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  • Association between triglyceride-glucose index and gout in young adult

    Association between triglyceride-glucose index and gout in young adult

    Introduction

    Gout is the most common form of inflammatory arthritis, characterized by acute pain, redness, swelling, and increased skin temperature. Recurrent attacks can lead to joint destruction and deformities1 Recent studies indicate a continued rise in global gout prevalence, with approximately 55.8 million affected individuals worldwide and an age-standardized prevalence rate (ASPR) of 659.3 per 100,000.2 In 2019, China had around 16.2 million gout patients, with prevalence rates above the global average and showing an upward trend. By 2029, ASPR in men and women is expected to reach 1170 and 400 per 100,000, respectively.3 Gout prevalence among young adults in China is also concerning, with rates of 1000, 2300, and 3400 per 100,000 in the 18–29, 30–39, and 40–49 age groups, respectively, exceeding those of the same age groups in the United States.3 Among young adults, the primary labor force—gout limits mobility and severely affects productivity,4,5 leading to direct and indirect economic losses of $172 to $6179 per person,6,7 imposing an increasing burden on patients and society. Identifying risk factors for gout in young populations and implementing early prevention strategies hold critical importance.

    The TyG index, calculated from triglyceride and glucose levels, was initially recognized as a novel indicator of insulin resistance (IR).8 In recent years, research has increasingly linked the TyG index to multiple metabolic diseases like coronary heart disease, heart failure, ischemic stroke, and hypertension. Studies have identified the TyG index as an independent risk factor for heart failure and an independent predictor of coronary heart disease severity, adverse outcomes, and all-cause mortality.9–12 Tao et al showed that higher TyG was linked to worse prognosis in hypertension, including increased stroke risk, especially ischemic stroke.13 The data indicate that the TyG index holds promise as a biomarker for disease prognosis and evaluation.

    The pathogenesis of gout is closely linked to metabolic syndrome. Biologically, the TyG index reflects triglyceride-glucose coupling and serves as a validated surrogate of insulin resistance,14,15 a state that can elevate serum urate by reducing renal urate excretion and up-regulating urate transporters such as URAT1 (SLC22A12) and GLUT9 (SLC2A9).16,17 TyG elevation also co-occurs with low HDL-C and systemic inflammation, both implicated in gout susceptibility and activity.18,19 Prior studies have linked TyG to gout in general populations: Cao et al reported that lower TyG was associated with lower gout odds,20 and Li et al suggested TyG may help flag early gout rather than establish prediction or causation.21 However, most TyG-gout studies have focused on general or older populations, and it remains unclear whether those findings apply to young adults.21,22 Compared with older individuals, young adults tend to develop insulin resistance earlier, have shorter exposure to metabolic abnormalities, and exhibit more clustered metabolic risks (eg, central adiposity and dyslipidemia with low HDL-C); these features may modify both the effect size and clinical utility of TyG in this age stratum.23,24 Focusing on this group may therefore refine risk stratification and identify opportunities for earlier preventive strategies. Accordingly, we hypothesized that higher TyG would be independently associated with the presence of gout among young adults.

    Methods

    Study Population

    This retrospective case-control study received approval from the Medical Ethics Committee of Meizhou People’s Hospital (No.: MPH-2024-C-127) and was conducted in full compliance with the Declaration of Helsinki. Written informed consent was obtained from all participants. We consecutively collected data from all patients diagnosed with gout at Meizhou People’s Hospital between 2019 and 2023, designating them as the case group. We obtained all variables from the Meizhou People’s Hospital electronic medical record (EMR) and its linked laboratory information system for 2019–2023. Collected data included complete blood counts, assessments of liver and kidney function, fasting blood glucose, and lipid profile measurements. Inclusion criteria were: (1) diagnosis consistent with the 2015 ACR/EULAR gout classification criteria;25 (2) age ranging from 18 to 44 years. Exclusion criteria included: (1) secondary gout diagnosis; (2) severe conditions such as liver, kidney, and heart diseases, or cancer; (3) missing data. Simultaneously, individuals undergoing routine health examinations at Meizhou People’s Hospital were collected as the control cohort during the same time frame. Data included complete blood counts, liver and kidney function assessments, fasting blood glucose (FBG), and lipid profiles. Inclusion criteria required individuals aged 18–44 years, while exclusion criteria included (1) severe conditions such as liver, kidney, or heart diseases, or cancer, and (2) missing data. Cases and controls were frequency-matched 1:4 on age and sex using SPSS 26.0 (IBM Corp., Armonk, NY, USA).

    Definitions

    In this study, the TyG index is defined as the natural logarithm of the product of fasting triglycerides (TG) and FBG, divided by 2, represented as TyG = ln [fasting TG (mg/dL) * FBG (mg/dL)/2]. The Systemic immune-inflammation index (SII) is determined by the multiplying platelet and neutrophil counts and then dividing by the lymphocyte count, represented as SII = platelets (*109/L) * neutrophils (*109/L) / lymphocytes (*109/L).

    Statistical Analysis

    Statistical analysis was performed utilizing SPSS 26.0 software. The Shapiro–Wilk test was used to assess normality. For normally distributed variables such as age, data were presented as mean ± standard deviation and inter-group comparisons were conducted utilizing the Student’s t-test. Total cholesterol (TC), TyG index, uric acid (UA), TG, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), FBG, creatinine, alanine aminotransferase (ALT), glutamate aminotransferase (AST), white blood cell (WBC) count, lymphocyte count, neutrophil count, platelet count, and the SII did not follow a normal distribution. These variables were presented as medians (interquartile ranges) and compared between groups utilizing the Mann–Whitney U-test. Male sex, history of hypertension, and diabetes history were reported as frequencies (percentages) and compared between groups utilizing the chi-square test. For the multivariable logistic regression analysis, variables were categorized as follows: (1) known factors associated with gout outcomes, including age, hypertension, diabetes, and UA levels; and (2) variables showing P < 0.05 in the univariate regression, including HDL-C, creatinine, ALT, AST, WBC count, and the SII. Since the TyG index is derived from TG and FBG, and SII is calculated from neutrophil, lymphocyte and platelet counts, these individual components were excluded from the multivariate regression model to avoid collinearity. Because sex distribution was highly imbalanced by design (97% male in both groups), sex was handled through restriction/frequency matching and was not entered as a covariate in multivariable models. A multivariable logistic regression model (enter method: simultaneous forced entry of prespecified covariates in one block and retained regardless of univariable significance) was applied to assess the association between the TyG index and the presence of gout in young patients. We assessed multicollinearity among all covariates entered into the multivariable model using variance inflation factors (VIF) and tolerance; VIF < 5 and tolerance > 0.20 were considered acceptable The diagnostic performance of TyG index for gout was assessed using receiver operating characteristic (ROC) analysis. The diagnostic performance of TyG was quantified using the area under the ROC curve (AUC), and the optimal cutoff was determined by maximizing Youden’s J. Spearman’s rank correlation coefficient was utilized to investigate the relationships among the TyG index, UA, WBC, SII, and HDL-C. A P-value below 0.05 was regarded as indicative of statistical significance.

    Results

    Baseline Analysis of Gout and Healthy Control Groups

    From 2,572 gout candidates, 102 with secondary gout and 463 with serious disease were excluded; an additional 1,560 were excluded for missing key variables (ALT, n=321; creatinine, n=389; hypertension/diabetes, n=289; SII, n=219; TyG, n=342), leaving 447 cases. Among 32,920 potential controls, 177 had serious disease and 8,634 had missing data (ALT, n=1,796; creatinine, n=2,125; hypertension/diabetes, n=1,569; SII, n=1,105; TyG, n=2,039), yielding 24,109 eligible controls, from which 1,788 were frequency-matched 1:4 to the cases by age and sex for analysis (Figure 1). Because TyG components were ordered selectively in routine care, TyG missingness may not have been completely at random; thus, potential selection bias is noted. The final analytic sample comprised 2,235 individuals (447 cases and 1,788 controls; mean age 34.5 ± 6.9 years). Males accounted for 97% (2175 individuals). The gout group consisted of 447 patients, averaging 34.6 ± 6.8 years in age, with 435 (97%) being male. The healthy control group included 1788 individuals, averaging 34.6 ± 6.8 years in age, with 1740 (97%) males.

    Figure 1 The flowchart of the study participants.

    At baseline, TG, TC, FBG, creatinine, ALT, AST, WBC count, platelet count, and the SII were notably elevated in the gout group versus the healthy control group. Conversely, individuals with gout exhibited significantly lower levels of HDL-C (P < 0.05). The median TyG index was 4.86 (0.44) in the gout cohort, compared to 4.63 (0.40) in the healthy control group (P < 0.001, Table 1).

