagement, and education is vital to building an ecosystem for a health data integration platform. Instead of academic-led projects, the health care providers themselves ideally drive collaboration among health care providers. The providers are best positioned to address hospital-specific requirements, while academics take a neutral mediator role. This also includes the ideation phase, where it is vital to ensure the involvement of all stakeholders. Finally, balancing innovation with implementation is key to developing an innovative yet sustainable health data integration platform.

Polydatin combined with hawthorn flavonoids alleviate high fat diet induced atherosclerosis by remodeling the gut microbiota and glycolipid metabolism

Background

Atherosclerosis is a widely studied pathophysiological foundation of cardiovascular diseases. Inflammation and dyslipidemia are risk factors that promote the formation of atherosclerotic plaques. The gut microbiota and their metabolites are considered independent risk factors for atherosclerosis. Polydatin combined with hawthorn flavonoids, as the extracts of Polygonum cuspidatum Sieb. et Zucc. and Crataegus pinnatifida Bunge, have shown excellent cardiovascular protective effects. However, the underlying mechanism requires further investigation. Our study aimed to explore the anti-atherosclerotic mechanism through gut microbiota and their metabolites.

Methods

ApoE-/- mice were fed either a normal-chow diet or a high-fat diet. The polydatin combined with hawthorn flavonoids group received varied doses of polydatin and hawthorn flavonoids: a high dose (polydatin 200 mg/kg daily; hawthorn flavonoids 100 mg/kg daily), a medium dose (polydatin 100 mg/kg daily; hawthorn flavonoids 50 mg/kg daily), and a low dose (polydatin 50 mg/kg daily; hawthorn flavonoids 25 mg/kg daily). The control and model groups were administered distilled water (0.2 mL daily). The experiment lasted for 24 weeks.

Results

Polydatin combined with hawthorn flavonoids administration significantly reduced lipid and inflammatory cytokine levels, meanwhile, the atherosclerotic lesions in a high-fat diet-induced ApoE-/- mice were significantly decreased. Additionally, polydatin combined with hawthorn flavonoids also inhibited the enhancement of trimethylamine N-oxide (TMAO), trimethylamine (TMA) levels of HFD-induced ApoE-/- mice by regulating the expression of hepatic flavin-containing enzyme monooxygenase 3 (FMO3). 16S rRNA sequencing results demonstrated that high-dose polydatin combined with hawthorn flavonoids treatment increased the abundance of Actinobacteriota, Atopobiaceae and Coriobacteriaea_UCG-002, and decreased the abundance of Desulfobacterota. Norank_f_Muribaculaceae was enriched in the medium-dose polydatin combined with hawthorn flavonoids and simvastatin groups, and Lactobacillus was mainly increased in the simvastatin and the low-dose polydatin combined with hawthorn flavonoids groups. According to the metagenetic results, functional annotations also suggested that the biological processes of each group mainly focused on metabolism-related processes. Specifically, polydatin combined with hawthorn flavonoids may regulate the abundance of TMA-producing bacteria (Coriobacteriaceae, Desulfovibrio, Muribaculum, and Clostridium) and related enzymes in glycolipid metabolic pathways to exert an important effect on the prevention of atherosclerosis.

Conclusion

Our results suggested that polydatin combined with hawthorn flavonoids could regulate the glucolipid metabolism-related pathway, attenuate inflammatory cytokine levels, and reduce atherosclerotic plaques by remodeling gut microbiota.

Metformin: Its salutary effects beyond diabetes mellitus

Metformin, an oral hypoglycemic agent, is commonly used in patients with type II diabetes mellitus. Studies have shown its use is associated with a reduction in major cardiovascular events (MACE) in patients with type 2 diabetes such as hospitalization for acute myocardial infarction, stroke, transient ischemic attack, or cardiovascular death. There is also a suggestion that metformin may have effects beyond those relating to lowering of blood sugar. The goal of this review is to assess the effects of metformin in coronary artery disease (CAD), but more importantly, its effects on disease states other than CAD.

