The increasing prevalence of diabetes mellitus (DM) and prediabetes (Pre-DM) in elderly individuals necessitates refined diagnostic tools. The oral glucose tolerance test (OGTT) is cumbersome, and age may alter glycemic parameters, suggesting a need for age-specific thresholds. This study aimed to evaluate the diagnostic performance of glycated hemoglobin (HbA1c) and glycated albumin (GA) for dysglycemia in community-dwelling older adults in Chengdu, China.

This was a community-based cross-sectional study that consecutively enrolled eligible community-dwelling residents aged 60 years or older in Chengdu, China. A total of 1,162 participants underwent measurements of fasting plasma glucose (FPG), HbA1c, and GA. A standard 75‑g oral glucose tolerance test (OGTT) with two‑hour post-prandial plasma glucose (2hPG) measurement was performed, and glycemic status was defined according to the World Health Organization (WHO) diagnostic criteria. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cutoff values for HbA1c and GA to detect DM and Pre-DM.

Among the 1,162 participants (65.2% were female; median age, 67 years), 38.2%, 34.5%, and 27.3% were classified as having normal glucose tolerance (NGT), Pre-DM, and DM, respectively. For the diagnosis of DM, HbA1c demonstrated an AUC of 0.86 (95% CI: 0.83-0.88). An optimal cutoff value of 6.0% yielded greater sensitivity (72.56%) than did the conventional threshold of 6.5% (sensitivity: 34.70%), while maintaining a specificity of 85.36%. Diagnostic performance was superior in females than in males (AUC = 0.87 vs 0.83, P = 0.001) and varied significantly across age and BMI groups, supporting the consideration of age‑specific cutoff values. GA demonstrated moderate diagnostic performance (AUC = 0.70), and its combination with HbA1c did not improve performance. Both biomarkers exhibited limited ability for identifying Pre-DM.

HbA1c at a lower cutoff value of 6.0% demonstrated high diagnostic accuracy for DM in older adults, though its performance was influenced by age, sex, and BMI. In contrast, GA did not confer a significant diagnostic advantage. These findings suggest that the current cutoff value of HbA1c warrants reassessment in elderly individuals while also highlighting its limitations for Pre-DM screening, where OGTT may still be necessary.

The trial was registered with the Chinese Clinical Trial Registry (https://www.chictr.org.cn, ChiCTR2300070831) on 24 April 2023.

Our research endeavored to formulate a patient-specific prognostic algorithm and elucidate the interconnection between critical genetic polymorphisms at PTPN1 loci and the predisposition to small vessel pathologies in Han Chinese subjects presenting with T2DM. From January 1, 2019, to June 30, 2024, a total of 3,847 patients with T2DM were enrolled in this cross-sectional case-control study. They were grouped into four groups by means of fundus examination and renal function assessment: the T2DM alone group (T2DM group), the T2DM combined with diabetic retinopathy (DR) group (T2DM + DR group), the T2DM combined with diabetic nephropathy (DN) group (T2DM + DN group), and the T2DM combined with DR + DN group (T2DM + DR +DN group). The genotypes of four SNP loci (rs968289, rs6067484, rs2206521, rs754118) of the PTPN1 gene were detected by PCR-RFLP. To evaluate the association between SNP loci and microvascular complications, multivariate logistic regression analysis was employed, followed by LASSO regression for variable selection to develop a nomogram prediction model. The rs968289-GG genotype demonstrated a statistically significant link to the risk of DR (adjusted OR = 1.47, 95%CI: 1.15-1.88, P = 0.002); the rs6067484-CC genotype exhibited a significant relationship with the risk of DN (adjusted OR = 1.58, 95%CI: 1.21-2.06, P < 0.001); The rs2206521-AA genotype significantly correlated with the risk of DR + DN co-morbidity (adjusted OR = 1.69, 95%CI: 1.28-2.24, P < 0.001). The column-line graphical model constructed based on nine independent predictors had AUCs of 0.823 and 0.808 in the training and validation sets, with sensitivity and specificity of 76.4%/78.9% and 74.2%/80.1%, respectively. Significant associations were observed between specific genotypic variants at the PTPN1 gene's rs968289, rs6067484 and rs2206521 loci and microvascular complication risk in Chinese Han T2DM patients. The column-line graph prediction model integrating genetic markers and clinical indicators has good discriminative ability and clinical utility, providing an important tool for individualized risk assessment and precise prevention of diabetic microvascular complications.

