We conducted the diet and diabetes remission (DIREM) study to assess whether an integrated lifestyle intervention would lead to achieving remission in type 2 diabetes.

Patients with type 2 diabetes were randomly assigned to calorie-carbohydrate restriction (CCR) group, intermittent fasting with calorie-carbohydrate restriction (IFCCR), or usual care group (control). The total study duration was 6 months, consisting of two phases: a 12-week integrated lifestyle intervention (ILI) phase, followed by a 12-week maintenance and structured monitoring (MSM) phase. The intervention was presented in the form of a structured behavioural model and also emphasised physical activity.

One hundred and twenty participants were randomly assigned to the study. Diabetes remission occurred in 9 (22.5%) of 40 participants in the CCR group (OR (CCR vs. Control) = 11.7, 95% CI: 1.4-98.3; p = 0.024), 12 (30.0%) of 40 participants in the IFCCR group (OR (IFCCR vs. Control) = 18.1, 95% CI: 2.2-151.0; p = 0.007) and 1 (2.5%) of 40 participants in the control group. The odds of remission were higher in the IFCCR group compared to the CCR group, but it was not significant (OR (IFCCR vs. CCR) = 1.5, 95% CI: 0.6-4.3; p = 0.4).

Both calorie-carbohydrate restriction alone and in combination with intermittent fasting significantly improved glycemic control and induced diabetes remission compared with the control group. No significant difference was found between the two interventions. Larger long-term studies are needed to confirm these findings.

This trial was registered in the Iranian Registry of Clinical Trials (IRCT), IRCT20240418061519N1 (https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20240418061519N1).

To compare the clinical efficacy, safety, and prognostic factors of Ilizarov bone Transport combined with antibiotic-impregnated bone cement filling versus the Masquelet technique in treating Cierny-Mader type Ⅲ-Ⅳ tibial osteomyelitis with large bone defects, providing evidence for clinical decision-making.

A retrospective multicenter study included 112 patients from the Second People's Hospital of Anhui Province (January 2018-January 2023), divided into the Ilizarov group (n = 56) and Masquelet group (n = 56). Propensity score matching (PSM) balanced baseline confounders. Primary outcomes included bone healing time (graft consolidation time for the Masquelet technique), infection control rate, and Paley scoring excellent-good rate; secondary outcomes included treatment course, limb function, complication rates, and reoperation rates.

All patients were followed up for 12-36 months. After PSM, the Ilizarov group had longer bone healing time (8.2 ± 1.45 vs. 6.5 ± 1.28 months, P < 0.001) but shorter total treatment course (10.5 ± 2.1 vs. 14.8 ± 2.5 months, P < 0.001). The external fixator index (EFI) for the Ilizarov group was 42.3 ± 8.5 days/cm.No significant differences were observed in infection control rate or Paley excellent-good rate (P > 0.05). The Ilizarov group had lower donor site morbidity (0% vs. 17.9%, P = 0.001) but higher pin tract infection rate (12.5% vs. 3.6%, P = 0.026). Bone defect > 12 cm and diabetes mellitus (HbA1c ≥ 7.0%) were independent risk factors for delayed healing (P < 0.05).Reoperation rates were 23.8% (13/56) in the Ilizarov group and 15.0% (8/56) in the Masquelet group (P = 0.28).

Both techniques are safe and effective. The Masquelet technique achieves faster bone healing, while the Ilizarov technique avoids donor site trauma and shortens total treatment course. Clinical selection should be individualized based on bone defect length, soft tissue conditions, host comorbidities, vascular status, and patient willingness.

Diabetic kidney disease (DKD) is a major microvascular complication of type 1 diabetes mellitus (T1DM) and is associated with insulin resistance (IR). The triglyceride glucose (TyG) index has been identified as an alternative marker of IR. This study aimed to investigate the association between the TyG index and DKD in in adult patients with T1DM.

A retrospective analysis was conducted on 210 adult patients with T1DM who were admitted to a single center between January 2021 and August 2025. The patients were divided into a non-DKD group (n = 150) and a DKD group (n = 60). They were further categorized into three groups according to tertiles of the TyG index. Demographic characteristics and biochemical parameters were collected and analyzed. Correlation analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were performed. The calibration curve and decision curve analysis (DCA) were used to evaluate the accuracy and clinical utility.