Severe hypoglycaemia and diabetic ketoacidosis in adults presenting to a hospital emergency department: Adverse prognostic markers for survival in type 2 diabetes and the role of SGLT2 inhibitors

AIMS

To determine the prognosis associated with severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) in adults presenting to a hospital emergency department (ED).

METHODS

Medical records of adults with type 1 (T1D) and type 2 (T2D) diabetes who attended the ED with SH and DKA between 1 January 2019 and 30 June 2023, were reviewed for comorbidities, long-term survival, mortality and causes of death.

RESULTS

A total of 429 episodes of DKA occurred in 293 people and 643 episodes of SH in 515 people. DKA predominated in T1D (77.6%) and SH in T2D (54.3%). In T2D, 32.3% of DKA events were associated with sodium-glucose cotransporter-2 inhibitor (SGLT2-i) medication. In both SH and DKA, patients with T2D were older and had more comorbidities than T1D, particularly cardiorenal disease, heart failure, cognitive impairment and cancer (all p < 0.005). Compared with T1D, mortality was higher in T2D after SH (48.4% vs. 19.9%, p < 0.005) and after DKA (30.8% vs. 13.4%, p = 0.001) with shorter median times to fatal outcome (SH: 134 vs. 511 days; DKA: 43 vs. 266 days, both p < 0.005). Long-term survival was lower (p < 0.005) and mortality risk was higher in T2D after index presentation with SH (HR 3.43 [95% CI: 2.43-4.84], p < 0.005) and DKA (HR 3.00 [95% CI: 1.77-5.10], p < 0.005). Irrespective of diabetes type, most causes of death in SH and DKA were non-cardiovascular.

CONCLUSIONS

SH and DKA events requiring hospital treatment herald a poor prognosis with greater mortality in T2D adults with multimorbidity. A significant number of DKA episodes in T2D occurred in people receiving SGLT2-i medication.

Computational insights into the aggregation mechanism of human calcitonin

Human calcitonin (hCT) is a peptide hormone that regulates calcium homeostasis, but its abnormal aggregation can disrupt physiological functions and increase the risk of medullary thyroid carcinoma. To elucidate the mechanisms underlying hCT aggregation, we investigated the self-assembly dynamics of hCT segments (hCT1-14, hCT15-25, and hCT26-32) and the folding and dimerization of full-length hCT1-32 through microsecond atomistic discrete molecular dynamics (DMD) simulations. Our results revealed that hCT1-14 and hCT26-32 predominantly existed as isolated monomers with transient small-sized oligomers, indicating weak aggregation tendencies. In contrast, hCT15-25 exhibited robust aggregation capability, forming stable β-sheet aggregates independently. Full-length hCT1-32 monomers displayed dynamic helical structures, with dimerization decreasing helix content and enhancing β-sheet formation. The transition to β-sheets in full-length hCT1-32 correlated with the loss of helical structure in the hCT15-25 region. Conformations with high helical content in hCT15-25 corresponded to significantly reduced β-sheet structures across the peptide, underscoring the importance of helical stability in preventing β-sheet conversion. Thus, the development of amyloid-resistant hCT analogues should focus on enhancing helical stability in this crucial region. Overall, our study not only elucidates the aggregation mechanism of hCT but also identifies a critical target for designing drug inhibitors to prevent hCT aggregation.

The efficacy and safety of Baduanjin exercise as complementary therapy for pain reduction and functional improvement in knee osteoarthritis: A meta-analysis of randomized controlled trials

OBJECTIVES

To systematically evaluate the efficacy and safety of Baduanjin exercise in patients with knee osteoarthritis through meta-analysis. While Baduanjin exercise, a traditional Chinese exercise therapy, is part of complementary and alternative medicine, its therapeutic value for knee osteoarthritis remains uncertain due to limited supporting evidence. This study seeks to address this gap.

