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  • This shark can change color — thanks to hidden nano mirrors in its skin

    This shark can change color — thanks to hidden nano mirrors in its skin

    New research into the anatomy of blue sharks (Prionace glauca) reveals a unique nanostructure in their skin that produces their iconic blue coloration, but intriguingly, also suggests a potential capacity for color change.

    “Blue is one of the rarest colors in the animal kingdom, and animals have developed a variety of unique strategies through evolution to produce it, making these processes especially fascinating,” says Dr Viktoriia Kamska, a post-doctoral researcher in the lab of Professor Mason Dean at City University of Hong Kong.

    The team revealed that the secret to the shark’s color lies in the pulp cavities of the tooth-like scales — known as dermal denticles — that armor the shark’s skin. The key features of this color-producing mechanism inside the pulp cavity are guanine crystals, which act as blue reflectors, alongside melanin-containing vesicles called melanosomes, which act as absorbers of other wavelengths. “These components are packed into separate cells, reminiscent of bags filled with mirrors and bags with black absorbers, but kept in close association so they work together,” explains Dr. Kamska. As a result, a pigment (melanin) collaborates with a structured material (guanine platelets of specific thickness and spacing) to enhance color saturation.

    “When you combine these materials together, you also create a powerful ability to produce and change color,” says Professor Dean. “What’s fascinating is that we can observe tiny changes in the cells containing the crystals and see and model how they influence the color of the whole organism.”

    This anatomical breakthrough was made possible using a mixture of fine-scale dissection, optical microscopy, electron microscopy, spectroscopy, and a suite of other imaging techniques to characterize the form, function, and architectural arrangements of the color-producing nanostructures. “We started looking at color at the organismal level, on the scale of meters and centimeters, but structural color is achieved at the nanometer scale, so we have to use a range of different approaches,” says Professor Dean.

    Identifying the likely nanoscale culprits behind the shark’s blue color was only part of the equation. Dr Kamska and her collaborators also used computational simulations to confirm which architectural parameters of these nanostructures are responsible for producing the specific wavelengths of the observed spectral appearance. “It’s challenging to manually manipulate structures at such a small scale, so these simulations are incredibly useful for understanding what color palette is available,” says Dr Kamska.

    The discovery also reveals that the shark’s trademark color is potentially mutable through tiny changes in the relative distances between layers of guanine crystals within the denticle pulp cavities. Whereas narrower spaces between layers create the iconic blues, increasing this space shifts the color into greens and golds.

    Dr Kamska and her team have demonstrated that this structural mechanism of color change could be driven by environmental factors that affect guanine platelet spacing. “In this way, very fine scale alterations resulting from something as simple as humidity or water pressure changes could alter body color, that then shape how the animal camouflages or counter-shades in its natural environment,” says Professor Dean.

    For example, the deeper a shark swims, the more pressure that their skin is subjected to, and the tighter the guanine crystals would likely be pushed together — which should darken the shark’s color to better suit its surroundings. “The next step is to see how this mechanism really functions in sharks living in their natural environment,” says Dr Kamska.

    While this research provides important new insights into shark anatomy and evolution, it also has a strong potential for bio-inspired engineering applications. “Not only do these denticles provide sharks with hydrodynamic and antifouling benefits, but we’ve now found that they also have a role in producing and maybe changing color too,” says Professor Dean. “Such a multi-functional structural design — a marine surface combining features for high-speed hydrodynamics and camouflaging optics — as far as we know, hasn’t been seen before.”

    Therefore, this discovery could have implications for improving environmental sustainability within the manufacturing industry. “A major benefit of structural coloration over chemical coloration is that it reduces the toxicity of materials and reduces environmental pollution,” says Dr Kamska. “Structural color is a tool that could help a lot, especially in marine environments, where dynamic blue camouflage would be useful.”

    “As nanofabrication tools get better, this creates a playground to study how structures lead to new functions,” says Professor Dean. “We know a lot about how other fishes make colors, but sharks and rays diverged from bony fishes hundreds of millions of years ago – so this represents a completely different evolutionary path for making color.”

    This research, funded by Hong Kong’s University Grants Committee, General Research Fund, is being presented at the Society for Experimental Biology Annual Conference in Antwerp, Belgium on July 9th, 2025.

