Pancreatic β-cell failure is a pathological feature in type 1 diabetes. One promising approach involves inducing transdifferentiation of related pancreatic cell types, specifically α cells that produce glucagon. The chemokine stromal cell-derived factor-1 alpha (SDF-1α) is implicated in pancreatic α-to-β like cell transition. Here, the serum level of SDF-1α was lower in T1D with C-peptide loss, the miR-23a was negatively correlated with SDF-1α. We discovered that exosomal miR-23a, secreted from β cells, functionally downregulates the expression of SDF-1α, leading to increased Pax4 expression and decreased Arx expression in vivo. Adenovirus-vectored miR-23a sponge and mimic were constructed to further explored the miR-23a on pancreatic α-to-β like cell transition in vitro, which yielded results consistent with our cell-based assays. Suppression of miR-23a upregulated insulin level and downregulated glucagon level in STZ-induced diabetes mice models, effectively promoting α-to-β like cell transition. Our findings highlight miR-23a as a new therapeutic target for regenerating pancreatic β cells from α cells.

Rationale: Adult-onset Still’s disease (AOSD) is a rare multisystem disorder considered a complex autoinflammatory syndrome. The clinical and biological features of AOSD typically include a high fever with arthritic symptoms, evanescent skin rash, sore throat, striking neutrophilic leukocytosis, hyperferritinemia, and abnormal liver function. The typical rash and fever are important diagnostic clues for AOSD. Here, we report a case of atypical rash manifesting as persistent itchy urticaria. Patient concerns: A 57-year-old female presented with a 6-day history of fever. During her hospital stay, she progressively developed rashes that were not associated with fever, primarily distributed on her back and the distal extremities, and associated with pronounced itching. The rash was initially suspected to be urticaria; however, the patient exhibited a poor response to antihistamines. After malignancies and other rheumatic diseases were excluded, the diagnosis leaned towards AOSD based on diagnostic criteria. The patient’s fever was well controlled with the initiation of glucocorticoids, and no further rashes were observed. Diagnoses: Although the patient exhibited atypical rashes, after ruling out malignancies and other rheumatic diseases, she met 2 major and 3 minor criteria. Based on Yamaguchi’s criteria, the patient was diagnosed with AOSD. Interventions: Initially, the patient was administered an intravenous infusion of methylprednisolone at 40 mg once daily. This was later transitioned to oral administration with gradual dose reduction. Outcomes: Follow-up at 1 year showed no recurrence of the rash, with a stable condition and no relapse. Lessons: This case provides valuable insights for the early diagnosis of AOSD, emphasizing the importance of considering this diagnosis even when presenting with atypical skin rash.

The prevalence of isolated systolic hypertension (ISH) has doubled between 2002−2005 and 2014 among the oldest‐old population in China. However, the prevalence and characteristics of ISH among the oldest‐old population in southwestern China remain less known. This study aimed to investigate the prevalence of ISH among the oldest‐old population in Chengdu and identify associated factors to provide valuable information for disease etiology and prevention. We recruited 1,312 participants aged over 80 years by using a stratified cluster sampling method between September 2015 and June 2016, from three districts (Jinjiang, Qingyang, and Longquanyi) of Chengdu, the largest city of southwest China. A structured questionnaire, anthropometric data, and blood pressure were collected according to the standard method. Blood pressure was measured three times by using a standardized mercury sphygmomanometer after a 10‐minute seated rest. Of 1312 participants, 53.0% (n = 695) had ISH. The prevalence of ISH in men and women was 54.7% and 51.3%, respectively, with no significant sex difference (P = .222). The prevalence of ISH increased with advanced age in men (P for trend = 0.029), 52.5% for the 80−84 years group, 55.2% for the 85−89 years group, and 70.4% for the 90–98 years group, respectively. Multivariable logistic regression analyses found that drinking (OR = 1.85, 95%CI = 1.26−2.71), being overweight (OR = 1.88, 95%CI = 1.19−2.96), and having a higher heart rate (OR = 0.66, 95%CI = 0.51−0.86) were associated with ISH. Stratified by sex, these three factors remained significant in men. Our work highlights that the burden of ISH is substantial among the oldest‐old population in southwestern China.