METHODS

The study protocol has been registered in PROSPERO(CRD42024501559). A systematic review and meta-analysis were conducted by searching six databases up to January 2024 (PubMed, Cochrane Library, EBSCO, Web of Science and CNKI, and Wanfang Medical), including RCTs that assessed Baduanjin exercise for KOA treatment. Two reviewers independently selected studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias tool (RoB2). Meta-analyses were performed using RevMan version 5.4.1 software. The outcome indicators included the WOMAC knee pain score, stiffness score, and physical function score, as well as the total score and adverse events. For summary results, weighted mean difference (MD) and 95 % confidence intervals (CI) were used.

RESULTS

Twelve RCTs involving 846 participants were included. Baduanjin exercise significantly improved WOMAC pain score (MD=-2.59, 95 % CI: -4.20 to -0.97, P = 0.002), stiffness score (MD=-2.42, 95 % CI: -3.75 to - 1.08, P = 0.004), physical function score (MD=-4.42, 95 % CI: -5.67 to -3.17, P < 0.00001), and total score (MD=-11.27, 95 % CI: -14.26 to -8.28, P < 0.00001) compared to controls. Subgroup analyses revealed significant improvements regardless of intervention duration, frequency, or location. No adverse events were reported. However, high heterogeneity and methodological biases were observed.

CONCLUSION

Baduanjin exercise appears to be an effective and safe complementary therapy for improving pain and function in patients with KOA. High-quality RCTs are needed to confirm these findings and explore optimal intervention parameters. Future research should address the identified methodological limitations.

Monkeypox (Mpox) Vaccine Hesitancy Among Mpox Cases: A Qualitative Study

Human mpox has been an increasing concern in the United States and California since late 2022. While the Jynneos vaccine offers a degree of cross-protection against the disease, vaccine hesitancy is common among those recommended for vaccination. The purpose of this study was to assess vaccine knowledge, facilitators, and barriers to vaccine uptake among individuals previously diagnosed with mpox, or mpox cases, in Santa Clara County, California. In-depth interviews were conducted by public health department staff among mpox cases diagnosed in Santa Clara County between July and September 2022. Responses were analyzed using a grounded theory data analysis approach. Among the 47 participants, 36 (77%) had heard of mpox before diagnosis, and of these, 20 (56%) did not think they were at risk of developing mpox, and 28 (78%) were aware that a vaccine was available. Those who did not receive the vaccine stated vaccine access and availability were the main barriers. Among the six participants not interested in the vaccine, the main hesitancies were lack of perceived risk, stigma of being branded by scarring and labeled gay, and vaccine safety. Overall, the following themes were attributed to reasons for vaccine hesitancy: (a) lack of awareness of the disease and vaccine, including perceived risks; (b) lack of vaccine availability and accessibility; and (c) stigma associated with receiving the vaccine, including being publicly labeled as "gay" and the scarring on forearm potentially seen as branding. We recommend tailoring outreach and educational campaigns to address reasons for mpox vaccine hesitancy.

Association of long-term weight management pharmacotherapy with multiple health outcomes: an umbrella review and evidence map

BACKGROUND

Multiple meta-analyses (MAs) have demonstrated that six pharmacotherapies, including orlistat, liraglutide, phentermine/topiramate, naltrexone/bupropion, semaglutide, and tirzepatide, improve weight loss and weight maintenance. However, few studies have synthesized and evaluated the quality of this evidence.

OBJECTIVE

To identify the relevant MAs of randomized clinical trials (RCTs) that explored the association between the six pharmacotherapies and obesity-related health outcomes and adverse events (AEs).

METHODS

A comprehensive search was conducted across PubMed, Embase, Cochrane Library, and Web of Science from database inception up to January 2024. We calculated the effect size as the mean difference and risk ratio using the random-effects model. The quality of MAs was evaluated using "A Measurement Tool to Assess Systematic Reviews 2".

