Although many surgical fields remain male dominated, the rising number of female medical students and physicians raises important questions about engagement dynamics within academic and professional settings. Endocrine Surgery (ES) currently demonstrates high rates of female representation among its fellows all over the world. This study examines gender differences in audience participation at the 43rd Workshop of the Surgical Working Group on Endocrinology (CAEK). Lecture sessions of the 43rd Workshop of the CAEK were prospectively observed and analyzed. The study recorded the gender appearance of chairs, speakers, participants asking the first question following each lecture and whether this influenced subsequent audience participation. Gender distributions among attendees and question patterns were compared. A total of 385 participants (52% female, 48% male) attended the conference. 37 sessions were included. Overall, 63 questions were recorded. 34 (54%) came from women and 29 (46%) from men. The first question was posed by a male participant in 14 sessions (51.9%) and by a female participant in 13 sessions (48.1%). When discussion was started by a man, 65.9% of subsequent questions came from other men. 90.9% of follow-up questions came from women, when discussion was opened by another woman. Female participation at the 43rd Workshop CAEK was well balanced, although the gender of the first questioner influenced subsequent audience engagement, as observed in other studies. These findings suggest equitable academic engagement in endocrine surgery in Germany, while indicating that the gender of the first questioner is associated with subsequent audience participation.
Farooqi, Teichmann, and collaborators developed the Hormone Cell Atlas, a 14-million-cell dataset mapping hormone production and sensitivity across 47 human tissues. Their findings expand knowledge on sites of production and receiver cells, opening new avenues in endocrinology and metabolism.
We lack national data on the maturing clinical use of telemedicine (TM) in children's primary care. This manuscript describes patterns of TM use for problem-based visits overall, across clinical domains, and associations of use with clinic visit volume. We conducted a retrospective repeated cross-sectional analysis using electronic health records from 1088 pediatric and family medicine primary care practices nationwide, including children aged less than 18 years who received care between 2019 and 2024. We assessed monthly TM use by measuring problem-based visits per 1000 active primary care patients and the proportion conducted via TM, overall and within 6 distinct clinical domains. Regression modeling evaluated whether TM visit volume was associated with an increase, no change, or decrease in total visit volume. The study included 19 633 472 problem-based visits (6% TM, 55% Medicaid, 14% Spanish language). TM represented less than 1% of visits in 2019, peaked at 55% in April 2020, and declined to 6% in 2024. In 2024, TM represented 20% of endocrinology (including obesity) visits and 15% of behavioral health visits compared to only 3% of respiratory visits. From 2019 to May 2023, each additional TM visit was associated with a non-significant net change in total visit volume (-0.1, 95% CI, -0.3-0.2). After May 2023, each additional TM visit was associated with an increase in total visit volume (2.02, 95% CI, 1.67-2.37). Within primary care practices, TM use continues to meaningfully contribute to problem-based care delivery with variation across time and clinical domains.
Obesity is highly prevalent among patients with chronic musculoskeletal pain and is associated with low back pain, knee osteoarthritis, reduced mobility, and poorer functional outcomes. Glucagon-like peptide-1 (GLP-1) receptor agonists and related therapies have transformed obesity medicine and may become more relevant to pain medicine specialists. This narrative review examines whether GLP-1-based medications should be considered within pain practice, particularly for obesity-associated low back pain and knee osteoarthritis. Chronic pain impacts a substantial portion of adults, while low back pain and osteoarthritis remain leading causes of disability worldwide. Obesity is associated with low back pain and knee osteoarthritis, and weight reduction has been shown to improve pain and function in these conditions. GLP-1-based therapies can produce clinically meaningful weight loss in patients with obesity and chronic pain. Literature also suggests possible anti-inflammatory and chondroprotective effects relevant to pain. GLP-1-based medications should not be viewed as primary analgesics or replacements for standard pain evaluation, rehabilitation, pharmacologic care, or interventional treatment. However, they are reasonable to consider as part of comprehensive pain management in patients with obesity when excess weight plausibly contributes to chronic pain, impaired mobility, or reduced rehabilitation tolerance. Pain physicians familiar and comfortable with obesity pharmacotherapy may consider prescribing within appropriate indications and safety parameters. Alternatively, referral to obesity medicine, endocrinology, primary care, or another experienced clinician is appropriate.
