bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Early Diagnosis of Autism Spectrum Disorder in South Indian Children: A Multicentric Real World Data
Authors: Arun Prajna , Divya P. , Hariharan R. , Subramanian S.
Published: January 2025

ABSTRACT

Background:

Global autism spectrum disorder (ASD) incidence is rising, emphasizing early diagnosis for improved outcomes. Most data are from developed nations, pointing to the need for information from developing nations like India.

Objectives:

The study aims to analyze the sociodemographic and clinical profiles of children with ASD, to assess ASD severity using Childhood Autism Rating Scale (CARS) and Indian Scale for Assessment of Autism (ISAA), to evaluate treatment outcomes with Autism Treatment Evaluation Checklist (ATEC), and to identify factors associated with early diagnosis.

Subjects and Methods:

A cohort study conducted in the outpatient departments of five centers in Tamil Nadu from May 1, 2022, to May 31, 2023, focused on children with ASD. SPSS Version 26 was used for analysis. Descriptive statistics included frequency, percentage, and mean ± standard deviation. Chi-squared or Fisher’s exact test (P < 0.05) examined factors associated with age at diagnosis, whereas Spearman’s rank correlation assessed associations among ATEC, CARS, and ISAA scores.

Results:

The male-to-female ratio was 7:3, with a mean diagnosis age of 3.2 years. 67.9% were from urban residence, 68.9% belonged to upper socio-economic class, and 6.6% had a history of consanguinity. Neonatal convulsions occurred in 35%, 23% required NICU, and 4.7% had a family history of ASD. Poor eye contact and solitary play were reported in 87% & 83%, respectively, Tantrums in 57%, and poor interaction in 64%.

Conclusion:

Urban residence, neonatal convulsions, and ASD severity were significantly associated with early diagnosis. There was no correlation of the ATEC scale with either the CARS or ISAA scale.
Meibomian Gland Loss and Dysfunction in Mild versus Moderate-Severe Thyroid Eye Disease
Authors: Aghaei Hossein , Zarastvand Fatemeh , Abdolalizadeh Parya , Karimi Nasser , Es’haghi Acieh , Clark Jeremy D. , Compton Christopher J. , West Nicole L. , Kashkouli Mohsen Bahmani
Published: January 2025

Purpose:

To compare meibomian gland (MG) loss and MG dysfunction (MGD) in patients with mild versus moderate-severe thyroid eye disease (TED).

Methods:

Consecutive patients with TED and no other causes of dry eye disease underwent meibography and meiboscore of each eyelid were graded as 0 (no MG loss), 1 (<33% loss), 2 (33%–66% loss), and 3 (>66% loss), with a total score of 0–6. MG expression score (0–3), eyelid margin signs of MGD, lipid layer thickness (LLT), ocular surface disease index (OSDI), tear secretion, noninvasive tear break-up time (NITBUT), and tear meniscus height (TMH) were also assessed by a masked observer.

Results:

Included were 21 eyes (21 patients) with mild and 19 eyes (19 patients) with moderate-severe TED. The two groups were not different except for a higher frequency of smoking (P < 0.01). Eyes with moderate-severe TED showed a higher upper eyelid meiboscore (P = 0.03), MG expression score (P < 0.01), and tear film osmolality (P = 0.02) as well as lower LLT (P = 0.03). Total meiboscore had a significantly positive correlation with OSDI (rs = 0.37) and tear film osmolality (rs = 0.50) as well as a negative correlation with NITBUT (rs = −0.55), TMH (rs = −0.44), and LLT (rs = −0.38). While older age, male gender, smoking, and longer duration of disease were significantly associated with the higher (≥3) meiboscore in univariate analysis, none remained significant in multivariate analysis.

Conclusion:

MG loss and MGD were significantly more severe in moderate-severe than mild TED.
Progressive Changes in a Torpedo Maculopathy Lesion Over a 6-Year Period
Authors: Chitturi Sai Prashanti , Prabhu Vishma , Chhablani Jay , Venkatesh Ramesh
Published: January 2025

Purpose:

To report the longitudinal changes on optical coherence tomography (OCT) in a patient with torpedo maculopathy (TM).

Methods:

Retrospective observational study.

Results:

A 37-year-old male, without any ocular symptoms, on dilated fundus examination showed a characteristic torpedo-shaped, flat, horizontally oriented, ovoid-shaped, hypopigmented chorioretinal lesion, temporal to the foveal center. At the most recent visit, after 6 years, the lesion exhibited changes on OCT, including the collapse of the subretinal cleft, the thinning of the retinal pigment epithelium (RPE) layer and inner choroidal layers, and the increased visibility of the underlying choroid and inner retinal excavation. The fundus autofluorescence demonstrated an increase in hypoautofluorescence in the center of the torpedo lesion, which was surrounded by a hyperautofluorescent boundary.

Conclusion:

This appears to be the first report of longitudinal changes in a classic case of TM, demonstrating changes in the RPE, inner choroidal, and outer retinal layers over time.
Ocular Manifestations of Coronavirus Disease 2019: A Hospital-Based Prospective Study at a Coronavirus Disease Dedicated Tertiary Center
Authors: Tripathi Anchal , Chaudhary Rajat , Kushwaha Saurabh , Pathak Lav
Published: January 2025

Purpose:

To investigate ophthalmic manifestations in coronavirus disease 2019 (COVID-19) patients admitted to a designated COVID-19 center in Northern India during the period from April 13, 2020, to April 13, 2022. This aims to provide a comprehensive understanding of ocular involvement in the context of the pandemic.