RESULTS

Sixteen MAs comprising 235 RCTs that described 115 unique associations between the six pharmacotherapies and various health outcomes were included. Overall, 101 statistically significant associations (88%) had beneficial outcomes on body weight, weight loss, waist circumference, body mass index, total cholesterol, triglycerides, both low-density and high-density lipoprotein cholesterol, blood pressure, and glycemic profile. The pharmacotherapies were associated with significant weight loss and partial improvements in the lipid profile, blood pressure, and glycemic control among individuals with overweight or obesity. Notable AEs were associated with liraglutide, naltrexone/bupropion, semaglutide, and orlistat. The methodological quality of the included MAs requires improvement.

CONCLUSIONS

This umbrella review identified significant beneficial associations between pharmacotherapies and anthropometric measures, lipid profile, blood pressure, glycemic profile, and quality-of-life outcomes in individuals with overweight or obesity. In addition, the umbrella review highlighted safety considerations. The findings affirm the efficacy of the six pharmacotherapies in promoting weight loss in this demographic. Further clinical trials with long-term follow-up are essential to evaluate the effects of these pharmacotherapies on clinical outcomes, including cancer, cardiovascular events, and mortality.

Recent Advances in the Management of Dyslipidemia: A Systematic Review

Dyslipidemia refers to abnormal levels of lipids in the bloodstream, typically exhibiting an increased pattern. Total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and triglycerides (TGs) are all contributing factors to this disorder. This leads to an increased risk of atherosclerosis and cardiovascular diseases, such as coronary artery disease, which elevates the likelihood of morbidity. Dyslipidemia can be managed via the use of numerous classes of drugs and treatments. The conventional pharmacological agents comprising 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, selective cholesterol absorption inhibitors, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), bile acid sequestrants, monoclonal antibodies, and nutritional supplementation, such as inhibitors of cholesterol synthesis and absorption, and promoters of LDL-C excretion, are also discussed. Furthermore, conventional pharmacological treatment of dyslipidemia may elicit a variety of adverse side effects that are detrimental to the quality of life of the user. These side effects include muscle pain, weakness, liver enzyme elevations, and hyperglycemia. This systematic review further analyzes the pharmacological actions of novel lipid-lowering agents such as adenosine triphosphate-citrate lyase inhibitors (ACLi), selective peroxisome proliferator-activated receptor alpha (PPARα) modulators, cholesteryl ester transfer protein inhibitors (CETPi), antisense oligonucleotides (ASO), and angiopoietin-like protein 3 inhibitors (ANGPTL3i) as well as their efficacy in treating dyslipidemia while sparing the user of potentially severe side effects. Compared to existing treatments, novel therapies have shown significantly greater effectiveness in managing dyslipidemia-related lipid profiles and exhibit fewer systemic adverse effects. Some of the recent therapies discussed are alternative treatments that offer patients promising efficacy and improved tolerability. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure a robust and transparent search process, aiming to minimize bias and maximize the retrieval of pertinent studies for review. Thus, this systematic review provides an overview of current and novel treatments for dyslipidemia, describing their efficacy, mechanism of action, safety, and side effects. As experimental investigations and clinical research progress, there is a possibility that a combination of newly tested medications and traditional ones may emerge as a promising treatment option for dyslipidemia in the future.

AIScholar: An OpenFaaS-enhanced cloud platform for intelligent medical data analytics

This paper presents AIScholar, an intelligent research cloud platform developed based on artificial intelligence analysis methods and the OpenFaaS serverless framework, designed for intelligent analysis of clinical medical data with high scalability. AIScholar simplifies the complex analysis process by encapsulating a wide range of medical data analytics methods into a series of customizable cloud tools that emphasize ease of use and expandability, within OpenFaaS's serverless computing framework. As a multifaceted auxiliary tool in medical scientific exploration, AIScholar accelerates the deployment of computational resources, enabling clinicians and scientific personnel to derive new insights from clinical medical data with unprecedented efficiency. A case study focusing on breast cancer clinical data underscores the practicality that AIScholar offers to clinicians for diagnosis and decision-making. Insights generated by the platform have a direct impact on the physicians' ability to identify and address clinical issues, signifying its real-world application significance in clinical practice. Consequently, AIScholar makes a meaningful impact on medical research and clinical practice by providing powerful analytical tools to clinicians and scientific personnel, thereby promoting significant advancements in the analysis of clinical medical data.

