Diabetes mellitus is an escalating global health issue,with 463 million adults affected in 2019.Without intervention,this number is projected to increase to 578 million by 2030 and 700 million by 2045[1].Diabetic woun...Diabetes mellitus is an escalating global health issue,with 463 million adults affected in 2019.Without intervention,this number is projected to increase to 578 million by 2030 and 700 million by 2045[1].Diabetic wound,a significant complication,is characterized by delayed healing,high disability rates,and elevated mortality[2].The challenges of wound healing in diabetic patients,compounded by their high morbidity and mortality rates,have drawn growing attention in biomedical research.展开更多
Objective:To compare the clinical efficacy and safety of intravitreal injection of faricimab and conbercept in the treatment of diabetic macular edema(DME).Methods:A total of 50 patients diagnosed with DME in our hosp...Objective:To compare the clinical efficacy and safety of intravitreal injection of faricimab and conbercept in the treatment of diabetic macular edema(DME).Methods:A total of 50 patients diagnosed with DME in our hospital from January 2023 to May 2025 were selected and randomly divided into an observation group and a control group,with 25 cases in each group,using a random number table method.The observation group received intravitreal injection of faricimab,while the control group received intravitreal injection of conbercept.Both groups adopted a loading phase plus maintenance phase treatment regimen.The best-corrected visual acuity(BCVA,expressed in logMAR)and central subfield thickness(CST)of the two groups were compared before treatment and at 1,3,and 6 months after treatment,and the incidence of adverse events during treatment was recorded.Results:The logMAR BCVA in the observation group was lower than that in the control group at 3 and 6 months after treatment(both p<0.05).The CST in the observation group was smaller than that in the control group at 1,3,and 6 months after treatment(all p<0.05).There was no statistically significant difference in the overall incidence of adverse events between the two groups(χ^(2)=0.189,p=0.663).Conclusion:Both intravitreal injections of faricimab and conbercept are effective in improving visual acuity and reducing macular edema in patients with DME,with good safety profiles.However,faricimab demonstrates superior efficacy in the medium to long term(3 and 6 months)compared to conbercept,making it more suitable for long-term treatment of patients with DME.展开更多
Diabetic wounds present challenges in clinical management due to persistent inflammation caused by excessive exudate infiltration.Inspired by the gradient wettability of cactus thorn,this study has devised a biomimeti...Diabetic wounds present challenges in clinical management due to persistent inflammation caused by excessive exudate infiltration.Inspired by the gradient wettability of cactus thorn,this study has devised a biomimetic Janus nanofiber membrane as a water diode,which endows with gradient wettability and gradient pore size,offering sustainable unidirectional self-drainage and antibacterial properties for enhanced diabetic wound healing.The Janus membrane is fabricated by depositing a hydrophilic polyacrylonitrile/chlorin e6 layer with smaller pore sizes onto a hydrophobic poly(ε-caprolactone)with larger pore sizes,thereby generating a vertical gradient in both wettability and pore structure.The incorporation of chlorin e6 in the upper layer enables the utilization of external light energy to generate heat for evaporation and produce reactive oxygen species,achieving a high sterilization efficiency of 99%.Meanwhile,the gradient structure of the Janus membrane facilitates continuous antigravity exudate drainage at a rate of 0.95 g cm^(−2) h^(−1).This dual functionality of effective exudate drainage and sterilization significantly reduces inflammatory factors,allows the polarization of macrophages toward the M2 proliferative phenotype,enhances angiogenesis,and accelerates wound healing.Therefore,this study provides a groundbreaking bioinspired strategy for the development of advanced wound dressings tailored for diabetic wound regeneration.展开更多
Infected diabetic wounds represent one of the most severe complications of diabetes mellitus,with complex pathological mechanisms that present significant challenges in clinical management.Ferroptosis,an emerging form...Infected diabetic wounds represent one of the most severe complications of diabetes mellitus,with complex pathological mechanisms that present significant challenges in clinical management.Ferroptosis,an emerging form of iron-dependent programmed cell death driven by excessive lipid peroxidation,plays a critical role in the progression of infected diabetic wounds.This review systematically examines the central mechanisms of ferroptosis in infected diabetic wounds from three key perspectives:dysregulation of iron metabolism,accumulation of lipid peroxidation products,and impairment of the antioxidant defense system.Moreover,it analyzes the impact of ferroptosis on various cell types-fibroblasts,macrophages,vascular endothelial cells,and keratinocytes-during the impaired healing process.Based on these mechanistic insights,the review summarizes recent advances in ferroptosis-targeted therapeutic strategies for wound repair,including ferroptosis inhibitors,cell-based therapies,and innovative hydrogel materials with promising application potential.By integrating current knowledge on the role of ferroptosis in infected diabetic wounds and associated treatment approaches,this article aims to provide new perspectives and a solid theoretical foundation for future research and the comprehensive management of this challenging condition.展开更多
Diabetic retinopathy(DR),a common complication of diabetes,is characterized by retinal angiogenesis and inflammation.The role of hepatoma-derived growth factor(HDGF)in mediating inflammation during DR remains unclear....Diabetic retinopathy(DR),a common complication of diabetes,is characterized by retinal angiogenesis and inflammation.The role of hepatoma-derived growth factor(HDGF)in mediating inflammation during DR remains unclear.We measured HDGF levels in the aqueous humor and found that HDGF was increased in DR but decreased after anti-angiogenesis treatment.Using public single-cell RNA sequencing datasets,we found that elevated HDGF in DR was mainly produced by Müller cells and targeted microglia.Additionally,integrin beta 2(Itgb2),a target gene of HDGF that induces microglial activation,was significantly upregulated in DR.To verify these results,we performed enzyme-linked immunosorbent assays,quantitative reverse transcription-PCR,Western blotting,and fluorescence immunostaining in cultured Müller and microglial cells treated with HDGF or anti-HDGF,as well as in DR mice receiving intravitreal injections of HDGF or its antibody.Exogenous HDGF further promoted microglial activation,migration,and secretion of pro-inflammatory cytokines,while neutralization of HDGF suppressed these effects caused by high glucose.Furthermore,the HDGF receptor nucleolin was overexpressed in microglia under high glucose stimulation.Therefore,blocking HDGF from Müller cells in DR reduced the excessive inflammatory response in microglia,highlighting HDGF as a potential therapeutic target.展开更多
Objective:To evaluate the effects of a piceatannol-loaded self-nanoemulsifying drug delivery system(PIC-SNEDDS)on wound healing in diabetic rats and its mechanisms of wound healing action.Methods:Diabetes was induced ...Objective:To evaluate the effects of a piceatannol-loaded self-nanoemulsifying drug delivery system(PIC-SNEDDS)on wound healing in diabetic rats and its mechanisms of wound healing action.Methods:Diabetes was induced in rats using streptozotocin,after which full-thickness excisional wounds were created.Piceatannol was administered topically either as a raw hydrogel or formulated into a PIC-SNEDDS,which was prepared using an optimized oil-surfactant mixture and incorporated into a hydrogel for application.Wound healing activity was assessed through measurements of wound contraction,oxidative stress biomarkers,and collagen content,along with histological and immunohistochemical evaluation of inflammatory,angiogenic,and remodeling markers.Results:PIC-SNEDDS markedly enhanced diabetic wound healing by promoting epithelial regeneration,granulation tissue formation,epidermal proliferation,and keratinization.The formulation also reduced the expression of pro-inflammatory markers(interleukin-6,nuclear factor-kappa B,and tumor necrosis factor-α)while increasingα-smooth muscle actin,transforming growth factor-β1,vascular endothelial growth factor-A,and hydroxyproline levels.Additionally,it improved antioxidant status by lowering malondialdehyde levels and boosting superoxide dismutase and catalase activity,along with upregulation of COL1A1 mRNA expression.Conclusions:PIC-SNEDDS promotes the healing of diabetic wounds and exhibits anti-inflammatory,antioxidant,pro-collagen,and angiogenic properties.展开更多
