Inflammation plays a key role in complications and organ damage in type 2 diabetes mellitus (T2DM). The Aggregate Index of Systemic Inflammation (AISI) and Systemic Inflammation Response Index (SIRI) have emerged as potential markers for inflammation and prognosis. This study aimed to assess the association between AISI, SIRI levels, and mortality in T2DM patients. This study combined a population-level time-trend analysis using Global Burden of Disease data from 1990 to 2021 with a retrospective cohort study using National Health and Nutrition Examination Survey data from 1999 to 2018 linked to the National Death Index mortality files. The Global Burden of Disease data revealed an upward trend in T2DM incidence, with a slight decline in mortality rates from 2003 onward. In the National Health and Nutrition Examination Survey cohort, higher AISI and SIRI levels correlated with increased risks of cardiovascular disease (CVD) and all-cause mortality. After adjusting for confounders, the highest quartile of both indices (Q4) showed significantly higher mortality risks: for AISI quartile 4 (Q4) vs Q1, hazard ratio (HR) = 1.46 for CVD and HR = 1.71 for all-cause mortality; for SIRI Q4 vs Q1, HR = 1.98 for CVD and HR = 2.13 for all-cause mortality. These findings suggest AISI and SIRI may serve as simple markers for risk stratification in T2DM.

This study aimed to investigate the frequency of primary sarcopenia in individuals with and without restless legs syndrome (RLS). In this cross-sectional study, 114 patients who presented to our outpatient clinic for the first time and were diagnosed with RLS and 147 patients without RLS were consecutively included. Patients with malignancy, uncontrolled diabetes mellitus, or diseases that may cause secondary sarcopenia or neuropathy were excluded from the study. The European Working Group on Sarcopenia in Older People 2 criteria for the diagnosis of sarcopenia and the International RLS Study Group criteria for the diagnosis of RLS were applied. The association between RLS and sarcopenia was analyzed using a logistic regression analysis. There were no significant differences in terms of chronic diseases. While there was no significant difference between the groups with and without RLS (70.11 ± 9.56 vs 71.76 ± 9.61) in terms of age (P = .170), females were significantly higher in the RLS group (P = .001). The rate of sarcopenia was significantly higher in patients with RLS (54% vs 37%, P = .005). In the multivariate logistic regression analysis of sarcopenia and sex (female), it was determined that both were associated with RLS [odds ratio 1.941 (95%) confidence interval 1.107-3.402, P = .021; odds ratio 2.733, (95%) confidence interval 1.442-5.177, P = .002], respectively). Primary sarcopenia is more common in patients with RLS than in those without RLS. Screening for sarcopenia should be considered in patients with restless leg syndrome.

Individuals with diabetes have an increased risk of cardiovascular disease, infection, hospitalization, and premature mortality. However, less is known about how diabetes shapes the broader pattern of emergency department (ED) presentations, acute care use, clinical complexity, and short-term mortality in an unselected ED population. We aimed to describe ED presentation patterns and outcomes among individuals with and without diabetes in a large regional cohort.

We conducted a population-based cohort study including all adult ED visits to nine hospitals in Region Skåne, Sweden, between 2017 and 2018. ED visits for patients with a registered diabetes diagnosis (n = 60,654) were compared with those without diabetes (n = 502,800). We analysed ED visit frequency, recurrent ED use, arrival by ambulance, triage priority, length of stay, comorbidity burden, presenting complaints, and mortality after ED presentation.

The most common presenting complaints were broadly similar in both groups, with dyspnoea, chest pain, and abdominal pain among the leading causes of ED presentation. However, diabetes visits were characterized by greater acute care complexity. Compared with visits by individuals without diabetes, visits by individuals with diabetes more often involved a previous ED visit within 90 days, higher triage priority, ambulance arrival, longer ED stay, and substantially higher comorbidity burden. Early mortality after ED presentation was also higher among individuals with diabetes and occurred at younger ages, particularly among men. Mortality diagnoses differed between groups, with cardiovascular causes more prominent among individuals with diabetes.

In this large population-based ED cohort, individuals with diabetes presented with broadly similar symptom categories as those without diabetes, but with markedly greater clinical complexity, higher acuity, recurrent acute care use, and earlier mortality. Diabetes in emergency care may therefore identify a patient group with substantial multimorbidity, reduced physiological reserve, and increased vulnerability during acute illness.

Epidermal cysts are one of the most prevalent skin lesions encountered in clinical practice. Although generally harmless, complications may arise when epidermal cysts are neglected, leading to potentially severe consequences, such as necrotizing fasciitis. Here, we report an unusual case of an extensive soft-tissue defect and necrotizing fasciitis resulting from an untreated epidermal cyst on the upper back.

A 37-year-old male patient presented with a 12 × 10 cm epidermal cyst on his back with severe inflammation. The patient was also diagnosed with diabetes mellitus, which raised the need for comprehensive medical and surgical evaluations for treatment.

Magnetic resonance imaging revealed a broad soft-tissue defect with necrotizing fasciitis involving the back muscles.