Objective: To investigate the current application status of detection methods and reagents for islet autoantibodies in domestic medical institutions, and to assess their detection proficiency. Methods: From October 15, 2024 to March 15, 2025, a total of 175 questionnaires were distributed to core network member units of the National Clinical Research Center for Endocrine and Metabolic Diseases, member units of the Chinese Diabetes Society and the Chinese Society of Endocrinology, member units of the China Type 1 Diabetes Alliance, and other relevant institutions. After collection, statistical analysis of detection methods for islet autoantibodies and the proportion of domestic reagents. Ten representative institutions were selected, and each was provided with 150 blinded and coded standardized evaluation samples (including 50 new-onset type 1 diabetes samples and 100 healthy donor samples). After each institution completes testing and submits the results, the national center uniformly analyzes the sensitivity, specificity and accuracy, as well as the consistency between test results from participating laboratories and those of the"gold standard"[radioligand assay (RLA) or electrochemiluminescence (ECL)]. Spearman correlation analysis was adopted to assess the correlation between the test results of participating laboratories and the gold standard measurements. Results: A total of 127 valid questionnaires were collected from all 31 provinces, municipalities, and autonomous regions in China. The proportion of institutions adopting chemiluminescence immunoassay(CLIA) was 76.6%(95/124), and that of domestic reagents used was 91.7%(121/132). Results from 10 institutions showed the following results: the median sensitivity values for glutamic acid decarboxylase autoantibody (GADA), protein tyrosine phosphatase-2 autoantibodies (IA-2A), insulin autoantibody (IAA), zinc transporter 8 autoantibody (ZnT8A) were 76.0%(range:38.0%-90.0%), 36.0%(range:8.0%-66.0%),24.0%(range:2.0%-50.0%), and 46.0%(range:0-54.0%), respectively; the median specificity values were 100.0%(range:98.0%-100.0%),100.0%(range:99.0%-100.0%), 98.0%(range:95.0%-100.0%),99.0%(range:98.0%-100.0%), respectively; the median accuracy values were 92.0%(range:78.0-96.7%), 78.7%(range:69.3-88.7%), 72.7%(range:66.0-83.3%), and 80.7%(range:66.0%-84.7%), respectively. The median concordance rates between test results from institutions and the "gold standard" were 95.7% (range:82.7%-100.0%) for GADA, 88.3% (range:80.7%-96.7%) for IA-2A, 87.3% (range:82.7%-92.0%) for IAA, and 94.4% (range:81.3%-96.0%) for ZnT8A. The median correlation coefficients (ρ) were 0.857 (range:0.780-0.905) for GADA, 0.829 (range:0.507-0.871) for IA-2A, 0.781 (range:0.601-0.811) for IAA, and 0.805 (range:0.448-0.887) for ZnT8A. Conclusions: At the present stage in China, the mainstream detection method for islet autoantibodies is CLIA, and reagents have basically achieved localization. Overall, the detection quality for GADA is relatively satisfactory; however, the detection levels of IA-2A, InT8A, and particularyl IAA, still need further improvement. 目的： 调查我国胰岛自身抗体检测方法及试剂使用现状，并评估其检测性能。 方法： 2024年10月15日至2025年3月15日向内分泌与代谢性疾病国家临床医学研究中心核心网络成员单位、中华医学会糖尿病学分会和内分泌学分会成员单位、中国1型糖尿病联盟成员单位等单位发放问卷调查表175份，统计分析胰岛自身抗体检测方法和国产试剂占比。选择10家代表性单位，分别发放150例盲法编号的标准化评估样本（含50例新诊断1型糖尿病患者和100名健康志愿者样本）。各单位自行检测反馈结果后，中心统一分析灵敏度、特异度和准确度及参与单位检测结果与“金标准”［放射配体法（RLA）或电化学发光法（ECL）］检测结果的一致性。采用Spearman相关性分析参与单位检测结果与“金标准”检测结果的相关性。 结果： 回收有效调查表127份，覆盖31个省、自治区、直辖市。采用化学发光免疫分析法（CLIA）占比为76.6%（95/124），国产试剂占比91.7%（121/132）。