Shouhui Tongbian Capsule ameliorates obesity by enhancing energy consumption and promoting lipolysis via cAMP-PKA pathway

BACKGROUND

The prevalence of obesity and its associated diseases has sharply increased, becoming a global health issue. White adipose tissue (WAT), responsible for lipid storage via hyperplasia and hypertrophy, and brown adipose tissue (BAT), which facilitates energy dissipation, have increasingly been recognized as critical regulators of weight loss. Shouhui Tongbian Capsule (SHTB) has traditionally been used for detoxification, weight loss, and lipid reduction, and clinical evidence supports its use for relieving constipation. In traditional Chinese medicine (TCM), "dissipating turbidity" is seen as a shared approach to treating both constipation and obesity. Our evidence suggests that SHTB improves obesity and metabolic disorders, but the underlying mechanisms remain unclear.

PURPOSE

This study aimed to evaluate the pharmacological effects of SHTB on obesity and to explore the underlying mechanisms involved.

METHODS

Obese mice induced by a high-fat diet were treated with SHTB, and effects on body weight, adipose tissue, and metabolism were assessed. Active ingredients were identified through UPLC-MS, while metabolomics and RNA sequencing were performed to explore the mechanisms of SHTB in obesity, and molecular biology techniques validated its effects on energy consumption and lipolysis in adipose tissue. Finally, rescue experiments in vivo and in vitro confirmed the proposed mechanisms.

RESULTS

SHTB significantly reduced body weight, body fat percentage, and WAT mass while increasing BAT weight, and enhancing energy expenditure. Metabolomics and RNA sequencing indicated activation of the G-protein coupled receptor signaling and cAMP-PKA pathway, leading to increased lipolysis in WAT and enhanced thermogenesis in BAT. H89, a PKA agonist, counteracted these effects, supporting the involvement of cAMP-PKA signaling.

CONCLUSION

SHTB may prevent obesity by promoting lipolysis and enhancing BAT thermogenesis via the cAMP-PKA pathway, offering a potential therapeutic approach for obesity management.

Dose-Dependent Relationship Between Long-Term Metformin Use and the Risk of Diabetic Retinopathy: A Population-Based Cohort Study

BACKGROUND AND OBJECTIVE

Recent research has raised concerns about the association between metformin treatment in patients with diabetes mellitus (DM) and an increased risk of diabetic retinopathy. We sought to investigate this relationship, specifically examining if metformin use affects diabetic retinopathy risk in a dose-dependent manner.

METHODS

This study was a secondary data analysis based on a nationwide population database in Taiwan. Patients with new-onset DM, an age of 20 years or older, and a diagnosis of type 2 DM received at any time during 2002-2013 were included in the study. Patients diagnosed with new-onset type 2 DM between 2002 and 2013 were enrolled as the study population. We divided them into two groups: those treated with metformin and those treated with sulfonylureas. A Cox proportional hazards model was employed to estimate the risk of diabetic retinopathy after 5 years of follow-up, including cumulative defined daily dose and intensity of metformin treatment.

RESULTS

A total of 241,231 patients received treatment with metformin, while 152,617 patients were treated with sulfonylureas. Compared with patients treated with sulfonylureas, patients who received metformin treatment, at a cumulative defined daily dose < 30, had a lower risk of diabetic retinopathy (adjusted hazard ratio = 0.77; 95% confidence interval 0.60-0.98). However, those with varying defined daily doses, especially at a higher metformin treatment level (> 25 defined daily dose), had a 2.43 times higher risk of diabetic retinopathy (95% confidence interval 1.37-4.30) compared with patients treated with sulfonylureas.

CONCLUSIONS

Patients with DM treated with a lower cumulative dosage of metformin showed beneficial effects that were associated with a lower risk of diabetic retinopathy. In contrast, a higher intensity of metformin use had a greater risk of diabetic retinopathy.