    Table 1 Clinical Characteristics of Gout Individuals and Healthy Controls

    Association and discriminative performance of the TyG index (logistic regression and ROC analyses) Univariate logistic regression analysis indicated a significant association between the TyG index and gout (OR = 8.841, 95% CI: 6.379–12.253, P < 0.001); HDL-C was inversely related to gout (OR = 0.061, 95% CI: 0.041–0.091, P < 0.001); and WBC count showed a positive association with gout (OR = 1.694, 95% CI: 1.594–1.799, P < 0.001). Additional factors – including hypertension, diabetes mellitus, UA, creatinine, ALT, AST, WBC count, and the SII – were significantly associated with gout (all P < 0.001, Table 2).

    Table 2 Logistic Regression Analysis Between TyG Index and Gout

    After adjustment for age, hypertension, diabetes mellitus, UA, HDL-C, creatinine, ALT, AST, WBC count, and the SII, multivariate logistic regression analysis identified the TyG index as an independent associated factor for gout among young adults (OR = 2.454, 95% CI: 1.496–4.026, P < 0.001). Other independent associated factors included hypertension (OR = 1.886, 95% CI: 1.053–3.380, P = 0.033), HDL-C (OR = 0.247, 95% CI: 0.145–0.420, P < 0.001), WBC count (OR = 1.222, 95% CI: 1.129–1.324, P < 0.001), creatinine (OR = 1.020, 95% CI: 1.010–1.030, P < 0.001), ALT (OR = 1.012, 95% CI: 1.002–1.019, P = 0.017), UA (OR = 1.006, 95% CI: 1.004–1.007, P < 0.001), and the SII (OR = 1.003, 95% CI: 1.002–1.003, P < 0.001, Table 2). In multivariable models, collinearity checks showed no problematic multicollinearity (all VIFs < 5, all tolerances > 0.20; Table S1).

    We also evaluated the diagnostic performance of TyG in gout using receiver operating characteristic (ROC) analysis. TyG yielded an AUC of 0.709 (95% CI, 0.683–0.736), with an optimal cutoff of 4.735 (sensitivity 0.669; specificity 0.638; Figure 2).

    Figure 2 ROC curve of the TyG index for discriminating gout among young adults.

    Correlation Analysis Between TyG and Clinical Baseline Data

    We performed a correlation analysis to investigate the associations among the TyG index, UA, WBC, SII, and HDL-C. The results revealed that the TyG index exhibited significant positive correlations with UA (r = 0.3393, P < 0.001), WBC (r = 0.3250, P < 0.001), and SII (r = 0.2069, P < 0.001; Figure 3A–C). Conversely, a significant negative correlation was observed between the TyG index and HDL-C (r = −0.4913, P < 0.001, Figure 3D).

    Figure 3 Correlations between the TyG index and clinical variables. (A) TyG vs UA; (B) TyG vs WBC; (C) TyG vs SII; (D) TyG vs HDL-C.

    Discussion

    In this single-center case-control study, young patients with gout at Meizhou People’s Hospital had higher TyG values than controls. In multivariable logistic regression, higher TyG was independently associated with the presence of gout. Beyond association, TyG showed diagnostic value with an AUC of 0.709. TyG correlated positively with UA, WBC, and SII and inversely with HDL-C, supporting its role as a readily available metabolic marker to aid risk stratification and case-finding in young adults.

    A study based on the KNHANES database reported that among gout patients over the age of 19, males accounted for 90.7% (733,915/808,778), with 54.9% having comorbid hypertension (444,290/808,778) and 18.4% having diabetes (149,184/808,778).26 Another study based on the NHANES database found that males comprised 69.4% (504/726) of gout patients, with 73.0% having hypertension (530/726) and 34.7% having diabetes (236/726).16 In our study of 447 young gout patients, 12% had hypertension and 5.2% had diabetes. The mean UA level among young gout patients was 522.25 (217.10) μmol/L. Because the sex distribution was highly imbalanced by design (97% male in both groups), internal comparability was improved. However, this limits generalizability to women; future studies with more balanced sex distributions are warranted. Given that our study focused on young adults aged 18–45, the percentage of gout patients with hypertension and diabetes was relatively lower. Overall, our study population demonstrates a certain level of representativeness.

    In our study, multivariable logistic regression showed that higher TyG was independently associated with the presence of gout (adjusted OR = 2.454). Similarly, NHANES-based analyses in US adults reported an association between higher TyG and prevalent gout, with adjusted ORs ranging from 1.43 to 1.64.14–16 The larger effect size in our young Chinese cohort may reflect differences in age structure and ethnicity. Beyond association, TyG also demonstrated acceptable discriminative performance for case-finding. These results suggest that the TyG-gout association may be stronger in young adults than in the general population, potentially due to (i) population differences between China and the US; (ii) greater work-related stress and irregular schedules in younger individuals;27,28 and (iii) unhealthy dietary patterns, including higher consumption of sugar-sweetened beverages.29,30 While the observed discrimination supports potential case-finding value, prospective work is needed to define actionable thresholds and assess incremental clinical utility.

    The potential connection between the TyG index and gout likely centers around IR, as the TyG index serves as an important marker for this condition. IR is characterized by a diminished response to insulin, influenced by various factors, which leads to compensatory and secondary metabolic adaptations. This condition is frequently associated with metabolic disorders like obesity and metabolic syndrome, both of which are closely linked to gout.31 Natalie McCormick et al found a causal relationship between IR, hyperuricemia (HUA), and gout.32 Sun et al highlighted a bidirectional relationship between IR and HUA.33 There are several theoretical mechanisms linking IR with gout. Yoo et al suggested that HUA observed in gout patients may be due to increased adiposity associated with IR.34 Additionally, research has shown that IR enhances sodium reabsorption in renal tubules, thus reducing UA excretion.35,36 Kottgenet et al proposed that IR elevates serum UA levels by promoting the generation of intermediates, such as pyrophosphate and ribose-5-phosphate, in glycolysis and the pentose phosphate pathway.37 Conversely, elevated UA levels can worsen IR by reducing nitric oxide availability, intensifying mitochondrial oxidative stress, and initiating inflammation through multiple pathways.35,36 Chang JB et al reported that overproduction of uric acid and reactive oxygen species is implicated in IR.38 Further research is required to determine whether additional pathways, beyond those mediated by IR, link the TyG index with gout.

    Interestingly, this study also suggests a potential association between HDL-C levels and the incidence of gout in young adults. A Mendelian randomization study by Yang et al revealed a significant causal link between elevated HDL-C and a reduced risk of gout.39 Another Mendelian randomization study reported that each standard deviation increase in HDL-C was linked to an approximately 25% reduction in gout risk and a reduction in serum UA by 0.09 mg/dL.40 Mendelian randomization analyses suggest a causal link consistent with a protective role of higher HDL-C. Mechanistically, HDL exerts anti-inflammatory and antioxidant actions relevant to gout pathophysiology: experimental work shows that HDL attenuates monosodium urate (MSU) crystal-induced inflammation by limiting leukocyte recruitment and chemokine (eg, CCL2) production in synovial cells and in vivo models; HDL can also dampen crystal-triggered cytokine responses.41,42 In parallel, HDL particles possess inflammasome-modulating and antioxidant capacities (eg, via ApoA-I-dependent signaling and paraoxonase-1 activity), which may reduce oxidative stress and blunt downstream NLRP3 activation central to gout flares.43 Taken together with our data, these observations are consistent with HDL-C acting as an associated protective marker in this cross-sectional design.

    To further characterize the clinical milieu associated with TyG, we conducted a correlation analysis. The findings revealed a positive correlation between the TyG index and UA, which is closely associated with gout.44 Furthermore, the TyG index demonstrated a positive correlation with WBC count and the SII. Yu et al reported higher WBC counts in acute gout compared with remission, while Yi et al observed higher SII in acute gouty arthritis than in healthy controls.45,46 Conversely, the TyG index demonstrated a negative correlation with HDL-C levels. Prior research has indicated that the anti-inflammatory properties of HDL-C are diminished in individuals with gout.47 Therefore, we hypothesized that the TyG index may have a potential association with gout and the precise underlying mechanisms connecting TyG to gout require further investigation.

    The strength of our research: this study included 447 young patients diagnosed with gout over a five-year span, matched by sex and age, with a 1:4 ratio between case and control groups, resulting in 1788 healthy individuals as controls. The study design is robust, enhancing the reliability of the findings. This study represents one of the few investigations exploring the link between the TyG index and gout, specifically within a young Chinese population.

