Search Results (5,996)

Hemolysis rate is usually used as the acceptance criterion for stored red blood cells (RBCs) in clinical practice. However, there is a current lack of parameters for the characterization of hemoglobin quality. This study aimed to incorporate oxygen affinity, cooperativity, and the Bohr effect into a parameter system to monitor oxygen supply efficiency in stored RBCs, potentially serving as a basis for quality assessment. Han Chinese blood from plains, Tibetan blood from plateau, bovine hemoglobin (bHb), and a dextran–bovine hemoglobin conjugate (Dex20-bHb) were analyzed using the BLOODOX-2018. Oxygen affinity (P₅₀) was determined by oxygen dissociation curves (ODCs) at pH = 7.4. Cooperativity was assessed through the Hill coefficient, calculated from the fitting range of the Hill equation. The Bohr effect was evaluated by the acid-base sensitivity index (SI) under simulated pH conditions of the lungs (pH = 7.6) and tissues (pH = 7.2) to calculate corresponding P₅₀ values. Oxygen partial pressures (PO₂) simulating lungs (PO₂ = 100 mmHg for plains and 60 mmHg for plateau) and tissues (PO₂ = 40 mmHg for plains and 30 mmHg for plateau) were used to calculate theoretical oxygen-release capacities in both environments. Multiple regression analysis explored relationships among parameters, constructing a system to assess changes in rat RBCs during storage. Optimized test methods determined P₅₀, Hill coefficient, SI, and theoretical oxygen-release capacities for Han Chinese blood, Tibetan blood, bHb, and Dex20-bHb samples in various environments. We constructed a parameter system to characterize blood’s oxygen supply efficiency, revealing the significant influence of the Bohr effect. This influence varied with environmental changes in oxygen affinity. We validated the system using stored rat RBCs, finding consistent P₅₀ trends with predictions, and initial increases in Hill coefficient and SI followed by decreases. Theoretical oxygen-release capacities varied significantly between plateau and plain environments. These results support using oxygen supply efficiency to assess RBC storage quality for developing transfusion strategies. P₅₀, Hill coefficient, SI, and theoretical oxygen-release capacity in different environments can be incorporated into blood oxygen supply efficiency characterization systems to assess the quality changes in RBCs during storage. Full article

Type 2 diabetes mellitus (T2DM) and obesity represent a growing global public health challenge, strongly associated with excess body weight, unhealthy dietary habits, and a sedentary lifestyle. The ketogenic diet (KD), characterized by very low carbohydrate intake, moderate protein intake, and high fat consumption, induces a metabolic state known as ketosis, in which the body switches from glucose to fat as its primary energy source. KD has gained increasing interest as a strategy to improve glycemic control, reduce body weight, and improve lipid profiles in individuals with obesity and T2DM. The purpose of this narrative review is to summarize the current scientific evidence on the effects of KD on key metabolic parameters, including blood glucose levels, glycated hemoglobin (HbA1c), body weight, and body composition. The analysis is based on peer-reviewed articles retrieved from PubMed, Embase, and Scopus with particular emphasis on clinical studies that provide robust evidence on the efficacy and safety of KD in the treatment of metabolic disorders. Full article

Erythropoiesis is a tightly regulated developmental process that requires the switch from fetal hemoglobin (HbF) to adult hemoglobin (HbA). In β-hemoglobinpathies such as SCD and β-thalassemia, disease severity is influenced by the fetal-to-adult hemoglobin switch because persistence or induction of HbF will ameliorate the clinical manifestations. miRNAs play an essential role in regulating this switch by modulating the expression levels of key transcription factors, such as BCL11A, KLF1, and MYB, which repress γ-globin expression. Multiple miRNAs have been identified as potential modulators of the hemoglobin switch, including miR-144, miR-486, miR-26b, and miR-15a. The molecular interactions between miRNA and γ-to β-globin switch have the potential for new therapeutic interventions that aim to reactivate HbF expression to ameliorate β-hemoglobinopathies such as SCD and β-thalassemia. In this review, the latest advancements in miRNA-mediated regulation of Hb switching and nanoparticle-based strategies for miRNA delivery are explored. Full article