Background:Diabetic foot,a severe complication of diabetes,is characterized by chronic refractory wounds.Sanhuang Oil,a topical herbal formula,demonstrates significant therapeutic effects including antibacterial,anti-...Background:Diabetic foot,a severe complication of diabetes,is characterized by chronic refractory wounds.Sanhuang Oil,a topical herbal formula,demonstrates significant therapeutic effects including antibacterial,anti-inflammatory,and immunomodulatory activities.However,its active constituents and mechanisms of action against diabetic foot remain to be elucidated.Methods:In this study,the chemical constituents of Sanhuang Oil were identified using UPLC-QE-Orbitrap-MS.Subsequently,the mechanism by which Sanhuang Oil promotes diabetic foot ulcer healing was predicted by integrating network pharmacology and molecular docking.Additionally,diabetic mouse model was established in ICR mice using a combination of a high-fat diet(HFD)and streptozotocin(STZ)chemical induction.A full-thickness skin defect was created on the dorsum of the mice.Wound healing and the healing rate were observed following Sanhuang Oil intervention.The mechanism underlying Sanhuang Oil’s promotion of diabetic ulcer healing was further investigated using transcriptomics and histopathological examination(H&E staining).Results:A total of 97 active ingredients were identified from Sanhuang Oil.Network pharmacology analysis predicted 543 common targets,and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis identified 203 relevant pathways.Molecular docking further confirmed high binding affinity(binding energy≤−5.0 kcal/mol)between specific active components in Sanhuang Oil(e.g.,coptisine,phellodendrine,baicalein)and key targets associated with diabetic foot ulcers(e.g.,EGFR,AKT1,STAT3).In vivo experimental results demonstrated that the wound healing rate was significantly higher in Sanhuang Oil-treated groups compared to the model group(P<0.001).HE staining revealed that the high-dose Sanhuang Oil group exhibited more pronounced epithelial tissue coverage over the wound,reduced inflammatory cell infiltration,and increased collagen deposition and fibroblast proliferation.transcriptomic analysis identified Pdk4,Ttn,Csrp3,Actn2,Myoz2,Tnnc2,Myod1,Myog,Myot,and Myf6 as key regulatory proteins involved in promoting wound healing.Conclusion:Sanhuang Oil promotes wound healing in diabetic ulcer mice,potentially by mitigating inflammation and regulating key targets such as Pdk4 to enhance fibroblast function.These findings provide novel insights into the multi-target,multi-pathway mechanism of Sanhuang Oil for treating diabetic foot ulcers.展开更多
Background:Diabetic macular edema is a prevalent retinal condition and a leading cause of visual impairment among diabetic patients’Early detection of affected areas is beneficial for effective diagnosis and treatmen...Background:Diabetic macular edema is a prevalent retinal condition and a leading cause of visual impairment among diabetic patients’Early detection of affected areas is beneficial for effective diagnosis and treatment.Traditionally,diagnosis relies on optical coherence tomography imaging technology interpreted by ophthalmologists.However,this manual image interpretation is often slow and subjective.Therefore,developing automated segmentation for macular edema images is essential to enhance to improve the diagnosis efficiency and accuracy.Methods:In order to improve clinical diagnostic efficiency and accuracy,we proposed a SegNet network structure integrated with a convolutional block attention module(CBAM).This network introduces a multi-scale input module,the CBAM attention mechanism,and jump connection.The multi-scale input module enhances the network’s perceptual capabilities,while the lightweight CBAM effectively fuses relevant features across channels and spatial dimensions,allowing for better learning of varying information levels.Results:Experimental results demonstrate that the proposed network achieves an IoU of 80.127%and an accuracy of 99.162%.Compared to the traditional segmentation network,this model has fewer parameters,faster training and testing speed,and superior performance on semantic segmentation tasks,indicating its highly practical applicability.Conclusion:The C-SegNet proposed in this study enables accurate segmentation of Diabetic macular edema lesion images,which facilitates quicker diagnosis for healthcare professionals.展开更多
Moutan Cortex terpene glycoside is derived from the dried root bark of Paeonia suffruticosa Andr.in the Paeoniaceae family,which holds significant value as a traditional Chinese medicine.This study investigated that M...Moutan Cortex terpene glycoside is derived from the dried root bark of Paeonia suffruticosa Andr.in the Paeoniaceae family,which holds significant value as a traditional Chinese medicine.This study investigated that Moutan Cortex terpene glycoside(MCTG)improved diabetic kidney disease(DKD)by targeting sirtuin 1(SIRT1)mediated autophagy pathway.Mechanistic insights were gained using DKD model rats and human umbilical vein endothelial cells(HUVECs)to delineate how MCTG operated in the treatment of DKD.Furthermore,network pharmacology was used to identify the primary metabolic pathways affected by MCTG,with key targets being confirmed through polymerase chain reaction(PCR),Western blot,Transmission electron microscope,immunofluorescence staining and monodansylcadaverine(MDC)staining.Finally,small interfering RNA transfection testified SIRT1 in advanced glycation end-products(AGEs)-induced HUVECs injury.MCTG effectively decreased blood glucose rise in DKD rats and reduced levels of cytokines and biochemical indicators.Network pharmacology revealed that metabolism was the main pathway of Moutan Cortex,and the main targets were verified by PCR and protein experiments.Based on these results,we found that Moutan Cortex could improve DKD and SIRT1 was a potential target.Furthermore,knockdown of SIRT1 attenuated AGEs-induced the expression of Beclin 1 and microtubule-associated protein 1 light chain 3 II/I(LC3 II/I)in HUVECs.In summary,this study demonstrated that Moutan Cortex could alleviate DKD via down-regulating SIRT1-mediated autophagy pathway.展开更多
AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabe...AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabetic macular edema(DME)and visually significant cataract.METHODS:This nonrandomized,retrospective analysis included 54 eyes undergoing phacoemulsification with DEX-I(DEX-I group)and 47 eyes receiving anti-VEGF injections(anti-VEGF group).Best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured preoperatively and postoperatively at 1 and 3mo.RESULTS:The two groups had comparable baseline characteristics,with similar age(DEX-I:66.83±7.27y;anti-VEGF:66.81±6.79y)and gender distribution(51.9%vs 59.6%males).Both groups showed significant BCVA improvement at 1 and 3mo,with no significant intergroup differences.CMT reduction was significantly greater in the DEX-I group at 3mo(25.03%vs 14.07%;P=0.049),particularly in recalcitrant eyes(25.09%vs 11.10%;P=0.007).Postoperative intraocular pressure(IOP)>21 mm Hg was observed in 14.8%of DEX-I eyes and 4.25%of anti-VEGF eyes(P=0.08),normalizing by 3mo.DEX-I required no reinjection,while 29.79%of anti-VEGF eyes needed a fourth dose at 3mo.Complications were minimal,with one posterior capsular injury in the DEX-I group.CONCLUSION:Combined phacoemulsification with intravitreal DEX-I offers superior CMT reduction and comparable visual acuity improvement to anti-VEGF injections in DME,with fewer required treatments.It is an effective strategy for managing cataract with DME,offering benefits,especially for recalcitrant cases.Both therapies have favourable safety profiles,but further long-term studies are needed for clinical guidance.展开更多