10家代表性单位反馈结果显示：谷氨酸脱羧酶自身抗体（GADA）、蛋白酪氨酸磷酸酶自身抗体（IA-2A）、胰岛素自身抗体（IAA）、锌转运体8自身抗体（ZnT8A）诊断1型糖尿病灵敏度中位数分别为76.0%（范围：38.0%~90.0%）、36.0%（范围：8.0%~66.0%）、24.0%（范围：2.0%~50.0%）和46.0%（范围：0~54.0%）；特异度中位数分别为：100.0%（范围：98.0%~100.0%）、100.0%（范围：99.0%~100.0%）、98.0%（范围：95.0%~100.0%）和99.0%（范围：98.0%~100.0%）；准确度中位数分别为92.0%（范围：78.0%~96.7%）、78.7%（范围：69.3%~88.7%）、72.7%（范围：66.0%~83.3%）和80.7%（范围：66.0%~84.7%）。参与单位检测结果与“金标准”检测结果的一致率中位数分别为：GADA 95.7%（范围：82.7%~100.0%）、IA-2A 88.3%（范围：80.7%~96.7%）、IAA 87.3%（范围：82.7%~92.0%）和ZnT8A 94.4%（范围：81.3%~96.0%）；相关系数（ρ）中位数分别为GADA 0.857（范围：0.780~0.905）、IA-2A 0.829（范围：0.507~0.871）、IAA 0.781（范围：0.601~0.811）和ZnT8A 0.805（范围：0.448~0.887）。 结论： 我国现阶段胰岛自身抗体检测方法主流为CLIA，且试剂基本实现国产化。总体GADA检测质量较好，而IA-2A、ZnT8A，特别是IAA检测水平尚待提高。.
A rare case of composite pheochromocytoma (PCC) with ganglioneuroblastoma (GNB) was reported in this article, and the patient's diagnostic and treatment course-including biochemical evaluation, imaging findings, surgery, pathology, genetic testing, and postoperative follow-up-was retrospectively analyzed. Relevant literature in PubMed, Embase, CNKI, and Wanfang Data from database inception to October 1 2025 was systematically searched to identify comparable adult cases, and their clinicopathological features were summarized. The patient was a 48-year-old man who presented to the Department of Endocrinology, First Medical Center of Chinese PLA General Hospital on March 25, 2025, with hypertension for 3 months and a left adrenal mass detected 12 days earlier. Biochemical testing showed markedly elevated normetanephrine (NMN). MRI and 18F-NOTATATE somatostatin receptor positron emission tomography-computed tomography (18F-NOTATATE-PET-CT) revealed a cystic-solid mass in the left adrenal gland, with increased uptake in the solid component [The maximum standardized uptake value (SUVmax) was 9.4]. Robot-assisted laparoscopic tumor resection was performed on the patient. Composite PCC, consisting of a pheochromocytoma component and a GNB component, was confirmed by postoperative pathology. No clearly pathogenic variants were detected by germline whole-exome sequencing. After surgery, blood pressure was normalized without antihypertensive medication, and no evidence of recurrence or metastasis was observed at the 6-month follow-up. The literature review identified 14 adult cases of PCC with GNB; together with the present case, 15 cases were analyzed. The age [M(Q1, Q3)] was 49 (35, 55) years. Hypertension was documented in 11 patients, elevated catecholamines or their metabolites were observed in most cases, tumors>5 cm in maximum diameter were found in 8 patients, and hereditary syndromes were identified in 3 patients. Composite PCC with GNB in adults is exceedingly rare. Its clinical, biochemical, and imaging manifestations frequently overlap with those of conventional PCC, rendering definitive diagnosis dependent on histopathological examination. Prognosis appears to be correlated with tumor components, size, and genetic syndrome status. Therefore, comprehensive postoperative pathological evaluation, germline genetic testing, and long-term surveillance are strongly recommended. 该文报道1例合并节细胞神经母细胞瘤（GNB）的混合性嗜铬细胞瘤（PCC）罕见病例，回顾性分析其诊疗经过，包括生化评估、影像学检查、手术治疗、病理及基因检测结果和术后随访情况。系统检索PubMed、Embase、中国知网、万方数据知识服务平台自建库至2025年10月1日的相关文献，筛选类似成人患者并对病例特点进行分析汇总。患者男，48岁，2025年3月25日因“血压高3个月，发现左侧肾上腺占位12 d”于解放军总医院第一医学中心内分泌科就诊。生化检测提示甲氧基去甲肾上腺素（NMN）升高，MRI及18F-NOTATATE生长抑素受体正电子发射断层显像-X线计算机断层成像（18F-NOTATATE-PET-CT）显示左侧肾上腺囊实性肿块，实性区摄取增高［最大标准化摄取值（SUVmax）为9.4］。行机器人辅助腹腔镜肿瘤切除术后，病理证实为混合性PCC（PCC成分合并GNB成分）。胚系基因全外显子组检测未见明确致病变异。术后患者血压恢复正常，停用降压药，6个月复查未见复发转移征象。文献复习共纳入14例合并GNB的混合性PCC成人患者，结合本例共15例。患者年龄［M（Q1，Q3）］为49（35，55）岁，其中11例患者存在高血压，多数存在儿茶酚胺或其代谢产物水平升高，8例患者肿瘤长径>5 cm，3例患者合并遗传综合征。成人合并GNB的混合性PCC极为罕见，其临床表现、生化及影像学特征与普通PCC难以区分，确诊依赖病理学检查。预后与肿瘤组分、大小及是否合并遗传综合征等因素相关，建议术后进行全面的病理评估、胚系基因检测并长期随访。.