    This study has several limitations. First, case ascertainment and control selection may introduce selection bias: cases were hospital patients, whereas controls were health-checkup attendees who may differ in health-seeking behavior and metabolic profiles. In addition, TyG availability depended on routine test ordering, making missingness unlikely to be completely at random; bias in either direction is possible. We therefore interpret the TyG-gout association with appropriate caution. Second, we did not capture lifestyle and anthropometric variables (eg, BMI/waist circumference, alcohol intake, consumption of purine- or fructose-rich foods, overall diet quality, physical activity). These factors are biologically linked to both TyG and serum urate and may introduce residual confounding. Third, this single-center study -predominantly male (97%)-limits generalizability to women and to other settings or regions. Future work should include multicenter, community-based cohorts and prospective designs to validate thresholds, assess incremental clinical utility, and clarify temporality.

    Conclusion

    Our findings indicate that the TyG index is independently associated with the presence of gout among young adults, tracks a pro-inflammatory/low-HDL milieu, and exhibits moderate discriminative value for case-finding in this demographic. As a routinely available metric, TyG may support clinical risk stratification; further research is needed to establish actionable thresholds, assess incremental clinical utility, and clarify temporality and causal pathways in prospective studies, while interpreting the present results in light of missing TyG data and unmeasured lifestyle factors.

    Abbreviations

    ASPR, age-standardized prevalence rate; IR, insulin resistance; VIF, variance inflation factors; ROC, receiver operating characteristic; AUC, area under the ROC curve; TG, triglycerides; FBG, fasting blood glucose; SII, systemic immune-inflammation index; TC, total cholesterol; UA, uric acid; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; ALT, alanine aminotransferase; AST, glutamate aminotransferase; WBC, white blood cell.

    Data Sharing Statement

    The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

    Ethics Approval and Consent to Participate

    The research presented in this work strictly adheres to the ethical standards outlined in the Declaration of Helsinki as endorsed by the World Medical Association. This study is granted by the Medical Ethics Committee of Meizhou People’s Hospital (No.: MPH-2024-C-127). Written informed consent was obtained from all participants.

    Acknowledgments

    We would like to thank the patients for their valuable participation in this study and the staff of the Department of General Medicine for their unwavering support.

    Author Contributions

    All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

    Funding

    This research was supported by Medical Research Foundation of Guangdong Province (A2023324), State Key Laboratory of Neurology and Oncology Drug Development (SKLSIM-F-202412), Medical and Health Research Project of Meizhou City (2024-B-50).

    Disclosure

    The authors declare no competing interests in this work.

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    41. Scanu A, Oliviero F, Gruaz L, et al. High-density lipoproteins downregulate CCL2 production in human fibroblast-like synoviocytes stimulated by urate crystals. Arthritis Res Ther. 2010;12(1):R23. doi:10.1186/ar2930

    42. Scanu A, Luisetto R, Oliviero F, et al. High-density lipoproteins inhibit urate crystal-induced inflammation in mice. Ann Rheum Dis. 2015;74(3):587–594. doi:10.1136/annrheumdis-2013-203803

    43. Thacker SG, Zarzour A, Chen Y, et al. High-density lipoprotein reduces inflammation from cholesterol crystals by inhibiting inflammasome activation. Immunology. 2016;149(3):306–319. doi:10.1111/imm.12638

    44. Zhang WZ. Uric acid en route to gout. Adv Clin Chem. 2023;116:209–275. doi:10.1016/bs.acc.2023.05.003

    45. Yu H, Xue W, Yu H, Gu H, Qin L, Peng A. Joint application of multiple inflammatory cytokines in diagnosis of gout flare. J Inflamm Res. 2023;16:1771–1782. doi:10.2147/JIR.S408929

    46. Jiang Y, Tu X, Liao X, et al. New inflammatory marker associated with disease activity in gouty arthritis: the systemic inflammatory response index. J Inflamm Res. 2023;16:5565–5573. doi:10.2147/JIR.S432898

    47. Wang Y, Wang Y, Jia X, et al. The anti-inflammatory properties of HDLs are impaired in gout. Clin Rheumatol. 2021;40(4):1525–1531. doi:10.1007/s10067-020-05374-z

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  • Apple iPhone event may lack sparkle, but rumoured iPhone Air likely to spur upgrades

    Apple iPhone event may lack sparkle, but rumoured iPhone Air likely to spur upgrades

    When Apple debuts new iPhones on Tuesday, analysts say its biggest challenge will be to ride out another ho-hum launch as rivals have skated past it in embedding artificial intelligence into their products and services.

    The biggest draw this year could be a rumoured “iPhone Air”, a phone slimmer than what Apple has sold before and taking its name from the company’s slender laptop, MacBook Air.

    Apple would need to iron out how to pack batteries and cameras into a thinner device, analysts said, and seek to price it between the base iPhone 17 models and more expensive Pro models to attract a large number of customers.

    Dipanjan Chatterjee, vice-president and principal analyst at Forrester, said a slimmer iPhone could spur upgrades. “It’s been a while since we have seen any meaningful update to the form factor of the device beyond tepid incremental changes, and the novelty of the Air will likely induce many 14, 15 and even 16 iPhone users to migrate up,” Chatterjee said.

    The slimmer phone could also be a stepping stone towards an iPhone that folds out flat like a book and would act as a platform for an upgraded Siri, neither of which are likely to arrive until next year, analysts said.

    Apple competitors like Samsung have already introduced several generations of foldable phones. Photo: Reuters

    Samsung Electronics is on its seventh generation of folding phones and Alphabet’s Google is on its third, yet Chatterjee estimated they were less than 2 per cent of all phone sales and would not grow beyond 5 per cent “any time soon”.

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  • A study of the correlation between different blood glucose values and

    A study of the correlation between different blood glucose values and

    Introduction

    Diabetes mellitus (DM) is a chronic metabolic disease involving the cochlea, vestibular and balance systems. Type 2 diabetes mellitus (T2DM) is the most common form of diabetes mellitus.1 Because T2DM can lead to nervous system damage, somatosensory impairment, visual impairment and vestibular damage, and then cause abnormal balance function, can lead to the development of sensory complications such as diabetic peripheral neuropathy, diabetic retinopathy, and diabetic vestibulopathy,2,3 and can severely affect patients’ postural control and reduce their ability to balance, often leads to impaired mobility and an increased risk of falls.3–7 The occurrence of falls is related to many factors, but the most important is impaired balance.8 Balance refers to the ability of multiple physiological systems to sense, process and integrate to maintain or restore body stability. It is often divided into static balance and Dynamic equilibrium. It is the most basic factor in preventing falls. Evidence suggests that DM complications have a direct impact on the vestibular system,9 and at the same time, patients with DM damage the sensory systems (vision, proprioception, and vestibular) that are required for balance due to their complications, suggesting that DM complications may have a direct impact on the vestibular system, their fall risk is significantly higher than the general population.8 Long-term glucose metabolic disorders, varying degrees of impairment of DM-related sensory functions (somatosensory, visual, and vestibular nerves) and motor control, followed by impairment of their balance functions,10,11 affect their social participation and quality of life.

    Prediabetes (Pre-DM) is a transitional stage before the onset of DM, an intermediate hyperglycemic state between normoglycemia and DM. According to the 11th edition of the IDF Diabetes Atlas, the global 2024 of adults aged 20–79 with DM is 589 million, of whom 635 million have impaired glucose tolerance and 488 million have impaired fasting glucose (https://diabetesatlas.org/). DM is one of the fastest-growing challenges in global public health in the 21st century, and early intervention of pre-DM can delay or even block T2DM progression, thus understanding, evaluating the balance function status of pre-DM patients, and improving the management of pre-DM patients are important, helps to maintain or improve balance through functional exercise to reduce the risk of falls. Studies have shown that patients with impaired glucose regulation have a reduced ability to balance and maintain postural stability when their proprioception is disturbed, the ability of the vestibular system to maintain postural balance was lower than that of normal subjects.12 However, there are few studies on the static balance function of Pre-DM patients, and the internal relationship has not been further explored. In recent years, digital instruments have been used to quantitatively assess balance function, the main principle being that the characteristics of the body’s center of gravity swing during the test can be recorded through a force platform, which can quantitatively study the postural stability of the subject.13,14 Therefore, this study aimed to apply the Italian Tecnobody Pro-kin252 type balance test system for open/closed eyes and with/without cushion conditions, and to provide a reference for the design of the eye balance test system, to quantitatively evaluate the independent and integrated effects of proprioceptive, visual, and vestibular systems in balance function in Pre-DM patients, to explore the association between blood glucose levels and static balance function in Pre-DM patients, and to provide a theoretical basis for the study of the role of the proprioceptive, visual, and vestibular systems in balance function in Pre-DM patients, developing postural control strategies for Pre-DM patients to reduce fall risk and improve social participation and quality of life in Pre-DM patients.

