Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is more severe in people with diabetes mellitus due to immune dysfunction, exacerbated inflammation and increased risk of co-morbidities and mortality. In this context, this study aims to analyse the epidemiological profile of hospitalized people with diabetes mellitus and COVID-19 in Brazil over 4 years of the pandemic.

The epidemiological analysis was conducted using data from the Open-Data-SUS (Sistema Único de Saúde, Brazilian Unified Health System) platform (Brazilian Ministry of Health) covering the period from March 2020 to March 2024. Data were processed in Statistical Package for the Social Sciences software, with missing values imputed using XLSTAT. Variables included demographic profile, viral infection, co-morbidities, clinical signs and symptoms, intensive care unit (ICU) admission and mechanical ventilation, and outcomes. Statistical analyses comprised bivariate and multivariable logistic regression with a 5% significance level, focusing on two primary comparisons: the risk of death and the likelihood of classification as diabetes mellitus. The study protocol was approved by the institutional ethics committee.

Among 2,078,062 people hospitalized with SARS-CoV-2 in Brazil, 22.2% (N = 461,647) had diabetes mellitus, with marked regional heterogeneity in both prevalence and mortality. Overall mortality was 32.9% (N = 683,088). Diabetes mellitus was not only highly prevalent but also emerged as an independent risk factor for in-hospital death, significantly increasing mortality odds (OR = 1.178; 95% confidence interval [95% CI] = 1.168-1.188), as well as higher likelihood of ICU admission (OR = 1.102; 95% CI = 1.093-1.112) and invasive mechanical ventilation (OR = 1.102; 95% CI = 1.087-1.118). Older age, female sex and self-identification as Black, mixed-race or Asian were also strongly associated with diabetes mellitus. The presence of co-morbidities, such as cardiopathy (heart disease), kidney disease, obesity, liver disease, and neurological disorders further amplified the risk of poor outcomes. Regarding vaccination, most people were unvaccinated, and while COVID-19 vaccination showed a modest association with DM diagnosis, it consistently reduced the risk of death (OR = 0.588; 95% CI = 0.583-0.594). Conversely, nosocomial infection substantially increased mortality risk, despite presenting a divergent pattern in relation to diabetes mellitus in adjusted models. Clinical symptoms most strongly associated with death included dyspnoea, respiratory discomfort and peripheral oxygen saturation below 95%. Hospital management variables were decisive: ICU admission and ventilatory support, especially invasive mechanical ventilation (OR = 12.933; 95% CI = 12.752-13.115), markedly increased mortality. Overall, advanced age remained the strongest predictor, with individuals older than 85 years experiencing more than a 30-fold increased risk of death compared with younger groups (OR = 32.840; 95% CI = 30.840-34.969).

Diabetes mellitus is an independent predictor of worse outcomes in hospitalized people with COVID-19 in Brazil. Mortality is strongly influenced by age, co-morbidities and severity markers, while vaccination provides substantial protection.

Type 2 diabetes mellitus (T2DM) is a chronic condition with significant psychological and physiological challenges. Clinical hypnosis has emerged as a complementary intervention to support emotional regulation and self-management in T2DM care. This critical narrative review evaluates empirical studies on the use of clinical hypnosis for managing psychological and physiological outcomes in individuals with T2DM. Systematic search procedures were applied in Scopus, PubMed, and Google Scholar, yielding six eligible studies published between 2011 and 2025 for inclusion in this critical narrative review. The findings suggest potential benefits in reducing stress and anxiety, enhancing self-care, and improving glycemic control. However, methodological limitations - such as non-randomized designs, small samples, and heterogeneous protocols - limit causal conclusions and replicability. Clinical hypnosis shows promise as an adjunctive approach in T2DM management, but further research using rigorous designs and objective measures is needed to establish its effectiveness and mechanisms.

The precise diagnosis and scientific management of diabetes are highly important for improving patients' quality of life and reducing the risk of complications. However, in actual clinical settings, diagnostic processes often face challenges, including significant individual differences among patients, complex and diverse parameters, and heterogeneity in disease progression. These challenges not only impose greater requirements on the adaptability and precision of diagnostic and therapeutic models but also highlight the need for explainable disease mechanisms and rational treatment strategies. To address these issues, this study proposes an Extended Belief Rule Base (EBRB) model based on neighborhood covering reduction, abbreviated as NCR-EBRB, for diabetes prediction and diagnosis. During the model construction phase, the Extreme Gradient Boosting (XGBoost) method is first employed for feature importance evaluation to reasonably screen key features and effectively reduce model dimensionality. In the model inference phase, the Neighborhood Covering Reduction (NCR) method is adopted to implement rule reduction in the rule base, combined with a threshold-based rule activation strategy to filter out inefficient rules, ensuring efficient reasoning processes and effective result output. During the model optimization phase, the Projection Covariance Matrix Adaptive Evolution Strategy (P-CMA-ES) is applied to optimize the parameters of the streamlined rule base, aiming to identify optimal parameter configurations for further improving model performance. Through this meticulous parameter tuning, the diagnostic accuracy is enhanced, and the robustness of the model is improved.