Background/Objectives: The Prognostic Nutritional Index (PNI), which integrates serum albumin and lymphocyte count, reflects both nutritional and inflammatory status. However, its role in early renal function decline among patients with type 2 diabetes (T2D), particularly in relation to glycemic control, remains unclear. This study aimed to: (1) characterize the dose–response relationship between PNI and early renal function decline in type 2 diabetes using restricted cubic splines; (2) identify whether glycemic control (HbA1c) modifies the PNI–renal decline association; and (3) evaluate the clinical utility of combining PNI and HbA1c for risk stratification. Methods: We analyzed data from 1711 community-based participants with T2D who had preserved renal function at baseline. The PNI was calculated as serum albumin (g/L) + 5 × lymphocyte count (×10⁹/L). The primary outcome was a composite of rapid estimated glomerular filtration rate (eGFR) decline (>3 mL/min/1.73 m² per year) or incident chronic kidney disease (CKD) stage 3. Restricted cubic spline models, multivariable regression, and Johnson–Neyman analyses were used to examine non-linearity and effect modification by glycated hemoglobin (HbA1c). Results: A consistent inverse linear association was observed between PNI and the rate of eGFR decline (P for non-linearity > 0.05). Johnson–Neyman analysis further demonstrated that the protective association of PNI was statistically significant within an HbA1c range of 7.24% to 8.71%. Stratification by clinical cut-offs revealed a significant effect modification by glycemic status. The inverse linear association between PNI and renal risk was most pronounced under hyperglycemic stress, as evidenced by the markedly elevated incidence (50.0%) among individuals with both poor glycemic control (HbA1c ≥ 8%) and low PNI (<50). Conversely, under good glycemic control (HbA1c < 8%), this inverse association was substantially attenuated, with a lower incidence observed in the low-PNI subgroup (6.7%) than in the high-PNI subgroup (15.9%). These findings indicate that the protective role of PNI is conditional upon the glycemic milieu. Conclusions: The PNI demonstrates a stable linear association with early renal function decline in T2D, with its protective effect most pronounced at suboptimal HbA1c levels. Combining PNI and HbA1c effectively identifies a high-risk subgroup characterized by synergistic risk, underscoring the need for integrated nutritional and glycemic management. Full article

One of the major factors currently hindering the development of hemoglobin-based oxygen carriers (HBOCs) is the autoxidation of hemoglobin to inactive methemoglobin (MetHb). The effects of spermine on the stability, aggregation, structure, and function of adult hemoglobin (HbA) were studied. The interaction of spermine with HbA was elucidated by dynamic light scattering, colloid osmotic pressure measurements, thermal denaturation analysis, static light scattering, and oxygen dissociation assay. The antioxidant capacity of spermine was confirmed through UV–vis spectroscopic recordings, calculations of MetHb formation, and hydroxyl radical scavenging. The P50 value was determined by the oxygen dissociation curve to investigate the roles of spermine in increasing HbA’s oxygen affinity. The pH-dependent affinity between spermine and HbA was validated through surface plasmon resonance experiments. The transformation of HbA’s partial α-helix to a β-sheet structure induced by spermine was clarified using a microfluidic modulation spectrometer. The binding of spermine to βASP99, βGLU101, αTHR38, and αASN97 on HbA and the conformational shift in HbA towards the ‘R’ state were investigated via molecular docking and molecular dynamics simulations. In a word, spermine can enhance the oxygen affinity of HbA, effectively reduce autoxidation, and hold promise for applications in the research of HBOCs or hemoglobin modification. Full article

