Frontiers in Endocrinology最新文献

Background: Diabetic foot ulcers (DFUs), particularly those with ischemic components, present a major therapeutic challenge due to poor perfusion, high infection risk, and delayed wound healing. Conventional treatments often fail to achieve satisfactory outcomes in complex cases. Vacuum sealing drainage (VSD) has shown promise in wound healing by enhancing angiogenesis, stimulating granulation tissue formation, and reducing bacterial colonization while antibiotic-loaded bone cement (ALBC) offers localized, high-concentration antimicrobial delivery. However, the sequential application of these two modalities is rarely reported in ischemic DFUs.

Case presentation: We report the case of a 78-year-old female with type 2 diabetes mellitus who presented with a chronic, infected, ischemic foot ulcer that was unresponsive to standard wound care and systemic antibiotics. Surgical debridement was performed, followed by the application of VSD to enhance granulation tissue formation and maintain negative pressure drainage. Antibiotic-loaded bone cement was subsequently applied to fill the wound cavity and control local infection. Over the subsequent weeks, sequential application of VSD and ALBC resulted in remarkable improvement of the ulcer, ultimately achieving complete wound healing without the need for revascularization or major amputation.

Conclusion: This case demonstrates that the sequential application of VSD and ALBC may offer a synergistic therapeutic strategy for the management of complex diabetic ischemic ulcers. This approach may provide an effective alternative in cases where infection control and wound healing are otherwise difficult to achieve.

Background: The rising global incidence of thyroid nodules necessitates improved non-invasive methods for differentiating benign from malignant lesions. However, research on artificial intelligence (AI) models using multiphase CT imaging to differentiate benign from malignant thyroid nodules is limited.

Methods: This retrospective study analyzed multiphase CT data (noncontrast, arterial, and venous phases) from 604 patients with thyroid nodules confirmed by postoperative pathology. We developed and compared multiple machine learning and deep learning models using extracted radiomics features, raw 3D DICOM data, and key clinical factors (sex, age, thyroglobulin and thyrotropin levels). Model performance was evaluated using receiver operating characteristic (ROC) analysis, and Gradient-weighted Class Activation Mapping (Grad-CAM) was used for visualization.

Results: Models incorporating imaging data significantly outperformed a clinical-only model (AUC = 0.811). Nomograms combining either a radiomics score (Rad-Score) or a deep learning score (AI-Score) with clinical data demonstrated the highest diagnostic accuracy. The nomogram based on Rad-Score and clinical data achieved a peak AUC of 0.885. Similarly, the AI-Score-based nomogram reached an AUC of 0.881. Both integrated approaches proved superior to models relying on a single data type.

Conclusions: AI models integrating multiphase CT radiomics or deep learning features with clinical data provide a robust and highly accurate approach for differentiating benign from malignant thyroid nodules. These integrated models show significant potential for improving clinical decision-making.

[This corrects the article DOI: 10.3389/fendo.2025.1634206.].

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are increasingly prescribed for heart failure and chronic kidney disease, irrespective of diabetic status. While their cardiovascular and renal benefits are well established, euglycemic ketoacidosis (EKA) remains a rare but potentially life-threatening complication that can occur even in non-diabetic individuals.

Case presentation: We report a 58-year-old man with ischemic cardiomyopathy (LVEF 35%) and stage 2 chronic kidney disease who developed nausea, vomiting, and fatigue two weeks after initiating dapagliflozin. Laboratory evaluation revealed high-anion-gap metabolic acidosis (pH 7.21 [reference: 7.35-7.45], HCO₃ ^- 12 mmol/L [reference: 22-28 mmol/L], anion gap 23 mmol/L [reference: 8-16 mmol/L])with markedly elevated β-hydroxybutyrate (5.4 mmol/L) and normal plasma glucose (108 mg/dL). Diabetes, infection, lactic acidosis, and hepatic dysfunction were excluded.

Management & outcome: The SGLT2 inhibitor was discontinued, and the patient was treated with intravenous saline, insulin infusion, and dextrose. Metabolic parameters normalized within 48 hours, and he was discharged in stable condition. No recurrence was noted at three-month follow-up.

Conclusion: This case highlights that SGLT2 inhibitors can precipitate euglycemic ketoacidosis even in non-diabetic patients. Because normal glucose levels may obscure recognition, clinicians should maintain a high index of suspicion and perform ketone testing in patients on SGLT2 therapy who present with unexplained gastrointestinal or constitutional symptoms.

Background: Insulin allergy, although rare in type 1 diabetes (T1DM), poses a significant clinical challenge due to the indispensable role of insulin therapy. Rapid induction of insulin tolerance is critical for affected individuals, especially in acute complications such as diabetic ketoacidosis (DKA).

