Research on emotion regulation has increasingly emphasized the flexible use of strategies in response to situational demands, highlighting the importance of strategy-situation fit. Despite its theoretical prominence, empirical evidence remains limited. In the present study, we examined whether individuals show context-sensitive preferences for distraction versus reappraisal as a function of negative affect intensity and whether such preferences are associated with greater well-being, reflecting strategy-situation fit. We reanalyzed 12 ambulatory assessment data sets (1,511 participants with 161,513 measurement occasions) collected from predominantly White samples including both student and community samples and used a coordinated data analysis approach and dynamic structural equation modeling. Results indicated a very small but statistically significant tendency for individuals to shift toward distraction relative to reappraisal as negative affect increased (β¯ = .02), consistent with context-sensitive strategy use. However, individual differences in this tendency were not predicted by baseline depressive symptoms nor were these differences associated with aggregated positive affect and negative affect in daily life (|β¯|s ≤ .03), providing no support for strategy-situation fit as operationalized here. These findings suggest that although individuals exhibit modest context-sensitive adjustments in strategy use, such adjustments may not reflect differences in mental health and may not translate into improved well-being in everyday life. We highlight methodological and conceptual challenges in capturing context sensitivity in naturalistic settings, discuss limitations of current operationalizations, and outline directions for future research to better assess emotion regulation flexibility in daily life. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

This study aimed to establish a nationally representative Continuous Metabolic Syndrome (cMetS) sample of Iranian adults, validate its predictive ability for MetS components, determine age- and gender-specific cutoff points, and assess 15-year trends.

This secondary analytical cross-sectional study utilized data from the nationally representative four WHO STEPS surveys (2005-2021) among adults aged 25-60 with complete metabolic measurements. cMetS was calculated by combining residuals of waist circumference, mean arterial pressure, glucose, high-density lipoprotein-cholesterol, and triglycerides. A lower cMetS score suggests a more favorable metabolic profile. Optimal cutoff points for cMetS were determined using receiver operator characteristic curve analysis. To assess the validity of our cutoff, we conducted two distinct phases. In addition, a generalized additive model predicted cMetS values until 2025.

Among 18030 adults, 8419 (46.7%) had MetS in 2021. The overall cMetS cutoff point for predicting the presence of MetS was 0.47 with sensitivity 80.09% (79.39-80.79), specificity 81.94% (81.27-82.61), and AUC 89.20% (88.65-89.75). In 2020, the overall cMetS score for both genders was 0.22 (95% Prediction Interval [PI]: 0.20-0.24), with men having a higher score of 0.34 (95% PI: 0.3-0.37) compared to women at 0.13 (95% PI: 0.11-0.15). Projections indicate that the overall cMetS score is expected to decrease to 0.2 (95% PI: 0.15-0.25) by 2025. The 15-year trend of cMetS scores indicated a declining pattern.

This comprehensive study across the nation affirmed the reliability of the cMetS score within a sample of Iranian adults based on population data and is significant for its provision of a nationally representative viewpoint on the adult population of Iran, introducing a novel approach for assessing trends in cMetS scores.

Oral potentially malignant disorders (OPMDs), including conditions such as Oral lichen planus, Oral leukoplakia, Proliferative verrucous leukoplakia and Oral submucous fibrosis are associated with an increased risk of oral squamous cell carcinoma. Emerging evidence suggests that alterations in the oral microbiome may contribute to the pathogenesis of these disorders and their malignant transformation. This systematic review aimed to synthesize current evidence on oral microbiome composition and diversity in patients with OPMDs.

A comprehensive literature search of PubMed, Scopus, Web of Science, and Google Scholar was conducted to identify eligible human studies published through August 2025. Studies evaluating oral microbiome profiles in patients with clinically and/or histopathologically diagnosed oral potentially malignant disorders (OPMDs) were included. Data on study characteristics, sampling and analytical methods, microbial diversity, and differentially abundant taxa were extracted independently by two reviewers. Risk of bias was assessed using the Newcastle-Ottawa Scale. Owing to substantial clinical and methodological heterogeneity, findings were synthesized qualitatively.

A total of 56 studies were included, comprising 30 studies of Oral lichen planus, 9 of Oral leukoplakia, and 17 examining other OPMDs. 16srRNA sequencing was mostly used and whole unstimulated saliva was the most frequently collected specimen. The most prevalent microbial phyla identified in OPMD patients included Firmicutes, Proteobacteria, and Fusobacteria, but the direction and magnitude of changes varied across OPMD subtypes and sampling methods. Several studies reported an increase in pathogenic species such as Porphyromonas and Prevotella, while commensal bacteria like Streptococcus were less abundant. Findings concerning microbial richness and diversity were inconsistent.

