N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing for early heart failure (HF) detection in asymptomatic older adults with diabetes in the USA remains limited despite guideline recommendations. This study evaluated the cost-effectiveness of incorporating NT-proBNP testing into routine clinical assessments for adults aged ≥65 years from a Medicare perspective.

A five-state Markov model with an embedded decision tree compared NT-proBNP testing plus standard clinical assessments with standard assessments alone in adults aged ≥65 years with type 2 diabetes, with or without other HF risk factors. Model inputs (ie, baseline event rates, treatment effects, utilities, and costs) were derived from published literature and publicly available Medicare data. Outcomes, including direct medical costs (ie, diagnostic testing, cardioprotective treatments, HF-related hospitalization, and chronic/advanced HF treatment), life-years (LYs), and quality-adjusted life-years (QALYs), were calculated over a lifetime horizon. Sensitivity and scenario analyses were performed.

Compared with standard clinical assessment alone, NT-proBNP testing prolonged survival (6.27 vs 4.99 LYs) and improved quality of life (3.45 vs 2.84 QALYs). Although lifetime HF hospitalizations were similar (0.43 vs 0.43), LY-adjusted hospitalizations were lower with NT-proBNP testing (0.29 vs 0.43). Lifetime costs were higher with NT-proBNP testing (US$117 010 vs US$92 283), reflecting longer survival and greater use of appropriate cardioprotective treatments. NT-proBNP was cost-effective, with an incremental cost per QALY gained of US$40 883. Results were robust, with the model most sensitive to changes in diabetes management costs, mortality among high-risk individuals, and cardioprotective drug effectiveness.

Annual NT-proBNP testing in older adults with type 2 diabetes is cost-effective for early HF detection in a Medicare setting, supporting broader adoption of guideline-recommended testing in this high-risk population.

The National Health Service (NHS) England's Diabetes Prevention Programme (DPP) is a cost-effective, publicly funded program of structured dietary and physical activity counselling that has been shown to reduce the incidence of progression from prediabetes to type 2 diabetes. We sought to examine the cost-effectiveness of implementing an NHS England-style DPP in Quebec and Ontario.

We compared usual care for people with prediabetes with a DPP using a cohort-state transition Markov model of 4 mutually exclusive health states (normal glucose tolerance, prediabetes, type 2 diabetes, and death) over a 35-year time horizon, run separately for Quebec and Ontario. We sourced transition probabilities, costs, and utilities from Canadian sources, the NHS England DPP, and published literature. We modelled the reduction in progression from prediabetes to type 2 diabetes using effectiveness data from the first 3 years of follow-up from the NHS England DPP. We adopted a health care system perspective and used a 1.5% annual discount rate. We presented costs in 2025 Canadian dollars and effectiveness in quality-adjusted life-years (QALYs). We generated base-case results using probabilistic analysis with 10 000 simulations.

The mean total costs of the DPP strategy were $101 833 per participant in Quebec and $101 835 in Ontario, compared with $102 077 for usual care, yielding incremental cost savings of $244 per participant in Quebec and $242 in Ontario. The 95% uncertainty range (UR) for incremental costs was -$1017 to $405 in Quebec and -$1016 to $408 in Ontario. The DPP generated a mean gain of 0.060 QALYs per participant (95% UR 0.024 to 0.094). It was less costly and more effective than usual care in 74.8% of simulations in Quebec and 74.7% in Ontario. Sensitivity analyses confirmed robustness to parameter uncertainty.

An NHS England-style DPP would be cost-effective in Ontario and Quebec. Our findings support the potential value of investing in DPPs in Canada and highlight an opportunity to reduce the burden of type 2 diabetes.

Cardiovascular disease remains the leading cause of morbidity and mortality in Mexico. Dyslipidemia is a major modifiable cardiovascular risk factor; however, national data describing lipid profiles and achievement of low-density lipoprotein cholesterol (LDL-C) targets among patients at high and very high cardiovascular risk across all levels of health care are limited.

To characterize lipid profiles, associated comorbidities, and LDL-C target attainment among Mexican patients at cardiovascular risk enrolled in the Mexican Registry of Dyslipidemias (REMEXDIS-IMSS).