Background/Objectives: Older adults often face nutrition challenges due to mobility issues, chronic conditions, and limited access to adequate nutrition. Digital and technology-based interventions, including those with nutrition education, nutrition counseling and Medically Tailored Meals [MTMs], can help address these barriers. However, the extent and characteristics of such programs in the United States remain unclear. This scoping review aimed to map the existing evidence on digital and technology-based (“digi-tech”) nutrition interventions for older adults in the United States, with particular attention to the presence, characteristics, and gaps related to MTMs. Methods: This scoping review followed the PRISMA-ScR framework to map existing evidence on technology-enabled nutrition care interventions for older adults aged ≥ 60 years in the United States. Systematic searches were conducted across multiple databases, yielding 18,177 records. Following title and abstract screening, full-text review, and eligibility assessment, 16 intervention studies were included. Study designs comprised randomized controlled trials, quasi-experimental and non-randomized studies, mixed-methods feasibility studies, pilot studies, and one retrospective longitudinal cohort study. Data were extracted on study design, population characteristics, intervention components, technology modalities, outcomes, feasibility, acceptability, and reported barriers. Results: Interventions varied in duration [8 weeks to ≥12 months] and content. Foci ranged from remote nutrition education and mobile app-based tracking to multicomponent interventions integrating exercise, nutrition counseling, health literacy, and meal delivery. Telehealth was the most commonly used technology modality, followed by mobile health applications, wearable devices, and online educational platforms. Most interventions reported high feasibility and acceptability, with improvements in diet quality, adherence to healthy eating patterns, clinical measures such as HbA1c and blood pressure, and functional performance. Common implementation barriers included declining technology use over time, digi-tech literacy, and access to devices or the internet. Notably, no studies evaluated a digi-tech-based MTMs intervention exclusively for older adults in the U.S. Conclusions: Digital and technology-based nutrition interventions show promise for improving dietary and health outcomes in older adults, but there is insufficient empirical evidence. Future research might develop and evaluate hybrid digi-tech intervention models that leverage the potential of digi-tech tools while addressing barriers to technology adoption among older adults. Full article

Background: Diabetic retinopathy is a leading cause of vision impairment and a significant complication of diabetes mellitus, especially in low- and middle-income countries. This study aimed to identify the barriers affecting diabetic retinopathy screening among people with diabetes mellitus. Methods: This cross-sectional study was conducted between April and October 2024 at the National Center for Diabetes, Endocrinology and Genetics. Data collection was performed using a structured, validated electronic questionnaire adapted from previous studies. Sample size calculation was carried out before data collection. Data were collected using a structured electronic questionnaire. A total of 998 responses were included in the study. The collected data incorporated sociodemographic characteristics, diabetes history, screening practices, and reported barriers. Descriptive and categorical data analyses were performed. Results: Of 998 participants, 82% were over 50 years old, 79% had type 2 diabetes mellitus, and 30% had never had an eye examination. Diabetic retinopathy was diagnosed in 12%. The main barriers to regular attendance among those previously screened (699) were as follows: lack of awareness of its importance (11%), believing that being asymptomatic made screening unnecessary (19%), and transportation difficulties (14%). Among those never screened (299), 56% lacked awareness, 62% believed being asymptomatic negates the need for screening, and 13% faced transportation difficulties. Age > 50 years, higher educational level, availability of health insurance, longer duration of diagnosis of diabetes mellitus, and HbA_1c > 7% were significantly associated with prior screening (p < 0.05). Conclusions: Public health strategies should enhance the education provided to people and physician–person communication and remove logistical obstacles to improve screening compliance. Full article

