Endothelial dysfunction and platelet hyperactivity in type 2 diabetes mellitus: molecular insights and therapeutic strategies

Nailfold capillary abnormalities as indicators of diabetic nephropathy progression: a cross-sectional study in type 2 diabetes

BACKGROUND

Type 2 diabetes mellitus (DM) leads to chronic hyperglycemia and microvascular complications, including diabetic nephropathy (DN). Nailfold videocapillaroscopy (NVC) is a non-invasive method for assessing the microvascular abnormalities and may aid in early DN detection. This study investigates the correlation between DN and nailfold capillary abnormalities in type 2 DM.

METHODS

This prospective cross-sectional study involved 453 participants with type 2 DM, divided into 3 groups based on estimated glomerular filtration rate (eGFR) or albumin-to-creatinine (A/C) ratio. Chronic kidney disease (CKD) risk categories based on the 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Participants underwent structured interviews, clinical assessments, and laboratory tests. NVC was performed to assess capillary morphology, distribution, density, and blood flow.

RESULTS

Significant differences in NVC measurements were observed across eGFR groups, with higher NVC scores and more severe capillary abnormalities noted in lower eGFR groups. The 'comma-like' capillary distribution pattern (23.08%, p = 0.016), more ratio of ramified capillaries (p = 0.0137) were observed in the eGFR <30 ml/min/1.73m2 group. Reduced fundus transparency (p = 0.0015) and impaired visibility of the sub-venous plexus (p = 0.0016) were noted in the lower eGFR groups. Capillary lengths, both input and mean, were shorter in the A/C ratio > 300 mg/g group (p = 0.0382 and p = 0.0478, respectively). The NVC score was higher in the A/C ratio > 300 mg/g groups (p = 0.0028).

CONCLUSION

Nailfold capillary abnormalities correlate with DN severity, indicating their potential as a non-invasive biomarker for early DN detection and monitoring in type 2 DM.

An emerging role of SNAREs in ischemic stroke: From pre-to post-diseases

Ischemic stroke is a debilitating condition characterized by high morbidity, disability, recurrence, and mortality rates on a global scale, posing a significant threat to public health and economic stability. Extensive research has thoroughly explored the molecular mechanisms underlying ischemic stroke, elucidating a strong association between soluble N-ethylmaleimide-sensitive factor (NSF) attachment protein receptor proteins (SNAREs) and the pathogenesis of this condition. SNAREs, a class of highly conserved proteins involved in membrane fusion, play a crucial role in modulating neuronal information transmission and promoting myelin formation in the central nervous system (CNS). Preventing the SNARE complex formation, malfunctions in SNARE-dependent exocytosis, and altered regulation of SNARE-mediated vesicle fusion are linked to excitotoxicity, endoplasmic reticulum (ER) stress, and programmed cell death (PCD) in ischemic stroke. However, its underlying mechanisms remain unclear. This study conducts a comprehensive review of the existing literature on SNARE proteins, encompassing the structure, classification, and expression of the SNARE protein family, as well as the assembly - disassembly cycle of SNARE complexes and their physiological roles in the CNS. We thoroughly examine the mechanisms by which SNAREs contribute to the pathological progression and associated risk factors of ischemic stroke (hypertension, hyperglycemia, dyslipidemia, and atherosclerosis). Furthermore, our findings highlight the promise of SNAREs as a viable target for pharmacological interventions in the treatment of ischemic stroke.

BAD-Glucokinase Axis Regulates Platelet Activation and Thrombosis

BACKGROUND

BAD (Bcl2-associated death promoter), a member of the Bcl2 proapoptotic family, promotes cell apoptosis by sequestering the prosurvival proteins Bcl-XL and Bcl2 from the proapoptotic proteins BAK (Bcl2 homologous antagonist/killer) and BAX (Bcl2-associated X protein) in nucleated cells. BAD is also expressed in platelets, playing a role in regulating platelet lifespan, apoptosis, and clearance. However, whether BAD regulates platelet activation and arterial thrombosis remains unclear.

METHODS

The role of BAD in platelet activation and arterial thrombosis was investigated using BAD-deficient mice (Bad-/-), in vitro functional studies, and arterial thrombosis models. The regulatory effect of BAD on platelet energy metabolism was detected using a Seahorse Extracellular Flux Analyzer. The regulatory effect of BAD on glucokinase was investigated by coimmunoprecipitation and activity measurement. The glucokinase heterozygous knockout mice (Gck+/-) and activator were used to study its role in platelet activation.

RESULTS

BAD-deficient mice (Bad-/-) and wild-type mice transfused with Bad-/- platelets displayed prolonged tail bleeding and arterial occlusion times. Bad-/- platelets exhibited decreased aggregation in response to stimulations by proteinase-activated receptor 4-activating peptide, thrombin, and U46619. Furthermore, BAD ablation suppressed platelet integrin αIIbβ3 activation, granule secretion, and clot retraction induced by these agonists. Mechanistically, BAD interacted with glucokinase, and BAD deficiency resulted in decreased platelet glucokinase activity, mitochondrial oxidative phosphorylation, and mitochondrial ATP production. The partial loss of glucokinase (Gck+/-) phenocopied platelet function defects caused by BAD deficiency, and a glucokinase activator rescued the impaired mitochondrial ATP production and function of Bad-/- platelets. Additionally, the glucokinase activator enhanced human platelet activation.

CONCLUSIONS

Our findings demonstrate the critical role of the BAD-glucokinase axis in platelet activation and thrombosis, suggesting a potential target for antithrombotic therapy.

Improved ASCVD Screening in Diabetes: a Focus on Scoring Models and Detection Techniques

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Diabetes accelerates the progression of atherosclerosis through key mechanisms such as insulin resistance, hyperglycemia, dyslipidemia, chronic inflammation, and oxidative stress, significantly increasing the risk of coronary artery disease, stroke, and heart failure. Traditional risk assessment models and treatment strategies often fall short in fully addressing these complexities, leaving a substantial residual cardiovascular risk in diabetic patients. This review focuses on the need for enhanced screening protocols in diabetic populations, examining advanced risk scoring models and detection techniques aimed at improving early identification and management of ASCVD. Also, this study examines the pathophysiological links between diabetes and atherosclerosis, emphasizing the need for enhanced screening protocols. Emerging tools, such as non-invasive imaging techniques (e.g., coronary artery calcium scoring, CCTA) and biomarkers (e.g., polygenic risk scores), offer promise for improved early detection and risk stratification. Additionally, newer therapeutic strategies targeting inflammation and insulin resistance are being explored to mitigate cardiovascular risks in this population. Given the significant cardiovascular risk associated with diabetes, particularly T2DM, these advancements are crucial in reducing morbidity and mortality related to atherosclerotic events.

SETD7 drives diabetic endothelial dysfunction through FBXO45-mediated GPX4 ubiquitylation

BACKGROUND

Vasculopathy is the most prevalent complication of diabetes. Endothelial damage, a primary contributor to hyperglycemic vascular complications, impacts macro- and micro-vasculatures, causing functional impairment of multiple organs. SETD7 was initially identified as a transcriptional activator based on its ability to methylate histone 3 lysine 4. However, its function in the context of diabetic endothelial dysfunction remains poorly understood. This study aims to elucidate the involvement and underlying mechanisms of SETD7 in diabetic endothelial dysfunction.

METHODS

SETD7 knockout mice were generated to investigate the effects of SETD7 on Streptozotocin (STZ)-induced hyperglycemia and vascular endothelial injury. Endothelial-specific SETD7 interruption adeno-associated virus (AAV) system was utilized to investigate the effects of SETD7 on diabetic vascular endothelial injury in BKS-DB(Lepr) KO/KO (db/db) mice. In vitro manipulation of SETD7 activation or knockdown was conducted to assess its regulation on the lipid peroxidation, oxidative stress, and cell function of primary rat aortic endothelial cells (RAECs) under high glucose conditions.

RESULTS

Our study revealed that knockout and endothelial deficiency of SETD7 partially restored damaged vascular function and attenuated the inflammatory response caused by high glucose in both STZ-induced and db/db mice. Moreover, SETD7 activation aggravated oxidative stress injury and resulted in profound dysfunction through Glutathione Peroxidase 4 (GPX4)-mediated lipid peroxidation in RAECs. Mechanistically, SETD7 deficiency reduced p53 mono-methylation and blocked FBXO45 transcription, thereby inhibiting the protein degradation of GPX4 and subsequent lipid peroxidation as well as oxidative stress.

CONCLUSIONS

In summary, our study demonstrates that SETD7-p53-FBXO45-GPX4 is involved in high glucose-induced oxidative stress injury and exacerbated endothelial dysfunction, which offering great significance for mitigating hyperglycemia-induced endothelial damage.

Association of stress hyperglycemia ratio with short-term and long-term prognosis in patients undergoing coronary artery bypass grafting across different glucose metabolism states: a large-scale cohort study

BACKGROUND

Stress hyperglycemia ratio (SHR) is recognized as a reliable indicator of acute hyperglycemia during stress. Patients undergoing coronary artery bypass grafting (CABG) are at high risk of stress hyperglycemia, but little attention has been paid to this population. This study is the first to investigate the association between SHR and both short-term and long-term prognosis in CABG patients, with a further exploration of the impact of SHR across different glucose metabolic states.

METHODS

A total of 18,307 patients undergoing isolated CABG were consecutively enrolled and categorized into three groups based on SHR tertiles. The perioperative outcome was defined as a composite of in-hospital death, myocardial infarction, cerebrovascular accident, and reoperation during hospitalization. The long-term outcome was major adverse cardiovascular and cerebrovascular events (MACCEs). Restricted cubic spline and logistic regression linked SHR to perioperative risks. Kaplan-Meier and Cox regression analyses were used to determine the relationship with long-term prognosis. Subgroup analyses were further conducted based on different glucose metabolic states.

