To assess the link between persistent lipoprotein(a) [Lp(a)] exposure levels and clinical outcomes in patients with acute myocardial infarction (AMI).

This longitudinal cohort study included 1131 AMI patients, categorizing persistent Lp(a) exposure based on measurements at admission and after 1 year. Patients were segmented into four groups using a 300 mg/L Lp(a) threshold: (1) persistent low Lp(a) (lowon admission - lowat 1 year); (2) fortified Lp(a) (lowon admission - highat 1 year); (3) attenuated Lp(a) (highon admission - lowat 1 year); and (4) persistent high Lp(a) (highon admission - highat 1 year). Multivariate Cox regression, subgroup analysis and sensitivity analysis assessed the association between Lp(a) trajectories and major adverse cardiovascular and cerebrovascular events (MACCE), cardiovascular death, non-fatal MI, non-fatal stroke, unplanned revascularization, and all-cause death.

Over a median 50-month follow-up, 343 (35.70%) patients encountered MACCE, and 210 (18.70%) died, including 126 (11.20%) from cardiovascular causes. The group with persistent high Lp(a) faced increased risk of MACCE (HRadjusted, 1.871; 95% CI: 1.474-2.374), non-fatal stroke (HRadjusted, 1.647; 95% CI: 1.031-2.632), unplanned revascularization (HRadjusted, 1.571; 95% CI: 1.008-2.449), and both all-cause (HRadjusted, 1.546; 95% CI: 1.134-2.108) and cardiovascular death (HRadjusted, 2.163; 95% CI: 1.405-3.331), compared to the persistent low Lp(a) group.

In AMI patients, sustained high Lp(a) levels were significantly associated with increased risk of MACCE, non-fatal stroke, unplanned revascularization, and both all-cause and cardiovascular death.

In recent years, the increase of the post-transplantation diabetes mellitus (PTDM) after renal transplantation encourages people to do a lot of research on the disease. This paper conducted a bibliometric study on PTDM related literature to explore the risk factors of diabetes after kidney transplantation, as well as the current status, hotspots and development trends of PTDM research, so as to provide reference for researchers in related fields.

We searched the Web of Science Core Collection (WoSCC) database for PTDM literature from January 1, 1990, to August 20, 2023, and used VOSviewer, CiteSpace, and the R package 'bibliometrix' to do bibliometric analysis.

Obesity, 3 months after transplantation tacrolimus concentration >10 ng/mL, temporary hyperglycemia, delayed graft function, acute rejection is specific risk factors related to PTDM in renal transplant recipients. In addition, 74 countries led by China and the United States published 1546 papers, and the number of PTDM-related publications is increasing every year. Primary institutions included the University of California, Los Angeles, Mayo Clinic, University of Oslo, and University of Toronto. The Journal of Transplantation is the most widely read journal in the subject. The authors with the most published literature are Trond Jenssen and Adnan Sharif, and the most cited author is Kasiske BL. Expectations for continued growth in global PTDM research are increasingly high. Future studies will mainly focus on exploring the risk factors of PTDM and identifying new therapeutic approaches and targets.

This study aimed to compare the immunological and immunogenetic profiles over a spectrum of childhood- and adulthood-onset T1D at diagnosis. The cross-sectional study involved participants with recently diagnosed T1D (n = 168), aged 2.9-68.2 years. HLA-II alleles, single nucleotide polymorphisms (SNP) (rs2476601, rs3087243, rs1990760, rs13266634), thyroid and coeliac disease-related autoantibodies and anti-enterovirus antibodies (anti-EV) were analysed regarding the diabetes-associated autoantibodies' (DAA) status and the age of participants. In the longitudinal study, 19 immune checkpoint gene expression levels in children (n = 25) aged 3.6-14.5 years were measured at diagnosis and 1 year after diagnosis. The duration of symptoms before diagnosis was age-dependent. Older age increased the odds of being single DAA-positive (OR 1.05; 95% CI 1.02-1.09), while anti-EV IgG positivity increased the odds of being multiple DAA-positive (adjusted OR 4.42; 95% CI 1.62-12.04). The DAA-negative T1D participants were older than the DAA-positive individuals. The checkpoint gene expression levels between the two time points were similar, but exhibited more pronounced variability at the time of diagnosis. These results confirm immunological variability in recent-onset T1D cases between children and adults and stress the importance of further research to define the comprehensive immunological profile of the disease age-related subgroups.

Improving β-cell function can lead to remission in some patients with type 2 diabetes mellitus (T2DM). However, research on pharmacotherapy-induced remission in youth-onset T2DM remains scarce. Our study aimed to identify the clinical characteristics of pediatric patients who experience remission.

We retrospectively reviewed 88 pediatric patients with T2DM followed for at least 1 year at Seoul National University Bundang Hospital between 2013 and 2023. Remission was defined as a glycosylated hemoglobin (HbA1c) level less than 6.5% for at least 3 months after ceasing glucose-lowering pharmacotherapy.

Among 88 patients (60 males, 68.2%) diagnosed at an average age of 14.4±2.1 years, 19 patients (21.6%) achieved remission after a median duration of 1.4 years. The remission group had a larger proportion of males (89.5% vs. 62.3%, P=0.024) and a lower urinary albumin-to-creatinine ratio (ACR) at diagnosis (P=0.011). They also showed lower HbA1c levels at 1 year and more significant changes in HbA1c and body mass index (all P<0.05). Higher urinary ACR levels correlated with a longer duration to achieve remission (hazard ratio, 0.928; P=0.013). In three of the 19 remission patients (15.8%), recurrence occurred after a median of 1.5 years.

Among Korean youth with T2DM, 21.6% achieved remission after a median duration of 1.4 years. Those who experienced remission were predominantly male, had lower ACR at diagnosis, and had significant weight loss within the first year. Further investigation into the factors influencing remission and long-term outcomes is essential.

To assess renal perfusion and ectopic fat deposition in patients with type 2 diabetes mellitus (T2DM), and to evaluate the effects of ectopic fat deposition on renal hemodynamics.

All participants underwent quantitative magnetic resonance imaging (MRI) to measure the cortical and medullary renal blood flow (RBF) and proton density fat fraction (PDFF). Patients with T2DM were classified into three groups according to the estimated glomerular filtration rate (mL/min/1.73 m2). One-way analysis of variance was used to assess differences among groups. Pearson's correlation coefficient was used to analyze correlations. Additionally, a receiver operating characteristic (ROC) curve was constructed to assess diagnostic performance.

Renal PDFF values of the renal cortex and medulla, as well as perirenal fat thickness, were significantly different among the four groups: healthy control < T2DM < diabetic kidney disease (DKD) I-II < DKD III-IV. Additionally, significant differences in cortical and medullary RBF values were observed among the four groups: healthy control > T2DM > DKD I-II > DKD III-IV. A significant negative correlation was observed between renal PDFF and RBF values. Medullary RBF values demonstrated the best performance in discriminating T2DM from DKD with the largest area under the ROC curve (AUC) of 0.971. The cortical PDFF achieved the largest AUC (0.961) for distinguishing DKD I-II from DKD III-IV.