Extensive debridement was performed, and various approaches were used to address the challenging wound size. After debridement, a soft-tissue defect measuring 35 × 30 cm was identified, and negative-pressure wound therapy followed by split-thickness skin grafting was used to cover the wound.

At the 6-week post-surgery follow-up at the outpatient clinic, the patient exhibited a completely healed wound, and the patient's uncontrolled diabetes mellitus was managed.

This case underscores the importance of not overlooking epidermal cysts and considering surgical intervention when they result in substantial skin and soft-tissue defects.

Cardiac autonomic neuropathy (CAN) is a serious but often underdiagnosed complication among type 2 diabetes mellitus (T2DM) patients that increases the risk of morbidity and mortality. Evidence on the burden of CAN and its associated factors in Zanzibar is very limited. Therefore, this study aimed to determine the prevalence and predictors of CAN in patients with T2DM attending a tertiary diabetes clinic in Zanzibar.

This was a hospital-based cross-sectional study among patients with T2DM attending Mnazi Mmoja Hospital, Zanzibar. All participants were selected by systematic random sampling. CAN was measured using the CAN 504 analyzer with Ewing's cardiovascular reflex tests. Sociodemographic, clinical, anthropometric, and biochemical data were collected using standardized procedures. A modified Poisson regression model with robust variance was used to identify factors associated with CAN.

A total of 364 patients were analyzed, with a mean (SD) age of 56 (10.9) years, and the majority were female (n = 243, 66.8%). The prevalence of CAN was found in 291 (79.9%) patients. Of those with CAN, 220 (60.4%) had early CAN, 65 (17.9%) had definite CAN, and only 6 (1.6%) had severe CAN. Patients with normal body mass index (BMI) had lower risk of CAN (aPR 0.86, 95% CI 0.76-0.99, p = 0.036), while patients with sedentary lifestyle (aPR 1.00, 95% CI 1.00-1.00, p = 0.002) and elevated HbA1c levels (aPR 1.01, 95% CI 1.00-1.03, p = 0.013) had higher risk.

This study revealed a high prevalence of CAN among adults with T2DM attending a tertiary diabetes clinic in Zanzibar. Normal BMI was associated with lower CAN prevalence, whereas greater sedentary behavior and higher HbA1c were associated with higher prevalence. These findings support earlier screening and targeted risk factor modification in high-risk patients.

Diabetic glaucoma, a severe microvascular and neurodegenerative complication of diabetes, involves complex pathological mechanisms including chronic hyperglycemia‑induced oxidative stress, inflammatory responses, microcirculatory disturbances, and retinal ganglion cell (RGC) apoptosis. While conventional Western medicine has achieved significant success in intraocular pressure (IOP) control, it faces challenges in providing long‑term neuroprotection and delaying disease progression. Traditional Chinese Medicine (TCM), guided by its holistic concept and treatment based on syndrome differentiation, demonstrates unique advantages through multi-component, multi‑target, and multi‑pathway synergistic regulation. This review systematically elucidates the TCM pathogenesis evolution pattern of "deficiency leading to stasis, ocular collateral damage" in diabetic glaucoma and establishes correlation networks between TCM syndrome types and modern pathological mechanisms. Integrating epidemiological evidence, we analyze the core mechanisms of representative Chinese herbs and formulas-including Ginkgo biloba extract, indirubin‑related components, and the Si‑Hua formula-in exerting antioxidant, anti‑inflammatory, microcirculation‑improving, and direct neuroprotective effects through regulation of key signaling pathways such as PI3K/AKT, Nrf2, and NF‑κB. Importantly, this article employs network pharmacology methods to visually present the synergistic "component‑target‑pathway" interaction network of the Si‑Hua formula, and introduces a quantitative comparison of the regulatory intensity of key herbal components on signaling pathways. We also discuss the chemical structures of major secondary metabolites from these herbs and the principles of reverse pharmacology that connect TCM to modern drug discovery. By quantitatively evaluating the regulatory intensity of key herbal components on signaling pathways and exploring the interventional potential of TCM in emerging mechanisms like ferroptosis (Figure 9), this review aims to establish a comprehensive scientific framework for TCM prevention and treatment of diabetic glaucoma, providing solid academic support for the modernization and internationalization of TCM.

Youth with cancer may face acute and long-term academic and social challenges. Most existing research has relied on cross-sectional or single-informant methods to describe these challenges. This longitudinal, convergent mixed-methods study aimed to characterize academic and social challenges faced by youth with cancer, from the perspective of youth, caregivers, and educators-from onset of diagnosis into survivorship.

Seventy-five triads of youth (M_age = 9.07 years, SD_age = 3.15 years, range 5-14 years), caregivers, and educators completed a Perceptions Questionnaire across three timepoints: at diagnosis (T1), mid-treatment (T2), and one-year post-treatment (T3). Higher ratings indicated greater perceived impact on school attendance, medical issues, teacher knowledge, social issues, and academic performance. A subset of fifteen triads also participated in semi-structured Waking Day interviews at parallel timepoints. A convergent analysis involving mixed modeling using questionnaire data and trajectory analysis by three qualitative coders characterized patterns of change and compared diagnostic groups.

