Pub Date : 2025-09-27DOI: 10.1016/j.jdiacomp.2025.109178
Kai-Yang Chen , Hoi-Chun Chan , Chi-Ming Chan
<div><h3>Background</h3><div>Diabetic retinopathy (DR) is a severe microvascular diabetes complication and a leading cause of preventable blindness. Fibrates, being lipid-lowering agents, have been found to have promise in modifying DR progression.</div></div><div><h3>Objective</h3><div>To determine fibrates' effectiveness and safety profile in reducing the incidence, progression, and severity of diabetic retinopathy.</div></div><div><h3>Methods</h3><div>Randomized controlled trials and observational cohort studies that compared fibrate therapy with no fibrate therapy in patients with diabetes were eligible for this systematic review and meta-analysis. The outcomes of interest included the incidence of DR, long-term progression, progression to Proliferative Diabetic Retinopathy (PDR), and adverse effects. Risk of bias was assessed using the RoB 2 and ROBINS-I tools, and results were synthesized narratively due to heterogeneity in the study populations, follow-up durations, and diagnostic methods.</div></div><div><h3>Results</h3><div>Only 17 articles were eligible for inclusion in this study. Fibrates significantly reduced the incidence of diabetic retinopathy (OR 0.72 (95 % CI: 0.66–0.77), <em>p</em> < 0.001; I<sup>2</sup> = 26.53 %) and slowed long-term progression (OR 0.67 (95 % CI: 0.57–0.79), p < 0.001).; I<sup>2</sup> = 26.39 %) compared to placebo. Combining fibrates with statin reduces DR progression by 17 % compared to fibrate alone HR 0.84 (95 % CI: 0.80–0.89), <em>p</em> < 0.001; I<sup>2</sup> = 31.7 %. While progression to proliferative diabetic retinopathy showed a favorable trend (RR 0.71 (95 % CI: 0.15–3.32), <em>p</em> = 0.67, the result was not statistically significant. Analysis of adverse events, including all-cause mortality (OR 0.86 (95 % CI: 0.62–1.19), <em>p</em> = 0.36; I<sup>2</sup> = 0 %), revealed no significant safety benefits in comparison between fibrates and placebo.</div></div><div><h3>Conclusion</h3><div>Fibrates significantly reduce both the incidence and long-term progression of diabetic retinopathy. Safety analyses revealed no significant difference between placebo and fibrates in reducing serious adverse events or all-cause mortality.</div><div><strong>What is known about this research topic?</strong><ul><li><span>•</span><span><div>Diabetic retinopathy (DR) is a leading cause of preventable blindness, with limited systemic therapies beyond glycemic and blood pressure control.</div></span></li><li><span>•</span><span><div>Fibrates, primarily lipid-lowering agents, have shown potential benefits for microvascular complications, including DR, in trials like FIELD and ACCORD Eye.</div></span></li></ul></div><div><strong>What this study adds and its future implications</strong><ul><li><span>•</span><span><div>This meta-analysis confirms fibrates significantly reduce the incidence and long-term progression of DR, with fenofibrate showing the greatest benefit.</div></span></li><li><span>•</span><span><div>Alt
背景：糖尿病视网膜病变（DR）是一种严重的微血管糖尿病并发症，也是可预防失明的主要原因。贝特类，作为降脂剂，已被发现在改变DR进展方面有希望。目的：确定贝特类药物在降低糖尿病视网膜病变的发生率、进展和严重程度方面的有效性和安全性。方法：比较糖尿病患者贝特治疗与非贝特治疗的随机对照试验和观察性队列研究符合本系统评价和荟萃分析的要求。研究结果包括DR的发生率、长期进展、进展为增殖性糖尿病视网膜病变（PDR）和不良反应。使用rob2和ROBINS-I工具评估偏倚风险，由于研究人群、随访时间和诊断方法的异质性，对结果进行叙述性综合。结果：只有17篇文章符合纳入本研究的条件。与安慰剂相比，贝特酯显著降低了糖尿病视网膜病变的发生率（OR 0.72 (95% CI: 0.66-0.77), p 2 = 26.53%），并减缓了长期进展（OR 0.67 (95% CI: 0.57-0.79), p 2 = 26.39%）。贝特类药物联合他汀类药物与单独贝特类药物相比，DR进展减少17% (HR 0.84) (95% CI: 0.80-0.89), p 2 = 31.7%。进展为增生性糖尿病视网膜病变有良好趋势(RR 0.71 (95% CI: 0.15 ~ 3.32), p = 0.67，但结果无统计学意义。不良事件分析，包括全因死亡率(OR 0.86 (95% CI: 0.62-1.19), p = 0.36；I2 = 0%)，显示贝特类药物与安慰剂相比没有显著的安全性益处。结论：贝特类药物可显著降低糖尿病视网膜病变的发病率和长期进展。安全性分析显示，安慰剂和贝特类药物在减少严重不良事件或全因死亡率方面无显著差异。关于这个研究课题我们知道些什么？这项研究补充了什么及其未来的意义。
{"title":"Can fibrate therapy redefine the management of diabetic retinopathy? A comprehensive systematic review and meta-analysis of efficacy and safety","authors":"Kai-Yang Chen , Hoi-Chun Chan , Chi-Ming Chan","doi":"10.1016/j.jdiacomp.2025.109178","DOIUrl":"10.1016/j.jdiacomp.2025.109178","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic retinopathy (DR) is a severe microvascular diabetes complication and a leading cause of preventable blindness. Fibrates, being lipid-lowering agents, have been found to have promise in modifying DR progression.</div></div><div><h3>Objective</h3><div>To determine fibrates' effectiveness and safety profile in reducing the incidence, progression, and severity of diabetic retinopathy.</div></div><div><h3>Methods</h3><div>Randomized controlled trials and observational cohort studies that compared fibrate therapy with no fibrate therapy in patients with diabetes were eligible for this systematic review and meta-analysis. The outcomes of interest included the incidence of DR, long-term progression, progression to Proliferative Diabetic Retinopathy (PDR), and adverse effects. Risk of bias was assessed using the RoB 2 and ROBINS-I tools, and results were synthesized narratively due to heterogeneity in the study populations, follow-up durations, and diagnostic methods.