Multiple Autoimmune Syndrome (MAS) involves at least three distinct autoimmune diseases. MAS' exact cause is unknown, however, genetic, immunologic, environmental, and infectious factors like Helicobacter pylori (H.pylori) are involved in its pathophysiology. Hence, in the current study, we described the demographic, and clinical characteristics of Multiple Sclerosis (MS) patients coexisting with vitiligo. Furthermore, we investigated the relationship between H. pylori eradication and patients' clinical improvement.

In this case-series study, eight female MS patients with clinically confirmed vitiligo were assessed for demographic and clinical characteristics via questionnaires and medical records. H. pylori infection also was evaluated using ELISA and stool antigen (HpSag) tests, and positive cases received eradication therapy.

The mean onset ages for MS and vitiligo were 23.12 ± 5.27 and 26.75 ± 4.97 years, with disease durations of 10.4 and 6.8 years, respectively. Six patients (75%) had an active vitiligo, and only one had active MS. Family history of MS and vitiligo was observed in 37.5% and 50% of patients, while 87.5% had other autoimmune diseases in their families. The mean H.pylori IgG and IgM levels were 15.58 ± 13.63 and 0.43 ± 0.31, respectively and H. pylori infection was detected in 25% of patients by either serology or stool antigen test, and no active vitiligo was observed post-eradication.

Since, our findings showed a potential association between H. pylori infection and the pathophysiology of vitiligo, eradication therapy may be used as a complementary approach alongside standard vitiligo treatments or even MS in MAS patients.

Obstructive sleep apnea (OSA) and age are strongly associated with recurrent events following acute coronary syndrome (ACS), but their interaction is unclear. This study was designed to evaluate the age-dependent impact of OSA on long-term outcomes in patients with ACS.

In this prospective, large-scale cohort study, 2160 patients admitted for ACS were recruited for sleep monitoring after clinical stabilization. OSA was diagnosed when the apnea-hypopnea index was ≥15 events/h. The primary endpoint was major adverse cardiovascular event (MACE), which included cardiovascular death, myocardial infarction, stroke and ischemia-driven revascularization.

Of 1927 eligible patients (average age: 56.4 ± 10.5 years; 298 [15.5%] women), 52.6% had OSA. The prevalence of OSA did not increase with age. During 2.9 years (interquartile range: 1.5 years to 3.6 years) of follow-up, the risk increase effect of OSA versus non-OSA on MACE gradually decreased with age and was no longer pronounced in the subpopulations age 58 years and older. In younger patients with ACS (adjusted HR, 1.68; 95% CI, 1.12-2.52) but not in older patients with ACS ≥58 years (adjusted HR, 0.98; 95% CI, 0.69-1.40), OSA was associated with a 1.68-fold increased risk of MACEs versus non-OSA. Subgroup and sensitivity analyses were consistent with main results.

OSA was associated with an increased risk of subsequent MACEs among younger patients with ACS. Aggressive screening and diagnosis for OSA may be recommended for younger patients with ACS. Further studies are needed to verify these findings.

National Natural Science Foundation of China (grant numbers 82370338, 82270258), Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0529100), National High Level Hospital Clinical Research Funding (BJ-2024-226, BJ-2025-112, BJ-2025-325), Beijing Natural Science Foundation [24JL001].

Clinicaltrials.gov, no. NCT03362385.

Pesticides removal from soil was investigated using a DBD (dielectric barrier discharge) plasma with microsecond pseudo-pulsed high-voltage power supply, focusing on the modeling and optimization of Trifluralin removal as the target pollutant. We performed a detailed parametric analysis (discharge voltage, remediation time, as well as soil moisture and organics content) to determine the optimum operational conditions. Plasma treatment experiments were also carried out on pristine sandy and loam soils. All four factors significantly impacted the herbicide removal, with notable cross effects. Under optimum conditions, 96.1 ± 2.0% Trifluralin and almost 68.5% mineralization were achieved within 17.6 min. In the presence of humic acids, the degradation efficiency decreased considerably, partly due to the competition for reactive species and energy consumption as well. The degradation kinetics fitted well to the pseudo-second-order model (R² = 0.998). The energy efficiencies were respectively 0.997 and 9.252 mg/kWh for 10 and 100 mg/kg Trifluralin, where •OH and ¹O₂ were the dominant reactive species in the targeted herbicide mineralization. The mechanistic degradation pathways were proposed based on the identified transformation products, which primarily encompassed successive hydroxylation, defluorination, and deamination. Furthermore, the toxicity of transformation products was evaluated through both seed germination assessment and the ECOSAR (Ecological Structure-Activity Relationships) predictive model, which indeed verified that the environmental risk was substantially reduced. This study gives a new point of view on cold DBD plasma as a promising and robust technique towards the remediation of soils contaminated with chemically stable and recalcitrant organics that are resistant to conventional treatment methods.