Methods:

This is a hospital-based prospective observational study. All COVID-19-positive (reverse transcriptase polymerase chain reaction positive – via pharyngeal and nasal swabs) patients, who were admitted to our hospital, were included in the study. Upon receiving ophthalmology referrals, patients were seen in the COVID-19 ward, with data collected on demographic distribution, presenting ocular symptoms, and specific ocular findings.

Results:

Out of 3278 patients admitted to our center, 287 developed ocular symptoms. The study revealed a mean age of 63.8 ± 13.9 years, with males constituting 61.3% of the cases. The mean logMAR best-corrected visual acuity was found to be 0.30 ± 0.60. The mean duration between COVID-19 diagnosis and development of the first ophthalmic symptom was 10.4 ± 9.8 days. The predominant ocular symptoms included redness, discharge, and watering. Anterior segment manifestations were predominant, with conjunctivitis being the most prevalent ocular pathology (74.21%), followed by episcleritis (9.41%) and subconjunctival hemorrhage (7.31%). Conjunctivitis presented bilaterally in 41.5% of these patients, emphasizing its significance in the spectrum of COVID-19 ocular manifestations.

Conclusions:

This research contributes substantial evidence regarding ophthalmic manifestations in COVID-19 patients. Ophthalmologists should remain vigilant, considering the potential for ocular symptoms to precede respiratory manifestations. The study emphasizes the need for comprehensive patient assessments and preventive measures in ophthalmic practices.
Outcome of hand hygiene audit in intensive care unit during COVID-19: An experience from a tertiary care centre
Authors: Arthi E. , Sujitha V. , Vidya J. , Shobana A. , Muthamizh N. , Devi C. Sheela
Published: January 2025

Background:

Hand hygiene (HH) remains a simple, cost-effective method to prevent healthcare-associated infections. Although the recent COVID-19 pandemic has brought out the importance of HH, its compliance remains below the set standards. Hence, monitoring HH compliance in hospital setup through audits remains vital as part of hospital infection prevention and control practices.

Aim:

The present study was done with the aim of assessing HH compliance in critical care units during the COVID-19 pandemic.

Materials and Methods:

This prospective cross-sectional study was conducted in the COVID intensive care unit (ICU) of 750-bed tertiary care hospital for 6 months among the healthcare workers in ICU. The HH audit was conducted by direct observation method adapted and modified from the world health organization (WHO)’s HH audit tool through the hand hygiene audit App (Ibhar).

Results:

The HH complete adherence rate, HH partial adherence rate and HH adherence rate (HHAR, complete + partial) were determined. Profession-specific HHAR (e.g. doctors, nurses and others), gender-specific HHAR and moment-specific HHAR (for each WHO moment) were also calculated.

Conclusion:

This study highlights the differences in HH compliance between different groups of healthcare workers, and the need to address these gaps by adopting multimodal strategies to modify the behaviour and attitude.
Gender differences in awareness and practices of cancer prevention recommendations in Korea:
a cross-sectional survey
Authors: Choi Yoonjoo , Kim Naeun , Oh Jin-Kyoung , Choi Yoon-Jung , Park Bohyun , Kim Byungmi
Published: January 2025

OBJECTIVES: Gender is a major determinant of health behaviors that influences cancer prevention awareness and practices. This study investigated the relationship of the awareness and practice rates of cancer prevention recommendations with gender and socioeconomic status.METHODS: We used data from the Korean National Cancer Prevention Awareness and Practice Survey (2023). The sample included 4,000 men and women aged 20-74 years. We conducted multiple logistic regression analyses to evaluate associations with the awareness and practices of cancer prevention, and a joinpoint regression analysis using age-standardized rates to analyze trends in awareness and practice rates from 2007 to 2023.RESULTS: The awareness rates were 79.4% and 81.2% for men and women, respectively. The overall practice rates were substantially lower (43.1% for men and 48.9% for women). For men, awareness rates did not differ significantly by socio-demographic characteristics, but practice rates increased with age (20-29: 15.9%; 60-74: 53.8%). For women, both awareness (20-29: 73.0%; 60-74: 85.7%) and practice (20-29: 16.8%; 60-74: 67.5%) rates increased with age. The easiest recommendations to follow were “reducing salt intake and avoiding burnt or charred foods” (men: 29.9%; women: 28.4%), whereas the most difficult recommendation was “engaging in regular physical activity” (men: 32.5%; women: 34.4%).CONCLUSIONS: While awareness of cancer prevention recommendations was high, the practice of these recommendations was low. Gender influenced changes in awareness and practice rates over time, reflecting a large gap in practice. Future research should explore appropriate intervention points for cancer prevention practices and the development of more effective cancer prevention policies.
Comprehensive review on diabetic foot ulcers and neuropathy: Treatment, prevention and management
Authors: Parveen Kehkashan , Hussain Malik Asif , Anwar Sadaf , Elagib Halima Mustafa , Kausar Mohd Adnan
Published: January 2025