The prevalence of diabetes mellitus in total joint arthroplasty (TJA) patients has been reported as high as 20%. While preoperative hemoglobin A1c (HbA1c) optimization has been heavily studied and associated with improved outcomes in diabetic patients undergoing TJA, there is still limited research on the sustainability of maintaining optimized HbA1C levels during the peri- and postoperative period following TJA.

We queried our clinical database for all total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) performed between January 1, 2016, and December 31, 2022. Analyses of HbA1c trends were conducted on patients who had at least two HbA1c values within the two years prior to their surgery, as well as at least two HbA1c test values within the two years following their surgery. A total of 976 THAs and 1,168 TKAs were performed during the 6-year period, including 245 THAs and 200 TKAs in patients who met the criteria for inclusion. The study examined several common thresholds for HbA1C optimization.

Patients who had a more lenient preoperative optimization threshold had a greater rise in average HbA1c values within the two-year postoperative period. Within six months postoperatively, 19.6 and 34.4% of the THA and TKA patients, respectively, who underwent preoperative HbA1c optimization had postoperative HbA1c values greater than 7.5. This rose to 32.6% and 50.0% at one year and 50.0 and 62.5% at 2 years for THA and TKA patients, respectively. Furthermore, 21.2% of these patients did not have follow-up for their diabetes care within two years postoperatively.

While preoperative optimization of HbA1c levels is achievable for many diabetic TJA patients, maintaining these improvements postoperatively requires a multifaceted approach. Enhanced patient education, coordinated care models, and the continued monitoring and emphasis on the importance of glycemic control are potential strategies for improving long-term diabetic management.

Respiratory syncytial virus has traditionally been associated with childhood illness, but it is increasingly recognised as a cause of severe disease in adults, particularly older people and those with chronic comorbidities. Despite its growing clinical relevance, evidence describing outcomes and predictors of disease severity in adults remains relatively limited.

To identify factors associated with hospital admission, clinical severity and 90-day mortality in adults with respiratory syncytial virus infection.

A single-centre observational cohort study was conducted including 340 adults with polymerase chain reaction-confirmed respiratory syncytial virus infection between October 2023 and September 2024. Clinical, demographic and care-related variables were analysed using multivariable logistic regression and ordinal regression models. Clinical severity was assessed using an ordinal composite outcome including non-hospitalisation, hospital admission, intensive care unit admission and death.

Of the 340 patients, 172 (50.6%) required hospital admission and 39 (11.5%) died within 90 days. Age 65 years or older, diabetes mellitus, immunosuppression, institutionalisation and chronic heart disease were independently associated with hospital admission. Age 65 years or older and chronic kidney disease were the strongest predictors of 90-day mortality. Ordinal regression analysis showed that these factors were consistently associated with increasing clinical severity.

Adults with respiratory syncytial virus infection experience substantial morbidity and mortality, particularly those who are older, have chronic comorbidities or are socially vulnerable. These findings support early risk stratification and may assist critical care and interprofessional teams in identifying patients who require closer monitoring and timely escalation of care.

Arrhythmia recurrence after atrial fibrillation (AF) catheter ablation remains a substantial clinical challenge, but risk factors of arrhythmia recurrence are not well defined.

This study aimed to elucidate baseline clinical risk factors for post-ablation recurrence and variations by AF phenotype and study heterogeneity.

We systematically searched eight databases for prospective cohort studies assessing associations between clinical risk factors and post-ablation arrhythmia recurrence up to 31 December 2025. Study quality was evaluated using Newcastle-Ottawa scale. Multivariable-adjusted hazard ratios (aHRs) were pooled through random-effects meta-analyses with subgroup, meta-regression, and sensitivity analyses.