</div></div><div><h3>Results</h3><div>Only 17 articles were eligible for inclusion in this study. Fibrates significantly reduced the incidence of diabetic retinopathy (OR 0.72 (95 % CI: 0.66–0.77), <em>p</em> < 0.001; I<sup>2</sup> = 26.53 %) and slowed long-term progression (OR 0.67 (95 % CI: 0.57–0.79), p < 0.001).; I<sup>2</sup> = 26.39 %) compared to placebo. Combining fibrates with statin reduces DR progression by 17 % compared to fibrate alone HR 0.84 (95 % CI: 0.80–0.89), <em>p</em> < 0.001; I<sup>2</sup> = 31.7 %. While progression to proliferative diabetic retinopathy showed a favorable trend (RR 0.71 (95 % CI: 0.15–3.32), <em>p</em> = 0.67, the result was not statistically significant. Analysis of adverse events, including all-cause mortality (OR 0.86 (95 % CI: 0.62–1.19), <em>p</em> = 0.36; I<sup>2</sup> = 0 %), revealed no significant safety benefits in comparison between fibrates and placebo.</div></div><div><h3>Conclusion</h3><div>Fibrates significantly reduce both the incidence and long-term progression of diabetic retinopathy. Safety analyses revealed no significant difference between placebo and fibrates in reducing serious adverse events or all-cause mortality.</div><div><strong>What is known about this research topic?</strong><ul><li><span>•</span><span><div>Diabetic retinopathy (DR) is a leading cause of preventable blindness, with limited systemic therapies beyond glycemic and blood pressure control.</div></span></li><li><span>•</span><span><div>Fibrates, primarily lipid-lowering agents, have shown potential benefits for microvascular complications, including DR, in trials like FIELD and ACCORD Eye.</div></span></li></ul></div><div><strong>What this study adds and its future implications</strong><ul><li><span>•</span><span><div>This meta-analysis confirms fibrates significantly reduce the incidence and long-term progression of DR, with fenofibrate showing the greatest benefit.</div></span></li><li><span>•</span><span><div>Alt","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 11","pages":"Article 109178"},"PeriodicalIF":3.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-24DOI: 10.1016/j.jdiacomp.2025.109176
Maria Sambataro , Luisa Sambado , Mayra Colardo , Anna Furlan , Piero Maria Stefani , Elisabetta Durante , Antonio Antico , Stefania Conte , Silvia Della Bella , Laura Nollino , Zavan Barbara , Nicola Menegotto , Elisa Vian , Marco Segatto , Matteo Fassan
<div><h3>Aims</h3><div>Diabetic foot is the leading cause of both major and minor non-traumatic amputations yet a truly understanding of the phenomenon is still lacking. The updated definition for diabetes-related foot disease from the International Working Group on the Diabetic Foot (IWGDF 2023 update) is “disease of the foot of a person with current or previously diagnosed diabetes mellitus that includes one or more of the following: peripheral neuropathy, peripheral artery disease, infection, ulcer(s), neuro‐osteoarthropathy, gangrene, or amputation”, but what comes first? Our hypothesis is that distal sensory and autonomic neuropathy activate neuroischemic signaling and dysregulation of bone cell apoptosis portending to infections.</div></div><div><h3>Methods</h3><div>We studied 374 adults with Type 2 diabetes mellitus (T2DM) and diabetic neuropathy (DN) divided into the following subgroups: 106 partecipants without foot lesions (DNp); 119 nonmacrovascular partecipants with ulcers/lesions/osteomyelitis (DNpU); 149 revascularized partecipants with ulcers/lesions/osteomyelitis (DNpUV) and a group of 53 healthy adults as healthy control (NC). During routine foot care visits participants underwent neuro electrophysiology tests and vascular assessment. Biopsy specimens from exposed bone (grade III University of Texas wound classification, TUC) were cultured according to microbiological standards and histological analysis was performed. Pro/anti-inflammatory cytokines and blood cells subsets (lymphocytes subpopulations, classical, non-classical and SLAN<sup>+</sup> monocytes, classical DCs, innate lymphoid cells) were analyzed. Nerve Growth Factor (NGF) species, fractalkine/CX3CL1 migration marker, autophagy markers (Ulk1, Beclin1, LC3, and p62), pro/anti-apoptotic proteins (Bax, Bcl2, cleaved Caspase-3), signal transduction of proteins involved in inflammation and cell survival (p65-NF-kB, Akt and ERK1/2) were measured.</div></div><div><h3>Results</h3><div>Sural nerve (sS) conduction velocity (CV) and sensory Action Potential (sAP) thresholds defined DN. II and III TUC associates with progressive worsening of neuronal function while vibration perception threshold (VPT) and systolic/diastolic orthostatic hypotension inversely correlated with TcPO<sub>2</sub> and critical ischemia. In III TUC versus I TUC diabetic foot ulcer (DFU) and DNp samples the amount of circulating mature NGF (mNGF) was significantly reduced (<em>p</em> < 0.01) while immature NGF (proNGF) was significantly increased (<em>p</em> < 0.05). In all groups we found higher number of SLAN+ monocytes co-expressing CX3CR1 directly correlating with proNGF levels, worse autonomic and sensory testing and inversely correlating with mNGF levels, sensory nerves CV and AP, innate lymphoid cells and subsets of lymphocytes. Surprisingly, we found 59 bone's biopsies with an altered histological pattern but negative microbiological cultures. In all biopsied patients CX3CR1-SLAN+ cells were
