Diabetic gastroparesis is characterized by delayed gastric emptying due to diabetes mellitus, affecting up to 50% of patients with type 1 and type 2 diabetes who have poor glycemic control, significantly impairing their quality of life. IGF-1 presents significant potential as a therapeutic target for DGP due to its neuroprotective effects and its role in inhibiting smooth muscle cell apoptosis. By promoting the survival and regeneration of interstitial cells of Cajal and reducing inflammation, IGF-1 could enhance gastrointestinal regulation, thereby improving gastric motility and alleviating DGP symptoms. Although IGF-1 has not yet been utilized as a targeted therapy for DGP, its ability to modulate key signaling pathways, such as SCF/C-Kit, PI3K/AKT, and ERK/MAPK, suggests promising therapeutic avenues. Future research should focus on investigating these mechanisms to determine IGF-1's precise role in DGP pathophysiology and explore its clinical applications.

Gestational diabetes mellitus (GDM) is a common metabolic disorder that creates considerable risks regarding both maternal and fetal health. Conventional screening approaches for GDM which are typically performed in the late second trimester; frequently miss an important window for early intervention.

This meta-analysis seeks to evaluate the diagnostic accuracy of first-trimester maternal serum biomarkers, particularly pregnancy-associated plasma protein-A (PAPP-A) and beta-human chorionic gonadotropin (β-hCG), in the prediction of GDM. This systematic review of observational studies was conducted to assess PAPP-A and/or β-hCG levels during the first trimester, examining their correlation with the subsequent diagnosis of GDM. This meta-analysis collected data from numerous studies to evaluate sensitivity, specificity, likelihood ratios and diagnostic odds ratios; alongside with developing summary receiver operating characteristic (sROC) curves.

This diagnostic meta-analysis assessed 23 studies encompassing first-trimester PAPP-A and β-hCG measurements with regards to early prediction of GDM. The overall pooled sensitivity and specificity were found to be 63% (95% CI: 53-73%) and 70% (95% CI: 61-78%), alongside an AUC of 0.72 (95% CI: 0.68-0.76). Substantial heterogeneity was observed regarding both sensitivity and specificity (I² >95%). Unaccompanied PAPP-A showed a sensitivity of 67% (95% CI: 55-77%) and specificity of 66% (95% CI: 54-76%) with AUC of 0.71, while β-hCG alone exhibited low sensitivity of 29% (95% CI: 7-69%) despite a high specificity of 87% (95% CI: 64-96%) with its AUC found to be 0.71. Fagan's analysis revealed modest clinical impact; which was found to be raising post-test probability from 20% to ~ 39% after a positive result. Deek's tests suggested no major publication bias (p = 0.45 for overall, 0.41 for PAPP-A, 0.08 for β-hCG). Subgroup analyses revealed higher sensitivity levels in studies utilizing ADA criteria and in studies with smaller samples, while those with cohort designs generated more conservative estimates upon comparison with their case-control counterparts.

First-trimester PAPP-A and β-hCG are found to express modest diagnostic accuracy and therefore are best considered as adjuncts to early risk stratification regarding GDM. PAPP-A, as stand-alone, provides balanced though moderate levels of sensitivity and specificity, whereas β-hCG shows high specificity levels but very low sensitivity level; thus, limiting its independent predictive value. Neither biomarker is found to be sufficient as a stand-alone diagnostic tool, but both may contribute to comprehensive risk models which might inform timely intervention. Future research should emphasize standardized methodologies and validation in large, diverse populations in order to improve clinical applicability.

