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The meniscus plays a critical role in maintaining knee joint stability, absorbing shock, and distributing load-bearing stress. Middle-aged individuals are prone to meniscal tears due to degenerative changes, while type 2 diabetes mellitus (T2DM), a prevalent chronic metabolic disorder, may impair cartilage healing and postoperative recovery, potentially compromising surgical outcomes. However, comparative evidence regarding arthroscopic meniscal repair versus partial meniscectomy in this specific population remains limited. This retrospective cohort study included 122 middle-aged patients with T2DM who underwent arthroscopic treatment for meniscal tears at our center between January 2023 and May 2024. Patients were divided into a repair group (n = 62) and a resection group (n = 60) based on the surgical procedure. Clinical outcomes within 12 months postoperatively were compared, including knee function (Lysholm and International Knee Documentation Committee scores), pain relief (Visual Analog Scale score), complication rate, and magnetic resonance imaging-based imaging findings. Multivariate logistic regression analysis was performed to identify independent predictors of functional recovery. Baseline characteristics were comparable between groups (all P > .05). At both 6 and 12 months postoperatively, the repair group showed significantly better Lysholm and International Knee Documentation Committee scores compared to the resection group (P < .001), along with consistently lower Visual Analog Scale scores (P < .01). Magnetic resonance imaging follow-up revealed a lower rate of cartilage degeneration in the repair group (Outerbridge grade ≥ 2: 16.1% vs 30.0%, P = .048), and the meniscal healing rate reached 85.5%. Complication rates were similar between groups (9.7% vs 11.7%, P = .71). Multivariate analysis identified surgical approach (repair: odds ratio [OR] = 1.92, P = .016), diabetes duration >10 years (OR = 1.78, P = .022), and preoperative glycated hemoglobin >7.5% (OR = 1.66, P = .031) as independent predictors of functional outcome. In middle-aged patients with T2DM and meniscal tears, arthroscopic meniscal repair offers superior outcomes in terms of functional recovery, pain relief, and cartilage preservation compared to partial meniscectomy, with comparable safety profiles. Patients with better glycemic control and shorter diabetes duration are more likely to benefit, supporting the preference for tissue-preserving strategies when feasible.

This study aims to compare the outcomes of assisted reproductive treatment in women with low ovarian reserve (LOR), defined as an anti-Müllerian hormone level of ≤1.2 ng/mL, versus normal ovarian reserve (NOR; 1.2 ng/mL < anti-Müllerian hormone ≤3.0 ng/mL) using the long follicular-phase protocol. It further evaluates the efficacy of the long follicular-phase, antagonist, and progestin-primed ovarian stimulation (PPOS) protocols specifically within the LOR population. A retrospective analysis was conducted on 2309 patients treated between October 2022 and October 2024. Participants included 973 LOR patients and 1336 NOR patients. LOR patients were divided by protocol: Group A (long follicular-phase protocol, n = 95), Group C (antagonist, n = 200), and Group D (PPOS, n = 678). All NOR patients received the long follicular protocol (Group B, n = 1336). Groups were stratified by age (<35 and ≥35 years). Regarding the long follicular protocol: In women <35, Group A had significantly fewer retrieved oocytes and high-quality embryos than Group B (P <.05), yet clinical pregnancy and live birth rates (LBRs) were similar (P >.05). In women ≥35, Group A had fewer oocytes but a higher MII rate than Group B, with no significant difference in pregnancy or live birth rates. Comparing protocols within the LOR population: Group A exhibited significantly lower baseline hormone levels but higher numbers of punctured follicles, retrieved oocytes, and 2PN fertilized oocytes compared to Groups C and D (P <.05). Notably, among patients ≥35, Group A produced significantly more high-quality embryos. Generally, age negatively impacted outcomes across all groups. For individuals with LOR, the long follicular-phase protocol yields clinical pregnancy and live birth rates comparable to those with normal reserve, despite lower oocyte yield. Our research findings, while not conclusive in the LOR population, suggest a possible trend that long follicular-phase protocol may offer certain advantages over antagonist and PPOS protocols in key experimental parameters. Nevertheless, age remains a key factor affecting stimulation response.

