Catheter-associated urinary tract infections (CAUTI) are among the most common healthcare-associated infections, particularly in hospitalised patients requiring prolonged catheterisation. Despite standard protocols, preventable lapses in catheter care and clinical practices contribute to the incidence of these infections.

This study aimed to identify significant risk factors and develop a point-based CAUTI Risk Scoring System for early prediction and intervention.

A prospective observational study was conducted over six months at a tertiary care hospital, including 100 catheterized adult inpatients. Demographic data, Clinical variables, and catheter practices were documented. CAUTI was confirmed by urine culture. A risk stratification model was developed by assigning weighted scores to statistically significant variables, categorising patients into low, moderate, and high CAUTI risk groups. A domain-wise heatmap visually represented the novelty and interdisciplinary relevance of the study's contributions across ten clinical research domains.

Among the 26% of study participants who had CAUTI overall, the important procedural predictors were open-type drainage systems (p < 0.00001), kinking of catheter tubing (p < 0.00001), and raised urobag placement (p < 0.00001). Clinical risk variables included diabetes mellitus (p = 0.00001), catheter duration greater than 7 days (p = 0.0043), female sex (p = 0.0023), and immobility (p = 0.0014). Strong early signals included turbid urine (p = 0.00004) and unexplained fever (p = 0.00001). A cumulative risk rating system placed patients into low (0-3), moderate (4-6), and high-risk (≥7) categories.

This study presents the first validated CAUTI Risk Scoring System, including clinical, procedural, and early bedside indicators. The scoring tool enables proactive intervention and serves as a necessary adjunct to infection prevention plans in hospital environments.

Intraoperative Floppy Iris Syndrome (IFIS) is an intraoperative event observed during cataract surgery, characterized by iris billowing, progressive miosis, and iris prolapse. While prior studies have focused on male patients and α-adrenergic antagonists, risk factors for IFIS in females remain unclear. This study aimed to identify independent risk factors for IFIS in female cataract patients.

Female patients undergoing cataract surgery at Shanghai General Hospital from 2022 to 2024 were included. A total of 298 patients were enrolled in a cross-sectional study, and 416 in a cohort study. IFIS was assessed via surgical video, and logistic regression was used to identify risk factors, which were validated in the cohort.

In the cross-sectional analysis, diabetes mellitus (DM) (OR=14.471, 95% CI: 2.183-95.929, P=0.006) and angiotensin II receptor blocker (ARB) use (OR=1.672, 95% CI: 1.057-26.774, P=0.043) were significantly associated with IFIS. In the cohort study, DM (P=0.023) and ARB use (P=0.039) remained independent risk factors.

Diabetes and ARB medication are independent risk factors for IFIS in female cataract patients. Preoperative identification of these factors may help reduce intraoperative complications and improve surgical safety.

Peripheral artery disease in diabetes mellitus represents a distinct clinical entity characterized by diffuse distal arterial disease, medial calcification, microvascular dysfunction, neuropathy, and a pro-thromboinflammatory milieu. These features contribute to atypical presentations, diagnostic challenges, accelerated progression, and elevated risks of limb loss and cardiovascular events. Management requires integrated strategies encompassing metabolic optimization, lifestyle modification, pharmacotherapy, antithrombotic therapy, supervised exercise, and timely revascularization. Emerging approaches, including GLP-1 receptor agonists, SGLT2 inhibitors, and regenerative therapies, show promise in improving vascular, functional, and limb outcomes. Advancing outcomes in diabetic peripheral artery disease will depend on mechanism-driven screening, individualized therapies, and novel interventions to prevent complications.

Preadmission metformin may lower mortality in diabetic sepsis patients, but evidence is conflicting, necessitating a systematic review and meta-analysis for confirmation.

We systematically searched MEDLINE (via PubMed), EMBASE, and Cochrane CENTRAL from inception to September 1, 2025, for cohort studies evaluating metformin use in septic patients with diabetes. Study quality was assessed using the Newcastle-Ottawa Scale. Two reviewers independently screened studies, extracted data, and evaluated methodological quality. Meta-analysis was conducted using STATA statistical software and Review Manager software, calculating pooled odds ratios with 95% confidence intervals via the inverse variance random-effects model. The MET group included diabetic sepsis patients with preadmission metformin exposure, and the NM group included those without.