Type 2 diabetes mellitus (T2DM) is a metabolic disease characterised by chronic hyperglycaemia, whereas obesity is a major risk factor which increases morbidity and mortality. Treatments that alter white adipose tissue to express a metabolically active brown adipose phenotype in rats may offer adjunct treatment in people with T2DM. To investigate whether inorganic nitrate supplementation from beetroot juice (BJ) alters brown adipose tissue (BAT) fat fraction and activation in humans. Thirteen older adults with T2DM (glycated haemoglobin [HbA1c]: 58 ± 13 mmol·mol^-1 and body mass index: 29.1 ± 3.1 kg·m^-2) completed a double-blind, randomised, balanced and placebo-controlled crossover study. Outcome measures (including BAT fat fraction; activation; plasma [nitrate] and [nitrite]) were assessed before and after 14-day of 140 mL·day^-1 BJ containing inorganic nitrate (∼12.4 mmol·L¹) or a placebo (∼0.1 mmol·L¹). Magnetic resonance imaging (MRI) and infrared thermography (IRT) were performed to image supraclavicular BAT following a rested cooling protocol, consisting of 60-min exposure via a cold water (8.1 ± 1.2°C) perfused jacket. Respiratory parameters, including respiratory exchange ratio [RER] and mean skin temperature, were measured during the cooling protocol to confirm participants were not shivering. BJ significantly increased venous plasma [nitrate] and [nitrite] versus placebo (p < 0.001) but did not affect BAT fat fraction (p = 0.650) or activation (p = 0.152). Cooling significantly reduced mean skin temperature in BJ (-0.8 ± 0.7°C) and placebo (-0.6 ± 0.6°C) (p < 0.001) and RER remained representative of nonshivering thermogenesis throughout (0.88 ± 0.05 a.u.). 14-day of nitrate supplementation did not increase BAT fat fraction or activation in older adults with T2DM.

To evaluate the risk of diabetic retinopathy (DR) progression and associated ophthalmic complications after YAG laser capsulotomy in patients with nonproliferative DR (NPDR) after cataract surgery.

Multicenter study using deidentified electronic health records from 69 U.S. healthcare organizations across outpatient and academic ophthalmology settings.

Retrospective cohort study using propensity score matching to balance baseline characteristics.

Patients aged 18 years or older with type 1 or 2 diabetes and NPDR who underwent cataract surgery with or without subsequent YAG laser capsulotomy were identified. Patients were followed for 1-year postcataract surgery. Exclusion criteria included less than 6 months of follow-up. Primary outcomes included development of proliferative DR (PDR), vitreous hemorrhage (VH), tractional retinal detachment (TRD), neovascular glaucoma, and need for panretinal photocoagulation (PRP) or pars plana vitrectomy.

10 750 patients (10 750 eyes) were included after matching: 5375 YAG-treated and 5375 control eyes. At 1 year, YAG-treated patients had higher risk of PDR (hazard ratio [HR], 1.91; 95% CI, 1.67-2.18), VH (HR, 1.40; 95% CI, 1.15-1.72), TRD (HR, 2.04; 95% CI, 1.32-3.13), and PRP (HR, 1.48; 95% CI, 1.14-1.91). A secondary analysis of patients with ≥5 years of NPDR showed similar elevated risks.

YAG laser capsulotomy in patients with NPDR is associated with increased risk of DR progression and vision-threatening complications. Ophthalmic screening and close follow-up are recommended in this population after YAG treatment.