Monoclonal gammopathy of renal significance (MGRS) refers to a spectrum of kidney disorders caused by monoclonal immunoglobulins produced by small, often clinically silent clones of B-cells or plasma cells that do not meet the diagnostic criteria for overt haematological malignancy. These entities are frequently overlooked, as their clinical presentation often mimics more common renal diseases and typical markers of monoclonal protein may be absent. We describe the case of a 49-year-old woman with type 2 diabetes and hypertension who presented with nephrotic-range proteinuria. Despite unremarkable findings on serum and urine protein electrophoresis and a normal bone marrow biopsy, serum free light chain analysis revealed significantly elevated kappa chains. Renal biopsy demonstrated classic features of both kappa light chain cast nephropathy and light chain deposition disease. This case highlights the role of renal biopsy and serum free light chain assays in the diagnosis of MGRS, especially when traditional paraprotein studies are inconclusive.

To assess long-term trends, regional disparities, determinants, and quality of care for type 2 diabetes mellitus (T2DM) among women aged 55 years or above worldwide.

Using Global Burden of Disease 2023 data, we quantified incidence, mortality, and disability-adjusted life years (DALYs) attributable to T2DM among women aged 55 years or above from 1990 to 2023. Temporal trends were evaluated using joinpoint regression. Regional determinants were identified through explainable machine learning models (XGBoost with Shapley Additive Explanations). A Quality-of-Care Index, derived from mortality, disability, and prevalence indicators, was constructed to evaluate health care performance.

In 2023, South Asia recorded the largest absolute burden of T2DM among women aged 55 years or above, with 749,064 cases (95% uncertainty intervals [UI] 592,209-892,315), 274,542 deaths (171,620-381,640), and 8.11 million DALYs (5.82-10.43 million), followed by East Asia and high-income North America. From 1990 to 2023, Eastern Europe exhibited the steepest long-term increases in age-standardized incidence, mortality, and DALYs rates, with an average annual percent change of 2.49% for incidence and 3.97% for mortality. Mortality and DALYs burdens peaked among women aged 65-69 years. Across regions, high fasting plasma glucose, high body mass index, and low physical activity were the leading contributors to disease burden. Distinct regional risk patterns were observed, including air pollution in Asia, unhealthy dietary patterns in high-income North America, sedentary behavior in Oceania, and alcohol use in South Asia. Lower Quality-of-Care Index scores were strongly associated with higher mortality and DALYs rates, highlighting substantial inequities in diabetes care.

The escalating burden of T2DM among women aged 55 years or older reflects interactions between biological aging and metabolic, behavioral, and environmental risks. Age-targeted prevention, improved care quality, and mitigation of modifiable exposures are critical to reduce diabetes-related disability globally.

The optimal timing of radiotherapy (RT) in patients with WHO grade 2 meningiomas remains controversial, particularly following gross total resection (GTR). This multicenter study compared long-term outcomes of early RT versus late RT, focusing on progression-free survival (PFS), overall survival (OS), and tumor-related mortality.

This retrospective multicenter cohort study included 263 adult patients with histopathologically confirmed WHO grade 2 meningiomas treated between 2005 and 2023. Patients were stratified by RT timing: early adjuvant RT after initial surgery versus late RT administered after radiologic or clinical progression. Outcomes were analyzed in the overall cohort and in a prespecified GTR subgroup. PFS and OS were estimated using the Kaplan-Meier method. Tumor-related mortality was assessed using cause-specific Cox and Fine-Gray competing-risk models.

With a median follow-up exceeding 7 years, early RT was associated with a significant improvement in PFS compared with late RT. In the overall cohort, 10-year PFS was 84.8% with early RT versus 18.6% with late RT (p < 0.001). Among patients undergoing GTR, 10-year PFS remained high with early RT (89.3%) but declined markedly after late RT (18.8%; p < 0.001). RT timing was the strongest independent predictor of PFS in multivariable models, although its effect attenuated over time. Tumor-related mortality was approximately sixfold higher in the late RT group (16.7% vs 2.7%; p = 0.011), whereas all-cause mortality did not differ significantly (24.2% vs 14.7%; p = 0.198). Mitotic count and Ki-67 index were independently associated with early and long-term PFS, whereas male sex, older age, and subtotal resection predicted tumor-related mortality.