Diabetic foot (DF) is a major public health concern. As evident from numerous previous studies, supervision of DF ulcer (DFU) is crucial, and a specific quality check-up is needed. Patients should be educated about glycaemic management, DFUs, foot lesions, proper care for injuries, diet, and surgery. Certain reasonably priced treatments, such as hyperbaric oxygen and vacuum-assisted closure therapy, are also available for DFUs, along with modern wound care products and techniques. Nonetheless, DF care (cleaning, applying antimicrobial cream when wounded, and foot reflexology), blood glucose monitoring to control diabetes, and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs. Between 50% and 80% of DF infections are preventable. Regardless of the intensity of the lesion, it needs to be treated carefully and checked daily during infection. Tissue regeneration can be aided by cleaning, dressing, and application of topical medicines. The choice of shoes is also important because it affects blood circulation and nerve impulses. In general, regular check-ups, monitoring of the patient’s condition, measuring blood glucose levels, and providing frequent guidance regarding DFU care are crucial. Finally, this important clinical problem requires involvement of multiple professionals to properly manage it.
SMAD specific E3 ubiquitin protein ligase 1 accelerates diabetic macular edema progression by WNT inhibitory factor 1
Authors: Liang Li-Fang , Zhao Jia-Qi , Wu Yi-Fei , Chen Hui-Jie , Huang Tian , Lu Xiao-He
Published: January 2025

BACKGROUND

Diabetic macular edema (DME) is the most common cause of vision loss in people with diabetes. Tight junction disruption of the retinal pigment epithelium (RPE) cells has been reported to induce DME development. SMAD-specific E3 ubiquitin protein ligase (SMURF) 1 was associated with the tight junctions of cells. However, the mechanism of SMURF1 in the DME process remains unclear.

AIM

To investigate the role of SMURF1 in RPE cell tight junction during DME.

METHODS

ARPE-19 cells treated with high glucose (HG) and desferrioxamine mesylate (DFX) for establishment of the DME cell model. DME mice models were constructed by streptozotocin induction. The trans-epithelial electrical resistance and permeability of RPE cells were analyzed. The expressions of tight junction-related and autophagy-related proteins were determined. The interaction between insulin like growth factor 2 mRNA binding protein 2 (IGF2BP2) and SMURF1 mRNA was verified by RNA immunoprecipitation (RIP). SMURF1 N6-methyladenosine (m6A) level was detected by methylated RIP.

RESULTS

SMURF1 and vascular endothelial growth factor (VEGF) were upregulated in DME. SMURF1 knockdown reduced HG/DFX-induced autophagy, which protected RPE cell tight junctions and ameliorated retinal damage in DME mice. SMURF1 activated the Wnt/β-catenin-VEGF signaling pathway by promoting WNT inhibitory factor (WIF) 1 ubiquitination and degradation. IGF2BP2 upregulated SMURF1 expression in an m6A modification-dependent manner.

CONCLUSION

M6A-modified SMURF1 promoted WIF1 ubiquitination and degradation, which activated autophagy to inhibit RPE cell tight junctions, ultimately promoting DME progression.
Triglyceride-glucose related indices as predictors for major adverse cardiovascular events and overall mortality in type-2 diabetes mellitus patients
Authors: Liu Mao-Jun , Pei Jun-Yu , Zeng Cheng , Xing Ying , Zhang Yi-Feng , Tang Pei-Qi , Deng Si-Min , Hu Xin-Qun
Published: January 2025

BACKGROUND

Recent studies have indicated that triglyceride glucose (TyG)-waist height ratio (WHtR) and TyG-waist circumference (TyG-WC) are effective indicators for evaluating insulin resistance. However, research on the association in TyG-WHtR, TyG-WC, and the risk and prognosis of major adverse cardiovascular events (MACEs) in type 2 diabetes mellitus (T2DM) cases are limited.

AIM

To clarify the relation in TyG-WHtR, TyG-WC, and the risk of MACEs and overall mortality in T2DM patients.

METHODS

Information for this investigation was obtained from Action to Control Cardiovascular Risk in Diabetes (ACCORD)/ACCORD Follow-On (ACCORDION) study database. The Cox regression model was applied to assess the relation among TyG-WHtR, TyG-WC and future MACEs risk and overall mortality in T2DM cases. The RCS analysis was utilized to explore the nonlinear correlation. Subgroup and interaction analyses were conducted to prove the robustness. The receiver operating characteristic curves were applied to analysis the additional predicting value of TyG-WHtR and TyG-WC.

RESULTS

After full adjustment for confounding variables, the highest baseline TyG-WHtR cohort respectively exhibited a 1.353-fold and 1.420-fold higher risk for MACEs and overall mortality, than the lowest quartile group. Similarly, the highest baseline TyG-WC cohort showed a 1.314-fold and 1.480-fold higher risk for MACEs and overall mortality, respectively. Each 1 SD increase in TyG-WHtR was significantly related to an 11.7% increase in MACEs and a 14.9% enhance in overall mortality. Each 1 SD increase in TyG-WC corresponded to an 11.5% in MACEs and a 16.6% increase in overall mortality. Including these two indexes in conventional models significantly improved the predictive power for MACEs and overall mortality.