Emerging evidence suggests a profound connection between oral health status and esophageal diseases. Nevertheless, the causal relationship remains controversial. This Mendelian randomization (MR) study was performed to probe into the genetic causality between oral health status and esophageal diseases. Summary statistics from genome-wide association studies were obtained from the FinnGen project and the UK Biobank consortium. The number of instrumental single nucleotide polymorphisms per trait ranged from approximately 8.97 million to 16.38 million. The analyzed datasets included sample sizes of up to 4,63,010 individuals. Univariable MR analyses were conducted to explore the potential bidirectional causality between oral health status and esophageal diseases. Inverse-variance weighted method was primarily employed. To confirm the reliability of our findings, we conducted sensitivity analyses, including Cochran's Q test, MR-Egger intercept test, and leave-one-out test. Furthermore, we conducted multivariable MR analysis to adjust for potential confounders. Mouth ulcers were strongly associated with esophageal carcinoma and Barrett's esophagus. Toothache tended to increase the risk of Barrett's esophagus. Excessive attrition of teeth was an increased risk for gastro-esophageal reflux. Patients with dental caries exhibited an increased susceptibility to ulcer of esophagus. In reverse, Barrett's esophagus increased the risk of chronic periodontitis and excessive attrition of teeth. Ulcer of esophagus tended to increase the risk of excessive attrition of teeth. Sensitivity analysis yielded consistent results, indicating no heterogeneity or pleiotropy. This study suggests potential causal associations between oral health status and esophageal diseases.

Background: Previous meta-analyses have extensively compared the outcomes of intravascular imaging-guided versus coronary angiography-guided percutaneous coronary intervention (PCI) in the treatment of coronary artery disease. However, conducting repeated meta-analyses within a short period may increase the probability of type I or type II errors. Therefore, we employed both traditional meta-analysis and trial sequential analysis (TSA) methods to compare the clinical outcomes of intravascular imaging-guided and coronary angiography-guided PCI.

Methods: We searched PubMed, Cochrane Library, Embase, and Web of Science for literature comparing intravascular imaging-guided versus coronary angiography-guided PCI from inception to August 10, 2024. Four researchers, divided into 2 groups, independently extracted the data. The primary outcomes were major adverse cardiovascular events (MACEs) and target lesion failure (TLF). Secondary outcomes included stent thrombosis and all-cause mortality. TSA was used to analyze these outcomes.

Results: A total of 23 randomized controlled trials with 17,766 participants were included. Compared to angiography, intravascular ultrasound has a significant advantage in reducing MACE (risk ratio [RR]: 0.66; 95% confidence interval [CI]: 0.55-0.80) and TLF (RR: 0.64; 95% CI: 0.54-0.75) during follow-up, supported by high certainty of evidence and confirmed by an 80% power TSA, demonstrating a true positive effect. However, no significant differences were observed in reducing stent thrombosis or all-cause mortality. Similarly, compared to angiography, optical coherence tomography shows a significant advantage in reducing MACE beyond 1 year (RR: 0.79; 95% CI: 0.64-0.99), but further exploration is needed, given that only 3 studies were included. In other aspects, including the reduction of stent thrombosis and all-cause mortality, no significant differences were found.

Conclusion: Intravascular ultrasound showed truly superior efficacy in reducing MACE and TLF compared to angiography. However, additional studies are needed to further assess the effectiveness of optical coherence tomography.

Treating ulcerative colitis (UC) requires mucosal healing (MH); however, clinical remission does not always involve MH. Fecal calprotectin (FC) is a useful marker to determine MH. Leucine-rich alpha-2 glycoprotein (LRG) and prostaglandin E-major urinary metabolite (PGE-MUM) have similar performance to FC and may also predict MH. No previous studies have provided a detailed comparative analysis of LRG, PGE-MUM, and FC. Herein, we investigated their associations with endoscopic activity and their potentials as predictors of MH. This single-center, prospective, observational study included patients with ulcerative colitis in clinical remission for >3 months (partial Mayo score ≤ 2) who were to undergo colonoscopy between July 2023 and June 2024. Endoscopic remission (ER) was defined as Mayo endoscopic score of 0, while histological remission (HR) was based on the Geboes score. Overall, 46 patients were enrolled, and all underwent colonoscopy; 20 (43%) had ER, and 9 (20%) had HR. The median LRG, PGE-MUM, and FC levels were significantly higher in patients without ER than in those who achieved ER (P < .05). The areas under the receiver operating characteristic curves of LRG, PGE-MUM, and FC for determining ER were 0.686 (95% confidence interval [CI]: 0.530-0.845), 0.695 (95% CI: 0.552-0.872), and 0.788 (95% CI: 0.658-0.919), respectively. The optimal cutoff value obtained from the receiver operating characteristic curve, LRG, PGE-MUM, and FC values for determining ER were 14.2 µg/mL, 30.6 μg/gCr, and 143 mg/kg, respectively. The areas under the receiver operating characteristic curves for LRG + FC and PGE-MUM + FC to determine ER were 0.800 (95% CI: 0.672-0.928) and 0.865 (95% CI: 0.764-0.966), respectively. LRG and PGE-MUM are potential biomarkers for determining ER in clinical remission. Combining LRG and PGE-MUM assessments with FC may improve the accuracy of confirming ER in ulcerative colitis, even during the remission phase.