Early RT provides a durable and clinically meaningful PFS benefit over late RT in WHO grade 2 meningiomas, including after GTR, without conferring an OS advantage. These findings emphasize the importance of RT timing and tumor biology in postoperative risk stratification and support consideration of early RT in selected patients, pending results from randomized trials.

Paclitaxel-induced peripheral neuropathy (CIPN) is a debilitating side effect affecting up to 70% of patients receiving paclitaxel chemotherapy, with severe symptoms occurring in approximately 30%. While non-modifiable risk factors such as age and genetics have been established, the role of modifiable factors, including vitamin D insufficiency, remains poorly characterized. This study aimed to evaluate the association between pre-treatment vitamin D levels and the incidence of severe CIPN in breast cancer patients receiving paclitaxel-based chemotherapy. A prospective cohort study was conducted on 300 breast cancer patients (stage I-III) receiving paclitaxel-based chemotherapy (80 mg/m²) for 12 weeks at Kafrelsheikh University Hospitals. Baseline serum 25(OH)D was quantified using the Elecsys Vitamin D Total II assay on the Cobas e411 platform, standardized to the VDSP reference method. Pre-treatment vitamin D levels were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS), with insufficiency defined as ≤ 20 ng/mL. CIPN was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20-item scale (EORTC QLQ-CIPN20), with particular focus on grade 3-4 sensory neuropathy. Statistical analyses included receiver operating characteristic (ROC) curves and multivariate logistic regression to identify independent risk factors. The mean pre-treatment vitamin D level was 23.45 ± 8.3 ng/mL, with 39.3% (118/300) of patients classified as having vitamin D insufficiency. Patients with vitamin D insufficiency demonstrated significantly higher rates of grade 3-4 sensory CIPN compared to those with sufficient levels (32.2% vs. 5.5%, p < 0.001). Mean vitamin D levels were significantly lower in patients who developed severe CIPN (17.5 ± 4.9 ng/mL vs. 24.6 ± 8.4 ng/mL, p < 0.001). ROC analysis demonstrated vitamin D's predictive value for motor CIPN (AUC = 0.747, p = 0.038). Multivariate logistic regression analysis confirmed vitamin D insufficiency as an independent predictor of sensory CIPN (OR = 6.72, 95% CI: 3.09-14.61, p < 0.001), even after adjusting for age, body mass index, and treatment schedule. Vitamin D insufficiency is independently associated with an increased risk of severe paclitaxel-induced peripheral neuropathy in breast cancer patients. While causal inference cannot be drawn from this observational design, these findings provide a strong rationale for future randomized controlled trials to evaluate whether vitamin D supplementation could serve as a candidate preventive strategy to mitigate CIPN severity and optimize cancer therapy outcomes.

Objective: Advanced malignant melanoma still poses significant challenges in treatment. Combining nab-paclitaxel, bevacizumab, and immunotherapy has shown promising efficacy across various cancer types. This retrospective study aimed to assess the efficacy and safety of this regimen in patients with advanced melanoma and explore related biomarkers. Methods: Patients with histologically confirmed inoperable stage Ⅲ or Ⅳ melanoma and Eastern Cooperative Oncology Group Performance Status 0-2 were included in this retrospective study conducted from September 2020 to August 2023. Patients received combination therapy with nab-paclitaxel, bevacizumab, and toripalimab (Q3W) at Nanjing Drum Tower Hospital. Maintenance therapy with bevacizumab and toripalimab was given after 6-8 cycles without disease progression or intolerable adverse reactions. Personalized radiotherapy was delivered. The primary endpoint was the confirmed objective response rate (ORR) and disease control rate (DCR). Results: As of January 20, 2024, 28 out of 41 patients showed tumor shrinkage, including 4.9% (n=2) achieving complete response (CR) and 63.4% (n=26) achieving partial response (PR). The confirmed ORR was 63.4% (95% CI: 46.9%-77.9%) and the DCR was 92.7% (95% CI: 80.1%-98.5%). The median PFS was 14.2 months, the 1-year survival rate was 75.5% (95% CI: 62.7%-90.9%), and the 2-year survival rate was 54.6% (95% CI: 38.1%-78.1%). Moreover, patients who received radiotherapy exhibited a longer median progression-free survival (mPFS) (14.3 months vs 7.0 months, HR=0.45 [95% CI: 0.20-1.01]). Grade 3 treatment-related adverse events were leukopenia, neutropenia, AST/ALT elevation, adrenal insufficiency, hypertriglyceridemia and neurotoxicity. No treatment-related deaths were observed. In addition, biomarker analysis showed that liver metastasis, MET mutation, and NF1 mutation were independent predictors of PFS (P=0.006, 0.038, and 0.002, respectively). Conclusions: This study demonstrates that toripalimab, in combination with nab-paclitaxel and bevacizumab, offers a potential therapeutic option for advanced melanoma with acceptable toxicity. Furthermore, this triplet therapy combined with radiotherapy significantly improves PFS. Preliminary biomarker analysis suggests that patients with liver metastasis, MET or NF1 mutations may be less likely to benefit from this treatment regimen.