CONCLUSION

TyG-WHtR and TyG-WC were promising predictors of MACEs and overall mortality risk in T2DM cases.
From metabolic regulation to kidney protection: β-arrestin 2 as a dual-function therapeutic target
Authors: Yang Jian , Zhang Cheng-Zhi , Zhang Jing
Published: January 2025

We are deeply interested in the recent findings on β-arrestin 2. Liu et al demonstrated that β-arrestin 2 knockout provides significant protection in diabetic nephropathy, underscoring its potential as a promising therapeutic target for diabetic nephropathy treatment. Furthermore, the role of β-arrestin 2 in metabolic regulation is equally critical, particularly in insulin signaling, hepatic glucose production, and adipose tissue function. Although β-arrestin 2 plays a distinct role in metabolism and kidney protection, its tissue-specific regulation opens up valuable avenues for developing targeted therapeutic strategies centered on β-arrestin 2.
Optimizing risk management for post-amputation wound complications in diabetic patients: Focus on glycemic and immunosuppressive control
Authors: Li Zhi-Peng , Sun Jin-Ke , Fu Wei-Ping , Zhang Chang-Jiang
Published: January 2025

This study highlights the importance of identifying and addressing risk factors associated with wound complications following transtibial amputation in diabetic patients. These amputations, often necessitated by severe diabetic foot ulcers, carry significant risks of postoperative complications such as infection and delayed wound healing. Elevated hemoglobin A1c levels, indicative of poor glycemic control, and a history of kidney transplantation, due to required immunosuppressive therapy, are key factors influencing these outcomes. This paper emphasizes the need for enhanced glycemic management and personalized postoperative care, particularly for immunocompromised individuals, to minimize complications and improve patient prognosis. Future research should focus on prospective studies to validate targeted interventions and optimize care strategies, ultimately aiming to reduce the healthcare burden associated with diabetic foot complications.
Risk factors and a predictive model of diabetic foot in hospitalized patients with type 2 diabetes
Authors: Li Ming-Zhuo , Tang Fang , Liu Ya-Fei , Lao Jia-Hui , Yang Yang , Cao Jia , Song Ru , Wu Peng , Wang Yi-Bing
Published: January 2025

BACKGROUND

The risk factors and prediction models for diabetic foot (DF) remain incompletely understood, with several potential factors still requiring in-depth investigations.

AIM

To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.

METHODS

We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021. A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors. Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions. The Cox model was further employed to evaluate the impact of risk factors on DF. The area under the curve (AUC) was measured to evaluate the accuracy of the prediction model.

RESULTS

Seventy-five diabetic inpatients experienced DF. The incidence density of DF was 4.5/1000 person-years. A long duration of diabetes, lower extremity arterial disease, lower serum albumin, fasting plasma glucose (FPG), and diabetic nephropathy were independently associated with DF. Among these risk factors, the serum albumin concentration was inversely associated with DF, with a hazard ratio (HR) and 95% confidence interval (CI) of 0.91 (0.88-0.95) (P < 0.001). Additionally, a U -shaped nonlinear relationship was observed between the FPG level and DF. After adjusting for other variables, the HRs and 95%CI for FPG < 4.4 mmol/L and ≥ 7.0 mmol/L were 3.99 (1.55-10.25) (P = 0.004) and 3.12 (1.66-5.87) (P < 0.001), respectively, which was greater than the mid-range level (4.4-6.9 mmol/L). The AUC for predicting DF over 3 years was 0.797.

CONCLUSION

FPG demonstrated a U -shaped relationship with DF. Serum albumin levels were negatively associated with DF. The prediction nomogram model of DF showed good discrimination ability using diabetes duration, lower extremity arterial disease, serum albumin, FPG, and diabetic nephropathy (Clinicaltrial.gov NCT05519163).
Cross-sectional study of the association between triglyceride glucose-body mass index and obstructive sleep apnea risk
Authors: Gong Li , Su Ming , Xu Jing-Han , Peng Zhen-Fei , Du Lin , Chen Ze-Yao , Liu Yu-Zhou , Chan Lu-Cia , Huang Yin-Luan , Chen Yu-Tian , Huang Feng-Yi , Piao Chun-Li
Published: January 2025

BACKGROUND

The triglyceride glucose-body mass index (TyG-BMI) is a novel indicator of insulin resistance (IR). Obstructive sleep apnea (OSA) is a prevalent disorder characterized by recurrent complete or partial collapse of the pharyngeal airway during sleep; however, the relationship between these two conditions remains unexplored. We hypothesized that a higher TyG-BMI is associated with the occurrence of OSA.

AIM

To assess the association between TyG-BMI and OSA in adults in the United States.

METHODS

A cross-sectional study was conducted utilizing data from the National Health and Nutrition Examination Surveys spanning from 2005-2008 to 2015-2018. TyG-BMI was calculated as Ln [triglyceride (mg/dL) × fasting blood glucose (mg/ dL)/2] × BMI. Restricted cubic splines were used to analyze the risk of TyG-BMI and OSA occurrence. To identify potential nonlinear relationships, we combined Cox proportional hazard regression with smooth curve fitting. We also conducted sensitivity and subgroup analyses to verify the robustness of our findings.

RESULTS

We included 16794 participants in the final analysis. Multivariate regression analysis showed that participants with a higher TyG-BMI had a higher OSA incidence. After adjusting for all covariates, TyG-BMI was positively correlated with the prevalence of OSA (odds ratio: 1.28; 95% confidence interval: 1.17, 1.40; P < 0.001); no significant nonlinear relationship was observed. Subgroup analysis showed no strong correlation between TyG-BMI and OSA in patients with diabetes. The correlation between TyG-BMI and OSA was influenced by age, sex, smoking status, marital status, hypertensive stratification, and obesity; these subgroups played a moderating role between TyG-BMI and OSA. Even after adjusting for all covariates, there was a positive association between TYG-BMI and OSA prevalence.