{"title":"Neuroinflammation and osteomyelitis in adults with Type 2 diabetes mellitus and peripheral neuropathy without and with foot lesions. What comes first?","authors":"Maria Sambataro , Luisa Sambado , Mayra Colardo , Anna Furlan , Piero Maria Stefani , Elisabetta Durante , Antonio Antico , Stefania Conte , Silvia Della Bella , Laura Nollino , Zavan Barbara , Nicola Menegotto , Elisa Vian , Marco Segatto , Matteo Fassan","doi":"10.1016/j.jdiacomp.2025.109176","DOIUrl":"10.1016/j.jdiacomp.2025.109176","url":null,"abstract":"<div><h3>Aims</h3><div>Diabetic foot is the leading cause of both major and minor non-traumatic amputations yet a truly understanding of the phenomenon is still lacking. The updated definition for diabetes-related foot disease from the International Working Group on the Diabetic Foot (IWGDF 2023 update) is “disease of the foot of a person with current or previously diagnosed diabetes mellitus that includes one or more of the following: peripheral neuropathy, peripheral artery disease, infection, ulcer(s), neuro‐osteoarthropathy, gangrene, or amputation”, but what comes first? Our hypothesis is that distal sensory and autonomic neuropathy activate neuroischemic signaling and dysregulation of bone cell apoptosis portending to infections.</div></div><div><h3>Methods</h3><div>We studied 374 adults with Type 2 diabetes mellitus (T2DM) and diabetic neuropathy (DN) divided into the following subgroups: 106 partecipants without foot lesions (DNp); 119 nonmacrovascular partecipants with ulcers/lesions/osteomyelitis (DNpU); 149 revascularized partecipants with ulcers/lesions/osteomyelitis (DNpUV) and a group of 53 healthy adults as healthy control (NC). During routine foot care visits participants underwent neuro electrophysiology tests and vascular assessment. Biopsy specimens from exposed bone (grade III University of Texas wound classification, TUC) were cultured according to microbiological standards and histological analysis was performed. Pro/anti-inflammatory cytokines and blood cells subsets (lymphocytes subpopulations, classical, non-classical and SLAN<sup>+</sup> monocytes, classical DCs, innate lymphoid cells) were analyzed. Nerve Growth Factor (NGF) species, fractalkine/CX3CL1 migration marker, autophagy markers (Ulk1, Beclin1, LC3, and p62), pro/anti-apoptotic proteins (Bax, Bcl2, cleaved Caspase-3), signal transduction of proteins involved in inflammation and cell survival (p65-NF-kB, Akt and ERK1/2) were measured.</div></div><div><h3>Results</h3><div>Sural nerve (sS) conduction velocity (CV) and sensory Action Potential (sAP) thresholds defined DN. II and III TUC associates with progressive worsening of neuronal function while vibration perception threshold (VPT) and systolic/diastolic orthostatic hypotension inversely correlated with TcPO<sub>2</sub> and critical ischemia. In III TUC versus I TUC diabetic foot ulcer (DFU) and DNp samples the amount of circulating mature NGF (mNGF) was significantly reduced (<em>p</em> < 0.01) while immature NGF (proNGF) was significantly increased (<em>p</em> < 0.05). In all groups we found higher number of SLAN+ monocytes co-expressing CX3CR1 directly correlating with proNGF levels, worse autonomic and sensory testing and inversely correlating with mNGF levels, sensory nerves CV and AP, innate lymphoid cells and subsets of lymphocytes. Surprisingly, we found 59 bone's biopsies with an altered histological pattern but negative microbiological cultures. In all biopsied patients CX3CR1-SLAN+ cells were ","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 11","pages":"Article 109176"},"PeriodicalIF":3.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.jdiacomp.2025.109177
Karolina Hoffmann , Anna Paczkowska , Viviana Maggio , Manfredi Rizzo
Nishizawa et al. demonstrate that cardiovascular–kidney–metabolic (CKM) staging is a strong predictor of all-cause mortality in type 2 diabetes, even before contemporary ardiorenal therapies were widely available. In their cohort, mortality rose sharply from stage 3 onward, underscoring that pathological risk begins well before overt cardiorenal failure. Because CKM staging relies on routine clinical data, it offers a pragmatic framework for early risk stratification, yet it is often applied too late. Integrating CKM assessment into electronic health systems and initiating cardiorenalprotective interventions in stages 1–2 could substantially improve outcomes. Future studies should validate CKM staging in modern therapy settings and evaluate stageguided interventions.