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  • Gunmen in Pakistan kidnap, kill nine bus passengers, officials say | News

    Gunmen in Pakistan kidnap, kill nine bus passengers, officials say | News

    Separatist Baloch fighters have in past claimed responsibility for attacks in the southwestern Balochistan province.

    Nine bus passengers have been killed after gunmen kidnapped them in Pakistan’s restive southwestern Balochistan province, officials have said.

    The passengers were taken from several buses on Thursday evening, the provincial government spokesman, Shahid Rind, said on Friday.

    The bus was travelling from Balochistan to the central region of Punjab. It is thought the travellers were targeted due to their Punjabi ethnicity, officials said.

    The bodies of the victims, riddled with bullet wounds, were found in the mountains overnight, another government official, Naveed Alam, said.

    Prime Minister Shehbaz Sharif and Interior Minister Mohsin Naqvi confirmed the incident and strongly condemned the killings. “The blood of innocent people will be avenged. The killing of innocent citizens is an open act of terrorism by India-sponsored terrorists,” Sharif said.

    There was no immediate reaction from India to his statement. No one has yet claimed responsibility for the attack.

    The Balochistan Liberation Army (BLA), separatist Baloch fighters, have in the past been involved in such incidents, killing passengers after identifying them as coming from the eastern Punjab province.

    The BLA is the strongest of a number of groups involved in a rebellion, who have for years operated in the area bordering Afghanistan and Iran, a mineral-rich region.

    The ethnic Baloch fighters blame the authorities in Pakistan for stealing their regional resources to fund spending in Punjab province.

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  • RSV Raises Risk for Diverse Complications Across Adulthood

    RSV Raises Risk for Diverse Complications Across Adulthood

    Respiratory syncytial virus (RSV) infections were associated with significantly increased risk for complications beyond pulmonology, including poor kidney outcomes and cardiovascular conditions, according to data from a pair of new studies.

    In a study of nearly 45,000 individuals published online in Influenza and Other Respiratory Viruses, Wang Chun Kwok, MD, of the University of Hong Kong, Hong Kong, and colleagues compared data from 41,206 adult patients hospitalized with flu and 3565 hospitalized for RSV infections at centers in Hong Kong.

    Overall, patients with RSV infection had significantly higher risk not only for in-patient mortality but also severe respiratory failure, secondary bacterial pneumonia, and acute kidney injury than patients with flu (P < .001 for all).

    In addition, the researchers highlighted end-stage kidney disease requiring renal replacement therapy as a significant independent risk factor for poor outcomes among the RSV patients, with an adjusted odds ratio of 4.74 for in-hospital mortality (P < .001). 

    The patients with RSV infection also were stratified by age based on current US recommendations for RSV vaccination (aged 60 years and older, younger than 60 years, and 50-59 years).

    Notably, the findings of increased risk were consistent across all adult age groups, the researchers wrote. “The risk factors for severe RSV infections demonstrated in this study provided insights on the target patient subgroups for vaccination, especially among countries and places with limited resources that do not allow vaccination for the entire population,” they concluded.

    Flu vs RSV

    The study by Kwok and colleagues provides an essential comparison, said Seyedmohammad Pourshahid, MD, assistant professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University, Philadelphia, in an interview.

    “For decades, influenza has set the standard in how we talk about vaccine-preventable adult respiratory disease, but with RSV vaccines now entering clinical use, it’s critical to understand whether RSV deserves similar attention,” he said.

    “The findings speak to more than just respiratory illness. The added burden of renal complications and secondary infections makes it clear that RSV can be a systemic threat, especially in hospitalized adults,” said Pourshahid. What stands out is that this pattern was seen across a range of adult ages, not just in the elderly, which challenges the current boundaries we draw around vaccine eligibility,” he added.

    Limitations of the study include not only the retrospective design but also the impact of variables including coding accuracy, variability in care, and the effect of existing vaccine use for influenza, which all play a role in shaping outcomes, said Pourshahid. However, the consistent trends seen in the study point toward a need to reevaluate RSV prevention, he said. 

    “From a clinical perspective, this means not underestimating RSV, especially in patients with kidney or cardiopulmonary disease. From a public health perspective, it raises the question of whether our current vaccine recommendations are too narrow,” Pourshahid told Medscape Medical News. “With further data, particularly post-vaccine implementation, we may find that the case for broader immunization is stronger than expected,” he said.