Objective: To investigate factors influencing the anamnestic immune response 9 years after hepatitis B vaccination in elderly people (aged > 60 years). Methods: We quantitatively tested 630 elderly people who participated in the free hepatitis B vaccination program for adults in Zhangjiagang City during 2015 for hepatitis B surface antibody (anti-HBs) titers. Three booster doses of hepatitis B vaccine were given to subjects with anti-HBs titers below 10 mIU/mL, while a single booster dose was administered to those with titers between 10 and 100 mIU/mL, in accordance with their antibody titer measurements. The post-booster anti-HBs titers were evaluated at 2–3 months. A logistic regression model was used to identify factors influencing the anamnestic immune response, and a receiver operating characteristic curve analysis was conducted. Results: Among the 90 participants who received three doses and the 101 participants who received one dose, baseline characteristics did not differ significantly between the two cohorts. Both groups exhibited robust anamnestic immune responses. Significant differences were observed before and after booster vaccination within each group (Z = −8.24, p < 0.001; Z = −8.73, p < 0.001). Multivariate logistic regression indicated that individuals with higher pre-booster anti-HBs titers were less likely to show weak anamnestic responses compared to those with lower pre-booster titers (OR = 0.30, 95% CI: 0.16–0.58). Furthermore, a high anamnestic immune response (>1000 mIU/mL) was significantly more frequent among subjects with pre-booster titers ≥ 4.58 mIU/mL. Conclusions: Booster immunization administered nine years after hepatitis B vaccination induces robust anamnestic immunity, with its magnitude significantly correlated with pre-booster anti-HBs titers. Particular attention should be given to individuals with extremely low pre-booster anti-HBs levels. Full article

Time-resolved spectroscopy (TRS) is a promising tool for noninvasive cerebral monitoring in neonates. However, the optimal forehead site for probe placement remains unclear. In this study, we evaluated the effect of probe positioning on TRS-derived optical parameters in neonates. TRS measurements were obtained from the midline and right lateral forehead of 30 neonates (≥36 weeks’ corrected gestational age). We compared various parameters between the two probe positions, including optical intensity, attenuation, mean optical path length, scattering coefficient, total hemoglobin (tHb), cerebral oxygen saturation (ScO₂) and cerebral blood volume (CBV). No significant differences were observed in tHb, ScO₂ and CBV between the midline and lateral sites. However, the lateral site showed a significantly lower scattering coefficient and shorter mean path length. Light intensity was increased and attenuation was reduced at the lateral site. Thus, while tHb, ScO₂ and CBV values were consistent between sites, the midline provided more stable scattering and optical path data. These findings suggest that the midline forehead may be a more suitable site for TRS-based neonatal cerebral monitoring. Full article

Background: In internal medicine, the management of type 2 diabetes mellitus (T2DM) is challenged by multimorbidity and polypharmacy. The fixed-dose combination of sitagliptin and extended-release metformin (SITA/MET ER) is a valuable option for frail and comorbid patients. Methods: This multicenter, retrospective, observational study involved five Italian Internal Medicine units. Consecutive patients with T2DM who initiated SITA/MET ER were included. Demographic, clinical, and laboratory data were collected at baseline (T0) and at follow-up (T1, 3–4 months). The primary endpoint was change in HbA1c; secondary endpoints included fasting plasma glucose (FPG), treatment adherence, adverse events, and modifications in concomitant antidiabetic therapies. Results: A total of 292 patients (mean age 70.8 ± 10.6 years; 43% female) were analyzed. At baseline, mean HbA1c was 7.4 ± 1.0% and FPG 150.2 ± 42.5 mg/dL, with significant reductions observed at follow-up (HbA1c 7.0 ± 0.8%, FPG 136.8 ± 29.6 mg/dL; both p < 0.05). SITA/MET ER was predominantly prescribed to patients with a complex clinical profile, as reflected by the high prevalence of microvascular (37%) and macrovascular (42%) complications. The use of sulfonylureas decreased from 11% to 3% (p < 0.001), while SGLT2 inhibitor and insulin use remained stable. Treatment adherence to SITA/MET ER was excellent, with full compliance reported and no adverse events recorded. Conclusions: In this real-world internal medicine study, SITA/MET ER improved glycemic control and was well tolerated among patients with complex clinical profiles. These findings support the role of SITA/MET ER as a flexible and practical therapeutic choice in this setting. Full article