Among 152 studies involving 49,919 patients, 16 clinical risk factors were identified. In primary meta-analysis pooling aHRs, the strongest associations were observed for smoking (aHR:2.15 [1.49-3.10)]), periodontitis (aHR:2.04 [1.48-2.83]), metabolic syndrome (aHR:1.71 [1.12-2.62]), sleep apnea (aHR:1.65 [1.31-2.09]) and persistent AF (aHR:1.64 [1.53-1.76]), followed by chronic kidney disease, alcohol consumption, overweight/ obesity, diabetes mellitus, female sex, hypertension, AF history, left atrial enlargement and impaired left ventricular ejection fraction. Untreated sleep apnea (aHR:2.41 [1.51-3.86]) and uncontrolled hypertension (aHR:1.67 [1.12-2.40]) conferred heightened risks. Sensitivity analyses pooling adjusted odds ratios (aORs) additionally identified depression (aOR:2.86 [1.51-5.41]), anxiety (aOR:2.54 [1.59-4.04]). Subgroup analyses revealed no difference across AF phenotypes. Meta-regression identified ablation modality as a significant moderator for AF history, and geographic region for female sex, heart failure and diabetes.

Expanded pre-ablation risk profiles with consistent effect across AF phenotypes substantiate personalized risk stratification for ablation candidacy and pre-procedural optimization.

Oral leukoplakia (OLK) is the most common oral potentially malignant disorder, with a malignant transformation rate of up to 9.8%. Type 2 diabetes mellitus (T2DM) is associated with increasing cancer risk. However, risk factors for malignant transformation in OLK-T2DM patients remain undefined. This study aimed to identify these factors and develop prediction models integrating glycaemic and clinical indicators.

A retrospective nested case-control study was conducted in a real-world OLK-T2DM cohort (2013-2025). Cases (n = 55) with histologically confirmed malignant transformation to oral squamous cell carcinoma were matched 1:2 by age and sex with controls (n = 110) without transformation. Glycaemic control (fasting plasma glucose [FPG], haemoglobin A1c [HbA1c]) was the main exposure. Risk factors were analysed using univariable analyses, multivariable conditional logistic regression, multivariable stratified Cox regression models and machine learning models.

Suboptimal glycaemic control (HbA1c > 7% or FPG > 7.2 mmol/L) was strongly associated with malignant transformation, with each 1 mmol/L increase in FPG raising malignant transformation risk by 60% to 174% according to the results of multivariable stratified Cox regression models for the risk of malignant transformation. Moderate and severe oral epithelial dysplasia (adjusted hazard ratio = 399.43, P = .021) was also an independent predictor. By integrating glycaemic and clinical indicators, machine learning models achieved stable predictive performance (area under the receiver operating characteristic curve up to 0.78; accuracy up to 76.91%).

Suboptimal glycaemic control was independently associated with increased malignant transformation risk in OLK-T2DM patients after adjustment for key confounders. This association was consistent across both regression and machine learning models.

These findings underscore the importance of early monitoring and strict glycaemic management, and suggest that incorporating glycaemic indicators into risk prediction tools may help improve the identification and management of high-risk patients.

Small fiber neuropathy is a painful diabetes complication that may present with burning pain, dysesthesia, and autonomic features such as swelling, color changes, and hyperhidrosis. Some cases overlap with erythromelalgia, a rare condition marked by episodic erythema, temperature sensitivity, and vasomotor instability. Spinal cord stimulation has shown promise for refractory neuropathic pain, but evidence for its use for small fiber neuropathy and erythromelalgia is limited.

A 32-year-old man with longstanding Type 1 diabetes reported more than a decade of progressive neuropathic symptoms, including burning pain, temperature sensitivity, erythema, swelling, and hyperhidrosis affecting all extremities. Our exam found decreased temperature sensation in a "stocking-glove" distribution with autonomic dysfunction in the distal extremities. Electromyography showed no large fiber involvement, and an expanded autoimmune and genetic workup was unrevealing. Despite conservative therapies, he achieved only partial relief. He underwent a dual-lead spinal cord stimulation trial targeting the cervical and thoracic regions. He reported approximately 75%-80% pain relief, improved mobility, and resolution of his vasomotor symptoms.

This case illustrates the potential role of dual-lead spinal cord stimulation for treating refractory diabetic small fiber neuropathy with erythromelalgia-like features involving both the upper and lower extremities. Our patient reported significant improvements in pain and autonomic symptoms. These findings support considering targeted neuromodulation for patients who have medication-resistant small fiber neuropathy in multiple extremities.