    Material and Methods

    Study Design and Patient Selection

    This was an observational study of 92 Pre-DM patients 2023 from a Fujian University of Traditional Chinese Medicine Third People’s Hospital between October and February 2024.

    We recruited patients according to the following inclusion and exclusion criteria. Inclusion criteria: (1) adult patients over 18 years of age; and (2) those meeting the Impaired Fasting Glucose (IFG) and/or Impaired Glucose Tolerance (IGT) diagnosis in the Chinese guidelines for Type 2 diabetes prevention and control (2020 edition):15 IFG: 6.1 mmol/L≤Fasting Blood Glucose (FBG) < 7.0 mmol/L, with 2-Hour Postprandial Blood Glucose (2hPG) < 7.8 mmol/L; IGT (Impaired Glucose Tolerance): FBG<7.0 mmol/L, with 7.8 mmol/L≤2hPG<11.1 mmol/L. (3) those who voluntarily participate in the project and sign the informed consent form.

    Exclusion criteria were (1) those with missing case data, unable to cooperate with the research process or who dropped out of the study; (2) persons with endocrine disease other than T2DM; (3) due to drugs, poisoning and other exogenous factors lead to balance dysfunction; (4) patients with hip, knee and ankle diseases, limb defects, or serious musculoskeletal disorders (such as severe kyphosis, severe scoliosis, etc) affecting postural stability; (5) those with severe mental disorders (eg, major depression, mania) or severe cognitive impairment who are unable to complete the assessment; (6) presence of central nervous system disease (eg, Parkinson’s disease) or vestibular or auditory nerve related diseases (eg, vestibular neuritis, acoustic neuroma); (7) persons with sensory/perceptual abnormalities such as Vision/visual field impairment or lateral neglect that affect balance function assessment.

    The study was reviewed and approved by the Institutional Review Board (Medical Ethics Committee of The Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine (Approval No.2023KS-85-1)) and complied with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants.

    Data Acquisition

    Laboratory Parameters

    All subjects were Fujian University of Traditional Chinese Medicine for blood biochemical tests at the laboratory department of the Third People’s Hospital. FBG, Fasting Insulin (FIns), 2hPG, Glycated Hemoglobin A1C (HbA1c), homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Fast for 8 to 10 hours before blood collection.

    Functional Assessment of Static Balance

    The static balance index of the subjects in standing position was tested by the static balance assessment module of the balance feedback training instrument (Italian TECNO-BODY company, model: PK-254 Pro-Kin). Adjust the resistance buffer to 10 gears in advance (static, the ramp does not move). Before the test, the balance panel was reset, and the parameters were adjusted to “Open eyes/close eyes” to evaluate the balance function of the subjects under 4 standing conditions. The order was as follows: T1 Mode: Eyes Open and upright on the rigid balance board, sensory input mainly depends on the combined effect of vision, proprioception and vestibular sense; T2 mode: eyes closed and upright on the rigid balance board, the sensory input mainly depends on proprioception and vestibular sense; T3 mode: Eyes Open and upright on the balance plate with sponge pad, sensory input mainly depends on visual and vestibular sense; T4 Mode: Standing upright with eyes closed on a balance board equipped with a foam pad, where sensory input primarily relies on the vestibular sense. The test is conducted in a quiet, well-lit environment, with detailed instructions for the patient and his or her family.

    The test indicators are as follows: ①X-axis mean Center of Pressure (C.o.P): Trajectory of pressure center movement in the coronal plane. C.o.P refers to the mean distance of pressure center movement; the larger the absolute value of C.o.P, the poorer the balance stability. ②Y-axis C.o.P: Trajectory of pressure center movement in the sagittal plane. ③Area of Movement Ellipse: The area enclosed by the trajectory of body’s center of gravity sway, reflecting the amplitude of center of gravity oscillation. It represents the area of the pressure center movement trajectory; the larger the value, the poorer the balance stability. ④Romberg Ratio: The ratio of trajectory area under upright standing conditions with eyes closed versus eyes open. It reflects the compensatory capacity of vestibular and proprioceptive senses when maintaining posture with visual input removed, as well as the impact of visual feedback on patients’ balance function.

    Statistical Analysis

    In order to carry out our analysis, various methods were used according to the nature of the data: SPSS 26.0 statistical software was used for processing, and the measurement data were expressed as ( ± s) if they conformed to a normal distribution; those who did not conform to a normal distribution, and those who did not conform to a normal distribution, presented as M (IQR). If variables are ordinal or rankable data, meet the requirements of independence and monotonic correlation under study, and are not normally distributed, Spearman’s rank test was used for correlation analysis, and P < 0.05 was considered to be statistically significant.

    Results

    Demographics and Disease Characteristics

    A total of 92 patients were included in this study. Patient Demographics and disease characteristics are summarized in Table 1. The age was 55.01±9.84 years, of which 30 were male and 62 were female. Body Mass Index (BMI) was 23.35±3.27.

    Table 1 Clinical Features and Biochemical Parameters of Patients

    Correlation Between General Population Characteristics and Static Equilibrium Index

    Age showed a positive correlation with the area of movement ellipse under conditions T3 and T4, respectively (P<0.01, P<0.05). Gender was negatively correlated with Y-axis C.o.P under condition T2 (P<0.05). Height exhibited a positive correlation with Y-axis mean C.o.P and the area of movement ellipse under conditions T1 and T2 (P<0.01). Weight showed a positive correlation with the area of movement ellipse under conditions T1 and T2, respectively (P<0.01, P<0.05); BMI was positively correlated with the area of movement ellipse under condition T2 (P<0.05) and negatively correlated with Y-axis mean C.o.P under condition T3 (P<0.01). See Table 2 for details.

    Table 2 Correlation Between General Demographic Characteristics and Static Equilibrium Index

    Correlations Between Glucose Indices, Insulin Resistance, and Static Balance Indices

    HbA1c showed a positive correlation with X-axis Center of Pressure (C.o.P) under conditions T1 and T2 (P<0.05). FIns and HOMA-IR showed a negative correlation with Y-axis C.o.P under condition T3 (P<0.05). No correlation was observed between FBG levels and the aforementioned static balance parameters (P>0.05).2hPG showed a negative correlation with the Romberg ratio for T2/T1 and T4/T3, respectively (P<0.01); it also showed a positive correlation with X-axis C.o.P and the area of the movement ellipse under condition T4 (P<0.01). See Table 3 for details.

    Table 3 Correlation of Glucose Indicators and Insulin Resistance with Static Balance Indicators

    Discussion

    Static balance is the ability of the body to maintain postural stability while at rest.16 The maintenance of postural balance relies on the central nervous system integration of proprioceptive, visual, and vestibular afferent information and the control of effectors.17 Proprioception is formed by the integration of afferent signals from muscles, tendons, joint capsules, ligaments, meniscus, articular cartilage, and cutaneous receptors located around the joint, which are processed in different central nervous systems, efferent activity through reflex responses and tone regulation circuits is clinically important in stabilizing joints, correcting posture, and maintaining balance.18 Vision is the environmental information obtained by processing visual information, so as to know the body’s environment and the specific location of the surrounding objects. The vestibular sense, by perceiving head position and movement, enables the body skeletal muscles to respond and coordinate head movements for adjustments to maintain postural balance.19,20 The Pro-kin252 balance tester mainly uses the electronic moving inclined plate to sense the change of the center of gravity of the human body, and converts the signal into data for quantitative evaluation of human balance function. Therefore, the static balance ability of Pre-DM patients was studied by balance tester.

    There were differences in sensory input to maintain balance in T1, T2, T3 and T4. In T1 condition, the balance was maintained by both vision and proprioception; in T2 condition, the balance was maintained by proprioception and vestibular sense; in T3 condition, the balance was maintained by vision and vestibular sense T4 blocks visual input, interferes with proprioception, and maintains balance mainly by vestibular sense. This study assessed the role of proprioception, vision, and vestibular perception in static balance in Pre-DM patients, respectively, by changing the input conditions of vision or proprioception with and without open and closed eyes and with and without cushions, analysis of the three senses in the static balance of the independent role and relationship.21 Falls are the most common accidental injury in elderly patients with DM in our country, and the decline in static balance is one of the main risk factors for falls in the elderly.22 Studies have shown that older adults with T2DM are 2.73 times more likely to have multiple falls than non-T2DM older adults and are more prone to serious events including reduced mobility, restricted mobility, hospitalization, and death.9,23,24 Balance disorders in patients with DM are mainly related to peripheral neuropathy impairment of proprioceptive function.25,26 Patients with Pre-DM have decreased balance and postural stability in the presence of proprioception interference12.Based on the above research background, this paper is the first to explore the correlation between different blood glucose values and static balance function in Pre-DM patients, it provides clues and data support for the follow-up development of postural management strategies and hypoglycemic exercise programs according to patients’ different blood glucose status.