RESULTS

A U-shaped association was observed between SHR and perioperative outcome in the overall population (P for nonlinear < 0.001). As SHR increased, the risk of perioperative events initially decreased (OR per SD: 0.87, 95% CI 0.79-0.97, P = 0.013) and then elevated (OR per SD: 1.16, 95% CI 1.04-1.28, P =  0.004), with an inflection point at 0.79. A similar U-shaped pattern was identified in patients with normal glucose regulation. Among those with prediabetes, the association was J-shaped, while in patients with diabetes, the association became nonsignificant when SHR exceeded 0.76. Adding SHR to the existing risk model improved the predictive performance for perioperative outcomes in the overall population (AUC: 0.720 → 0.752, P < 0.001; NRI: 0.036, P =  0.003; IDI: 0.015, P < 0.001). For long-term outcomes, the risk of events was monotonically elevated with increasing SHR, regardless of glucose metabolic status. The third tertile showed a 10.7% greater risk of MACCEs (HR: 1.107, 95% CI 1.023-1.231, P =  0.024).

CONCLUSIONS

SHR was significantly associated with prognosis in CABG patients, demonstrating a non-linear U-shaped relationship with short-term outcomes and a linear positive association with long-term outcomes. The in-hospital risk associated with SHR was attenuated in patients with diabetes.

RESEARCH INSIGHTS

WHAT IS CURRENTLY KNOWN ABOUT THIS TOPIC?: Stress hyperglycemia is common during the perioperative period in CABG patients and is linked to adverse short- and long-term outcomes. The stress hyperglycemia ratio (SHR) is a novel metric that accounts for baseline glycemia to better reflect acute stress-induced hyperglycemia. However, SHR has not been studied in the CABG population. WHAT IS THE KEY RESEARCH QUESTION?: This study is the first to investigate the association between SHR and both short-term and long-term prognosis in patients undergoing CABG, while further exploring its impact across different glucose metabolic states, categorized as normal glucose regulation, prediabetes, and diabetes. WHAT IS NEW?: In CABG patients, SHR shows a U-shaped relationship with perioperative events and a linear positive association with long-term outcomes, both of which are modulated by glucose metabolic status. HOW MIGHT THIS STUDYINFLUENCE CLINICAL PRACTICE?: Findings support the incorporation of SHR for risk stratification and personalized glucose management in CABG patients, ultimately improving both in-hospital and long-term prognosis.

A Systematic Review of risk factors for major adverse cardiovascular events in patients with coronary heart disease who underwent percutaneous coronary intervention

Objective

This study aims to systematically review the risk factors for major adverse cardiovascular events (MACE) in patients with coronary heart disease who have undergone percutaneous coronary intervention (PCI).

Design

Systematic review and meta-analysis.

Data sources

The Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database for Chinese Technical Periodicals (VIP) were screened until December 2024.

Eligibility criteria for selecting studies

Case-control studies or cohort studies on the risk factors for MACE in patients with coronary heart disease who underwent PCI. Data extraction and synthesis: The literature review, data extraction, and quality evaluation were conducted by two independent researchers, and the meta-analysis was performed using RevMan 5.4 software.

Main outcomes

The main outcome was that MACE occurred during the follow-up period.

Results

A total of 40 articles were included. The meta-analysis erevealed that dyslipidemia (OR = 1.50; 95% CI [1.19, 1.89], p = 0.0007), diabetes mellitus (OR = 1.70; 95% CI [1.43, 2.02], p < 0.00001), hypertension (OR = 1.62; 95% CI [1.35, 1.96], p < 0.0001), history of smoking (OR = 2.08; 95% CI [1.51, 2.85], p < 0.0001), poorer ventricular function (OR = 2.39; 95% CI [2.17-2.64], p < 0.0001), impaired left ventricular ejection fraction (LVEF) (OR = 1.86; 95% CI [1.71-2.03], p < 0.0001), door to balloon (D-to-B) time (OR = 0.61; 95% CI [0.42-0.88]; p = 0.009), thrombolysis in myocardial infarction (TIMI) (OR = 1.41; 95% CI [1.17, 1.70], p = 0.0004), renal dysfunction (OR = 1.82; 95% CI [1.37, 2.43], p < 0.0001), and multi-vessel coronary artery disease (OR = 0.41; 95% CI [0.37, 0.46], p < 0.0001) were significantly associated with MACE after PCI.

Conclusion

The independent risk factors of MACE after PCI are dyslipidemia, hypertension, diabetes mellitus, smoking history, Killip class > II, LVEF ≤40%, D-to-B time >90 min, TIMI flow grade ≤ II, renal insufficiency, and multivessel disease.

Evaluation of Middle Cerebral Artery Culprit Plaque Inflammation in Ischemic Stroke Using CAIPIRINHA-Dixon-TWIST Dynamic Contrast-Enhanced Magnetic Resonance Imaging

BACKGROUND

Middle cerebral artery (MCA) plaques are a leading cause of ischemic stroke (IS). Plaque inflammation is crucial for plaque stability and urgently needs quantitative detection.

PURPOSE

To explore the utility of Controlled Aliasing in Parallel Imaging Results in Higher Acceleration (CAIPIRINHA)-Dixon-Time-resolved angiography With Interleaved Stochastic Trajectories (TWIST) (CDT) dynamic contrast-enhanced MRI (DCE-MRI) for evaluating MCA culprit plaque inflammation changes over stroke time and with diabetes mellitus (DM).

STUDY TYPE

Prospective.

POPULATION

Ninety-four patients (51.6 ± 12.23 years, 32 females, 23 DM) with acute IS (AIS; N = 43) and non-acute IS (non-AIS; 14 days < stroke time ≤ 3 months; N = 51).

FIELD STRENGTH/SEQUENCE

3-T, CDT DCE-MRI and three-dimensional (3D) Sampling Perfection with Application optimized Contrast using different flip angle Evolution (3D-SPACE) T1-weighted imaging (T1WI).

ASSESSMENT

Stroke time (from initial IS symptoms to MRI) and DM were registered. For 94 MCA culprit plaques, Ktrans from CDT DCE-MRI and enhancement ratio (ER) from 3D-SPACE T1WI were compared between groups with and without AIS and DM.

STATISTICAL TESTS

Shapiro-Wilk test, Bland-Altman analysis, Passing and Bablok test, independent t-test, Mann-Whitney U test, Chi-squared test, Fisher's exact test, receiver operating characteristics (ROC) with the area under the curve (AUC), DeLong's test, and Spearman rank correlation test with the P-value significance level of 0.05.

RESULTS

Ktrans and ER of MCA culprit plaques were significantly higher in AIS than non-AIS patients (Ktrans = 0.098 s-1 vs. 0.037 s-1; ER = 0.86 vs. 0.55). Ktrans showed better AUC for distinguishing AIS from non-AIS patients (0.87 vs. 0.75) and stronger negative correlation with stroke time than ER (r = -0.60 vs. -0.34). DM patients had significantly higher Ktrans and ER than non-DM patients in IS and AIS groups.

DATA CONCLUSION

Imaging by CDT DCE-MRI may allow to quantitatively evaluate MCA culprit plaques over stroke time and DM.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 2.

Gut Microbiota and Their Metabolites: The Hidden Driver of Diabetic Nephropathy? Unveiling Gut Microbe's Role in DN

BACKGROUND

Diabetic nephropathy (DN) is a severe microvascular complication of diabetes with a complex pathogenesis.

METHODS

Recent studies were reviewed to explore the role of gut microbiota and its metabolites in DN development.

RESULTS

Dysbiosis of gut bacteria contributes to pathological changes such as glomerular sclerosis and renal tubule injury. Microbial metabolites are involved in DN through immune and inflammatory pathways.

CONCLUSIONS

Understanding the relationship between gut microbiota, its metabolites, and DN may offer potential implications for DN diagnosis, prevention, and treatment. Translating this knowledge into clinical practice presents challenges and opportunities.

IRAP Drives Ribosomal Degradation to Refuel Energy for Platelet Activation during Septic Thrombosis

Platelets play crucial roles in multiple pathophysiological processes after energy-dependent activation. It is puzzling how such a small cellular debris has abundant energy supply. In this study, it is shown that insulin-regulated aminopeptidase (IRAP), a type II transmembrane protein, is a key regulator for platelet activation by promoting energy regeneration during septic thrombosis. Through interaction with certain endosome membrane proteins, IRAP can not only promote granule release, but also facilitate lysosomal degradation of theoretically discarded ribosomes in an mTORC1- and S-acylation-dependent manner in activated platelets. Plentiful amino acids obtained from IRAP-mediated ribophagy are recruited to aerobic glycolysis and then promote energy metabolism reprogramming, thereby producing abundant energy for platelet life extension and prolonged activation. Consequently, targeted blocking IRAP can dramatically alleviate platelet hyperactivation and septic thrombosis.

Pathophysiological hallmarks in type 2 diabetes heterogeneity (review)

The mechanistic complexity in type 2 diabetes (T2DM) is primarily responsible for the degrees of heterogeneity and development of complications. A complex mode of interactions between different pathophysiological events and diabetogenic environmental factors support for the genesis of diabetes heterogeneity both in phenotypic and clinical contexts. The currently used diabetes classification strategies suffer from several inconsistencies that cannot fully capture the inherent heterogeneity among the diabetes patients. To effectively address this pathobiological and heterogeneity-related issue in diabetes research, the current review proposes nine pathophysiological hallmarks of T2DM that aims to mechanistically explain complexities of diabetes associated pathophysiological events and their underlying features. These pathophysiological hallmarks are pancreatic beta cell dysfunction, insulin sensitivity, insulin resistance, obesity, aging, subclinical inflammation, metabolic dysregulation, prothrombotic state induction and hypertension. Detail knowledge of these pathophysiological hallmarks with their key molecular mediators, influencing factors, clinical biomarkers and clinical assessment methodologies will greatly support precision medicine approaches in diabetes including patient stratification, subtype diagnosis and treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-024-00783-w.

Impdh1 was identified as a key protein promotes diabetic vasculopathy by intervention of vascular endothelial cell pyroptosis

BACKGROUND

Diabetic angiopathy (DA) is a diabetic vascular complication. Pyroptosis is an inflammatory death that plays an important role in the development of DA, but the underlying mechanisms have not been fully elucidated.