Diabetic retinopathy(DR)is a leading cause of vision loss among working-age populations,with early screening significantly reducing the risk of blindness.However,resource-limited regions often face challenges in DR sc...Diabetic retinopathy(DR)is a leading cause of vision loss among working-age populations,with early screening significantly reducing the risk of blindness.However,resource-limited regions often face challenges in DR screening due to a shortage of ophthalmologists.This study reports the implementation and outcomes of the Chinese local standard DB52/T 1726-2023,Regulations for the application of diabetic retinopathy screening artificial intelligence,in Cambodian healthcare institutions.A pilot DR screening program with independent operational capability is established by providing a non-mydriatic fundus camera and deploying a localized diabetic retinopathy artificial intelligence(DR-AI)screening platform at the Cambodia-Kingdom Friendship Hospital in Phnom Penh,along with comprehensive training.From January to August 2025,a total of 565 patients with type 2 diabetes were screened,yielding a DR detection rate of 26.0%(147 cases).Research findings demonstrate that applying mature Chinese DR-AI screening standards and technological solutions through international collaboration in regions with a scarcity of ophthalmic professionals is both feasible and effective.This project serves as a reference for promoting DR-AI in resource-constrained countries and regions,highlighting its significant potential to leverage AI in addressing the global burden of chronic diseases and advancing the modernization of health systems.展开更多
AIM:To compare spontaneous brain regional activities between diabetic vitreous hemorrhage patients(DVHs)and healthy controls(HCs).METHODS:Thirty-two DVHs and 32 HCs were enrolled in this study.Baseline demographic and...AIM:To compare spontaneous brain regional activities between diabetic vitreous hemorrhage patients(DVHs)and healthy controls(HCs).METHODS:Thirty-two DVHs and 32 HCs were enrolled in this study.Baseline demographic and vision data were compared between groups using an independent sample t-test.Resting-state functional magnetic resonance imaging(rs-fMRI)was used in all participants.fMRI data was obtained and analyzed using MRIcro and SPM8 software.Fractional amplitude of low-frequency fluctuation(fALFF)technology was used to measure regional spontaneous brain activity,and sensitivity was tested using receiver operating characteristic curves(ROCs).The fALFF values were analyzed using REST software and two-sample t-tests were used to compare values between groups.Hospital anxiety and depression scale(HADS)score was assessed in DVHs and Pearson’s correlation was used to test relationships between mean fALFF value and both HADS score and duration of DVH.RESULTS:Except for the best-corrected visual acuity(BCVA)in both eyes,which showed a statistically significant difference(P<0.05),there were no statistically significant differences in the other indicators(P>0.05)between the HCs and DVHs group.Compared with controls,fALFF value was higher in DVH in cerebellum posterior lobe(CPL)and lower in right anterior cingulate cortex(ACC)and right medial orbitofrontal cortex(OFC).In DVH patients,mean fALFF value of CPL was positively correlated with HADS score and duration of diabetes.However,no such correlation was found,for right ACC or right medial OFC.DVH may lead to abnormal activities in certain brain regions related to visual control and mood.CONCLUSION:Visual impairment caused by DVH may lead to adjustment in regional visual brain activities and may be related to depression or reward system processing in some brain regions.展开更多
Overt and harmful diabetes mellitus(DM)has detrimental effects on individuals and,by extension,the community.Among the microvascular DM complications is diabetic retinopathy(DR).DR may cause irreversible vision deteri...Overt and harmful diabetes mellitus(DM)has detrimental effects on individuals and,by extension,the community.Among the microvascular DM complications is diabetic retinopathy(DR).DR may cause irreversible vision deterioration in cases of poor blood glucose regulation.Changes in vascular permeability are key trigger points for diabetic macular edema(DME),a condition characterized by the accumulation of fluid in the macula.The development of vascular endothelial growth factor(VEGF)pathway inhibitors has provided a pathogenesis-based treatment approach for DME.Optical coherence tomography(OCT)provides highresolution imaging of the anatomy,including the aging of DME and its structural damage,in distinct morphologic subtypes of macular edema,thereby supporting the assessment of macular edema treatment.The availability of repeated OCT monitoring provides clinical reassurance through the treatment.OCT angiography(OCTA)provides retinal blood flow maps with high spatial resolution.The ability promotes an understanding of disease pathogenesis and facilitates the implementation of new therapeutic methods.This review compares the potential of OCT and OCTA in the diagnosis and treatment of DME,as well as their respective therapeutic applications.展开更多
Background:Inflammation,caused by prolonged hyperglycemia,plays a substantially more important part in the progression of diabetic peripheral neuropathy(DPN).Notably,the MAPK pathway that mediates the Nuclear Factor-k...Background:Inflammation,caused by prolonged hyperglycemia,plays a substantially more important part in the progression of diabetic peripheral neuropathy(DPN).Notably,the MAPK pathway that mediates the Nuclear Factor-kappa B(NF-κB)pathway contributes to inflammation-induced peripheral nerve damage,affecting cell survival.Juan Bi Tong Luo(JBTL),a traditional Chinese medicine(TCM),has demonstrated favorable results in alleviating pain and numbness in patients with DPN;however,whether JBTL exerts its effect through the MAPK mediating NF-κB pathway remains unclear.Methods:This study investigated whether JBTL modulates apoptosis in DPN models and Schwann cells cultured in 100 mM of glucose by MAPK/NF-κB.Results:The JBTL altered inflammation,reduced peripheral nerve tissue damage,and improved cell survival rates by down-regulating MAPK/NF-κB.Conclusion:Our findings demonstrate that the effect of JBTL on DPN is likely mediated by suppressing inflammation induced by the MAPK/NF-κB pathway,thus providing evidence for the clinical efficacy of JBTL in treating DPN.展开更多
Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)–derived fractional flow reserve(CT-FFR) for long term outcomes. We examined the long-term prognostic value ...Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)–derived fractional flow reserve(CT-FFR) for long term outcomes. We examined the long-term prognostic value of CT-FFR combined with CCTA–defined atherosclerotic extent in diabetic patients with coronary artery disease(CAD).Methods A retrospective pooled analysis of individual patient data was performed. Deep-learning-based vessel-specific CTFFR was calculated. All patients enrolled were followed-up for at least 5 years. Predictive abilities for major adverse cardiac events(MACE) were compared among three models(model 1), constructed using clinical variables;model 2, model 1+CCTA–derived atherosclerotic extent(Leiden risk score);and model 3, model 2+CT-FFR.Results A total of 480 diabetic patients [median age, 61(55–66) years;52.9% men] were included. During a median follow-up time of 2197(2126–2355) days, 55 patients(11.5%) experienced MACE. In multivariate-adjusted Cox models, Leiden risk score(HR: 1.06;95% CI: 1.01–1.11;P = 0.013) and CT-FFR ≤ 0.80(HR: 6.54;95% CI: 3.18–13.45;P < 0.001) were the independent predictors. The discriminant ability was higher in model 2 than in model 1(C-index, 0.75 vs. 0.63;P < 0.001) and was further promoted by adding CT-FFR to model 3(C-index, 0.81 vs. 0.75;P = 0.002). Net reclassification improvement(NRI) was 0.19(P = 0.009) for model 2 beyond model 1. Of note, adding CT-FFR to model 3 also exhibited significantly improved reclassification compared with model 2(NRI = 0.14;P = 0.011).Conclusion In diabetic patients with CAD, CT-FFR provides robust and incremental prognostic information for predicting longterm outcomes. The combined model exhibits improved prediction abilities, which is beneficial for risk stratification.展开更多