Oral squamous cell carcinoma (OSCC) is marked by frequent recurrence rates and an unclear etiology, underscoring the critical need for early detection to improve therapeutic outcomes and reduce healthcare costs. MicroRNAs (miRNAs) have emerged as key regulators of oral carcinogenesis by modulating gene expression at the posttranscriptional level and influencing various aspects of cellular physiology.

This study aimed to comprehensively evaluate the prognostic significance of miR-1304 and miR-4652 expression levels in patients with OSCC, and to explore their potential as predictive biomarkers for disease progression and patient survival.

TargetScan was used to predict potential gene interactions of the microRNAs. Subsequently, the expression levels of C-Myc and the microRNAs miR-1304-3p and miR-4652-5p were evaluated in 30 pairs of OSCC and adjacent normal tissue samples. qRT-PCR analyses were performed to compare the expression of these molecules between tumor and normal tissues. Additionally, receiver operating characteristic (ROC) curves were generated to assess the potential diagnostic value of these microRNAs in OSCC.

The expression levels of miR-1304, miR-4652, and C-Myc were significantly higher in OSCC tissues compared to their matched adjacent non-tumor tissues (p < 0.0001). Notably, high C-Myc expression was significantly correlated with both tumor grade (p = 0.003) and tumor stage (p = 0.005). ROC curve analysis demonstrated that the areas under the curve (AUCs) for C-Myc, hsa-miR-1304, and hsa-miR-4652 were 0.99, 0.99, and 0.95, respectively (p < 0.0001), indicating strong diagnostic potential.

These findings suggest that the upregulation of miR-1304 and miR-4652 could be used as biomarkers in OSCC. However, more studies with large samples are necessary.

Surgical scars of the nasal region following basal cell carcinoma (BCC) excision often present aesthetic and functional challenges, particularly the "trap-door" deformity related to flap reconstruction. Fractional CO₂ laser represents a promising therapeutic option to improve scar quality through collagen remodeling and dermal reorganization. This retrospective study analysed eight patients (six males and two females, mean age 71 ± 10 years) with nasal post-surgical scars after BCC excision and flap reconstruction. All patients underwent two sessions of fractional CO₂ laser in Deep Pulse or High Pulse modes, with a two-month interval between treatments. Clinical outcomes were evaluated using the Patient and Observer Scar Assessment Scale (POSAS) and three-dimensional profilometry with the Antera 3D system before treatment and two months after the last session. A statistically significant improvement was observed in both patient-reported (overall opinion p = 0.0007; thickness p = 0.03) and observer-reported parameters (vascularity p = 0.007; thickness p = 0.005; pliability p = 0.02; overall opinion p = 0.00004). Antera 3D analysis showed a mean reduction in scar depression of 23.5% (p = 0.01). All patients developed transient erythema and edema that were resolved within a week. Fractional CO₂ laser proved to be a safe and effective method to improve nasal post-surgical scars, enhancing texture, vascularity, and contour.

Acute myeloid leukemia (AML) blasts often have high CD135 (FLT3 receptor) expression, but its clinical impact is unclear. We analyzed CD135 expression, and the clinical characteristics and outcomes of 214 patients with de novo AML diagnosed between October 2022 and May 2024. Subsequently, we collected data on additional 78 patients, diagnosed with AML at four medical centers from June to December 2024, for external validation. The high-CD135-expression group had significantly lower CD34 surface expression (p = 0.003) and higher CD33 expression (p = 0.014) on AML blasts. The high-CD135-expression group also showed a higher frequency of NPM1 (p < 0.001) and DNMT3A (p = 0.032) mutations, but was not significantly associated with CD135 expression (p = 0.229). The patients in the high-CD135-expression group had lower initial induction therapy response rates than those in the low-CD135-expression group (p < 0.001). High CD135 expression was independently associated with poorer OS and PFS. In the subgroup of patients with high CD135 expression and FLT3-ITD mutations, those who received TKI combined with chemotherapy had significantly better OS (p = 0.007). Then we developed a prognostic nomogram incorporating CD135 expression. This model performed well both in the development cohort (area under the curve [AUC] = 0.817) and multicenter validation cohort (AUC = 0.722). CD135 expression on AML blasts is a pivotal marker that integrates molecular pathogenesis with clinical outcomes, highlighting its dual role as a prognostic indicator and therapeutic target in precision clinical approaches for AM.