    In this study, the correlation analysis of general population characteristics and static balance index showed that age was positively correlated with the area of motor ellipse under T3 and T4 conditions, indicating that age is related to vestibular sensation, age was associated with decreased equilibrium stability. Studies have shown that the vestibular system degenerates with age, and older adults are prone to chronic imbalance, decreased mobility, and gait changes.27,28 The older the patient, the worse the reactive balance control, that is, the balance stability also decreased.10 This is consistent with the results of this study. In addition, studies have shown that gender and age can affect balance function, and the range of normal values of each index varies by gender and age of patients29,30, and this study also found a correlation between gender and static balance. Height was positively correlated with the average Y-axis C.o.P and the area of the movement ellipse under both T1 and T2 conditions. This suggests that height appears to be associated with proprioception. The results indicate that taller patients exhibit poorer balance stability, which may necessitate enhanced postural control in the sagittal plane to prevent falls. The findings of this study reveal that body weight was positively correlated with the area of the movement ellipse under T1 and T2 conditions, implying that body weight has a closer association with proprioception. Specifically, individuals with greater body weight demonstrated poorer balance stability. Research has identified body weight as one of the internal factors influencing human balance ability, with body weight showing an inverse relationship with human balance ability, and balance index being inversely proportional to BMI.31,32 Due to the fact that obese individuals often lack exercise and have increased weight burden, this adversely affects both dynamic and static balance functions, thereby impacting fall efficacy.33 BMI was positively correlated with the area of the movement ellipse under T2 conditions and negatively correlated with the Y-axis C.o.P under T3 conditions. This indicates that BMI is associated with proprioception, vision, and vestibular sense, and that higher BMI values correspond to poorer stability, particularly in terms of postural control in the sagittal plane.

    As a more stable indicator of blood glucose control, HbA1c can reflect the average blood glucose level in patients with Pre-DM over the past 2–3 months. Since it is not affected by short-term diet or exercise, it serves to evaluate and monitor long-term blood glucose control. This study found that HbA1c in Pre-DM patients was positively correlated with the X-axis C.o.P under both T1 and T2 conditions, indicating that HbA1c may have a closer association with proprioception. Research has revealed that in patients with DM, the incidence of abnormal balance function increases significantly due to complications such as concurrent neuropathy, retinopathy, and muscle atrophy.34 Among DM patients, the incidence of vestibular function impairment is as high as 70%, while the prevalence of diabetic retinopathy ranges from 24% to 37%;35,36 these conditions impair visual input and ultimately lead to balance dysfunction. Decreased balance ability in patients with type T2DM is characterized primarily by significant declines in vestibular sense and vision.37 Furthermore, the findings of this study also showed that HbA1c in Pre-DM patients was positively correlated with the X-axis C.o.P under T1 and T2 conditions, suggesting an association between HbA1c and postural control ability in the coronal plane. It may thus be possible to reduce the incidence of falls by enhancing coronal plane exercise training in Pre-DM patients.

    FIns, which measures insulin levels in the fasting state, is used to evaluate pancreatic β-cell function and insulin resistance. HOMA-IR, by incorporating both blood glucose and insulin levels, more accurately reflects insulin resistance status and is well suited for assessing long-term insulin sensitivity. At present, there are few studies on FIns, HOMA-IR and static balance in patients with Pre-DM. However, the findings of this study revealed that HOMA-IR and FIns were negatively correlated with the Y-axis C.o.P under T3 conditions. This suggests that in patients at the Pre-DM stage, their vestibular system and visual function may still be in a compensatory phase, allowing them to maintain body balance through adjustments and adaptations—hence the observed negative correlation. Studies have indicated that human activities primarily occur in the anteroposterior direction, and the range of stability limits in this direction is significantly associated with the muscle strength of the ankle plantar flexor muscles. Therefore, incorporating strength training for plantar flexors into balance training for DM patients may help prevent falls.37,38 The results of this study further suggest that HOMA-IR and FIns may be associated with postural control ability in the sagittal plane. Thus, enhancing sagittal plane exercise training in Pre-DM patients could potentially reduce the incidence of falls.

    2hPG is measured during the Oral Glucose Tolerance Test as the blood glucose level 2 hours after oral glucose administration. It is used to assess the body’s glucose metabolism and insulin secretion, and more comprehensively reflects pancreatic β-cell function and insulin sensitivity, and aids in identifying DM and Pre-DM. 2hPG was positively correlated with the X-axis C.o.P and the area of the movement ellipse under T4 conditions, while negatively correlated with the Romberg ratio. This indicates that in Pre-DM patients, 2hPG is associated with vestibular sense, with minimal dependence on vision. This may be attributed to damage to the nerves and blood vessels of the vestibular system caused by fluctuations in insulin levels and blood glucose, leading to vestibular system dysfunction and subsequent impairment of balance function in patients.37 Thus,we speculate that enhancing blood glucose management and implementing targeted exercises for proprioception, vision, and vestibular sense in Pre-DM patients may help improve their static balance function, thereby reducing the risk of falls in this population. Specifically, if HbA1c is poorly controlled in Pre-DM patients, emphasis should be placed on strengthening proprioception and vestibular sense exercises; if there is abnormal FIns secretion in Pre-DM patients, exercises targeting vestibular sense and vision can be reinforced; and for patients with poorly controlled 2hPG, vestibular sense training should be prioritized. Regarding exercise training for Pre-DM patients, since HbA1c and 2hPG in Pre-DM patients are associated with postural control ability in the coronal plane, enhancing coronal plane exercise training is recommended. Additionally, as HOMA-IR and FIns in Pre-DM patients are correlated with postural control ability in the sagittal plane, it is advisable to increase sagittal plane exercise training. Such targeted interventions may be beneficial for improving blood glucose levels and static balance function in Pre-DM patients.

    Conclusion

    The main innovation of our study lies in systematically investigating the relationship between different glycemic parameters and static balance function in Pre-DM patients, further exploring evidence of the association between the two, and thus providing a new perspective for research in this field. The results showed that age was negatively correlated with vision and vestibular sense; height and weight were negatively correlated with proprioception; and BMI was negatively correlated with proprioception, vision, and vestibular sense. Specifically, 2hPG and HbA1c were negatively correlated with vestibular sense and proprioception, respectively; HOMA-IR and FIns were negatively correlated with vestibular sense and vision; while no correlation was observed between FBG and static balance. Proprioception, vestibular sense, and vision play crucial roles in maintaining static balance in Pre-DM patients, providing preliminary clues for further exploration of optimized directions in clinical practice.

    Accordingly, we propose the following: For Pre-DM patients, those with poorly controlled 2hPG or HbA1c may be advised to enhance coronal plane postural control training; those with poorly controlled HOMA-IR or FIns may be recommended to strengthen sagittal plane postural control training. Based on the glycemic control status of Pre-DM patients, formulating appropriate and rational glucose-lowering regimens and conducting targeted training for vestibular sense, proprioception, and vision may, on the one hand, benefit their glycemic levels and static balance ability, help prevent falls, and reduce the incidence of fall-related adverse events. On the other hand, enhancing static balance training may stabilize blood glucose levels in Pre-DM patients and delay disease progression.

    Although this study obtained preliminary findings through cross-sectional analysis, it has limitations: the current conclusions are based solely on correlation analysis, and causal relationships have not yet been verified. In future studies, we plan to expand the sample size, broaden research dimensions, and further systematically investigate the association patterns between different glycemic levels and balance function in Pre-DM patients. Meanwhile, through interventional or prospective experimental designs, we will conduct standardized exploration of the potential impact of balance function training on glycemic management, aiming to provide more valuable preliminary research evidence for fall prevention. Its clinical practical value remains to be verified in subsequent studies.

    Acknowledgments

    We thank the nurses and doctors who assisted in this study. We thank the Third People’s Hospital affiliated to the Fujian University of Traditional Chinese Medicine for the clinical data.