METHODS

The GSE169332 dataset from the Gene Expression Omnibus (GEO) was subjected to single-cell RNA sequencing (scRNA-seq) analysis, and the data of diabetic mice were subjected to bulk RNA-seq. The pathway through which the inflammatory microenvironment participated in the DA was explored by pseudotime analysis and cell-cell communication. DA models were constructed using in vitro mouse models. The histopathological changes in the collected aorta were observed by hematoxylin and eosin (H&E) and Masson staining. The distribution and expression of the phenotypic markers related to pyroptosis in aortic tissues (NLRP3, pro-Caspase1, and GSDMD-N) were observed by immunohistochemistry (IHC) or immunofluorescence (IF) staining. Following the silencing of the expression of high glucose (HG)-induced Impdh1 in endothelial cells (ECs), Impdh1 expression was detected by real-time quantitative reverse transcription PCR (qRT-PCR), and the expression of Impdh1, NLRP3, pro-Caspase1, and GSDMD was detected by IF staining; cell migration was detected by cell scratch assay, cell viability was detected by cell counting kit-8 (CCK-8) assay, and tube formation was detected by tube formation assay; the levels of IL-1β and IL-18 were detected using the enzyme-linked immunosorbent assay (ELISA) kits.

RESULTS

Impdh1 was identified by scRNA-seq and bulk RNA-seq as a key molecule in the progression of DA associated with pyroptosis of aortic ECs. By constructing mouse models of DA, it was found that silencing Impdh1 can inhibit mouse aortic pyroptosis. Silencing of the expression of HG-induced Impdh1 revealed an effective amelioration of EC damage and pyroptosis.

CONCLUSION

Impdh1 is identified as a potential pyroptosis-related gene associated with DA by scRNA-seq of GEO data and bulk RNA-seq. Impdh1 protects aortic ECs by inhibiting pyroptosis and inflammation.

CLINICAL TRIAL NUMBER

Not applicable.

The role of PTP1B in cardiometabolic disorders and endothelial dysfunction

Cardiovascular diseases (CVD) are a global health concern that accounts for a large share of annual mortality. Endothelial dysfunction is the main underlying factor that eventually leads to cardiovascular events. Recent studies have underscored the critical function of Protein Tyrosine Phosphatase 1B (PTP1B) in the onset of endothelial dysfunction, chiefly through its involvement in metabolic diseases such as diabetes, obesity, and leptin resistance. PTP1B attenuates insulin and leptin signalling by dephosphorylating their respective receptors at key tyrosine residues, resulting in resistance-both of which are significant mechanisms underpinning the development of endothelial dysfunction. PTP1B also contributes to the disruption of the endoplasmic reticulum, causing endoplasmic reticulum stress, another molecular driver of endothelial dysfunction. Efforts to inhibit PTP1B activity hold the promise of advancing the prevention and management of CVD and metabolic disorders, as these conditions share common risk factors and underlying cellular mechanisms. Numerous small molecules have been reported as PTP1B inhibitors; however, their progression to advanced clinical trials has been hindered by major challenges such as low selectivity and undesirable side effects. This review provides an in-depth analysis of PTP1B's involvement in metabolic diseases and its interaction with CVD and examines the strategies and challenges related to inhibiting this enzyme.

Insulin resistance and periodontitis: Mediation by blood pressure

AIM

This study investigated the association between the triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, and moderate/severe periodontitis and the role of blood pressure as a mediator in this association. A second aim was to assess the role of cardiometabolic conditions such as obesity, hypertension, and dyslipidemia as potential effect modifiers.

METHODS

Data from 5733 US adults aged 30-64 years and with complete periodontal examination were analyzed (NHANES 2011-2014). Participants were classified as having moderate/severe periodontitis or mild/no periodontitis according to the CDC/AAP criteria as the outcome. The exposure was the TyG index, while both systolic (SBP), and diastolic (DBP) blood pressure were tested as mediators using parametric g-formula. Analyses were adjusted for relevant confounders, namely, age, sex, ethnicity, poverty-income ratio, and smoking, using inverse probability treatment weighting. Obesity status (based on a body mass index ≥30 kg/m2), self-report of hypertension and dyslipidemia (calculated based on the thresholds provided by National Cholesterol Education Program-Adult Treatment Panel-III) were tested as effect modifiers.

RESULTS

The findings showed the TyG index to be associated with increased odds of moderate/severe periodontitis [odds ratio (OR), 95% confidence interval (CI) = 1.17 (1.11-1.23)], with 50% of the total effect mediated by SBP. Stratified analysis showed a stronger association in individuals with obesity, hypertension, and dyslipidemia compared to those without these conditions. However, in those taking anti-hypertensive medications, the association was partially mitigated. Sensitivity analysis using imputed data showed consistent results.

CONCLUSION

The TyG index was associated with increased odds of moderate/severe periodontitis, especially in individuals with obesity, hypertension, and dyslipidemia. SBP levels partially mediated this association.

Assessing Stroke Recurrence Risk by Using a Lipoprotein-Associated Phospholipase A2 and Platelet Count-Based Nomogram

Stroke recurrence remains a critical challenge in clinical neurology, necessitating the identification of reliable predictive markers for better management and treatment strategies. This study investigates the interaction between lipoprotein-associated phospholipase A2 (Lp-PLA2) and platelets as a potential predictor for stroke recurrence, aiming to refine risk assessment and therapeutic approaches. In a retrospective cohort of 580 ischemic stroke patients, we analyzed clinical data with a focus on Lp-PLA2 and platelet levels. By using multivariable logistic regression, we identified independent predictors of stroke recurrence. These predictors were then used to develop a comprehensive nomogram. The study established diabetes mellitus, hypertension, low-density lipoprotein (LDL), Lp-PLA2 levels, and platelet counts as independent predictors of stroke recurrence. Crucially, the interaction parameter Lp-PLA2 * platelet (multiplication of Lp-PLA2 and platelet count) exhibited superior predictive power over each factor considered separately. Our nomogram incorporated diabetes mellitus, cerebral infarction causes, hypertension, LDL, and the Lp-PLA2 * platelet count interaction and demonstrated enhanced accuracy in predicting stroke recurrence compared to traditional risk models. The interaction between Lp-PLA2 and platelets emerged as a significant predictor for stroke recurrence when integrated with traditional risk factors. The developed nomogram offers a novel and practical tool in molecular neurobiology for assessing individual risks, facilitating personalized treatment strategies. This approach underscores the importance of multifactorial assessment in stroke management and opens avenues for targeted interventions to mitigate recurrence risks.

Circulating microRNAs and physical activity: Impact in diabetes

The term "ci-miRNAs," or "circulating microRNAs," refers to extracellular microRNAs (miRNAs) that exist outside of cells and can be detected in various bodily fluids, including blood, saliva, urine, and breast milk. These ci-miRNAs play a role in regulating gene expression and are mainly recognized for their functions beyond the cell, serving as signaling molecules in the blood. Researchers have thoroughly investigated the roles of these circulating miRNAs in various diseases. The capacity to detect and quantify ci-miRNAs in bodily fluids suggests their potential as biomarkers for monitoring several health conditions, including cancer, heart disease, brain disorders, and metabolic disorders, where fluctuations in miRNA levels may correlate with different physiological and pathological states. Current methods enable researchers to identify and measure miRNAs in these fluids, facilitating the exploration of their roles in health maintenance and disease resistance. Although research on ci-miRNAs is ongoing, recent studies focus on uncovering their significance, assessing their viability as biomarkers, and clarifying their functions. However, our understanding of how various types, intensities, and durations of exercise influence the levels of these miRNAs in the bloodstream is still limited. This section seeks to provide an overview of the changes in ci-miRNAs in response to exercise.

Efficacy and Safety of Dual Antiplatelet Treatment up to 72 Hours in Acute Ischemic Stroke Stratified by Glycemic Status

OBJECTIVE

The objective was to investigate the efficacy and safety of clopidogrel-aspirin versus aspirin alone in patients after ischemic stroke by glycemic status using data from the Intensive Statin and Antiplatelet Therapy for Acute High-risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial.

METHODS

Patients with mild ischemic stroke or high-risk transient ischemic attack (TIA) were randomized to clopidogrel-aspirin or aspirin alone. They were categorized into 3 subgroups according to glycemic status based on medical history and diagnosis by a clinician during hospitalization: without type 2 diabetes mellitus, with newly diagnosed type 2 diabetes, and with a history of type 2 diabetes mellitus. The primary efficacy and safety outcomes were new stroke and moderate-to-severe bleeding risk within 90-day follow-up.

RESULTS

A total of 6,100 patients were enrolled (3,050 in each arm), with a median age of 65 years (interquartile range [IQR], 57-71) and 2,185 female (35.8%). Clopidogrel-aspirin treatment was associated with a reduction in recurrent stroke compared with aspirin alone in patients without type 2 diabetes mellitus (6.3% vs 8.4%; hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.59-0.94; p = 0.01) and those with newly diagnosed type 2 diabetes mellitus (5.8% vs 13.0%; HR, 0.30; 95% CI, 0.14-0.66; p = 0.002), but not in those with a history of type 2 diabetes mellitus (10.0% vs 9.9%; HR, 0.98; 95% CI, 0.72-1.33; p = 0.88) (p for interaction = 0.03). Moderate-to-severe bleeding events did not differ significantly by treatment across glycemic subgroups.

INTERPRETATION

In the INSPIRES trial, patients without or with type 2 diabetes mellitus derived greater benefit from clopidogrel-aspirin than those with a history of type 2 diabetes mellitus after mild ischemic stroke or high-risk TIA.

TRIAL REGISTRATION

INSPIRES, NCT03635749. Registered 15 August 2018, https://clinicaltrials.gov/search?cond=NCT03635749. ANN NEUROL 2025.

Pathogenesis of cardiovascular diseases: effects of mitochondrial CF6 on endothelial cell function

Cardiovascular disease (CVD) stands as a predominant global cause of morbidity and mortality, necessitating effective and cost-efficient therapies for cardiovascular risk reduction. Mitochondrial coupling factor 6 (CF6), identified as a novel proatherogenic peptide, emerges as a significant risk factor in endothelial dysfunction development, correlating with CVD severity. CF6 expression can be heightened by CVD risk factors like mechanical force, hypoxia, or high glucose stimuli through the NF-κB pathway. Many studies have explored the CF6-CVD relationship, revealing elevated plasma CF6 levels in essential hypertension, atherosclerotic cardiovascular disease (ASCVD), stroke, and preeclampsia patients. CF6 acts as a vasoactive and proatherogenic peptide in CVD, inducing intracellular acidosis in vascular endothelial cells, inhibiting nitric oxide (NO) and prostacyclin generation, increasing blood pressure, and producing proatherogenic molecules, significantly contributing to CVD development. CF6 induces an imbalance in endothelium-dependent factors, including NO, prostacyclin, and asymmetric dimethylarginine (ADMA), promoting vasoconstriction, vascular remodeling, thrombosis, and insulin resistance, possibly via C-src Ca2+ and PRMT-1/DDAH-2-ADMA-NO pathways. This review offers a comprehensive exploration of CF6 in the context of CVD, providing mechanistic insights into its role in processes impacting CVD, with a focus on CF6 functions, intracellular signaling, and regulatory mechanisms in vascular endothelial cells.

