Type 2 diabetes mellitus (T2DM) has become a global public health crisis with a steady upward prevalence, and China alone has over 100 million adult T2DM patients. Long-term persistent hyperglycemia damages microvasculature and peripheral nerves, leading to disabling complications such as diabetic foot (DF) and diabetic peripheral neuropathy (DPN). These complications severely reduce patients' quality of life and increase medical burdens, thus creating an urgent need for effective adjunctive therapeutic interventions.

To evaluate the efficacy and safety of alprostadil injection in treating type 2 diabetes-related DF or DPN.

A prospective randomized controlled trial was conducted involving 120 eligible patients (62 with DF, 58 with DPN) recruited from our hospital between 2018 and 2021. Inclusion criteria included confirmed T2DM diagnosis and meeting diagnostic criteria for DF/DPN; exclusion criteria included severe organ dysfunction. Patients were randomly divided into control group (n=60, receiving standard care including blood glucose control and symptom management) and observation group (n=60, standard care plus 40μg alprostadil intravenous infusion daily for 14-21 days). Outcomes included total efficacy rate, lipid profiles (TC, TG, LDL-C, HDL-C), and adverse events.

Clinical outcomes showed significant advantages in the observation group: total efficacy rate was 93.33% (56/60) versus 76.67% (46/60) in the control group (P=0.011). Lipid profiles improved more remarkably in the observation group: TC decreased by (1.24±0.32) mmol/L, TG by (0.86±0.21) mmol/L, LDL-C by (0.92±0.25) mmol/L, and HDL-C increased by (0.35±0.10) mmol/L (all P<0.05). Adverse event rate was 3.33% (2/60) in the observation group, much lower than 18.83% (11/60) in the control group (P=0.008).

Alprostadil injection as an adjunctive therapy for T2DM-related DF or DPN exhibits significant efficacy and good safety. It not only enhances the overall therapeutic response but also effectively improves lipid metabolism disorders, with a low incidence of adverse events.

This study aimed to investigate the relationship between blood uric acid (UA), serum lipoprotein(a) [Lp(a)], and the severity of neurological damage in patients with acute penetrating artery occlusive cerebral infarction combined with type 2 diabetes mellitus (T2DM).

To evaluate the role of UA and Lp(a) levels as independent risk factors for neurological damage severity and poor prognosis, and to observe the therapeutic effect of tanshinone.

Clinical data of patients were analyzed to compare differences in indicators between the mild and moderate groups, as well as between groups with good and poor prognosis.

Patients in the moderate infarction group showed significantly higher levels of UA, Lp(a), and other biochemical markers, along with higher rates of unhealthy lifestyle habits and comorbidities. UA, Lp(a), and infarct diameter were independent risk factors for poor prognosis. Their combined prediction model demonstrated good sensitivity and specificity. Pre-treatment UA and Lp(a) levels were significantly positively correlated with pre-treatment NIHSS scores and post-treatment mRS scores, respectively.

In patients with acute penetrating artery occlusive cerebral infarction combined with T2DM, blood uric acid and serum Lp(a) levels are associated with the severity of neurological damage and serve as independent risk factors for poor prognosis.

Dressing change frequency is fundamental to wound care yet governed by tradition, creating a clinical paradox: protecting acute wounds versus debriding diabetic, biofilm-laden ones. Because "one-size-fits-all" protocols ignore this pathophysiological divide, the mechanistic principles for tailoring frequency to the specific wound state remain critically undefined.

We established parallel full-thickness wound models in normal (acute) and diabetic mice, randomized to high-, intermediate-, or low-frequency dressing change regimens. Healing was evaluated via macroscopic closure, histology, and qRT-PCR analysis of key genes regulating inflammation, macrophage polarization, and matrix remodeling.

An intermediate-frequency regimen drove superior healing in acute wounds, with accelerated closure and organized collagen deposition. In stark contrast, diabetic wounds required high-frequency treatment; low-frequency intervention was actively detrimental. These opposing outcomes were governed by a common mechanism: the optimal frequency orchestrated a rapid resolution of LBP-mediated inflammation and triggered a decisive M1-to-M2 macrophage shift, driving effective collagen synthesis.

This study challenges the static paradigm in wound care. We establish that dressing frequency is a dynamic therapeutic variable that must be tailored to the wound's pathophysiology. Our findings provide the first evidence-based rationale for modulating intervention rhythm based on a wound's inflammatory state-a critical strategy to accelerate acute repair and rescue diabetic nonhealing wounds.

