Bone transport-induced remote microinjury may promote diabetic foot ulcer healing but requires osteotomy and may cause fracture or osteomyelitis. This study evaluated whether osteotomy-free remote periosteal distraction (RPD) could promote repair in a rabbit ischemic diabetic foot wound model. Seventy-two diabetic male rabbits were randomized into RPD, Sham, and Control groups, and ischemic foot wounds were created. In the RPD group, a custom-made plate was implanted beneath the tibial periosteum and connected to an external distractor. The periosteum was distracted outward for 7 days and returned inward for another 7 days. Sham animals underwent the same implantation procedure without device adjustment, whereas Control animals received wound creation alone. Wound closure, histological changes, vascular parameters, and angiogenesis-related markers were evaluated. On days 8 and 16, RPD resulted in a smaller residual wound area than the Control and Sham groups. RPD increased epithelial thickness and collagen deposition compared with the Control and Sham groups. RPD was associated with increased serum VEGF levels, higher VEGF mRNA expression, and larger CD31-, VEGF-, and VEGFR2-positive areas in wound tissues. On day 16, ex vivo micro-CT angiography demonstrated higher vascular volume in the wound region after RPD treatment. Osteotomy-free RPD promoted wound repair in an ischemic diabetic wound model. These effects were associated with enhanced neovascularization and increased VEGF and VEGFR2 expression at the wound site. RPD may represent a potentially less invasive alternative to osteotomy-based tibial distraction for improving ischemic diabetic ulcer healing, but further mechanistic, safety, and clinical studies are required.

To reassess the clinico-epidemiological characteristics of chronic pancreatitis (CP) in Japan, we conducted a nationwide epidemiological survey.

A two-stage nationwide survey was performed targeting patients with CP treated at participating hospitals in 2021. The first-stage survey estimated the number of patients, and the second-stage survey collected detailed clinical information.

The estimated number of patients with definite or probable CP in 2021 was 73,590 (prevalence, 58.6 per 100,000 population), representing a 30% increase from 2016. The estimated number of newly diagnosed patients was 17,490, corresponding to an annual incidence of 13.9 per 100,000 population. Detailed clinical data were available for 4633 patients. The male-to-female ratio was 4.15:1, the mean age in 2021 was 64.4 years, and the mean age at diagnosis was 58.7 years. Alcohol was the leading etiology (69.6%), followed by idiopathic CP (24.3%). Notably, alcohol-related CP accounted for 39.5% of female cases. Diabetes mellitus and pancreatic exocrine insufficiency were present in 45.8% and 36.6% of patients, respectively. Endoscopic treatment was the initial intervention in 92.8% of patients undergoing treatment for pancreatic stones and/or pancreatic duct strictures. Malignancies were identified up to the time of the survey in 18.0% of patients, including pancreatic cancer in 89 patients.

The prevalence of CP in Japan continues to increase. The aging CP population, the increasing proportion of alcohol-related CP among women, and the substantial burden of diabetes, exocrine insufficiency, and malignancy underscore the growing healthcare impact of CP and the need for effective prevention and long-term management strategies.

To identify the clinical and biometric factors associated with the histopathological splitting of the anterior lens capsule in eyes undergoing cataract surgery.

XXXX University Hospital, XXXXcity, XXXXstate, XXXXcountry(anonymized_for_review).

Single-center retrospective cross-sectional study.

The study included patients who underwent cataract surgery between 2022 and 2025, had an anterior capsulorhexis specimen, and complete clinical data (one eye per patient). Specimens were stained with haematoxylin-eosin and Masson's trichrome and assessed for capsular splitting. Collected variables were age, sex, nuclear hardness (Emery-Little classification), diabetes mellitus, axial length, and lens thickness. Factors associated with splitting were examined using logistic regression.