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The 2025 American thyroid association (ATA) guidelines introduced a revised risk stratification system for thyroid cancer incorporating histology-specific models and a four-tier classification framework. However, its clinical performance in patients with papillary thyroid carcinoma (PTC) remains insufficiently validated. This study compared the 2015 and 2025 ATA risk stratification systems for predicting PTC recurrence and evaluated reclassification patterns. This retrospective cohort study included 284 patients who underwent surgery for PTC at Samsung Medical Center, Seoul, Korea, between 2019 and 2021. Risk classification was performed according to the 2015 ATA three-tier system (low, intermediate, and high risk) and the 2025 ATA four-tier system (low, low-intermediate, intermediate-high, and high risk). Predictive performance for recurrence was assessed using disease-free survival (DFS) and the integrated area under the receiver operating characteristic curve (iAUC). During follow-up, structural recurrence occurred in 23 patients (8.1%). Under the 2015 system, recurrence occurred in 0/119 low-risk, 8/106 intermediate-risk, and 15/59 high-risk patients. Under the 2025 system, recurrence occurred in 0/86 low-risk, 1/56 low-intermediate-risk, 2/53 intermediate-high-risk, and 20/89 high-risk patients, with recurrence events predominantly concentrated in the high-risk group. The 2025 ATA system resulted in substantial reclassification, particularly among patients initially classified as intermediate risk. The iAUC for predicting DFS was 0.873 for the 2015 system and 0.852 for the 2025 system. The 2025 ATA risk stratification system demonstrated predictive performance comparable to the 2015 system while concentrating recurrence events predominantly within the high-risk group, suggesting improved risk discrimination in patients with PTC.
Is the preconception 1-h plasma glucose level during the oral glucose tolerance test (OGTT) more strongly associated with subsequent gestational diabetes mellitus than the fasting or 2-h glucose levels in women with PMOS/PCOS undergoing IVF treatment? Preconception 1-h plasma glucose showed a stronger and more consistent association with gestational diabetes mellitus than the fasting or 2-h glucose levels in women with PMOS/PCOS undergoing IVF treatment. Women with PMOS/PCOS have an increased risk of gestational diabetes mellitus. International guidelines recommend a preconception OGTT in women with PMOS/PCOS without pre-existing diabetes because of the risk of hyperglycaemia and pregnancy complications. However, the comparative predictive value of different preconception OGTT time points, particularly 1-h glucose, remains unclear. This was a multi-centre retrospective cohort study including 2571 women with PMOS/PCOS who underwent their first IVF treatment at three reproductive medicine centres in China and had a preconception 75-g OGTT between March 2018 and December 2023. Women with PMOS/PCOS who completed a preconception 75-g OGTT before initiation of the IVF treatment were included. The primary outcome was GDM diagnosed at 24-28 weeks of gestation. Generalized linear mixed-effects models were used to assess associations between OGTT glucose levels and GDM, adjusting for age, BMI, infertility duration, hormonal profiles, and treatment protocols. Stratified analyses by BMI and PMOS/PCOS phenotype were conducted, and multiple imputation was applied for missing data. Preconception fasting (aOR 1.97 [1.49-2.61]), 1-h (aOR 1.23 [1.13-1.34]) and 2-h glucose (aOR 1.30 [1.17-1.45]) were all significantly associated with GDM (all P < 0.001). Within the diabetic range, only the 1-h glucose measurement of ≥11.6 mmol/l remained a significant indicator. The association of 1-h glucose with GDM was significant in normal-weight and obese women but not in overweight women. The associations were consistent across PMOS/PCOS phenotypes. The retrospective design may have introduced residual confounding and limits causal inference. Missing data required imputation, and subgroup analyses may have limited statistical power. These findings suggest that preconception 1-h glucose may provide additional value for identifying women who are a higher risk of GDM among normal-weight and obese women with PMOS/PCOS undergoing IVF treatment, and support its consideration in preconception metabolic assessments. This work was supported by the National Natural Science Foundation of China (82522038, 82471670 and 82401908), the Natural Science Foundation of Fujian Province (2025J011428), and the "Yongjiang Science and Technology Innovation 2035" Key Research and Development Program (2025Z151). The authors declared no competing interests. N/A.