    Additional studies should follow vaccinated patients to identify any changes in the patterns of complications, Pourshahid said. “These kinds of real-world data will be essential in helping us understand not just whether the vaccine prevents RSV infection, but whether it also reduces the broader complications that come with it,” he said.

    In another study, published in Clinical Infections Diseases, Paulina Sudnik, MD, of the University of Rochester, Rochester, New York, and colleagues found that approximately one-third of 471 adults hospitalized with RSV experienced a cardiovascular event (CVE) during the high-risk period of the first 28 days after hospital admission.

    Previous studies support an association between respiratory viral infections such as influenza and COVID-19 and acute CVEs, but data on the patients with CVEs in the context of RSV are lacking, the researchers wrote. 

    The study population included 471 adults aged 18 years and older who were hospitalized for at least 24 hours with RSV. Overall, 174 of the patients (37%) experienced a total of 270 CVEs during the high-risk period. The most common CVE was congestive heart failure (25%), followed by atrial fibrillation or flutter (13%), and myocardial infarction (9%).

    Although 44% of the CVEs occurred in patients with no prior history of CVEs, preexisting conditions including hypertension, congestive heart failure, atrial fibrillation, and coronary artery disease, or evidence of at least three classic cardiac risk factors were significantly associated with increased CVE risk among patients older than 65 years. 

    Additionally, the monthly incidence of CVE after RSV infection was significantly increased compared to the pre-infection period, with incidence rate ratios of 18.5 and 1.6 during the high-risk and low-risk periods, respectively, compared to the pre-RSV period. 

    The study was limited by several factors, including the retrospective design and a lack of data on subclinical cardiac injury and CVEs that were mild or occurred outside the hospital setting. 

    However, the results were strengthened by the comparison of CVE data before and after RSV hospitalization, and the data may inform clinical decision-making on RSV vaccination, the researchers concluded. 

    Translating Data Into Practice

    The study by Sudnick and colleagues brings needed attention to a dimension of RSV that is often overlooked, Pourshahid said in an interview.

    “While most clinical focus has been on its respiratory manifestations, this work shifts the lens to cardiovascular complications and raises important questions about who is truly at risk and how those risks unfold,” he said. “The fact that many of the events occurred in people without known heart disease adds weight to the idea that RSV can act as a stressor, revealing latent disease or perhaps even provoking new events through inflammation and hemodynamic strain,” he added.

    Several limitations prevent drawing broad conclusions from the study, Pourshahid told Medscape Medical News. “The data come from a specific region and rely on retrospective review, which limits how far we can generalize, and hospitalized patients also tend to be monitored more closely, so we may be picking up events that would otherwise go unnoticed,” he said. However, these limitations don’t detract from the message that the RSV’s impact is wider than clinicians might often consider, he added.

    Clinically, the data reinforce the importance of paying close attention to the cardiovascular profile of patients admitted with RSV, even those without known cardiac disease, and contribute to conversations among policy makers and vaccine and vaccine developers, he noted. “Preventing RSV might mean preventing not just respiratory failure but also heart failure, arrhythmias, or ischemic events, which is an important shift in how we think about vaccine value,” he said.

    Prospective studies that can look more closely at how these events happen, how often they recur, and whether vaccines can interrupt that trajectory,” Pourshahid said.

    “As this study took place before RSV vaccines became available, we are in a key moment to begin tracking how the clinical picture changes in vaccinated populations,” he said.

    Kwok and Desmond Yat Hin Yap disclosed receiving research support from GlaxoSmithKline. 

    The study by Sudnik and colleagues received no outside funding. Sudnik disclosed having no financial conflicts. 

    Pourshahid had no financial conflicts to disclose.

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  • Valeo unveils next-generation vehicle technology at IAA MOBILITY 2025

    Valeo unveils next-generation vehicle technology at IAA MOBILITY 2025

    Valeo Group | 11 Jul, 2025
    | 8 min

    Valeo unveils its innovations in hardware, software, and AI for safer, more sustainable, and personalized mobility.


    July 11, 2025 — Paris, France — Valeo, the key technology partner to automakers and new mobility players worldwide, will be at IAA MOBILITY 2025 from September 8 to 12. At Booth B01 in Hall A1 of Munich Messe, Valeo will unveil its latest technologies designed to accelerate the development of a new generation of software-defined vehicles (SDVs), offering greater updatability, upgradability, and personalization.