Quantitative MRI effectively evaluates renal perfusion and ectopic fat deposition in T2DM patients, aiding in assessing kidney function and disease progression. Additionally, renal ectopic fat deposition may be an important risk factor for renal hemodynamic injury.

Quantitative MRI could serve as a radiation-free imaging modality for assessing renal perfusion and ectopic fat deposition, which may be an important risk factor for DKD progression.

Quantitative MRI can be used to assess kidney function and monitor disease progression in patients with T2DM. In patients with T2DM, decreased renal perfusion, increased renal ectopic fat deposition, and kidney damage were significantly correlated. Renal ectopic fat deposition may be an important risk factor for renal hemodynamic injury.

The Cardiac Metabolic Index (CMI) is a comprehensive metabolic indicator, but studies on its relationship with Diabetic Kidney Disease (DKD) are limited. We aim to explore the association between CMI and DKD.

We obtained participant-related data from the National Health and Nutrition Examination Survey (NHANES), including complete information on DKD, CMI, and other covariates. We employed weighted multivariable logistic regression models, restricted cubic spline (RCS) regression analysis, subgroup analyses, and interaction tests to explore the relationship between CMI and DKD. Additionally, we utilized receiver operating characteristic (ROC) curves to compare the performance of CMI in identifying DKD relative to a body shape index (ABSI), body roundness index (BRI), visceral adiposity index (VAI), and lipid accumulation product (LAP) indices.

According to the logistic regression analysis, a positive correlation between CMI and DKD was observed among the 2371 participants included in the study (OR: 1.40, 95% CI: 1.19-1.66). RCS analysis indicated that this relationship is nonlinear. When CMI was converted from a continuous variable to quartiles, the prevalence of DKD in the highest quartile group showed a significant 84% increase compared to the lowest quartile group (OR: 1.84, 95% CI: 1.24-2.72). The area under the ROC curve of CMI for identifying DKD was 0.67, outperforming other indices. The results of subgroup analyses and interaction tests were stable.

Elevated CMI is associated with an increased risk of DKD and can serve as a low-cost screening tool, allowing physicians to potentially identify high-risk diabetic patients early and implement timely interventions to slow the progression of DKD.

In diabetes, nutrition therapy necessitates effective management strategies to improve blood glucose levels, blood pressure, and lipid profiles, thereby lowering the risk of cardiovascular disease and stroke. Tableware is a food-level strategy to accurately measure food consumed and control food portion size. This prospective, randomized study investigated the impact of quantified tableware (QTW) on glycemic control in T2DM patients. Conducted at Mackay Memory Hospital, Taiwan, from August 2015 to December 2016, the study included 94 adult T2DM participants with poor glycemic control (HbA1c >7 %), randomly assigned to control (n = 47) and intervention (n = 47) groups. All participants received regular counseling from the dietician, while the intervention group additionally used a set of QTW designed by the Taiwanese Association of Diabetes Educators to accurately measure all the food consumed per meal in appropriate proportions. The primary aim was the change in HbA1c at 12 months. Secondary aims included achieving HbA1c < 7 %, BP < 140/90, and LDL < 100 mg/dl, known as the ABC goals (HbA1c, blood pressure, LDL). Seventy-seven patients, 43 in the control group and 34 in the intervention group completed the study. After 12 months, the intervention group showed a significant reduction in HbA1c levels compared to the control group (-0.7 ± 0.9 vs -0.2 ± 1.0 %, p = 0.037). Additionally, 32.4 % of the intervention group achieved HbA1c < 7 %, compared to 11.6 % in the control group (p = 0.026). Achievement of the LDL goal and any two of the ABC goals significantly increased only in the intervention group. Using QTW improved glycemic control and achievement of the LDL goal in T2DM patients. These results indicate that QTW can effectively enhance glycemic control, blood pressure, and lipid profiles in T2DM patients. Further studies are needed to confirm these findings and explore broader applications.

Background Type 2 diabetes mellitus (T2DM) is a major cause of morbidity and mortality worldwide. This study aimed to determine the levels of knowledge, attitude, and practice regarding T2DM among Lebanese patients with T2DM compared to the general population. Methodology This was a cross-sectional, online-based questionnaire study conducted in Lebanon among patients with T2DM and the general population between July and September 2021. Data collection encompassed sociodemographic characteristics, habits, and personal/family history of T2DM and assessed the levels of knowledge (44 items), attitude (29 items), and practice (16 items) concerning T2DM. Results A total of 1,127 participants were included, and 445 participants had clinically diagnosed T2DM. Only 9% of the participants (103 out of 1,127 participants) showed adequate knowledge level regarding T2DM. Higher scores were noted among young (p = 0.048) and employed (p = 0.025) participants, who also had a higher educational level (p = 0.005) and were aware of their own HbA1c level (p = 0.005). Poor attitude was reported in approximately half of T2DM patients (231 out of 445 participants). A better attitude was noticed in participants with a higher T2DM-related knowledge level (p = 0.016) or a diabetic family member (p = 0.03). Concerning practice, 13.3% of responses were deemed adequate (59 out of 445 participants). Higher levels of T2DM-related knowledge (p = 0.001) and education (p = 0.032) were positively correlated with better practice, in contrast to smoking (p < 0.001) and obesity (p = 0.005). Conclusions We found a significant knowledge gap and poor attitude and practice regarding diabetes among Lebanese patients with T2DM, emphasizing the need for targeted awareness campaigns.

As a prevalent metabolic disorder, the increasing incidence of diabetes imposes a significant burden on global healthcare. Flavonoids in natural phytochemical products exhibit notable hypoglycemic properties, making them potential alternatives for diabetes treatment. This article summarizes the hypoglycemic properties of flavonoid subcategories studied in recent years, including flavones, isoflavones, flavonols, flavanols, and others. The relevant targets and signal pathways, such as α-amylase, α-glucosidase, insulin receptor substrate (IRS)/phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT), PKR-like endoplasmic reticulum kinase (PERK)/eukaryotic initiation factor 2α (eIF2α)/activation transcription factor 4 (ATF4)/C/EBP homologous protein (CHOP), etc., are also elaborated. Additionally, flavonoids have also been demonstrated to modulate the gut microbiota and its metabolites. Through the aforementioned mechanisms, flavonoids mainly suppress carbohydrate metabolism and gluconeogenesis; facilitate glucose uptake, glycogenesis, and insulin secretion; and mitigate insulin resistance, oxidative stress, inflammation, etc. Notably, several studies have indicated that certain flavonoids displayed synergistic hypoglycemic effects. In conclusion, this article provides a comprehensive review of the hypoglycemic effects of the flavonoids investigated in recent years, aiming to offer theoretical insights for their further exploration.

The gut microbiota is closely associated with the onset and development of type 2 diabetes mellitus (T2DM), characterized by insulin resistance (IR) and chronic low-grade inflammation. However, despite the widespread use of first-line antidiabetic drugs, IR in diabetes and its complications continue to rise. The gut microbiota and its metabolic products may promote the development of T2DM by exacerbating IR. Therefore, regulating the gut microbiota has become a promising therapeutic strategy, with particular attention given to probiotics, prebiotics, synbiotics, and fecal microbiota transplantation. This review first examines the relationship between gut microbiota and IR in T2DM, summarizing the research progress of microbiota-based therapies in modulating IR. We then delve into how gut microbiota-related metabolic products contribute to IR. Finally, we summarize the research findings on the role of traditional Chinese medicine in regulating the gut microbiota and its metabolic products to improve IR. In conclusion, the gut microbiota and its metabolic products play a crucial role in the pathophysiological process of T2DM by modulating IR, offering new insights into potential therapeutic strategies for T2DM.