Male preconception health remains a critically under-addressed area of family planning. While research suggests air pollution may harm semen quality, downstream impacts on pregnancy, particularly for more vulnerable infertility treatment populations, are understudied. Among couples seeking infertility treatment, we examined the relationship between men's exposure to ambient air pollution and intrauterine insemination (IUI) cycle treatment outcomes. In the Folic Acid and Zinc Supplementation Trial (2013-2018), 592 male partners resided in the Salt Lake City area with at least one IUI cycle in 9 months of follow-up (n = 1223 cycles). Residential air pollution exposure was estimated using Community Multiscale Air Quality models and averaged across the 74-day window of spermatogenesis prior to the insemination date, as well as across developmental windows of mitosis, meiosis I-II, spermiogenesis, and spermiation. Treatment-cycle probabilities of hCG+ pregnancy, pregnancy loss, and livebirth were evaluated using generalised linear mixed models adjusted for age, season, income, and co-pollutants (fine particulate matter [PM2.5], nitrogen dioxide [NO2], ozone [O3], and sulfur dioxide [SO2]). In multivariable models, we observed a lower probability of pregnancy per 5 ppb increase in O3 and NO2 across the 74-day spermatogenesis window (relative risk [RR] 0.71, 95% confidence interval [CI] 0.55, 0.93; RR 0.73, 95% CI 0.50, 1.05, respectively), with associations noted during mitosis and meiosis. PM2.5 and SO2 were less consistently associated with IUI outcomes. Findings from mixture models were similar, as were findings for air pollutants and a lower probability of live birth. No clear patterns emerged between air pollutants and pregnancy loss. Ambient air pollution during spermatogenesis, especially during mitosis and meiosis, was associated with a lower chance of pregnancy and live birth in an IUI treatment population. Further understanding pathways between men's air pollution exposure and pregnancy and live birth is an important future research need. clinicaltrials.gov identifier: NCT01857310.
Vitamin D (VitD) plays an essential role in immune regulation, and growing evidence associates low VitD status with elevated systemic inflammation. However, large-scale, population-based evidence linking VitD status to systemic inflammatory markers in Chinese population are lacking. This study aimed to investigate the relationship between VitD levels and inflammatory markers in healthy Chinese individuals. This cross-sectional study was conducted at Zhejiang Provincial People's Hospital (March 2019-August 2023) including a total of 51,521 participants. VitD levels were categorized according to serum 25-hydroxyvitamin D concentrations, and inflammatory markers were derived using established formulas. Primary outcome measures included the systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), and aggregate index of systemic inflammation (AISI). Associations between VitD levels and inflammatory markers were assessed using Spearman's correlation and linear regression. SII, PLR, and AISI were significantly higher among participants with VitD deficiency (P < 0.05). VitD levels were negatively correlated with SII (r = -0.063, P < 0.001), PLR (r = -0.095, P < 0.001), and AISI (r = -0.044, P < 0.001). In multivariable linear regression adjusting for age, sex, low-density lipoprotein cholesterol, triglycerides, uric acid, glucose, albumin, alanine transaminase, alkaline phosphatase, serum creatinine, and hemoglobin, VitD deficiency remained independently associated with SII, PLR, and AISI. VitD deficiency is an independent risk factor for elevated inflammatory markers, supporting a potential immunomodulatory role of VitD and highlighting the need for further research on its potential benefits in chronic disease prevention.