This meta-analysis of 14 studies (12,687 patients), all with low bias risk, demonstrated that preadmission metformin use in sepsis-diabetes patients was associated with reduced overall mortality (OR 0.58, 95% CI 0.44-0.75, P < 0.00001). Significant reductions were observed in 28-day (OR 0.61, P = 0.002), 90-day (OR 0.48, P = 0.001), 365-day (OR 0.33, P = 0.0005), and in-hospital mortality (OR 0.43, P < 0.02). However, 30-day (OR 0.71, P = 0.06), 60-day (OR 0.72, P = 0.22), and ICU mortality (OR 0.76, P = 0.25) showed no significant differences. Notably, metformin also significantly improved serum creatinine (MD -0.32, P = 0.04) and metformin usage was associated with elevated serum lactate levels.

This meta-analysis links preadmission metformin use in diabetic sepsis patients to reduced mortality-particularly 28-day, 90-day, 365-day, and in-hospital-along with decreased serum creatinine. Clinically and from a public health standpoint, these data support the integration of metformin history as a favorable prognostic indicator into updated clinical guidelines, thereby informing future antimicrobial stewardship and sepsis bundle strategies. These findings support further evaluation of metformin's benefits in large-scale, multicenter randomized controlled trials.

Diabetes mellitus (DM) is a chronic metabolic disorder associated with hyperglycemia, dyslipidemia, oxidative stress, inflammation, apoptosis, and renal dysfunction. Although phlorizin (PHL) possesses well-documented antidiabetic properties, its clinical applicability is limited by poor bioavailability and rapid metabolism, which may restrict its therapeutic efficacy. This study evaluated the therapeutic potential of phlorizin (PHL) and its chitosan nanoparticle formulation (PHL-CSNPs) in streptozotocin (STZ)-induced type 1 diabetic rats. Ninety adult male albino rats were randomly divided into six groups (n = 15 each): non-diabetic control, non-diabetic treated with crude PHL, non-diabetic treated with PHL-CSNPs, diabetic untreated (STZ-induced T1DM), diabetic treated with crude PHL, and diabetic treated with PHL-CSNPs. STZ-induced T1DM caused significant reductions in serum insulin, body weight gain, renal antioxidant defences, and mitochondrial function, accompanied by marked elevations in fasting blood glucose, dyslipidemia, oxidative stress markers, pro-inflammatory cytokines, apoptotic markers, and renal fibrotic mediators, as well as pronounced histopathological and ultrastructural kidney damage. In diabetic rats, treatment with PHL-CSNPs significantly improved insulin levels, glucose homeostasis, and body weight, restored lipid profiles and antioxidant enzyme activities, enhanced mitochondrial respiratory complex activities and ATP production, suppressed NF-κB-mediated inflammation, upregulated Nrf2/HO-1 signalling, decreased Bax and caspase-3 levels, increased Bcl-2 levels, and reduced TGF-β1-mediated fibrosis. Crude PHL provided moderate protective effects but was consistently less effective than the nanoparticle formulation. Importantly, the chitosan nanoparticle formulation markedly enhanced the therapeutic efficacy of PHL, likely by improving its stability, bioavailability, and renal tissue delivery, thereby producing stronger antioxidant, anti-inflammatory, and anti-apoptotic effects than crude PHL. Non-diabetic rats treated with either PHL or PHL-CSNPs maintained normal metabolic and renal parameters, confirming the safety of the treatments. Histopathological and ultrastructural analyses further confirmed the preservation of renal architecture in PHL-CSNP-treated diabetic rats. Collectively, this study demonstrates that nanoencapsulation significantly potentiates the biological activity of PHL, providing a clear therapeutic advantage over the crude compound. Overall, these findings demonstrate that PHL-CSNPs provide superior nephroprotective, antioxidant, anti-inflammatory, and metabolic benefits, highlighting their potential as a promising therapeutic strategy for managing type 1 diabetes-induced metabolic and renal complications.

To investigate the clinical features and genetic etiology of a patient with Alström syndrome (ALMS) who presented with paroxysmal palpitations.

Clinical data were collected from a 20-year-old female patient who was admitted to Fuwai Hospital, Chinese Academy of Medical Sciences in April 2024. Her medical history was obtained, and physical examination, auxiliary investigations, and laboratory tests were carried out. Peripheral blood samples were collected from the patient and her parents. Whole-exome sequencing (WES) was performed, followed by bioinformatic analysis to identify candidate variants. Pathogenicity assessment was conducted based on the guidelines from American College of Medical Genetics and Genomics (ACMG). Sanger sequencing was subsequently conducted for the patient and her parents to confirm the presence of the variants and determine their parental origin. The study was approved by the Ethics Committee of the institution (Ethics No.: 2026-3045).

