Search Results (725)

Background and Objectives: Lower limb defects often present significant reconstructive challenges due to limited soft tissue availability and exposure of critical structures. Perforator-based flaps offer reliable solutions, with minimal donor site morbidity. This study aimed to evaluate the efficacy of infrared thermography (IRT) in preoperative planning and postoperative monitoring of perforator-based flaps, assessing its accuracy in identifying perforators, predicting complications, and optimizing outcomes. Materials and Methods: A prospective observational study was conducted on 76 patients undergoing lower limb reconstruction with fascio-cutaneous perforator flaps between 2022 and 2024. Perforator mapping was performed concurrently with IRT and Doppler ultrasonography (D-US), with intraoperative confirmation. Flap design variables and systemic parameters were recorded. Postoperative monitoring employed thermal imaging on days 1 and 7. Outcomes were correlated with thermal, anatomical, and systemic factors using statistical analyses, including t-tests and Pearson correlation. Results: IRT showed high sensitivity (97.4%) and positive predictive value (96.8%) for perforator detection. A total of nine minor complications occurred, predominantly in patients with diabetes mellitus and/or elevated glycemia (p = 0.05). Larger flap-to-defect ratios (A/C and B/C) correlated with increased complications in propeller flaps, while smaller ratios posed risks for V-Y and Keystone flaps. Thermal analysis indicated significantly lower flap temperatures and greater temperature gradients in flaps with complications by postoperative day 7 (p < 0.05). CRP levels correlated with glycemia and white blood cell counts, highlighting systemic inflammation’s impact on outcomes. Conclusions: IRT proves to be a reliable, non-invasive method for perforator localization and flap monitoring, enhancing surgical planning and early complication detection. Combined with D-US, it improves perforator selection and perfusion assessment. Thermographic parameters, systemic factors, and flap design metrics collectively predict flap viability. Integration of IRT into surgical workflows offers a cost-effective tool for optimizing reconstructive outcomes in lower limb surgery. Full article

Background: Taste changes are common during pregnancy and can have a significant impact on dietary habits. Objective: This study aimed to investigate the influence of the perception of sweet and fat taste on diet in pregnant diabetic women. Methods: This cross-sectional observational study included 66 pregnant women, 33 with gestational diabetes and 33 with pre-gestational type 2 diabetes. Taste perception tests were conducted to evaluate thresholds for detecting sweet and fatty tastes. Dietary surveys were used to assess daily nutrient intake, and various biochemical parameters, such as glycemia, HbA1c, and cholesterol, were analyzed. Results: The low-fat taster group (threshold > 0.75 mmol/L) included more patients with diabetes compared to those with gestational diabetes. All diabetic patients had low sucrose perception. Although pregnant women with gestational diabetes detected sweetness at high concentrations, pregnant women with diabetes detected it at lower concentrations (0.012 ± 0.023 mmol/L vs. 0.006 ± 0.005 mmol/L; p = 0.3). High-fat tasters exhibited elevated glycemia compared to low-fat tasters (6.04 ± 1.88 mmol/L vs. 7.47 ± 3.4 mmol/L; p = 0.03). They also had higher cholesterol (p = 0.04) and lower HDL-C levels (4.96 ± 1.04 mmol/L vs. 1.36 ± 0.29 mmol/L; p = 0.03). High-fat tasters showed more frequent daily consumption of oil, butter, cheese, and chocolate. The highly sweet tasters had higher cholesterol levels and lower LDL levels. Individuals who reported being highly sensitive to sweet taste consumed more daily oil, sweetened yogurt, or cream desserts, as well as white sugar. Conclusions: These findings indicate that altered sensitivity to fat and sweet tastes is associated with different dietary habits and metabolic profiles in pregnant women with diabetes. Specifically, reduced sensitivity to the taste of fat is associated with higher consumption of high-fat foods and poorer lipid profiles. In contrast, sensitivity to sweet taste correlates with an increased intake of sugary and fatty foods. Understanding these taste-related behaviors can help develop personalized nutritional strategies to improve metabolic control and maternal–fetal outcomes in this high-risk group. Full article