Exocrine pancreatic insufficiency (EPI) is a major cause of maldigestion and malnutrition, resulting from primary pancreatic diseases or other conditions. As the prevalence of EPI continues to rise, accurate identification of its etiology has become critical for the diagnosis and treatment of pancreatic secretory insufficiency. EPI can result from both pancreatic and non-pancreatic disorders. Pancreatic disorders include acute and chronic pancreatitis, pancreatic tumors, cystic fibrosis, procedures that involve pancreatic resection, and other rare causes. Non-pancreatic disorders of EPI include diabetes mellitus, celiac disease, inflammatory bowel disease, gastrointestinal and esophagectomy surgery, as well as advanced patient age. This review aims to provide a comprehensive analysis of the literature on EPI etiology, with a thorough overview to support its consideration as a potential diagnosis.

Background: Diet plays an important role in preventing and managing the progression from prediabetes to type 2 diabetes mellitus (T2DM). This study aims to develop prediction models incorporating specific dietary indicators and explore the performance in T2DM patients and non-T2DM patients. Methods: This retrospective study was conducted on 2215 patients from the Henan Rural Cohort. The key variables were selected using univariate analysis and the least absolute shrinkage and selection operator (LASSO). Multiple predictive models were constructed separately based on dietary and clinical factors. The performance of different models was compared and the impact of integrating dietary factors on prediction accuracy was evaluated. Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the predictive performance. Meanwhile, group and spatial validation sets were used to further assess the models. SHapley Additive exPlanations (SHAP) analysis was applied to identify key factors influencing the progression of T2DM. Results: Nine dietary indicators were quantitatively collected through standardized questionnaires to construct dietary models. The extreme gradient boosting (XGBoost) model outperformed the other three models in T2DM prediction. The area under the curve (AUC) and F1 score of the dietary model in the validation cohort were 0.929 [95% confidence interval (CI) 0.916-0.942] and 0.865 (95%CI 0.845-0.884), respectively. Both were higher than the traditional model (AUC and F1 score were 0.854 and 0.779, respectively, p < 0.001). SHAP analysis showed that fasting plasma glucose, eggs, whole grains, income level, red meat, nuts, high-density lipoprotein cholesterol, and age were key predictors of the progression. Additionally, the calibration curves displayed a favorable agreement between the dietary model and actual observations. DCA revealed that employing the XGBoost model to predict the risk of T2DM occurrence would be advantageous if the threshold were beyond 9%. Conclusions: The XGBoost model constructed by dietary indicators has shown good performance in predicting T2DM. Emphasizing the role of diet is crucial in personalized patient care and management.

Undiagnosed diabetes mellitus (UDM) is associated with poorer health outcomes compared to diagnosed DM. We investigated factors associated with UDM in a highly urbanized Chinese setting to facilitate UDM detection.

We analysed data from the cross-sectional Hong Kong Population Health Survey. We defined UDM by blood glucose and HbA1c levels and a negative history of self-reported doctor-diagnosed DM. We categorized diabetes status into UDM, incident DM (IDM, i.e. recently diagnosed) and individuals without diabetes and used multinomial logistic regression models to investigate the relationship between diabetes status and social and health service-related factors.

We included 98 IDM cases, 101 UDM cases, and 2,153 individuals without diabetes. Individuals aged 35-44 years (aOR 12.65, 95% C.I. 2.54-62.97) and those living in subsidized-sale housing (aOR 2.01, 95% C.I. 1.14-3.56) had a higher risk of UDM relative to not having diabetes, but not IDM. Males who were economically active (aOR 4.22, 95% C.I. 1.25-14.30), and males who did not have regular check-ups (aOR 3.05, 95% C.I. 1.16-8.00) had higher risks of UDM relative to not having diabetes, whereas males with a higher household income had a lower risk of UDM (aOR 0.94, 95% C.I. 0.89-0.99). Compared to individuals without diabetes, UDM cases had comparable physical activity levels but most were work- and transport-related rather than recreational.

Compared to individuals without diabetes or IDM cases, economically active males, males without regular check-ups and males with lower household income had a higher risk of UDM. Targeted active DM screening can reduce UDM. However, further research on the benefits of different types of physical activity is needed.

The quantitation of glycated hemoglobin (Hb A1c) represents an average blood glucose level for a period of 2 to 3 months for diagnosing, monitoring, and managing diabetes mellitus. Unreliable results are reported when hemoglobin (Hb) variants are present in the sample. Patients are advised to use an alternate method due to the presence of the variant Hb and a reflex test to Hb electrophoresis to obtain precise information about the Hb variant. The present study utilizes x axis values from Hb A1c capillary electrophoresis (CE) to identify clinically significant Hb variants Hb E, S, and D.

Patient samples (n = 60) that showed a variant peak in the Hb A1c test with an x axis value of 190 to 240 were selected for the study. The migration position of the Hb variant (x axis value) and variant percent of the Hb A1c test were compared with the x axis value and variant percent in the Hb electrophoresis test to presumptively identify the variants. The identity of the variants was confirmed using mass spectrometry (MS).

Out of 60 samples, 20 samples were identified as Hb E (x axis 225-227), 20 samples were identified as Hb S (x axis 210-214), and 18 samples were identified as Hb D-Punjab (x axis 200-201). Two variants with an x axis value of 194 were identified as an α variant Hb Q India using MS. There is an overall negative shift of the x axis (-1 to -13 units) and a lower variant percent (-0.2% to -8.7%) in Hb A1c CE when compared with Hb electrophoresis.

The present study highlights the significance of the x axis value and variant percent to identify clinically significant Hb variants in the Hb A1c CE test.

The onset of childhood diabetes necessitates that the child and family quickly must learn numerous self-management tasks. Diabetes education is key to successful self-management, and established diabetes-related habits are known to be difficult to change. Hence, the initial hospital-based diabetes education and support is a distinct opportunity to optimize habits and disease management. The aim of this study is to investigate parents' experiences with the education and support provided at the hospital when a child has been newly diagnosed with type 1 diabetes.

Twenty semi-structured interviews were conducted with parents of children (0-18 years) newly diagnosed with type 1 diabetes. Inductive thematic analysis was used for data analysis.

Four overarching themes, each with its own implications were identified: 1) From a feeling of uncertainty toward a sense of perceived security 2) Certainty induces calmness 3) A balanced approach to diabetes 4) Trying to learn all about diabetes in just one week. The four themes stress the families' need of immediate reassurance from the health professionals.

The study sheds light on families' challenges during initial hospital-based diabetes education, offering insights for healthcare professionals to tailor support strategies and improve diabetes management.