A total of 244 patients (244 eyes) were included. Capsular splitting was observed in 69 of 244 eyes (28.3%). In univariable analysis, older age (per 1-year increase: odds ratio [OR], 1.121; 95% confidence interval [CI], 1.081-1.162; P < .001), nuclear hardness grade ≥3 (OR, 2.821; 95% CI, 1.379-5.771; P = .005), shorter axial length (per mm: OR, 0.763; 95% CI, 0.648-0.900; P = .001), and greater lens thickness (per mm: OR, 4.224; 95% CI, 2.232-7.993; P < .001) were significantly associated with splitting. Sex and diabetes mellitus were not associated with splitting. In multivariable analysis, which included variables significant in the univariable analysis, only age remained independently associated with splitting (per 1-year increase: OR, 1.105; 95% CI, 1.062-1.151; P < .001).

Capsular splitting is primarily age-related. These results suggest progressive weakening of the anterior lens capsule with increasing age.

Recent observational studies have demonstrated an association between apolipoproteins and vitamin K-dependent coagulation factors. Further research investigating this association is required. This study aimed to assess the association between atorvastatin use and prothrombin time (PT), apolipoprotein A-I (ApoA-I) levels, and apolipoprotein B (ApoB) levels in type 2 diabetes mellitus (T2DM) patients without established atherosclerotic cardiovascular disease and to investigate the association between PT and these apolipoproteins.

A cross-sectional study recruited 147 T2DM patients attending Family Medicine clinics at King Abdullah University Hospital and Jordan University of Science and Technology Health Care Center, 72 patients started receiving atorvastatin at least 6 months before the recruitment date (case group), and 75 patients were not on statins (control group). PT showed an inverse association with ApoB in both groups (case group: β = -0.09, 95% CI: -0.17 to -0.02, p = 0.017; and control group: β = -0.08, 95% CI: -0.15 to -0.02, p = 0.015). No significant association was observed between PT and ApoA-I.

The inverse association between PT and ApoB may suggest a potential link between the reduction in ApoB levels, through atorvastatin use, and the modulation of coagulation pathways relevant to venous thrombosis, although this requires confirmation in future prospective studies.

Cuffless wearable technologies enable continual blood pressure (BP) monitoring and may improve tolerability compared with conventional cuff-based methods. Pediatric data comparing cuffless devices with ambulatory blood pressure monitoring (ABPM) remain limited.

In this prospective observational study, children with well controlled type 1 diabetes mellitus and normal office BP underwent simultaneous 24-h monitoring using a wrist-worn cuffless optical device and conventional ABPM. Between-method differences were assessed for averaged 24-h, daytime, and nighttime systolic and diastolic BP. Equivalence was evaluated using the two one-sided tests procedure with a prespecified exploratory ± 10 mmHg margin, whereas individual-level agreement was assessed using Bland-Altman analysis.

Twenty-one participants were included (mean age 14.7 ± 2.6 years). Mean differences (Aktiia - ABPM) were -4.5 mmHg for 24-h systolic BP and -0.8 mmHg for 24-h diastolic BP. The 90% confidence intervals were fully contained within the ±10 mmHg margin for 24-h and nighttime systolic BP and for diastolic BP across all periods, but not for daytime systolic BP. Bland-Altman analysis showed modest mean bias but wide limits of agreement, particularly for systolic BP. Nocturnal systolic and diastolic BP dipping was attenuated with cuffless monitoring.

In this selected pediatric cohort, continual cuffless BP monitoring was feasible and showed group-level comparability with ABPM for averaged 24-h BP values. However, it should not be considered interchangeable with ABPM for individual clinical decisions or assessment of nocturnal dipping. Larger studies in more diverse pediatric populations are required before broader clinical implementation.

The prevalence and impact of fatty pancreas (FP) on pancreatic and metabolic disorders remain incompletely characterized. We synthesized current evidence on FP prevalence and its associations with pancreatic and metabolic disorders.

We performed a systematic review and meta-analysis of PubMed, Embase, and Cochrane Library through October 22, 2024. Prevalence was analyzed separately in the healthy population and the overall study population, with restricted sensitivity analyses according to population selection.