BACKGROUND The incidence of diabetic atherosclerosis(DMA)is increasing worldwide,but its pathogenesis remains incompletely understood.In addition to cardiovascular complications,bladder dysfunction is one of the commo...BACKGROUND The incidence of diabetic atherosclerosis(DMA)is increasing worldwide,but its pathogenesis remains incompletely understood.In addition to cardiovascular complications,bladder dysfunction is one of the common comorbidities associated with DMA but is often refractory to current treatments.AIM To investigate the therapeutic effect of human amniotic fluid stem cell-derived extracellular vesicles(hAFSC-EVs)on the recovery of bladder dysfunction in DMA rats.METHODS Eighty rats were divided into normal control,streptozotocin-induced diabetic rats,diabetic rats subjected to arterial balloon endothelial injury of common iliac artery(DMA),and DMA rats treated with hAFSC-EVs(DMA+hAFSC-EVs).At 4 weeks and 12 weeks after DMA induction,levels of blood glucose,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,homeostasis model assessment(HOMA)-insulin resistance,and HOMA-βwere measured.Cystometry,common iliac artery wall thickness,and bladder tumor necrosis factor(TNF)-α,interleukin(IL)-6,transforming growth factor(TGF)-β1,Smad3,connective tissue growth factor(CTGF)and fibronectin were also evaluated.RESULTS Bladder weight and blood glucose,triglyceride,HOMA-insulin resistance,common iliac artery intima thickness,voided volume,intercontraction interval,bladder capacity,and mRNA expression of TNF-α,IL-6,TGF-β1,Smad3,CTGF and fibronectin were significantly increased at 4 weeks and 12 weeks after induction,while the HOMA-βlevel decreased at 4 weeks and 12 weeks,and the high-density lipoprotein cholesterol level decreased at 12 weeks.hAFSC-EVs treatment in DMA rats significantly reduced bladder weight and blood glucose,thickness of common iliac arterial intima,voided volume,intercontraction interval and bladder capacity at 4 weeks.The mRNA expression of TNF-α,TGF-β1,and CTGF in DMA rats treated with hAFSC-EVs were significantly decreased at 4 weeks,while the mRNA expressions of IL-6 and Smad3 were significantly decreased 12 weeks.CONCLUSION hAFSC-EVs treatment can help restore DMA-induced bladder dysfunction,which is associated with lowered blood glucose levels,reduced arterial wall thickness,and decreased TNF-α,IL-6,TGF-β1,Smad3,and CTGF expression.展开更多
AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR),and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA scree...AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR),and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA screening indicators to detect concurrent DR at an early stage.METHODS:A total of 200 patients who treated in the ophthalmology department of the Seventh Affiliated Hospital,Sun Yat-sen University from 2022 to 2023 were included,including 95 first-diagnosed DR patients and 105 patients without DR,and all patients underwent OCTA examination and a collection of demographics and renal function parameters.After a quality check,automated measurements of the foveal avascular zone area,vessel density(VD),and perfusion density(PD)of both 3 mm×3 mm and 6 mm×6 mm windows were obtained.RESULTS:Using random forest and multivariate Logistic regression methods,we developed a diagnostic model for DR based on 12 variables(age,FBG,SBP,DBP,HbA1c,ALT,ALP,urea/Scr,DM duration,HUA,DN,and CMT).Adding specific OCTA parameters enhanced the efficacy of the existing diagnostic model for DR(outer vessel density in 6 mm×6 mm window,AUC=0.837 vs 0.819,P=0.03).In the study of DN patients,the parameters in the 6 mm×6 mm window improved the diagnostic efficacy of DR(inner VD;outer VD;full VD;outer PD;full PD).CONCLUSION:The outer VD in the 6 mm×6 mm window can enhance the efficacy of the traditional DR diagnostic model.Meanwhile,compared with the 3 mm×3 mm window,the microvascular parameters in the 6 mm×6 mm window focusing on DN patients can be more sensitive to diagnosing the occurrence of DR.展开更多
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 ...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.展开更多
BACKGROUND Gastroparesis may repeatedly induce diabetic ketoacidosis(DKA),and the differential diagnosis of these diseases is challenging because of similar gastrointestinal symptoms.If DKA is accompanied by gastropar...BACKGROUND Gastroparesis may repeatedly induce diabetic ketoacidosis(DKA),and the differential diagnosis of these diseases is challenging because of similar gastrointestinal symptoms.If DKA is accompanied by gastroparesis,patients present with persistent gastrointestinal symptoms without relief and may even experience recurrent DKA.Misdiagnosis results in poor treatment outcomes and prognosis.We hypothesized that biomarkers or screening tools can be identified by comparing the clinical data between DKA alone and DKA+gastroparesis to facilitate early screening.AIM To achieve early detection and diagnosis of DKA+gastroparesis to enable early treatment aimed at relieving gastrointestinal symptoms and preventing reinduction of DKA.METHODS We conducted a case-control study in which 15 patients hospitalized for DKA at the Endocrinology Department of Peking Union Medical College Hospital and diagnosed with DKA and gastroparesis between December 1999 and January 2023(DKA+gastroparesis group)were included.Then,we selected 60 DKA patients without DKA as a control group(DKA alone group)based on gender,age,disease course,and diabetes subtype in a 1:4 matching ratio.Clinical manifestations and physical and laboratory examination results were statistically compared between the groups.RESULTS The DKA+gastroparesis group was composed of nine males and six females,with a mean age of 35±11 years,while the DKA alone group included 34 males and 26 females,with a mean age of 34±17 years.In the DKA+gastroparesis group,urine ketone levels normalized,while gastrointestinal symptoms persisted despite treatment,and the tests indicated lower glycosylated hemoglobin levels(HbA1c;7.07%vs 11.51%,P<0.01),largest amplitude of glycemic excursions(5.86 vs 17.41,P<0.01),standard deviation of blood glucose(SDBG;2.69 vs 5.83,P<0.01),and coefficient of blood glucose variation(0.31 vs 0.55,P=0.014)compared with the DKA alone group.Probable gastroparesis was considered at HbA1c<8.55%.Besides,the patients in the DKA+gastroparesis group had lower body mass index(19.28 kg/m^(2) vs 23.86 kg/m^(2),P=0.02)and higher high density lipoprotein cholesterol level(2.34 mmol/L vs 1.05 mmol/L,P=0.019)compared to the DKA alone group,but no difference was observed in the remaining lipid profiles between the two groups.CONCLUSION Gastroparesis should be considered in DKA patients who fail to have improved gastrointestinal symptoms after ketone elimination and acidosis correction,particularly when the HbA1c level is<8.55%.展开更多
Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retin...Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature.However,growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit,which includes both the retinal vascular structures and neural tissues.Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening.However,diabetic corneal neuropathy is commonly overlooked and underdiagnosed,leading to severe ocular surface impairment.Several studies have found that these two conditions tend to occur together,and they share similarities in their pathogenesis pathways,being triggered by a status of chronic hyperglycemia.This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy,whether diabetic corneal neuropathy precedes diabetic retinopathy,as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy.We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.展开更多
基金supported by a grant from General Scientific Research Project of Zhejiang Provincial Department of Education(No.Y202455614).
文摘Diabetes mellitus is an escalating global health issue,with 463 million adults affected in 2019.Without intervention,this number is projected to increase to 578 million by 2030 and 700 million by 2045[1].Diabetic wound,a significant complication,is characterized by delayed healing,high disability rates,and elevated mortality[2].The challenges of wound healing in diabetic patients,compounded by their high morbidity and mortality rates,have drawn growing attention in biomedical research.