The pathogenesis of early-stage skin lesions in diabetic foot (DF) remains poorly understood, and cannot be fully explained by conventional theories. Skin microbiota dysbiosis has recently emerged as a critical factor, but the underlying mechanisms remain unclear. In this study, we integrated metabolomics and metagenomics analyses of skin samples to investigate metabolic dysregulation driven by microbial dysbiosis. We identified elevated serine as a key metabolic alteration strongly correlated with a dysbiotic microbiota structure. Functionally, we demonstrate that abnormal serine accumulation contributes to the dysregulation of the early skin immune microenvironment in the diabetic foot. Mechanistically, our results reveal that excess serine synergizes with lipopolysaccharide (LPS) to stimulate the release of eHsp90α from keratinocytes, which was strictly dependent on the Akt/mTOR/HIF-1α pathway. This released eHsp90α then acts as a damage-associated molecular pattern, promoting both the migration and subsequent pyroptotic cell death of macrophages. Collectively, our findings suggest a novel pathogenic axis where a microbiota-host derived metabolite collaborates with a bacterial endotoxin to promote inflammatory cell death, which is closely associated with early skin lesions in DF. This work not only elucidates a new mechanism for DF pathogenesis but also suggests that the serine-eHsp90α-pyroptosis axis may serve as a potential candidate for future therapeutic exploration.
AMP-activated protein kinase (AMPK) is a critical regulator of endothelial function, oxidative stress, and inflammation. Lipid peroxidation products such as 4-hydroxynonenal (4-HNE) accumulate under conditions of oxidative stress and are implicated in vascular dysfunction. However, whether 4-HNE directly reacts with AMPK and alters its activity remains unclear. To explore the effects of 4-HNE on the LKB1-AMPK axis, with a focus on AMPKα1 and AMPKα2 in different cell types (HUVECs, H9c2 cells), a cell-free system, and in vivo (Akita mice), and to understand the underlying mechanisms in human atherosclerotic plaques. In HUVECs and H9c2 cells, cells were treated with 4-HNE, and protein levels were detected by Western blots. AMPKα2 activity was measured after enrichment via immunoprecipitation. Cell viability was also examined. In a cell-free system, recombinant AMPK was incubated with 4-HNE. In Akita mice, AMPKα2 activity was measured in aortas after tempol treatment. In human atherosclerotic plaques, immunohistochemistry, co - immunoprecipitation, and mass spectrometry were employed. In HUVECs, low 4-HNE concentrations (1-15 μM) didn't change LKB1 levels, but higher ones (20-25 μM) reduced them. 4-HNE had a variable impact on AMPKα1 levels, while significantly inhibiting AMPKα2 activity in a dose - and time-dependent manner. In H9c2 cells, 4-HNE (10 μM) selectively decreased AMPKα2 levels. In the cell-free system, 4-HNE dose-dependently inhibited AMPKα2 activity. In Akita mice, oxidative stress reduced aortic AMPKα2 activity, reversed by Tempol. In human plaques, 4-HNE levels correlated with plaque severity and AMPKα2 inhibition. Cys174 and Cys200 were key for 4-HNE-mediated AMPKα2 inactivation 4-HNE modified AMPKα2 at Cys174 and Cys200, and antioxidants blocked 4-HNE-induced inhibition. Finally, pretreatment with N-ethylmaleimide, a cysteine blocker, abolished the binding of 4-HNE and AMPKα2, supporting a primary role for cysteine modification in the binding of 4-HNE with AMPKα2. We conclude that 4-HNE inhibits AMPKα2 activity through oxidative modification of specific cysteine residues in human atherosclerosis.
Few studies have examined menopause's impact on health outcomes in women living with Type 1 diabetes mellitus (T1D). We compared physical, diabetes-related, and psychosocial outcomes between premenopausal and postmenopausal women with T1D. A cross-sectional analysis of 211 women aged 40-60 years from the BETTER registry (121 premenopausal; 90 postmenopausal). Outcomes included physical complications (retinopathy, neuropathy, cardiovascular disease [CVD], falls), diabetes management (HbA1c, insulin doses, hypoglycemia, medication), and psychosocial outcomes (depressive symptoms, fear of hypoglycemia [FOH]). Overlap weighting balanced covariates between groups; weighted regression models estimated associations as risk ratios (RR) for binary and mean differences (MD) for continuous outcomes (95% CI). In weighted models, postmenopausal women had higher risks of CVD (RR 3.31 [1.07-10.23]), neuropathy (RR 2.22 [1.17-4.21]), retinopathy (RR 2.20 [1.15-4.23]), falls (RR 2.64 [1.73-4.03]), and moderate-to-severe depressive symptoms (RR 1.48 [1.01-2.17]), and lower odds of antihypertensive (RR 0.57 [0.38-0.84]) and lipid-lowering prescriptions (RR 0.68 [0.54-0.86]), and elevated diabetes distress (RR 0.80 [0.68-0.95]). Insulin doses, HbA1c, hypoglycemia frequency, and FOH did not differ. Postmenopausal women with T1D showed less favourable physical and psychosocial health profiles than premenopausal women, underscoring the need for prospective studies to clarify these associations.