    Funding

    This study was National Administration of Traditional Chinese Medicine (NATCM) Fifth Batch National Clinical Excellence Talent Cultivation Program (No. [2022]1); National Administration of Traditional Chinese Medicine (NATCM) High-Level Key Discipline Construction Project in Traditional Chinese Medicine (Document No. [2023]85); National Traditional Chinese Medicine Advantageous Specialties Construction Project (Document No.Guozhongyiyi Zheng Han [2024] No.90); Fujian Provincial Traditional Chinese Medicine Clinical Medical Research Center for Glucose and Lipid Metabolism Disorders (No. FJSSK [2023]3); Project supported by the Natural Science Foundation of Fujian Province, China (No. 2025J01955); Fujian Provincial Traditional Chinese Medicine Science and Technology Project Funding Program (No. 2025YBA033); Joint Open Research Project between the Discipline of TCM Health Management of Fujian University of Traditional Chinese Medicine and the Key Specialty of Its Affiliated Third People’s Hospital (under the High-Level Key Discipline of Traditional Chinese Medicine-TCM Health Management) (No. XJG2023001). Funding agencies had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, the preparation, review, and approval of the manuscript, and the decision to submit the manuscript for publication.

    Disclosure

    The authors state that there is no competing interest in this work.

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    30. Xu BH, Xie B, Huang YX. Study on influencing factors of static balance posture graph in normal adults. Chinese Journal of Physical Medicine and Rehabilitation. 2003;2003(6):22–25.

    31. Yuan MZ. Effects of obesity on balance ability in young adults. Journal of Military Physical Education and Sports College. 2011;30(4):106–108.

    32. Huang SQ, Xu YH, Yin LH. Analysis of differences in balance ability and body mass index among men and women of different ages: a study of 414 cases. Shandong Sports Science & Technology. 2016;38(2):52–55.

    33. Zhang Y, Wang ZH, Shao MN, et al. Research on the effects of overweight and obesity on static and dynamic balance ability in middle-aged and elderly adults[A]//Sports Biomechanics Branch of Chinese Sports Science Society. Abstracts of the 20th National Academic Conference on Sports Biomechanics[C]. Beijing: Sports Biomechanics Branch of Chinese Sports Science Society, 2018: 2.

    34. Brown SJ, Handsaker JC, Bowling FL, et al. Diabetic peripheral neuropathy compromises balance during daily activities. Diabetes Care. 2015;38(6):1116–1122. doi:10.2337/dc14-1982

    35. Agrawal Y, Carey JP, Della Santina CC, et al. Disorders of balance and vestibular function in US adults: data from the national health and nutrition examination survey, 2001-2004. Arch Intern Med. 2009;169(10):938. doi:10.1001/archinternmed.2009.66

    36. Diabetes Prevention Program Research Group. The prevalence of retinopathy in impaired glucose tolerance and recent-onset diabetes in the Diabetes Prevention Program. Diabet Med. 2007;24(2):137–144. doi:10.1111/j.1464-5491.2007.02043.x

    37. Huang XB, Liu B, Sun JW, et al. Analysis and evaluation of balance function in patients with type 2 diabetes mellitus. Journal of Clinical Otorhinolaryngology Head and Neck Surgery. 2016;2016(1):27–30.

    38. Melzer I, Benjuya N, Kaplanski J, et al. Association between ankle muscle strength and limit of stability in older adults. Age Ageing. 2009;38(1):119–123. doi:10.1093/ageing/afn249

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  • Commercial shipping likely cut Red Sea cables that disrupted internet access, experts say – The Washington Post

    1. Commercial shipping likely cut Red Sea cables that disrupted internet access, experts say  The Washington Post
    2. Microsoft cloud services disrupted by Red Sea cable cuts  BBC
    3. Undersea cables cut in the Red Sea, disrupting internet access in Asia and the Mideast  AP News
    4. UAE internet users report outages; e& and du say ‘working to resolve the issue’  Khaleej Times
    5. Internet disruptions in Middle East and South Asia after Red Sea cable cuts  Al Jazeera

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  • Nepal rolls back social media ban after deadly protests rock capital | Nepal

    Nepal rolls back social media ban after deadly protests rock capital | Nepal

    Nepal’s government has lifted its ban on 26 prominent social media apps and messaging services after at least 19 people were killed and more than 100 injured in clashes on Monday.

    The country’s communication and information minister announced the ban would be rolled back hours after demonstrators protesting against the block surged towards the parliament complex in the capital, Kathmandu.

    “We have withdrawn the shutdown of the social media. They are working now,” said the communications minister, Prithvi Subba Gurung.

    Thousands of young Nepalese have in recent days joined “Gen Z” protests, which they say reflect their frustration with the ban and the government’s perceived lack of action to tackle corruption and boost economic opportunities.

    “We are protesting against corruption that has been institutionalised in Nepal,” student Yujan Rajbhandari, 24, said.

    In Kathmandu protesters barged into the parliament complex on Monday, breaking through a barricade and setting fire to an ambulance. Police used water cannons, batons and rubber bullets to control the crowd, while the army was deployed and a curfew imposed in the capital.

    Demonstrators gather outside Nepal’s parliament during a protest in Kathmandu on Monday. Photograph: Prabin Ranabhat/AFP/Getty Images

    Amnesty International said live ammunition was used and had resulted in deaths and serious injuries of several protesters. “The law enforcement agencies must only use force where absolutely necessary and it must be strictly proportionate to the legitimate aim sought to be achieved,” Amnesty said in a statement.

    The prime minister, KP Sharma Oli, said he was saddened by the incidents of violence due to the “infiltration from different selfish centres”.

    The government had formed a committee to investigate the violence and would pay relief for the families of the dead and provide free treatment for the injured people, he added.

    Protesters carried placards with slogans such as “Shut down corruption and not social media”, “Unban social media” and “Youths against corruption”.

    Student Ikshama Tumrok, 20, said she was protesting the “authoritarian attitude” of the government.

    Many displayed a flag from Japanese manga series One Piece, symbolic of criticism against declining democratic freedoms – also used recently in Indonesia.

    Nepal’s government said last month that social media firms would be given seven days to register under new regulations, including to establish a point of contact and designate resident grievance and compliance officers.

    Meta’s Facebook, Instagram and WhatsApp, Alphabet’s YouTube, China’s Tencent and Snapchat, Pinterest and X all missed the deadline and were subsequently blocked.

    The government has said social media users make fake IDs and use them to spread hate speech and fake news, commit fraud and other crimes on these platforms.

    Popular online platforms had previously been blocked, including the Telegram messaging app in July. Last year the government lifted a nine-month ban on TikTok in August after the platform agreed to comply with Nepali regulations.

    With Reuters and Agence France-Presse

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  • Billy Porter recovering from ‘serious case of sepsis’ as Broadway show closes early | Billy Porter

    Billy Porter recovering from ‘serious case of sepsis’ as Broadway show closes early | Billy Porter

    Billy Porter is “recovering from a serious case of sepsis”, forcing the early closure of Broadway’s revival of Cabaret in which he played a leading role.

    The show’s producers announced on Sunday that Porter “is recovering from a serious case of sepsis” that will prevent him from returning to the stage.

    “His doctors are confident that he will make a full recovery,” they added, “but have advised him to maintain a restful schedule these next couple of weeks”.

    Porter has yet to issue a statement on his health.

    The 55-year-old actor had been playing the role of Emcee since July, when he and Marisha Wallace took over from Orville Peck and Eva Noblezada as Emcee and Sally Bowles respectively. The same production of Cabaret is still being staged in London, where it swept the 2022 Olivier awards with Eddie Redmayne and Jessie Buckley in the leading roles. Porter and Wallace also appeared in the West End production.

    Despite acclaim, ticket sales for the Broadway production have declined recently, with the New York Times reporting that the show’s weekly grosses peaked at $2m in May 2024, but dropped to $505,142 by the end of August 2025. The show will now close at a loss on 21 September, rather than 19 October.

    Producer Adam Speers said it was a “painful decision” to end the show’s Broadway run.

    “Billy was an extraordinary Emcee, bringing his signature passion and remarkable talent. We wish Billy a speedy recovery and I look forward to working with him again in the very near future,” he said.

    The Broadway production’s two alternates for Emcee, Marty Lauter and David Merino, will share the role for the final performances.

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  • Smart material delivers drugs in response to arthritis flare-ups

    Smart material delivers drugs in response to arthritis flare-ups

    Researchers have developed a material that can sense tiny changes within the body, such as during an arthritis flare-up, and release drugs exactly where and when they are needed.

    The squishy material can be loaded with anti-inflammatory drugs that are released in response to small changes in pH in the body. During an arthritis flare-up, a joint becomes inflamed and slightly more acidic than the surrounding tissue.

    The material, developed by researchers at the University of Cambridge, has been designed to respond to this natural change in pH. As acidity increases, the material becomes softer and more jelly-like, triggering the release of drug molecules that can be encapsulated within its structure.