From 3,984 records, 124 studies were included. The pooled prevalence was 30.5% among 141,416 healthy or routine-examination participants and 42.3% across all included study populations. After pancreatic disease, pancreatic surgical, and metabolic high-risk populations were excluded, the prevalence was 31.1%. In the healthy population, FP prevalence varied by region, ranging from 12.0% in Africa to 38.8% in the Region of the Americas, although estimates for some regions were based on limited country-level data. Higher prevalence was observed in older age, male sex, high-income countries, and very-high-HDI regions. FP prevalence was higher in 2020-2024 than in the preceding publication period in both the overall study population and the healthy population, while temporal meta-regression showed positive but non-significant slopes. FP was associated with increased risks of pancreatitis (OR 2.66), pancreatic cancer (OR 3.01), fatty liver (OR 4.86), metabolic syndrome (OR 3.90), obesity (OR 2.75), diabetes mellitus (OR 2.43), and hypertension (OR 2.17; all P < 0.001).

FP was common in the included populations and was associated with several pancreatic and metabolic disorders. Prevalence was higher in recent publication periods, although continuous temporal trends were not statistically significant. These findings support greater clinical attention to FP, particularly among older adults and high-risk populations. Targeted evaluation for associated disorders and appropriate risk-factor management may be considered in individuals with FP.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024499559, CRD42024499559.

Metagenomic next-generation sequencing (mNGS) offers high sensitivity and specificity for pathogen detection. Type 2 diabetes mellitus (T2DM) is a key risk factor for opportunistic infections, including community-acquired pneumonia (CAP). Targeted treatment of the pathogen is beneficial to the prognosis of patients with CAP. This study aimed to explore the pathogen distribution and clinical presentation of CAP in patients with T2DM via bronchoalveolar lavage fluid (BALF) mNGS.

In this comparative observational study, a total of 285 patients with CAP were enrolled. Ultimately, 117 CAP patients without T2DM and 96 CAP patients with T2DM were included. Demographics, clinical data, laboratory data, and BALF mNGS results were collected. Least absolute shrinkage and selection operator (LASSO) regression was performed to determine potential variables, which were subsequently included in a binary logistic regression model to identify clinical and microbiological features associated with pre-existing T2DM in CAP patients.

Thirteen potential T2DM-associated variables were selected by LASSO regression. Furthermore, binary logistic model identified that higher body mass index (BMI) [odds ratio (OR) =1.107, 95% confidence interval (CI): 1.004-1.221], lower rate of connective tissue disease (CTD) (OR =0.046, 95% CI: 0.002-0.935), elevated blood urea nitrogen (BUN) (OR =1.091, 95% CI: 1.003-1.187), the presence of COVID-19 (OR =6.582, 95% CI: 1.244-34.829) and Aspergillus (OR =2.909, 95% CI: 1.018-8.311) were independent variables for T2DM in CAP patients.

Collectively, our analysis revealed that CAP patients with T2DM had a distinct clinical profile and pathogen spectrum, characterized by a higher prevalence of COVID-19 and Aspergillus infection, a greater tendency for renal dysfunction, and a higher BMI but a lower rate of CTD. These findings underscore T2DM as a significant risk factor for COVID-19 and Aspergillus pneumonia. In clinical practice, stricter infection screening strategies should be implemented for this population, along with targeted anti-infective therapy and enhanced dynamic assessment of renal function, weight management, and blood glucose control, will help improve outcomes.

The co-occurrence of early-onset type 1 diabetes mellitus (T1DM), acquired generalized lipodystrophy (AGL), and severe insulin resistance (SIR) is extremely rare, poses significant therapeutic challenges and no cases associated with pathogenic Cytotoxic T-lymphocyte-associated 4 (CTLA4) variants have been previously documented.

We performed genetic testing, flow cytometric immunophenotyping, leptin measurement and a 4.5-year clinical follow-up in a 3-year-3-month-old boy with early-onset T1DM, insulin allergy following initial insulin therapy, progressive lipodystrophy, SIR and mild hepatic dysfunction. We additionally conducted a systematic literature review to summarize CTLA4 variant-related autoimmune endocrine disorders and fat metabolism abnormalities. Pathological biopsy of subcutaneous adipose tissue revealed scattered lymphocytes and histiocytes infiltrating the fat septa and perivascular areas. A heterozygous pathogenic c.151C>T (p.Arg51*) variant in the CTLA4 gene was identified by whole-exome sequencing (WES) analysis. His father and sister carried the same variant with incomplete penetrance. The patient showed markedly reduced CTLA4 expression on regulatory T cells and undetectable serum leptin. Treatment with abatacept normalized liver function but did not improve glycemic control or insulin resistance. During the follow-up, the patient's growth consistently exceeded the 97th percentile for age and gender.