    Valeo’s display will focus on advanced driver assistance systems (ADAS), innovative electrified vehicle solutions, smart lighting, and next-generation interior experiences. Valeo will also present its latest initiatives for more efficient, safer, and decarbonized transportation globally.

    Learn more about Valeo at IAA MOBILITY 2025 in our press kit.

    The key partner for software-defined vehicles

    The transition to software-defined vehicles (SDV) marks a new era of open innovation, co-development, and business model transformation in the automotive industry.

    At IAA MOBILITY 2025, Valeo will present its vision and comprehensive SDV offering through an immersive multimedia experience. This demonstration will feature Valeo anSWer, its complete software offering—from end-user features to full ecosystem integration with digital testing—showcasing SDV applications already on the road and future-ready solutions for upcoming vehicle generations.

    Valeo will present its portfolio of sensors and embedded software — the largest on the market, its range of upgradable computing units and its technologies designed to evolve vehicles throughout their lifecycle. These innovations enable the addition of new safety, comfort, and personalization features, without hardware changes.

    Highlights include Valeo SCALA™ 3 LiDAR, the key to unlocking level 3 and beyond functions, and Valeo Assist XR, a remote support solution that leverages real-time vehicle data for efficient roadside assistance and predictive maintenance.

    The Group will showcase its ADB (Adaptive Driving Beam) and high-definition smart lighting systems, enabling updatable features for more safety and a more personalized driving experience. Valeo will also unveil its innovation in HD digital signaling, and more specifically a mini-LED-based solution developed in collaboration with Lextar, which displays rich and dynamic information on the vehicle.

    Electrifying mobility: From charger to road

    Valeo envisions automotive electrification as smart, seamless, and efficient. At IAA MOBILITY 2025, the Group will present its comprehensive vision for electrified mobility, encompassing both hardware and software solutions, from charging systems to onboard thermal management and compact powertrains tailored for various applications.

    Highlights include Valeo Ineez™, the new generation of AC charging stations with full connectivity, real-time monitoring, and Vehicle-To-Grid (V2G) compatibility. V2G is also, by design, embedded in Valeo’s new compact and modular high-voltage On-Board Charger (OBC). The combination of these solutions transforms the vehicle into a true mobile energy hub.

    Advanced hardware and software systems will also be featured, enabling efficient, compact, and modular thermal management across all types of electrified vehicles. The display will include Valeo Smart Thermal Management solutions to ensure optimal energy efficiency in all seasons—up to 24% recovered electric range when combined with Valeo Predict4Range software — as well as an immersive cooling technology for enhanced battery stability and safety.

    Valeo will also display technologies that assist automakers in reducing emissions and fuel consumption through hybridization, such as the two-speed High Voltage eAxle system, which improves take-off, acceleration, and efficiency at high speeds, and eAccess, a ready-to-use 48V powertrain designed for light urban mobility.

    A smart, personalized, and human-centered cabin

    Inside the vehicle, safety merges with experience through Valeo Panovision, an immersive next-gen infotainment display, and Valeo Racer, the first automotive extended reality (XR) video game that combines live video and real-time data from the vehicle’s existing ADAS sensors, developed in partnership with Unity.

    Advanced driver monitoring systems will also be highlighted, tracking vital signs and attention levels for greater comfort and protection.

    Valeo will present the Aquablade™ wiper blade to improve visibility and reduce braking distances by enhancing driver reaction time.

    Last, but not least, the Group will introduce, for the first time in Munich, its next generation of steering wheel. This new prototype shows Valeo’s vision for the future where steer-by-wire technology offers less wheel rotation and allows for a better user experience.

    Sustainable mobility: From production to end of lifecycle

    Valeo is dedicated to reducing the environmental impact of mobility not only by addressing CO2 emissions but also by considering the entire vehicle lifecycle. At IAA MOBILITY 2025, the Group will demonstrate its tangible actions across the three pillars of sustainable automotive mobility: reducing the use of critical materials, creating longer-lasting parts, and incorporating end-of-life management from the design stage. Notable displays will include iBEE (inner Brushless Electrical Excitation), a new-generation motor without permanent magnets developed with MAHLE, and examples of the Group’s extensive portfolio of remanufactured components, including inverters and compressors.