{"title":"The cardiovascular–kidney–metabolic staging in type 2 diabetes: the clock starts ticking early","authors":"Karolina Hoffmann , Anna Paczkowska , Viviana Maggio , Manfredi Rizzo","doi":"10.1016/j.jdiacomp.2025.109177","DOIUrl":"10.1016/j.jdiacomp.2025.109177","url":null,"abstract":"<div><div>Nishizawa et al. demonstrate that cardiovascular–kidney–metabolic (CKM) staging is a strong predictor of all-cause mortality in type 2 diabetes, even before contemporary ardiorenal therapies were widely available. In their cohort, mortality rose sharply from stage 3 onward, underscoring that pathological risk begins well before overt cardiorenal failure. Because CKM staging relies on routine clinical data, it offers a pragmatic framework for early risk stratification, yet it is often applied too late. Integrating CKM assessment into electronic health systems and initiating cardiorenalprotective interventions in stages 1–2 could substantially improve outcomes. Future studies should validate CKM staging in modern therapy settings and evaluate stageguided interventions.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 11","pages":"Article 109177"},"PeriodicalIF":3.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As a structurally unique peroxisome proliferator-activated receptor pan-agonist, chiglitazar has showed dual therapeutic benefits for glycemic control and lipid management in type 2 diabetes mellitus (T2DM). Despite these clinical advantages, comprehensive pharmacoeconomic evaluations comparing chiglitazar with conventional therapies like sitagliptin remain unavailable for China's healthcare system.
Objective
This study aimed to conduct a comparative cost-utility analysis of chiglitazar versus sitagliptin for T2DM treatment in China, evaluating long-term clinical and economic outcomes from a healthcare system perspective.
Methods
Data on patient demographics and post-treatment effects were collected from a double-blind, phase 3, randomized controlled trial conducted in China. The United Kingdom Prospective Diabetes Study Outcomes Model 2.1 was employed to evaluate the long-term effectiveness and associated costs. Uncertainties were addressed using one-way and probabilistic sensitivity analyses. Additionally, the binary search method was utilized to estimate an optimal annual cost for sitagliptin in scenario analyses.
Results
After a 40-year simulation, the life expectancy results were comparable among treatments: 14.93 years for chiglitazar 32 mg, 14.94 years for chiglitazar 48 mg, and 14.93 years for sitagliptin 100 mg. The corresponding quality-adjusted life years (QALYs) reached 12.82, 12.83, and 12.81, respectively. Total accumulated costs over the simulation period were $44,241.09 (chiglitazar 32 mg), $45,044.25 (chiglitazar 48 mg), and $44,821.45 (sitagliptin 100 mg). Long-term economic evaluation revealed that chiglitazar 32 mg provided the optimal cost-effectiveness, whereas sitagliptin 100 mg was the least economically advantageous option. Both one-way and probabilistic sensitivity analyses confirmed the robustness of these findings. Scenario analysis showed that sitagliptin 100 mg only becomes cost-effective when its annual cost is reduced by at least 42.33 % compared to chiglitazar 32 mg.
Conclusion
Based on cost-utility analysis within the Chinese healthcare context, chiglitazar demonstrates significantly better long-term health outcomes and cost-effectiveness relative to sitagliptin for T2DM management.
{"title":"A comparative analysis of cost-utility: Chiglitazar vs. sitagliptin in patients with type 2 diabetes in China","authors":"Zeyu Xie , Zhuoru Liang , Guimei Zheng , Weiling Cao","doi":"10.1016/j.jdiacomp.2025.109174","DOIUrl":"10.1016/j.jdiacomp.2025.109174","url":null,"abstract":"<div><h3>Background</h3><div>As a structurally unique peroxisome proliferator-activated receptor pan-agonist, chiglitazar has showed dual therapeutic benefits for glycemic control and lipid management in type 2 diabetes mellitus (T2DM). Despite these clinical advantages, comprehensive pharmacoeconomic evaluations comparing chiglitazar with conventional therapies like sitagliptin remain unavailable for China's healthcare system.</div></div><div><h3>Objective</h3><div>This study aimed to conduct a comparative cost-utility analysis of chiglitazar versus sitagliptin for T2DM treatment in China, evaluating long-term clinical and economic outcomes from a healthcare system perspective.</div></div><div><h3>Methods</h3><div>Data on patient demographics and post-treatment effects were collected from a double-blind, phase 3, randomized controlled trial conducted in China. The United Kingdom Prospective Diabetes Study Outcomes Model 2.1 was employed to evaluate the long-term effectiveness and associated costs. Uncertainties were addressed using one-way and probabilistic sensitivity analyses. Additionally, the binary search method was utilized to estimate an optimal annual cost for sitagliptin in scenario analyses.</div></div><div><h3>Results</h3><div>After a 40-year simulation, the life expectancy results were comparable among treatments: 14.93 years for chiglitazar 32 mg, 14.94 years for chiglitazar 48 mg, and 14.93 years for sitagliptin 100 mg. The corresponding quality-adjusted life years (QALYs) reached 12.82, 12.83, and 12.81, respectively. Total accumulated costs over the simulation period were $44,241.09 (chiglitazar 32 mg), $45,044.25 (chiglitazar 48 mg), and $44,821.45 (sitagliptin 100 mg). Long-term economic evaluation revealed that chiglitazar 32 mg provided the optimal cost-effectiveness, whereas sitagliptin 100 mg was the least economically advantageous option. Both one-way and probabilistic sensitivity analyses confirmed the robustness of these findings. Scenario analysis showed that sitagliptin 100 mg only becomes cost-effective when its annual cost is reduced by at least 42.33 % compared to chiglitazar 32 mg.</div></div><div><h3>Conclusion</h3><div>Based on cost-utility analysis within the Chinese healthcare context, chiglitazar demonstrates significantly better long-term health outcomes and cost-effectiveness relative to sitagliptin for T2DM management.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 11","pages":"Article 109174"},"PeriodicalIF":3.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145047102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-10DOI: 10.1016/j.jdiacomp.2025.109175
Maryam A. Rizk , Sahar M. El-Haggar , Osama M. Ibrahim , Hossam Arafa Ghazi
Globally, the prevalence of diabetes mellitus is rising. One of the main causes of end-stage renal disease (ESRD) and a risk factor for higher morbidity and death in diabetic patients is diabetic nephropathy (DN), sometimes referred to as diabetic kidney disease (DKD). DN, a microvascular consequence of diabetes, affects 20–40 % of diabetics globally. The study's objective was to assess if levocetirizine may have albuminuria lowering effect and anti-inflammatory effect in patients treated with angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors therapy by reducing albuminuria and improving DKD indicators.