Pregnancy represents a unique physiological state that involves closely coordinated hormonal, immunological, and metabolic adaptations that ensure an optimal distribution of nutrients between the mother and the fetus. The maternal liver undergoes adaptive changes throughout the anabolic and catabolic phases of this reproductive process, where carbohydrate, lipid, and protein metabolism participate to sustain embryonic development, fetal growth, and maternal energy balance. This mini-review integrates recent in vitro, animal, and clinical evidence on the regulatory functions of microRNAs (miRNAs) small non-coding RNAs that fine-tune gene expression post-transcriptionally in maternal hepatic metabolism during pregnancy. Highlighted miRNAs include miR-29a, miR-351, miR-16-5p, miR-155-5p, miR-146b, and miR-1323, which collectively influence insulin signaling, gluconeogenesis, lipid mobilization, and inflammatory responses in hepatic tissue. Dysregulation of these miRNAs has been linked to metabolic disorders such as obesity, insulin resistance, and gestational diabetes mellitus (GDM). This review focuses on liver-specific expression patterns and pregnancy-associated miRNA pathways, underscoring their potential as early, non-invasive biomarkers as well as therapeutic targets. By deepening the understanding of epigenetic regulation in maternal-fetal metabolic adaptation, this review provides insights into molecular findings with clinical perspectives as key components of translational research.

Respiratory tract infections, which are among the most common infections, can be serious and fatal in patients with diabetes mellitus (DM). Studies show that community-acquired pneumonia (CAP) is more severe in people with DM. However, the impact of serum glucose and HbA1c levels on mortality associated with pneumonia remains controversial. We designed this study to investigate the impact of DM on the prognosis of pneumonia and to elucidate the relationship between glycaemic parameters and mortality in CAP. The study included a retrospective analysis of patients with CAP treated in the Chest Diseases Department and Intensive Care Unit (ICU) of Antalya Research and Training Hospital between January 2022 and June 2025. Patient demographics, clinical and laboratory parameters, and clinical outcomes were analysed. The mortality rate of patients with DM was significantly higher than that of patients without DM (p=0.028). When comparing discharged and deceased patients with DM, HbA1c and random blood glucose on admission were higher in the deceased patients (p=0.012 and p=0.019, respectively). Regression analysis identified CRP (p = 0.024), length of ICU stay (p = 0.005), HbA1c (p = 0.032), and PSI (Pneumonia Severity Index) score (p = 0.008) as significant predictors of mortality. DM is not only a comorbidity but also a factor that strongly influences the clinical course of CAP. Our study confirms the finding that patients with DM have a poor prognosis and high mortality during the course of CAP. It also showed that HbA1c and blood glucose levels at admission are associated with mortality. As pneumonia may be more severe in patients with high blood glucose and HbA1c on admission, it should be considered that these patients with DM may need to be treated earlier in ICU.

Prostate cancer (PCa) is a major health concern in ageing populations. While guidelines often preclude older men from robotic-assisted radical prostatectomy (RARP), outcomes are not well defined. We evaluated functional and oncological outcomes of RARP in patients ≥ 80 years. A multi-centre review of prospectively maintained surgical databases from three high-volume robotic surgeons was performed. Men ≥ 80 years old who underwent RARP between 2016 and 2024 were included. Demographic, surgical, functional, and oncological outcomes were analysed. Thirty men (mean age 82.6 years) were included. Fifteen, five and ten patients had ISUP Grade Group 2-3, 4 and 5 diseases, respectively. Twenty (20/30, 67%) patients had high-risk disease, with 16 clinical stage ≥ T2c. Mean operative time was 132 min and mean estimated blood loss was 187 mLs. Two complications occurred, one Clavien-Dindo grade II and one grade III. Median follow-up was 30.5 months (IQR 11.5-45.3). At 12 months, 16 out of 23 patients (70%) were pad-free or using one safety pad, and 4 (4/23, 17%) required one pad/day. Pathology revealed locally advanced disease in 22 (22/30, 73%) patients (≥ T3), and 6 (6/22, 20%) patients with a positive surgical margin. Biochemical recurrence is defined as PSA ≥ 0.2 ng/ml (Bellera et al. Ann Oncol 23(8):2166-2172, 2012) and it was observed in 11 patients (11/30, 37%), with 7 patients receiving further treatment. Small cohort size and retrospective analysis limit generalisability. RARP is safe and feasible in carefully selected octogenarians, showing acceptable functional and oncological outcomes. Older men should not be precluded from surgery based on age alone. This study supports offering RARP to these men after counselling on peri-operative risks and alternatives.

Robot-assisted radical prostatectomy (RARP) is an effective treatment for localized prostate cancer (PCa), but positive surgical margins (PSMs) occur in up to 22% cases. This study quantifies the relationship between the tumor location on preoperative MRI and PSM location on final pathology examination.

We retrospectively reviewed PCa patients who underwent both prostate MRI and RARP between January 1, 2022 and December 31, 2022. The RARP specimens were divided into 14 regions, and concordance between MRI-detected lesions (PIRADS > 2) and PSM locations was assessed.