    Do Not Miss:

    September 8

    • 11:00am-12:30pm: Press conference with Christophe Périllat, CEO of Valeo
      (exact 15 min slot to be confirmed by the organiser in the course of July)

    September 10

    • 10:45am: Keynote with Christophe Périllat, CEO of Valeo

    September 9-12

    • 10:00am-6:00pm: Valeo Demo cars – Book your demo ride at Valeo booth or contact Andreas Vom Bruch | +49 1 622 320 803 | andreas.vom-bruch@valeo.com

     

    Download the press release

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  • Aurelia Institute expands MIT-born space education and research beyond academia

    Aurelia Institute expands MIT-born space education and research beyond academia

    Founded by Ariel Ekblaw (SM ’17, PhD ’20), Danielle DeLatte ’11, and former MIT research scientist Sana Sharma, Aurelia builds on the work initiated through MIT’s Space Exploration Initiative.

    Its portfolio includes technology prototyping, microgravity experimentation, and policy engagement designed to broaden participation in space-related fields.

    Microgravity missions double as workforce training

    Each year, Aurelia charters a microgravity flight carrying around 25 participants. The missions combine scientific research with early-career exposure to real spaceflight conditions. To date, nearly 200 individuals, ranging from artists to teachers, have participated in flights through either Aurelia or its MIT predecessor. More than 70 percent of them have remained active in the space sector.

    “We’ve done that every year,” says Ekblaw. “We now have multiple cohorts of students that connect across years. It brings together people from very different backgrounds. We’ve had artists, designers, architects, ethicists, teachers, and others fly with us.”

    Aurelia also delivers open-source education for designing microgravity experiments and contributes to outreach programs that intersect with academia, industry, and the arts.

    TESSERAE technology tested aboard the ISS

    A core part of Aurelia’s research includes TESSERAE (Tessellated Electromagnetic Space Structures for the Exploration of Reconfigurable, Adaptive Environments), a self-assembling modular architecture system for use in orbit. The project began during Ekblaw’s graduate studies and has since been tested in microgravity flights, a suborbital launch with Blue Origin, and on the International Space Station (ISS).

    In 2022, TESSERAE was included on the first private mission to the ISS, where astronauts evaluated its autonomous assembly and disassembly under space conditions. A follow-up test is scheduled for early 2026, supported by a NASA grant.

    Aurelia recently spun off the TESSERAE project into a separate company, with plans for future spinoffs as research matures.

    Designing habitats for space and Earth

    Aurelia’s research portfolio also includes human-scale space architecture projects. These include a space garden, a 20-foot geodesic dome depicting future orbital habitats, and other deployable structures aimed at supporting life in orbit.

    “The architectural work is asking, ‘How are we going to outfit these systems and actually make the habitats part of a life worth living?’” says Ekblaw.

    One recent installation, a pavilion designed to reflect future space environments, was featured in a six-month exhibition at the Seattle Museum of Flight.

    The team frames space as a proving ground for robust technologies that may also serve communities on Earth. “When you design something for the rigors of space, you often hit on really robust technologies for Earth,” Ekblaw says.

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  • BankIslami denies unusual price movement reports – Business & Finance

    BankIslami denies unusual price movement reports – Business & Finance

    BankIslami Pakistan Limited (BIPL) dismissed on Friday reports of unusual movement in the price or volume of its shares during the preceding period.

    The bank rebutted the reports in a notice to the Pakistan Stock Exchange (PSX) today.

    “We do not have any information on the reason for the movement in price; however, we believe that the shares of BIPL may have attracted investor interest due to perceived valuation gaps, potentially contributing to the observed changes,” it told the bourse.

    However, BIPL said the movement appears to reflect broader market dynamics and investor sentiment, rather than any specific action or undisclosed development related to BIPL.

    BankIslami delivers record 24pc surge in profit in FY24

    In the last 30 days, the share price of BIPL has rose from Rs23.94 to R34.90 9, at the time of filing this report, registering a 46% increase.

    Over the past year, BankIslami launched Pakistan’s largest Islamic banking marketing campaign, amplifying brand presence and customer engagement.

    The bank also spearheaded a major technological overhaul, with the launch of its new internet and mobile banking applications as well as revamping its core banking system to enhance operational efficiency and digital capabilities.

