Transient ischemic attack (TIA) often precedes ischemic stroke, and the risk of recurrence is highest in the first days to weeks after the initial TIA. Although sociodemographic and socioeconomic factors are associated with stroke incidence, care, and long term outcomes, their relationship to very early progression from TIA to ischemic stroke remains less well defined.

We performed a retrospective cohort study using the National Institutes of Health All of Us Research Program. Adults with TIA were identified using predefined SNOMED, ICD-9-CM, and ICD-10-CM concept codes and were followed for 30 days for subsequent ischemic stroke. Covariates included race, sex at birth, age, income, insurance status, smoking status, hypertension, diabetes mellitus, atrial fibrillation, and carotid stenosis. Multivariable logistic regression was used to evaluate adjusted associations with 30 day ischemic stroke. Model discrimination was assessed using the C-statistic, and calibration was assessed using the Hosmer-Lemeshow goodness of fit test. Interaction terms between race and sex, income, and insurance status were evaluated using likelihood ratio testing.

Among 19,241 participants with TIA, 3,900 (20.3%) experienced ischemic stroke within 30 days. African American race was associated with higher odds of 30 day stroke compared with White race (adjusted odds ratio [aOR] 1.281, 95% confidence interval [CI] 1.157 to 1.419; p < 0.001). Female sex showed a trend toward lower odds that did not reach conventional significance (aOR 0.933, 95% CI 0.863 to 1.010; p = 0.086). Hypertension, diabetes mellitus, atrial fibrillation, and carotid stenosis were independently associated with increased 30 day stroke risk. Income categories showed inconsistent associations without a consistent directional trend, and insurance status was not independently associated with stroke after adjustment. Interaction terms between race and sex, income, and insurance did not significantly improve model fit (likelihood ratio test p = 0.690).

In this national cohort, early ischemic stroke after TIA remained associated with both established vascular risk factors and African American race after adjustment for income, insurance status, and major clinical covariates. These findings suggest that short term post TIA stroke risk may reflect both clinical risk burden and additional patient level or care process factors not captured by routine socioeconomic measures.

Type 2 diabetes mellitus is characterized by insulin resistance, impaired β-cell function, and persistent hyperglycemia. Light exposure may further influence glucose metabolism by modulating vitamin D synthesis, circadian rhythms, melatonin secretion, and sleep-related behaviors.

Relevant publications indexed in the Web of Science Core Collection from 2001 to 2025 were retrieved. A total of 2,491 studies were finally included, and bibliometric and visualization analyses were performed using Bibliometrix, VOSviewer, and CiteSpace.

The number of publications in this field showed a sustained increase, with a marked acceleration after 2019 and a peak in 2024. The United States and China were the main contributing countries. High-frequency keywords included type 2 diabetes, insulin resistance, obesity, inflammation, glycemic control, circadian rhythm, sleep, and gut microbiota. Research hotspots have shifted from early topics related to vitamin D, obesity, and glucose metabolism toward light exposure, circadian rhythm disruption, sleep behavior, and environmental chronomedicine.

Research on light exposure and type 2 diabetes has expanded from the "sunlight-vitamin D-glucose metabolism" framework to circadian and behavioral medicine. Future studies should integrate objective light exposure assessment, sleep/activity monitoring, and continuous glucose monitoring data to further verify the underlying mechanisms.

