Diabetic foot ulcers (DFU) represent one of the most common side effects of diabetes, significantly impacting patients’ quality of life and imposing considerable financial burdens on families and society at large. Despite advancements in therapies targeting lower limb revascularization and various medications and dressings, outcomes for patients with severe lesions remain limited. A recent breakthrough in DFU treatment stems from the development of mesenchymal stem cells (MSCs). MSCs have shown promising results in treating various diseases and skin wounds due to their ability for multidirectional differentiation and immunomodulation. Recent studies highlight that MSCs primarily repair tissue through their paracrine activities, with exosomes playing a crucial role as the main biologically active components. These exosomes transport proteins, mRNA, DNA, and other substances, facilitating DFU treatment through immunomodulation, antioxidant effects, angiogenesis promotion, endothelial cell migration and proliferation, and collagen remodeling. Mesenchymal stem cell-derived exosomes (MSC-Exo) not only deliver comparable therapeutic effects to MSCs but also mitigate adverse reactions like immune rejection associated with MSCs transplantation. This article provides an overview of DFU pathophysiology and explores the mechanisms and research progress of MSC-Exo in DFU therapy.

This study aimed to analyze the safety and mid-term outcomes of a hybrid treatment method combining rotational atherectomy (RA) with drug-coated balloon (DCB) angioplasty in patients with femoropopliteal artery in-stent restenosis (ISR). This single-center retrospective study enrolled patients from January 2018 to March 2022 who had femoropopliteal artery in-stent restenosis treated by RA and DCB. Preoperative demographics, operative details, and postoperative 12-month follow-up outcomes were analyzed statistically. 38 consecutive patients (31 men; mean age 69.55 ± 9.18 years, range 54–91 years) with Tosaka II (n = 8) and III (n = 30) ISR were treated with RA Most patients had a high prevalence of typical vascular comorbidities. Overall, 50% of patients had chronic limb-threatening ischemia, and the average lesion length was 155.0 ± 54.8 mm. The primary patency rate, assessed by duplex ultrasound at 12 months, was 86.7%; 7.9% (3/38) of patients underwent target lesion revascularization (TLR). The overall mortality rate was 2.6% (1/38), and the ulcer healing rate reached 83.3% (5/6), with none of these patients requiring amputation. Subgroup analysis based on target lesion length (≥ 200 mm) showed that the 12-month primary patency rate was 75.0% for the ≥ 200 mm group and 95.5% for the < 200 mm group. Cox univariate regression analysis did not identify any risk factors affecting primary patency rate and freedom from clinically driven TLR (CD-TLR) at 12 months. Rotarex®S combined with DCB seems safe and provides acceptable 12-month primary patency and TLR rates in femoropopliteal in-stent restenosis. Well-designed comparative or large registry studies are necessary to provide high quality and long-term data on this technique to provide firm conclusions on the efficacy of Rotarex®S and DCB in ISR in the femoropopliteal area.

Background: Cognitive impairment is a major public health concern in aging populations, and early identification of risk factors is critical. The red blood cell distribution width to albumin ratio (RAR) has emerged as a potential biomarker reflecting inflammatory and nutritional status, but its association with cognitive impairment remains unclear.Objective: This study investigates the relationship between RAR and cognitive impairment in older adults, and explores potential mediating variables that may influence this association.Methods: A total of 2,913 participants aged ≥60 years from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 cycles were analyzed, including 1,291 with cognitive impairment. Logistic regression assessed the association between RAR and cognitive impairment, adjusting for potential confounders such as age, gender, race, education, marital status, weight, height, and comorbidities. Restricted cubic spline (RCS) analysis evaluated the dose-response relationship and identified nonlinear thresholds. Subgroup analyses explored interactions between RAR and demographic/clinical factors. Causal mediation analysis, using a generalized linear model with a probit link and adjusting for age, sex, race, and education, was performed to estimate total, direct, and indirect effects via bootstrap resampling.Results: RAR was positively associated with cognitive impairment (P < 0.05). RCS analysis revealed a nonlinear threshold, with RAR ≥3.2 significantly increasing the risk of cognitive impairment (OR = 1.24, 95% CI: 1.11–1.38, P < 0.001). Subgroup analysis showed significant interactions between RAR and cardiovascular disease (CVD), hypertension, and depression (P for interaction <0.05). Stratified analysis found a stronger association between RAR and cognitive impairment in individuals without hypertension, CVD, or depression. Mediation analysis indicated that CVD (P = 0.036) and depression (P = 0.032) partially mediated the relationship, with CVD explaining 4.49% of the total effect. Hypertension had no significant mediating effect.Conclusion: RAR is significantly associated with cognitive impairment, with a stronger association when RAR ≥3.2. CVD and depression partially mediate this relationship, suggesting RAR as a potential biomarker for cognitive impairment in older adults.