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  • A Small Satellite Could See a Perfect Solar Eclipse Every Month

    A Small Satellite Could See a Perfect Solar Eclipse Every Month

    There was a total solar eclipse in the UK back in 1999. I travelled down to Cornwall, a loooooong 8 hour car drive and quite typically for UK, it was cloud. For me, I either need to wait until 2090 when I will be the ripe old age of 117 or travel abroad. Even if I had seen it, I would have been able to enjoy the spectacle for just over 2 minutes! Imagine though, experiencing a total solar eclipse that lasts 48 minutes instead of the usual four minutes or so that we see on Earth. A UK led space mission plans to make this possible by creating artificial solar eclipses in space, revolutionising how we study our nearest star and potentially saving decades of waiting for natural eclipses.

    The Moon Enabled Sun Occultation Mission (MESOM) proposes placing a small satellite in a carefully calculated orbit that aligns it with the Moon’s shadow approximately once every 29.6 days. This ingenious approach would allow scientists to study the Sun’s corona, its outermost atmosphere, in unprecedented detail, capturing the equivalent of 80 Earth based eclipses over just two years.

    Total Solar Eclipse showing the stunning outer atmosphere of the Sun known as the corona. (Credit : Luc Viatour)

    The corona holds many of the Sun’s deepest mysteries. This wispy, ethereal layer is only visible during total solar eclipses when the Moon blocks the Sun’s brilliant disk, revealing the shimmering plasma that extends millions of kilometers into space. On Earth, total eclipses are rare treats that last mere minutes and occur only along narrow paths. Those wanting to study or just enjoy the event often travel thousands of miles and wait years between opportunities.

    Understanding the corona is crucial for space weather prediction. Solar flares and coronal mass ejections, massive bursts of plasma and magnetic field, originate in this region and can disrupt satellites, power systems, and communication systems on Earth. They can also affect everything from GPS navigation to airline routes over polar regions.

    MESOM would eliminate the solar eclipse waiting game or the reliance on large expensive equipment entirely. By positioning itself in the Moon’s shadow, the satellite would experience artificial eclipses lasting up to 48 minutes, ten times longer than typical Earth based observations. These extended viewing periods would allow for detailed measurements impossible from our planet’s surface.

    “MESOM capitalises on the chaotic dynamics of the Sun-Earth-Moon system to reproduce total solar eclipse conditions in space while using the Moon as a natural occulter. The satellite would naturally pass through the darkest part of the Moon’s shadow during every two of its revolutions.” – Dr. Nicola Baresi from the Surrey Space Centre.

    MESOM would carry a sophisticated suite of instruments including a high resolution coronal imager led by the US Naval Research Laboratory, a corona mass spectrometer from Aberystwyth University and University College London to analyse plasma composition, and a Spanish built spectropolarimeter to study the Sun’s magnetic field and phenomena like sunspots and solar flares.

    Solar flare captured from Skylab. (Credit : NASA) Solar flare captured from Skylab. (Credit : NASA)

    The research team, spanning the Mullard Space Science Laboratory at UCL, Aberystwyth University, and the Surrey Space Centre, expects ESA’s response about their proposal later this year. If approved, MESOM could operate for two years, providing an unprecedented opportunity for longer term study of the Sun’s corona.

    This innovative approach demonsstrates how creative orbital mechanics can solve longstanding scientific challenges. Rather than building massive, expensive instruments or waiting for rare natural events, MESOM uses the Moon as a free, perfectly sized disk to block the Sun’s light exactly when and where scientists need it.

    If successful, MESOM will transform solar science from a field often waiting for events to happen, dependent on rare eclipses to a systematic study capable of monitoring our star’s behaviour almost continuously, helping protect our increasingly technology dependent civilisation from the Sun’s more violent outbursts.

    Source : A Small Satellite Could See a Perfect Solar Eclipse Every Month

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  • Will Pakistani govt arrest Imran Khan’s sons? Ex-PM’s first wife calls his incarceration ‘personal vendetta’

    Will Pakistani govt arrest Imran Khan’s sons? Ex-PM’s first wife calls his incarceration ‘personal vendetta’

    Days after former Pakistani PM Imran Khan’s sons spoke about his incarceration and demanded his release, Jemima Goldsmith, Khan’s ex-wife slammed the government for threatening them with arrest if they attempt to visit the country. In a strongly worded post on X, Goldsmith said her sons, Sulaiman and Qasim Khan, have not been allowed to speak to Imran, who has been held in solitary confinement in Rawalpindi’s Adiala Jail for nearly two years. “Pakistan’s govt has now said if they go there to try to see him, they too will be arrested and put behind bars. This isn’t politics. It’s a personal vendetta,” she wrote.