文摘Objective:To compare the clinical efficacy and safety of intravitreal injection of faricimab and conbercept in the treatment of diabetic macular edema(DME).Methods:A total of 50 patients diagnosed with DME in our hospital from January 2023 to May 2025 were selected and randomly divided into an observation group and a control group,with 25 cases in each group,using a random number table method.The observation group received intravitreal injection of faricimab,while the control group received intravitreal injection of conbercept.Both groups adopted a loading phase plus maintenance phase treatment regimen.The best-corrected visual acuity(BCVA,expressed in logMAR)and central subfield thickness(CST)of the two groups were compared before treatment and at 1,3,and 6 months after treatment,and the incidence of adverse events during treatment was recorded.Results:The logMAR BCVA in the observation group was lower than that in the control group at 3 and 6 months after treatment(both p<0.05).The CST in the observation group was smaller than that in the control group at 1,3,and 6 months after treatment(all p<0.05).There was no statistically significant difference in the overall incidence of adverse events between the two groups(χ^(2)=0.189,p=0.663).Conclusion:Both intravitreal injections of faricimab and conbercept are effective in improving visual acuity and reducing macular edema in patients with DME,with good safety profiles.However,faricimab demonstrates superior efficacy in the medium to long term(3 and 6 months)compared to conbercept,making it more suitable for long-term treatment of patients with DME.
基金financially supported by the National Key Research and Development Program of China (2021YFA1201304)the National Natural Science Foundation of China (52503082)+3 种基金China Postdoctoral Science Foundation (2024M750402)Postdoctoral Fellowship Program of CPSF (GZC20230419)Shanghai Anticancer Association EYAS PROJECT (SACA-CY23C05)The Fundamental Research Funds for the Central Universities (2232023D-03, 2232024Y-01)
文摘Diabetic wounds present challenges in clinical management due to persistent inflammation caused by excessive exudate infiltration.Inspired by the gradient wettability of cactus thorn,this study has devised a biomimetic Janus nanofiber membrane as a water diode,which endows with gradient wettability and gradient pore size,offering sustainable unidirectional self-drainage and antibacterial properties for enhanced diabetic wound healing.The Janus membrane is fabricated by depositing a hydrophilic polyacrylonitrile/chlorin e6 layer with smaller pore sizes onto a hydrophobic poly(ε-caprolactone)with larger pore sizes,thereby generating a vertical gradient in both wettability and pore structure.The incorporation of chlorin e6 in the upper layer enables the utilization of external light energy to generate heat for evaporation and produce reactive oxygen species,achieving a high sterilization efficiency of 99%.Meanwhile,the gradient structure of the Janus membrane facilitates continuous antigravity exudate drainage at a rate of 0.95 g cm^(−2) h^(−1).This dual functionality of effective exudate drainage and sterilization significantly reduces inflammatory factors,allows the polarization of macrophages toward the M2 proliferative phenotype,enhances angiogenesis,and accelerates wound healing.Therefore,this study provides a groundbreaking bioinspired strategy for the development of advanced wound dressings tailored for diabetic wound regeneration.
基金supported by the Academician Innovation Platform of Hainan Province,National Natural Science Foundation of China(82560446)Natural Science Foundation of Hainan Province(822MS174),(822RC692)the Science and Technology Special Fund of Hainan Province(ZDYF2025SHFZ049).
文摘Infected diabetic wounds represent one of the most severe complications of diabetes mellitus,with complex pathological mechanisms that present significant challenges in clinical management.Ferroptosis,an emerging form of iron-dependent programmed cell death driven by excessive lipid peroxidation,plays a critical role in the progression of infected diabetic wounds.This review systematically examines the central mechanisms of ferroptosis in infected diabetic wounds from three key perspectives:dysregulation of iron metabolism,accumulation of lipid peroxidation products,and impairment of the antioxidant defense system.Moreover,it analyzes the impact of ferroptosis on various cell types-fibroblasts,macrophages,vascular endothelial cells,and keratinocytes-during the impaired healing process.Based on these mechanistic insights,the review summarizes recent advances in ferroptosis-targeted therapeutic strategies for wound repair,including ferroptosis inhibitors,cell-based therapies,and innovative hydrogel materials with promising application potential.By integrating current knowledge on the role of ferroptosis in infected diabetic wounds and associated treatment approaches,this article aims to provide new perspectives and a solid theoretical foundation for future research and the comprehensive management of this challenging condition.
基金supported by National Natural Science Foundation of China(Grant No.81900873 to A.Q.)the Jiangsu Provincial Key Research and Development Programme-social development(Grant No.BE2023777 to W.Z.)+1 种基金the Key Medical Research Project of Jiangsu Commission of Health(Grant No.H2022185 to W.Z.)the Clinical Capacity Enhancement Project of Jiangsu Province Hospital(Grant No.JSPH-MB-2023-18 to W.Z.)。
文摘Diabetic retinopathy(DR),a common complication of diabetes,is characterized by retinal angiogenesis and inflammation.The role of hepatoma-derived growth factor(HDGF)in mediating inflammation during DR remains unclear.We measured HDGF levels in the aqueous humor and found that HDGF was increased in DR but decreased after anti-angiogenesis treatment.Using public single-cell RNA sequencing datasets,we found that elevated HDGF in DR was mainly produced by Müller cells and targeted microglia.Additionally,integrin beta 2(Itgb2),a target gene of HDGF that induces microglial activation,was significantly upregulated in DR.To verify these results,we performed enzyme-linked immunosorbent assays,quantitative reverse transcription-PCR,Western blotting,and fluorescence immunostaining in cultured Müller and microglial cells treated with HDGF or anti-HDGF,as well as in DR mice receiving intravitreal injections of HDGF or its antibody.Exogenous HDGF further promoted microglial activation,migration,and secretion of pro-inflammatory cytokines,while neutralization of HDGF suppressed these effects caused by high glucose.Furthermore,the HDGF receptor nucleolin was overexpressed in microglia under high glucose stimulation.Therefore,blocking HDGF from Müller cells in DR reduced the excessive inflammatory response in microglia,highlighting HDGF as a potential therapeutic target.
基金funded by the Deanship of Scientific Research at King Abdulaziz University,Jeddah,under Grant No.G:534-140-1443.
文摘Objective:To evaluate the effects of a piceatannol-loaded self-nanoemulsifying drug delivery system(PIC-SNEDDS)on wound healing in diabetic rats and its mechanisms of wound healing action.Methods:Diabetes was induced in rats using streptozotocin,after which full-thickness excisional wounds were created.Piceatannol was administered topically either as a raw hydrogel or formulated into a PIC-SNEDDS,which was prepared using an optimized oil-surfactant mixture and incorporated into a hydrogel for application.Wound healing activity was assessed through measurements of wound contraction,oxidative stress biomarkers,and collagen content,along with histological and immunohistochemical evaluation of inflammatory,angiogenic,and remodeling markers.Results:PIC-SNEDDS markedly enhanced diabetic wound healing by promoting epithelial regeneration,granulation tissue formation,epidermal proliferation,and keratinization.The formulation also reduced the expression of pro-inflammatory markers(interleukin-6,nuclear factor-kappa B,and tumor necrosis factor-α)while increasingα-smooth muscle actin,transforming growth factor-β1,vascular endothelial growth factor-A,and hydroxyproline levels.Additionally,it improved antioxidant status by lowering malondialdehyde levels and boosting superoxide dismutase and catalase activity,along with upregulation of COL1A1 mRNA expression.Conclusions:PIC-SNEDDS promotes the healing of diabetic wounds and exhibits anti-inflammatory,antioxidant,pro-collagen,and angiogenic properties.