A cross-sectional analysis of baseline data from the ongoing REMEXDIS-IMSS multicenter prospective observational cohort is reported. Between September 2022 and January 2024, adults at high or very high cardiovascular risk were recruited from participating Mexican Institute of Social Security (IMSS) centers. Baseline demographic, clinical, and biochemical data were collected through standardized outpatient assessments and are presented as medians (interquartile range) or frequencies and percentages. Comparisons were performed using the Mann-Whitney U test and χ² test.

Overall, 51.3% of participants were classified as being at high cardiovascular risk and 48.7% at very high cardiovascular risk. The median age was 64 years, and 54.3% of participants were women. Diabetes mellitus, hypertension, and smoking were present in 64.7, 67.4, and 33.2% of participants, respectively. LDL-C targets were achieved by 56.4% of patients at high cardiovascular risk and 43.1% of those at very high cardiovascular risk. Greater treatment intensity was consistently associated with improved LDL-C control, with the highest rate of target attainment observed among patients receiving triple lipid-lowering therapy (a statin, ezetimibe, and a PCSK9 inhibitor).

In this large national cohort, nearly 50% of the patients at high and very high cardiovascular risk, particularly those at very high risk, did not achieve the recommended LDL-C targets, highlighting the need to intensify lipid-lowering therapy and improve access to combination treatment in routine clinical practice.

Sutureless duodeno-ileal magnetic compression anastomosis (DI-MCA) is a novel technology for metabolic and bariatric surgery, but pooled evidence on feasibility, safety, and early efficacy is lacking.

To systematically review feasibility, safety, and early efficacy of DI-MCA across device classes and procedural contexts.

International; prospective clinical studies.

MEDLINE, EMBASE, CENTRAL, Web of Science, and ClinicalTrials.gov were searched to 31 March 2026. Eligible studies reported DI-MCA using linear (LMAS), biofragmentable (BMAS), self-forming (SNAP/SNAP-S), or immediately-patent (IMPA-DI) devices. Cohort overlap was resolved by investigator correspondence. Proportions were pooled with Freeman-Tukey transformation; continuous outcomes with REML and Hartung-Knapp correction. Bias: MINORS; certainty: Grading of Recommendations, Assessment, Development, and Evaluations.

Twelve prospective studies (220 enrolled, 218 implanted) met inclusion criteria; after de-duplication, 153 enrolled adults (151 implanted) were verified-unique. The pooled device-related leak rate was .0% (95% confidence interval [CI] .0-1.7), with zero 30-day mortality. Efficacy is reported descriptively by procedural context. Primary DI-MCA with concurrent sleeve gastrectomy: 6-month percent total weight loss (%TWL) 28.1% (n = 24, LMAS 1.9 cm) and 10.7% (n = 17, BMAS 4-5 cm), with 12-month data in 5 patients (%TWL 34.0%). Revisional solo DI-MCA: %TWL 5.4% at 6 months (n = 24) and 5.3% at 12 months (n = 23). Solo biofragmentable DI-MCA in mild obesity with type 2 diabetes: 12-month %TWL 8.7% (n = 8/15); HbA1c 8.2%→6.6%. Protein-energy malnutrition (9.3%, 5/54) was confined to the SNAP subset. Certainty of evidence was low to very low.

DI-MCA is feasible, with no device-related anastomotic leak and no 30-day mortality; early efficacy is device- and context-dependent. All available data are derived from small, industry-sponsored single-arm studies in highly selected patients at experienced investigational centers, and support feasibility and early safety rather than comparative effectiveness or generalizability to routine practice. Larger comparative studies with longer follow-up are needed; the SNAP malnutrition signal warrants prospective surveillance.

Finerenone reduces kidney and cardiovascular events in patients with chronic kidney disease and type 2 diabetes mellitus, but its safety profile in terms of arrhythmic outcomes remains uncertain.

We systematically searched PubMed, Cochrane Library, and ClinicalTrials.gov (inception-March 2026) for randomized trials reporting arrhythmias or conduction disorders with finerenone versus control. Risk ratios (RRs) were pooled using fixed-effects models; heterogeneity was assessed with I².

