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China: A recent study published in the Journal of Inflammation Research highlights the significance of the fibrinogen/albumin ratio (FAR) as an independent predictor for the development of contrast-induced acute kidney injury (CI-AKI) in patients with congestive heart failure (CHF). The findings suggest that FAR may serve as a simple yet effective biomarker for early risk stratification in this high-risk population.
Patients with congestive heart failure face a heightened risk of mortality and poor clinical outcomes, particularly when undergoing contrast-enhanced procedures. One significant complication is contrast-induced acute kidney injury, which can further impair renal function and worsen prognosis. While the fibrinogen/albumin ratio has emerged as a potential inflammatory marker, its association with the risk of CI-AKI or all-cause mortality in CHF patients has not been well established.
To address this gap, GuangHui Zhang, First Clinical Medical College, Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China, and colleagues investigated the correlation between preoperative FAR levels and the occurrence of CI-AKI and overall mortality in individuals with CHF.
For this purpose, the researchers conducted a retrospective observational study involving CHF patients undergoing coronary angiography (CAG). The patients were categorized into groups based on their fibrinogen/albumin ratio (FAR) quartiles. To evaluate the relationship between FAR and clinical outcomes, the researchers employed multivariate logistic regression and restricted cubic spline (RCS) analyses.
The study revealed the following findings:
The authors of this study concluded that the fibrinogen/albumin ratio is an independent risk factor for the occurrence of contrast-induced acute kidney injury in patients with congestive heart failure undergoing coronary angiography. They emphasized that assessing FAR before the procedure could help clinicians identify high-risk patients and implement strategies to prevent CI-AKI.
The study has several limitations, including its retrospective design, which may introduce biases. It did not assess blood viscosity indicators or specific CI-AKI biomarkers like cystatin C, NGAL, or KIM-1. Additionally, dynamic changes in FAR were not analyzed, and further research is needed to explore their impact on long-term renal function in CHF patients.
Reference:
Zhang G, Huang D, Chen J, Yang X, Ruan H, Huang X. Fibrinogen/Albumin Ratio is Associated with the Occurrence of Contrast-Induced Acute Kidney Injury in Patients with Congestive Heart Failure. J Inflamm Res. 2025;18:5149-5159. https://doi.org/10.2147/JIR.S507160
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A new study study presented at a joint meeting of the European Society of Paediatric Endocrinology and the European Society of Endocrinology, boys who experience delayed puberty are 2.5 times more likely to develop type 2 diabetes in early adulthood. This increased risk is independent of weight and socioeconomic status, highlighting pubertal timing as a key factor in long-term metabolic health.
Type 2 diabetes affects more than 90% of diabetics and is influenced by genetic, environmental, demographic, and socioeconomic variables. Previously known as adult-onset diabetes, type 2 diabetes often strikes individuals 45 years of age or older, but it is also increasingly being diagnosed in children, teenagers, and young adults, and researchers are looking at the different risk factors. Uncertainty surrounds the association between male delayed puberty and adult-onset type 2 diabetes. Therefore, Orit Pinhas-Hamiel and colleagues looked at the relationship between the chance of acquiring type 2 diabetes in early adulthood and delayed puberty throughout adolescence.
Nearly, 9,64,108 Israeli teenage boys (mean age 17.3 years) who were screened before military enlistment between 1992 and 2015 and monitored until December 31, 2019, were the subjects of this population-based study conducted nationally. Board-designated specialists used laboratory testing and physical examination to diagnose delayed puberty. The Israeli National Diabetes Registry was connected to the data. We used Cox proportional hazard models.
Almost, 0.45% of teenage boys were diagnosed with delayed puberty. Over a total follow-up of 15,242,068 years, T2D was identified in 6,259 people without delayed puberty and 111 people (2.58%) with delayed puberty. Teenagers without delayed puberty had an incidence rate of 41.3 T2D per 105 person-years, whereas those with delayed puberty had an incidence rate of 140.3.
After adjusting for birth year, socioeconomic position, cognitive function, education level, and country of birth, the hazard ratio (HR) for T2D among those with delayed puberty remained almost constant at 2.52. The HR was 1.37 with further modification to the baseline BMI. When limited to those diagnosed at or before the age of 35, the link was much stronger (1.65), and it remained after adjusting for baseline health condition.
Using adolescents without hypogonadism as the baseline group, the adjusted HR was 1.31 in a sensitivity analysis restricted to overweight and obese adolescents. Overall, independent of baseline BMI and other variables, teenage boys who have delayed puberty have a much higher risk of developing type 2 diabetes in their early adult years. These results point to delayed puberty as a possible indicator of metabolic risk that needs more research.