Patients with DKD had significantly higher TyG values than those without DKD and were more likely to present with chronic diabetic complications and comorbidities (P < 0.05). After adjusting for confounding factors, the TyG index was positively correlated with the urinary albumin-to-creatinine ratio (UACR, r = 0.202, P < 0.05) and negatively correlated with the estimated glomerular filtration rate (eGFR, r = - 0.190, P < 0.05). Logistic regression analysis showed that in Model 3, compared with the T1 group, the odds ratio (OR) for DKD in the T3 group was 2.248 (95% CI: 1.390-3.635, P = 0.001). ROC curve analysis demonstrated that the area under the curve (AUC) for the TyG index was 0.682 (95% CI: 0.605-0.758, P < 0.001), with a sensitivity of 0.750 and a specificity of 0.681. In comparison, the AUCs for the estimated glucose disposal rate (eGDR) and HbA1c was 0.554 (95% CI: 0.467-0.641, P = 0.235) and 0.586 (95% CI: 0.500-0.672, P = 0.059), respectively. DCA confirmed the clinical practicality of TyG model.

The TyG index demonstrated a positive association with DKD in patients with T1DM and may serve as an adjunctive marker for early risk stratification or as a component of a multi-marker panel, rather than as a standalone diagnostic tool for DKD.

Not applicable.

The coexistence of multiple genetic disorders in a single individual is more frequent in populations with high consanguinity rates. When a single diagnosis does not fully explain the clinical phenotype, the presence of additional genetic conditions should be considered. This approach is essential for accurate genetic counseling and optimal long-term management. Here, we aimed to present two siblings diagnosed with both neonatal diabetes mellitus (NDM) and leukocyte adhesion deficiency type 1 (LAD-1), a combination not previously reported.

We report two sisters born to consanguineous parents, both diagnosed with permanent neonatal diabetes mellitus and LAD-1. Genetic analysis revealed a homozygous c.-331C>G mutation in the INS promoter region and a homozygous c.388T>C mutation in the ITGB2 gene in both patients.The index case presented with hyperglycemia on the 14th postnatal day and was diagnosed with permanent NDM. She also had additional congenital anomalies, including meningomyelocele and developmental hip dislocation. Due to recurrent infections and decreased CD18 expression on leukocytes, she was subsequently diagnosed with LAD-1.The second sibling developed hyperglycemia on the second postnatal day and was diagnosed with permanent NDM. She also showed delayed umbilical cord separation, leukocytosis, and absent CD18 expression, leading to the diagnosis of LAD-1.

The coexistence of two distinct rare genetic disorders in the same individual is uncommon, and its occurrence in siblings is exceptionally rare. To our knowledge, the coexistence of LAD-1 and NDM has not been previously reported. These cases emphasize the importance of considering multiple genetic diagnoses in patients with atypical or complex clinical findings, especially in consanguineous populations. Early recognition is critical for appropriate clinical management and genetic counseling.

Rapid detection of drug-resistant leukemia played a crucial role in formulating appropriate treatment plans for patients and improving their prognosis. In this research, an integrated optofluidic platform was developed to detect and analyze leukemia and drug-resistant leukemia cell. The detection technique was designed by embedding optical fibers coupled with photosensors and a laser source into optofluidic chip. The scattered light signals were detected when the cells pass through the detecting area.

The platform was first validated by classifying 1 μm polystyrene microparticles and 1 μm polystyrene microparticles coated with spherical 10 nm Fe₃O₄ nanoparticles. After validation, the method was applied to classify leukemia and drug-resistant leukemia cells by injecting the testing sample and obtaining. The SVM classifier demonstrated the highest classification accuracy of 91.1% compared with LR, RF, and KNN classifiers for analyzing leukemia cells and drug-resistant leukemia cells. The proposed method can perform detection within 10 min with a total experimental timeframe of 20 min.

The presented results demonstrate the feasibility of applying microfluidics and machine learning approaches to detect and classify biological entities with slight variations based on scattered light signals. This platform holds significant potential for clinical diagnostics, offering a rapid, cost-effective, and efficient method for detecting drug-resistant leukemia cells, potentially aiding in personalized treatment strategies.

Omission of sentinel node biopsy is increasingly offered to selected older women with cN0 low-risk breast cancer (BC). We hypothesized that some younger women might exhibit a low enough incidence of lymph node metastases to possibly justify excluding axillary surgery.

We statistically analyzed, using parametric and nonparametric tests as appropriate, multiple demographic and clinicopathologic variables in cT1-2 N0 M0 BC patients of all ages undergoing axillary LN excisional surgery from a long-term, prospectively maintained database.

Patients with (816) and without (3617) LN metastases were compared. Although older patients were significantly (p < 0.0001) less likely to have LN metastases compared to younger patients, 3/61 (4.92%) of those < 50 years old with grade 1 tumors ≤ 1 cm in size (T1a and b) and no lymphovascular invasion had LN metastases compared to 30/504 (5.95%) ≥ 50. Patients aged 50 or older with Grade 2/3, < 1 cm, LVI-negative tumors had only 53/774 (6.85%) LN positive, compared to 19/131 (14.5%) in women < 50 with the same pathology.