Pleurotus eryngii is an edible mushroom with previously characterized β-glucans. Its potential to ameliorate postprandial glycemia and regulate appetite at the postprandial state has been previously shown. However, its effect on protein digestion remains unexplored. We aimed to investigate the effect of baked P. eryngii with a known β-glucan content (4.5 g) on plasma free amino acids of patients with central obesity and metabolic abnormalities at a postprandial state. In this acute, randomized controlled cross-over study, thirteen healthy male volunteers consumed one meal that was prepared with P. eryngii and one control meal; each meal was separated by one month. Blood was collected, and plasma was isolated at different timepoints before and after the consumption. Gas chromatography–mass spectrometry was used to quantify 24 free amino acids in the plasma samples. The area under the curve with respect to increase (AUCi) was computed, and the AUCi for aromatic amino acids was found to be higher after the consumption of the control meal compared to the P. eryngii meal (p = 0.027 for phenylalanine, p = 0.008 for tyrosine, and p = 0.003 for tryptophan). The above novel findings suggest that the β-glucans present in P. eryngii mushrooms are potential modulators of AA release into the bloodstream. Full article

Background/Objectives: Diatomaceous earth (DE), a natural substance rich in amorphous silica and recognized as a food additive, is gaining attention as a dietary silicon supplement. However, its bioavailability and impact on lipid digestion and absorption remain poorly characterized. This study aimed to investigate silicon bioavailability after short-term DE supplementation and its effects on postprandial glycemia and triglyceridemia, the expression of lipid metabolism-related proteins, and the modulation of the intestinal mucosal barrier. Methods: Female Wistar rats received daily oral supplementation of DE (equivalent to 2 or 4 mg silicon/kg body weight) for one week. Silicon digestibility, excretion, and hepatic accumulation were quantified. Postprandial glycemia and triglyceridemia were monitored. Lipid profile was analyzed by HPSEC in gastric and intestinal contents. Jejunal morphology and mucin-secreting cells were assessed histologically. Lipid metabolism markers were evaluated by immunohistochemistry and Western blot in both intestinal and hepatic tissues. Results: DE supplementation enhanced silicon absorption and increased hepatic levels. Fecal output and moisture content were also elevated, especially at the higher dose. DE significantly reduced postprandial triglyceridemia and consequently increased luminal triglyceride retention. These changes were associated with decreased jejunal levels of IFABP, ACAT2, and MTP, as well as reduced hepatic levels of MTP and LDLr, alongside increased levels of ABCG5/G8 and LXRα/β, indicating a partial blockage of lipid absorption and enhanced cholesterol efflux. The effects on the intestinal barrier were evidenced by villi shortening and an increase in mucin-producing cells. Conclusion: Food-grade DE is a bioavailable source of silicon with hypolipidemic potential, mainly by reducing intestinal lipid absorption. This is supported by lower postprandial triglycerides, increased luminal lipid retention, and decreased expression of lipid transport proteins. The study in healthy female rats underscores the importance of sex-specific responses and supports DE as a dietary strategy to improve lipid metabolism. Full article

Plant supplements are frequently used by diabetes mellitus (DM) patients in the management of their disease. Background/Objectives: The present study aimed to identify the prevalence of plant supplement use in DM patients from Romania and to evaluate patients’ practices, profiles, and beliefs regarding plant supplements and the impact of their use on glycemic control. Methods: A cross-sectional online survey was conducted among Romanian diabetic patients. Results: Out of 329 validated responses, 44.07% reported supplement use. Momordica charantia L. (35.17%) was the most used. Female patients were statistically significantly more prevalent in the plant supplement user group. Plant supplement use was associated with statistically significantly lower HbA1c (7.11% vs. 7.66%, p < 0.01) and basal glycemia (127.75 mg/dL vs. 136.08 mg/dL, p < 0.01) over the previous three months. Diabetic polyneuropathy was statistically significantly less prevalent among patients who used plant supplements (31.03% vs. 42.39%, p = 0.035). The greatest proportion of responders reported that they started to use plant supplements for improving blood glycemia (88.97%), followed by the purpose of preventing DM complications (27.59%). A significant improvement in health status was reported by 53.79% of patients using herbal supplements. Conclusions: Plant supplement use was common and associated with improved glycemic parameters and lower complication prevalence. Full article