This study aimed to identify sex-specific eating behavior profiles and assess the associations between eating behaviors subscales and profiles and body composition indices in Spanish preschoolers from the CORALS cohort. We conducted a cross-sectional analysis of baseline data from 1208 children aged 3-6 years (50.1% girls) from the CORALS cohort. Eating behaviors were assessed using the Child Eating Behavior Questionnaire (CEBQ). Sex-specific latent profile analyses were conducted separately for girls and boys. Associations of CEBQ subscales and profiles with BMI, fat mass index, fat-free mass index, and waist to height ratio (z scores) were examined using multiple linear regression models adjusted for sociodemographic variables, energy intake, playing outdoors, and sleep duration. Four eating behavior profiles were identified in both sexes: controlled, avid, typical, and avoidant. Food approach subscales and avid eater profile were positively associated with body composition indices, whereas food avoidance subscales and avoidant and controlled profiles showed inverse associations. Controlled eater profile showed opposite associations with fat-free mass by sex: positive associations in boys (β = 0.42, 95% CI: 0.21, 0.62) but negative in girls (β = -0.55 95% CI: -0.77, -0.32). Eating behavior profiles were associated with body composition indices similarly in boys and girls, with the exception of the controlled eater profile in relation to fat-free mass index, for which the association differed by sex. Combining subscale-level and profile-level approaches may improve understanding of early eating behavior patterns and their role in body composition development. ClinicalTrials.gov NCT06317883 (observational cohort).
Although exocrine pancreatic insufficiency (EPI) is thought to be common in type 1 diabetes, little is known about the relationship of EPI with type 1 diabetes parameters or food intake and abdominal complaints. Characterising individuals with EPI could help prevent EPI-related complications such as malabsorption and osteoporosis. In a cross-sectional cohort of 443 individuals with type 1 diabetes (62% female, median age 42 years [IQR 29-54], mean BMI 25±4 kg/m2, median diabetes duration 16 years [IQR 6-29]), we associated faecal elastase (FE) levels, as a marker of EPI, with type 1 diabetes parameters and clinical features, using linear and Poisson regression models. The mean FE level (±SD) was 349.5±146.8 µg/g faeces. A number of variables were independently associated with lower FE levels: older age (-10.97 µg/g faeces per 10 years; 95% CI -21.02, -0.92), longer diabetes duration (-13.09 µg/g per 10 years; 95% CI -23.54, -2.64), higher HbA1c (-1.44 mmol/mol per 1 SD increase in FE levels, 95% CI -2.59, -0.30), male sex (-54.07 µg/g; 95% CI -81.41, -26.73) and smoking (-85.06 µg/g; 95% CI -128.52, -41.60). In a linear analysis, we found no evidence of associations between FE levels and markers of residual beta cell function, liver disease, macronutrient intakes or gastrointestinal complaints. Using a cut-off of 200 µg/g faeces, 76 individuals (17%) were found to have EPI, which was associated with a 4.31 mmol/mol (0.39%) higher HbA1c (95% CI 1.35, 7.26), an 8% higher mean glucose (95% CI 2, 14), a 9% lower fibre intake (95% CI 1, 17) and an 8% lower energy intake (95% CI 1, 15). The lack of evidence for associations with clinical parameters in this relatively healthy population of individuals with type 1 diabetes does not support the use of FE for routine screening for EPI. However, the high prevalence of low FE levels and their association with lower food intake and higher glucose levels justify a need for clinical awareness for EPI and its complications, especially in individuals with long diabetes duration.
