Heyuan Ding

Altitude and eosinophil (EOS) are closely related to chronic obstructive pulmonary disease (COPD). There are limited studies on the association of altitude and EOS with mortality of COPD patients. Our aim was to explore the association of altitude and EOS with one-year all-cause mortality of patients hospitalized for acute exacerbation of COPD (AECOPD). A total of 351 inpatients with AECOPD in two hospitals from 2021 to 2022 were enrolled and divided into two groups based on the altitude and followed up for one year. Logistic and Cox regression analyses were used to determine the relationship of altitude and eosinophil with one-year all-cause mortality. Restricted cubic spline (RCS) was used to investigate the relationship between variables and outcome. In addition, a post hoc analysis was conducted to explore the relationship between EOS and one-year mortality of AECOPD patients at high altitude. Patients at high altitude had a higher one-year all-cause mortality compared with patients at low altitude (P = 0.001). Multivariate COX regression showed that altitude (HR 3.03, 95% CI 1.22-7.54, P = 0.017), age (HR 2.77, 95% CI 1.31-5.88, P = 0.008) and CRP (HR 2.62, 95% CI 1.29-5.29, P = 0.007) increased the mortality risk in AECOPD patients. BMI (HR 0.34, 95% CI 0.15-0.78, P = 0.011) and EOS (HR 0.16, 95% CI 0.04-0.68, P = 0.013) decreased the mortality risk in AECOPD patients. Age, BMI, EOS and CRP were linearly correlated with one-year mortality of AECOPD. A post hoc analysis revealed that EOS (HR 0.17, 95% CI 0.04-0.70, P = 0.014) decreased the mortality risk in AECOPD patients at high altitude. Patients with COPD at high altitude had a higher one-year mortality. Altitude and EOS are associated with one-year mortality in COPD patients, which underscores the potential therapeutic benefits of EOS in mitigating the mortality risk of AECOPD patients at high altitude.

Osteoporosis (OP) prevalence is significantly higher in type 2 diabetes (T2DM) patients, but the connecting molecular mechanisms are unclear. This study identified diabetes-related gene signatures in OP using integrated bulk and single-cell RNA-seq datasets from OP and T2DM. Bioinformatics and machine learning (LASSO, RF, SVM-RFE) analyses were employed, with hub genes validated clinically and in an OVX mouse model. We identified 40 immune-related diabetes-associated genes (DRGs), including four hub genes (BCL2L11, IL1R2, IL4R, TLR4) for OP diagnosis. A nomogram based on these showed high accuracy (AUC = 0.925), validated externally (p < 0.01). Immune infiltration revealed changes in plasma cells, NK cells, and macrophages. Single-cell analysis highlighted myeloid-specific DRG enrichment and active roles in RESISTIN and VISFATIN pathways. Pseudotime analysis linked DRG score negatively to differentiation. Elevated IL1R2 in OP mice was confirmed. The four identified genes represent diagnostic value and potential therapeutic targets for modulating the T2DM-OP interaction. Our results further uncover critical myeloid-mediated mechanisms underlying this comorbidity, thereby providing new insights for future therapeutic development.

Hyponatremia is strongly associated with syndrome of inappropriate antidiuretic hormone secretion (SIADH). We present an 82-year-old male with refractory hyponatremia unresponsive to the discontinuation of hydrochlorothiazide and comprehensive treatment (fluid restriction, sodium supplementation, and tolvaptan). Two consecutive urine cultures identified extensively drug-resistant Klebsiella pneumoniae (XDRKP). After tigecycline treatment, serum sodium returned to normal and remained stable during one-year follow-up. This case suggests a close relationship between XDRKP infection and SIADH, highlighting the need to evaluate drug-resistant pathogens in patients with refractory hyponatremia and the importance of antimicrobial therapy in the management of electrolyte disorders secondary to drug-resistant urinary tract infections.

Background: Diabetic kidney disease (DKD) is the most frequent complication in patients with type 2 diabetes mellitus (T2DM). It causes a chronic and progressive decline in kidney function, and ultimately patients require renal replacement therapy. To date, an increasing number of clinical studies have been conducted to explore the potential and novel biomarkers, which can advance the diagnosis, estimate the prognosis, and optimize the therapeutic strategies at the early stage of DKD. In the current study, we sought to investigate the association of plasma myoglobin with DKD.Methods: A total of 355 T2DM patients with DKD and 710 T2DM patients without DKD were enrolled in this study. Laboratory parameters including blood cell count, hemoglobin A1c, biochemical parameters, and plasma myoglobin were recorded. Patients were classified on admission according to the tertile of myoglobin and clinical parameters were compared between the groups. Pearson correlation analysis, linear regression, logistic regression, receiver operating characteristics (ROC) analysis, and spline regression were performed.Results: Plasma myoglobin significantly increased in patients with DKD and was associated with renal function and inflammatory parameters. Plasma myoglobin was an independent risk factor for the development of DKD. The area under ROC curve of myoglobin was 0.831. Spline regression showed that there was a significant linear association between DKD incidence and a high level of plasma myoglobin when it exceeded 36.4 mg/mL.Conclusions: This study shows that elevated plasma myoglobin level is closely associated with the development of kidney injury in patients with T2DM. image