基金supported by the Natural Science Foundation of Hubei Provincial Department of Education(D20232101)Shandong Second Medical University 2024 Affiliated Hospital(Teaching Hospital)Scientific Research Development Fund Project(2024FYQ026)+3 种基金the innovative Research Programme of Xiangyang No.1 People’s Hospital(XYY2023ZY01)Faculty Development Grants of Xiangyang No.1 People’s Hospital Affiliated to Hubei University of Medicine(XYY2023D05)Joint supported by Hubei Provincial Natural Science Foundation and Xiangyang of China(2025AFD091)Traditional Chinese Medicine Scientific Research Project of Hubei Provincial Administration of Traditional Chinese Medicine(ZY2025D019).
文摘Background:Diabetic foot,a severe complication of diabetes,is characterized by chronic refractory wounds.Sanhuang Oil,a topical herbal formula,demonstrates significant therapeutic effects including antibacterial,anti-inflammatory,and immunomodulatory activities.However,its active constituents and mechanisms of action against diabetic foot remain to be elucidated.Methods:In this study,the chemical constituents of Sanhuang Oil were identified using UPLC-QE-Orbitrap-MS.Subsequently,the mechanism by which Sanhuang Oil promotes diabetic foot ulcer healing was predicted by integrating network pharmacology and molecular docking.Additionally,diabetic mouse model was established in ICR mice using a combination of a high-fat diet(HFD)and streptozotocin(STZ)chemical induction.A full-thickness skin defect was created on the dorsum of the mice.Wound healing and the healing rate were observed following Sanhuang Oil intervention.The mechanism underlying Sanhuang Oil’s promotion of diabetic ulcer healing was further investigated using transcriptomics and histopathological examination(H&E staining).Results:A total of 97 active ingredients were identified from Sanhuang Oil.Network pharmacology analysis predicted 543 common targets,and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis identified 203 relevant pathways.Molecular docking further confirmed high binding affinity(binding energy≤−5.0 kcal/mol)between specific active components in Sanhuang Oil(e.g.,coptisine,phellodendrine,baicalein)and key targets associated with diabetic foot ulcers(e.g.,EGFR,AKT1,STAT3).In vivo experimental results demonstrated that the wound healing rate was significantly higher in Sanhuang Oil-treated groups compared to the model group(P<0.001).HE staining revealed that the high-dose Sanhuang Oil group exhibited more pronounced epithelial tissue coverage over the wound,reduced inflammatory cell infiltration,and increased collagen deposition and fibroblast proliferation.transcriptomic analysis identified Pdk4,Ttn,Csrp3,Actn2,Myoz2,Tnnc2,Myod1,Myog,Myot,and Myf6 as key regulatory proteins involved in promoting wound healing.Conclusion:Sanhuang Oil promotes wound healing in diabetic ulcer mice,potentially by mitigating inflammation and regulating key targets such as Pdk4 to enhance fibroblast function.These findings provide novel insights into the multi-target,multi-pathway mechanism of Sanhuang Oil for treating diabetic foot ulcers.
基金supported by the Guangdong Pharmaceutical University 2024 Higher Education Research Projects(GKP202403,GMP202402)the Guangdong Pharmaceutical University College Students’Innovation and Entrepreneurship Training Programs(Grant No.202504302033,202504302034,202504302036,and 202504302244).
文摘Background:Diabetic macular edema is a prevalent retinal condition and a leading cause of visual impairment among diabetic patients’Early detection of affected areas is beneficial for effective diagnosis and treatment.Traditionally,diagnosis relies on optical coherence tomography imaging technology interpreted by ophthalmologists.However,this manual image interpretation is often slow and subjective.Therefore,developing automated segmentation for macular edema images is essential to enhance to improve the diagnosis efficiency and accuracy.Methods:In order to improve clinical diagnostic efficiency and accuracy,we proposed a SegNet network structure integrated with a convolutional block attention module(CBAM).This network introduces a multi-scale input module,the CBAM attention mechanism,and jump connection.The multi-scale input module enhances the network’s perceptual capabilities,while the lightweight CBAM effectively fuses relevant features across channels and spatial dimensions,allowing for better learning of varying information levels.Results:Experimental results demonstrate that the proposed network achieves an IoU of 80.127%and an accuracy of 99.162%.Compared to the traditional segmentation network,this model has fewer parameters,faster training and testing speed,and superior performance on semantic segmentation tasks,indicating its highly practical applicability.Conclusion:The C-SegNet proposed in this study enables accurate segmentation of Diabetic macular edema lesion images,which facilitates quicker diagnosis for healthcare professionals.
基金supported by grants from the National Natural Science Foundation of China(82474093,81973536)Jiangsu Province“Blue and Green Project”(184080H10240)+2 种基金Graduate Research Innovation Program of Jiangsu(KYCX23_0871)the National Natural Science Foundation of the Youth Science Fund Project(81703775)Health Research Program of Wuxi Municipal Health Commission(Q202107).
文摘Moutan Cortex terpene glycoside is derived from the dried root bark of Paeonia suffruticosa Andr.in the Paeoniaceae family,which holds significant value as a traditional Chinese medicine.This study investigated that Moutan Cortex terpene glycoside(MCTG)improved diabetic kidney disease(DKD)by targeting sirtuin 1(SIRT1)mediated autophagy pathway.Mechanistic insights were gained using DKD model rats and human umbilical vein endothelial cells(HUVECs)to delineate how MCTG operated in the treatment of DKD.Furthermore,network pharmacology was used to identify the primary metabolic pathways affected by MCTG,with key targets being confirmed through polymerase chain reaction(PCR),Western blot,Transmission electron microscope,immunofluorescence staining and monodansylcadaverine(MDC)staining.Finally,small interfering RNA transfection testified SIRT1 in advanced glycation end-products(AGEs)-induced HUVECs injury.MCTG effectively decreased blood glucose rise in DKD rats and reduced levels of cytokines and biochemical indicators.Network pharmacology revealed that metabolism was the main pathway of Moutan Cortex,and the main targets were verified by PCR and protein experiments.Based on these results,we found that Moutan Cortex could improve DKD and SIRT1 was a potential target.Furthermore,knockdown of SIRT1 attenuated AGEs-induced the expression of Beclin 1 and microtubule-associated protein 1 light chain 3 II/I(LC3 II/I)in HUVECs.In summary,this study demonstrated that Moutan Cortex could alleviate DKD via down-regulating SIRT1-mediated autophagy pathway.
文摘AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabetic macular edema(DME)and visually significant cataract.METHODS:This nonrandomized,retrospective analysis included 54 eyes undergoing phacoemulsification with DEX-I(DEX-I group)and 47 eyes receiving anti-VEGF injections(anti-VEGF group).Best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured preoperatively and postoperatively at 1 and 3mo.RESULTS:The two groups had comparable baseline characteristics,with similar age(DEX-I:66.83±7.27y;anti-VEGF:66.81±6.79y)and gender distribution(51.9%vs 59.6%males).Both groups showed significant BCVA improvement at 1 and 3mo,with no significant intergroup differences.CMT reduction was significantly greater in the DEX-I group at 3mo(25.03%vs 14.07%;P=0.049),particularly in recalcitrant eyes(25.09%vs 11.10%;P=0.007).Postoperative intraocular pressure(IOP)>21 mm Hg was observed in 14.8%of DEX-I eyes and 4.25%of anti-VEGF eyes(P=0.08),normalizing by 3mo.DEX-I required no reinjection,while 29.79%of anti-VEGF eyes needed a fourth dose at 3mo.Complications were minimal,with one posterior capsular injury in the DEX-I group.CONCLUSION:Combined phacoemulsification with intravitreal DEX-I offers superior CMT reduction and comparable visual acuity improvement to anti-VEGF injections in DME,with fewer required treatments.It is an effective strategy for managing cataract with DME,offering benefits,especially for recalcitrant cases.Both therapies have favourable safety profiles,but further long-term studies are needed for clinical guidance.