Source:
Pinhas-Hamiel, O., Simchoni, M., Derazne, E., Bardugo, A., Bendor, C. D., Vinograd, A., Lutski, M., Zucker, I., Afek, A., & Twig, G. (2025). Delayed puberty and early-onset type 2 diabetes: a nationwide cohort study of 1.6 million adolescents. Endocrine Abstracts. https://doi.org/10.1530/endoabs.110.oc2.6
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China: A recent study conducted in China has shed light on a surprising link between high levels of high-density lipoprotein cholesterol (HDL-C)—often termed “good cholesterol”—and a greater risk of low muscle mass in older adults, especially men. The research, published in Frontiers in Endocrinology, was led by Dr. Weixiao Zhang from the Department of Nuclear Medicine at Nanjing BenQ Medical Center, affiliated with Nanjing Medical University.
The investigation involved 1,995 adults aged 50 and above, aiming to explore the connection between HDL-C levels and chest CT-defined muscle mass. Researchers measured the muscle area of the erector spinae at the T12 vertebral level and analyzed how HDL-C levels corresponded with low muscle mass, a key indicator of sarcopenia.
The study led to the following findings:
The researchers employed multivariate logistic regression and restricted cubic spline (RCS) models to validate these findings, both confirming a linear relationship between HDL-C levels and the risk of low muscle mass. These results suggest that HDL-C, traditionally associated with cardiovascular benefits, may also play a role in age-related muscle health, though not necessarily a protective one.
Despite the compelling data, the study acknowledges some limitations. The observational nature of the research does not allow for causal conclusions. Additionally, functional assessments like grip strength, which are important in diagnosing sarcopenia, were not included. The findings are also limited to a Chinese population, and further studies across diverse ethnic groups are necessary to broaden applicability.
Moreover, since the study participants were drawn from individuals undergoing CT scans for lung cancer screening, the possibility of selection bias cannot be ruled out. Lifestyle factors like diet and exercise, which could influence both HDL-C and muscle mass, were also not accounted for.
The authors concluded, “The findings present HDL-C as a potentially useful biomarker for identifying older individuals, particularly men, who are at increased risk of muscle loss. Further research is needed to understand the mechanisms behind this association and whether interventions targeting HDL-C could aid in sarcopenia prevention or management.”
Reference:
Zhang W, Liu Y, Zhang Y, Zhang D, Wang J and Chen X (2025) Associations between high-density lipoprotein cholesterol levels and computed tomography-defined low muscle mass in older adults and sex-related differences. Front. Endocrinol. 16:1600431. doi: 10.3389/fendo.2025.1600431
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Current tuberculosis infection tests struggle to detect the disease in those with HIV. A common co-infection, HIV can hide TB from traditional tests by eliminating the immune cells relied upon to sound the alarm.
While more than 90% of the 2 billion TB cases worldwide are latent-symptom-free and not contagious-the weakening of the immune system in those with HIV can allow latent TB to turn active, increasing the potential for new infections to spread and often resulting in fatal outcomes. Tuberculosis is the leading cause of death among those with HIV worldwide.
Now, Tulane University researchers have developed a new handheld TB test that significantly improves detection in people with HIV, according to a new study in Nature Biomedical Engineering. Powered by a beetle-inspired chemical reaction, the device requires no electricity and addresses a critical gap in TB infection detection that has long hobbled efforts to eliminate the world’s deadliest infectious disease.
Dubbed the ASTRA (Antigen-Specific T-cell Response Assay), the credit card-sized device requires only a drop of blood to provide same day diagnoses without need for a laboratory or trained staff. When tested against the traditional IGRA blood test (Interferon-Gamma Release Assay), the ASTRA detected TB in HIV-infected individuals with 87% specificity compared to IGRA’s 60%, while also outperforming in detection of TB without HIV co-infection.
“The goal was to develop a TB test that could be taken anywhere and provide quicker, more accurate results for anybody,” said senior author Tony Hu, PhD, Weatherhead Presidential Chair in Biotechnology Innovation at Tulane University and director of the Tulane Center for Cellular & Molecular Diagnostics. “Current tests such as the IGRA are cost-prohibitive or require access to facilities that resource-limited communities don’t have. If we are going to eliminate TB, we have to diagnose and treat as many infection cases as possible.”
Added Bo Ning, lead author and assistant professor of biochemistry at Tulane University School of Medicine: “If your community has an immunocompromised population, someone may have latent TB. This can help block the spread of TB and ensure that no one slips through the cracks.”
To create a test that would not be stymied by HIV, the researchers identified two new biomarkers that could detect TB without relying on the immune cells susceptible to the virus.
After adding a drop of blood to the device, it must incubate for 4 hours to allow a preloaded reagent to stimulate a response from the immune cells. The reagent acts as a “wanted poster” asking if they’ve seen tuberculosis bacteria before.
To avoid the use of electricity, the researchers looked to an unlikely source for inspiration: the bombardier beetle. When threatened, these large insects combine two chemicals, and the resulting reaction produces a forceful spray. Similarly, two chemicals in the ASTRA are combined to propel the sample across a chip for final analysis and diagnosis.