Six trials (21,015 patients; mean age 67.2 years; 33.9% women) were included. Finerenone was not associated with increased atrial or ventricular arrhythmias, high-grade atrioventricular block, or cardiac arrest (all RRs non-significant; low heterogeneity).

Finerenone shows no clear increase in clinically reported arrhythmic events in the pooled analysis; however, the included studies were not designed to assess the rate of arrhythmic outcomes and might have underestimated the true rates.

Scoparia dulcis L. is a pantropical medicinal plant traditionally used in Brazil, Asia, and Africa to manage diabetes. This study systematically reviewed and meta-analyzed the effects of S. dulcis extracts and isolated compounds on glycemic outcomes in animal models of diabetes. PubMed, Embase, and Scopus were searched through February 2026 in accordance with PRISMA guidelines. In vivo preclinical studies evaluating glycemic outcomes after treatment with S. dulcis were included. Risk of bias was assessed using a modified CAMARADES checklist, and treatment effects were pooled as standardized mean differences (SMDs) with 95% confidence intervals. Fourteen studies met the inclusion criteria. Aqueous, ethanolic, and methanolic extracts, as well as the isolated alkaloid coixol, significantly reduced blood glucose at 60 min (SMD =  - 4.15; 95% CI: -6.03 to - 2.27), 120 min (SMD =  - 3.59; 95% CI: -5.07 to - 2.11), 1 week (SMD =  - 3.47; 95% CI: -4.45 to - 2.48), and 2 weeks (SMD =  - 5.61; 95% CI: -7.15 to - 4.06) (all p < 0.0001). Heterogeneity was substantial (I² = 61-73%). The aqueous extract consistently showed the greatest effect. These findings support the traditional use of S. dulcis and provide a rationale for future clinical trials evaluating its antidiabetic potential.

Patients with type 2 diabetes mellitus (T2DM) commonly exhibit atherogenic dyslipidemia and increased oxidative stress, which may contribute to the development and progression of diabetic kidney disease (DKD). We investigated the associations of intermediate-density lipoprotein cholesterol (IDL-C) and α-tocopherol in low-density lipoprotein (LDL-α-tocopherol) with renal dysfunction in T2DM.

A total of 188 outpatients with T2DM were categorized into tertiles according to estimated glomerular filtration rate (eGFR). Lipoprotein fractions (HDL-, LDL-, IDL-, and VLDL-cholesterol) and LDL-α-tocopherol content were quantified using anion-exchange high-performance liquid chromatography. Arterial stiffness was assessed by brachial-ankle pulse wave velocity. Multivariable analyses were performed to evaluate associations between eGFR, lipoprotein parameters, and lipid-lowering therapy.

Declining eGFR was associated with longer diabetes duration and increased arterial stiffness. IDL-C levels and the LDL-α-tocopherol/LDL-C ratio increased significantly across decreasing eGFR tertiles, whereas LDL-C levels showed a decreasing trend. eGFR was independently and inversely correlated with IDL-C and the LDL-α-tocopherol/LDL-C ratio. Statin or fibrate therapy was associated with lower IDL-C levels and higher LDL-α-tocopherol/LDL-C ratios.

In patients with T2DM, declining DKD is associated with atherogenic IDL accumulation and increased LDL α-tocopherol content, suggesting altered lipoprotein metabolism that may influence LDL oxidation and cardiovascular risk.

Fournier's gangrene (FG) is a rapidly progressive necrotizing fasciitis of the perineal and genital regions associated with high mortality. Prompt intervention is crucial, particularly in patients with predisposing risk factors. A 75-year-old man with type 2 diabetes mellitus receiving long-term corticosteroid therapy presented with progressive scrotal pain and left thigh swelling. Physical examination revealed scrotal necrosis, and contrast-enhanced computed tomography demonstrated a perianal abscess with extensive subcutaneous emphysema. Emergency surgical debridement and bilateral orchiectomy were performed. Pus cultures demonstrated polymicrobial infection, whereas blood cultures yielded additional organisms, including Campylobacter ureolyticus, resulting in microbiological discordance between the two specimen types. The patient recovered without major complications following broad-spectrum antimicrobial therapy and intensive glycemic control. C. ureolyticus, which was identified in the present case, has previously been associated with necrotizing soft tissue infections, perianal abscesses, and bacteremia, and may cause severe infections, particularly in patients with underlying comorbidities or immunosuppression. The spatially heterogeneous and polymicrobial nature of FG may have contributed to the discordant culture results between the local specimen and blood cultures. This case highlights the complementary value of obtaining both pus and blood cultures for identifying uncommon pathogens in severe polymicrobial FG.