Background: Postoperative cognitive dysfunction (POCD) is a prevalent complication in elderly patients undergoing hip fracture surgery, often resulting in increased morbidity and prolonged rehabilitation. Biomarkers such as Neuron-Specific Enolase (NSE) and S100B protein have shown potential in detecting cerebral injury, yet their role in predicting long-term cognitive decline remains unclear. This study aimed to evaluate the association between biomarkers serum levels and the incidence of POCD in elderly patients undergoing proximal femur fracture surgery. Methods: A multicentric prospective observational study was conducted from January 2023 to February 2024, including 146 elderly patients with hip fractures treated surgically at ASL Bari and the University Orthopedic Department of Foggia. Biomarker levels of NSE and S100B were measured preoperatively (T0), at three days post-surgery (T1), and at one-year follow-up (T2). Cognitive function was assessed using the Pfeiffer Scale (PS) and the Mini-Mental State Examination (MMSE). Statistical analysis was performed using U Mann-Whitney tests and logistic regression to identify risk factors. Results: At three days post-surgery, 20.5% of patients exhibited POCD, with no significant differences in NSE and S100B levels compared to baseline. However, at one year, of the 96 patients investigated 37.9% of patients showed cognitive decline, with significantly elevated NSE (19.88 ± 4.03 μg/L) and S100B (1.86 ± 0.9 μg/L) compared to non-POCD patients (p = 0.01). Risk factors for long-term POCD included older age (OR: 1.24), diabetes mellitus (OR: 4.41), and lower baseline cognitive function (MMSE and PS scores, OR: 0.25 and 9.81, respectively). Conclusions: The study demonstrates that while early POCD is not associated with significant changes in NSE and S100B levels, their elevation at one-year follow-up suggests a possible correlation with chronic neuroinflammation and persistent neuronal damage. Preoperative cognitive impairment, advanced age, and diabetes mellitus are significant predictors of long-term cognitive decline. Incorporating biomarker evaluation and cognitive screening into perioperative management may enhance patient outcomes following hip fracture surgery.

Dendrobium officinale is a traditional Chinese medicinal herb that has been extensively documented in classical medical texts for its effectiveness in treating diabetes mellitus. Modern pharmacological studies have shown that it possesses antitumor, antioxidant, immunomodulatory, and blood glucose- and lipid-lowering effects. Dendrobium officinale polysaccharides (DOPs), the main bioactive constituent of this herbal medicine, interact with the gut microbiota to reshape microbial composition, restore intestinal barrier integrity, modulate mucosal immunity, and ultimately ameliorate metabolic disorders. This review highlights the structural characteristics and bioactivities of DOPs, as well as the mechanisms by which gut microbiota are involved in the pathogenesis of diabetes mellitus. In particular, we point out that DOPs have significantly improved metabolic indicators related to diabetes by regulating intestinal microbiota. It aims to clarify the benefits of DOPs in ameliorating diabetes mellitus through gut microbiota modulation and provide new perspectives for its potential development as a prebiotic and for future clinical applications.

To investigate the effects of half-day outpatient management of gestational diabetes mellitus (GDM) on blood glucose, fetal weight, maternal, and infant outcomes during the COVID-19 epidemic.

From January 1, 2020, to December 31, 2022, 4674 pregnant women were diagnosed with GDM in the Woman and Child Care Center of Qinhuangdao City. Patients with GDM were divided into the case group and the control group according to their own wishes. To retrospectively analyze the differences in the maternal and infant outcomes between the two groups, the glucose tolerance, blood glucose levels before meals, 2 hours after meals, and at bedtime before delivery, hemoglobin A1C before delivery, mode of delivery, birth weight, and maternal and infant complications, perinatal complications of the two groups were observed.

There were significant differences in fasting blood glucose, blood glucose levels at 1 hour and 2 hours after sugar intake between the two groups at the time of admission. Before meals, 2 hours after meals, and at bedtime before delivery, blood glucose levels, and hemoglobin A1C were lower than those of the control group, and the difference was significant. There was no significant difference between the two groups in the complications of low-weight infants, neonatal asphyxia, stillbirth, polyamniotic fluid, premature rupture of membranes, hypertensive diseases during pregnancy, and postpartum hemorrhage. Significant differences were observed in complications such as macrosomia, neonatal hypoglycemia, and neonatal hyperbilirubinemia.

The half-day outpatient management of GDM can effectively control the blood glucose level of pregnant women with GDM and improve clinical outcomes.

