Optimal use of renin-angiotensin system (RAS) modulators plays a crucial role in improving the outcomes for chronic heart failure (CHF) patients with reduced ejection fraction (rEF). Despite their established benefits, there is limited evidence regarding real-world prescribing patterns, dose optimization, and factors influencing RAS modulator use in this population.

This study aimed to evaluate the patterns of use, dose optimization, and associated factors affecting the administration of RAS modulators among CHF patients with rEF at Public Comprehensive Specialized Hospitals (PCSHs).

A hospital-based, multicenter cohort study was conducted from February 1, 2020, to May 31, 2024, at PCSHs among CHF patients with rEF.

A total sample size of 385 patients was determined using a systematic random sampling technique at the Northwest Ethiopian PCSHs during the study period. Data were collected from medical records and interviews using standardized questionnaires. Data analysis was performed using SPSS version 27.0, and binary logistic regression analysis was employed to identify factors associated with the use and optimization of RAS modulators. The study strictly adhered to the most recent guideline recommendations from the American Heart Association (2022) and the European Society of Cardiology (2021).

Of 385 patients, 263 (68.3%) were prescribed RAS modulators; however, only 86 (32.7%) of these patients were receiving an optimal dose. Predictors significantly associated with the use of RAS modulators included a duration of CHF with rEF of ⩾3 years (AOR: 1.79, 95% CI: 1.02-3.15), the presence of ischemic heart disease (AOR: 8.23, 95% CI: 4.23-16), hypertension (AOR: 2, 95% CI: 1.09-3.69), diabetes mellitus (AOR: 7.34, 95% CI: 1.48-36.34), chronic kidney disease (AOR: 4.35, 95% CI: 1.32-14.34), and a furosemide dose of ⩾40 mg (AOR: 0.26, 95% CI: 0.013-0.49). Regarding suboptimal RAS modulator dosing, significant predictors identified were age ⩾65 years (AOR: 2.83, 95% CI: 1.46-5.50), a previous history of hospitalization (AOR: 2.05, 95% CI: 1.07-3.95), the use of diuretics (AOR: 5.34, 95% CI: 2.73-10.44), a furosemide dose of ⩾40 mg (AOR: 3.88, 95% CI: 1.89-7.97), and CHF with rEF for ⩾3 years (AOR: 0.31, 95% CI: 0.16-0.63).

The majority of CHF patients with rEF received suboptimal doses of RAS modulators, with only one-third receiving optimal therapy. This highlights a critical gap in treatment that must be urgently addressed. Targeted interventions are needed to identify and mitigate modifiable predictors contributing to suboptimal dosing, thereby improving therapeutic outcomes and reducing the burden of CHF with rEF.

Radical nephroureterectomy (RNU) with complete bladder cuff excision is the primary treatment for high-risk non-metastatic upper urinary tract urothelial carcinoma (UTUC). Gemcitabine-platinum combination chemotherapy is established as the preferred adjuvant therapy post-RNU; however, both RNU and platinum-based therapies can significantly impair renal function. This study aimed to construct a nomogram to predict acute kidney disease (AKD) occurrence in UTUC patients undergoing gemcitabine-platinum chemotherapy after RNU.

We collected data from patients who underwent RNU followed by adjuvant gemcitabine-platinum chemotherapy at Beijing Friendship Hospital, Capital Medical University, between September 2015 and September 2024. Demographic, perioperative, and pre-chemotherapy data were analyzed. After rigorous screening, 126 patients were included and randomly allocated to a development cohort (n=88, 70%) and a validation cohort (n=38, 30%) in a 7:3 ratio. Risk factors for AKD identified by univariate and backward stepwise multivariate logistic regression analyses were used to develop the nomogram. Its performance was assessed using calibration curves, Harrell's concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) analysis.

AKD occurred in 31 patients (24.6%). Multivariate logistic regression identified five significant independent predictors: age (P=0.04), diabetes mellitus (P=0.03), proteinuria (P=0.003), serum creatinine before chemotherapy (P=0.002), and postoperative acute kidney injury (AKI) (P=0.01). The nomogram demonstrated strong discriminatory power, with an area under the curve (AUC) of 0.895 [95% confidence interval (CI): 0.825-0.964] in the development cohort and 0.893 (95% CI: 0.776-1.000) in the validation cohort. DCA and CIC indicated good clinical utility.