The new device delivers results in about 4 hours, compared to the IGRA, which takes 24 hours, and a common TB skin test, which can take between two and three days for a diagnosis.
The ASTRA’s performance was validated using samples collected from a cohort in Eswatini, a country with high TB incidence and the highest reported HIV prevalence (27.3%) worldwide.
Increasing testing accuracy, access and speed is even more vital as TB resistance to drugs grows more robust, Hu said.
“The sooner you have a diagnosis, the sooner you can begin the process of determining proper treatment,” Hu said. “TB is the No. 1 pathogen HIV patients worry about globally. If treatment is available, we should be working to kill these bacteria, latent or not.”
Reference:
Ning, B., Chandra, S., Pan, Y. et al. Self-powered rapid antigen-specific T-cell response assay for Mycobacterium tuberculosis infections. Nat. Biomed. Eng (2025). https://doi.org/10.1038/s41551-025-01441-5.
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Recent study investigates the perioperative management of patients undergoing transcatheter aortic valve implantation (TAVI) using remimazolam, a short-acting benzodiazepine, in combination with flumazenil, contrasting it with sevoflurane. The hypothesis posited that this combination could significantly reduce emergence time when compared to traditional sevoflurane anesthesia.
Methodology
A prospective, randomized, open-label trial was conducted, enrolling 60 patients with severe aortic stenosis aged 18 or older. Participants were divided into two groups: one receiving remimazolam with flumazenil and the other receiving sevoflurane. The primary outcome focused on the time taken for extubation post-anesthesia discontinuation, while secondary outcomes included hemodynamic variables, vasopressor usage, complication rates, and muscle recovery metrics. Results indicated that the median time to extubation was significantly shorter in the remimazolam group (6.5 minutes) compared to the sevoflurane group (14.2 minutes), showcasing a notable difference of 6.9 minutes with a confidence interval of -8.7 to -5.0 (P < 0.001). The remimazolam group also required fewer boluses of ephedrine for hemodynamic support, suggesting improved cardiovascular stability; however, mean arterial pressure (MAP), heart rate (HR), and overall vasopressor requirements did not differ significantly between groups.
Intraoperative Findings
Intraoperatively, parameters such as perfusion index (PI) and regional cerebral oxygen saturation (rSO2) showed statistically significant differences; the remimazolam group had lower values than those receiving sevoflurane, hinting at variations in hemodynamic responses although the clinical significance remains debatable. No significant intraoperative complications were reported in either group.
Flumazenil Considerations
The use of flumazenil to reverse the sedative effects of remimazolam is acknowledged, although potential risks including resedation are noted. Statistical analysis was conducted utilizing mixed models to assess intraoperative variables, reinforcing the findings of reduced emergence time without compromising intraoperative hemodynamics.
Conclusions and Implications
Despite limitations including a lack of blinding and a single-center study design, the data generally supports the conclusion that a combination of remimazolam and flumazenil results in more efficient emergence from anesthesia compared to sevoflurane in high-risk patients undergoing TAVI. These findings suggest that remimazolam could be a viable anesthetic option for these procedures, addressing safety and recovery time effectively within the perioperative context.
Key Points
– A prospective, randomized, open-label trial with 60 patients assessed the efficacy of remimazolam combined with flumazenil against sevoflurane for perioperative management in transcatheter aortic valve implantation (TAVI), focusing on emergence time as the primary endpoint.
– The median extubation time post-anesthesia was significantly shorter in the remimazolam group (6.5 minutes) compared to the sevoflurane group (14.2 minutes), indicating a notable reduction of 6.9 minutes (P < 0.001).
– Hemodynamic support requirements were lower in the remimazolam group, with fewer doses of ephedrine administered, signifying greater cardiovascular stability; however, other hemodynamic metrics such as mean arterial pressure and heart rate did not differ notably between the groups.
– Intraoperative measurements, including perfusion index and regional cerebral oxygen saturation, presented statistically lower values in the remimazolam cohort, suggesting altered hemodynamic responses, although the clinical relevance of these differences is questionable.
– The administration of flumazenil to counteract remimazolam’s sedative effects was acknowledged, alongside the consideration of risks such as potential resedation; mixed models were employed for statistical analysis of intraoperative variables.
– The study concludes that remimazolam and flumazenil offer a more efficient emergence from anesthesia compared to sevoflurane for high-risk TAVI patients, with implications for enhanced safety and reduced recovery times, despite inherent limitations including a lack of blinding and a single-center study design.
Reference –
Harimochi, S., Godai, K., Nakahara, M. et al. Comparison of remimazolam and sevoflurane for general anesthesia during transcatheter aortic valve implantation: a randomized trial. Can J Anesth/J Can Anesth 72, 397–408 (2025). https://doi.org/10.1007/s12630-024-02900-4
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