Patients and methods
A controlled, parallel, trial was carried out on sixty DKD patients. Sixty patients were divided into two groups at random. Group 1 (control group) received an empagliflozin 10 mg once day in addition to 80 mg valsartan. Group 2 (levocetirizine group) received the same medications as the control group plus a 5 mg of levocetirizine once daily in the evening, titrated dose based on each patient's creatinine clearance (CrCl) for three months. Serum creatinine, serum urea, serum cystatin-C, HbA₁c, tumor necrosis factor alpha (TNF-α), estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio (UACR) were measured at baseline and compared to these data three months after drug administration.
Results
Levocetirizine decreased significantly UACR at the end of the three-months (p = 0.037) compared to the control group. There was no variation in eGFR between the two groups, eGFR was significantly lower than baseline (p < 0.001) in both groups. Comparing the levocetirizine group to the control group, there is a substantial drop in TNF-α (p = 0.004), cystatin-C (p = 0.034), and HbA₁c (p = 0.007).
Conclusion
Levocetirizine reduces albuminuria, inflammatory, and renal indicators, which makes it a potentially has albuminuria lowering effect and anti-inflammatory drug which decreases disease progression.
{"title":"Efficacy of levocetirizine in reducing albuminuria and inflammatory biomarkers in patients with diabetic kidney disease: A randomized controlled trial","authors":"Maryam A. Rizk , Sahar M. El-Haggar , Osama M. Ibrahim , Hossam Arafa Ghazi","doi":"10.1016/j.jdiacomp.2025.109175","DOIUrl":"10.1016/j.jdiacomp.2025.109175","url":null,"abstract":"<div><div>Globally, the prevalence of diabetes mellitus is rising. One of the main causes of end-stage renal disease (ESRD) and a risk factor for higher morbidity and death in diabetic patients is diabetic nephropathy (DN), sometimes referred to as diabetic kidney disease (DKD). DN, a microvascular consequence of diabetes, affects 20–40 % of diabetics globally. The study's objective was to assess if levocetirizine may have albuminuria lowering effect and anti-inflammatory effect in patients treated with angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors therapy by reducing albuminuria and improving DKD indicators.</div></div><div><h3>Patients and methods</h3><div>A controlled, parallel, trial was carried out on sixty DKD patients. Sixty patients were divided into two groups at random. Group 1 (control group) received an empagliflozin 10 mg once day in addition to 80 mg valsartan. Group 2 (levocetirizine group) received the same medications as the control group plus a 5 mg of levocetirizine once daily in the evening, titrated dose based on each patient's creatinine clearance (CrCl) for three months. Serum creatinine, serum urea, serum cystatin-C, HbA₁c, tumor necrosis factor alpha (TNF-α), estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio (UACR) were measured at baseline and compared to these data three months after drug administration.</div></div><div><h3>Results</h3><div>Levocetirizine decreased significantly UACR at the end of the three-months (<em>p</em> = 0.037) compared to the control group. There was no variation in eGFR between the two groups, eGFR was significantly lower than baseline (<em>p</em> < 0.001) in both groups. Comparing the levocetirizine group to the control group, there is a substantial drop in TNF-α (<em>p</em> = 0.004), cystatin-C (<em>p</em> = 0.034), and HbA₁c (<em>p</em> = 0.007).</div></div><div><h3>Conclusion</h3><div>Levocetirizine reduces albuminuria, inflammatory, and renal indicators, which makes it a potentially has albuminuria lowering effect and anti-inflammatory drug which decreases disease progression.</div></div><div><h3>Trial registration identifier</h3><div><span><span>NCT05638880</span><svg><path></path></svg></span></div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 11","pages":"Article 109175"},"PeriodicalIF":3.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145047103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-06DOI: 10.1016/S1056-8727(25)00220-X
{"title":"Contents/Barcode","authors":"","doi":"10.1016/S1056-8727(25)00220-X","DOIUrl":"10.1016/S1056-8727(25)00220-X","url":null,"abstract":"","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 10","pages":"Article 109167"},"PeriodicalIF":3.1,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.jdiacomp.2025.109162
YuDie Fang , Lijuan Jing , YunXia Zhu , Hongping Wang , Juan Xia , Tao Lei , Jun Lu , Jie Gao
Aims
To investigate the association between Flow-Mediated Dilation (FMD) and the urinary albumin-to-creatinine ratio (UACR) in individuals with type 2 diabetes mellitus (T2DM).