Oral microbial dysbiosis is a common feature of oral potentially malignant disorders; however, a reproducible microbial signature has not yet been established. Substantial heterogeneity in study design, sampling strategies, and analytical approaches limits causal inference and clinical applicability. Future standardized longitudinal studies are needed to clarify the role of the oral microbiome in malignant transformation and its potential utility as a prognostic biomarker.

Prospero registration number: CRD42024516735.

Mucormycosis is an opportunistic fungal infection that commonly occurs in patients with predisposing conditions, such as poorly controlled diabetes mellitus and immunocompromised states. In patients with diabetes, rhinocerebral disease is more commonly described, whereas isolated pulmonary mucormycosis (PM) is less typical and is more often associated with profound immunocompromise. The presentation in this case was further notable for occurring in the setting of a hyperosmolar hyperglycemic state (HHS) rather than diabetic ketoacidosis (DKA), without rhinocerebral involvement. We present the case of a 53-year-old man with type 2 diabetes mellitus treated with insulin who initially presented with cough, fatigue, and generalized malaise and re-presented five days later after a syncopal ground-level fall with right shoulder pain and persistent weakness. He was found to have a HHS and sepsis secondary to pneumonia, with sputum and bronchoalveolar lavage cultures growing Enterobacter cloacae complex. Imaging obtained during the evaluation of the shoulder injury revealed a nondisplaced proximal humeral fracture and an incidental large cavitary pulmonary lesion, prompting computed tomography of the chest, which demonstrated multiple cavitary consolidations and moderate-to-large bilateral pleural effusions. Bronchoscopy with biopsy demonstrated necrotic tissue containing broad, aseptate fungal hyphae morphologically consistent with mucormycosis. Computed tomography of the sinuses showed no evidence of rhinocerebral involvement. The patient was treated with meropenem and liposomal amphotericin B and was transferred to a tertiary-care facility for surgical evaluation and debridement. PM should be considered in patients with poorly controlled diabetes who develop pneumonia or cavitary disease, even in the absence of classic rhinocerebral involvement. This case underscores the need for prompt identification of PM, antifungal therapy, and early surgical intervention to improve outcomes.

Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries, with a rising incidence driven by obesity, metabolic syndrome, diabetes mellitus, and aging populations. Artificial intelligence (AI) has rapidly advanced in gynecologic oncology, particularly in diagnostic imaging, digital pathology, radiomics, and multimodal prognostic modeling. Recent breakthroughs in machine learning, deep learning, and whole-slide imaging (WSI), including multimodal prognostic architectures such as HECTOR and explainable AI (XAI), have enabled the development of sophisticated diagnostic and prognostic systems. These systems can differentiate benign from malignant lesions, predict myometrial invasion and lymph node metastases, stratify recurrence risk, and support individualized therapeutic decision-making. Notably, recent multimodal deep-learning models, particularly the HECTOR framework, have demonstrated improved prognostic performance compared with conventional clinicopathologic risk-stratification systems for predicting distant recurrence in externally validated cohorts, although further prospective validation remains necessary. Despite these promising advances, current evidence remains limited by predominantly retrospective study designs, relatively small and frequently imbalanced datasets, potential overfitting of AI models, heterogeneous imaging protocols, limited external validation, and insufficient prospective clinical evidence. These limitations restrict model generalizability across different populations and healthcare settings. Furthermore, ethical, regulatory, and data-governance challenges remain important barriers to widespread clinical implementation. This structured narrative review summarizes AI applications in endometrial cancer, focusing on ultrasound imaging, radiomics, digital pathology, multimodal deep-learning, explainable AI, prognostic modeling, clinical translation, and future perspectives in personalized care.

The Leukocyte Glucose Index (LGI) reflects systemic inflammation and glycemic burden and has shown promising predictive value in cardiovascular and metabolic diseases. However, its association with prevalent diabetic retinopathy (DR) remains unclear. We investigated the association and dose-response relationship between LGI and prevalent DR in patients with T2DM and its incremental value beyond traditional clinical factors.

1, 727 hospitalized patients with T2DM, including 661 with DR and 1, 066 without DR. Multivariable logistic regression, subgroup, trend, and restricted cubic spline analyses were performed to assess the association between LGI and prevalent DR. Variables selected by LASSO regression and multivariable logistic regression were used to develop a nomogram. Model performance was evaluated by discrimination, calibration, bootstrap internal validation, reclassification metrics, and decision curve analysis (DCA).