CONCLUSION

A higher TyG-BMI index is linked to higher chances of developing OSA. As TyG-BMI is an indicator of IR, managing IR may help reduce the risk of OSA.
Association between serum retinol-binding protein and lower limb atherosclerosis risk in type 2 diabetes mellitus
Authors: Zhang Yu-Ling , Peng Gui-Liang , Leng Wei-Ling , Lian Yu , Cheng Li-Qing , Li Xing , Wang Yu-Lin , Zhou Ling , Long Min
Published: January 2025

BACKGROUND

Serum retinol-binding protein (RBP) is the primary transport protein of circulating vitamin A. RBP has a crucial role in maintaining nutrient metabolism and physiologic homeostasis. Several studies have indicated that serum RBP participates in the progression of diabetes and diabetes-related complications. However, the impact of serum RBP on lower limb atherosclerosis has not been determined in individuals with type 2 diabetes mellitus (T2DM).

AIM

To determine the association between serum RBP and lower limb atherosclerosis in individuals with T2DM.

METHODS

This retrospective study enrolled 4428 eligible T2DM patients and divided the patients into non-lower limb atherosclerosis (n = 1913) and lower limb atherosclerosis groups (n = 2515) based on lower limb arterial ultrasonography results. At hospital admission, baseline serum RBP levels were assessed, and all subjects were categorized into three groups (Q1-Q3) based on RBP tertiles. Logistic regression, restricted cubic spline regression, subgroup analysis, and machine learning were used to assess the association between RBP levels and lower limb atherosclerosis risk.

RESULTS

Among 4428 individuals with T2DM, 2515 (56.80%) had lower limb atherosclerosis. Logistic analysis showed that lower limb atherosclerosis risk increased by 1% for every 1 unit rise in serum RBP level (odds ratio = 1.01, 95% confidence interval: 1.00-1.02, P = 0.004). Patients in the highest tertile group (Q3) had a higher lower limb atherosclerosis risk compared to the lowest tertile group (Q1) (odds ratio = 1.36, 95% confidence interval: 1.12-1.67, P = 0.002). The lower limb atherosclerosis risk gradually increased with an increase in RBP tertile (P for trend = 0.005). Restricted cubic spline analysis indicated a linear correlation between serum RBP levels and lower limb atherosclerosis risk (non-linear P < 0.05). Machine learning demonstrated the significance and diagnostic value of serum RBP in predicting lower limb atherosclerosis risk.

CONCLUSION

Elevated serum RBP levels correlate with an increased lower limb atherosclerosis risk in individuals with T2DM.
Association between high-sensitivity troponin T levels below the ninety-ninth percentile and diabetic kidney disease: A cross-sectional study
Authors: Luo Xiao-Yan , Huang Li-Hua , Kang Kun-Peng
Published: January 2025

BACKGROUND

Identification of myocardial injury has traditionally relied on high-sensitivity troponin T (hs-TnT) levels exceeding the 99th percentile threshold. However, patients with detectable hs-TnT levels below this threshold represent a heterogeneous group with an inadequately characterized risk profile.

AIM

To investigate the association between hs-TnT levels below the 99th percentile and the presence of diabetic kidney disease (DKD) in patients with diabetes mellitus.

METHODS

This study analyzed data from the National Health and Nutrition Examination Survey obtained between 1999 and 2004, focusing on adults with type 2 diabetes mellitus. Serum hs-TnT concentrations were evaluated. DKD was defined as impaired glomerular filtration rate (< 60 mL/minute/1.73 m²), proteinuria (urinary albumin-to-creatinine ratio of ≥ 30 mg/g), or both conditions in patients with diabetes mellitus. Weighted multivariable logistic regression analysis and restricted cubic spline analyses were employed to examine the independent association between hs-TnT and DKD, with the likelihood ratio test being used to evaluate nonlinearity.

RESULTS

The study included 2505 patients with a mean age of 55.02 (standard error: 0.72) years, of whom 44.87% were females. Among the participants, 909 (32.34%) were diagnosed with DKD. Multivariable logistic regression analysis indicated that, compared to the lowest tertile of hs-TnT (< 5.93 ng/L), tertile 2 (5.94-9.79 ng/L) had an odds ratio of 1.25 (95% confidence interval: 0.77-2.02, P = 0.350), while tertile 3 (9.80-21.88 ng/L) had an odds ratio of 2.07 (95% confidence interval: 1.13-3.80, P = 0.022), with a significant trend (P for trend = 0.022). Smoothed curve fitting demonstrated a linear association between hs-TnT levels and DKD in the overall population (P = 0.061 for nonlinearity) and in male (P = 0.136 for nonlinearity) and female (P = 0.067 for nonlinearity) subgroups. Further stratification and sensitivity analyses yielded consistent conclusions.