Introduction: Primary Sjögren’s (pSS) is an autoimmune disease that affects several organs, especially the heart, and raises cardiovascular risk. Investigating the associations of hemoglobin-to-red cell distribution width (RDW) ratio (HRR), vitamin D status, and cardiac function could provide valuable insights and biomarkers regarding early cardiovascular risk in patients with pSS. Method: This cross-sectional study involved 61 patients diagnosed with pSS based on ACR/EULAR criteria. Data on demographics, hematological (Hb, RDW), echocardiography, and serum vitamin D levels were collected. Echocardiograms were conducted by trained cardiologists following established guidelines, while vitamin D levels were measured using ELISA. Statistical analyses, including univariate linear regression, were performed with SPSS in order to identify whether HRR tertiles were related to cardiac function and vitamin D status. Results: A study of 61 pSS patients (mean age 59.8 years, 89% female) revealed that patients with a lower hemoglobin-to-RDW ratio (HRR ≤ 0.98) had significantly higher pulmonary artery pressures (PAPs) and lower values for the tricuspid annular plane systolic excursion (TAPSE)/PAPs ratio, contributing to poor right heart function. These associations were particularly strong in patients with insufficient levels of vitamin D (<30 ng/mL), while differences in other echocardiographic parameters remained nonsignificant between HRR groups. Conclusions: These findings underscore the clinical value of HRR as a composite biomarker that reflects the interplay between anemia, inflammation, and cardiovascular health in primary Sjögren’s disease. They also suggest that vitamin D status may be an important therapeutic consideration to mitigate cardiopulmonary risks in this population. Full article

Metabolic syndrome (MetS) is characterised by cardiometabolic risk factors and is closely associated with increased oxidative stress and chronic low-grade inflammation. MetS is largely driven by adverse lifestyle behaviours, particularly physical inactivity, and regular physical activity is recognised as a central strategy for its prevention and management. This study aimed to assess the long-term impact of a five-year follow-up period of physical activity on oxidative stress, inflammatory biomarkers, and cardiometabolic health in adults with MetS. Forty participants diagnosed with MetS (50% men, aged 55–75 years) were selected and stratified into two groups: those who increased their physical activity and those who reduced it during the intervention. Physical activity was assessed using metabolic equivalent task minutes per week (MET·min/week), and evaluations were performed at baseline, 3 years, and 5 years. Participants who increased physical activity showed a progressive reduction in reactive oxygen species (ROS) produced by peripheral blood mononuclear cells (PBMCs), together with a decrease in plasma malondialdehyde (MDA). Antioxidant enzyme activities, including catalase and superoxide dismutase, exhibited a favourable long-term profile, with recovery or maintenance of higher activity levels by the end of follow-up, reflecting enhanced endogenous antioxidant defence. Inflammatory status improved and was characterised by a reduction in myeloperoxidase (MPO) activity and a sustained increase in plasma interleukin-15 (IL-15). These participants also showed reductions in body weight, body mass index (BMI), waist circumference, fasting glucose, and glycosylated haemoglobin A1c (HbA1c), consistent with improved insulin sensitivity and metabolic control. Participants who reduced physical activity tended to show unfavourable trajectories in several biomarkers. Increasing physical activity over time is associated with substantial improvements in redox balance, inflammatory status, and cardiometabolic health in adults with MetS. These findings reinforce the central role of physical activity as a fundamental therapeutic component within lifestyle interventions aimed at mitigating metabolic dysfunction and preventing MetS progression. Full article