Case presentation: We report a case of a 50-year-old male with newly diagnosed T1DM who developed type I hypersensitivity reactions to multiple insulin analogs, manifesting as localized erythema, pruritus, and induration. After conventional management, including switching insulin preparations, proved ineffective, a rapid desensitization protocol was initiated using continuous subcutaneous insulin infusion (CSII). Preceding the pump initiation, half of the estimated basal dose of insulin glargine was administered subcutaneously. CSII with insulin aspart was then started at an extremely low initial rate, with increments every 30 minutes.

Results: The target basal infusion rate was successfully achieved within 5 hours without the use of antihistamines or corticosteroids. The procedure was well-tolerated, with no systemic or local allergic reactions. Following desensitization, the patient successfully transitioned to daily injections of glargine and pre-meal aspart insulin, with no recurrence of allergic reactions during long-term follow-up.

Conclusion: A CSII-based rapid desensitization protocol is a safe, effective, and efficient strategy for managing insulin allergy in T1DM, including cases with sensitivities to multiple insulin preparations. This approach is particularly suitable for patients requiring urgent insulin therapy.

Background: Patients with prior coronary artery bypass grafting (CABG) presenting with an acute coronary syndrome (ACS) constitute a subgroup at high cardiovascular risk and have a poor prognosis even after percutaneous coronary intervention (PCI). The stress hyperglycemia ratio (SHR) is a novel marker reflecting acute hyperglycemia adjusted for chronic glycemic status, but its prognostic value in this specific population remains unknown. This study aimed to investigate the association of SHR with long-term adverse cardiovascular outcomes in ACS patients with prior CABG.

Methods: The SHR was calculated using the following formula: admission fasting blood glucose (AFBG)/[1.59 × glycosylated hemoglobin A1c (HbA1c) - 2.59]. The primary endpoint was the long-term incidence of major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, non-fatal stroke, non-fatal myocardial infarction, or unplanned revascularization.

Results: A total of 1,208 ACS patients with prior CABG who underwent PCI were included in the final analysis. During a median follow-up of 1,291 days, 368 (30.5%) patients developed at least one primary endpoint event. Kaplan-Meier analysis revealed a graded, positive relationship between the SHR tertiles and the follow-up incidence of MACCE (log-rank P < 0.001). In multivariate Cox proportional hazards regression analysis adjusted for GRACE risk score and other confounders, compared with those in the lowest SHR tertile, patients in the middle and highest tertiles had a higher risk of MACCE (adjusted hazard ratio [HR]: 1.557, 95% confidence interval [CI] 1.166-2.079, P = 0.003, and 1.943, 95% CI 1.476-2.557, P < 0.001, respectively). Similar results were obtained when SHR was analyzed as a continuous variable (adjusted HR per unit increase 1.276, 95% CI 1.105-1.474, P = 0.001). The addition of SHR to the baseline reference prediction model including GRACE risk score improved model predictive performance markedly (C-statistic: increased from 0.559 to 0.626, P = 0.002; cNRI: 0.580, P = 0.016; IDI: 0.133, P = 0.010).

Conclusions: In ACS patients with prior CABG undergoing PCI, an elevated SHR was a strong and independent predictor of long-term MACCE. This simple metric provides potent prognostic information, potentially enhancing risk stratification and guiding management in this high-risk patient population.

[This corrects the article DOI: 10.3389/fendo.2025.1697718.].

Background: Thyroid nodules (TNs) are common in adults and have been linked to various metabolic and demographic factors. This study aims to explore the associations between metabolic indicators and TNs in a Chinese health examination population, and to develop a simplified predictive model based on independent risk factors.

Methods: We conducted a cross-sectional analysis of 23,305 adults (12,977 men, 10,328 women; aged 18-90 years) who underwent health examinations at the Second Hospital of Hebei Medical University between January 2021 and December 2022. Exclusion criteria included prior thyroid surgery, endocrine or systemic disorders, pregnancy, and incomplete data. Demographic, lifestyle, and biochemical parameters were collected. Group differences were assessed using chi-square tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors, with model performance evaluated by the area under the receiver operating characteristic curve (AUC).

Results: The overall prevalence of TNs was 64.7% (n=15,085). The prevalence increased from 38.8% in those aged 30 years or younger to 87.8% in those older than 70 years (P for trend <0.01), and was higher in women (70.8%) compared to men (59.9%) (χ²=509.8, P<0.01). In multivariate analysis, older age (OR = 1.06 per year, 95% CI: 1.06-1.06, P<0.01), female sex (OR = 2.12, 95% CI: 1.93-2.32, P<0.01), and higher body mass index (OR = 1.04 per unit, 95% CI: 1.03-1.05, P<0.01) were identified as independent risk factors. The three-variable model yielded an AUC of 0.706.

Conclusions: Thyroid nodules are highly prevalent in this health examination population. Age, female sex, and higher body mass index are independent risk factors. Other metabolic disturbances were more common in individuals with TNs, but they were not independent predictors. A simplified model based on age, sex, and body mass index may help identify high-risk individuals in large-scale screenings.