CONCLUSION

Our study findings suggest that in individuals with type 2 diabetes, detectable hs-TnT levels below the 99th percentile are associated with DKD.
Investigating the impact of intestinal glucagon-like peptide-1 on hypoglycemia in type 1 diabetes
Authors: Nassar Mahmoud , Gill Angad Singh , Marte Erlin
Published: January 2025

Recent advances in understanding type 1 diabetes (T1D) highlight the complexity of managing hypoglycemia, a frequent and perilous complication of diabetes therapy. This letter delves into a novel study by Jin et al , which elucidates the role of intestinal glucagon-like peptide-1 (GLP-1) in the counterregulatory response to hypoglycemia in T1D models. The study employed immunofluorescence, Western blotting, and enzyme-linked immunosorbent assay to track changes in GLP-1 and its receptor expression in diabetic mice subjected to recurrent hypoglycemic episodes. Findings indicate a significant increase in intestinal GLP-1 and GLP-1 receptor expression, correlating with diminished adrenal and glucagon responses, crucial for glucose stabilization during hypoglycemic events. This letter aims to explore the implications of these findings for future therapeutic strategies and the broader understanding of T1D management.
Correlation between key indicators of continuous glucose monitoring and the risk of diabetic foot
Authors: Geng Xin-Qian , Chen Shun-Fang , Wang Fei-Ying , Yang Hui-Jun , Zhao Yun-Li , Xu Zhang-Rong , Yang Ying
Published: January 2025

BACKGROUND

Continuous glucose monitoring (CGM) metrics, such as time in range (TIR) and glycemic risk index (GRI), have been linked to various diabetes-related complications, including diabetic foot (DF).

AIM

To investigate the association between CGM-derived indicators and the risk of DF in individuals with type 2 diabetes mellitus (T2DM).

METHODS

A total of 591 individuals with T2DM (297 with DF and 294 without DF) were enrolled. Relevant clinical data, complications, comorbidities, hematological parameters, and 72-hour CGM data were collected. Logistic regression analysis was employed to examine the relationship between these measurements and the risk of DF.

RESULTS

Individuals with DF exhibited higher mean blood glucose (MBG) levels and increased proportions of time above range (TAR), TAR level 1, and TAR level 2, but lower TIR (all P < 0.001). Patients with DF had significantly lower rates of achieving target ranges for TIR, TAR, and TAR level 2 than those without DF (all P < 0.05). Logistic regression analysis revealed that GRI, MBG, and TAR level 1 were positively associated with DF risk, while TIR was inversely correlated (all P < 0.05). Achieving TIR and TAR was inversely correlated with white blood cell count and glycated hemoglobin A1c levels (P < 0.05). Additionally, achieving TAR was influenced by fasting plasma glucose, body mass index, diabetes duration, and antidiabetic medication use.

CONCLUSION

CGM metrics, particularly TIR and GRI, are significantly associated with the risk of DF in T2DM, emphasizing the importance of improved glucose control.
Distant metastasis in the right inguinal area from gastric cancer: A case report
Authors: Hao Jia-Qi , Hu Shu-Yue , Zhuang Zi-Xuan , Zhang Yu-Jie , Zhang Jia-Wan , He Feng-Jun , Zhuang Wen , Wang Mo-Jin
Published: January 2025

BACKGROUND

Gastric cancer is the fifth most common cancer and the fourth leading cause of death worldwide. Most cases of newly diagnosed gastric cancer involve not only locally advanced tumor growth and regional lymph node metastases but also distant metastases. We report a rare case finding of a mass in the right inguinal area which is derived from gastric cancer.

CASE SUMMARY

A 68-year-old male initially diagnosed with an inguinal hernia presented with a 2 cm mass in the right inguinal area. Gastrointestinal symptoms led to the discovery of a stomach tumor. Biopsy confirmed gastrointestinal adenocarcinoma. The diagnosis was advanced gastric cancer with peritoneal dissemination, and the inguinal mass was due to direct infiltration. Due to gastrointestinal bleeding, the patient underwent palliative gastrectomy and lymph node dissection. Postoperatively, the patient received hyperthermic intraperitoneal chemotherapy and localized radiation therapy.

CONCLUSION

This case indicates that a systematic evaluation should be conducted during the initial consultation to explore the potential connection between unrecognized distant masses and the primary tumor.
Prognostic value of preoperative fibrinogen to albumin ratio in predicting postoperative outcomes in patients with gallbladder cancer
Authors: Wang Peng-Fu , Duan Ya-Jian
Published: January 2025

BACKGROUND

Gallbladder cancer (GBC) is known for its poor prognosis and challenging management. The preoperative fibrinogen to albumin ratio (FAR) has been proposed as a potential prognostic marker for predicting postoperative outcomes in GBC patients, but its efficacy and prognostic value remain underexplored.

AIM

To evaluate the prognostic value of preoperative FAR in GBC outcomes.

METHODS

This retrospective cohort study included 66 patients who underwent curative surgery for GBC at our institution from January 2018 to January 2022. Preoperative FAR values were obtained within one week prior to surgery. Patients were followed through outpatient visits or telephone interviews, with overall survival (OS) as the primary endpoint. Statistical analyses, including receiver operating characteristic curve analysis and Kaplan-Meier survival estimates, were performed using SPSS software (version 27.0).