Age, diabetes mellitus, preoperative proteinuria, serum creatinine before chemotherapy, and postoperative AKI are significant risk factors for AKD in UTUC patients receiving gemcitabine-platinum chemotherapy after RNU. The developed nomogram serves as an effective predictive tool for AKD in this population.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated potential in improving glycemic control and reducing adverse outcomes in patients with Type 2 diabetes mellitus (T2DM); however, their efficacy in individuals aged 80 years and older remains understudied. To evaluate the efficacy of GLP-1 RAs compared with dipeptidyl peptidase-4 inhibitors (DPP4i) in patients aged ≥ 80 years with T2DM.

De-identified records from the TriNetX United States database identified 284,417 patients aged ≥ 80 years with T2DM, including 12,032 new GLP-1 RA users and 28,230 new DPP4i users, analyzed from January 2018 to December 2022.

This retrospective cohort study utilized a new-user and active comparator design to evaluate clinical outcomes between GLP-1 RA and DPP4i users during a follow-up period of up to 5 years. Propensity score matching, incorporating all the baseline covariates, was used to minimize baseline differences. The Cox proportional hazards regression model was used to estimate hazard ratios (HRs) for clinical outcomes. Sensitivity analyses were performed to validate the findings.

After 1:1 propensity score matching, 11,464 patients were included in each group. Both cohorts had a mean age of 81.6 years; 47.7% were female, and 67% were White. GLP-1 RA users had significantly lower risks of major adverse cardiovascular events (HR: 0.86, 95% CI: 0.81-0.91), major adverse kidney events (HR: 0.86, 95% CI: 0.82-0.91), all-cause hospitalization (HR: 0.91, 95% CI: 0.84-0.97), and all-cause mortality (HR: 0.82, 95% CI: 0.77-0.88) compared with DPP4i users. No significant differences were observed between the groups in the rate of heart failure or bone fractures.

GLP-1 RAs may offer substantial cardiorenal and survival benefits in patients aged 80 years and older with T2DM. These findings support the use of GLP-1 RAs as a therapeutic option in this high-risk, older population.

Saliva is an important body fluid in the oral cavity containing lots of biomarkers, whose inherent micro-ecosystem holds significant value for early diagnosis and monitoring of oral diseases. Simultaneously, saliva has particular advantages, such as ease of sampling, painless and non-invasive collection, and suitability for repeated sampling, making it highly appropriate for surveillance and follow-up of diseases. In a series of studies conducted by the research group for preventive dentistry in Peking University School and Hospital of Stomatology, we compared different segments of saliva and those samples collected via different sampling methods using proteomic/peptidomic and microbiomic technologies to explore the stability of saliva samples. Besides, the significance of applying representative salivary biomarkers in early prevention and control of representative oral diseases (e.g. dental caries, periodontal diseases) and systemic conditions (e.g. type 2 diabetes mellitus, chronic kidney disease) was confirmed as well.

Laparoscopic sleeve gastrectomy is the most common metabolic bariatric surgery performed in Japan. Nevertheless, concerns persist regarding its long-term efficacy, which is considered inferior to that of procedures involving gastrointestinal bypass. In response to these concerns, a modified approach known as the "sleeve plus procedure" has been introduced and is now covered by insurance for patients with severe obesity and type 2 diabetes mellitus (T2DM). We successfully performed proximal jejunal bypass with sleeve gastrectomy (PJB-SG), a variant of this approach, marking the first documented case of its kind in Japan. This report presents the clinical outcomes of this procedure along with a review of the relevant literature.

A 50-year-old female patient with a body mass index of 46.9 kg/m² presented with obstructive sleep apnea and T2DM. The patient exhibited resistance to pharmacological treatment, including glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors. Fifteen months after the initial consultation, she opted for PJB-SG. The operation lasted 207 min, with 18 mL of blood loss. At 252 days postoperatively, the patient had achieved a total weight loss of 18.0% and a hemoglobin A1c level of 6.0% while continuing a minimal dose of SGLT2 inhibitors. No adverse events related to the bypass procedure, such as diarrhea or liver dysfunction, were observed.

To our knowledge, this is the first reported case of PJB-SG conducted in Japan. This procedure may represent a promising alternative for patients with severe obesity and T2DM in Japan.

The current study aimed to assess the demographic features, clinical characteristics, species diversity, and contributing factors among patients with severe acute respiratory syndrome coronavirus-2 pneumonia-associated mucormycosis in northwestern Iran.