Background: Face-to-face diabetic interventions (FFIs) are the gold standard for diabetic care, and smartphone application (app)-based self-management interventions (SBIs) can be a potential alternative. A few previous reviews compared the effects of both practices. Objectives: This study is aimed at (1) comparing the effectiveness of FFIs and SBIs on maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus (GDM) and (2) exploring potential covariates affecting those outcomes. Methods: Randomized controlled trials (RCTs) were retrieved from PubMed, EMBASE, CINAHL, Cochrane Library, Scopus, and Web of Science from inception to January 15, 2024. Meta-analyses, subgroup analyses, and metaregression analyses were conducted using the R software package meta, Version 4.3.1. Cochrane risk of bias Version 2 (RoB2) and grading of recommendations, assessment, development, and evaluation (GRADE) criteria were employed to appraise the quality of studies and certainty of outcomes. Results: We selected 15 RCTs from 2505 women with GDM across 11 countries for this review. The meta-analyses revealed that women in the SBIs can significantly reduce gestation weight gain (t = -2.45, p = 0.04) and macrosomia (t = -3.35, p = 0.02) when compared to those in the FFIs. We observed a higher likelihood of cesarean delivery when using generic apps (RR = 1.12, 95% confidence interval (CI): 0.59, 2.13) than GDM-specific apps (RR = 0.82, 95% CI: 0.64, 1.06). There was similar fasting plasma glucose, 2-h postprandial plasma glucose, hemoglobin A1c (HbA1c), cesarean section delivery rate, neonatal birthweight, large for gestational age, neonatal hypoglycemia, and neonatal intensive care unit admission between SBIs and FFIs. More than half (52%) were rated low risk based on RoB2. According to the GRADE criteria, very low to moderate evidence was found. Conclusions: SBIs can be considered an alternative management method for women with GDM to reap the benefits of smartphone apps. More high-quality RCTs are required to reaffirm the findings.

Background: Spinal muscular atrophy (SMA) is a severe neuromuscular disorder characterized by the degeneration of alpha motor neurons in the spinal cord, leading to progressive proximal muscle weakness and paralysis. SMA is clinically categorized into four phenotypes based on age of onset and motor function achieved. Patients with SMA type 3 (juvenile, Kugelberg-Welander disease) initially have the ability to walk unaided, but experience a gradual decline in motor abilities over time. However, their lifespan is not affected by the presence of the disease. Leptin, a cytokine-like hormone secreted by adipocytes, has receptors widely distributed in musculoskeletal tissues. Several studies suggest that adiponectin deficiency contributes to the development of insulin resistance, with lower adiponectin levels closely associated with greater insulin resistance and hyperinsulinemia. However, the role of adiponectin in different types of sarcopenia and its connection to insulin sensitivity remains controversial. The purpose of this study was to measure leptin and adiponectin levels in patients with SMA type 3 and explore their association with markers of insulin sensitivity. Methods: This cross-sectional study included 23 adult patients with SMA type 3 (SMA group) and 18 community-based healthy volunteers (control group), conducted from July 2020 to September 2024. Anthropometric parameters, body composition, body fat percentage, surrogate markers of insulin sensitivity (Homeostasis model assessment of insulin resistance index-HOMA-IR and ISI Matsuda), and circulating levels of leptin and adiponectin were measured in all participants. Results: Insulin resistance was present in 91.3% of patients with SMA type 3, as determined by HOMA-IR and ISI Matsuda insulin sensitivity markers. In the control group, 64.7% had insulin resistance (IR) according to HOMA-IR, while 44.4% met the ISI Matsuda criterion for IR, showing a significant difference in peripheral insulin sensitivity between groups. A significant difference in serum adiponectin levels was observed between patients with SMA type 3 and the control group, whereas there was no significant difference in serum leptin concentrations. High adiponectin levels were observed in 50% of patients with SMA type 3. In the healthy control group, adiponectin levels positively correlated with ISI Matsuda and negatively correlated with HOMA-IR, confirming the insulin-sensitizing role of adiponectin. However, this correlation was not observed in patients with SMA type 3. Conclusions: Our results suggest that in this specific type of hereditary neuromuscular disease, the interplay between sarcopenia and insulin leads to adiponectin resistance, challenging the canonical narrative between insulin sensitivity and adiponectin, and indicating a need for further research.

Women are at increased risk of developing kidney disease and cardiovascular disease (CVD) in their middle and older ages due to the impact of aging and hormonal variation associated with menopause transition. Women with diabetes are at greater risk of reduced kidney function. Reduced or even mildly reduced kidney function enhances the risk of developing atherosclerotic cardiovascular disease (ASCVD) among women with type 2 diabetes (T2D). Thus, the objective of this study is to determine the association of reduced or mildly reduced kidney function with an estimated 10-year risk of ASCVD, CVD, and cardiovascular risk factors among T2D women.

This cross-sectional study is conducted among 393 T2D women, aged between 40-70 years, subdivided into three groups according to the level of estimated glomerular filtration rate (eGFR) (eGFR ≥90 mL/min/1.73m2(normal), eGFR 60-89 mL/min/1.73m2 (mildly reduced) and eGFR <60 mL/min/1.73m2 (reduced)). Association of kidney function with an estimated 10-year risk of ASCVD as well as cardiovascular disease was determined.

Based on the current study findings, the presence of cardiovascular disease was found to be associated with mildly reduced (p=0.014) and reduced eGFR (p=0.004) among T2D participants with previous CVD. No association was found between mildly reduced or reduced eGFR with an estimated 10-year intermediate/high risk for ASCVD among T2D women without CVD. Even though the level of eGFR was significantly varied between pre and post-menopause T2D women, no association of kidney function with estimated 10-year ASCVD risk was observed. Among cardiovascular risk factors, the presence of hypertension was associated with mildly reduced/reduced eGFR among T2D women.

This study's findings highlight the graded, independent association of kidney function with cardiovascular disease among middle-aged and elderly T2D women with previous CVD, while no association with estimated 10-year risk for ASCVD among women without CVD.

To examine the association between dietary inflammatory index (DII) and risk of gestational diabetes mellitus (GDM).

A prospective birth cohort study was conducted in Iran. During the first trimester of pregnancy, food intake was measured using a food frequency questionnaire. Each participant's DII score was calculated, and then, the Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95% CI of GDM across the quartiles of DII. We systematically searched the literature to conduct a meta-analysis of observational studies (PROSPERO: CRD42022331703). To estimate the summary relative risk for the highest versus lowest category of DII, a random-effects meta-analysis was performed. The certainty of evidence was assessed using the GRADE approach.

In the prospective cohort study (n = 635 pregnant mothers), the multivariable HRs of GDM for the third and fourth quartiles of DII were 2.98 (95%CI: 1.98, 6.46) and 2.72 (95%CI: 1.11, 6.63), respectively. Based on a meta-analysis of six prospective cohorts and a case-control study (1014 cases of GDM in 7027 pregnant mothers), being in the highest category of the DII was associated with a 27% higher risk of GDM (relative risk: 1.27, 95%CI: 1.01, 1.59; I2 = 50%; low certainty of evidence). A dose-response meta-analysis suggested a positive monotonic association between DII and GDM risk.