RESULTS

The cohort consisted of 36 male and 30 female patients, with a mean age of 61.81 ± 8.58 years. The optimal FAR cut-off value was determined to be 0.088, with an area under the receiver operating characteristic curve of 0.7899, sensitivity of 68.96%, and specificity of 80.01%. Patients with FAR ≤ 0.088 showed significantly better survival rates (1-year: 60.5%, 2-year: 52.6%, 3-year: 25.9%) and a median OS of 25.6 months (95% confidence interval: 18.8-30.5 months), compared to those with FAR > 0.088 who had a median OS of 10.8 months (95% confidence interval: 6.3-12.9 months).

CONCLUSION

Lower preoperative FAR is associated with longer OS in GBC patients, confirming its potential as a valuable prognostic indicator for improving outcome predictions and guiding patient management strategies in gallbladder cancer.
Long-term survival outcomes of duodenal adenocarcinoma: A cohort study with 15-year single-center experience
Authors: Xie Qing-Feng , Long Lian-Sheng , Luo Yang-Yang , Lu Meng-Ting , Ming Wai-Kit , Zhao Li-Ying , Liu Hao
Published: January 2025

BACKGROUND

Duodenal adenocarcinoma (DA), a rare gastrointestinal malignancy, lacks clear natural history and management strategies. This study aimed to investigate the long-term outcomes of patients with DA, focusing on long-term survival and the impact of tumor characteristics, surgery, and adjuvant therapy.

AIM

To bridge this knowledge gap, we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA, along with analyzing the impact of the tumor characteristics, operations and adjuvant therapy on survival outcomes.

METHODS

A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed. This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics, clinical presentation, treatment modalities, and survival outcomes. The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival (OS) and disease-free survival was evaluated using Kaplan-Meier survival curves, the Cox proportional hazards model, and statistical comparisons of survival distributions.

RESULTS

The median OS time for the cohort was 39 months, with 3- and 5-year OS rates of 51.2% and 43.6%, respectively. Radical resection was performed in 82.6% of cases, and was significantly associated with an improved 5-year OS, with a rate of 57.8%. Adjuvant therapy showed a survival benefit in the specific patient subsets, particularly in tumor stage II or III tumors, with an improved OS. Adjuvant therapy (hazard ratio= 2.71, 95% confidence interval: 1.30-5.62, P = 0.008), pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.

CONCLUSION

Radical operation for DA is associated with a remarkable improvement in the 5-year OS. Importantly, postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation, especially in patients with stage III. It highlights the necessity for early diagnosis, tailored surgical approaches, and a nuanced understanding of the role of adjuvant therapy.
Value of brief hematological characteristics in differentiating carcinoembryonic-antigen-negative colorectal cancer from benign colorectal diseases
Authors: Yi Li-Ling , Lao Xian-Jun , Lu Liu-Yi , Zhu Chun-Ling , Zhou Dong-Yi , Li Si-Ting , Fan Meng-Li , Peng Qi-Liu
Published: January 2025

BACKGROUND

Colorectal cancer (CRC) remains one of the most common malignancies worldwide, with a significant subset of patients exhibiting absence of carcinoembryonic-antigen (CEA) expression. The lack of effective diagnostic method for CEA-negative CRC prevents its early treatment.

AIM

To identify potentially valuable biomarkers for identifying CEA-negative CRC, the hematological characteristics of patients with CEA-negative CRC was investigated.

METHODS

In this retrospective analysis, 74 patients were included who had been pathologically confirmed to have CEA-negative CRC, along with 79 individuals diagnosed with benign colorectal conditions. The utility of various biomarkers was evaluated using analysis of the receiver operating characteristic (ROC) curve.

RESULTS

Compared with patients with benign colorectal diseases, those with CEA-negative CRC had lower hemoglobin-to-red blood cell distribution width ratio (HRR) and lymphocyte-to-red blood cell distribution width ratio (LRR), and higher platelet-to-lymphocyte ratio (PLR) (P < 0.05). Correlation analysis showed that HRR was negatively correlated with T stage (r = -0.237), LRR was negatively correlated with T stage (r = -0.265) and distant metastasis (r = -0.321), and PLR was positively correlated with T stage (r = 0.251) (all P < 0.05). ROC analysis indicated that HRR outperformed LRR and PLR in identifying CEA-negative CRC. Combining HRR and PLR provided the highest area under the curve (area under the curve = 0.808; sensitivity = 82.43%; specificity = 68.35%) for distinguishing CEA-negative CRC from benign colorectal diseases.

CONCLUSION

HRR, LRR, and PLR alone or in combination could be used to distinguish CEA-negative CRC from benign colorectal diseases.
Reducing invasiveness in liver surgery-where is the limit?
Authors: Romic Ivan , Separovic Ivan , Grgic Dora , Petrovic Igor , Mavrek Josip , Silovski Hrvoje
Published: January 2025

In this article, we comment on the article by Wang et al published in the recent issue of the World Journal of Gastroenterology Surgery . Most prominent advancements in liver surgery in the last two decades are related to refinements in surgical technique (extraglissonean approach) and advancements in surgical technology (laparoscopy and robotics). In this article, authors present both these aspects: Laparoscopic segmentectomy using extraglissonean approach. Furthermore, they describe segmental resections of all 8 segments which is the main novelty that can be observed in the article. By now, extraglissonean approach was thoroughly described mainly in hepatectomies or lateral sectionectomies. Various “hilar gates” are defined which allows safe liver resection by ligating Glissonean pedicles first which is then followed by parenchymal resection. We here focus on past, present and future perspectives of extraglissonean approach and laparoscopic liver resections and comment the value of the presented article.
Predictive value of magnetic resonance imaging parameters combined with tumor markers for rectal cancer recurrence risk after surgery
Authors: Wu Lei , Zhu Jing-Jie , Liang Xiao-Han , Tong He , Song Yan
Published: January 2025

BACKGROUND

An increasing number of studies to date have found preoperative magnetic resonance imaging (MRI) features valuable in predicting the prognosis of rectal cancer (RC). However, research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC, urgently necessitating further in-depth exploration.