Immature Platelet Fraction and Other Platelet Indices in Type 2 Diabetes Mellitus

BACKGROUND

Diabetes mellitus (DM) has become a significant global health concern, with its associated complications imposing a substantial burden on healthcare systems worldwide. While it is widely recognized as a complex metabolic disorder, the understanding of its pathophysiology continues to evolve, leading to the identification of various diabetes subtypes and their diverse clinical presentations. Despite extensive research, the impact of diabetes on platelet function remains a lesser explored domain.

METHODS

We conducted a case-control study to investigate the variation of platelet indices in individuals with type 2 diabetes mellitus (T2DM) compared to healthy controls. Our study, conducted at a tertiary care facility in the national capital region, aimed to identify potential prognostic markers and explore the utility of platelet indices in predicting diabetic complications. A total of 230 participants, including 115 T2DM cases and 115 age and sex-matched healthy controls, were enrolled in the study. Baseline investigations, including hemogram and platelet indices, were performed and statistical analyses were conducted to compare the results between the two groups.

RESULTS

 Significant differences were found in platelet parameters between T2DM cases and controls, with elevated levels observed in individuals with T2DM. Immature platelet fraction (IPF), mean platelet volume, plateletcrit, platelet distribution width, platelet large cell count, and platelet large cell ratio were among the parameters that were significantly elevated in individuals with T2DM. Furthermore, IPF emerged as a promising biomarker, demonstrating excellent diagnostic performance with an area under the ROC curve of 0.941. A cutoff value of IPF (%) ≥9.6 showed high sensitivity (86%) and specificity (95%) in distinguishing T2DM cases from controls.

CONCLUSION

Our study provides novel insights into the relationship between platelet indices and T2DM, highlighting the potential utility of IPF as a prognostic marker in diabetic individuals. These findings warrant further investigation in larger cohorts and prospective studies to validate the proposed cutoff values and explore their clinical and therapeutic implications in the management of T2DM and delaying its complications.

The Influence of Lifestyle Modifications on Cardiovascular Outcomes in Older Adults: Findings from a Cross-Sectional Study

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among older adults. Lifestyle modifications, including diet, physical activity, and smoking cessation, are key to reducing cardiovascular risk. This study examines the combined effects of these behaviors on cardiovascular outcomes and their mediating mechanisms. Methods: A cross-sectional study was conducted among older adults (aged ≥ 60 years) in Riyadh, Saudi Arabia. Data on dietary quality, physical activity, and smoking status were collected using validated questionnaires. Cardiovascular outcomes, including low-density lipoprotein cholesterol (LDL), systolic blood pressure (SBP), and body mass index (BMI), were measured. A composite cardiovascular risk score was computed. Path analysis was employed to assess direct and indirect effects of lifestyle factors on cardiovascular outcomes. Results: Participants adhering to a healthy diet, engaging in regular physical activity, and avoiding smoking had significantly lower composite cardiovascular risk scores. Non-smoking status showed the strongest direct effect (β = -0.20, p = 0.006), while dietary quality and physical activity exhibited significant indirect effects mediated by LDL, SBP, and BMI. Combined adherence to multiple healthy behaviors resulted in the greatest reductions in cardiovascular risk. The path analysis highlighted dietary quality and physical activity as critical mediators of cardiovascular health improvements. Conclusions: Lifestyle modifications significantly reduce cardiovascular risk in older adults, with cumulative benefits observed for combined adherence to healthy behaviors. These findings emphasize the importance of comprehensive lifestyle interventions targeting diet, physical activity, and smoking cessation to promote cardiovascular health in aging populations.

Oxidative Stress and Cardiovascular Complications in Type 2 Diabetes: From Pathophysiology to Lifestyle Modifications

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that significantly increases the risk of cardiovascular disease, which is the leading cause of morbidity and mortality among diabetic patients. A central pathophysiological mechanism linking T2DM to cardiovascular complications is oxidative stress, defined as an imbalance between reactive oxygen species (ROS) production and the body's antioxidant defenses. Hyperglycemia in T2DM promotes oxidative stress through various pathways, including the formation of advanced glycation end products, the activation of protein kinase C, mitochondrial dysfunction, and the polyol pathway. These processes enhance ROS generation, leading to endothelial dysfunction, vascular inflammation, and the exacerbation of cardiovascular damage. Additionally, oxidative stress disrupts nitric oxide signaling, impairing vasodilation and promoting vasoconstriction, which contributes to vascular complications. This review explores the molecular mechanisms by which oxidative stress contributes to the pathogenesis of cardiovascular disease in T2DM. It also examines the potential of lifestyle modifications, such as dietary changes and physical activity, in reducing oxidative stress and mitigating cardiovascular risks in this high-risk population. Understanding these mechanisms is critical for developing targeted therapeutic strategies to improve cardiovascular outcomes in diabetic patients.

Hyperactivity and Pro-inflammatory Functions of Platelets in Diabetes

Cardiovascular complications claim the lives of up to 70% of patients with diabetes mellitus (DM). The mechanisms increasing cardiovascular risk in DM remain to be fully understood and successfully addressed. Nonetheless, there is increasing evidence in the scientific literature of the participation of platelets in the cardiovascular complications of DM. Multiple reports describe the hyperactivity of platelets in DM and their participation in inflammatory responses. The understanding of the mechanisms underlying the contribution of platelets to cardiovascular pathologies in DM will help the development of targeted therapeutic strategies able to reduce cardiovascular risk in these patients. In this literature review, we summarise our current understanding of the molecular mechanisms leading to the contribution of platelets to cardiovascular risk in DM. Both platelet haemostatic activity leading to thrombus formation and their participation to inflammatory processes are stimulated by the biochemical conditions associated with DM. We also present evidence on how DM affect the efficacy of existing therapeutic treatments for thrombosis and, by converse, how antidiabetic drugs may affect platelet function and the haemostasis/thrombosis balance. Taken together, the growing evidence of the different and unexpected roles of platelets in the progression of DM provides a strong rationale for the design of cardiovascular drugs targeting specifically platelets, their pro-inflammatory activity and their activation mechanisms in this disease. Overall, this article provides an important up-to-date overview of the pathophysiological alterations of platelets in DM, which need to be taken into account for the effective management of cardiovascular health in this disease.

Type 2 diabetes prediction method based on dual-teacher knowledge distillation and feature enhancement

Diabetes prediction is an important topic in the field of medical health. Accurate prediction can help early intervention and reduce patients' health risks and medical costs. This paper proposes a data preprocessing method, including removing outliers, filling missing values, and using sparse autoencoder (SAE) feature enhancement. This study proposes a new method for type 2 diabetes classification using a dual Convolutional Neural Network (CNN) teacher-student distillation model (DCTSD-Model), aiming to improve the accuracy and reliability of diabetes prediction. The variables of the original data are expanded by SAE to enhance the expressive power of the features. The proposed CNN and DCTSD-Model models are evaluated on the feature enhancement dataset using 10-fold cross validation. The experimental results show that after data preprocessing, DCTSD-Model adopts the dual teacher model knowledge distillation method to help the student model learn rich category information by generating soft labels, and uses weighted random samplers to learn samples of different categories, which solves the category imbalance problem and achieves excellent classification performance. The accuracy of DCTSD-Model on the classification task reached 98.57%, which is significantly higher than other models, showing higher classification ability and reliability. This method provides an effective solution for diabetes prediction and lays a solid foundation for further research and application.

Dual Antiplatelet Treatment up to 72 Hours After Ischemic Stroke Stratified by Risk Profile: A Post Hoc Analysis

BACKGROUND

Risk profile of recurrence may influence the effect of antiplatelet therapy. This study aimed to evaluate the efficacy and safety of clopidogrel-aspirin initiated within 72 hours after symptom onset for acute mild stroke or high-risk transient ischemic attack stratified by risk profile.

METHODS

This is a secondary post hoc analysis of the INSPIRES (Intensive Statin and Antiplatelet Therapy for Acute High-risk Intracranial or Extracranial Atherosclerosis) randomized clinical trial that enrolled patients 35 to 80 years old with acute mild ischemic stroke or high-risk transient ischemic attack between 2018 and 2022. Patients were stratified into different groups based on the Essen Stroke Risk Score (ESRS) and modified ESRS. The primary efficacy outcome was any new stroke within 90 days. The primary safety outcome was moderate-to-severe bleeding within 90 days.

RESULTS

Among 6100 patients (3050 each in the clopidogrel-aspirin group and aspirin group), the median age was 65 years (interquartile range, 57-71 years), and 3915 (64.2%) were male. Clopidogrel-aspirin was associated with a reduced risk of new stroke in patients with an ESRS of <3 (hazard ratio [HR], 0.67 [95% CI, 0.52-0.86]), but not in those with an ESRS of ≥3 (HR, 0.92 [95% CI, 0.72-1.18]), compared with aspirin (Pinteraction=0.07). Similar results were found in patients stratified by modified ESRS (modified ESRS <6 in male and <5 in female: HR, 0.68 [95% CI, 0.55-0.83]; modified ESRS ≥6 in male and ≥5 in female: HR, 1.14 [95% CI, 0.82-1.59]; Pinteraction=0.01). The association between antiplatelet therapy and the moderate-to-severe bleeding did not differ across risk profile subgroups (ESRS of <3: HR, 1.35 [95% CI, 0.54-3.35]; ESRS of ≥3: HR, 3.21 [95% CI, 1.18-8.78]; Pinteraction=0.21; modified ESRS of <6 in male and <5 in female: HR, 1.96 [95% CI, 0.88-4.36]; modified ESRS of ≥6 in male and ≥5 in female: HR, 2.27 [95% CI, 0.70-7.39]; Pinteraction=0.85).