Melanosis coli (MC) combined with pneumatosis intestinalis (PI) is an exceedingly rare condition. We present the case of an 85-year-old male with a history of chronic constipation, hypertensive heart disease, and type 2 diabetes mellitus. The patient was admitted to the hospital because of an acute sigmoid volvulus with complete intestinal obstruction. After 3 days of conservative treatment, surgical intervention was performed, consisting of sigmoidectomy with volvulus reduction and formation of a descending colostomy. Histopathological examination confirmed MC with PI and associated mucosal necrosis. The patient, unfortunately, developed severe complications and eventually died of hemorrhagic shock and circulatory failure 22 days after surgery. This case explores the potential mechanisms underlying MC complicated by PI, emphasizing the need for increased clinical vigilance in elderly diabetic patients with chronic constipation and pre-existing cardiovascular disease, particularly following the use of anthraquinone-based laxatives and alpha-glucosidase inhibitors (αGIs).

Osimertinib is the standard third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) of choice for EGFR mutation-positive non-small cell lung cancer. Its major adverse effects include diarrhea and skin symptoms, although syndrome of inappropriate secretion of antidiuretic hormone (SIADH) has been reported as a rare event. In previous reports, patients were switched to another drug after the onset of SIADH. We report the first case of osimertinib-induced SIADH in a patient with lung adenocarcinoma with an EGFR T790M mutation, with, therefore, no effective therapeutic alternative, where the patient was able to resume treatment at a reduced dose without recurrence of SIADH.

An 80-year-old man with a history of hypertension, diabetes mellitus, and partial right nephrectomy for right renal cell carcinoma, but with preserved renal function, underwent thoracoscopic left upper lobectomy in 2013 for lung adenocarcinoma with the EGFR mutation of exon 19 deletion. He was administered gefitinib for multiple postoperative recurrent lung metastases in 2017. However, since a right lower lobe nodule continued to grow and a biopsy confirmed the presence of the resistant mutation of Exon 20 T790M, we administered 80 mg/day osimertinib in 2022, with subsequent shrinkage of the metastases. Seven months later, the patient developed hyponatremia. Evaluation confirmed SIADH diagnosis, and without lung cancer progression, osimertinib-induced SIADH was suspected. Hence, we discontinued osimertinib and initiated saline infusion, oral sodium chloride, and water restriction, which led to normalization of serum sodium levels by day 14. One month later, osimertinib 80 mg/day was resumed; however, two months later, hyponatremia recurred, necessitating discontinuation of osimertinib and initiation of water restriction and oral sodium chloride therapy. Five days later, serum sodium normalized. Based on his clinical course, the cause of SIADH was attributed to osimertinib. Osimertinib was then restarted at 40 mg/day, without recurrence of SIADH. At 18 months after dose reduction, there has been no growth of the pulmonary metastases.

This case suggests that osimertinib treatment can be continued with dose reduction in lung adenocarcinoma patients who develop SIADH, especially when alternative treatment options are limited.

Type 2 diabetes mellitus (T2DM) is a globally prevalent metabolic disease, and emerging studies have revealed its strong association with calcific aortic valve disease (CAVD). Chronic inflammation, oxidative stress, and immune dysregulation induced by hyperglycemia in T2DM may accelerate CAVD progression, although the molecular mechanisms remain unclear.

We integrated and analyzed four CAVD and two T2DM gene expression datasets from the GEO database. Through differential gene expression analysis, weighted gene co-expression network analysis (WGCNA), and secretory protein screening, we identified shared pathogenic genes between T2DM and CAVD. Protein-protein interaction (PPI) networks, functional enrichment analysis, and Connectivity Map (cMAP) prediction were conducted to identify potential therapeutic targets. A diagnostic model was constructed using 113 machine learning algorithms, and immune infiltration analysis was performed using CIBERSORT. The expression of key genes was validated in clinical valve tissue samples via RT-qPCR, Western blotting, and immunohistochemistry.

A total of 13 intersecting genes were identified as potential secretory biomarkers. The diagnostic model built with four key genes (CDH19, COL1A2, PRG4, and SPP1) showed excellent predictive performance (average AUC = 0.95). Immune infiltration analysis revealed significant differences in macrophage and T cell subtypes between CAVD and controls. CDH19 was downregulated, while COL1A2, PRG4, and SPP1 were significantly upregulated in T2DM-associated CAVD tissues. Among the candidate compounds, phorbol-12-myristate-13-acetate (PMA) emerged as a top therapeutic molecule potentially capable of reversing pathological gene expression.