Type 5 Diabetes Mellitus (T5DM) is an emerging diabetes phenotype linked to chronic undernutrition. It predominantly affects young, lean individuals in low- and middle-income countries. After its formal recognition by the International Diabetes Federation in 2025, T5DM resurfaced as a clinically relevant insulin-deficient phenotype. It is now viewed as distinct from classical autoimmune and insulin-resistant forms of diabetes. This review synthesises recent evidence on the epidemiology, pathophysiology, clinical characteristics, and management of T5DM. Recent studies show that T5DM is influenced by early-life nutritional deprivation. This fits within the Developmental Origins of Health and Disease (DOHaD) framework. Undernutrition during key developmental periods harms pancreatic morphogenesis. It creates a permanent reduction of functional beta-cell mass through epigenetic programming. Clinically, T5DM often appears before age 30. Patients have low body mass index, sarcopenia, marked insulinopenia, absence of diabetes-associated autoantibodies, and resistance to ketosis, despite significant hyperglycemia. Diagnostic challenges remain, as patients are frequently misclassified as type 1 or type 2 diabetes. Relying only on body mass index is insufficient. Accurate diagnosis requires a multidimensional assessment including nutritional history, metabolic features, and exclusion of monogenic diabetes. T5DM is a distinct insulin-deficient phenotype caused by chronic undernutrition. Effective management requires more than glycaemic control. Nutritional rehabilitation is key, with a focus on adequate energy intake, high-biological-value protein supplementation, and correction of key micronutrient deficiencies. Given preserved insulin sensitivity, low-dose insulin should be used cautiously to avoid iatrogenic hypoglycemia. Better recognition and tailored management strategies are needed for optimal clinical outcomes.

Type 2 diabetes (T2D) has emerged among the top ten causes of disability and mortality worldwide. Health literacy is crucial for effective self-management to reduce the burden associated with T2D. Studies have reported the effectiveness of educational strategies for improving health literacy to promote good health and well-being. However, contextual factors influence the effectiveness of these strategies. Therefore, this paper intends to explain how and why context shapes the mechanisms through which educational strategies work to improve health literacy for adults with type 2 diabetes in low socioeconomic communities.

Theory-driven realist review methods will explain how and why contexts activate different mechanisms through which educational strategies work to produce intended or unintended outcomes in low socioeconomic communities. The following five steps of realist review, which are non-linear and iterative, will be undertaken: (i) Define the scope of the review and locate existing theories on educational strategies to improve health literacy, (ii) Develop the initial programme theories, (iii) Search for evidence, (iv) Select papers and appraise, and (v) Extract data and synthesis. The following databases will be searched, but not limited to, PubMed, Education Resource Information Centre (ERIC), and PsycINFO. Papers will be selected based on relevance, richness, and rigour. Data extraction will follow both inductive and deductive approaches. The Intervention-Context-Actor-Mechanism Outcome (ICAMO) configurations will be utilised to analyse and synthesise data using retroductive reasoning. Finally, the revised programme theories, which explain how the educational strategies are expected to work across different contexts in low socioeconomic communities, will be prepared and disseminated.

The findings may inform practice, influence policy, and contribute to the design of health literacy programmes in similar settings. The realist review is registered with the Open Science Framework: (https://osf.io/9w867).

Diabetic retinopathy (DR) is a leading cause of vision impairment worldwide, yet the cell-type-specific molecular alterations associated with disease progression remain incompletely understood. This study aimed to characterize transcriptional changes across retinal cell types in diabetes and DR and identify candidate disease-associated biomarkers using single-cell transcriptomics and machine-learning approaches.

We generated a single-cell RNA sequencing (scRNA-seq) atlas comprising 297 121 high-quality retinal cells from 20 eyes of 13 Chinese donors, including non-diabetic controls (NON), diabetes without retinopathy (DM), and DR samples. Following quality control, batch correction, clustering, and cell-type annotation, differential expression analyses were performed across disease states within each retinal cell type. Candidate biomarkers were further prioritized using a machine-learning framework incorporating L1-regularized logistic regression, recursive feature elimination with cross-validation, and stability selection.

We identified 10 major retinal cell populations and characterized extensive cell-type-specific transcriptional alterations associated with diabetes and DR. Pathway enrichment analyses consistently highlighted immune activation, oxidative stress, neurodegeneration, and synaptic dysfunction across multiple retinal cell types. A total of 707 cell-type-specific candidate marker genes were identified, providing a comprehensive resource for investigating disease-associated molecular mechanisms and potential therapeutic targets.

This study establishes a single-cell transcriptomic atlas of the Chinese diabetic retina and reveals cell-type-specific molecular signatures associated with DR progression. These findings provide biological insights into retinal disease mechanisms and nominate candidate biomarkers for future functional and translational studies.