Our prospective cohort demonstrated a positive correlation between GDM risk and the inflammatory potential of diet in the first trimester of pregnancy. The results need to be confirmed by larger cohort studies.

Not applicable.

Cancer and diabetes are increasingly prevalent, and it is not unusual for an individual to have both conditions at the same time. This occurrence has significant ramifications to the person, the clinical team providing care, and the broader health system.

For the period 2006-2019, we used national-level diabetes (Virtual Diabetes Register) and cancer (New Zealand Cancer Registry) data on nearly five million individuals over 44 million person-years of follow-up. We used cancer incidence among those with and without prevalent diabetes to project cancer incidence across the 2020-2044 period, using age-period-cohort modelling to account for factors driving trends in cancer incidence.

Cancer rates were highest among those with diabetes for 21 of the 24 most common cancers, and people with diabetes also have faster projected increases in cancer than those without diabetes. The greatest differences in cancer incidence by diabetes status were for uterine, liver, pancreatic and kidney cancers, which all have a strong relationship with obesity. In terms of projected burden, cancers in people with diabetes were projected to more than double from 20,243 to 48,773, a 141 % increase from 2015 to 19-2040-44. Age-standardised cancer incidence was projected to increase 2.4 times faster for people with diabetes.

Our findings reinforce the fact that diabetes prevention activities are also cancer prevention activities, and must therefore be prioritised and resourced in tandem. The projected volume of diabetes and cancer co-occurrence also has important policy implications in terms of workforce development, as well as service delivery.

Type 2 diabetes (T2D) is a heterogeneous disease influenced by both genetic and environmental factors. Recent studies suggest that T2D subtypes may exhibit distinct gene expression profiles. In this study, we aimed to identify T2D cluster-specific miRNA expression signatures for the previously reported five clinical subtypes that characterize the underlying pathophysiology of long-standing T2D: severe insulin-resistant diabetes (SIRD), severe insulin-deficient diabetes (SIDD), mild age-related diabetes (MARD), mild obesity-related diabetes (MOD), and mild early-onset diabetes (MEOD). We analyzed the circulating microRNAs (miRNAs) in 45 subjects representing the five T2D clusters and 7 non-T2D healthy controls by single-end small RNA sequencing. Bioinformatic analyses identified a total of 430 known circulating miRNAs and 13 previously unreported novel miRNAs. Of these, 71 were upregulated and 37 were downregulated in either controls or individual clusters. Each T2D subtype was associated with a specific dysregulated miRNA profile, distinct from that of healthy controls. Specifically, 3 upregulated miRNAs were unique to SIRD, 1 to MARD, 9 to MOD, and 18 to MEOD. Among the downregulated miRNAs, 11 were specific to SIRD, 9 to SIDD, 2 to MARD, and 1 to MEOD. Our study confirms the heterogeneity of T2D, represented by distinguishable subtypes both clinically and epigenetically and highlights the potential of miRNAs as markers for distinguishing the pathophysiology of T2D subtypes.

The incidence of diabetes mellitus (DM) is dramatically increasing worldwide, and it is expected to affect 700 million cases by 2045. Diabetes influences health care economics, human quality of life, morbidity, and mortality, which were primarily seen extensively in developing countries. Uncontrolled DM, which results in consistent hyperglycemia, may lead to severe life-threatening complications such as nephropathy, retinopathy, neuropathy, and cardiovascular complications.

In addition to traditional therapies with insulin and oral anti-diabetics, researchers have developed new approaches for treatment, including stem cell (SC) therapy, which exhibits promising outcomes. Besides its significant role in treating type one DM (T1DM) and type two DM (T2DM), it can also attenuate diabetic complications. Furthermore, the development of insulin- producing cells can be achieved by using the different types of SCs, such as embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), and multiple types of adult stem cells, such as pancreatic, hepatic, and mesenchymal stem cells (MSC). All these types have been extensively studied and proved their ability to develop insulin-producing cells, but every type has limitations.

This review aims to enlighten researchers about recent advances in stem cell research and their potential benefits in DM and diabetic complications.

This study aimed to assess the prevalence of IH and diabetes, as well as insulin secretion, insulin sensitivity, and related curve patterns in subjects with different glucose tolerance categories according to the diagnostic criteria established by the American Diabetes Association (ADA) and the more recently published International Diabetes Federation (IDF) guidelines.

We used data of 5,387 adult participants from the Shanghai High-risk Diabetic Screen (SHiDS) study. All participants underwent a five-point 75 g oral glucose tolerance test (OGTT). Glycemic states were then classified according to the ADA/IDF diagnostic criteria, while OGTT-derived indices were employed to evaluate insulin secretion and sensitivity.

Overall, 3,729 subjects were diagnosed consistently under ADA/IDF criteria; while 941 and 717 subjects exhibited inconsistencies in the diagnostic classification for diabetes and IH, respectively. Notably, all of these individuals with discrepant diagnoses displayed β-cell dysfunction and/or insulin resistance compared to the NGT/NGT group.

The ADA criteria can identify individuals with elevated haemoglobinA1c (HbA1c) levels when the 1-hour plasma glucose (1-h PG) stay within the normal range, while the IDF criteria can identify subjects with impaired insulin sensitivity and secretion when fasting plasma glucose (FPG), 2-hour plasma glucose (2-h PG) and HbA1c values are in the normal range.

Type 1 diabetes is an autoimmune disease characterized by the destruction of insulin-producing pancreatic β-cells, leading to hyperglycemia and various complications. Despite insulin replacement therapy, there is a need for therapies targeting the underlying autoimmune response. This review aims to explore the mechanistic insights into T1D pathogenesis and the impact of delivery systems on immunotherapy. Genetic predisposition and environmental factors contribute to T1D development, triggering an immune-mediated attack on β-cells. T cells, particularly CD4+ and CD8+ T cells, play a central role in β-cell destruction. Antigen- specific immunotherapy is a unique way to modify the immune system by targeting specific antigens (substances that trigger the immune system) for immunotherapy. It aims to restore immune tolerance by targeting autoantigens associated with T1D. Nanoparticle-based delivery systems offer precise antigen delivery, promoting immune tolerance induction. Various studies have demonstrated the efficacy of nanoparticle-mediated delivery of autoantigens and immunomodulatory agents in preclinical models, and several patents have been made in T1D. Combining antigen-specific immunotherapy with β-cell regeneration strategies presents a promising approach for T1D treatment. However, challenges remain in optimizing delivery systems for targeted immune modulation while ensuring safety and efficacy.

Experimental and clinical studies have suggested that symbiotics might effectively manage type 2 diabetes mellitus (T2DM) by modulating the intestinal microbiota. However, these studies' limited sources, small sample sizes, and varied study designs have led to inconsistent outcomes regarding glycaemic control. This study aimed to investigate the effects of symbiotics on the anthropometric measures, glycaemic control, and lipid profiles of patients with T2DM.