To investigate the association of preoperative serum Secreted Phosphoprotein 1 (SPON1) and Apolipoprotein E (APOE) with chronic postsurgical pain (CPSP) following total knee arthroplasty (TKA), providing a hypothetical basis for validation studies.

This retrospective study included 218 patients who underwent unilateral TKA between March 2023 and February 2025 with 6-month follow-up. CPSP was defined as a knee pain score >3 on the Visual Analog Scale (VAS) during movement at 6 months postoperatively. Demographic and clinical data, preoperative and postoperative pain scores, painDETECT questionnaire (PD-Q), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Hospital Anxiety and Depression Scale (HADS) scores, and preoperative serum SPON1 and APOE levels were collected. ROC curve was performed to evaluate the performance of serum SPON1 and APOE in discriminating CPSP-positive from CPSP-negative patients after TKA. Multivariable logistic regression analysis was performed to explore risk factors for CPSP following TKA.

Fifty-five patients were CPSP-positive and 163 were CPSP-negative. The CPSP-positive group had fewer years of education, higher prevalence of diabetes mellitus, longer duration of preoperative pain and knee osteoarthritis (KOA), and higher preoperative VAS, PD-Q, WOMAC, and HADS scores (all P<0.05). Serum SPON1 and APOE levels were significantly higher in the CPSP-positive group (both P<0.05), and positively correlated (r=0.253, P<0.05). The combination of SPON1 and APOE had an AUC of 0.908 (95% CI: 0.864-0.951), indicating good discriminative ability between CPSP-positive and CPSP-negative patients, superior to SPON1 alone (Z = -3.144，P=0.002) APOE alone (Z = -3.078，P=0.002). Multivariable analysis showed more years of education were a protective factor, whereas higher preoperative PD-Q and WOMAC scores and elevated serum SPON1 and APOE levels were risk factors for CPSP.

Serum SPON1 and APOE levels were associated with CPSP after TKA, and their combination showed favorable discriminative ability. Because the model was not validated, these results represent preliminary evidence of an association; the clinical value of these markers as potential biomarkers requires confirmation in prospective studies.

We sought to characterize immune-related endocrine toxicities (IETs) in gynecologic oncology patients receiving immunotherapy (IO), including risk factors, onset and resolution characteristics, and clinical outcomes.

This IRB-approved retrospective cohort study included all gynecologic oncology patients who received IO at a single institution between January 1, 2017, to January 1, 2023. Clinical characteristics, IO regimen, endocrine toxicities, management strategies, time to onset, resolution, and oncologic outcomes were abstracted from electronic medical records.

Among 333 patients, 128 (38.4%) developed an IET (immune-related endocrine toxicities). The most common IETs were hypothyroidism (31.2%, n = 104), hyperthyroidism (11.7%, n = 39), and insulin-dependent diabetes mellitus (2.4%, n = 8). Most toxicities were grade 1 (44.5%, n = 57) or grade 2 (50.8%, n = 65), while 4.7% (n = 6) were grade 3 or 4. Median time from IO initiation to IET diagnosis was 9.0 weeks (IQR, 5.4-18.7). Overall, 62.5% of patients with an IET required endocrine-directed therapy, and 56.3% required subsequent dose adjustment. Most IETs did not resolve during the median follow-up period of 16.4 months (67.2%, n = 86). Among IETs that resolved, median time to resolution was 8.1 weeks (IQR, 3.4-16.3). Pre-existing endocrine disorders were present in 43.8% of patients, most commonly hypothyroidism and diabetes. Among patients receiving endocrine-directed therapy, 51.9% required medication dose escalation during IO.

IETs are common among patients with gynecologic cancers receiving immunotherapy. While mostly low-grade, these events are usually chronic and frequently require medications or dose adjustments. These findings highlight the need for routine endocrine monitoring and long-term management strategies.