AIM

To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.

METHODS

The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis. General demographic data, MRI data, and tumor markers levels were collected. According to the reviewed data of patients six months after surgery, the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk (37 cases) and low recurrence risk (53 cases) groups. Independent sample t -test and χ 2 test were used to analyze differences between the two groups. A logistic regression model was used to explore the risk factors of the high recurrence risk group, and a clinical prediction model was constructed. The clinical prediction model is presented in the form of a nomogram. The receiver operating characteristic curve, Hosmer-Lemeshow goodness of fit test, calibration curve, and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.

RESULTS

The detection of positive extramural vascular invasion through preoperative MRI [odds ratio (OR) = 4.29, P = 0.045], along with elevated carcinoembryonic antigen (OR = 1.08, P = 0.041), carbohydrate antigen 125 (OR = 1.19, P = 0.034), and carbohydrate antigen 199 (OR = 1.27, P < 0.001) levels, are independent risk factors for increased postoperative recurrence risk in patients with RC. Furthermore, there was a correlation between magnetic resonance based T staging, magnetic resonance based N staging, and circumferential resection margin results determined by MRI and the postoperative recurrence risk. Additionally, when extramural vascular invasion was integrated with tumor markers, the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence, thereby providing robust support for clinical decision-making.

CONCLUSION

The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC. Monitoring these markers helps clinicians identify patients at high risk, allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.
Common bile duct stump stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy in a child: A case report
Authors: Li Jian-Feng , Xie Min-Jian , Wei Jin-Xiu , Yang Cheng-Ning , Chen Guang-Wen , Li Li-Qun , Zhao Yi-Na , Liu Li-Jian , Xie Sheng
Published: January 2025

BACKGROUND

Pancreaticobiliary maljunction (PBM) is a rare congenital abnormality in pancreaticobiliary duct development. PBM is commonly found in children, and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux. Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM, but there are several associated complications that may occur after this operation.

CASE SUMMARY

The patient, a 12-year-old female, was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis. In 2022, she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital. In the first year after surgery, the patient had more than 10 recurrent acute pancreatitis episodes. After undergoing abdominal computed tomography and other examinations, she was diagnosed with “residual bile duct stones and recurrent acute pancreatitis”. On January 30, 2024, the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.

CONCLUSION

This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM. The patient was cured through endoscopic retrograde cholangiopancreatography.
Unmasking gastric carcinoma: Unveiling diagnostic biomarkers and the role of critical care
Authors: Ding Qun-Zhe , Wang Rui-Lan , Xie Yun
Published: January 2025

We discuss the findings of Wu et al on the utility of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammatory index as diagnostic markers for gastric carcinoma (GC). We commend the study's contributions to the field and suggest a prospective study to validate these markers' sensitivity and specificity for early GC detection. We also propose developing surveillance protocols that incorporate these markers with other diagnostic methods to enhance clinical decision-making. Furthermore, we highlight the need for a more diverse patient cohort to assess the generalizability of these markers across different ethnic groups and demographic factors. Our suggestions aim to refine the application of these markers in clinical practice and to understand their potential in diverse clinical scenarios.
Overview of endoscopic biliary stenting in malignant obstructive jaundice
Authors: Wang Hui , Jiao Yan , Ma Qiang , Liu Ya-Hui
Published: January 2025

This article discusses Wang et al ’s essay. Endoscopic biliary stenting, a less invasive alternative to surgery, is effective for malignant obstructive jaundice. This article summarizes the pathophysiology of biliary obstruction, the technical aspects of stenting, and the clinical outcomes. By comparison of endoscopic stenting with percutaneous biliary drainage, improvements and complications are focused on. Additionally, patient selection for stenting and future advancements in stent technology are important. Overall, endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice, especially those ineligibles for surgery.
Clinical significance of perioperative probiotic intervention on recovery following intestinal surgery
Authors: Wu Yang , Zhang Xin , Wang Guan-Qiao , Jiao Yan
Published: January 2025

Restoring the balance of gut microbiota has emerged as a critical strategy in treating intestinal disorders, with probiotics playing a pivotal role in maintaining bacterial equilibrium. Surgical preparations, trauma, and digestive tract reconstruction associated with intestinal surgeries often disrupt the intestinal flora, prompting interest in the potential role of probiotics in postoperative recovery. Lan et al conducted a prospective randomized study on 60 patients with acute appendicitis, revealing that postoperative administration of Bacillus licheniformis capsules facilitated early resolution of inflammation and restoration of gastrointestinal motility, offering a novel therapeutic avenue for accelerated postoperative recovery. This editorial delves into the effects of perioperative probiotic supplementation on physical and intestinal recovery following surgery. Within the framework of enhanced recovery after surgery, the exploration of new probiotic supplementation strategies to mitigate surgical complications and reshape gut microbiota is particularly intriguing.