A double-blind, placebo-controlled, parallel clinical trial was conducted at two diabetes outpatient clinics. The main researcher and participants were blinded to the capsule content throughout the study. Sixty-six patients with T2DM aged 30-75 years were randomly allocated, using even and odd numbers, into two equal groups. These groups received either symbiotic capsules containing 200 million colony-forming units plus fructo-oligosaccharide or a placebo for 12 weeks. The primary objective was a decrement in glycated haemoglobin [HbA1c]. The patients' anthropometric measures, fasting blood sugar, high-density lipoprotein [HDL], low-density lipoprotein [LDL], total serum cholesterol and serum triglyceride levels were also assessed at baseline and after 12 weeks of intervention. Non-parametric tests were used for statistical analyses.

Within-group analysis revealed significant decreases in body mass index (BMI) and waist circumference (P = 0.005 and 0.023, respectively) and a significant increase in HDL levels in the symbiotic group (P = 0.04). HbA1c levels significantly increased in the placebo group (P = 0.016) but were not significantly reduced in the symbiotic group. The between-group analysis revealed significantly lower fasting blood sugar (FBS) levels in the symbiotic group, and higher in the placebo group (P = 0.02). No significant changes existed in total serum cholesterol, LDL, and triglyceride levels in either the symbiotic or placebo group.

Symbiotics improve BMI, waist circumference, HDL, and FBS levels and prevent the worsening of HbA1c levels in patients with T2DM. Our preliminary results indicate the potential benefits of symbiotics in patients with T2DM, which may lead to better diabetes control. However, this evidence requires further assessment in larger trials.

The trial was registered retrospectively at the International Standard Registered Clinical/Social Study Number Registry (ISRCTN34652973) on 05/01/2024.

Pregnancies impacted by diabetes face the compounded challenge of strict glycemic control with mounting insulin resistance as the pregnancy progresses. New technological advances, including artificial intelligence (AI) and the Internet of Medical Things (IoMT), are revolutionizing health care delivery by providing innovative solutions for diabetes care during pregnancy. Together, AI and the IoMT are a multibillion-dollar industry that integrates advanced medical devices and sensors into a connected network that enables continuous monitoring of glucose levels. AI-driven clinical decision support systems (CDSSs) can predict glucose trends and provide tailored evidence-based treatments with real-time adjustments as insulin resistance changes with placental growth. Additionally, mobile health (mHealth) applications facilitate patient education and self-management through real-time tracking of diet, physical activity, and glucose levels. Remote monitoring capabilities are particularly beneficial for pregnant persons with diabetes as they extend quality care to underserved populations and reduce the need for frequent in-person visits. This high-resolution monitoring allows physicians and patients access to an unprecedented wealth of data to make more informed decisions based on real-time data, reducing complications for both the mother and fetus. These technologies can potentially improve maternal and fetal outcomes by enabling timely, individualized interventions based on personalized health data. While AI and IoMT offer significant promise in enhancing diabetes care for improved maternal and fetal outcomes, their implementation must address challenges such as data security, cost-effectiveness, and preserving the essential patient-provider relationship. KEY POINTS: · The IoMT expands how patients interact with their health care.. · AI has widespread application in the care of pregnancies complicated by diabetes.. · A need for validation and black-box methodologies challenges the application of AI-based tools.. · As research in AI grows, considerations for data privacy and ethical dilemmas will be required..

Where adopted, Autonomous artificial Intelligence (AI) for Diabetic Retinal Disease (DRD) resolves longstanding racial, ethnic, and socioeconomic disparities, but AI adoption bias persists. This preregistered trial determined sensitivity and specificity of a previously FDA authorized AI, improved to compensate for lower contrast and smaller imaged area of a widely adopted, lower cost, handheld fundus camera (RetinaVue700, Baxter Healthcare, Deerfield, IL) to identify DRD in participants with diabetes without known DRD, in primary care. In 626 participants (1252 eyes) 50.8% male, 45.7% Hispanic, 17.3% Black, DRD prevalence was 29.0%, all prespecified non-inferiority endpoints were met and no racial, ethnic or sex bias was identified, against a Wisconsin Reading Center level I prognostic standard using widefield stereoscopic photography and macular Optical Coherence Tomography. Results suggest this improved autonomous AI system can mitigate AI adoption bias, while preserving safety and efficacy, potentially contributing to rapid scaling of health access equity. ClinicalTrials.gov NCT05808699 (3/29/2023).

This study compared glycosylated hemoglobin (HbA1c) levels in the first and second trimesters of pregnancy and assessed maternal and neonatal outcomes according to HbA1c variations among women with pregestational diabetes. This retrospective, multicenter Korean study involved mothers with diabetes who had given birth in 17 hospitals. A total of 292 women were divided into three groups based on HbA1c levels during the first and second trimesters: women with HbA1c levels maintained at <6.5% (well-controlled [WC] group); women with HbA1c ≥ 6.5% (poorly-controlled [PC] group); and women with HbA1c ≥ 6.5% in the first trimester but <6.5% in the second trimester (improved-control [IC] group). The PC group had the highest pregnancy-associated hypertension (PAH) incidence, while the incidence did not significantly differ between the WC and IC groups. The receiver operating characteristic (ROC) curve indicated that HbA1c in the second trimester could predict PAH with a cut-off value of 5.7%. The PC versus WC versus IC group showed statistically significantly higher neonatal birthweight and significantly higher rates of large for gestational age (LGA); however, those were not significantly different between the WC and IC groups. HbA1c levels in the second trimester could predict LGA, with a cut-off value of 5.4%. Therefore, the second trimester HbA1c levels were significantly associated with both maternal and neonatal outcomes.

Gallstone disease (GSD), nonalcoholic fatty liver disease (NAFLD), metabolic dysfunction-associated fatty liver disease (MAFLD), and metabolic syndrome (MetS) are common medical disorders worldwide. This study aimed to ascertain how NAFLD, MAFLD, MetS, and other factors affect the development of GSD, and how the GSD-associated factors influence patient recovery after laparoscopic cholecystectomy (LC).

We included 200 patients who were diagnosed with GSD and underwent LC between January 2017 and February 2022. A total of 200 subjects without GSD and "non-calculous causes" during the same period were also included as controls. We compared the metabolic disorder differences between GSD patients and controls. Furthermore, we sub-grouped patients based on the comorbidities of preoperative NAFLD, MAFLD, and MetS, and compared the impacts of these comorbidities on short-term post-LC functional recovery of the patients.

The prevalence of NAFLD and MetS were higher in GSD patients (P < 0.05). Based on multivariate logistic regression analysis, hyperglycemia [odds ratio (OR) = 2.2, 95% confidence interval (CI): 1.4-3.4, P = 0.001] and low high-density lipoprotein cholesterol (HDL-C) level (OR = 1.8, 95% CI: 1.1-3.1, P = 0.048) were linked to GSD. NAFLD and MetS linked to liver enzymes after LC (P < 0.05). MetS also linked to the levels of inflammatory indicators after LC (P < 0.05). The obesity, hyperlipidemia, low HDL-C level, and hyperglycemia linked to liver enzymes after LC (P < 0.05). Hyperlipidemia, low HDL-C level, and hypertension linked to inflammation after LC (P < 0.05).

The prevalence of GSD may be linked to NAFLD and MetS. Hyperglycemia and low HDL-C level were independent risk factors of GSD.