Background: Cutaneous warts are exophytic, benign proliferative lesions caused by human papillomavirus infection of basal keratinocytes. Many intralesional immunomodulatory agents are used by dermatologists these days including Bacillus Calmette-Guerin vaccine, measles-mumps-rubella vaccine, purified protein derivative (PPD), Candida extract, vitamin D3, interferon alpha, zinc sulphate, and hepatitis B vaccine. Intralesional acyclovir is considered a novel intralesional therapy for warts as it directly destroys the viral cells. The objectives of this study are to provide the latest comparison among different intralesional therapies and to specifically compare acyclovir with PPD.

Methods: A comprehensive search strategy was implemented to identify relevant randomized controlled trials, and those with single-arm studies were excluded. After this, 5 studies were finally included in the review. Statistical analysis was done using a frequentist random-effects model. Dichotomous outcomes were analyzed using odds ratio and 95% confidence interval with statistical significance set as P-value < .05. All analyses were performed using R version 4.4.1.The study involved a total of 295 patients with sample size ranging from 30 being the least number of participants and 97 being the highest number of participants in a single study.

Results: Use of saline had the highest probability of being the best treatment for achieving a complete response (probability to be the best 96%, P-score = .96) and partial response (98% probability, P-score = .98) when compared with other modalities. The forest plot shows no statistically significant differences among the treatment arms except for saline (P < .01) for no response as compared with PPD. Blister formation was found to be higher on the use of cryotherapy (P = .03) and Mycobacterium w vaccine (P = .02).

Conclusion: This network's meta-analysis concludes the superiority of intralesional saline in achieving response to treatment when compared with other modalities such as cryotherapy and vaccines. A higher risk of adverse events was noted on use of vaccines. Future research is needed to strengthen these findings.

This retrospective observational study investigated the association between sleep disorders and alterations in glucose metabolism, insulin secretion, and glucagon regulation in patients with type 2 diabetes mellitus (T2DM). A total of 294 patients with T2DM were enrolled between January 2020 and December 2024, including 108 patients with sleep disorders and 186 without. Sleep quality was assessed using the Pittsburgh sleep quality index, with a score >7 indicating poor sleep quality. Clinical and biochemical parameters, including fasting plasma glucose, glycated hemoglobin (HbA1c), serum insulin, and plasma glucagon levels, were analyzed. An oral glucose tolerance test was conducted to evaluate dynamic changes in insulin and glucagon secretion. Compared with patients without sleep disorders, those with poor sleep quality exhibited significantly higher fasting plasma glucose, 2-hour plasma glucose, HbA1c, and homeostasis model assessment of insulin resistance (HOMA-IR) values, alongside lower homeostasis model assessment of β-cell function (HOMA-β) (all P <.001). During oral glucose tolerance test, insulin responses were attenuated, and glucagon concentrations remained consistently higher with insufficient suppression at postload time points in the sleep-disorder group. These results indicate that sleep disturbances are closely linked to increased insulin resistance, impaired β-cell function, and dysregulated α-cell activity, poor sleep quality was associated with impaired glucose metabolism.