Objective: To evaluate the efficacy and safety of resectable locally advanced colorectal cancer (LACRC) after neoadjuvant immunotherapy (IT). Methods: A retrospective analysis of the clinicopathological data of 32 patients with locally advanced colorectal cancer who received neoadjuvant immunotherapy followed by radical surgery at the Cancer Hospital Chinese Academy of Medical Sciences, from January 2019 to February 2024. Fisher's exact test was used for univariate analysis, and Logistic regression model was used for multivariate analysis. Results: Of the 32 patients, 23 were male and 9 were female; the median age was 55 years old. Seven patients with microsatellite instable-high (MSI-H) and 1 patient with microsatellite stable (MSS) received neoadjuvant immunotherapy. Eight patients received neoadjuvant immunotherapy, 16 patients (10 MSI-H and 6 MSS) received neoadjuvant chemotherapy combined with IT, and 8 patients (1 MSI-H and 7 MSS) received neoadjuvant chemoradiotherapy combined with IT. Postoperative pathological results showed that 25 patients achieved pathological complete response (pCR) (78.1%), while 7 patients did not achieve pCR (21.9%). The pCR rates were 94.4% (17/18) in MSI-H patients and 57.1% (8/14) in MSS patients, with statistically significant difference between the two groups (P=0.001). Postoperative complications occurred in 8 patients (25.0%), and there were no secondary operations or perioperative deaths. Multivariate analysis results showed that preoperative carcinoembryonic antigen (CEA) level ≥5 ng/ml(OR=0.035,95% CI:0.003～0.260, P=0.003), MSI-H and MSS POLE positive（OR=19.000，95% CI：2.573～399.227，P=0.012）were related to pCR. Conclusions: Neoadjuvant immunotherapy is safe and effective for resectable LACRC. Neoadjuvant immunotherapy alone for resectable MSI-H colorectal cancer (CRC) can achieve satisfactory results, and neoadjuvant immunotherapy in combination with various forms of conventional therapy for patients with resectable MSS CRC could also achieve better short-term effects.

Objective: To investigate the impact of different low density lipoprotein-cholesterol (LDL-C) levels on the risk of gastrointestinal cancer. Methods: A prospective cohort study was used to observe 126 050 in service and retired employees of Kailuan Group who participated in the physical examination for the first time in 2006 or 2008. A total of 122 734 people were finally included in the statistical analysis. The subjects were divided into five groups according to the baseline quintile of low-density lipoprotein cholesterol, namely Q1 group, Q2 group, Q3 group, Q4 group and Q5 group. The impact of different LDL-C groups on the incidence of gastrointestinal tumors was analyzed by Cox proportional hazard model. Results: During follow-up of (12.83±2.43) years, 1 460 cases of gastrointestinal tumors occurred, including 225 cases of esophageal cancer, 431 cases of gastric cancer and 804 cases of colorectal cancer. Cox proportional hazard model analysis found that after adjusting for age, sex, body mass index, high-sensitivity C-reactive protein, education, smoking, alcohol consumption, diabetes, hypertension, physical exercise, excessive salt intake, family history of cancer and taking lipid-lowering drugs, compared with Q5 group, the hazard ratio (HR) values of gastrointestinal tumors in Q1, Q2, Q3 and Q4 groups were 1.28 (95% CI: 1.08, 1.50), 1.07 (95% CI: 0.90, 1.26), 1.31 (95% CI: 1.11, 1.54) and 1.12 (95% CI: 0.94, 1.33), respectively. The HR values of esophageal cancer were 1.21 (95% CI: 0.80, 1.82), 0.82 (95% CI: 0.52, 1.30), 1.47 (95% CI: 1.00, 2.17) and 0.84 (95% CI: 0.54, 1.31), respectively. The HR values of gastric cancer were 1.05 (95% CI: 0.78, 1.41), 0.84 (95% CI: 0.61, 1.16), 1.21 (95% CI: 0.91, 1.63) and 1.04 (95% CI: 0.77, 1.41), respectively. The HR values of colorectal cancer were 1.44 (95% CI: 1.15, 1.80), 1.28 (95% CI: 1.02, 1.62), 1.31 (95% CI: 1.04, 1.65) and 1.26 (95% CI: 1.00, 1.59), respectively. Conclusions: The decrease of baseline LDL-C level may be a risk factor for gastrointestinal malignant tumors, but low LDL-C increases the risk of malignant tumors in a location dependent manner. Although low LDL-C level increases the risk of colorectal cancer, it has no significant correlation with esophageal cancer and gastric cancer.