CONCLUSIONS

This post hoc analysis of the INSPIRES trial showed that patients with a low level of risk profile assessed by ESRS received greater benefit from clopidogrel-aspirin initiated within 72 hours after symptom onset than aspirin alone.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03635749.

The Influence of Diabetes on Thrombotic Profiles and Outcomes on Patients with Peripheral Artery Disease

BACKGROUND

Elevated glycated hemoglobin (HbA1c) is associated with vascular complications, including arterial thrombosis postrevascularization. However, the objective relationship between levels of HbA1c and coagulation profiles has not been established. This study aims to determine the association between specific coagulation parameters and variations in HbA1c in patients undergoing lower extremity revascularization.

METHODS

Patients with peripheral artery disease undergoing revascularization were prospectively evaluated between December 2020 and July 2023. Patients were categorized based on their HbA1c levels, and their thromboelastography with platelet mapping (TEG-PM) results were compared at baseline, postoperative day 1, 1 month, 3 months and 6 months. The parameters included Maximum Amplitude (MA) with both adenosine diphosphate (ADP) and arachidonic acid (AA), as well as ADP and AA percent aggregation indicating clot strength. The study further assessed the differences in these parameters between groups with varying HbA1c levels through the use of unpaired Student's t-test for pairwise analysis and Mann-Whitney U tests.

RESULTS

Among 830 samples, those with HbA1c above 6.5 demonstrated a significant increase in ADP MA (52.6 vs. 43.5, P < 0.01), AA MA (36.6 vs. 29.65, P < 0.05), clot strength without platelets activator F MA (13.10 vs. 10.80, P < 0.01), and heparin-neutralized uninhibited clot strength from thrombin activation heparinized kaolin with heparinase MA (61.10 vs. 57.70, P < 0.01) values at baseline. Postoperatively, patients with HbA1c levels greater than 6.5 had higher median functional fibrinogen citrated functional fibrinogen levels (40.95 vs. 371.35, P < 0.05) and higher formation of fibrin in response to stimulation of thrombin by tissue factor citrated functional fibrinogen MA values (22.90 vs. 20.40, P < 0.05) when measured within 36 hrs of intervention, with these trends staying consistent during the 1-month follow-up visit. The trend analysis revealed a progressive increase in ADP MA values with rising HbA1c values, indicating a unit increase in the thrombotic risk relationship. Regression analysis showed a positive relationship between HbA1c and both ADP MA (a 2.261-unit increase for each unit increase in HbA1c) and AA MA. The R-square values indicate that HbA1c only explains a small percentage of the variance in these parameters, suggesting the confounding influence of other factors contributing to thrombosis.

CONCLUSIONS

Elevated HbA1c levels appear to be associated with prothrombotic tendencies in clot dynamics as measured by thromboelastography with platelet mapping, particularly in parameters related to platelet function. HbA1c explains a limited proportion of the variability in these measures, emphasizing the need for a comprehensive approach to evaluating clotting profiles in patients. This study lays the groundwork for further investigation into personalized antithrombotic strategies for patients with varying HbA1c levels.

Gender differences in the association between insulin resistance assessed by estimated glucose disposal rate and the risk of all-cause and cardiovascular deaths in adults without diabetes

AIM

We intended to examine the relationship between estimated glucose disposal rate (eGDR) and risks of all-cause and cardiovascular deaths in non-diabetic adults.

METHODS

38,175 participants from the National Health and Nutrition Examination Survey (1999-2018) were included, and deaths were identified through the National Death Index.

RESULTS

With a median follow-up of 9.8 years, we found that dose-response relationships between eGDR level and the risk of death differed between genders. In female participants, higher eGDR level was linearly correlated with lower risks of all-cause and cardiovascular deaths. In contrast, among male participants, there were L-shaped relationships between eGDR and risks of all-cause and cardiovascular deaths, with threshold points of 8.50 and 8.49 mg/kg/min, respectively. To the left of threshold points, eGDR was negatively linked with risks of all-cause (HR 0.91, 95 % CI 0.88-0.94, P < 0.001) and cardiovascular deaths (HR 0.87, 95 % CI 0.82-0.93, P < 0.001). After the inflection point, an increase in eGDR was not related to lower risks of all-cause and cardiovascular deaths (P > 0.05).

CONCLUSION

Higher eGDR level was associated with lower risks of all-cause and cardiovascular deaths in a linear dose-response manner among non-diabetic females, while L-shaped relationships were observed among non-diabetic males.

Key biomarkers in type 2 diabetes patients: A systematic review

Type 2 diabetes mellitus (T2DM) is not just a local health issue but a significant global health burden, affecting patient outcomes and clinical management worldwide. Despite the wealth of studies reporting T2DM biomarkers, there is an urgent need for a comparative review. This review aims to provide a comprehensive analysis based on the reported T2DM biomarkers and how these are linked with other conditions, such as inflammation and wound healing. A comparative review was conducted on 24 001 study participants, including 10 024 T2DM patients and 13 977 controls (CTL; age 30-90 years). Four main profiles were extracted and analysed from the clinical reports over the past 11 years: haematological (1084 cases vs. 1458 CTL), protein (6753 cases vs. 9613 CTL), cytokine (975 cases vs. 1350 CTL) and lipid (1212 cases vs. 1556 CTL). This review provides a detailed analysis of the haematological profile in T2DM patients, highlighting fundamental changes such as increased white blood cells and platelet counts, accompanied by decreases in red blood cell counts and iron absorption. In the serum protein profile, a reduction in albumin and anti-inflammatory cytokines was noted along with an increase in globulin levels and pro-inflammatory cytokines. Furthermore, changes in lipid profiles were discussed, specifically the decreases in high-density lipoprotein (HDL) and the increases in low-density lipoprotein (LDL) and triglycerides. Understanding the changes in these four biomarker profiles is essential for developing innovative strategies to create diagnostic and prognostic tools for diabetes management.

Clinical Predictors of Aspirin Resistance in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

Background

Aspirin treatment is recommended as a secondary prevention strategy and could be a potential primary prevention strategy for cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). However, aspirin resistance is notably common among diabetic patients, compromising the efficacy of aspirin treatment. Hence, our study sought to assess the clinical predictors of aspirin resistance (AR) in T2DM patients.

Methods

We conducted a systematic search of three major medical databases (PubMed, Embase, and Cochrane Library) to identify relevant articles up to September 17, 2024. Details of publications and investigated parameters were extracted from the selected studies. The meta package in the R language software was utilized to synthesize the evidence concerning clinical predictors of AR. We applied either a fixed- or random effects model based on the heterogeneity observed among the included studies. The pooled results were visually displayed using forest plots.

Results

In total, 10 publications were finally included in our study (n = 2113 patients). AR was predominantly linked to specific laboratory parameters, particularly those indicative of heightened insulin resistance and inadequate lipid management. Specifically, the laboratory parameters associated with AR included fasting glucose level (mean difference (MD) = 8.21; 95% confidence interval (CI) = 2.55 to 13.88), glycated hemoglobin (MD = 0.22; 95% CI = 0.06 to 0.38), high-density lipoprotein (HDL) level (MD = -2.02; 95% CI = -3.62 to -0.42), low-density lipoprotein (LDL) level (MD = 7.00; 95% CI = 2.87 to 11.13), total cholesterol level (MD = 9.52; 95% CI = 4.37 to 14.67), and triglyceride levels (MD = 12.51; 95% CI = 3.47 to 21.55).

Conclusions

Markers associated with dyslipidemia and blood glucose levels are robust indicators of AR in individuals with T2DM. These findings imply that assessing lipid and glucose regulation could enhance the development of personalized preventive approaches for vascular complications linked to diabetes.

The PROSPERO registration

CRD42023388170, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=388170.

Effect of aspirin on platelet-rich plasma of diabetes mellitus with lower extremity atherosclerosis

Aim: Platelet-rich plasma (PRP), enriched with multiple growth factors, is a promising adjunctive therapy for diabetic foot ulcers (DFUs). As a classic anti-platelet drug for diabetic patients, the effects of aspirin on the content of growth factors in PRP remains unclear.Methods: Our study enrolled diabetic patients who were currently taking or not taking aspirin as the research subjects, with healthy volunteers as the control. PRP from these individuals was activated with glucose calcium and thrombin. Growth factors levels in PRP activated supernatant (PRP-AS) and wound healing ability of platelet gel (PG) in the full-thickness skin defect diabetic mouse model were compared.Results: We found the level of growth factors in PRP-AS derived from two groups of diabetic patients were not statistically different, whereas both lower than that from healthy volunteers. Similarly, we found better wound healing ability of PG from healthy volunteers than those from diabetic patients, but no difference between the two groups of diabetic patients in the mouse model.Discussion: Aspirin does not interfere with autologous PRP therapy when using calcium gluconate and thrombin as agonists. However considering the content of growth factors, PRP from healthy volunteers is a preferable option for promoting DFU repair.

[Gly14]-Humanin ameliorates high glucose-induced endothelial senescence via SIRT6

High glucose (HG) induced endothelial senescence is related to endothelial dysfunction and cardiovascular complications in diabetic patients. Humanin, a member of mitochondrial derived peptides (MDPs), is thought to contribute to aging-related cardiovascular protection. The goal of the study is to explore the pathogenesis of HG-induced endothelial senescence and potential anti-senescent effects of Humanin. Human umbilical vein endothelial cells (HUVECs) were exposed to glucose to induce senescence, determined by β-galactosidase staining and the expressions of p21, p53, and p16. A clinically relevant dose of HG (15 mM, HG) induced endothelial senescence after 72 h incubation without elevated apoptosis. HG-induced senescence was attributed to the induction of reactive oxygen species (ROS) caused by SIRT6 downregulation, as ROS inhibitor N-acetyl cysteine blocked HG-induced senescence, while inactivation of SIRT6 increased ROS levels and promoted senescence. Strikingly. pretreatment with [Gly14]-Humanin (HNG) antagonized the downregulation of SIRT6 in response to HG and alleviated ROS production and cell senescence. HG-induced reduction of SIRT6 results in ROS overproduction and endothelial senescence. Humanin protects against HG-induced endothelial senescence via SIRT6. This study provides new directions for biological products related to Humanin to be a potential candidate for the prevention of vascular aging in diabetes.