Diabetes-associated hyperglycemia reshapes the oral microenvironment, aggravates biofilm-driven inflammation, and compromises the safety and efficacy of orthodontic treatment. Here, we develop a heat treatment-programmed bioactive orthodontic alloy, named NiTi-5Cu (AH), which combines structural functionality with microenvironment-responsive biological activity. By applying a solution-quench-aging process to NiTi-5Cu, we induce near-surface Cu enrichment and a more uniformly active electrochemical state, thereby enabling sustained Cu release. The resulting alloy maintains functional recoverability while exhibiting robust antibacterial and antibiofilm activities against Escherichia coli, Staphylococcus aureus, and Streptococcus mutans. In parallel, NiTi-5Cu (AH) exhibited no cytotoxicity toward human oral epithelial cells, vascular endothelial cells, and macrophages. Moreover, it induced M2-like macrophage polarization, shows favorable hemocompatibility isn both healthy and diabetic rabbits, and does not induce overt developmental or inflammatory toxicity in zebrafish assays. In a type 2 diabetic periodontitis rat model, intraoral placement of the alloy alleviates alveolar bone loss, inflammatory infiltration, and osteoclast activation. Moreover, 16S rRNA sequencing showed treatment-associated differences in oral-swab microbiota composition, while transcriptomic and metabolomic analyses revealed associative changes in inflammatory and metabolic pathways. Collectively, this work establishes a bioactive platform in which heat-treatment-engineered Cu release enables simultaneous antibiofilm regulation and periodontal protection, offering a promising metallic biomaterial strategy for diabetic oral care.

Gestational diabetes mellitus (GDM) is a common pregnancy complication with long-term metabolic consequences for both mother and offspring. While genome-wide association studies (GWAS) have identified risk loci, the cell-type-specific genetic architecture remains poorly characterized due to the limitations of bulk-tissue analyses.

We integrated GWAS summary statistics from FinnGen (12,332 cases, 131,109 controls) with single-cell expression quantitative trait loci (sc-eQTL) data from 12 immune cell types in the OneK1K cohort. Using the OTTERS framework and ACAT-O omnibus testing, we performed single-cell transcriptome-wide association studies (scTWAS) to identify GDM-associated genes. We performed bulk-level TWAS as a sensitivity analysis. To investigate the function of significant genes, we performed functional enrichment.

We detected 14 unique genes significantly associated with GDM across immune cell types (FDR < 0.05), with the strongest signals in CD4+ T cells and monocytes. Notably, ERAP1 and ERAP2 showed associations in 10 of 12 cell types (ACAT. P = 2.17 × 10-5), and RIOK2 emerged as a shared regulator. Gene Ontology analysis consistently highlighted "antigen processing and presentation via MHC class I" as the top enriched pathway (FDR < 10-5). In contrast, traditional bulk TWAS using GTEx whole blood identified only two genes with nominal associations.

Our sc-TWAS identifies cell-type-specific GDM-associated genes that are not detected in bulk tissue, highlighting dysregulated antigen presentation in peripheral immune cells. Colocalization prioritizes monocytic LNPEP as the primary causal candidate, while associations for ERAP1, ERAP2, and RIOK2 likely reflect complex LD or tissue-specific effects.

Extensive-stage small cell lung cancer (ES-SCLC) has limited treatment options, with first-line immunochemotherapy providing modest survival benefits.

This single-center, retrospective study aimed to develop a prognostic nomogram using real-world data from ES-SCLC patients treated with serplulimab-based immunochemotherapy to identify key factors influencing overall survival (OS).

109 ES-SCLC patients treated with first-line immunochemotherapy were analyzed. Baseline clinicopathological characteristics and hematological markers were assessed, and four prognostic factors - liver metastasis, maintenance therapy, albumin level, and neutrophil-to-lymphocyte ratio (NLR) - were identified by LASSO regression. A nomogram was constructed to predict 6-, 12-, and 24-month OS rates. The model's performance was validated with C-index, AUC, calibration curves, and decision curve analysis.

The nomogram effectively stratified patients into low-, intermediate-, and high-risk groups with significant OS differences (log-rank p < 0.001). Patients with liver metastasis, no maintenance therapy, low albumin levels, and high NLR had worse outcomes. The C-index for the training and internal validation sets was 0.698 and 0.832, respectively, with AUC values exceeding 0.7 across most time points, suggesting favorable discrimination within this exploratory cohort.