基金funded by the Chronic Disease Management Research Project of National Health Commission Capacity Building and Continuing Education Center 2025(GWJJMB202510024146)the Post-Subsidy Project for Standard Development of Guizhou Provincial Market Supervision and Administration Bureau 2025(DB52/T1726-2023)the Guizhou Provincial Health Commission Science and Technology Fund Project(gzwkj2024-076,gzwkj2026-146).
文摘Diabetic retinopathy(DR)is a leading cause of vision loss among working-age populations,with early screening significantly reducing the risk of blindness.However,resource-limited regions often face challenges in DR screening due to a shortage of ophthalmologists.This study reports the implementation and outcomes of the Chinese local standard DB52/T 1726-2023,Regulations for the application of diabetic retinopathy screening artificial intelligence,in Cambodian healthcare institutions.A pilot DR screening program with independent operational capability is established by providing a non-mydriatic fundus camera and deploying a localized diabetic retinopathy artificial intelligence(DR-AI)screening platform at the Cambodia-Kingdom Friendship Hospital in Phnom Penh,along with comprehensive training.From January to August 2025,a total of 565 patients with type 2 diabetes were screened,yielding a DR detection rate of 26.0%(147 cases).Research findings demonstrate that applying mature Chinese DR-AI screening standards and technological solutions through international collaboration in regions with a scarcity of ophthalmic professionals is both feasible and effective.This project serves as a reference for promoting DR-AI in resource-constrained countries and regions,highlighting its significant potential to leverage AI in addressing the global burden of chronic diseases and advancing the modernization of health systems.
基金Supported by National Natural Science Foundation of China(No.82160195,No.82460203)Zhejiang Traditional Chinese Medicine Science and Technology Plan Project(No.2025ZR172).
文摘AIM:To compare spontaneous brain regional activities between diabetic vitreous hemorrhage patients(DVHs)and healthy controls(HCs).METHODS:Thirty-two DVHs and 32 HCs were enrolled in this study.Baseline demographic and vision data were compared between groups using an independent sample t-test.Resting-state functional magnetic resonance imaging(rs-fMRI)was used in all participants.fMRI data was obtained and analyzed using MRIcro and SPM8 software.Fractional amplitude of low-frequency fluctuation(fALFF)technology was used to measure regional spontaneous brain activity,and sensitivity was tested using receiver operating characteristic curves(ROCs).The fALFF values were analyzed using REST software and two-sample t-tests were used to compare values between groups.Hospital anxiety and depression scale(HADS)score was assessed in DVHs and Pearson’s correlation was used to test relationships between mean fALFF value and both HADS score and duration of DVH.RESULTS:Except for the best-corrected visual acuity(BCVA)in both eyes,which showed a statistically significant difference(P<0.05),there were no statistically significant differences in the other indicators(P>0.05)between the HCs and DVHs group.Compared with controls,fALFF value was higher in DVH in cerebellum posterior lobe(CPL)and lower in right anterior cingulate cortex(ACC)and right medial orbitofrontal cortex(OFC).In DVH patients,mean fALFF value of CPL was positively correlated with HADS score and duration of diabetes.However,no such correlation was found,for right ACC or right medial OFC.DVH may lead to abnormal activities in certain brain regions related to visual control and mood.CONCLUSION:Visual impairment caused by DVH may lead to adjustment in regional visual brain activities and may be related to depression or reward system processing in some brain regions.
文摘Overt and harmful diabetes mellitus(DM)has detrimental effects on individuals and,by extension,the community.Among the microvascular DM complications is diabetic retinopathy(DR).DR may cause irreversible vision deterioration in cases of poor blood glucose regulation.Changes in vascular permeability are key trigger points for diabetic macular edema(DME),a condition characterized by the accumulation of fluid in the macula.The development of vascular endothelial growth factor(VEGF)pathway inhibitors has provided a pathogenesis-based treatment approach for DME.Optical coherence tomography(OCT)provides highresolution imaging of the anatomy,including the aging of DME and its structural damage,in distinct morphologic subtypes of macular edema,thereby supporting the assessment of macular edema treatment.The availability of repeated OCT monitoring provides clinical reassurance through the treatment.OCT angiography(OCTA)provides retinal blood flow maps with high spatial resolution.The ability promotes an understanding of disease pathogenesis and facilitates the implementation of new therapeutic methods.This review compares the potential of OCT and OCTA in the diagnosis and treatment of DME,as well as their respective therapeutic applications.
基金funded by grants from the Suzhou Gusu Health Talents Project(grant No.GSWS2024050 to Liu W)Natural Science Foundation Project of Nanjing University of Chinese Medicine(grant No.XZR2021043 to Liu W and grant No.XZR2023021 to Huang F)+1 种基金Suzhou Science Education Health Youth Project(grant No.KJXW2021046 to Liu W)Suzhou Major Disease Multi-center Clinical Research Project(grant No.DZXYJ202410 to Huang F).
文摘Background:Inflammation,caused by prolonged hyperglycemia,plays a substantially more important part in the progression of diabetic peripheral neuropathy(DPN).Notably,the MAPK pathway that mediates the Nuclear Factor-kappa B(NF-κB)pathway contributes to inflammation-induced peripheral nerve damage,affecting cell survival.Juan Bi Tong Luo(JBTL),a traditional Chinese medicine(TCM),has demonstrated favorable results in alleviating pain and numbness in patients with DPN;however,whether JBTL exerts its effect through the MAPK mediating NF-κB pathway remains unclear.Methods:This study investigated whether JBTL modulates apoptosis in DPN models and Schwann cells cultured in 100 mM of glucose by MAPK/NF-κB.Results:The JBTL altered inflammation,reduced peripheral nerve tissue damage,and improved cell survival rates by down-regulating MAPK/NF-κB.Conclusion:Our findings demonstrate that the effect of JBTL on DPN is likely mediated by suppressing inflammation induced by the MAPK/NF-κB pathway,thus providing evidence for the clinical efficacy of JBTL in treating DPN.
文摘Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)–derived fractional flow reserve(CT-FFR) for long term outcomes. We examined the long-term prognostic value of CT-FFR combined with CCTA–defined atherosclerotic extent in diabetic patients with coronary artery disease(CAD).Methods A retrospective pooled analysis of individual patient data was performed. Deep-learning-based vessel-specific CTFFR was calculated. All patients enrolled were followed-up for at least 5 years. Predictive abilities for major adverse cardiac events(MACE) were compared among three models(model 1), constructed using clinical variables;model 2, model 1+CCTA–derived atherosclerotic extent(Leiden risk score);and model 3, model 2+CT-FFR.Results A total of 480 diabetic patients [median age, 61(55–66) years;52.9% men] were included. During a median follow-up time of 2197(2126–2355) days, 55 patients(11.5%) experienced MACE. In multivariate-adjusted Cox models, Leiden risk score(HR: 1.06;95% CI: 1.01–1.11;P = 0.013) and CT-FFR ≤ 0.80(HR: 6.54;95% CI: 3.18–13.45;P < 0.001) were the independent predictors. The discriminant ability was higher in model 2 than in model 1(C-index, 0.75 vs. 0.63;P < 0.001) and was further promoted by adding CT-FFR to model 3(C-index, 0.81 vs. 0.75;P = 0.002). Net reclassification improvement(NRI) was 0.19(P = 0.009) for model 2 beyond model 1. Of note, adding CT-FFR to model 3 also exhibited significantly improved reclassification compared with model 2(NRI = 0.14;P = 0.011).Conclusion In diabetic patients with CAD, CT-FFR provides robust and incremental prognostic information for predicting longterm outcomes. The combined model exhibits improved prediction abilities, which is beneficial for risk stratification.