Higher LGI was independently associated with prevalent DR (adjusted OR = 1.340, 95% CI: 1.056-1.701, P = 0.016). Similar results were observed per standard deviation increase (adjusted OR = 1.166, 95% CI: 1.029-1.320) and in the highest versus lowest tertile (adjusted OR = 1.378, 95% CI: 1.028-1.848). A positive linear association was identified without evidence of nonlinearity. The nomogram achieved an AUC of 0.727 (95% CI: 0.703-0.752), with an optimism-corrected AUC of 0.719. Although the improvement in AUC after adding LGI was not statistically significant (0.727 vs. 0.725, P = 0.198), NRI and IDI indicated improved discrimination, and DCA showed greater net clinical benefit across a range of threshold probabilities.

Elevated LGI was independently associated with prevalent DR and showed a positive linear dose-response relationship. LGI may provide incremental discriminative value beyond traditional clinical factors and serve as a simple laboratory marker for identifying prevalent DR. Further external validation and prospective studies are warranted.

Therapeutic adherence is a key component of chronic disease management, particularly in high-risk patients. Type 2 diabetes (T2DM) is common in this population; however, real-world evidence on therapeutic adherence and the factors associated with it among high-risk patients with T2DM remains limited in Spain and other regions.

To evaluate therapeutic adherence and identify factors associated with nonadherence among high-risk patients with T2DM using real-world primary care data.

A cross-sectional study was conducted among adults with T2DM classified as high-risk chronic patients using primary healthcare electronic health records from the Madrid Region as of 30 April 2021. Sociodemographic, functional, clinical, lifestyle, pharmacological, and primary healthcare utilization variables were analyzed according to therapeutic adherence status. Multivariable logistic regression was performed to identify factors independently associated with therapeutic nonadherence.

Among 67,746 high-risk patients with T2DM, adherence information was available for 65,856 patients, of whom 45,669 (69.3%) were classified as nonadherent. Nonadherent patients had a higher prevalence of polypharmacy (62.1% vs. 58.7%) and greater healthcare utilization, with a higher mean number of primary care contacts during the first year (25.3 vs. 24.4). In the multivariable analysis, the independent factors associated with higher odds of nonadherence were older age (odds ratio (OR = 1.008), male sex (OR = 1.073), foreign status (OR = 1.157), Individual Health Card category 3 (annual income up to €18,000) (OR = 1.245), ischaemic heart disease (OR = 1.137), heart failure (OR = 1.072), COPD (OR = 1.571), asthma (OR = 1.622), depression (OR = 1.054), palliative care (OR = 1.352), smoking status (OR = 1.102), polypharmacy (OR = 1.345), and ≥20 primary care contacts (OR = 1.066).

Therapeutic nonadherence is highly prevalent among high-risk patients with T2DM managed in routine primary care. Nonadherence was independently associated with treatment burden, specific patterns of clinical complexity, behavioral factors, and healthcare needs, with some associations showing modest effect sizes, highlighting the multifactorial nature of therapeutic adherence in this population. These findings support the integration of routine adherence assessment and individualized medication management strategies into primary care for patients with complex chronic conditions.

The association between the systemic immune-inflammation index (SII) and diabetic peripheral neuropathy (DPN) remains inconsistent across studies. We investigated the association between SII and prevalent DPN across independent populations and explored complementary biological context using human sural nerve gene-expression data.

We analyzed a discovery cohort of 555 adults with diabetes from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and performed an exploratory targeted gene-expression analysis of human sural nerve samples from GSE95849. Findings were further evaluated in an independent hospital-based cohort of 400 patients with type 2 diabetes mellitus (T2DM), including 290 with DPN and 110 without DPN. Multivariable logistic regression, component analyses, sensitivity analyses, and restricted cubic spline models were used to evaluate the association between SII and prevalent DPN.

In NHANES, higher SII was inversely associated with prevalent DPN. Compared with participants in the lowest SII quartile, those in the highest quartile had lower odds of DPN (odds ratio [OR] = 0.239, 95% confidence interval [CI]: 0.102-0.560; P < 0.001). Exploratory targeted analysis of sural nerve tissue showed significantly lower BDNF expression in DPN samples than in samples from patients with diabetes without DPN (BH-adjusted P = 0.0004). JUN expression was also lower in DPN at the nominal level, but the difference did not remain statistically significant after multiple-comparison correction (BH-adjusted P = 0.0686), whereas PDGFRA expression did not differ between groups. In the external cohort, patients with DPN had lower platelet counts than those without DPN (81.6 vs. 135.9 × 10⁹/L; P < 0.001). SII remained inversely associated with prevalent DPN after multivariable adjustment (OR = 0.396 per 100-unit increase, 95% CI: 0.304-0.516; P < 0.001). Restricted cubic spline analysis indicated a significant nonlinear association (P for nonlinearity < 0.001). Among the hematological components examined, platelet count showed the strongest and most consistent association with DPN, whereas the neutrophil-to-lymphocyte ratio (NLR) was no longer significant after mutual adjustment.