Background: While China has achieved significant milestones in controlling infectious diseases, how mortality patterns have shifted across different life stages remains poorly understood. This study aims to delineate the evolving burden of infectious disease mortality to inform age-specific public health strategies. Methods: We analyzed national death surveillance data from China spanning 2004 to 2021. “Combined infectious mortality” was defined as the aggregate of communicable and parasitic diseases plus respiratory infections. Focusing on four key categories—respiratory infections, tuberculosis, viral hepatitis, and HIV/AIDS—we calculated crude and age-standardized mortality rates (ASMR). Log-linear regression models estimated annual percentage changes (EAPCs). Primary trend inferences were restricted to 2013–2019 (stable post-expansion period); 2020–2021 was treated separately due to the absence of a COVID-19 code. Results: During 2013–2019, mortality declined substantially faster in younger than in older age groups: EAPC was −14.70% (95% CI –16.96 to −12.38) for children aged 0–4 years, but only −1.62% (95% CI –3.66 to 0.46) for adults aged 75 + (interaction p < 0.0001). In 2021, over half (55.04%) of combined infectious deaths occurred in adults aged 75+. Cause hierarchy varied by age: respiratory infections dominated at both extremes; HIV/AIDS ranked highest among young adults (20–39 years), though its advantage was narrow; viral hepatitis predominated in middle-aged adults (40–59 years). HIV/AIDS mortality rose among 60–74 year-olds (EAPC 5.90% per year), with higher burden in rural and western regions. Conclusion: China is undergoing a distinctive epidemiological transition: infectious deaths are increasingly concentrated in older age groups, driven primarily by divergent age-specific mortality trends rather than population ageing alone. Public health strategies must extend beyond maternal-child health frameworks to address growing vulnerabilities in older populations—particularly respiratory infections and HIV in ageing rural communities.

Background: Recent studies have found that heart rate response is impaired in patients with type 2 diabetes. However, it remains unclear how chronotropic competence changes in these patients and which chronotropic index is more closely related to type 2 diabetes. This study aims to investigate the changes in chronotropic competence in type 2 diabetes and compares the association of two different chronotropic indices with type 2 diabetes.Patients and methods: Patients who underwent cardiopulmonary exercise testing at the Chengdu Second People's Hospital from October 2022 to October 2023, we included. Logistic regression was used to analyze the relationship between chronotropic indices and type 2 diabetes, comparing which of the two chronotropic indices is more closely related to type 2 diabetes.Results: A total of 166 patients were included in our study, of which 42.8% had type 2 diabetes and 57.2% did not have type 2 diabetes. After adjusting for confounders, the OR for chronotropic index 1 with type 2 diabetes was 0.001 (95% CI: 0.0001–0.521, P = 0.03), and the OR for chronotropic index 2 with type 2 diabetes was 0.665 (95% CI: 0.479–0.923, P = 0.015), both showing a negative correlation with type 2 diabetes. When chronotropic index 2 was included in the model as quartiles, it still showed a negative correlation with type 2 diabetes (OR: 0.388; 95% CI: 0.173–0.869; P = 0.021), while chronotropic index 1 showed no significant correlation.Conclusion: Heart rate response is reduced in patients with type 2 diabetes, and a low chronotropic index 2 is independently associated with type 2 diabetes.

Pancreatic β-cell failure is a pathological feature in type 1 diabetes. One promising approach is the transdifferentiation of developmentally related pancreatic cell types, including glucagon-producing α cells. The chemokine stromal cell-derived factor-1 alpha (SDF-1α) is implicated in pancreatic α-to-β like cell transition. Here, the serum level of SDF-1α was lower in T1D with C-peptide loss, the miR-23a was negatively correlated with SDF-1α. We identify exosomal miR-23a secreted from β cells, functionally negatively regulate the expression of SDF-1α, followed by increased expression of Pax4 and decreased expression of Arx in vivo. Adenovirus-vectored miR-23a sponge and mimic were constructed to further explored the miR-23a on pancreatic α-to-β like cell transition in vitro, and the results were similar to cell experiments. Repression of miR-23a upregulated the level of insulin and downregulated the level of glucagon in αTCl-6 cells and STZ-induced diabetes mice models, promoting α-to-β like cell transition. Our results identified miR-23a as a new therapeutic target for the regeneration of pancreatic β cells from α cells.