INTRODUCTION: Although white matter hyperintensity (WMH) can progress over time, little is known about the underlying mechanisms. In addition, type 2 diabetes mellitus (T2DM) exacerbates the accumulation of WMH. Here we aimed to investigate longitudinal changes in WMH shapes and volume in older adults with and without T2DM. METHODS: Participants underwent baseline and follow‐up magnetic resonance imaging (MRI). WMH volume and shape markers were automatically assessed. We compared WMH volume and shape markers at baseline and follow‐up. RESULTS: A total of 200 participants were included at baseline and 181 at follow‐up. The mean age ± SD of our study participants was 69.86 ± 6.03 years; 79 (39.90%) had a history of diabetes mellitus (T2DM) and 73 (36.50%) were male. For shape markers, participants with T2DM showed more complex periventricular (eccentricity, p = 0.027) and deep WMH shape markers (fractal dimension, p = 0.002) than participants without T2DM. At baseline, there were no statistically significant differences ( p > 0.05) in WMH volume when participants with T2DM were compared to participants without T2DM. At follow‐up, a more complex shape of periventricular/confluent WMH on follow‐up (concavity index, p = 0.005; inverse sphericity index, p = 0.001). In addition, total ( p < 0.001), periventricular ( p < 0.001), and deep ( p = 0.001) WMH volumes increased significantly. DISCUSSION: A more irregular shape of periventricular and deep WMH and higher WMH volumes were associated with T2DM participants. These findings suggest that WMH shape markers may be useful in determining prognosis for cerebral small vessel disease and aid in future preventive treatments. Highlights: Patients with diabetes mellitus have more irregular white matter hyperintensity (WMH) shapes and increased WMH volumes. Diabetes mellitus exacerbates the changes in WMH shapes and volumes WMH shape markers might have the potential to aid in future preventive treatments and prevent clinical deterioration.

Background: Cognitive impairment is common among older adults with diabetes mellitus (DM). This study aimed to examine the associations between DM with/without diabetic retinopathy (DR) and adverse cognitive outcomes in older adults, and to assess the potential role of the dietary inflammatory profile in these associations. Methods: This observational study included older adults from the National Health and Nutrition Examination Survey (NHANES), UK Biobank (UKB), and the Wenzhou dataset. Cognitive outcomes were assessed using cognitive tests in NHANES and the Wenzhou dataset, and by all-cause dementia identified from ICD-10 codes in UKB, respectively. Dietary inflammatory index (DII) scores were derived from 24-h dietary recalls in NHANES, the Oxford WebQ in UKB, and the FFQ-25 in the Wenzhou dataset, respectively. Weighted multivariable-adjusted Poisson regression, robust Cox proportional hazards regression and conditional logistic regression were used in NHANES, UKB and the Wenzhou dataset, respectively. Exploratory mediation analyses were conducted in all three datasets to assess the potential role of DII in the associations between DM with or without DR and cognitive outcomes. Results: In NHANES, poorer cognitive performance was associated with DM and higher DII in the overall sample, while poorer cognitive performance was associated with DR and higher DII among participants with DM. Exploratory mediation analyses in NHANES suggested a potential role of DII in the associations between DM with/without DR and cognitive function impairment (CFI) (DM: 15.0% mediated; DR: 8.0% mediated). Restricted cubic spline analysis showed that higher DII levels were associated with higher odds of CFI. In UKB and the Wenzhou dataset, exploratory mediation analyses showed significant indirect effects of DII in the association between DM and dementia (4.1% mediated) and between DR and cognitive impairment (13.6% mediated), respectively. Conclusion: Dietary inflammatory profile reflected by DII may play a potential role in the associations of DM with/without DR and cognitive dysfunction. Further prospective studies and randomized controlled trials are needed to clarify causality and potential clinical benefit.

Objectives: Immune checkpoint inhibitors are a new beneficial medication in the treatment of cancer. Whether preexisting TPOAb was related to longer overall survival (OS) is controversial. This retrospective study analyzed the OS and progression-free survival (PFS) of patients with lung cancer, and explored predictive factors associated with the efficacy of PD-1/PD-L1 inhibitors treatment. Methods: Patients with lung cancer who were hospitalized in the First Affiliated Hospital of Wenzhou Medical University between January 1, 2020 and December 30, 2020 were enrolled. Thyroid function, TPOAb, TGAb, and prognostic nutritional index levels and body mass index were analyzed. Supervising physicians independently assessed patient staging, OS, and PFS. Demographic data, pathological type, and previous treatment history were also collected. Results: In total, this study enrolled 69 patients, with ages of 46–80 years old. Patients with lower weight showed reduced OS and PFS rates relative to those with normal weight and overweight (p<0.05). The single patient with large cell neuroendocrine carcinoma (LCNEC) exhibited a 1-, 1.5- and 2-year OS rate lower than that of the patients diagnosed with squamous cell carcinoma, small cell lung cancer, or adenocarcinoma (p<0.05). This LCNEC patient also had lower 1-, 1.5-, and 2-year PFS rates compared to adenocarcinoma patients (p<0.05). TPOAb and TGAb levels were unrelated to OS or PFS. Multivariate Cox regression analyses revealed a positive association between body mass index, OS, and PFS. Conclusions: Patients with lower body weight were predictive of poorer survival outcomes when receiving PD-1/PD-L1 inhibitors treatment as compared to patients with normal weight and overweight. However, positive baseline TGAb and TPOAb levels were not associated with increased OS or PFS in patients with lung cancer.

1. Diabetes comprises a spectrum of chronic metabolic disorders due to insulin deficiency or insulin resistance and characterized by hyperglycemia. 1 Diabetes causes complications involving many or...