Lower SII was consistently associated with prevalent DPN across two independent populations, with a significant nonlinear relationship observed in the external cohort. Platelet count showed the strongest and most consistent association among the hematological components examined. Exploratory nerve-tissue gene-expression findings provide complementary biological context but do not establish a mechanistic or causal link between platelet-related hematological indices and DPN.

FGF21 is associated with atherosclerosis and the anatomical severity of coronary artery disease. No study has explored the relationship between FGF21 and intracranial atherosclerotic stenosis. The purpose of this study is to explore the association between FGF21 and intracranial atherosclerotic stenosis in patients with type 2 diabetes mellitus.

One hundred ten patients with type 2 diabetes were recruited. The levels of plasma FGF21 were measured by enzyme-linked immunosorbent assays. The severity of intracranial atherosclerotic stenosis was evaluated in strict accordance with the internationally recognized modified Warfarin-Aspirin Symptomatic Intracranial Disease criteria. Patients were categorized into three groups based on percent stenosis: no stenosis (0%), mild stenosis (1-49%), and moderate to severe stenosis (≥50%).

Plasma FGF21 level was different among no stenosis group, mild stenosis group and moderate to severe stenosis group (114.35 (105.35-124.04) vs. 124.81 (118.84-134.47) vs. 132.18 (120.43-150.05), H = 17.327, p < 0.001). FGF21 levels in the moderate-to-severe stenosis group were higher than those in the no stenosis + mild stenosis group (132.18 (120.43-150.05) vs. 122.44 (109.88-129.19), U = -3.138, p = 0.002). The highest tertile (T3) of FGF21 level (>129.55 ng/L) and lnFGF21 was associated with moderate to severe intracranial atherosclerotic stenosis in patients with T2DM after adjusting for age andα-glucosidase inhibitor use (OR = 6.453, 95% CI: 1.944-21.415, p = 0.002; OR = 2.191, 95% CI: 1.277-3.759, p = 0.004). Based on the receiver-operating characteristic (ROC) curve, the combination of lnFGF21, age, and α-glucosidase inhibitor use predicted moderate to severe intracranial atherosclerotic stenosis in patients with type 2 diabetes mellitus, with an area under the curve (AUC) of 0.768 (95% CI, 0.670-0.865). Bootstrap resampling with 1,000 replicates was performed for internal validation to assess model stability and calibration (bootstrap B = 1,000; MAE = 0.021, MSE = 0.00064, 90th percentile of absolute error = 0.038).

We observed a significant cross-sectional association between plasma FGF21 levels and intracranial atherosclerotic stenosis among patients with T2DM.

Diabetic ketoacidosis (DKA) may be associated with cardiac involvement. Increased cardiac biomarkers and abnormalities in cardiac function were mainly reported in adults with type 1 diabetes (T1D). Pediatric data are lacking. This study therefore assessed cardiac biomarker alterations and echocardiographic changes, including strain analysis, in children with diabetic ketoacidosis at the onset of type 1 diabetes.

In this prospective, observational, cohort study, patients < 18 years with T1D onset were consecutively enrolled at a single center from January 2024 to March 2025 and classified as DKA or non-DKA. Cardiac biomarkers (troponin I, NT-proBNP) were measured before and 24 h after therapy initiation in all patients, and additionally at 48 and 72 h in those with DKA. Echocardiography, including speckle-tracking strain analysis, was performed after 24 h in both groups and after 6 days in the DKA group.

Eighty-one patients were included (60% male; median age 9.8 years [5.2-14.1]); 43 (53.1%) had DKA. Troponin I and NT-proBNP were significantly higher in the DKA group at baseline (troponin I: 5.7 [4.1-10.8] vs. 3.9 [3.9-4.6] ng/L, p < 0.001; NT-proBNP: 87.0 [41.0-231.0] vs. 40.0 [16.8-69.0] ng/L, p = 0.002) and remained elevated at 24 h. Echocardiography showed lower E/A ratios, higher peak a'-wave velocities, and a significantly reduced left ventricular global longitudinal strain (GLS) in the DKA group (-  19.2 [-  20.4 to - 18.1] vs. - 21.5 [-  23.0 to - 18.9], p = 0.029), with most values within the normal range. In multivariable analysis, lower bicarbonate (indicating greater DKA severity) was independently associated with higher troponin I and NT-proBNP, and younger age with higher NT-proBNP.

In children with T1D, DKA at onset is associated with subclinical cardiac involvement, reflected by elevated cardiac biomarkers, altered diastolic filling parameters, and reduced left ventricular GLS. These findings indicate myocardial stress during the acute phase of DKA; whether they carry prognostic significance requires studies with longer-term follow-up.

The study was registered in the German Clinical Trial Register (DRKS00032719).