    Since the material is designed to respond only within a narrow pH range, the team say that drugs could be released precisely where and when they are needed, potentially reducing side effects.

    If used as an artificial cartilage in arthritic joints, this approach could allow for the continuous treatment of arthritis, improving the efficacy of drugs to relieve pain and fight inflammation. Arthritis affects more than 10 million people in the UK, costing the NHS an estimated £10.2 billion annually. Worldwide it is estimated to affect over 600 million people.

    While extensive clinical trials are needed before the material can be used in patients, the researchers say their approach could improve outcomes for people with arthritis, and for those with other conditions including cancer. Their results are reported in the Journal of the American Chemical Society.

    The material developed by the Cambridge team uses specially engineered and reversible crosslinks within a polymer network. The sensitivity of these links to changes in acidity levels gives the material highly responsive mechanical properties.

    The material was developed in Professor Oren Scherman’s research group in Cambridge’s Yusuf Hamied Department of Chemistry. The group specialises in designing and building these unique materials for a range of potential applications.

    “For a while now, we’ve been interested in using these materials in joints, since their properties can mimic those of cartilage,” said Scherman, who is Professor of Supramolecular and Polymer Chemistry and Director of the Melville Laboratory for Polymer Synthesis. “But to combine that with highly targeted drug delivery is a really exciting prospect.”

    “These materials can ‘sense’ when something is wrong in the body and respond by delivering treatment right where it’s needed,” said first author Dr Stephen O’Neill. “This could reduce the need for repeated doses of drugs, while improving patient quality of life.”

    Unlike many drug delivery systems that require external triggers such as heat or light, this one is powered by the body’s own chemistry. The researchers say this could pave the way for longer-lasting, targeted arthritis treatments that automatically respond to flare-ups, boosting effectiveness while reducing harmful side effects.

    In laboratory tests, researchers loaded the material with a fluorescent dye to mimic how a real drug might behave. They found that at acidity levels typical of an arthritic joint, the material released substantially more drug cargo compared with normal, healthy pH levels.

    “By tuning the chemistry of these gels, we can make them highly sensitive to the subtle shifts in acidity that occur in inflamed tissue,” said co-author Dr Jade McCune. “That means drugs are released when and where they are needed most.”

    The researchers say the approach could be tailored to a range of medical conditions, by fine-tuning the chemistry of the material. “It’s a highly flexible approach, so we could in theory incorporate both fast-acting and slow-acting drugs, and have a single treatment that lasts for days, weeks or even months,” said O’Neill.

    The team’s next steps will involve testing the materials in living systems to evaluate their performance and safety in a physiological environment. The team say that if successful, their approach could open the door to a new generation of responsive biomaterials capable of treating chronic diseases with greater precision.

    The research was supported by the European Research Council and the Engineering and Physical Sciences Research Council (EPSRC), part of UK Research and Innovation (UKRI). Oren Scherman is a Fellow of Jesus College, Cambridge.

    Source:

    Journal reference:

    O’Neill, S. J. K., et al. (2025) Kinetic Locking of pH-Sensitive Complexes for Mechanically Responsive Polymer Networks. Journal of the American Chemical Society. doi.org/10.1021/jacs.5c09897

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  • Rupert Murdoch seals deal passing control of media empire to eldest son | Media News

    Rupert Murdoch seals deal passing control of media empire to eldest son | Media News

    Legal settlement ensures Lachlan Murdoch will take control of sprawling media portfolio after 94-year-old mogul’s death.

    Rupert Murdoch’s family has reached a deal to end the years-long succession battle over the mogul’s media empire.

    The deal, announced by News Corp on Monday, will see eldest son Lachlan Murdoch take control of a sprawling media portfolio that includes Fox News, The Wall Street Journal, The New York Post, and The Times.

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    The agreement helps ensure that Murdoch’s media properties will retain their conservative bent long after the 94-year-old patriarch’s death.

    Under the settlement, Lachlan, who is widely viewed as more aligned with his father’s conservative views than his siblings, and his two younger sisters, Grace and Chloe, will be beneficiaries of a new family trust that has a controlling stake in Fox Corporation and News Corp.

    The deal stipulates that the trust will be in place until 2050.

    Voting rights will rest “solely” with Lachlan, 54, who has served as chairman of News Corp and CEO of Fox since his father stepped down from the day-to-day running of the businesses in 2023.

    Lachlan’s three oldest siblings, James, Elizabeth and Prudence, will relinquish their stakes in an existing family trust, receiving an equal split of the equity sales.

    Under the deal, the three elder siblings will be subject to a “long-term standstill agreement” barring them from acquiring shares of News Corp and Fox Corporation and “taking certain other actions with respect to the companies”.

    US media estimated the payout for the three siblings at about $3.3bn.

    “News Corp’s board of directors welcomes these developments and believes that the leadership, vision and management by the Company’s Chair, Lachlan Murdoch, will continue to be important to guiding the Company’s strategy and success,” News Corp said in a statement.

    The settlement caps a saga that has captivated political and media circles, and drawn comparisons with the plot of HBO’s award-winning drama Succession.

    “Rupert Murdoch has built his reputation on being aggressive in securing what he wants, and he wanted Lachlan Murdoch to control both Fox Corp and News Corp,” Lynne Vincent, an associate professor of management at Syracuse University’s Whitman School of Management, told Al Jazeera.

    “Not surprisingly, that is what is going to happen. Rupert Murdoch is very effective at getting what he wants.”

    Vincent said Lachlan Murdoch’s control of the media portfolio would ensure “business as usual” at the outlets.

    “From what we know, Lachlan Murdoch’s views and values are very similar to Rupert Murdoch’s,” she said.

    “From an organisational perspective, this provides Fox Corp and News Corp with a sense of stability, which might be appealing to some stakeholders.”

    Andrew Dodd, director of the Centre for Advancing Journalism at the University of Melbourne, called the settlement “bad news” for media diversity and pluralism.

    “This ensures the respective news outlets remain right wing and reactionary and will probably continue to be driven by the same sorts of agendas that have consumed Rupert over the last five decades,” Dodd told Al Jazeera.

    The legal fight over Rupert Murdoch’s succession plans erupted in 2023, when the Australian-born mogul sought to change the structure of the family trust to give full control of his companies to Lachlan after his death.

    James, Elizabeth and Prudence, who stood to inherit equal control of the companies along with Lachlan, took their father to court to block the bid.

    In December, a probate court in the US state of Nevada ruled against the attempt to change the trust, describing it as a “carefully crafted charade” designed to “permanently cement” Lachlan Murdoch’s control.

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  • Popular weight-loss medications raise pregnancy safety concerns for women

    Popular weight-loss medications raise pregnancy safety concerns for women

    Women taking popular weight-loss medications during their reproductive years may be unaware of associated risks to pregnancy and unborn babies, warn Flinders University researchers. 

    A new study has revealed that most Australian women of reproductive age prescribed GLP-1 receptor agonists-medications increasingly used for weight loss such as Ozempic-are not using effective contraception, despite known risks during pregnancy. 

    Published in the Medical Journal of Australia, the research analyzed data from over 1.6 million women aged 18 to 49 who attended general practices between 2011 and 2022. Of the 18,010 women who were first prescribed GLP-1 receptor agonists during that time, only 21% had reported using contraception. 

    Originally developed to manage type 2 diabetes, GLP-1 receptor agonists have gained popularity for their appetite-suppressing and weight-loss effects, with the study finding that most prescriptions are now issued to women without diabetes. 

    Lead author and pharmacist, Associate Professor Luke Grzeskowiak, says that in 2022 alone, more than 6,000 women began treatment on GLP-1s, and over 90% of those did not have a diabetes diagnosis. 

    We’re seeing widespread use of these medications among women of childbearing age, but very little evidence that contraception is being considered as part of routine care.


    These medications can be incredibly helpful, but they’re not risk-free, especially during pregnancy.” 


    Luke Grzeskowiak, Associate Professor, College of Medicine and Public Health, Flinders University

    The study found that 2.2% of women became pregnant within six months of starting GLP-1 treatment with pregnancy rates highest among younger women with diabetes, and among women without diabetes in their early thirties. 

    Women with polycystic ovary syndrome were twice as likely to conceive, suggesting that weight loss may improve fertility, even when unintended. 

    Importantly, women who were using contraception at the time of prescribing had a significantly lower risk of pregnancy. 

    A previous review of animal studies from the University of Amsterdam linked GLP-1 exposure during pregnancy to reduced foetal growth and skeletal abnormalities, and while human data is limited, the potential risks remain concerning.

    “Whilst the UK advises that women using GLP-1 receptor agonists should avoid pregnancy and use effective contraception, this advice is not being followed consistently in Australian clinical practice,” says Associate Professor Grzeskowiak.