To investigate the long-term prognostic value of coronary computed tomography angiography (CCTA)-derived high-risk attributes and radiomic features of pericoronary adipose tissue (PCAT) in diabetic patients for predicting major adverse cardiac event (MACE).

Diabetic patients with intermediate pre-test probability of coronary artery disease were prospectively enrolled and referred for CCTA. Three models (model-1 with clinical parameters; model-2 with clinical factors + CCTA imaging parameters; model-3 with the above parameters and PCAT radiomic features) were developed in the training cohort (835 patients) and tested in the independent validation cohort (557 patients). 1392 patients were included and MACEs occurred in 108 patients (7.8%). Multivariable Cox regression analysis revealed that HbA1c, coronary calcium Agatston score, significant stenosis and high-risk plaque were independent predictors for MACE whereas none of PCAT radiomic features showed predictive value. In the training cohort, model-2 demonstrated higher predictive performance over model-1 (C-index = 0.79 vs. 0.68, p < 0.001) whereas model-3 did not show incremental value over model-2(C-index = 0.79 vs. 0.80, p = 0.408). Similar findings were found in the validation cohort.

The combined model (clinical and CCTA high-risk anatomical features) demonstrated high efficacy in predicting MACE in diabetes. PCAT radiomic features failed to show incremental value for risk stratification.

We herein describe the cases of two young Japanese adults who presented with excessive daytime sleepiness (EDS). Based on their history, the postprandial nature of the sleepiness was suspected, although the patients themselves were not aware of the association. Oral glucose tolerance tests (OGTTs) reproduced the sleepiness and showed the patterns of insulin resistance (IR) compatible with type-2 diabetes mellitus (T2DM) in one patient and glucose intolerance in the other. There was no evidence of chronic hyperglycemia in either patient. Antidiabetic medications resulted in the disappearance of EDS in both patients; in one, a repeat OGTT revealed improved IR. We suggest that postprandial somnolence can present with EDS, and it can be effectively treated with antidiabetic medications, and that the OGTT can be useful in identifying IR, which may be the underliyng cause of the excessive postprandial somnolence.

Rosuvastatin and atorvastatin are the most widely prescribed moderate- to high-intensity statins. However, evidence on their efficacy and safety during actual use is limited.

To compare the real-world effectiveness and safety of rosuvastatin and atorvastatin.

Active comparator cohort study using target trial emulation.

The China Renal Data System (CRDS) and UK Biobank (UKB) databases.

Adults newly prescribed rosuvastatin or atorvastatin.

The primary outcome was all-cause mortality. Cox proportional hazards regressions were used after 1:1 multilevel propensity score matching.

Among the 285 680 eligible participants in both databases, 6-year all-cause mortality was lower for rosuvastatin than for atorvastatin (2.57 vs. 2.83 per 100 person-years in the CRDS database and 0.66 vs. 0.90 per 100 person-years in the UKB database), with differences in cumulative incidence of -1.03% (95% CI, -1.44% to -0.46%) in the CRDS database and -1.38% (CI, -2.50% to -0.21%) in the UKB database. For secondary outcomes in both databases, rosuvastatin conferred lower risks for major adverse cardiovascular events and major adverse liver outcomes. In the UKB database, the risk for development of type 2 diabetes mellitus was higher with rosuvastatin, and the 2 medications carried similar risks for development of chronic kidney disease and other statin-related adverse effects.

Possible residual confounding.

This study found differences in risks for some important outcomes associated with rosuvastatin and atorvastatin. The differences were relatively small, and many did not meet traditional standards for statistical significance. Further research is needed to understand whether these findings can be used with confidence in clinical practice.

National Key R&D Program of China and National Natural Science Foundation of China.

While observational research has highlighted a possible link between ankylosing spondylitis (AS) and type 2 diabetes (T2DM), the quality of evidence remains limited, and the causal relationship is yet to be established. This study aims to explore the causal link between AS and T2DM, as well as its impact on traits related to glucose metabolism.

To infer a causal relationship between AS and various diabetes-related traits, including type 1 diabetes (T1DM), T2DM, blood glucose levels, fasting glucose, glycated hemoglobin, and fasting insulin, we employed Mendelian randomization (MR) analysis. We sourced GWAS summary data for both exposure and outcome variables from the IEU OpenGWAS database, GWAS Catalog, and FinnGen database. To synthesize the results of the MR analyses, we applied meta-analysis techniques using either a fixed or random effects model. For identifying and excluding instrumental variants (IVs) that exhibit horizontal pleiotropy with the outcomes, we utilized the MR-PRESSO method. Sensitivity analyses were conducted using the MR-Egger method, along with Q and I^2 tests, to ensure the robustness of our findings.

Our analysis revealed a significant association between AS and an increased risk of T1DM with an odds ratio (OR) of 1.5754 (95% CI: 1.2935 to 1.9187) and T2DM with an OR of 1.0519 (95% CI: 1.0059 to 1.1001). Additionally, AS was associated with elevated levels of fasting glucose (beta coefficient = 0.0165, 95% CI: 0.0029 to 0.0301) and blood glucose (beta coefficient = 0.0280, 95% CI: 0.0086 to 0.0474), alongside a decrease in fasting insulin levels (beta coefficient = -0.0190, 95% CI: -0.0330 to -0.0050).

Our findings collectively underscore the detrimental impact of AS on the development of diabetes, highlighting the critical influence of autoimmune disorders in diabetes onset. This provides profound insights into the pathogenesis of diabetes from an immunological standpoint.

The relationship between remnant cholesterol (RC) and outcome of patients with prediabetes remains unclear. This study aims to explore the association between dynamic changes in RC and progression to diabetes or regression to normal blood glucose in pre-diabetic population through a nationwide cohort study.

Based on the China Health and Retirement Longitudinal Study (CHARLS), 2304 participants aged 45 years or older (58.60 ± 8.04 years) who participated in two surveys in 2011 and 2015 were included. Participants were divided into 3 groups according to the tertiles of dynamic changes in RC levels between the two surveys (Q1: ≤ - 1.59, Q2: - 1.59-12.73, Q3: ≥ 12.73, mmol/L). Multivariate Logistic regression models were used to analyze the association of the dynamic changes in RC and the progression and regression of prediabetes. Restricted cubic splines were used to analyze the dose-response relationship between RC and dynamic changes in RC and progression in the prediabetic population.

During follow-up, 522 (22.30%) participants developed diabetes, 1283 (54.8%) participants remained prediabetic, and 536 (22.9%) participants regressed to normoglycemia. Further analysis of dynamic changes in RC revealed that reducing RC levels during follow-up reduced the risk of developing diabetes (OR = 0.76, 95% CI: 0.58-0.99, P = 0.04). However, compared with people with increased RC levels, people with prediabetes and stable RC levels are more likely to return to normal blood glucose (OR = 1.45,95% CI: 1.12-1.88, P = 0.005). In the pre-diabetic population, there was non-linear dose-response relationship between the level of RC and dynamic change in RC and the risk of developing diabetes (P nonlinearity < 0.001).

Our findings revealed a substantial and non-linear association between dynamic change in RC levels and the outcome of prediabetes. Decreased RC level were associated with reduced risk of progression to diabetes in prediabetes.