Brachial-Ankle Pulse Wave Velocity as a Predictor of Diabetes Development: Elevated Risk Within Normal Range Values in a Low-Risk Population

BACKGROUND

Recent studies have suggested that increased brachial-ankle pulse wave velocity (baPWV) is a risk factor for diabetes. Exploring its relationship with insulin resistance is of interest, necessitating further studies across different sexes and age groups.

METHODS AND RESULTS

This cohort study involved 119 170 Korean adults with an average age of 39.8 years, none of whom had diabetes at baseline. As part of a health screening, baPWV measurements were taken. Over a median follow-up period of 5.6 years, fasting blood glucose, glycated hemoglobin, insulin levels, and questionnaire responses were collected. The risk of developing diabetes was evaluated using a flexible parametric proportional hazards model with data stratified by sex and age group (<40 versus ≥40 years). During the follow-up period, diabetes was diagnosed in 5966 participants (5.0%). A fully adjusted model found that the hazard ratios for diabetes onset associated with baPWV quartiles Q2 (1171.0-1270.5 cm/s), Q3 (1271.0-1376.0 cm/s), and Q4 (≥1376.5 cm/s) compared with Q1 (<1171.0 cm/s) were 1.06 (95% CI, 0.96-1.17), 1.25 (1.14-1.38), and 1.48 (1.34-1.62), respectively (P for trend <0.001). A significant sex-based interaction was noted in this association, with women showing a higher risk of diabetes development. Furthermore, higher baPWV quartiles were associated with an increased risk of developing insulin resistance, defined as the homeostatic model assessment of insulin resistance.

CONCLUSIONS

These findings highlight the importance of arterial stiffness, as measured by elevated baPWV, in the development of diabetes and insulin resistance. Notably, this study highlighted a strong association, particularly among women.

Exploring the Molecular Link Between Diabetes and Erectile Dysfunction Through Single-Cell Transcriptome Analysis

Erectile dysfunction (ED) is a pathophysiological condition in which the patients cannot achieve an erection during sexual activity, and it is often overlooked yet prevalent among diabetic men, globally affecting approximately 35-75% of diabetic individuals. The precise mechanisms through which diabetes contributes to ED remain elusive, but the existing literature suggests the potential involvement of nerve and vascular damage that affects the penile supply. In the present review, we reanalyze the existing human single-cell transcriptomic data from patients having diabetes mellitus-associated ED with normal erections. The analysis validates the expression of genes associated with antioxidative pathways, growth factors, adipokines, angiogenesis, vascular functions, penile erection, sexual function, and inflammation in diverse cell types from healthy individuals and those with ED. Our transcriptomic analysis reveals alterations in the expression of adiponectin receptors in the pathogenesis of ED compared to their counterparts in healthy subjects. This comprehensive review sheds light on the molecular underpinnings of ED in the context of diabetes, providing an in-depth understanding of the biological and cellular alterations involved and paving the way for possible targeted therapeutic discoveries in the field of diabetes-associated male infertility.

Effect of Chromium Supplementation on Serum Levels of Inflammatory Mediators: An Updated Systematic Review and Meta-analysis on Randomized Clinical Trials

Chromium has been recognized for its beneficial effects on inflammation reduction; therefore, we conducted a systematic review and meta-analysis to find the effect of chromium supplementation on serum levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) in subjects aged 18 years and older. Related articles were identified by searching databases such as the Cochrane Library, ClinicalTrials.gov, ISI Web of Science, Scopus, and PubMed up until Agust 2024. We computed the mean differences (MD) along with their standard deviations (SDs) to carry out the meta-analysis. Statistical heterogeneity of the intervention effects was assessed using I-squared statistics and Cochran's Q test. In total, twelve and eleven studies were included in the present systematic review and meta-analysis, respectively. The pooled results indicated that the differences in serum levels of CRP and TNF-α between chromium group and the comparison group were statistically significant (CRP: weighted mean difference (WMD) = -0.58 mg/L; 95% confidence interval (CI) = -0.95, -0.22 mg/L; P = 0.002; TNF-α: WMD = -1.22 pg/ml; 95% CI = -1.91, -0.53 pg/ml; p = 0.001). In contrast, chromium supplementation resulted in a non-significant decrease in serum levels of IL-6 (WMD = -0.63 pg/ml; 95% CI: -1.67, 0.4 pg/ml; P < 0.001). Our study supports the beneficial effect of chromium supplementation on serum concentration of CRP and TNF-α, but our results showed that chromium supplementation non-significantly reduced the serum levels of IL-6. However, it seems that chromium formulation, participants' BMI, sample size, and geographical region are strong variables that predict the effect of chromium supplementation on inflammatory mediators.

Recent Developments in Drug Design of Oral Synthetic Free Fatty Acid Receptor 1 Agonists

Over the past two decades, synthetic FFAR1 agonists such as TAK-875 and TSL1806 have undergone meticulous design and extensive clinical trials. However, due to issues primarily related to hepatotoxicity, no FFAR1 agonist has yet received regulatory approval. Research into the sources of hepatotoxicity suggests that one potential cause lies in the molecular structure itself. These structures typically feature lipid-like carboxylic acid head groups, which tend to generate toxic metabolites. Strategies to mitigate these risks focus on optimizing chemical groups to reduce lipophilicity and prevent the formation of reactive metabolites. Recent studies have concentrated on developing low-molecular-weight compounds that more closely resemble natural products, with CPL207280 showing promising potential and liver safety, currently in Phase II clinical trials. Moreover, ongoing research continues to explore the potential applications of FFAR1 agonists in diabetes management, as well as in conditions such as non-alcoholic fatty liver disease (NAFLD) and cerebrovascular diseases. Utilizing advanced technologies such as artificial intelligence and computer-aided design, the development of compact molecules that mimic natural structures represents a hopeful direction for future research and development.

Molecular Links and Clinical Effects of Inflammation and Metabolic Background on Ischemic Stroke: An Update Review

Stroke is a major global health concern, with 12.2 million new cases and 6.6 million deaths reported in 2019, making it the second leading cause of death and third leading cause of disability worldwide. Ischemic stroke, caused by blood vessel occlusion, accounts for 87% of stroke cases and results in neuronal death due to oxygen and nutrient deprivation. The rising global stroke burden is linked to aging populations and increased metabolic risk factors like high blood pressure, obesity, and elevated glucose levels, which promote chronic inflammation. This article explores the intricate molecular and clinical interplay between inflammation and metabolic disorders, emphasizing their role in ischemic stroke development, progression, and outcomes.

Downregulation of miR-25-3p and Its Impact on PTAFR and IGF2BP3 Expression in Type 2 Diabetes Mellitus: Implications for Biomarker Discovery and Disease Pathogenesis

Background

This study is designed to investigate the differential microRNA (miRNA) expression profiles in individuals with and without type 2 diabetes mellitus (T2DM). The focus is on miRNAs that play a crucial role in the onset and progression of T2DM, particularly in glucose metabolism, inflammation, platelet reactivity, and endothelial dysfunction.

Methods

Twenty samples were categorized into groups of T2DM and non-T2DM, and miRNA profiling was conducted using microarray analysis. The expression levels of the candidate miR-25-3p, as well as its target genes platelet-activating factor receptor (PTAFR) and insulin-like growth factor 2 mRNA binding protein 3 (IGF2BP3), were validated using quantitative polymerase chain reaction (qPCR).

Results

The present study revealed a significant reduction in the level of miR-25-3p in the T2DM group compared to the non-T2DM group. This suggests higher levels of PTAFR and IGF2BP3 in individuals with T2DM, indicating a potential biomarker for the condition.

Conclusions

The downregulation of miR-25-3p, which is associated with increased PTAFR levels, may contribute to heightened platelet reactivity and inflammation, worsening endothelial dysfunction, and potentially influencing vascular complications in diabetes. Additionally, the upregulation of IGF2BP3 is correlated with insulin resistance and β-cell dysfunction, which may contribute to elevated hyperglycemia and hyperinsulinemia, further aggravating the progression of diabetes. These findings highlight the potential of miR-25-3p and IGF2BP3 as biomarkers for T2DM and suggest their possible relevance for improving diagnosis and treatment strategies.

Evaluation of Triglyceride Glucose Index in Patients with Patent Foramen Ovale Who Experienced Cryptogenic Stroke

Background/Objectives: The prevalence of patent foramen ovale (PFO) has been found to be increased in patients with cryptogenic stroke, suggesting an association between these two clinical settings. Insulin resistance is a risk factor for the occurrence of stroke. The triglyceride glucose (TyG) index is a biomarker that reflects the IR status of the body. Our aim was to evaluate the TyG index values in patients with PFO who experienced cryptogenic stroke. Methods: One hundred and twenty nine patients with PFO who experienced embolic stroke and one hundred and eight control subjects were enrolled. All patients in the study group experienced embolic stroke within 2 weeks of enrollment. The TyG index value of each patient was calculated. Results: Patients with stroke were significantly older, had higher levels of glucose, creatinine, triglyceride (TG), leukocyte, and TyG index and lower high-density lipoprotein-cholesterol values. The TyG index had the highest sensitivity for the prediction of stroke in comparison to TG and glucose values. Comparison of ROC curves showed that the TyG index had the highest AUC compared to that of TG and glucose. The TyG index value of 8.89 predicted stroke occurrence with a sensitivity and specificity of 63.2% and 72.3%, respectively. The results of multivariable regression analyses showed that the TyG index had a higher odds ratio than TG, which indicated that it had a better predictive value. Conclusions: Assessment of the TyG index in cryptogenic stroke patients with PFO might be helpful for the management of these patients.

Stress hyperglycemia ratio is a risk factor for mortality in trauma and surgical intensive care patients: a retrospective cohort study from the MIMIC-IV

BACKGROUND

Stress hyperglycemia ratio (SHR) can reduce the impact of baseline glucose on the stress hyperglycemia level. Studies have shown that SHR is associated with adverse outcomes. However, its relationship with the prognosis of trauma/surgical ICU patients has not been fully studied. The objective of this study was to explore the relationship between SHR and the short-term and long-term mortality in trauma/surgical ICU patients.

METHODS

Clinical data of trauma/surgical ICU patients were extracted from MIMIC-IV. The primary outcome was 28-day all-cause mortality, and the secondary outcome was 365-day all-cause mortality. Boruta algorithm was used to screen the important features related to the 28-day mortality, and Kaplan-Meier curve, Cox proportional hazards regression, and restricted cubic spline were used to explore the relationship between SHR and clinical outcomes.