An essential instrument for evaluating older adults' nutritional status is the geriatric nutritional risk index (GNRI). This investigation aimed to examine the connection between the GNRI and erectile dysfunction (ED) risk. Three models were created, and the connection between GNRI and ED was investigated through multiple linear and logistic regressions. The nonlinear relationship between GNRI and ED was evaluated using smooth curve fitting. To further confirm the consistency of GNRI and ED relationships across various populations, subgroup analysis, interaction tests, and sensitivity analyses were employed. The receiver operating characteristic curve was applied to evaluate how well GNRI could forecast the occurrence of ED. Among 1898 participants, GNRI was negatively associated with the risk of ED occurrence. In the fully adjusted model, the risk of ED decreases by 4% (OR = 0.96, 95% CI 0.94-0.99, P = .0032) for every 1-unit rise in GNRI. Compared with the low GNRI group (<98), the risk of ED decreased by 35% (OR = 0.65, 95% CI 0.43-0.98, P = .0386) for every 1-unit increase in the high GNRI group (≥98). A negative, nonlinear connection between GNRI and ED was found using smooth curve fitting. The negative relationship between GNRI and ED remained consistent across most subgroups (P for interaction > .05). The sensitivity analysis and the receiver operating characteristic curve (with an area under curve of 0.651) demonstrate GNRI's good predictive ability. A higher GNRI was significantly associated with a lower risk of ED occurrence. The GNRI is a reliable, independent predictor of ED occurrence in older adults.

Frailty is a multidimensional syndrome associated with increased vulnerability to adverse health outcomes, particularly among older adults. Its relevance in cancer survivorship is increasingly recognized, yet the prognostic implications of frailty and pre-frailty among colorectal cancer survivors remain poorly defined. We conducted a prospective survival analysis using data from the 1997 to 2018 National Health Interview Survey, linked to mortality outcomes through December 31, 2019, via the National Death Index. Frailty status was determined using a modified fatigue, resistance, ambulation, illnesses, and low body mass index scale and categorized as robust (score = 0), pre-frail (score = 1-2), or frail (score = 3-5). Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality by frailty status, adjusting for demographic, socioeconomic, and clinical variables. Subgroup analyses were conducted by age and sex. Among 4052 colorectal cancer survivors, 70.2% were robust, 12.4% pre-frail, and 17.4% frail. Frailty and pre-frailty were more prevalent among survivors than among cancer-free participants (6.5% frail; 5.0% pre-frail). In fully adjusted models, pre-frail and frail survivors had significantly higher risks of all-cause mortality compared to robust individuals (HR for pre-frail, 1.44; 95% confidence interval, 1.21-1.71; P < .001; HR for frail, 2.19; 95% confidence interval, 1.89-2.56; P < .001). These associations persisted across age and sex subgroups, although they were attenuated in younger adults and in men for pre-frailty. Kaplan-Meier curves demonstrated significantly reduced survival across increasing frailty categories. Frailty and pre-frailty are common among colorectal cancer survivors and are independently associated with increased risk of all-cause mortality. Frailty assessment may help identify vulnerable colorectal cancer survivors and inform risk stratification in survivorship care planning.

This study aims to identify risk factors associated with postpartum hemorrhage (PPH) volume in pregnant women diagnosed with placenta previa. We retrospectively collected data on PPH volume in consecutive pregnant women at the First People's Hospital of Zunyi between March 24, 2020, and February 28, 2024. The outcome variable, PPH volume, was divided into 5 categories: <500 mL, 500 to 1000 mL, 1001 to 1500 mL, 1501 to 2000 mL, and > 2000 mL, according to the Chinese Medical Association (CMA) obstetric guideline (2023 edition). These data were documented within 24 hours of birth. We examined maternal characteristics and concurrent pregnancy conditions to identify the potential risk factors for PPH volume. Univariate and multivariate ordered logistic regression analyses were used to determine the association between these factors and PPH volume, with the analysis conducted using SPSS statistical software (version 26.0). In total, 246 pregnant women were included in this retrospective study. Univariate analysis revealed that gestational hypertension increased the risk of an elevated volume of PPH, with an odds ratio (OR) of 5.336 (95% confidence interval [CI]: 1.204-23.656). This significance persisted in the multivariate ordered logistic regression analysis (OR = 6.445, 95% CI: 1.414-29.371), suggesting that pregnant women diagnosed with gestational hypertension are approximately 6.445 times more likely to experience a higher level of PPH volume than those without this condition. The mode of delivery, particularly cesarean section, was initially associated with a lower volume of PPH (OR = 0.393, 95% CI: 0.226-0.685); however, this association was not statistically significant in the multivariate analysis. Gestational hypertension significantly contributes to an increased PPH volume in patients with placenta previa. Clinicians must diligently monitor and manage such patients to mitigate the risk of severe PPH and related complications. Further research is required to validate our findings.