Pituitary neuroendocrine tumors (PitNETs) are the most common intracranial tumors. Evidence suggests that these types of tumors may have high recurrence rates. In this context, the purinergic system, oxidative stress, and inflammation are important signaling pathways involved in the cancer’s pathophysiology. This study aimed to evaluate the sociodemographic and diagnostic profiles, as well as assess the purinergic signaling, immunological, and redox profiles, of patients after PitNET resection. We collected sociodemographic data and the patients’ diagnostic profiles. We also collected blood samples to analyze glycemia, triglycerides, albumin, and ATP levels. The ectonucleotidase activity was determined in peripheral blood mononuclear cells (PBMCs). In addition, we evaluated their redox and immunological profiles. There was a prevalence of gonadotropic macroadenoma derived from PIT-1 cells. We found that patients included in the PitNET group had increased glycemia, serum ATP levels, and ATP hydrolysis in PBMCs. Analyzing their immunological profiles, we found that patients had increased levels of IL-6, IL-10, and TNF, while the IL-27 level was decreased. Regarding their redox profiles, PitNET patients had increased levels of ROS and protein carbonylation. Unexpectedly, patients also showed increased levels of non-protein thiols (NPSHs), total thiols (PSHs), and ascorbic acid. Thus, the dysregulation of purinergic signaling sustained chronic inflammation and oxidative imbalance in PitNET patients for a long time after surgical resection. These data suggest that patients with PitNETs require long-term accompanying to prevent cancer recurrence prognosis. The biomarkers highlighted in this study may be good tools to help the medical approaches. Full article

Insulin, traditionally recognized for its pivotal role in glycemic regulation, exerts extensive effects beyond glucose homeostasis, influencing multiple physiological systems. This narrative review explores the multifaceted actions of insulin, emphasizing its impact on skeletal muscle remodeling, protein and lipid metabolism, growth, reproductive health, and the central nervous system. Methods: An in-depth review of articles with evidence-based research discussing insulin actions beyond glycemic control was conducted in this review paper. Results: Insulin directly influences lipid and protein metabolism as well as growth hormone levels. This hormone provides a protective effect on the skeletal and central nervous systems, helping to maintain homeostasis and potentially reducing the risk of certain disorders such as Alzheimer’s disease. The significance of insulin balance in the reproductive system is also crucial, with recent research indicating that insulin plays a role in worsening symptoms and complications associated with polycystic ovary syndrome. This review underscores the importance of maintaining proper insulin levels to lower the risk of insulin resistance. Ongoing research aims to deepen our understanding of insulin’s functions, which are essential for preventing specific diseases and developing new treatment strategies. Conclusions: Insulin’s action extends far beyond glucose metabolism, affecting many systems and preventing pathological changes in some. Full article

Background/Objectives: Public transportation drivers are exposed to a variety of occupational hazards. The scope of this study is to describe the most significant changes in symptoms and work-related disorders in the last decade in a sample of professional drivers from a large Romanian city, and, in particular, the cardio-metabolic and musculoskeletal impact. Methods: A retrospective study on 186 professional tram, trolley, and bus drivers from a total number of 344 employed by the company was conducted. The initial values (pre-employment) of the BMI, blood pressure, cholesterol, fasting glycemia, and musculoskeletal complaints were compared to the values of the last employment check-up. Results: After an average follow-up period of 11 years, BMI increased from 27.69 (SD = 4.68) to 30.06 (SD = 5.2) (p < 0.0001), cholesterol from 201.7 (SD = 39.87) to 212.62 (SD = 42.51), (p = 0.04). The number of cases of high blood pressure (25 to 56, p < 0.0001) and musculoskeletal complaints increased from 3 initial cases to 26 cases of neck pain (p = 0.07), from 2 to 49 cases of dorsal pain (p = 0.02), and from 18 to 59 cases of lumbar pain (p < 0.0001). High blood pressure and low back pain were significantly correlated with tenure, independent of other factors. Conclusions: As tenure is important in the development of cardiovascular and musculoskeletal diseases, specific interventions should be developed in the early stages of the drivers’ career. Full article

Postprandial dysmetabolism, which refers to the impaired regulation of glucose and lipid levels after meals, is recognized as an independent risk factor for cardiovascular diseases (CVDs). Diets rich in polyphenols have demonstrated potential in improving postprandial hyperglycemia and hyperlipidemia. This study investigates the effects of olive leaf polyphenols on postprandial metabolic outcomes following a high-fat and high-carbohydrate meal. A total of 36 healthy adults participated in a three-arm randomized crossover trial. They ingested either a biscuit made from olive leaf powder (OLB), olive leaf tea (OLT), or a placebo meal (CTRL) to assess the impact of olive leaf polyphenols on postprandial glycemia, lipid levels, platelet aggregation factor (PAF), and plasma antioxidant status (TAC). Although no statistically significant differences were observed in the primary biomarkers, including glucose and lipid profiles, a delayed insulin response was noted in the interventions involving olive leaf. These findings suggest that while acute olive leaf supplementation did not significantly alter postprandial glycemia or lipidemia, it may subtly influence insulin kinetics. Further research is needed to explore the long-term effects of olive leaf polyphenols on metabolic health, especially in populations at risk for CVDs. Full article