Postoperative wound management remains challenging, owing to the lack of tools for continuous, localized, and quantitative assessment of wound inflammation. To address this limitation, we advance a device-level integration strategy that enables localized multimodal monitoring within a suturable platform. We develop a multifunctional smart suture by engineering a metal-organic framework (MOF) layer onto a conductive thermoelectric (TE) fiber. This unique structure integrates bifunctional electrochemical and thermoelectric sensing on a single platform for real-time monitoring of wound healing dynamics. The precise deposition of metal organic framework layer is fabricated via atomic layer deposition, which provides a highly active interface for sensitive detection of physiologically relevant hydrogen peroxide (H2O2). This method features ultra-high sensitivity (8450 μA mM-1 cm-2) and a low detection limit (77.44 nM). Meanwhile, the TE fiber enables accurate local temperature monitoring with a sensitivity of 76.60 μV K-1. The smart suture retains sufficient mechanical strength and supports biocompatibility and stable sensing performance for surgical suturing. By fusing multimodal sensing outputs with machine learning-assisted analysis, the system enables classification of inflammation-related states. Evaluated in rat wound models, the suture demonstrates the capability to monitor changes in local inflammatory responses under experimental conditions, highlighting its potential for advanced wound monitoring.
Systemic alterations are highly prevalent in the population and may interfere with peri-implant repair. The aim of this study was to investigate the association between systemic conditions with the loss of dental implants. This is a retrospective study following STROBE guidelines, including data from 602 medical records of patients who received dental implants between 2000 and 2017. Data on healthy status (presence or absence of disease or systemic conditions), use of prescribed medications (yes/no, and type), number of implants placed and lost, type of prosthetic rehabilitation, and follow-up period were collected, along with demographic data and local risk factor. Fisher's exact test assessed the association between systemic conditions and implant loss. Implant survival was analyzed using Kaplan-Meier and compared by the log-rank test (Mantel-cox). Binary logistic regression estimated odds ratios and confidence intervals for factors associated with implant loss. A total of 1872 dental implants were placed, including 743 in healthy patients (success rate: 96.76%) and 1129 in systemically compromised patients (success rate: 97.60%), with no significant difference between groups (p = 0.1405). Kaplan-Meier analysis demonstrated similar implant survival rates between healthy and systemically compromised patients over a follow-up of 11 years (132 months, 93.84% and 94.92%, respectively). The curves showed substantial overlap, and no difference was observed (log-rank, p = 0.1566). The loss of implants was not associated with the presence of systemic condition or local factors (p > 0.05). Binary logistic regression analysis identified predictors of implant loss, with the model explaining 5.24% of the variance (R2 = 0.0524). A higher frequency of implant loss was observed in patients over 50 years of age, regardless of systemic status. According to the methodology of this study, no association was observed between systemic conditions and dental implant loss.
Percentage of excess weight loss (%EWL) is one of the most commonly used criteria for assessing outcomes after bariatric surgery (BS). However, this measure is based on weight and does not provide information on body composition. Our aim was to evaluate the achievement of different anthropometric objectives 12 months after BS, to analyze the concordance between %EWL and fat mass percentage (FM%) and waist-to-height ratio (WHtR) as well as to explore the differences in body composition and biochemical variables between and within groups of %EWL. 583 participants (160 males/423 females) who underwent BS (109 sleeve gastrectomy/474 Roux-en-Y gastric bypass) were included in a retrospective observational study. %EWL, FM% and other anthropometric and biochemical variables at 12 months post-surgery were analyzed using chi-square test and one- or two-way ANOVA. 95% of the cohort achieved a %EWL ≥50% while 63% achieved a %EWL ≥75%. However, one-third of patients with %EWL ≥75% had a FM% still corresponding to obesity, and 65% had a WHtR ≥0.50. Patients with "High %EWL and High FM%" had higher body mass index, FM%, waist-to-hip ratio, WHtR, trunk fat percentage, visceral adiposity and relative fat mass than those with "High %EWL and Low FM%" group (P < 0.001). Patients with "High %EWL and Low WHtR" had lower levels of uric acid, blood pressure, and triglyceride-glucose index, as well as higher levels of quantitative insulin sensitivity check index than patients with "High %EWL and High WHtR" (P < 0.05). Body composition variability within groups remains high with a significant number of patients who, despite reaching the %EWL threshold, still exhibiting a high FM% and WHtR. Complementing the %EWL with body composition measures allows for better characterization of patients as well as identification of those with a more unfavorable metabolic state not only at diagnosis but also at follow-up.