This cross-sectional descriptive study was performed on patients who tested positive for COVID-19 via reverse-transcriptase-polymerase chain reaction and were suspected of having invasive fungal infection. Mucormycosis was confirmed by histopathology of biopsy samples and species identification was performed using morphological and internal transcribed spacer-rDNA sequencing methods.

Mucormycosis was observed in 63 COVID-19 patients. Mean age of patients was 56.65±14.49 years (range of 22-85 years) and 63.5% of the involved patients were male. The most common involvement site of patients with mucormycosis was the sinus (63.5%). Among all participants, 84% of patients (n=53) had received intravenous dexamethasone, and 25.4% of them had diabetes mellitus. All patients with proven invasive mucormycosis received intravenous amphotericin B. In total, 21 (33%) positive cultures were identified and Rhizopus arrhizus was the main causative agent.

Awareness among physicians should be raised that corticosteroid therapy not only causes dysfunction of the immune system but may also lead to the development of this neglected mycosis through corticosteroid-induced diabetes in vulnerable patients.

To construct a model for predicting the risk of symptomatic ischemic cerebrovascular disease (ICVD) based on carotid plaque characteristics utilizing Automated Machine Learning (AutoML) technology, systematically identify key predictive factors, and provide evidence for clinical risk stratification and individualized intervention.

A single-center retrospective study design was employed, enrolling 626 patients with carotid plaques who were treated between January 2020 and December 2022. Structured electronic medical records (EMRs) were used to extract comprehensive clinical data, including: Demographic characteristics (gender, age); Cardiovascular risk factors (e.g., hypertension, diabetes mellitus); Lifestyle habits (smoking, alcohol consumption); Laboratory parameters (blood lipid profiles, C-reactive protein); Ultrasound-evaluated carotid plaque characteristics (stenosis severity, ulcer formation, plaque number, intraplaque neovascularization). The dataset was divided into a training set (501 patients, ∼80%) and a test set (125 patients, ∼20%). Utilizing the AutoML framework, we implemented the Improved Newton-Raphson Based Optimizer (INRBO) to optimize model hyperparameters. Feature importance was validated through dual-dimensional analysis employing LASSO regression and SHAP (SHapley Additive exPlanations) interpretability models. Furthermore, an interactive nursing decision support system was developed using MATLAB.

Among the 626 patients, 375 (59.90%) developed symptomatic ICVD. The prediction model constructed in this study demonstrated significantly enhanced performance: On the training set: ROC-AUC rose to 0.9537 and PR-AUC improved to 0.9522. On the independent test set: ROC-AUC remained high at 0.9343 and PR-AUC was 0.9104. These results consistently surpassed all other comparative models. The model definitively identified six core variables predicting symptomatic ICVD onset: Stenosis Severity; Ulcerative Plaque; Plaque Number; Intraplaque Neovascularization; Age; Diabetes Status. LASSO regression analysis independently selected seven variables, achieving an 85.71% overlap rate (6 out of 7 features) with the features selected by the AutoML model. SHAP analysis confirmed the top three feature importance rankings: (1) Stenosis Severity, (2) Ulcerative Plaque, (3) Plaque Number.

By integrating multidimensional clinical data with interpretable machine learning techniques, this study confirms the pivotal role of carotid plaque morphological features and metabolic factors in symptomatic ICVD risk prediction. Crucially, it achieves the real-time translation of risk assessment into actionable intervention decisions, thereby providing innovative tools and methodological advances for the precision diagnosis and treatment of cerebrovascular diseases.

The pathogenesis of type 2 diabetes mellitus (type 2 DM) involves two major abnormalities: insulin resistance(IR) and impaired insulin secretion, both of which contribute to the inability to regulate blood glucose levels. Adiponectin, a hormone secreted by adipose tissue, plays a role in glucose metabolism and possesses insulin-sensitizing properties. Additionally, adiponectin may play a central role in protecting against atherosclerosis by reducing inflammation, lipid accumulation, and oxidative stress. It has also been reported to increase nitric oxide production in endothelial cells through the activation of nitric oxide synthase. The aim of this study was to investigate the association of serum adiponectin level with glycemic control and atherogenic lipid profile in Sudanese patients with type 2 DM.

This was a case-control study. Patients with type 2 DM (n = 202) and healthy controls (n = 100) were consented and enrolled. Systolic and diastolic blood pressures (mm Hg), weight (kg), and height (m) were measured, and body mass index (kg/m²) was calculated. Blood samples were collected after an overnight fast. Fasting blood glucose (FBG), haemoglobin A1c (HbA1c), and lipid profile were measured using enzymatic methods. Adiponectin levels were determined using a sandwich ELISA. Multiple regression analysis was conducted to assess the correlation of adiponectin levels with HbA1c and lipid profile parameters.