This report established the first association between a pathogenic CTLA4 variant and AGL, which expands the known clinical phenotypic spectrum of CTLA4-related immune dysregulation disorders. CTLA4 genetic testing should be considered in patients presenting with early-onset T1DM and unexplained lipodystrophy to enable early diagnosis and guide personalized management.

Insulin pump-related skin complications are common in children with type 1 diabetes, yet stakeholder perspectives and management practices remain poorly characterized. We aimed to investigate knowledge, attitudes, practices, and educational needs related to these complications among caregivers, healthcare professionals, and manufacturer technical support staff in China.

This sequential explanatory mixed methods study included a cross-sectional, questionnaire-based survey (n=951) and semi-structured interviews (n=40). Quantitative data were analyzed descriptively, and qualitative data were analyzed using framework analysis. The quantitative and qualitative findings were integrated through triangulation.

Among 510 children represented by caregivers, 42.0% were reported to have experienced skin complications. Despite widespread concern, knowledge gaps persisted, particularly regarding infection management, and a knowledge-practice gap was evident. Qualitative findings identified role ambiguity as a structural barrier, with no stakeholder group assuming clear ownership of skin management. Participants described management as largely empirical and lacking standardized protocols. More than 96% of healthcare professionals and manufacturer technical support staff agreed that children and caregivers should receive comprehensive skin management training before pump initiation.

Based on self-reported data, this descriptive study suggests that insulin pump-related skin complications were common among Chinese children with type 1 diabetes. Four hypothesis-generating challenges for skin management were identified, including knowledge-practice gaps, role ambiguity, empirical management, and insufficient training. They point to directions for future research such as developing evidence-based guidelines, clarifying interdisciplinary roles, and developing/implementing longitudinal education programs.

The prognostic role of triglyceride-glucose (TyG) index and triglyceride-glucose body mass index (TyG-BMI) in patients undergoing coronary artery bypass grafting (CABG) remains unclear. This meta-analysis aimed to clarify prognostic value of TyG index and TyG-BMI among patients undergoing CABG.

Several databases were searched up to May 20, 2026. Primary prognostic outcomes included major adverse cardiovascular event (MACE) and major adverse cardiovascular and cerebrovascular event (MACCE). Secondary outcomes included all-cause mortality, cardiac mortality, nonfatal myocardial infarction (MI), nonfatal stroke, acute kidney injury (AKI), atrial fibrillation (AF), symptomatic graft failure (SGF) and cerebral infarction.

Fifteen studies with 16,185 cases were enrolled. The results demonstrated that elevated TyG index was related to increased risk of MACE [odds ratio (OR) =1.91, P<0.001] and MACCE (OR =1.67, P<0.001). Subgroup analysis indicated more significant association between TyG index and risk of MACE (OR =4.27, P=0.001) and MACCE (OR =1.71, P<0.001) among diabetic patients. Besides, TyG index was associated with the risk of all-cause mortality [hazard ratio (HR) =1.37, P=0.02], cardiac mortality (HR =2.59, P=0.001), nonfatal MI (OR =2.02, P=0.04), nonfatal stroke (OR =2.00, P<0.001), AF (OR =1.55, P<0.001), SGF (OR =2.987, P=0.003) and cerebral infarction (OR =1.93, P<0.001). Furthermore, elevated TyG-BMI was related to increased incidence of AKI (OR =1.03, P<0.001) among diabetic patients.

Preoperative elevated TyG index was associated with worse clinical outcomes such as increased incidence of MACE and MACCE in patients undergoing CABG, especially among diabetes mellitus (DM) patients. Besides, higher TyG-BMI index indicated increased risk of AKI in diabetic patients.