In the postpandemic context, the surge of digital health information has intensified public demand for clear and practical communication, particularly in China, where health literacy disparities persist. The Clear Communication Index, developed by the US Centers for Disease Control and Prevention (CDC), is a standardized tool for assessing the clarity and actionability of health materials, but no version adapted to the simplified Chinese context has been established.

This study aims to translate and culturally adapt the Clear Communication Index into simplified Chinese, and subsequently validate its psychometric properties using diabetes health communication materials from provincial CDCs across Mainland China, a disease area with a substantial public health burden and strong reliance on health education.

Following a standardized cross-cultural process (forward-back translation and expert review), we developed the simplified Chinese version of the Clear Communication Index (C-CCI) and finalized a 12-item scale across 4 dimensions (Main Message and Call to Action, Behavioral Recommendations, Numbers, Risk) with yes or no scoring (0-100). One top-ranked diabetes health education material was sampled from each provincial CDC website in Mainland China (30/31 included; 96.8%) on May 18, 2025. Twelve raters with multidisciplinary backgrounds completed a 3-week standardized training program and independently evaluated each article (360 ratings). Structural validity was examined using exploratory factor analysis and confirmatory factor analysis. Content validity was assessed by the item-level content validity index and the scale-level content validity index/average. Reliability was evaluated by internal consistency (Cronbach α) and inter-rater agreement (Fleiss kappa), while convergent/discriminant validity was assessed using composite reliability and average variance extracted (AVE).

The 4-factor structure was supported. Content validity was high, with the scale-level content validity index/average values of 0.976 for clarity and 1 for relevance. Overall reliability was acceptable (Cronbach α=0.837), with particularly strong internal consistency in the Risk dimension (Cronbach α=0.910). Inter-rater agreement was substantial (κ=0.624). Convergent validity (composite reliability=0.897-0.914; AVE=0.645-0.831) and discriminant validity were satisfactory. Application to 30 provincial CDC websites yielded a mean C-CCI score of 53.84 (SD 29.74), well below the recommended threshold of 90. No significant regional differences were observed in total scores; however, Behavioral Recommendations scored slightly higher in western provinces than in eastern and central regions (η²=0.034), representing a small effect size with limited practical significance.

The C-CCI demonstrated good validity, reliability, and feasibility for evaluating simplified Chinese health communication materials. These findings underscore the need to strengthen health communication practices in China and encourage provincial CDCs to align material development with national health literacy goals. Integrating the C-CCI into routine CDC review protocols could support evidence-based quality assurance and advance clearer, more actionable public health communication nationwide.

Diabetic kidney disease (DKD), mainly due to type 2 diabetes (T2DM) is the leading cause of end-stage kidney disease globally. However, DKD prevalence in sub-Saharan Africa, particularly Ethiopia, is underexplored, especially using reliable markers like quantified albuminuria and cystatin C based estimated glomerular equations (eGFR). This study aimed to assess DKD prevalence and associated factors using multiple diagnostic markers.

A cross-sectional study was conducted in adult T2DM patients at the University of Gondar Comprehensive Specialized Hospital using systematic random sampling. Data on socio-demographics and lab parameters were collected, with DKD diagnosed via eGFR and/or albuminuria (spot urine albumin-to-creatinine ratio and 24-hour collection). SPSS version 28 was used for data analysis, and factors were identified through multivariable logistic regression, with significance at 95% CI and p < 0.05.

In a study of 204 T2DM patients (mean age 60.2 years; 57.4% female), the prevalence of DKD was 37.3% (95% CI: 30.6-44.3). Significant factors associated with DKD included urban residence (AOR = 0.278, p = 0.023), poor blood pressure control (AOR = 2.33, p = 0.016), poor glycemic control (AOR = 2.93, p = 0.007), and longer diabetes duration (AOR = 6.78, p < 0.0001).

This study shows a high prevalence of DKD in T2DM patients, mainly identified via albuminuria. Poor blood pressure control, inadequate glycemic control, and longer diabetes duration were significantly associated with DKD. Regular screening and improved glycemic and blood pressure control are essential to slow DKD progression.