Adiponectin levels were significantly lower in patients with type 2 DM compared to healthy controls (p < 0.001). Adiponectin was inversely correlated with HbA1c (β = −0.200, p = 0.005), total cholesterol (TC) (β = −0.140, p = 0.044), and low- density lipoprotein cholesterol (LDL-C) (β = −0.162, p = 0.022), and positively correlated with high-density lipoprotein cholesterol (HDL-C) (β = 0.160, p = 0.030). No correlation was observed with triglyceride (TG) levels. Patients with type 2 DM also exhibited significantly higher systolic and diastolic blood pressure, body mass index (BMI), fasting blood glucose (FBG), HbA1c, total cholesterol, and LDL-C levels, along with significantly lower HDL-C levels compared to healthy controls (p < 0.05).

Patients with type 2 DM had decreased serum adiponectin levels. The present study supports that adiponectin levels are associated with glycemic control and an atherogenic lipid profile. Adiponectin can be considered clinically relevant both as a potential dual biomarker and as a therapeutic target for glycemic control and atherogenic dyslipidemia in patients with type 2 DM.

The online version contains supplementary material available at 10.1186/s12902-025-02053-5.

The gold standard for monitoring long-term glucose levels in patients with diabetes mellitus is glycated hemoglobin (HbA1c). In conditions where the erythrocyte half-life is decreased, for example, in long-term kidney diseases and hemoglobinopathies, HbA1C may underestimate the long-term glucose exposure. Therefore, in these patient groups, other methods to monitor long-term glucose have been suggested, including glycated serum protein (GSP). To further optimize the method, a correction against total serum albumin has been proposed, defined as a percentage of glycated albumin (%GA). The aim of this study was to investigate the correlation between HbA1c, GSP, and %GA-a strong correlation to HbA1c would strengthen the potential usefulness of GSP and %GA as alternative methods to monitor glucose exposure in certain patient populations.

In this study, randomly collected human samples (n = 271), with different levels of HbA1c were analyzed for GSP and total serum albumin and a %GA was calculated. We also divided the samples into subgroups based on their HbA1c-result, age, and gender.

Both %GA and GSP were strongly correlated with HbA1c, where %GA displayed the strongest correlation (R² 0.77 compared with R² 0.66.). When dividing into subgroups based on HbA1c-results, statistically significant differences in %GA were observed between all the different subgroups.

In conclusion, the findings of this study strengthen the possibility of using GSP and %GA as possible alternatives or at least a supplement to HbA1c for monitoring long-term glucose exposure. Theoretically, particularly %GA could have the potential to supplement HbA1C in patients where the erythrocyte half-life is altered.

Acute Invasive Fungal Sinusitis (AIFS) is an aggressive infection with significant morbidity and mortality. Early and accurate diagnosis is critical, but its nonspecific clinical presentation often complicates timely detection. This study aims to identify clinical, laboratory, and radiological predictors associated with biopsy-confirmed AIFS in patients with suspected disease.

A retrospective analysis was conducted on 134 adult patients who underwent biopsies for suspected AIFS at a tertiary referral center between January 2009 and January 2024. Patients diagnosed with chronic invasive fungal sinusitis were excluded. Among the patients, 60 cases (44.8%) were biopsy-confirmed AIFS. Key variables analyzed included demographic data, comorbidities, clinical signs, endoscopic findings, laboratory markers, and imaging findings. Backward stepwise and multivariable logistic regression analyses were used to identify independent predictors.

Of 36 clinical variables initially assessed, stepwise regression identified 5 significant variables for multivariable analysis. Mucosal necrosis in the nasal cavity (OR 39.853; 95% CI 10.278-154.535; p = 0.000) and cranial nerve palsies (OR 25.826; 95% CI 2.738-140.769; p = 0.000) were the strongest predictors. Other significant factors included unilateral mucosal thickening (OR 5.694; 95% CI 1.720-18.855; p = 0.004), diabetes mellitus (OR 3.462; 95% CI 1.202-9.970; p = 0.021), and female sex (OR 2.959; 95% CI 1.060-8.259; p = 0.038).

Cranial nerve palsies and mucosal necrosis in the nasal cavity are strong predictors of biopsy-confirmed AIFS, highlighting the importance of these clinical signs in early diagnosis.