 Increased clot permeability and susceptibility to lysis have been reported in women with heavy menstrual bleeding. We hypothesized that similar alterations in fibrin clot properties may also be present in women with postpartum hemorrhage (PPH) of unknown cause.

 To determine fibrin clot properties and their determinants in women after PPH of unknown cause.

 We studied 52 consecutive women, aged 35 years (27-40), after at least 3 months since PPH of unknown cause and 52 matched controls for age, weight, and fibrinogen. Coagulation factors (F), antithrombin, thrombin generation, along with a comprehensive plasma fibrin clot analysis including fibrin polymerization, clot permeability (K s), and fibrinolysis efficiency were determined.

 Women with PPH showed reduced activity of FII (-10.3%), FV (-6.6%), FIX (-6.5%), FX (-7.2%), and FXI (-5.7%) compared with the controls, though all values were within ranges (all p < 0.05). There were no intergroup differences in fibrinogen, FVIII, FXIII, and thrombin generation. The PPH group formed with a delay looser plasma fibrin network (K s; +16.3%, p = 0.008) with lower maximum absorbance and shorter clot lysis time (CLT; -13.5%, p = 0.001) compared with the controls. On multivariable logistic regression, PPH was independently associated with higher C-reactive protein (per 1 mg/L, odds ratio [OR] = 1.70, 95% confidence interval [CI]: 1.09-2.68), lower FII (per 1%, OR = 0.93, 95% CI: 0.89-0.98), lower FV (per 1%, OR = 0.93, 95% CI: 0.89-0.97), and shorter CLT (per 1 minute, OR = 0.94, 95% CI: 0.90-0.98).

 Prohemorrhagic fibrin clot properties, with lower, though normal coagulation factors, characterize women with PPH of unknown cause, which suggests novel mechanisms contributing to this type of bleeding.

Previous studies showed that women with gestational diabetes mellitus (GDM) are susceptible to cognitive dysfunction. We investigated the effects of GDM on brain pathologies and premature brain aging in rats. Seven-week-old female Sprague-Dawley rats were fed a normal diet (ND) or a high-fat diet (HFD) after two weeks of acclimatization. On pregnancy day 0, HFD-treated rats received streptozotocin (GDM group) or vehicle (Obese mothers). ND-treated rats received vehicle (ND-control mothers). On postpartum day 21, brains and blood were collected. The GDM group showed increased inflammatory and premature aging markers, mitochondrial changes, and compensatory increases in the blood-brain barrier and synaptic proteins in the prefrontal cortex and hippocampus. GDM triggers maternal brain inflammation and premature aging, suggesting compensatory mechanisms may protect against these effects.

The frequency of type 2 diabetes mellitus (T2DM) is rising annually. Coronary heart disease (CHD) is a prevalent complication affecting individuals with T2DM.

The aim of this investigation was to assess the level of DBH-AS1 in T2DM with CHD, and to determine its potential role in forecasting the occurrence of significant cardiovascular events.

The DBH-AS1 levels were detected by qRT-PCR. The diagnostic value of DBH-AS1 was assessed through receiver operating characteristic (ROC) curve analysis. Logistic regression was conducted to identify the risk factors for cardiovascular events among patients with T2DM with CHD. Cell proliferation was detected by Cell Counting Kit-8 (CCK-8) assay, apoptosis was detected by flow cytometry, and the concentration of inflammatory factors was detected by Enzyme Linked Immunosorbent (ELISA) kit.

DBH-AS1 was down-regulated in serum of both T2DM with CHD and cardiovascular events patients. Of the cardiovascular events that occurred, major events included recurrent angina (20%), cardiovascular death (7.5%), acute myocardial infarction (23.75%), severe arrhythmia (22.50%), acute heart failure (18.75%) and stroke (7.5%). And DBH-AS1 had a predictive value for each adverse of cardiovascular events. DBH-AS1 regulated the expression of miR-483-5p and affected the proliferation, apoptosis, and secretion of inflammatory factors of HCAECs.

DBH-AS1 may serve as a predictor for the occurrence of cardiovascular events in T2DM with CHD patients.

Obesity impairs intestinal glucose uptake (GU) (intestinal uptake of circulating glucose from blood) and alters gut microbiome. Exercise improves intestinal insulin-stimulated GU and alters microbiome. Genetics influence the risk of obesity and gut microbiome. However, the role of genetics on the effects of exercise on intestinal GU and microbiome is unclear.

Twelve monozygotic twin pairs discordant for BMI (age 40.4 ± 4.5 years, BMI heavier 36.7 ± 6.0, leaner 29.1 ± 5.7, 8 female pairs) performed a six-month-long training intervention. Small intestine and colonic insulin-stimulated GU was studied using [18F]FDG-PET and microbiota from fecal samples with 16s rRNA.

Ten pairs completed the intervention. At baseline, heavier twins had lower small intestine and colonic GU (p < 0.05). Response to exercise differed between twins (p = 0.05), with leaner twins increasing colonic GU. Alpha and beta diversity did not differ at baseline. During the intervention, beta diversity changed significantly, most prominently at the mid-point (p < 0.01). Beta diversity changes were only significant in the leaner twins when the twin groups were analyzed separately. Exercise was associated with changes at the phylum level, mainly at the mid-point (pFDR < 0.05); at the genus level, several microbes increased, such as Lactobacillus and Sellimonas (pFDR < 0.05). In type 1 analyses, many genera changes were associated with exercise, and fewer, such as Lactobacillus, were also associated with dietary sugar consumption (p < 0.05).

Obesity impairs insulin-stimulated intestinal GU independent of genetics. Though both twin groups exhibited some microbiota changes, most changes in insulin-stimulated colon GU and microbiota were significant in the leaner twins.

It is well-known that serum uric acid (SUA) can increase the risk of hypertension, diabetes, obesity and dyslipidemia. However, its independent association with the risk of cardiovascular diseases (CVD) is controversial particularly in different populations. Hence, this study was aimed to assess an independent association of SUA with CVD risk in a Punjabi Pakistani cohort.

This is a retrospective observational study in which 502 human subjects having CVD, hypertension and/or diabetes were grouped based on SUA levels as normouricemia (n = 266) and hyperuricemia (n = 236). Role of SUA was assessed in increasing the risk of CVD independent of other key confounding factors (i.e. age, gender, dyslipidemia, hypertension, diabetes, dietary and life-style habits). All clinical and biochemical data were analyzed in SPSS (ver. 20).

Subjects aged 55 ± 13 years were of both genders (males: 52%). SUA levels were significantly different among clinical subtypes of CVD [i.e. acute coronary syndrome (ACS), myocardial infarction (MI) and heart failure (HF)]. Spearman correlation showed a significantly positive association between CVD and SUA (rho = 0.149, p < 0.001). Multivariate logistic regression of SUA quartiles showed that hyperuricemia is associated with CVD [3rd quartile: OR: 1.78 (CI: 1.28-2.48), p = 0.001 and 4th quartile: OR: 2.37 (CI: 1.72-3.27), p < 0.001]. Moreover, this association remained significant even after adjusting for confounding factors.

This study showed that SUA is positively associated with CVD, thus it can act as an independent risk factor for CVD.