RESULTS

A total of 1744 patients were included, of whom 786 were male and 958 were female. The 28-day and 365-day mortality rates were 14.7% and 27.2%, respectively. Multivariate Cox proportional hazards analysis showed that an increase in SHR was significantly associated with an increased risk of 28-day mortality [HR (95% CI) 1.30 (1.07, 1.58), p = 0.009] and 365-day mortality [HR (95% CI) 1.05 (1.02-1.09), p = 0.005]. Restricted cubic spline curve showed that the relationship between SHR and survival rate was "U-shaped".

CONCLUSIONS

Increase in SHR is associated with an increased risk of 28-day and 365-day all-cause mortality in trauma/surgical ICU patients.

Low-magnitude high-frequency vibration ameliorates high glucose-induced endothelial injury by restoring mitochondrial function via AMPK/mTOR pathway

High glucose-induced dysfunction of endothelial cells is a critical and initiating factor in the genesis of diabetic vascular complications. Low-magnitude high-frequency vibration (LMHFV) is a non-invasive biophysical intervention. It has been reported that it exhibits protective effects on high glucose-induced osteoblast dysfunction, but little was known on diabetic vascular complications. In this work, we aim to clarify the role of LMHFV on high glucose-induced endothelial dysfunction and hypothesized that the protective effects functioned through adenosine monophosphate-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) pathway. We cultured primary murine aortic endothelial cells (MAECs) in normal or HG medium, respectively, before exposing to LMHFV. The tube formation, paracellular permeability assay, and aortic ring sprouting assay showed that the high glucose injured-function of MAECs was improved after LMHFV treatment. The intracellular ROS generation analysis, mitochondrial complex I activities measurement, ATP measurement and mitochondrial membrane potential (MMP), and mitochondrial ROS generation analysis of MAECs indicated that mitochondrial function was restored by LMHFV loading in a high glucose environment. Mechanically, western blot assays showed that AMPK phosphorylation was promoted and mTOR was inhibited in LMHFV-induced endothelial function restoration. After the administration of the AMPK inhibitor, Compound C, these protective effects resulting from LMHFV are reversed. These findings suggest that LMHFV plays a significant role in protecting endothelial cells' function and mitochondrial function in high glucose-induced injured MAECs via AMPK/mTOR signalling.

The Potential of Neuregulin 4 as a Novel Biomarker and Therapeutic Agent for Vascular Complications in Type 2 Diabetes Mellitus

Neuregulin 4 (Nrg4), a novel adipokine produced primarily by brown adipose tissue (BAT), has been functionally characterized to exert beneficial effects on modulating energy homeostasis and glucolipid metabolism, and is closely associated with the development and progression of obesity and obesity-associated metabolic diseases, such as type 2 diabetes mellitus (T2DM) and cardiovascular diseases. Recently, there has been a growing focus on the relationship between circulating Nrg4 levels and T2DM-related vascular complications. In this review, we discussed the known and potential roles of Nrg4 in various physiological and pathological processes, and its association with vascular complications in T2DM, in the aim of finding a potential biomarker recommended for the clinical diagnosis, prognosis and follow-up of T2DM patients at high risk of developing vascular complications as well as providing new therapeutic approaches.

Reduced FNDC5-AMPK signaling in diabetic atrium increases the susceptibility of atrial fibrillation by impairing mitochondrial dynamics and activating NLRP3 inflammasome

Fibronectin type III domain-containing protein 5 (FNDC5) exerts potential anti-arrhythmic effects. However, the function and mechanism of FNDC5 in diabetes-associated atrial fibrillation (AF) remain unknown. In this study, bioinformatics analysis, in vivo and in vitro experiments were conducted to explore the alteration and role of FNDC5 in diabetes-related atrial remodeling and AF susceptibility. RNA sequencing data from atrial samples of permanent AF patients and diabetic mice exhibited significantly decreased FNDC5 at the transcriptional level, which was in line with the protein expression in diabetic mice as well as high glucose and palmitic acid (HG+PA) injured atrial myocytes. Diabetic mice exhibited adverse atrial remodeling and increased AF inducibility. Moreover, reduced atrial FNDC5 was accompanied with exacerbated NOD-like receptor pyrin domain containing 3 (NLRP3) activation and disturbed mitochondrial fission and fusion processes, as evidenced by decreased expressions of optic atrophy 1 (OPA-1), mitofusin (MFN-1, MFN-2) and increased phosphorylation of dynamin-related protein 1 (Ser616). These effects were validated in HG+PA-treated atrial myocytes. Critically, FNDC5 overexpression remarkably enhanced cellular antioxidant capacity by upregulating the expressions of superoxide dismutase (SOD1, SOD2) level. In addition, HG+PA-induced mitochondrial dysfunction was ameliorated by FNDC5 overexpression as evidenced by improved mitochondrial dynamics and membrane potential. Moreover, NLRP3 inflammasome-mediated inflammation was reduced by FNDC5 overexpression, and AMPK signaling might serve as the key down-stream effector. The present study demonstrated that reduced atrial FNDC5-AMPK signaling contributed to the pathogenesis of diabetes- associated AF by impairing mitochondrial dynamics and activating the NLRP3 inflammasome. These findings provide promising therapeutic avenues for diabetes-associated AF.

SIKVAV promotion proliferation of vascular endothelial cells and related mechanisms

BACKGROUND

Vascular endothelial injury, a key factor in diabetic foot ulcers (DFUs) pathogenesis, is linked to the impaired proliferation and migration of vascular endothelial cells, modulated by hypoxia-inducible factor, growth factors, and inflammatory elements.

OBJECTIVE

The present study assesses the role of SIKVAV (Ser-Ile-Lys-Val-Ala-Val), a peptide shown to enhance cell proliferation and migration, on mouse aortic endothelial cell (MAEC) and the corresponding molecular mechanisms.

METHODS

MAEC were treated with SIKVAV at 0, 100, 200, 400, and 600 μg/mL for 0, 24, 48, and 72 h. Cell viability was tested using the CCK-8 assay. Proliferating cell nuclear antigen (PCNA), extracellular signal-regulated kinase 1/2 (ERK1/2), and protein kinase B (Akt) levels were measured by qRT-PCR and western blot.

RESULTS

SIKVAV augmented PCNA mRNA expression and stimulated vascular endothelial cell proliferation in a concentration and time-dependent fashion. Furthermore, it amplified the expression of p-ERK1/2 and p-Akt, pivotal components of the mitogen-activated protein kinase (MAPK)/ERK1/2 and phosphatidylinositol-3-kinase (PI3K)/Akt signaling pathways. The inhibition of these pathways suppressed PCNA mRNA expression, cell proliferation rate, and decreased p-ERK1/2 and p-Akt levels, highlighting SIKVAV's role in promoting vascular endothelial cell proliferation via these pathways.

CONCLUSION

The results of this study confirmed that SIKVAV grafted onto scaffolds can accelerate the proliferation of vascular endothelial cells for the therapy of skin wounds, and provide a theoretical basis for its application in ischemic disease as synthesized biomaterials scaffolds of tissue engineering.

Endothelial dysfunction markers syndecan-1 and thrombomodulin are associated with higher albuminuria levels in type 2 diabetes with no history of clinical cardiovascular disease

INTRODUCTION

Individuals with type 2 diabetes and increased albuminuria, a well-established marker of microvascular complications, are at a higher risk for cardiovascular disease (CVD) and premature mortality. Therefore, a better understanding of the underlying pathophysiology is needed to improve risk stratification and tailor prevention and intervention.

METHODS

We conducted a cross-sectional study including 463 individuals with type 2 diabetes, various degrees of albuminuria and without CVD. We analysed the association between albuminuria and markers of endothelial function (thrombomodulin and syndecan-1), thrombin generation (thrombin-antithrombin complex, prothrombin fragment 1 + 2), fibrinogen, platelet function (activation using soluble plasma selectin and aggregation using Multiplate® Analyzer) using regression models.

RESULTS

In the study cohort 33 % were women, the mean ± SD age was 65 ± 9 years, and median [IQR] diabetes duration was 15 [9-20] years. In total, 344 (74 %) individuals had normal albuminuria, 87 (19 %) moderately- and 32 (7 %) severely increased albuminuria levels. Higher markers of endothelial function and fibrinogen were independently associated with higher albuminuria levels (p < 0.01). No association between albuminuria and markers of thrombin generation and platelet was demonstrated.

CONCLUSION

We demonstrated an independent association between albuminuria and markers of endothelial function and fibrinogen in individuals with type 2 diabetes and no history of CVD.

Unveiling shared diagnostic biomarkers and molecular mechanisms between T2DM and sepsis: Insights from bioinformatics to experimental assays

Septic patients with T2DM were prone to prolonged recovery and unfavorable prognoses. Thus, this study aimed to pinpoint potential genes related to sepsis with T2DM and develop a predictive model for the disease. The candidate genes were screened using protein-protein interaction networks (PPI) and machine learning algorithms. The nomogram and receiver operating characteristic curve were developed to assess the diagnostic efficiency of the biomarkers. The relationship between sepsis and immune cells was analyzed using the CIBERSORT algorithm. The biomarkers were validated by qPCR and western blotting in basic experiments, and differences in organ damage in mice were studied. Three genes (MMP8, CD177, and S100A12) were identified using PPI and machine learning algorithms, demonstrating strong predictive capabilities. These biomarkers presented significant differences in gene expression patterns between diseased and healthy conditions. Additionally, the expression levels of biomarkers in mouse models and blood samples were consistent with the findings of the bioinformatics analysis. The study elucidated the common molecular mechanisms associated with the pathogenesis of T2DM and sepsis and developed a gene signature-based prediction model for sepsis. These findings provide new targets for the diagnosis and intervention of sepsis complicated with T2DM.