Methods
This cross-sectional study involved 194 individuals diagnosed with T2DM. Participants were categorized into two groups based on their UACR levels: the diabetic kidney disease group (DKD) (UACR≥30 mg/g) and the non-diabetic kidney disease group (non-DKD) (UACR <30 mg/g). The relationship between FMD and UACR was evaluated through Spearman correlation analysis and multivariable logistic regression analysis. Additionally, the predictive capacity of FMD for DKD was determined using receiver operating characteristic curve analysis.
Results
Median FMD was lower in DKD group than in non-DKD group (3.9 vs 4.9, p = 0.011). Furthermore, a notable negative correlation was observed between FMD and UACR (r = −0.253, p < 0.05). Through logistic regression analysis, an increase in FMD by one standard deviation (SD) corresponded to a 35.6 % decrease in the likelihood of elevated UACR (OR: 0.644 [0.459–0.904]) (Model 1). Consistent findings were noted even after accounting for variables such as sex, age, BMI, hypertension, smoking habits, and alcohol intake (Model 2), as well as HbA1c levels, disease duration, and triglycerides (Model 3). The area under the ROC curve (AUC) for FMD was 0.686 (95 % CI 0.596–0.777).
Conclusions
FMD is independently correlated with UACR, which provides a clinical basis for the prevention and control of vascular complications in early DKD.
目的探讨2型糖尿病（T2DM）患者血流介导的舒张（FMD）与尿白蛋白与肌酐比值（UACR）之间的关系。方法本横断面研究纳入194例诊断为T2DM的患者。参与者根据UACR水平分为两组：糖尿病肾病组（DKD） （UACR≥30 mg/g）和非糖尿病肾病组（非DKD） （UACR≤30 mg/g）。通过Spearman相关分析和多变量logistic回归分析评价口蹄疫与UACR的关系。此外，利用受试者工作特征曲线分析确定FMD对DKD的预测能力。结果DKD组FMD中位数低于非DKD组（3.9 vs 4.9, p = 0.011）。此外，FMD与UACR呈显著负相关（r = - 0.253, p < 0.05）。通过logistic回归分析，FMD每增加一个标准差（SD）， UACR升高的可能性降低35.6% (OR: 0.644[0.459-0.904])（模型1）。即使在考虑了性别、年龄、BMI、高血压、吸烟习惯和酒精摄入量（模型2）以及HbA1c水平、疾病持续时间和甘油三酯（模型3）等变量后，也注意到一致的结果。口蹄疫的ROC曲线下面积（AUC）为0.686 （95% CI 0.596 ~ 0.777）。结论sfmd与UACR独立相关，为预防和控制早期DKD血管并发症提供了临床依据。
{"title":"Relationship between flow-mediated dilation and urinary albumin-creatinine ratio in patients with type 2 diabetes mellitus","authors":"YuDie Fang , Lijuan Jing , YunXia Zhu , Hongping Wang , Juan Xia , Tao Lei , Jun Lu , Jie Gao","doi":"10.1016/j.jdiacomp.2025.109162","DOIUrl":"10.1016/j.jdiacomp.2025.109162","url":null,"abstract":"<div><h3>Aims</h3><div>To investigate the association between Flow-Mediated Dilation (FMD) and the urinary albumin-to-creatinine ratio (UACR) in individuals with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>This cross-sectional study involved 194 individuals diagnosed with T2DM. Participants were categorized into two groups based on their UACR levels: the diabetic kidney disease group (DKD) (UACR≥30 mg/g) and the non-diabetic kidney disease group (non-DKD) (UACR <30 mg/g). The relationship between FMD and UACR was evaluated through Spearman correlation analysis and multivariable logistic regression analysis. Additionally, the predictive capacity of FMD for DKD was determined using receiver operating characteristic curve analysis.</div></div><div><h3>Results</h3><div>Median FMD was lower in DKD group than in non-DKD group (3.9 vs 4.9, <em>p</em> = 0.011). Furthermore, a notable negative correlation was observed between FMD and UACR (<em>r</em> = −0.253, <em>p</em> < 0.05). Through logistic regression analysis, an increase in FMD by one standard deviation (SD) corresponded to a 35.6 % decrease in the likelihood of elevated UACR (OR: 0.644 [0.459–0.904]) (Model 1). Consistent findings were noted even after accounting for variables such as sex, age, BMI, hypertension, smoking habits, and alcohol intake (Model 2), as well as HbA1c levels, disease duration, and triglycerides (Model 3). The area under the ROC curve (AUC) for FMD was 0.686 (95 % CI 0.596–0.777).</div></div><div><h3>Conclusions</h3><div>FMD is independently correlated with UACR, which provides a clinical basis for the prevention and control of vascular complications in early DKD.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 10","pages":"Article 109162"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-28DOI: 10.1016/j.jdiacomp.2025.109159
Tammie M. Johnson , James R. Churilla
Purpose
The purpose of this study is to examine trends for mean serum insulin concentration (pmol/L) and prevalence of hyperinsulinemia (≥4.358 pmol/L fasting insulin) in US adults without diabetes.
Methods
We used data from the 1999–2018 National Health and Nutrition Examination Survey (NHANES). Participants (n = 14,150) were ≥20 years of age, not pregnant, had no history of diabetes, had a fasting blood glucose measure of less than 126 mg/dL, and had valid responses to all study variables. Consecutive cycles of NHANES data from 1999 to 2018 (20 years) were aggregated into five four-year intervals.
Results
The Annual Percent Change (APC) for mean fasting insulin ranged from 5.64 (adjusted for body mass index) to 7.65 % when unadjusted (all p-values for trend <0.0001). The APC for hyperinsulinemia prevalence ranged from 19.4 % (adjusted for waist circumference) to 22.3 % when unadjusted (all p-values for trend <0.0001). The subanalyses by gender consistently revealed significant positive trends for both outcomes.