Peripheral artery disease (PAD) caused by atherosclerotic stenosis or occlusion of the arteries of the lower extremities is a major global health concern. Despite advances in endovascular therapies, treating complex lesions such as heavily calcified segments and chronic total occlusions remains challenging, which limits procedural success and long-term patency. The novel 355-nm cold laser atherectomy (CLA) system offers a photochemical, low-thermal approach to plaque ablation, with potential advantages in safety and efficacy. The aim of this study was to evaluate the safety and efficacy of a 355-nm CLA system for treating lower limb atherosclerotic stenosis and occlusion in a prospective, multicenter, randomized controlled trial. This trial enrolled 110 patients with symptomatic lower extremity PAD (Rutherford classes 2-5) and ≥70% stenosis or occlusion. Patients were randomly assigned to the CLA and excimer laser atherectomy (ELA) groups. The primary endpoint was improvement in vessel diameter stenosis (DS%) prior to any adjunctive therapy. Secondary endpoints included primary patency, target lesion revascularization (TLR), Rutherford classification improvement, and ankle-brachial index values at 30 days and 6 months postoperatively, as well as a device-oriented composite endpoint. A total of 109 patients (CLA, n = 58; ELA, n = 51) were included in the analysis. Baseline demographics and comorbidities were well balanced between the groups. Postprocedural DS% improved significantly in both groups, with no significant intergroup differences (CLA, 59.92% ± 15.02%; ELA, 57.52% ± 17.22%; P = 0.438). The mean improvement in DS% (CLA, 34.28%; ELA, 34.35%) met the noninferiority threshold. At 30 days, the primary patency rates were 85.1% (CLA) and 87.8% (ELA), with TLR rates of 0.0% and 1.9%, respectively. At 6 months, patency decreased to 71.7% (CLA) and 61.5% (ELA), and TLR occurred in 6.5% and 10.2% of patients, respectively (P = 0.698). Ankle-brachial index values and Rutherford classification improved similarly in the 2 groups. Subgroup analyses revealed that for TASC (Trans-Atlantic Inter-Society Consensus) C/D and long lesions (≥10 cm), CLA had lower TLR rates at 6 months (P < 0.05), suggesting potential advantages for complex lesions. The 355-nm CLA system showed similar safety and efficacy to the excimer laser, with a trend toward reducing TLR in complex PAD lesions. These findings highlight its potential as a next-generation endovascular tool that could refine revascularization strategies and improve patient outcomes in clinical practice. (DCB for Dialysis Access Stent Graft Restenosis; NCT03360279).

Background and aim: Changes in cognitive function are commonly associated with aging in patients with cardiovascular diseases. The objective of this research was to construct and validate a nomogram-based predictive model for the identification of cognitive impairment in older people suffering from cardiovascular diseases.Methods and results: This retrospective study included 498 participants with cardiovascular diseases aged >60 selected from the NHANES 2011–2014. The study employed the Minor Absolute Shrinkage and Selection Operator (LASSO) regression model, in conjunction with multivariate logistic regression analysis, to identify relevant variables and develop a predictive model. We used statistical techniques as in the Minor Absolute Shrinkage (MAS) and the Selection Operator (LASSO) regression model, in conjunction with multivariate logistic regression analysis, to identify variables that were significantly predictive of the outcome. After which, based on the selected relevant variables, we developed a machine learning model that was predictive of cognitive impairment such as Alzheimer’s diseases in the older people. The effectiveness of the resultant nomogram was evaluated by assessing its discriminative capability, calibration, and conducting decision curve analysis (DCA). The constructed predictive nomogram included age, race, educational attainment, poverty income ratio, and presence of sleep disorder as variables. The model demonstrated robust discriminative capability, achieving an area under the receiver-operating characteristic curve of 0.756, and exhibited precise calibration. Consistent performance was confirmed through 10-fold cross-validation, and DCA deemed the nomogram clinically valuable.Conclusion: We constructed a NHANES cardiovascular-based nomogram predictive model of cognitive impairment. The model exhibited robust discriminative ability and validity, offering a scientific framework for community healthcare providers to assess and detect the risk of cognitive decline in these patients prematurely.