Women with grade 1, ≤ 1 cm invasive BCs, and no LVI had < 6% incidence of LN metastases regardless of age. Instead of excluding younger women from axillary node surgery de-escalation strategies, this study suggests that any woman with a tumor size ≤ 1 cm, Grade 1, and no LVI could be evaluated in prospective studies whose objective is to safely avoid axillary LN surgery.

Survival patterns in squamous cell carcinoma of the penis (SCCP) have been described in several studies. However, the years of life lost (YLL) among patients with SCCP compared to the general population have not been quantified.

Within the SEER database (2004-2021), SCCP patients aged 40-75 years were included. SCCP patients were stratified according to stage at diagnosis in localized (T1-2, N0, M0), regional (T3-4, anyN, M0; anyT, N +, M0), and metastatic (anyT, anyN, M1). For each patient, an age- and sex-mathced control was generated from Social Security Administration life tables using Monte Carlo simulation. Subsequently, the average YLL until the age of 75 years between SEER patient cases and simulated controls were quantified using the Kaplan-Meier methodology.

Overall, 1666 (64.9%) localized, 505 (28.1%) regional and 123 (7.0%) metastatic SCCP patients were included. Relative to population controls, SCCP patients of all-stages exhibited 4.4 YLL (p < 0.001). In subsequent stage stratified analyses YLL values were 3.0 vs. 6.0 vs. 10.7 YLL (p < 0.001) for respectively localized, regional and metastatic SCCP subgroups.

In general SCCP patients are at 4.4 YLL relative to population controls, the latter may reach 10.7 YLL when metastatic stage at presentation is diagnosed.

The C-reactive protein-albumin-lymphocyte index (CALLY), a composite inflammatory and nutritional biomarker, has shown prognostic utility in various cancers, but its role in metastatic hormone-sensitive prostate cancer (mHSPC) remains underexplored.

To evaluate the association between baseline CALLY index and overall survival (OS) and time to castration-resistant prostate cancer (CRPC) in mHSPC patients.

In this retrospective cohort study, 192 mHSPC patients receiving first-line endocrine therapy (2017-2024) were stratified by median CALLY (30) into low-CALLY (30) and high-CALLY (≥ 30) groups. Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. Weighted Cox models assessed associations with OS and CRPC-free survival. Subgroup analyses were conducted by age group, metastatic volume and first-line mHSPC therapy.

After IPTW adjustment, a high baseline CALLY index was identified as an independent protective factor for both clinical endpoints. Specifically, patients in the high-CALLY group had a 71% reduced risk of all-cause mortality (adjusted hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.18-0.46, p < 0.001) and a 49% reduced risk of CRPC progression (adjusted HR 0.51, 95% CI 0.34-0.77, p = 0.001), compared with the low-CALLY group. The prognostic association remained consistent across all prespecified subgroups, with pronounced benefits observed in patients with high-volume metastatic disease and those receiving first-line bicalutamide. Sensitivity analyses (treating CALLY as a continuous variable, conventional multivariable Cox regression) and E-value assessment further confirmed the robustness and independence of the findings.

The CALLY index is an accessible and independent prognostic biomarker for OS and CRPC progression in mHSPC. Its integration into clinical assessment could enhance risk stratification and support personalized treatment planning, potentially improving long-term patient outcomes.

Survival rates for children with brain tumors improve, highlighting the importance of understanding the long-term neurobehavioral outcomes because of its impact on children's well-being and quality of life. This study investigated the prevalence of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and emotional/behavioral difficulties in pediatric brain tumor survivors (PBTS), and identified the risks and protective factors on mental well-being.

A territory-wide retrospective cohort included 274 PBTS registered in the Hong Kong Paediatric Haematology and Oncology Study Group Registry. In addition, a cross-sectional follow-up survey on mental well-being was completed by 107 PBTS during survivorship follow-up. Emotional/behavioral difficulties, health-related quality of life, parental stress, and sleep variables were assessed by the survey and benchmarked against previously published Hong Kong-based reference/community cohorts.

Among 274 PBTS, 10.6% had ADHD and 6.9% had ASD, which are significantly higher than the general pediatric population prevalence. They had more emotional/behavioral symptoms, higher parental stress, and poorer quality of life. Younger age at diagnosis, seizure history, and supratentorial tumors were linked to more difficulties. Radiotherapy was associated with reduced quality of life. Better sleep correlated with fewer ADHD and emotional symptoms.

PBTS had increased risk of ADHD and ASD, and are more vulnerable to peer-relationship difficulties, poorer mental health, and quality of life. Improving sleep could be key to reducing neurobehavioral challenges. Implementing routine neurobehavioral monitoring, including sleep assessments, is crucial for enhancing survivorship care and overall well-being.