Conclusions
This study illustrates a significant positive trend for mean fasting insulin concentrations and hyperinsulinemia among US adults over 20 years. Monitoring serum insulin and hyperinsulinemia trends provides insights into the continuing rise in type 2 diabetes (T2D) and opportunities for T2D prevention.
{"title":"Trends in mean serum insulin and hyperinsulinemia among US adults without diabetes 1999–2018","authors":"Tammie M. Johnson , James R. Churilla","doi":"10.1016/j.jdiacomp.2025.109159","DOIUrl":"10.1016/j.jdiacomp.2025.109159","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study is to examine trends for mean serum insulin concentration (pmol/L) and prevalence of hyperinsulinemia (≥4.358 pmol/L fasting insulin) in US adults without diabetes.</div></div><div><h3>Methods</h3><div>We used data from the 1999–2018 National Health and Nutrition Examination Survey (NHANES). Participants (<em>n</em> = 14,150) were ≥20 years of age, not pregnant, had no history of diabetes, had a fasting blood glucose measure of less than 126 mg/dL, and had valid responses to all study variables. Consecutive cycles of NHANES data from 1999 to 2018 (20 years) were aggregated into five four-year intervals.</div></div><div><h3>Results</h3><div>The Annual Percent Change (APC) for mean fasting insulin ranged from 5.64 (adjusted for body mass index) to 7.65 % when unadjusted (all <em>p</em>-values for trend <0.0001). The APC for hyperinsulinemia prevalence ranged from 19.4 % (adjusted for waist circumference) to 22.3 % when unadjusted (all <em>p</em>-values for trend <0.0001). The subanalyses by gender consistently revealed significant positive trends for both outcomes.</div></div><div><h3>Conclusions</h3><div>This study illustrates a significant positive trend for mean fasting insulin concentrations and hyperinsulinemia among US adults over 20 years. Monitoring serum insulin and hyperinsulinemia trends provides insights into the continuing rise in type 2 diabetes (T2D) and opportunities for T2D prevention.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 11","pages":"Article 109159"},"PeriodicalIF":3.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-27DOI: 10.1016/j.jdiacomp.2025.109158
Steven James , Rebecca Barber , Jess Forster , Lindsay Sawatsky , Samantha Berry , Olive James , Kerrie Abel , Claire Trigg , Kim C. Donaghue , Maria E. Craig , Mahira Saiyed , Sheryl S. Salis , Jamie Wood , Willem Staels
Aims
Our review aimed to determine the prevalence of – and factors associated with – hearing loss, oral and olfactory disease, frozen shoulder, trigger finger, and hair loss in young adults with type 1 diabetes. These conditions were selected based on research team interests, existing literature, and group discussion.
Methods
We conducted a quantitative narrative review using a systematic process to identify cohort and cross-sectional studies involving young adults with type 1 diabetes (mean age 18–30 years). PubMed, CINAHL, and Cochrane were searched (January 2000–February 2024). Grey literature was not restricted, and quality appraisal was undertaken. Extracted data were synthesised and summarised narratively.
Results
The initial search found 3924 records and after title, abstract and full-text review, 19 records met inclusion criteria. Hearing loss prevalence ranged from 22.6 to 48.0 %, with age, diabetes duration, and systolic blood pressure identified as prominent associated features. For oral disease, peridontitis prevalence was 4.7 %, while alveolar bone loss ranged from 24.6 to 43.9 %; age was the primary associated factor. No eligible data were identified regarding frozen shoulder, trigger finger, or hair loss.
Conclusions
Further research is needed to characterize the prevalence and risk factors of atypical complications in type 1 diabetes. Clinical care should be guided by a robust understanding of these under-recognised comorbidities.
{"title":"Atypical complications and co-morbidities of type 1 diabetes in young adults","authors":"Steven James , Rebecca Barber , Jess Forster , Lindsay Sawatsky , Samantha Berry , Olive James , Kerrie Abel , Claire Trigg , Kim C. Donaghue , Maria E. Craig , Mahira Saiyed , Sheryl S. Salis , Jamie Wood , Willem Staels","doi":"10.1016/j.jdiacomp.2025.109158","DOIUrl":"10.1016/j.jdiacomp.2025.109158","url":null,"abstract":"<div><h3>Aims</h3><div>Our review aimed to determine the prevalence of – and factors associated with – hearing loss, oral and olfactory disease, frozen shoulder, trigger finger, and hair loss in young adults with type 1 diabetes. These conditions were selected based on research team interests, existing literature, and group discussion.</div></div><div><h3>Methods</h3><div>We conducted a quantitative narrative review using a systematic process to identify cohort and cross-sectional studies involving young adults with type 1 diabetes (mean age 18–30 years). PubMed, CINAHL, and Cochrane were searched (January 2000–February 2024). Grey literature was not restricted, and quality appraisal was undertaken. Extracted data were synthesised and summarised narratively.</div></div><div><h3>Results</h3><div>The initial search found 3924 records and after title, abstract and full-text review, 19 records met inclusion criteria. Hearing loss prevalence ranged from 22.6 to 48.0 %, with age, diabetes duration, and systolic blood pressure identified as prominent associated features. For oral disease, peridontitis prevalence was 4.7 %, while alveolar bone loss ranged from 24.6 to 43.9 %; age was the primary associated factor. No eligible data were identified regarding frozen shoulder, trigger finger, or hair loss.</div></div><div><h3>Conclusions</h3><div>Further research is needed to characterize the prevalence and risk factors of atypical complications in type 1 diabetes. Clinical care should be guided by a robust understanding of these under-recognised comorbidities.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 11","pages":"Article 109158"},"PeriodicalIF":3.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-27DOI: 10.1016/j.jdiacomp.2025.109161
Dhananjay Vaidya , Yvette Yeboah-Kordieh , Marjorie Howard , Christina E. Hugenschmidt , Paul A. Nyquist , Erin D. Michos , Rita R. Kalyani , Sevil Yasar , Brian Andres Robusto , Hussein N. Yassine , Jeanne M. Clark , Mark A. Espeland , Wendy L. Bennett
Background
Females have greater brain volume and cerebral blood flow than males when controlling for intracranial volume and age. Brain volume decreases after menopause, suggesting a role of sex hormones. We studied the association of sex hormones with brain volume, white matter hyperintensity volumes and cerebral blood flow in people with Type 2 Diabetes and with overweight and obesity conditions that accelerate brain atrophy.