Effect of Atherogenic Index of Plasma on Pre-Percutaneous Coronary Intervention Thrombolysis in Myocardial Infarction Flow in Patients With ST Elevation Myocardial Infarction

Dyslipidemia is an important risk factor for cardiovascular morbidity and mortality. Although low-density lipoprotein (LDL) is primarily responsible, the importance of triglyceride (TG) and high-density lipoprotein (HDL) has also been recognized. The present study investigated the effect of the atherogenic index of plasma (AIP), in which atherogenic and protective lipoproteins were evaluated together, on the initial flow in patients with ST elevation myocardial infarction. AIP was calculated as log(TG/HDL-cholesterol). Patients included in the study (n = 1535) were divided into Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 and >0. AIP was found to be significantly different between 2 groups (.55 ± .23 vs .67 ± .21; P < .001). AIP was an independent predictor for pre-intervention TIMI flow (Odds Ratio: 2.778). A moderate correlation was found between TIMI frame count measurements, calculated in patients with TIMI 2-3, and AIP (Pearson correlation coefficient: .63, P < .001). In the receiver operating characteristic analysis, AIP showed the highest area under curve (AUC) compared with other lipid parameters for predicting vascular patency. The AUC of AIP was .634, the cut-off value was .59, and the sensitivity and specificity were 67.6% and 68.4%, respectively (P < .001). In conclusion, AIP was found to be an important marker affecting pre-percutaneous coronary intervention TIMI flow.

Platelet indices as predictors of poor glucoregulation in type 2 diabetes mellitus adults at Bishoftu General Hospital, Ethiopia

BACKGROUND

Diabetes is a chronic metabolic syndrome that has become a global public health problem with significant morbidity and mortality. It is a pro-inflammatory and pro-thrombotic condition characterized by increased platelet activation and alterations in platelet indices. However, the use of platelet indices as predictors of poor glucoregulation has not been fully evaluated in this context, and evidence for their role as predictors of poor glycemic status in diabetic patients is limited.

AIM

To evaluate platelet indices and determine their prognostic significance in relation to inadequate glucoregulation among individuals diagnosed with type 2 diabetes at Bishoftu General Hospital in Ethiopia, from June 15 to August 12, 2022.

METHODS

A comparative cross-sectional study was conducted in 261 participants including 174 individuals with type 2 diabetes mellitus (T2DM) and 87 non-diabetic controls. The systematic random sampling technique was used to select par-ticipants. Data were collected using structured questionnaires, physical measurements, checklists, and laboratory tests. Platelet parameters and fasting blood glucose levels were determined from blood samples using Sysmex-XN550 and CobasC311 analyzers, respectively. The hematology analyzer output was checked and participants were also screened for malaria parasites using a prepared blood smear. Collected data were entered into Epi-data version 3.1 and exported to SPSS version 25 for analysis. The χ 2 test, Mann-Whitney U test, Kruskal-Wallis test, post hoc test, Spearman correlation, and receiver operating characteristic curve were used for analysis. A P value < 0.05 was considered statistically significant.

RESULTS

The results of our study indicate that diabetic patients have significantly higher levels of platelet distribution width (PDW), mean platelet volume (MPV), platelet large cell ratio (PLCR), and plateletcrit (PCT) compared to healthy individuals (P < 0.001). Furthermore, these indices were found to be significantly elevated in individuals with poor glycemic control in T2DM compared to those with good glycemic control and healthy controls. We also observed significant correlations between these indices and various anthropometric and clinical variables. Our findings suggest that PDW, with a cut-off value of 15.75 fL and an area under the curve (AUC) of 0.803, MPV, with a cut-off value of 12.25 fL and an AUC of 0.774, PLCR, with a cut-off value of 36.3% and an AUC of 0.775, and PCT, with a cut-off value of 0.24% and an AUC of 0.761, can serve as predictors of poor glycemic control in patients with diabetes mellitus.

CONCLUSION

The observed correlation between diabetic patients and a significant increase in platelet indices has highlighted their potential as predictors of poor glycemic control in diabetes. Therefore, regular screening and profiling of platelet indices is recommended as part of the follow-up process for individuals with diabetes mellitus.

Risk factors for deep vein thrombosis of the lower extremity after total hip arthroplasty

OBJECTIVE

To investigate the risk factors for deep vein thrombosis (DVT) following total hip arthroplasty (THA).

METHODS

Patients who underwent THA in the Department of Joint Surgery at the Sixth Affiliated Hospital of Xinjiang Medical University from September 2020 to December 2022 were retrospectively selected based on inclusion criteria. They were divided into the DVT group (n = 65) and the non-DVT group (n = 397) according to the occurrence of postoperative DVT. The following variables were reviewed for both groups: age, sex, Body Mass Index (BMI), affected limb, previous history (smoking and drinking), diabetes, hypertension, operation time, total cholesterol, triglycerides, fibrinogen, hemoglobin, albumin, platelets, D-dimer, International Normalized Ratio (INR), and fibrin degradation products. Univariate analysis was conducted on these factors, and those with statistical significance were further analyzed using a binary logistic regression model to assess their correlation with DVT after THA.

RESULTS

A total of 462 patients were included in the study, with the DVT group representing approximately 14% and the non-DVT group approximately 86%. The DVT group had an average age of 67.27 ± 4.10 years, while the non-DVT group had an average age of 66.72 ± 8.69 years. Univariate analysis revealed significant differences in diabetes mellitus, preoperative fibrinogen, preoperative D-dimer, preoperative INR, and preoperative and postoperative fibrin degradation products between the DVT and non-DVT groups. Binary logistic regression analysis identified diabetes mellitus, elevated preoperative fibrinogen, preoperative D-dimer, and preoperative INR (p < 0.05) as risk factors for DVT after THA.

CONCLUSION

This study found that diabetes mellitus, elevated preoperative fibrinogen, preoperative D-dimer, and preoperative INR are independent risk factors for DVT following THA. Surgeons should thoroughly assess these risk factors, implement timely and effective interventions, and guide patients to engage in functional exercises as early as possible to reduce the incidence of DVT, thereby improving the outcomes of THA and improving patient quality of life.

Exploring the Biological Effects of Anti-Diabetic Vanadium Compounds in the Liver, Heart and Brain

The prevalence of diabetes mellitus and diabetes-related complications is rapidly increasing worldwide, placing a substantial financial burden on healthcare systems. Approximately 537 million adults are currently diagnosed with type 1 or type 2 diabetes globally. However, interestingly, the increasing morbidity rate is primarily influenced by the effects of long-term hyperglycemia on vital organs such as the brain, the liver and the heart rather than the ability of the body to use glucose effectively. This can be attributed to the summation of the detrimental effects of excessive glucose on major vascular systems and the harmful side effects attributed to the current treatment associated with managing the disease. These drugs have been implicated in the onset and progression of cardiovascular disease, hepatocyte injury and cognitive dysfunction, thereby warranting extensive research into alternative treatment strategies. Literature has shown significant progress in utilizing metal-based compounds, specifically those containing transition metals such as zinc, magnesium and vanadium, in managing hyperglycaemia. Amongst these metals, research carried out on vanadium reflected the most promising anti-diabetic efficacy in cell culture and animal studies. This was attributed to the ability to improve glucose management in the bloodstream by enhancing its uptake and metabolism in the kidney, brain, skeletal muscle, heart and liver. Despite this, organic vanadium was considered toxic due to its accumulative characteristics. To alleviate vanadium's toxic nature while subsequently manipulating its therapeutic properties, vanadium complexes were synthesized using either vanadate or vanadyl as a base compound. This review attempts to evaluate organic vanadium salts' therapeutic and toxic effects, highlight vanadium complexes' research and provide insight into the novel dioxidovanadium complex synthesized in our laboratory to alleviate hyperglycaemia-associated macrovascular complications in the brain, heart and liver.

Aortic Stiffness Measured by Carotid Femoral-Pulse Wave Velocity at Different Stages of Normal Glucose, Prediabetes, and Diabetes Mellitus: A Systematic Review and Meta-Analysis

Background

To explore aortic stiffness measured by carotid femoral-pulse wave velocity (cf-PWV) at different stages of normal glucose, prediabetes, and diabetes mellitus (DM).

Methods

The literature comparing aortic stiffness (AS) with cf-PWV between DM and non-DM samples was systematically retrieved from Pubmed, Ovid Medline, Web of Science, Embase, Scopus, CNKI, and Wanfang databases. The Newcastle-Ottawa Scale was used to assess the quality of the literature. The primary endpoint was the mean difference (MD) of cf-PWV between the normal glucose and DM samples and normal glucose and prediabetes samples. The secondary endpoints were the MD of carotid intima-media thickness (cIMT) and carotid-radial pulse wave velocity (cr-PWV). Aggregated MD and 95% confidence intervals were calculated. When the I2 value was >50% or p < 0.01, the heterogeneity was considered large, and the random-effect model was used; otherwise, the fixed-effect model was used. A sensitivity analysis was conducted to identify the source of heterogeneity, and a funnel plot and the regression Egger test was utilized to assess the publication bias.

Results

A total of 37 studies were finally enrolled. Samples with DM had a higher cf-PWV value and cIMT value than those without DM, and the differences were statistically significant. The cr-PWV measurements tended to be higher in the DM group than in the non-DM group, but the difference was not significant. Samples with prediabetes also had a significantly higher cf-PWV value than samples with normal glucose.

Conclusions

Samples with DM and prediabetes were associated with a higher cf-PWV value, indicating that DM patients had a higher central AS. Central AS progresses at the prediabetes stage. These data provide insight into understanding the mechanism of adverse effects of DM and prediabetes on artery stiffness.

Circular RNAs in human diseases

Circular RNAs (circRNAs) are a unique class of RNA molecules formed through back-splicing rather than linear splicing. As an emerging field in molecular biology, circRNAs have garnered significant attention due to their distinct structure and potential functional implications. A comprehensive understanding of circRNAs' functions and potential clinical applications remains elusive despite accumulating evidence of their involvement in disease pathogenesis. Recent research highlights their significant roles in various human diseases, but comprehensive reviews on their functions and applications remain scarce. This review provides an in-depth examination of circRNAs, focusing first on their involvement in non-neoplastic diseases such as respiratory, endocrine, metabolic, musculoskeletal, cardiovascular, and renal disorders. We then explore their roles in tumors, with particular emphasis on exosomal circular RNAs, which are crucial for cancer initiation, progression, and resistance to treatment. By detailing their biogenesis, functions, and impact on disease mechanisms, this review underscores the potential of circRNAs as diagnostic biomarkers and therapeutic targets. The review not only enhances our understanding of circRNAs' roles in specific diseases and tumor types but also highlights their potential as novel diagnostic and therapeutic tools, thereby paving the way for future clinical investigations and potential therapeutic interventions.