The patient exhibited multisystem involvement including paroxysmal atrial flutter, retinitis pigmentosa, type 2 diabetes mellitus, and hypothyroidism. Electrophysiological examination confirmed right atrial isthmus-dependent atrial flutter. The patient underwent successful radiofrequency ablation. WES revealed that she has harbored heterozygous c.9472C>T (p.Lys579GlufsTer17) and c.1734dup (p.Gln3158Ter) variants of the ALMS1 gene. Bioinformatic analysis suggested that both variants can result in significant alteration in the protein. Pathogenicity analysis showed that both variants were unrecorded in the population and disease-related databases and have loss-of-function effects. Based on the ACMG guidelines, both variants were classified as likely pathogenic. Sanger sequencing confirmed that the two variants were inherited from different parents, constituting compound heterozygous variants. The possible mechanisms underlying the patient's clinical manifestations and recent advances in ALMS research were also summarized.

Compound heterozygous ALMS1 variants c.9472C>T and c.1734dup probably underlay the pathogenesis of ALMS in this patient. Above findings have expanded the genotype-phenotype spectrum of ALMS and facilitated understanding of its genetic basis, pathogenic mechanism, and clinical manifestations, thereby promoting early diagnosis and standardized management.

This investigation evaluated the predictive capacity of the oral microbiome and host salivary biomarkers on treatment outcomes for periodontitis in patients with type 2 diabetes mellitus (T2DM).

Two patient cohorts were enrolled: T2DM without periodontitis (DWoP; n = 32) and T2DM with periodontitis (DWP; n = 29). Whole saliva was collected at baseline and 4 to 7 wk posttreatment (i.e., DWoP, supragingival prophylaxis; DWP, scaling and root planing). The oral microbiome (operational taxonomic units; OTUs) and targeted salivary biomarkers were assessed in pre- and posttreatment saliva.

Most OTUs (57%-68%) and salivary biomarkers (43%-55%) decreased after treatment in both groups. Supragingival prophylaxis in the DWoP patients altered a limited number of taxa (V. dispar, P. denticola, Rothia, Neisseria), showing substantial increases in the microbiome, whereas predominantly gram-negative OTUs decreased. In the DWP, decreases were observed following therapy for Bacillota, Bacteroidetes, and Proteobacteria, again representing primarily gram-negative taxa. Microbe-host response biomarker correlations increased posttherapy in DWoP and decreased in DWP samples. Importantly, poor response (PR) to therapy was independent of HbA1c levels but associated with higher pretreatment levels of multiple bacterial genera (i.e., Alloprevotella, Campylobacter, Corynebacterium, Fusobacterium, and Leptotrichia) and elevated levels of interleukin (IL)-1b, IL-6, matrix metalloprotease-8 (MMP-8), adiponectin, and resistin. After therapy, PR was characterized by increases in Lachnospiraceae, Prevotella, and a lack of effects on Leptotrichia, Alloprevotella, Porphyromonas, and Stomatobaculum.

Poor clinical response to therapy was characterized by (1) less microbiome diversity and elevated levels of specific bacteria and salivary analytes pretherapy and (2) posttherapy elevations in multiple taxa and sustained levels of IL-1b and MMP-8 in both groups of PR patients. These findings support that a panel of salivary features could enhance our prediction and earlier decisions on response to therapy at the biological level, thus opening the door for more precise patient-level management.Knowledge Transfer Statement:These findings contribute to a pathway for understanding oral health using biological measures as a standard for better decisions in oral health care. Specifically, microbiome and host response parameters provided important insights with predictive value and differential biological presentation related to response to therapy. While these measures do not dictate disease causation, they appear to reflect the periodontal environment, hallmarks of disease, and response to therapy.