Methods
We analyzed data from 215 participants with overweight or obesity and Type 2 Diabetes from the Look AHEAD Brain Magnetic Resonance Imaging ancillary study (mean age 68 years, 73 % postmenopausal female). Estradiol and total testosterone levels were measured with electrochemoluminescence assays. The ratio of brain measurements to intracranial volume was analyzed to account for body size. We analyzed sex hormones as quantitative measures in males, whereas in females we grouped those with detectable vs. undetectable hormone levels (Estradiol <73 pmol/L [20 pg/mL]: 79 %; Total Testosterone <0.07 mmol/L [0.02 ng/mL]: 37 % undetectable in females).
Results
Females with detectable total testosterone levels had higher brain volume to intracranial volume ratio (median [25th, 75th percentile]: 0.85 [0.84, 0.86]) as compared to those with undetectable Total Testosterone levels (0.84 [0.83, 0.86]; rank sum p = 0.04). This association was attenuated after age and body mass index adjustment (p = 0.08). Neither white matter hyperintensity volumes or cerebral blood flow in females, nor any brain measures in males, were significantly associated with Estradiol or Total Testosterone.
Conclusions
In postmenopausal females with Type 2 Diabetes with overweight and obesity, detectable levels of total testosterone were associated greater brain volume relative to intracranial volume, suggesting a protective role for testosterone in female brain health. Our findings are limited by a small sample size and low sensitivity of hormone assays. Our suggestive findings can be combined with future larger studies to assess clinically important differences.
{"title":"Sex specific associations of sex hormones with brain volumes and cerebral blood flow: A cross sectional observational study within the look AHEAD type 2 diabetes cohort","authors":"Dhananjay Vaidya , Yvette Yeboah-Kordieh , Marjorie Howard , Christina E. Hugenschmidt , Paul A. Nyquist , Erin D. Michos , Rita R. Kalyani , Sevil Yasar , Brian Andres Robusto , Hussein N. Yassine , Jeanne M. Clark , Mark A. Espeland , Wendy L. Bennett","doi":"10.1016/j.jdiacomp.2025.109161","DOIUrl":"10.1016/j.jdiacomp.2025.109161","url":null,"abstract":"<div><h3>Background</h3><div>Females have greater brain volume and cerebral blood flow than males when controlling for intracranial volume and age. Brain volume decreases after menopause, suggesting a role of sex hormones. We studied the association of sex hormones with brain volume, white matter hyperintensity volumes and cerebral blood flow in people with Type 2 Diabetes and with overweight and obesity conditions that accelerate brain atrophy.</div></div><div><h3>Methods</h3><div>We analyzed data from 215 participants with overweight or obesity and Type 2 Diabetes from the Look AHEAD Brain Magnetic Resonance Imaging ancillary study (mean age 68 years, 73 % postmenopausal female). Estradiol and total testosterone levels were measured with electrochemoluminescence assays. The ratio of brain measurements to intracranial volume was analyzed to account for body size. We analyzed sex hormones as quantitative measures in males, whereas in females we grouped those with detectable vs. undetectable hormone levels (Estradiol <73 pmol/L [20 pg/mL]: 79 %; Total Testosterone <0.07 mmol/L [0.02 ng/mL]: 37 % undetectable in females).</div></div><div><h3>Results</h3><div>Females with detectable total testosterone levels had higher brain volume to intracranial volume ratio (median [25th, 75th percentile]: 0.85 [0.84, 0.86]) as compared to those with undetectable Total Testosterone levels (0.84 [0.83, 0.86]; rank sum <em>p</em> = 0.04). This association was attenuated after age and body mass index adjustment (<em>p</em> = 0.08). Neither white matter hyperintensity volumes or cerebral blood flow in females, nor any brain measures in males, were significantly associated with Estradiol or Total Testosterone.</div></div><div><h3>Conclusions</h3><div>In postmenopausal females with Type 2 Diabetes with overweight and obesity, detectable levels of total testosterone were associated greater brain volume relative to intracranial volume, suggesting a protective role for testosterone in female brain health. Our findings are limited by a small sample size and low sensitivity of hormone assays. Our suggestive findings can be combined with future larger studies to assess clinically important differences.</div></div><div><h3>Trial registration</h3><div><span><span>NCT00017953</span><svg><path></path></svg></span></div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"39 10","pages":"Article 109161"},"PeriodicalIF":3.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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