Fibrinogen to Albumin Ratio as an Independent Risk Factor for Type 2 Diabetic Kidney Disease

Background: Papillary thyroid carcinoma (PTC) is considered to be an inflammatory disease. This study aimed to investigate the association of monocyte to high‐density lipoprotein cholesterol ratio (MHR) with PTC.Methods: Clinical parameters from 300 patients with PTC and 552 patients with benign thyroid nodule were compared. Serum renal function and liver enzymes, fasting plasma glucose, lipid profile, and blood cell count were measured.Results: Patients with PTC had a higher MONO (p < 0.001) and MHR (p < 0.001). There was a step‐wise increase in the prevalence of PTC (p = 0.003) with the tertile of MHR. Logistic regression analysis revealed that MHR could be considered an independent risk factor (p < 0.001) in the case‐control study and the cohort study. Pearson correlation analysis and simple linear regression analysis indicated that MHR was positively associated with neutrophil (NEU) and lymphocyte (LYM) count as well as neutrophil‐to‐lymphocyte ratio (NLR). Area under the curve (AUC) was 0.711. The optimal cutoff of MHR was 0.33 × 10⁹/mmol.Conclusion: This study identifies novel evidence that patients with PTC have a higher MHR. MHR is an independent risk factor for PTC. These findings support the application of MHR to predict, diagnose, and evaluate the occurrence of PTC.

Objective: The aim of our study was to explore the association between serum cystatin C (CysC) and euthyroid Hashimoto’s thyroiditis. Methods: There were 119 female euthyroid Hashimoto’s thyroiditis patients and 225 healthy controls who were recruited. Serum CysC, thyroid function, thyroid autoantibodies, fasting glucose, liver enzymes, and lipid profile were determined. Clinical parameters were compared between two groups. Results: Serum CysC levels were significantly higher in euthyroid Hashimoto’s thyroiditis patients compared with controls. In the lowest, middle, and highest tertile groups of CysC, the percentage of Hashimoto’s thyroiditis was 15.9%, 34.2%, and 53.5%, respectively. The percentage of Hashimoto’s thyroiditis was significantly higher in the highest tertile than in the lowest and middle tertiles. Spearman’s correlation analysis showed that serum CysC levels were negatively correlated with free triiodothyronine (FT₃), and positively correlated with serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb). Logistic regression analysis showed that serum CysC was independently related to the status of euthyroid Hashimoto’s thyroiditis. Conclusions: The present study shows the first evidence suggesting that serum CysC levels are positively correlated with TPOAb and TGAb. Serum CysC might underlie the pathophysiologic features of euthyroid Hashimoto’s thyroiditis.

The aim of our study was to explore the diagnostic value of prealbumin to fibrinogen ratio (PFR) for predicting prognosis with the optimal cut-off value in diabetic peripheral neuropathy (DPN) patients. A total of 568 type 2 diabetes mellitus (T2DM) patients were enrolled in this study. The values including Toronto clinical neuropathy score (TCNS), nerve conduction velocity (NCV), vibration perception threshold (VPT), blood cells count, biochemical parameters, fibrinogen and PFR were recorded. The patients were divided into tertiles based on admission PFR value. Firstly, clinical parameters were compared among the groups. Secondly, a logistic regression and ROC analysis were performed as the statistical model. The percentage of DPN, TCNS and VPT were significantly higher in the lowest PFR tertile than in the middle PFR tertile and the highest PFR tertile (P<0.01-0.001). NCV was significantly lower in lowest PFR tertile than in the middle PFR tertile and the highest PFR tertile (P<0.01-0.001). The Spearman correlation analysis showed that PFR was negatively correlated with TCNS and VPT(P<0.001), while PFR was positively correlated with median motor NCV(P<0.001), peroneal motor NCV(P<0.001), median sensory NCV (P<0.001), and peroneal sensory NCV (P<0.001). After adjusting these potentially related factors, PFR was independently related to DPN (P=0.007). The area under ROC curve was 0.627. This study finds the first evidence to suggest PFR may be the key component associated with DPN in T2DM, while PFR might underlie the pathophysiologic features of DPN.

Chronic low-grade inflammation plays a central role in the pathophysiology of gestational diabetes mellitus (GDM). To investigate the ability of different inflammatory blood cell parameters in predicting the development of GDM and pregnancy outcomes, 258 women with GDM and 1,154 women without were included in this retrospective study. First-trimester neutrophil count outperformed white blood cell count and the neutrophil-to-lymphocyte ratio in the predictability for GDM. Subjects were grouped based on tertiles of neutrophil count during their first-trimester pregnancy. The results showed that as the neutrophil count increased, there was a stepwise increase in GDM incidence as well as in glucose and glycosylated hemoglobin levels, HOMA for insulin resistance (HOMA-IR), macrosomia incidence, and newborn weight. Neutrophil count was positively associated with prepregnancy BMI, HOMA-IR, and newborn weight. Additionally, neutrophil count was an independent risk factor for the development of GDM, regardless of the history of GDM. Spline regression showed that there was a significant linear association between GDM incidence and the continuous neutrophil count when it was >5.0 × 10⁹/L. This work suggested that the first-trimester neutrophil count is closely associated with the development of GDM and adverse pregnancy outcomes.