Data from 464 patients revealed PSMS in 130 (28%) patients, totaling 187 PSMs. Concordance between tumor and PSM location was found in 152 PSMs (81%). Of these, 38% corresponded with a T3 lesion on MRI, and 72% showed pathological T3 at the PSM location. Most PSMs (46%) were at the apex. The median size was 6.0 mm (IQR 1.9-10.3). In contrast, 19% of PSMs were in regions without MRI-detected lesions, mainly located at the apex (43%) and bladder neck (29%). In this group, 34% had no positive biopsy on the corresponding side. PSMs in this group showed pathological T3 in 66% of cases. The median size was 3 mm (IQR 2.5-7.0 mm), and 46% had a pathological ISUP Gleason score ≥ 2.

This study highlights the role of preoperative MRI assessment in predicting PSM locations during RARP. In 81% of cases, PSMs corresponded to MRI-detected lesions (PI-RADS > 2), suggesting that MRI can help by guiding surgical planning and potentially reduce PSM rates.

The objective of this study is to comprehensively describe the use of robotic surgery for the excision of thyroglossal duct cysts (TGDCs) in the literature. PubMed, Scopus, Cochrane Library, and EMBASE databases were searched. Screening, selection, data extraction, and quality analysis were performed by two independent authors using pre-defined criteria. Conflicts were resolved by independent senior authors. Descriptive statistics were used to summarize the data. From 25 unique articles, 14 articles were selected, describing 26 distinct patients with lingual (n = 16), suprahyoid (n = 1), or infrahyoid (n = 9) TGDCs treated with robotic surgery. The median age was 11 years (IQR = 17). A simple transoral approach was performed for all lingual TGDCs (n = 16). Suprahyoid and infrahyoid TGDCs were treated using transvestibular sublingual (n = 1), postauricular (n = 8), and bilateral axillary-breast (n = 1) approaches. No intraoperative complications were reported. Post-operative complications included minor bleeding (n = 1), oral-cutaneous fistula (n = 1), nerve weakness (n = 1), and seroma (n = 1). No recurrences were reported across a median follow-up of 16 months (IQR = 7.5). The current available evidence is limited to small case series and reports. This study demonstrates low complication rates, no reported recurrences, and favorable recovery in patients undergoing TGDC excision, supporting the role of robotic surgery as a safe and effective option in select cases.

Breast and colorectal cancers are among the most prevalent malignancies in Kuwait. As cancer care shifts toward outpatient and home-based models, this study explored oncology nurses' perspectives on how Kuwaiti adults with these cancers navigate home-based self-management and identified strategies used to empower patients in this process.

A qualitative study using a constructivist grounded theory approach was conducted in 2022 at a specialized cancer care center in Kuwait. Semi-structured interviews were held with seven purposively selected oncology nurses, each with at least 2 years of oncology experience. Data were analyzed through constant comparison and theoretical coding.

The central theme, "Holistic empowerment and self-management in cancer care amidst systemic challenges," reflected the nurses' multifaceted role in supporting patients' recovery and adaptation. Nurses emphasized that structured health education and family involvement enhanced confidence in managing medications, wound care, and rehabilitation at home. Emotional and psychological support during care transitions, particularly at discharge or palliative stages, strengthened patient motivation and trust. However, resource shortages, language barriers, and socioeconomic disparities constrained empowerment efforts. Collaboration with community organizations provided essential financial and emotional support to fill systemic gaps.

Oncology nurses play a pivotal role in facilitating self-management among cancer survivors in Kuwait. Strengthening their capacity through targeted training, cultural competence, and policy support can improve survivorship outcomes. These findings underscore the need for culturally competent, system-supported empowerment strategies to enhance survivorship care.

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a rare inherited white matter disorder. Initially, a "classic" phenotype has been characterized, presenting early-onset macrocephaly, cerebellar ataxia, mild spasticity, and a distinctive neuroimaging pattern of diffuse white matter abnormalities with subcortical cysts. An "improving" phenotype has also been described, featuring milder or absent neurological signs and a remitting pattern on neuroimaging. Mutations in four genes, MLC1, HEPACAM, GPRC5B and AQP4 have been associated with MLC. We describe clinical and genetic features of a cohort of genetically confirmed Italian MLC patients, representing the largest Italian cohort reported to date.

We conducted a retrospective, multicenter, observational study. Patients were included based on clinical and neuroimaging features consistent with MLC, along with a confirmed genetic diagnosis. Data were collected using a standardized database and included demographic, clinical, neuroimaging, neurophysiological, and genetic information.

Thirty-three patients from eight Italian centers were enrolled. Twenty-seven harbored biallelic MLC1 variants (23 distinct mutations, including three novel variants), while six had three distinct heterozygous HEPACAM variants. All MLC1-mutated patients exhibited the "classic" phenotype, frequently accompanied by orthopedic, gastrointestinal, and respiratory comorbidities. HEPACAM-mutated patients were consistent with the "improving" phenotype. No patients harbored mutations in GPRC5B or AQP4.

Our findings expand the mutational spectrum of MLC1, further characterize the disease phenotype, and provide valuable insights into its presence in Italy. They also underscore management needs of individuals with MLC, highlighting the importance of multidisciplinary care.