Our study identifies key secretory proteins and immune signatures in T2DM-associated CAVD and proposes a novel diagnostic model with strong clinical applicability. These findings offer new insights for early diagnosis and personalized treatment strategies in CAVD patients with T2DM.

Type 2 diabetes mellitus (T2DM) is a highly prevalent metabolic disorder with increasing global incidence, linked to gut microbiota dysbiosis. This study investigated the effects of semaglutide, a long-acting GLP-1 receptor agonist, on gut microbiota composition and metabolic profiles in 15 Chinese patients with T2DM poorly controlled by metformin.

Participants received semaglutide for 12 weeks, with fecal and blood samples collected before and after treatment. 16S rRNA gene sequencing revealed significant changes in gut microbiota diversity and composition after semaglutide treatment.

Alpha diversity indices increased, though not significantly, while beta diversity analysis showed structural shifts. At the phylum level, Firmicutes decreased, while Bacteroidota, Actinobacteriota and Proteobacteria increased. At the genus level, beneficial bacteria like Bifidobacterium increased, while potentially harmful genera like Klebsiella decreased. Metabolomic analysis identified 362 differentially expressed metabolites, with key pathways affected including Fc epsilon RI signaling, vascular smooth muscle contraction, and linoleic acid metabolism. Clinically, semaglutide improved glycemic control, reduced body weight, BMI and lipid. Significant correlations were observed between gut microbiota species, metabolites, and clinical indices such as BMI, HbA1c and lipid profiles.

Taken together, this study suggested that semaglutide's therapeutic benefits may be mediated through modulation of the gut microbiota and associated metabolic pathways, highlighting the potential for targeting the gut microbiome in diabetes management.

Postoperative delirium (POD) is a serious complication in geriatric patients admitted to the ICU following abdominal surgery. Malnutrition is a significant modifiable risk factor for POD, yet the comparative predictive value of established nutritional indices-Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT)-remains unclear in this high-risk population. This study aimed to directly compare these indices to identify the optimal preoperative predictor for POD.

This single-center retrospective study analyzed 333 patients (≥65 years) admitted post-abdominal surgery to the ICU (from October 2021 to December 2024). POD was diagnosed using CAM-ICU. A clinical prediction nomogram was developed based on significant predictors from the multivariate model. The discriminative ability of preoperative GNRI, PNI, and CONUT scores was compared using receiver operating characteristic (ROC) curves, DeLong's test for the area under the ROC curve (AUC) differences, along with net reclassification improvement (NRI) and integrated discrimination improvement (IDI) to assess model performance enhancements. Optimal cut-off values were determined by maximizing the Youden index, and corresponding sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa statistics were reported. The study was approved by the Institutional Ethics Committee of Jinling Hospital (Approval No. 2024NZKY-038-02).

Factors identified from multivariable analysis (diabetes mellitus, hypoalbuminemia, reduced total cholesterol) were incorporated into a clinical prediction nomogram, which demonstrated good discrimination (AUC = 0.769, 95%CI: 0.707-0.832, p<0.001) and calibration (Hosmer-Lemeshow test p = 0.444; Brier score = 0.137). Decision curve analysis confirmed its clinical utility. Among the nutritional indices, the CONUT score demonstrated superior predictive performance (AUC = 0.751, 95% CI: 0.686-0.816, p<0.001), significantly outperforming PNI (AUC = 0.673, p<0.001) and GNRI (AUC = 0.666, p<0.001). At an optimal cutoff of 7.5, CONUT achieved 60.9% sensitivity and 81.1% specificity. However, adding CONUT to the clinical nomogram did not significantly improve the predictive performance compared to the clinical model alone (p > 0.05).

We developed a practical nomogram and identified the CONUT score as a valuable preoperative predictor for POD-both demonstrating comparable predictive utility. The CONUT score outperformed PNI and GNRI by integrating key biomarkers (albumin, cholesterol, lymphocytes) into a single metric. Although its components overlap with the clinical model, CONUT offers high specificity and simplicity, making it an efficient tool for rapid preoperative risk stratification.