The study aimed to evaluate medication knowledge and adherence among patients with type 2 diabetes mellitus (T2DM) in northwestern China, identify factors influencing adherence, and examine the role of medication knowledge in adherence behavior.

This hospital-based,cross-sectional study was conducted at Xi'an People's Hospital (Xi'an Fourth Hospital) from February to May 2025. A total of 510 adult patients with T2DM were enrolled. Medication knowledge and adherence were assessed using "diabetes medication knowledge questionnaire (DMKQ)" and "general medication adherence scale (GMAS)", respectively. Multiple linear regression analysis was employed to identify independent risk factors associated with adherence.

The study revealed that 53.93% of patients achieved satisfactory medication adherence, while 58.04% possessed adequate medication knowledge. Forgetfulness or difficulty remembering medication schedules was the most frequently reported barrier to adherence. Notably, a substantial proportion of patients were unaware of potential medication side effects, and nearly half lacked sufficient knowledge on managing adverse effects. Multiple linear regression analysis identified gender (B = 0.564, P = 0.039), education level (B = 0.565, P = 0.032), living conditions (B = 0.776, P = 0.004), duration of antidiabetic drugs used (B = -0.046, P = 0.009) and medication knowledge (B = 1.318, P < 0.001) as independent factors of medication adherence, with medication knowledge exhibiting the strongest association (Beta = 0.533). Furthermore, a significant positive correlation was observed between medication knowledge and adherence.

Patients with diabetes in northwestern China often demonstrate suboptimal levels of both medication knowledge and adherence. As medication knowledge positively affects medication adherence, healthcare providers should assume a more proactive role in delivering comprehensive medication education to this patient population.

Monitoring medication adherence and main clinical outcomes changes in type 2 diabetes (T2D) is essential for optimal patient management. This study aimed to compute and evaluate medication adherence in its three process phases among T2D patients treated with oral antidiabetic (OAD) medications assessing association with main clinical outcomes.

This retrospective cohort study included newly diagnosed T2D patients initiating OAD therapy within 2015-2019 identified from the Nivel Primary Care Database (Nivel-PCD) in the Netherlands. Initiation was operationalised as ≥2 OAD prescriptions within follow-up. Implementation was quantified monthly using the Continuous Multiple-interval Measure of Medication Availability (CMA9). Group-based trajectory modelling (k-means via AdhereR) identified adherence patterns over 12 months. Persistence was assessed with a permissible-gap rule on the same 12-month series. Clinical measures (HbA1c, LDL cholesterol, blood pressure, BMI) were evaluated at baseline and at 12 months, and HbA1c trends were analysed over time.

Among 3,404 T2D patients started an OAD treatment, four distinct adherence clusters were identified: perfect adherence (70.1%), slow decline (13.3%), low adherence (10.6%), and slow increase (6.0%). Overall initiation was 99%. One-year persistence ranged from 26% (low adherence group) to 98.8% (perfect adherence group). Patients in the perfect-adherence group had higher baseline HbA1c but showed lower HbA1c and LDL levels over time compared with other groups. Blood pressure improved slightly in all groups. Changes in BMI were minimal.

Adherence trajectories provide a dynamic view of patients' behaviour and are associated with better glycaemic and lipid control. High-risk patients were often in the perfect-adherence group and appeared to gain the highest clinical benefit. These results support routine adherence monitoring and targeted, trajectory-informed interventions in T2D care.

Diabetes mellitus is a prevalent chronic condition with major impact on quality of life. Traditional treatment relied on insulin injections and self-monitoring, but advances in diabetes technology, such as continuous glucose monitoring (CGM), insulin pumps, and Hybrid Closed-Loop (HCL) systems, now provide new opportunities for optimizing glycemic control. HbA1c remains the established marker for long-term outcomes, though complementary use of Time in Range (TIR) offers more detailed insight into daily glucose variability. Clinical evidence shows that technologies such as CGM, HCL, and connected devices can reduce HbA1c, increase TIR, and lower the risk of severe hypoglycemia, while also improving quality of life and psychosocial outcomes. However, implementation must be tailored to individual patients, considering motivation, skills, and context. Future developments, including fully closed-loop systems, further highlight the need for clinicians to remain informed about rapidly evolving technologies and to critically assess their added value in daily practice.