Significant disruptions were observed at T1, which mostly improved over time (p < 0.001). Academic and social concerns persisted for those with brain tumors or who were female. Caregivers and educators consistently expressed concern about long-term academic impact, while youth showed decreasing concern compared to caregivers and educators (b = 0.61, SE = 0.26, p = 0.02 and b = 0.76, SE = 0.31, p = 0.02). Qualitative responses generally suggested more difficulties than questionnaire data and provided additional context.

Results affirm the importance of ongoing needs assessment for youth with cancer through multiple methods. Findings also may inform tailored psychosocial and educational interventions to enhance the quality of life for youth affected by cancer and their families.

Clinical guidelines recommend risk-management care for women with ≥ 20% lifetime risk of breast cancer (BC). Yet, guideline-concordant care-including conversations about BC risk with specialists-is low, and driving factors are not well understood. This study examined (a) associations between the material, psychosocial, and behavioral domains of financial constraint and BC risk conversations with genetics specialists and cancer/breast care specialists, and (b) whether competing resource demands are associated with the specialist BC conversations when controlling for insurance status (to disentangle the role of behavioral factors from material and psychological ones).

Non-Hispanic Black or white women aged 18-74 years, with no history of cancer and ≥ 20% lifetime BC risk were recruited from online research volunteer databases, social media, and clinics. Participants completed an online survey about personal/family history, decision-making factors, and risk-management behavior. We used descriptive statistics to calculate proportions and both adjusted and unadjusted logistic regression to estimate odds ratios and 95% confidence intervals.

A total of 662 Black (34%) and white (66%) high-risk women comprised the analytic sample for this paper. Overall rates of specialist BC risk conversations were low: 43% had discussed their BC risk with any specialist (genetics specialist, breast specialist, and/or cancer specialist). In multivariate logistic regressions adjusted for race and age, perceived financial hardship was associated with lower odds of BC risk conversations with genetics (OR = 0.42 [95% CI: 0.25, 0.70]) and breast/cancer specialists (OR = 0.39 [95% CI: 0.24, 0.65]). Similar associations were observed for the relationships between disrupted insurance or single motherhood and specialist risk conversations.

Limited financial and other resources are associated with lower rates of BC risk conversations with specialists, which are critical to risk management in high-risk women. Future work should further investigate the complexities of resource limitations in BC risk management and develop mitigation strategies.

Disparities in breast cancer care access and outcomes are persistent and globally recognized issues driven by a complex interplay of socioeconomic, geographical, and systemic factors. Given the complex psychosocial effects on this patient group, it is crucial to incorporate Patient and Public Involvement and Engagement (PPIE) into care models. PPIE is a collaborative approach that involves patients, caregivers, and community members. It engages diverse populations and addresses the needs of underrepresented and disadvantaged groups, thereby promoting health equity. However, the multifaceted connection between health equity and PPIE programs must be strengthened. This narrative review critically explores research and organizational models that describe how PPIE informs health equity in breast cancer care. Our focus is on adaptability: as patient needs, treatments, and technologies evolve, so must the strategies employed to ensure equitable care. We discuss how PPIE is crucial for tailoring efforts to provide equity in two areas of intervention: community-driven and data and targeted-driven approaches. Integrating PPIE into flexible organizational models and research projects has emerged as a critical driver for achieving health equity in breast cancer care in both areas. Community-led initiatives ensure that interventions are culturally relevant and address fundamental social determinants of health. Conversely, data-driven approaches provide the evidence needed to target resources effectively and measure progress. Advancing PPIE reporting in rigorous study designs is the first step to ensuring effective and reproducible implementation. Furthermore, the models' adaptive features may reduce health inequities, increasing their reach, and strengthening community collaborations.

Colorectal cancer (CRC) screening programmes often use the faecal immunochemical test (FIT) to identify individuals for follow-up colonoscopy but evidence on its impact on CRC incidence remains limited. Using a regression discontinuity design (RDD), we investigated whether CRC screening affects CRC incidence among adults aged 71-75 years with FIT values close to the threshold-an age group not consistently included in screening programmes.

Using registry data from 2014 to 2024, we compared CRC incidence among screening participants aged 71-75 years with FIT values just above versus just below the 100-ng/ml referral threshold, where only those above were offered colonoscopy. We included 2773 individuals with borderline FIT values (80-120 ng/ml). An RDD was used to estimate the effect of colonoscopy referral based on FIT on CRC incidence at values close to the threshold while mitigating healthy-user bias.

Over a median 8.4-year follow-up, 165 CRC cases were observed. As expected from the lead time, early incidence was higher in FIT-positive individuals offered colonoscopy but cumulative incidence later plateaued in this group while it continued to rise in FIT-negative individuals. After 10 years of follow-up, a reduction was seen between the groups from 12.1 to 6.6 cases per 1000 person-years, equivalent to 5.5 fewer cases (95% confidence interval: 1.44-9.56) per 1000 person-years, corresponding to a 45.5% reduction.

CRC screening reduces CRC incidence among adults aged 71-75 years with FIT values close to the FIT threshold. This could guide cancer screening policies for an age group that is only eligible for screening in some countries.