基金the Ministry of Science and Technology Taiwan,No.MOST 109-2314-B-182A-091,No.NSTC 112-2314-B-182A-062, No.NSTC 113-2314-B-182A-125.
文摘BACKGROUND The incidence of diabetic atherosclerosis(DMA)is increasing worldwide,but its pathogenesis remains incompletely understood.In addition to cardiovascular complications,bladder dysfunction is one of the common comorbidities associated with DMA but is often refractory to current treatments.AIM To investigate the therapeutic effect of human amniotic fluid stem cell-derived extracellular vesicles(hAFSC-EVs)on the recovery of bladder dysfunction in DMA rats.METHODS Eighty rats were divided into normal control,streptozotocin-induced diabetic rats,diabetic rats subjected to arterial balloon endothelial injury of common iliac artery(DMA),and DMA rats treated with hAFSC-EVs(DMA+hAFSC-EVs).At 4 weeks and 12 weeks after DMA induction,levels of blood glucose,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,homeostasis model assessment(HOMA)-insulin resistance,and HOMA-βwere measured.Cystometry,common iliac artery wall thickness,and bladder tumor necrosis factor(TNF)-α,interleukin(IL)-6,transforming growth factor(TGF)-β1,Smad3,connective tissue growth factor(CTGF)and fibronectin were also evaluated.RESULTS Bladder weight and blood glucose,triglyceride,HOMA-insulin resistance,common iliac artery intima thickness,voided volume,intercontraction interval,bladder capacity,and mRNA expression of TNF-α,IL-6,TGF-β1,Smad3,CTGF and fibronectin were significantly increased at 4 weeks and 12 weeks after induction,while the HOMA-βlevel decreased at 4 weeks and 12 weeks,and the high-density lipoprotein cholesterol level decreased at 12 weeks.hAFSC-EVs treatment in DMA rats significantly reduced bladder weight and blood glucose,thickness of common iliac arterial intima,voided volume,intercontraction interval and bladder capacity at 4 weeks.The mRNA expression of TNF-α,TGF-β1,and CTGF in DMA rats treated with hAFSC-EVs were significantly decreased at 4 weeks,while the mRNA expressions of IL-6 and Smad3 were significantly decreased 12 weeks.CONCLUSION hAFSC-EVs treatment can help restore DMA-induced bladder dysfunction,which is associated with lowered blood glucose levels,reduced arterial wall thickness,and decreased TNF-α,IL-6,TGF-β1,Smad3,and CTGF expression.
文摘AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR),and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA screening indicators to detect concurrent DR at an early stage.METHODS:A total of 200 patients who treated in the ophthalmology department of the Seventh Affiliated Hospital,Sun Yat-sen University from 2022 to 2023 were included,including 95 first-diagnosed DR patients and 105 patients without DR,and all patients underwent OCTA examination and a collection of demographics and renal function parameters.After a quality check,automated measurements of the foveal avascular zone area,vessel density(VD),and perfusion density(PD)of both 3 mm×3 mm and 6 mm×6 mm windows were obtained.RESULTS:Using random forest and multivariate Logistic regression methods,we developed a diagnostic model for DR based on 12 variables(age,FBG,SBP,DBP,HbA1c,ALT,ALP,urea/Scr,DM duration,HUA,DN,and CMT).Adding specific OCTA parameters enhanced the efficacy of the existing diagnostic model for DR(outer vessel density in 6 mm×6 mm window,AUC=0.837 vs 0.819,P=0.03).In the study of DN patients,the parameters in the 6 mm×6 mm window improved the diagnostic efficacy of DR(inner VD;outer VD;full VD;outer PD;full PD).CONCLUSION:The outer VD in the 6 mm×6 mm window can enhance the efficacy of the traditional DR diagnostic model.Meanwhile,compared with the 3 mm×3 mm window,the microvascular parameters in the 6 mm×6 mm window focusing on DN patients can be more sensitive to diagnosing the occurrence of DR.
基金Supported by the King Salman Center for Disability Research,No.KSRG-2023-407.
文摘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.
基金Supported by National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-015the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences,No.2021-I2M-C&T-B-003.
文摘BACKGROUND Gastroparesis may repeatedly induce diabetic ketoacidosis(DKA),and the differential diagnosis of these diseases is challenging because of similar gastrointestinal symptoms.If DKA is accompanied by gastroparesis,patients present with persistent gastrointestinal symptoms without relief and may even experience recurrent DKA.Misdiagnosis results in poor treatment outcomes and prognosis.We hypothesized that biomarkers or screening tools can be identified by comparing the clinical data between DKA alone and DKA+gastroparesis to facilitate early screening.AIM To achieve early detection and diagnosis of DKA+gastroparesis to enable early treatment aimed at relieving gastrointestinal symptoms and preventing reinduction of DKA.METHODS We conducted a case-control study in which 15 patients hospitalized for DKA at the Endocrinology Department of Peking Union Medical College Hospital and diagnosed with DKA and gastroparesis between December 1999 and January 2023(DKA+gastroparesis group)were included.Then,we selected 60 DKA patients without DKA as a control group(DKA alone group)based on gender,age,disease course,and diabetes subtype in a 1:4 matching ratio.Clinical manifestations and physical and laboratory examination results were statistically compared between the groups.RESULTS The DKA+gastroparesis group was composed of nine males and six females,with a mean age of 35±11 years,while the DKA alone group included 34 males and 26 females,with a mean age of 34±17 years.In the DKA+gastroparesis group,urine ketone levels normalized,while gastrointestinal symptoms persisted despite treatment,and the tests indicated lower glycosylated hemoglobin levels(HbA1c;7.07%vs 11.51%,P<0.01),largest amplitude of glycemic excursions(5.86 vs 17.41,P<0.01),standard deviation of blood glucose(SDBG;2.69 vs 5.83,P<0.01),and coefficient of blood glucose variation(0.31 vs 0.55,P=0.014)compared with the DKA alone group.Probable gastroparesis was considered at HbA1c<8.55%.Besides,the patients in the DKA+gastroparesis group had lower body mass index(19.28 kg/m^(2) vs 23.86 kg/m^(2),P=0.02)and higher high density lipoprotein cholesterol level(2.34 mmol/L vs 1.05 mmol/L,P=0.019)compared to the DKA alone group,but no difference was observed in the remaining lipid profiles between the two groups.CONCLUSION Gastroparesis should be considered in DKA patients who fail to have improved gastrointestinal symptoms after ketone elimination and acidosis correction,particularly when the HbA1c level is<8.55%.
文摘Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature.However,growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit,which includes both the retinal vascular structures and neural tissues.Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening.However,diabetic corneal neuropathy is commonly overlooked and underdiagnosed,leading to severe ocular surface impairment.Several studies have found that these two conditions tend to occur together,and they share similarities in their pathogenesis pathways,being triggered by a status of chronic hyperglycemia.This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy,whether diabetic corneal neuropathy precedes diabetic retinopathy,as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy.We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.