The identified nomogram provides an exploratory real-world tool for OS estimation in ES-SCLC patients receiving first-line serplulimab-based immunochemotherapy. By integrating baseline clinical factors and treatment-course information, the model may support dynamic risk stratification and help inform follow-up intensity, supportive care optimization, and prognostic counseling during routine clinical practice. Further prospective, multicenter external validation and time-dependent analyses are warranted to confirm and optimize its clinical applicability.

Most women with breast cancer undergo radiation therapy (RT) as part of treatment, but the impact of prior sexual trauma on their RT experience remains unclear. We sought to understand the patient experience and comfort during breast RT with a focus on how sexual trauma may negatively affect the RT experience of patients.

Between May and October 2022, IRB-approved surveys were distributed to female breast cancer patients treated with radiation at Sidney Kimmel Cancer Center. The 35-question survey assessed demographics, treatment details, body image satisfaction, comfort during various times throughout the RT process, and trauma history. Statistical analysis was performed using chi-square.

Of the 505 surveys collected, 420 met the inclusion criteria. At the time of their radiation treatment, most patients surveyed were over 60 (70%), postmenopausal (75%), and had at least a college degree (63%). Most patients had localized breast cancer (69%), had undergone a lumpectomy prior to radiation (79%), were treated by a female physician (53%), and had completed radiation therapy less than five years prior (61%) at the time of the survey. Although most patients reported general comfort during RT, notable discomfort was associated with gender dynamics. Fewer patients felt uncomfortable changing for treatment (9.8%), waiting in the general area (20%), or being set up for RT (22%), but many more expressed discomfort in waiting rooms with men (43%) or when treated by male radiation therapists (38%). A history of trauma exposure was prevalent: 38% had experienced verbal harassment, 39% an unwanted sexual advance, 33% unwanted sexual touching, and 19% an unwanted sexual encounter. Trends towards greater discomfort were associated with body exposure during treatment (p = 0.29), setup (p = 0.18) and being left alone in the treatment room (p = 0.29), though none of these differences reached statistical significance.

This study underscores the potential negative influence of prior sexual trauma on the RT experience for breast cancer patients. Although most patients reported overall comfort, those with a trauma history experienced trends toward greater distress related to exposure during treatment.

Adopting trauma-informed practices to increase provider training, gender considerations, and patient-centered modifications could enhance patient comfort, adherence, and satisfaction for breast cancer treatment.

The majority of patients with Tuberous Sclerosis Complex have cutaneous manifestations, the most common being facial angiofibroma (FA). The impact of facial angiofibroma on quality of life has not been comprehensively evaluated, and a health state utility has not previously been determined. The purpose of this study was to calculate the health utility of facial angiofibroma from the perspective of dermatology patients and explore any associations between participants' sociodemographic characteristics and the perceived utility of facial angiofibroma.

In a structured interview format, participants recruited from dermatology clinics (n = 100) were asked to imagine themselves in each of four health states (monocular blindness, binocular blindness, almost-clear facial angiofibroma and moderate facial angiofibroma). Visual analogue scale, time trade-off and standard gamble were conducted for each health state and each outcome was converted into a health state utility.

The adjusted mean health state utilities were 0.88 [0.84,0.92], 0.95 [0.91,0.99] and 0.94 [0.91,0.98] for almost-clear facial angiofibroma, by Visual Analogue Scale, Time Trade-Off and Standard Gamble, respectively, and 0.68 [0.64,0.72], 0.88 [0.84,0.92] and 0.91 [0.87,0.94] for moderate facial angiofibroma. Participants theoretically elected to sacrifice 6.8 years of their remaining 57 years of life (12%) and accept a 9% risk of immediate death to receive curative treatment for moderate facial angiofibroma.

The health state utility of moderate facial angiofibroma was significantly poorer than almost-clear facial angiofibroma. This highlights that reducing the severity of facial angiofibroma can deliver potential gains in quality of life.