Metabolic syndrome (MetS) increases the risk of cardiovascular disease development, with sex differences playing a significant role. AMP-activated protein kinase (AMPK), a key regulator of cellular energy homeostasis, becomes dysregulated in MetS, making it a potential therapeutic target. Therefore, we aimed to investigate the role of AMPK in the development of cardiovascular comorbidities in male and female rats with MetS. MetS was induced in young Wistar–Kyoto (WKY) rats through a high-fat diet (HFD; 10 weeks), and the function of AMPK was studied using Compound C (Cmpd C; 1.5 mg/kg, twice per week, during the last 4 weeks). An HFD induced MetS in males, but, in females, it did not affect body weight, blood pressure, or glycemia until AMPK inhibition occurred. Endothelial dysfunction, oxidative stress, and inflammation developed in both HFD male groups, while, in females, these arose only with AMPK inhibition. In both sexes, α1-AMPK activation decreased with eNOS and Nrf2 protein levels after HFD + Cmpd C treatment. Estradiol levels significantly dropped in HFD and Cmpd C females, whereas testosterone levels remained unchanged. Our results suggest that MetS and related cardiovascular comorbidities in males are driven by oxidative stress, inflammation, and endothelial dysfunction, with minimal additive effect of AMPK. In females, MetS arose only when inhibition of AMPK impaired estrogen signalling, emphasising their protective roles. Targeting AMPK-estrogen pathways may provide a therapeutic strategy, particularly for high-risk cardiovascular females and menopausal women. Full article

Diabetes mellitus (DM) is one of the most common endocrine disorders in dogs. Glycated albumin (GA), a biomarker of short-term glycemia, may offer a valuable tool for assessing glycemic control in dogs with DM. This pilot study evaluated the correlation between GA and conventional glycemic markers and continuous glucose monitoring (CGM)-derived metrics in dogs. A total of 30 dogs were included in this prospective pilot study, comprising dogs with diabetes mellitus (n = 10) and healthy controls (n = 20). Of these, 11 dogs that lacked anemia, hypoalbuminemia, or azotemia and whose owners consented to 14-day CGM were analyzed for sensor-based metrics (dogs with diabetes, n = 7; controls, n = 4). Across the full cohort, GA showed significant correlations with fructosamine and HbA1c, while within the CGM subset, GA was significantly associated with mean glucose level, TIR2, and TAR2. These findings suggest that GA, in conjunction with fructosamine and HbA1c, offers valuable insights into glycemic control over a 2-week period and could serve as a reliable biomarker for glucose monitoring in dogs with diabetes. Full article

Background: Metabolic bariatric surgery is a highly effective and long-lasting treatment for obesity and related chronic conditions. Women of reproductive age represent the largest group undergoing these procedures. Observational studies suggest an increased risk of preterm birth and impaired foetal growth in this population, though the underlying mechanisms remain unclear. A key hypothesis is that altered glucose metabolism, characterised by frequent hypoglycaemia and glycaemic fluctuations, may contribute to these adverse outcomes. While glycaemic variability following metabolic bariatric surgery has been documented, its pattern during pregnancy and impact on pregnancy outcomes are still underexplored. Methods: In this Belgian multicentre prospective cohort study, we will investigate glycaemic patterns during pregnancy in women who have undergone metabolic bariatric surgery. Women aged 18–45 years with a confirmed singleton pregnancy up to 11 weeks and 6 days and a history of Roux-en-Y gastric bypass or sleeve gastrectomy will be eligible for inclusion. Women with pregestational diabetes or those taking medication known to interfere with glucose metabolism will be excluded. All participants will receive blinded continuous glucose monitoring (Dexcom^® G6) for a 10-day period at four time points throughout the pregnancy. Foetal body composition and growth will be measured during routine ultrasound; skinfolds will be measured in the neonate. The primary outcome is the association between mean glycemia and glycaemic variability on continuous glucose monitoring and birth weight. The planned sample size is ninety-five women. Linear mixed models for repeated measurements will be used for analysis. Confounders such as smoking, micronutrient deficiency, and surgery-to-conception interval will be added to the model as covariates. In a second exploratory phase, each participant in the surgical group will be matched with a control participant—without a history of metabolic bariatric surgery—based on pre-pregnancy BMI and age. Control participants will undergo the same study procedures, allowing for exploratory comparison of glycaemic patterns and other study outcomes. Discussion: This prospective longitudinal study will be the largest study using continuous glucose monitoring to investigate glucose metabolism during pregnancy after metabolic bariatric surgery and its impact on foetal growth and newborn body composition. Trial registration: ClinicalTrials.gov: NCT05084339. Registration date: 15 October 2021. Full article