    “We need to ensure that reproductive health is part of every conversation when these drugs are prescribed to any women of childbearing age. 

    “It is also vitally important that we have clearer practice recommendations and guidelines for those prescribing GLP-1s to women to ensure their safe and effective use. 

    “Our advice is to speak to your GP about the risks and benefits of GLP-1 medicines before taking them, and only take those prescribed by a healthcare professional.” 

    The authors say that further studies evaluating the impact of these medications on pregnancy and unborn babies are warranted. 

    Source:

    Journal reference:

    Thapaliya, K., et al. (2025). Incidence of GLP‐1 receptor agonist use by women of reproductive age attending general practices in Australia, 2011–2022: a retrospective open cohort study. The Medical Journal of Australia. doi.org/10.5694/mja2.70026

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  • WWE Raw results, highlights (Sept. 8): AJ Lee reintroduces herself, Wrestlepalooza return match set

    WWE Raw results, highlights (Sept. 8): AJ Lee reintroduces herself, Wrestlepalooza return match set

    WWE has managed to do a great job of masking the absence of Undisputed WWE Champion Cody Rhodes as it tours through the Midwest after Clash in Paris. Monday’s latest “Raw” in Milwaukee continued to progress towards a stacked inaugural Wrestlepalooza event that has a lot to like on it, including the in-ring return of an underrated all-time great.

    “Hello, my name is AJ Lee”

    OK. So AJ Lee’s first promo back in a WWE ring after a decade was all one needed to see to know why she was the fan-favorite she was. This woman is magnetic, she is a natural, and man, does she have “it.”

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    Lee spoke directly to us who missed her career, introducing herself. Admittedly, her promo work may have felt extra authentic and special because that’s exactly what it was. This was April Mendez speaking from the heart, sharing her experiences and why she retired 10 years ago. She even managed to do the unfathomable and elicited a “therapy” chant after mentioning her mental health battles. It was a tremendous return to form, and I’m so curious to see how her first match goes.

    Speaking of which, it wasn’t long until her enemies Becky Lynch and Seth Rollins arrived to try and reclaim Lynch’s stolen Intercontinental crown.

    Lynch emerged first, wearing the most ridiculous sunglasses of all time to hide the black eye Lee gave her on “SmackDown.” She played the hypocrite role perfectly, claiming CM Punk was hiding behind his wife, as Punk said Rollins was in their previous interactions. Lynch, like Lee, said she’ll need therapy after the segment, garnering more chants. We all love some good therapy time.

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    “It works, I swear. It’s wonderful. I have some names I can give you,” Lee responded.

    This whole thing culminated with Lee’s ultimatum, telling Lynch to come fight her for the belt or accept her challenge to a mixed tag team match at Wrestlepalooza. Rollins wound up agreeing to the latter for the couple after Punk snuck up on them for a near-GTS.

    There we go, folks. The Lee comeback tour officially carries on, and this feels like one of the freshest returns WWE has arguably ever had.

    ❤️‍🩹 Reunion of the Night

    The Usos are officially back together and set to take on The Vision at Wrestlepalooza. The twins kicked off “Raw” with the usual show opener promo, but thankfully, it didn’t run overly long, as they were quickly interrupted by their rivals. The segment dissolved into a brawl when LA Knight attacked Bron Breakker from behind, but that was far from the highlight.

    It’s wild how much Jimmy Uso outshone his brother Jey on the mic tonight. He already demonstrated his excellence in that build to Jey’s WrestleMania match against Gunther. The dude’s delivery was just so much cleaner and natural-sounding. It probably helps that he wasn’t winded once he entered the ring, but ultimately, it makes you wonder how he performed in his world title run in an alternate universe.

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    I’m not sure I’d go so far as to say I wish that had happened instead of Jey overall, but if I had to choose between the two, I might say so.

    Overall, it’s great to see The Usos back together, as they are needed in the “Raw” tag team division. However, this might not be a permanent reunion, considering they made their entrance with every bit of Jey’s theme.

    Before the night ended, we even saw some friction between the brothers, as Jey (seemingly) left the arena early, asking Jimmy why he’d stick around to help Knight in his match against Bronson Reed. Jimmy even said his brother is starting to sound like Roman Reigns. If these two end up rematching, that would be a brutally misguided route to take.

    😴 Goodknight

    As mentioned, the opening segment set up the main event, as is the standard formula in WWE. The stunning stretch of no DQ finishes continued, but at the expense of Knight, who lost “cleanly” again. I’m unsure what WWE is doing with the “Megastar,” as his character development is moving in the right direction, but he’s now taking pins left and right — this time after being distracted by Breakker.

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    The match was fine, but all of The Vision stuff, particularly with the “Brons” is feeling so uninspired. It doesn’t help that they’re now separated from Rollins with Paul Heyman kayfabe injured.

    The bigger picture angle revolved around The Usos, as they saved Knight from the expected post-match beatdown. The Vision maintained their control, beating everyone down until Knight grabbed a chair and took a spear from Jey. It very much felt like a heel turn that Jimmy wasn’t happy about, almost like WWE is trying to replicate a bit of the dynamic Adam Copeland (Edge) and Christian Cage have over in AEW. That very clear heel-face tag team who have such a deep connection that they get along and love each other regardless. That’s another interesting possible route to go down, but Knight, like Penta, needs some sort of serious change, and he deserves one more than anyone right now.

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    👍 MONDAY NIGHT MONEY 👍

    1. Breakker has slowly started to morph more into a loose cannon Steiner rather than the brainless henchman he was at the start of The Vision’s angle, and it’s quite entertaining.

    2. Asuka beat Nikki Bella clean with the Asuka Lock. This was a better match and performance for Bella than in her title shot against Lynch, so good on her. Asuka, however, was the real star, as she’s just so, so good as this overprotective heel. At one point, she even used Kairi Sane as a shield on the outside of the ring, which was more clever than it was a heel tactic, but it’s all good fun.

    🤷 IT HAPPENED 🤷

    1. AJ Styles defeated El Grande “Amerikaiser” with the Styles Clash after shenanigan interferences from Dragon Lee and another masked dude. The match was fine for what it was, but what is happening here? Who is this for at this point? That also might have been the first singles loss for the Americano character since it started with Chad Gable.

    More interestingly, Styles cut a very, very interesting promo during the Netflix commercial. The timing of this feels intentional, considering all the Styles free agency reports afloat.

    2. Penta needs help. After the former AEW Tag Team champion hilariously questioned Adam Pearce’s love (literally), he landed a match against Rusev and lost. Losing to Rusev is nothing to be ashamed of, and Rusev should keep winning. But Penta desperately needs some wins, and he looked like a bozo out there getting distracted by The New Day, who came out for no other reason than to try and mask a burial in the making.

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    The Penta-New Day “feud” is boring and should not continue — unless, like The Usos, The Lucha Bros reunite. We haven’t seen Rey Fenix on “SmackDown” lately, after all.

    👎 RAW DEAL 👎

    1. Joe Tessitore replaced Michael Cole on this “Raw,” and he seriously has to tone it down, man. I appreciate enthusiasm, but the number of times he loses his mind to oversell a move or sequence is insane. See the Styles match finish, for example.

    2. To cap off the Asuka-Bella saga on this show, Rhea Ripley came to Bella’s aid backstage when tensions thickened. From that awesome, building duo of Ripley and Iyo Sky to Ripley and Bella, huh? Talk about one hell of a downgrade, as Ripley wanders aimlessly through the division after her world title matches. Naomi’s pregnancy butchered several immediate directions for some of these wrestlers. Stephanie Vaquer has yet to be seen since her Sky title match was made official.

    👑 Uncrowned Gem of the Night 👑

    Lyra Valkyria and Raquel Rodriguez had something to prove tonight. It’s not that I had low expectations; I simply didn’t think much of this match’s announcement. It had also been a while since we’d seen a Valkyria match, so shame on me.

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    These two are great against anyone. Put them together, and they deliver an absolute must-see banger. Rodriguez scored a big, surprising, much-needed win with a counter Tejana Bomb off the top rope. (Clean!) Roxanne Perez made a brief (typical) interference attempt, but it wasn’t a part of the finish.

    This is another reminder that Rodriguez needs to go back on a singles run and get some proper respect. She’s excellent, and this makes me hope for another pairing with Valkyria at some point. In the meantime, it appears Valkyria isn’t done with Bayley, as her old frenemy delivered another great psycho vignette. Before that, Valkyria will have to face Rodriguez’s other Judgment Day half, Perez, next week.

    👑 I give this show a Crown score of: 7.5/10. 👑

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