This study aimed to design a new composite with promising antimicrobial and antioxidant properties by a simple modification process of natural bentonite (B) with polysaccharide chitosan isolated from edible mushrooms Agaricus bisporus—ChM (sample B–ChM) and subsequently with a cationic surfactant—hexadecyltrimethylammonium bromide—HB (sample B–ChM–HB) for effective removal of mycotoxin zearalenone (ZEN). Characterization confirmed the presence of ChM in B–ChM and both ChM and HB in B–ChM–HB. Compared to non- or slightly inhibitory activity of B and B–ChM, B–ChM–HB showed fungicidal activity against yeast Candida albicans and mycotoxigenic mold Aspergillus flavus, with a reduction of 6.00 log10 (CFU/mL) and 5.32 log10 (CFU/mL), respectively. B–ChM–HB showed a very high neutralization ability on •DPPH (89.03%–95.99%) in the concentration range of 0.625–5.0 mg/mL, the highest ferrous ion chelating ability (80.25%) at a concentration of 0.625 mg/mL, and did not induce lipid peroxidation in the linoleic acid model system. While B and B–ChM exhibited low adsorption of ZEN, its adsorption by B–ChM–HB was significantly higher. The equilibrium results of B–ChM–HB for ZEN were in accordance with the linear isotherm model at pH 3 and 7, pointing out that hydrophobic interactions (partitioning process) were relevant for toxin adsorption by the composite. Similar maximum ZEN adsorbed amounts under the applied experimental conditions (14.4 mg/g) at both pH values suggested that its adsorption was independent of the pH. This study reported for the first time that a novel composite of B with ChM and HB showed promising antimicrobial and antioxidant properties and was an efficient adsorbent for mycotoxin ZEN. Full article

The valorization of cull sheep and the incorporation of agro-industrial by-products into animal feeding represent effective approaches to enhancing the sustainability of small ruminant production systems. This study investigated the effects of dietary inclusion of 17% partially destoned olive cake (OC) in the concentrate fed to Valle del Belice ewes on carcass characteristics, as well as on meat and salami quality. A 14-week feeding trial was conducted on 124 animals allocated to a control (CTR) and an experimental (EXP) group, balanced for parity, days in milk, and daily milk yield. At the end of the trial, five animals per group were slaughtered and their meat was processed into three types of salami: 100% sheep meat (SM), 90% sheep meat with 10% beef heifer brisket (HB), and 90% sheep meat with 10% pork backfat (PB). Meat and salami were evaluated for chemical composition, fatty acid profile, polyphenol content, antioxidant capacity, lipid oxidation, microbiological status, textural properties, and sensory characteristics. Dietary OC supplementation resulted in increased carcass weight, separable fat, intramuscular fat content, and monounsaturated fatty acids—particularly oleic acid—along with higher polyphenol levels and antioxidant activity. Salami produced from OC-fed ewes exhibited reduced weight loss during ripening, lower lipid oxidation, an improved MUFA/SFA ratio, and satisfactory sensory attributes. Microbiological analyses indicated a dominance of lactic acid bacteria and coagulase-negative staphylococci, with no pathogenic microorganisms detected. Overall, the inclusion of olive cake in the diet enhanced meat and processed product quality, supporting the valorization of olive oil by-products within circular economy frameworks. Full article

Congenital dyserythropoietic anaemia type-I (CDA-I) is a rare autosomal recessive disease characterised by ineffective erythropoiesis, haemolysis and non-haematological developmental abnormalities. Its treatment is multifactorial, including the management of anaemia, iron overload and prevention of osteoporosis. The only treatment specific to CDA-I is subcutaneous interferon alpha (IFNα) 2A. This study presents the first summary of all published cases of CDA-I patients (n = 33) treated with IFNα and categorises their outcome. We also present new unpublished cases (n = 7). Overall, we find that IFNα administration causes a statistically significant mean increase in haemoglobin of 30.7 g/L (p < 0.001). However, we note that previous studies do not assess the impact of IFNα therapy on providing symptomatic benefit to patients with CDA-I, or the weight of side effects on their quality of life. We collaborate directly with patients through the organisation Congenital Anaemia Network to establish patient preferences regarding IFNα treatment. We propose a classification framework for the use of IFNα in CDA-I that includes patient-reported outcome measures in addition to grading response according to changes in Hb levels. We believe that the use of this framework will aid standardisation in measuring response to therapy, improve clinical practice and assist in future research. Full article