Background: Type 2 diabetes mellitus (T2DM) is common among patients with chronic obstructive pulmonary disease (COPD). We examined the association between glycemic control and clinical outcomes in patients with COPD exacerbation and T2DM. Methods: A retrospective study of patients with T2DM and COPD exacerbation comparing controlled (HbA1c < 7.5%) to uncontrolled (HbA1c ≥ 7.5%) glycemia prior to admission. The primary endpoint is defined as a composite of 6-month rehospitalization/mortality. Secondary endpoints included 6-month mortality and 6-month readmission. Results: Of 426 admissions, 179 (42%) had uncontrolled glycemia. The risk of rehospitalization/mortality was significantly increased in the uncontrolled group in univariate (HR1.6, 95%CI 1.11–2.3, p = 0.01) and multivariate (HR 1.82, 95%CI 1.24–2.67, p = 0.002) analyses. The risk of 6-month rehospitalization was increased in the uncontrolled group in both univariate (HR1.94, 95%CI 1.16–3.23, p = 0.011) and multivariate (HR1.98, 95%CI 1.19–3.27, p = 0.008) analyses. No difference was found between 6-month mortality risks. Conclusions: Optimal glycemic control may improve COPD management and reduce adverse outcomes. Full article

Heat-inactivated probiotics, also known as postbiotics, have emerged as an alternative to live probiotics, and have been shown to be good therapeutic tools for the management and treatment of metabolic dysfunctions such as obesity and type 2 diabetes (T2D). The present study aimed to assess the anti-obesogenic and anti-diabetic properties of heat-inactivated Pediococcus acidilactici pA1c^® (pA1c^®HI) in mice fed a high-fat diet (HFD). The animals were given an HFD or HFD enriched with either the probiotic alive pA1c^® or the postbiotic pA1c^®HI. Body weight (BW), serum biochemical markers, gene expression, and histological changes were determined following 15 weeks of supplementation. The postbiotic pA1c^®HI exerted a similar effect on glucose metabolism to that exerted by pA1c^® supplementation. Nevertheless, we observed that pA1c^®HI supplementation maintained BW, attenuated adipogenesis, and protected the mice from liver damage more efficiently than pA1c^®. Similarly, in adipose tissue, pA1c^®HI significantly downregulated markers of de novo lipogenesis (DNL) and fat storage. The observed results show that pA1c^®HI administration was even more effective in mitigating the HFD’s detrimental effects than pA1c^® supplementation, and therefore, the viability of this Pediococcus acidilactici CECT 9879 strain is not required for preserving its beneficial properties in the context of obesity and T2D. Full article

This study exploited the skin temperature signal derived from a wrist-worn wearable device to define potential digital biomarkers for glycemia levels. Characterization of the skin temperature signal measured through the Empatica E4 device was obtained in 16 subjects (data taken from a dataset freely available on PhysioNet) by deriving standard metrics and a set of novel metrics describing both the current and the retrospective behavior of the signal. For each subject and for each metric, values that correspond to when glycemia was inside the tight range (70–140 mg/dL) were compared through the Wilcoxon rank-sum test against those above or below the range. For hypoglycemia characterization (below range), retrospective behavior of skin temperature described by the metric CV_{T SD} (standard deviation of the series of coefficient of variation) proved to be the most effective both in daytime and nighttime (100% and 50% of the analyzed subjects, respectively). On the other side, for hyperglycemia characterization (above range), differences were observed between daytime and nighttime, with current behavior of skin temperature, described by M2_T (deviation from the reference value of 32 °C), being the most informative during daytime, whereas retrospective behavior, described by SD_{T hhmm} (standard deviation of the series of means), showed the highest effectiveness during nighttime. Proposed variability features outperformed standard metrics, and in future studies, their integration with other digital biomarkers of glycemia could improve the performance of applications devoted to non-invasive detection of glycemic events. Full article