Chronic wounds, particularly in diabetic patients, represent a major clinical and economic burden on healthcare systems worldwide. Complementary therapies are increasingly integrated alongside conventional treatments to improve healing outcomes. Maggot debridement therapy (MDT), utilizing the larvae of Lucilia sericata, is a globally recognized method for treating non-healing wounds. These larvae secrete substances with antifungal, antibacterial and anti-inflammatory properties. Herbal remedies also play a role in chronic wound care, with various Achillea species traditionally used for medicinal purposes. This study investigated the wound healing effects of a pomade combining L. sericata larval secretions and Achillea sintenisii plant extract, compared to Furacin®, a commercial wound healing cream. Excisional wounds were created on diabetic Wistar albino rats, which were divided into four groups: DF (Furacin®), DM (L. sericata secretion), DA (A. sintenisii extract) and DM + DA (combined). Wound area, contraction rates and histological parameters were assessed at Days 0, 4, 8 and 12. Wound area decreased significantly across all groups over time (F = 511.9, p = 0.001), with mean values declining from 11.11 cm² at Day 0 to 7.44 cm² at Day 4, 4.93 cm² at Day 8 and 2.01 cm² at Day 12. Contraction rates rose progressively across all groups (F = 169.3, p = 0.001): at Day 4, contraction rates were 20.41% ± 1.24% (DF), 43.29% ± 3.96% (DM), 27.67% ± 0.94% (DA) and 42.22% ± 1.20% (DM + DA); at Day 8, rates increased to 42.86% ± 1.11% (DF), 63.34 ± 0.92% (DM), 52.97% ± 0.55% (DA) and 63.26% ± 0.52% (DM + DA) and at Day 12, the DM + DA group achieved the highest contraction rate of 92.91% ± 0.40%, significantly surpassing all other groups-DM (84.30% ± 0.88%), DA (79.43 ± 0.61%) and DF (71.77% ± 0.64%)-demonstrating a clear synergistic effect of the combined therapy (p < 0.05). Histological evaluation further corroborated these findings, with the DM + DA group consistently achieving the highest scores across all tissue repair parameters (epithelialization, fibroblast density, collagen deposition, angiogenesis and hair follicle regeneration), significantly superior to all other groups (p < 0.05). Taken together, these results confirm that the combination of L. sericata secretions and A. sintenisii extract exerts a synergistic wound healing effect superior to either agent alone or to Furacin® and could lead to the development of affordable, accessible and effective natural products for chronic wound care. These results may contribute to innovative treatment options in both veterinary and human medicine.

Metabolic diseases, particularly type 2 diabetes mellitus (T2DM) and obesity, have been traditionally understood through glucose-centric models. However, hyperglycaemia is a downstream consequence of systemic immune-metabolic dysregulation, with the gut microbiota acting as a central upstream regulator through defined molecular signalling pathways. This review examines four principal microbiota-host signalling axes through which ecological disruption drives systemic metabolic disease: short-chain fatty acid (SCFA) depletion impairing free fatty acid receptor (FFAR2/FFAR3) and AMP-activated protein kinase (AMPK) signalling; altered bile acid (BA) biotransformation perturbing farnesoid X receptor (FXR) and TGR5 signalling; increased intestinal permeability facilitating lipopolysaccharide (LPS) translocation and Toll-like receptor 4 (TLR4)-nuclear factor kappa B (NF-κB) activation; and diminished indole production reducing aryl hydrocarbon receptor (AhR)-driven interleukin-22 (IL-22) secretion. Therapeutic strategies targeting these pathways, including SCFA prodrugs, FXR modulators, TGR5 agonists, and next-generation probiotics, offer disease-modifying potential beyond glycaemic lowering and highlight the need for a multidimensional clinical endpoint framework spanning inflammatory, hepatic, and barrier biomarkers to enable comprehensive translational evaluation of microbiota-directed therapies.

Time-restricted feeding (TRF) has emerged as a promising dietary strategy for improving metabolic health, including type 2 diabetes mellitus (T2DM).

To explore the effects of TRF on body weight, glucose regulation, insulin sensitivity, and lipid metabolism in animal and human studies.

A systematic search of the PubMed and Scopus databases was conducted from February 24, 2025, to April 2, 2025, to identify animal and human studies investigating the metabolic effects of TRF.

The search strategy combined keywords related to "intermittent fasting," "diabetes," "time-restricted feeding," "TRF," "animal model," "insulin sensitivity," "glucose level," "T2DM," "body composition," "human," "glycemic control," and "insulin resistance." Studies were included if they reported the effects of TRF on at least 1 of the following end points: body weight, blood glucose level, insulin sensitivity, glucose tolerance, or lipid profile. Reviews, commentaries, and studies lacking relevant outcome data were excluded. A total of 11 studies met the inclusion criteria: 6 animal and 5 human investigations.

Across animal and human studies, TRF had duration-dependent metabolic effects. In animal models, short-term TRF (4-5 weeks) elicited modest improvements in glucose tolerance and body weight, whereas longer interventions (6-12 weeks) consistently enhanced glycemic control, reduced body weight, and favorably modulated lipid profiles. In humans, short-term time-restricted eating (3-4 weeks) produced modest reductions in fasting glucose levels and glycated hemoglobin (HbA1c), and extended interventions (12-24 weeks) improved insulin sensitivity, lowered HbA1c, and further optimized lipid metabolism and body weight.

TRF demonstrates therapeutic potential in managing T2DM by improving glucose regulation, insulin sensitivity, and lipid metabolism in animal and human models. Interventions extending beyond 6 weeks and with fasting windows of 14-16 hours yield the most consistent metabolic benefits, highlighting the need for standardized TRF protocols in future research.

Open Science Framework registration doi: 10.17605/OSF.IO/6MAQ9.