    Her reaction came after adviser to Pakistani Prime Minister Shehbaz Sharif Rana Sanaullah, said in atelevision interview that his sons would be arrested if they try to join the nationwide protest by Pakistan Tehreek-e-Insaaf (PTI). “Why won’t they be arrested? If they come to lead a violent movement, the consequences will follow,” he said. Law minister Aqeel Malik also warned that entry could be denied if their intent is to “spread discord.”

    How did demands for Imran Khan’s release begin again?

    It all started when reports claimed that Imran Khan directed PTI to begin its anti-government movement after Moharram. His sister Aleema Khan said that the former PM will lead the protest from jail and wants his party’s movement against the government to “hit its peak” on August 5 — the day he completes two years in prison. “Our family knows about the protest plan,” she added. However, she did not reveal the details regarding the upcoming demonstration. She announced that Imran Khan’s entire family would be part of the upcoming protest.

    Imran Khan’s sons break silence

    Imran Khan’s sons Qasim and Sulaiman Khan made an appeal to US President Donald Trump and “people of influence” around to world to step in and support their father’s release. Khan’s sons, who have stayed away from politics, urged the international community to step up efforts and put pressure on the Pakistani administration to release his father. In a television interview, they said that “they couldn’t stay quiet any longer.” “They are not giving him [Imran Khan] basic human rights. It is basically for human rights of not only our father but also other political prisoners and the restoration of proper democracy in Pakistan,” Qasim said.

    When asked about speculation that Khan might strike a deal with the government to secure his release, Qasim dismissed the idea outright. “I just don’t see him taking a deal like that to save his skin. He’s a very principled person … I don’t think he’ll just take a deal while other people are sitting in cells on his behalf, his supporters,” he said. Both brothers admitted they deeply miss their father, but what hurts more, they said, is “seeing a nation lose the man who gave everything for it”. “He always told us: if you stand for truth, you’ll pay a price. We’re seeing that now,” Qasim said.

    Cases against Imran khan

    Imran Khan is currently imprisoned due to his conviction in the Al-Qadir Trust corruption case, where he and his wife, Bushra Bibi, were sentenced to 14 years in jail in 2024. The case alleges that Khan facilitated the illegal transfer of £190 million (received from the UK’s National Crime Agency) in exchange for land given to a trust linked to him and Bushra Bibi. In addition, Khan was previously convicted in the Toshakhana case—for selling state gifts without proper disclosure—and sentenced to 3 years, which led to his disqualification from politics. Though this conviction was later suspended, it set the stage for further legal action. He was also sentenced to 10 years in the Cipher case, but that conviction was quashed by the Islamabad High Court in June 2024. Beyond convictions, Khan is facing over 180 legal cases, including terrorism charges related to the 2023 protests.

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  • NDMA issues alert for rains, possible flooding from Sunday – RADIO PAKISTAN

    1. NDMA issues alert for rains, possible flooding from Sunday  RADIO PAKISTAN
    2. NDMA issues weather and GLOF alert amid forecast of torrential rains across Pakistan  Ptv.com.pk
    3. More heavy showers expected across Punjab as rain-related incidents claim 4 lives, injure 40  Dawn
    4. Rainfall likely in city from July 17  The Express Tribune
    5. Heavy rains trigger urban flooding in Lahore  Business Recorder

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  • 25-(OH)D Deficiency and the Risk of Minor Amputation in Patients with

    25-(OH)D Deficiency and the Risk of Minor Amputation in Patients with

    Introduction

    Diabetic foot ulcer (DFU), the most common chronic complication of diabetes, typically arises from distal neuropathy or lower limb vascular disease, resulting in skin ulcers and deep tissue destruction in the feet and ankles.1 Surgical debridement, weight-bearing pressure reduction, improvement of lower limb ischemia, anti-infective treatment, and early referral to multidisciplinary treatment are vital treatment measures for DFU.2 Alarmingly, approximately 20% of DFU patients will ultimately undergo lower limb amputation.3 Moreover, 85% of diabetes-related lower limb amputations originate from DFU.4 This condition imposes substantial medical, economic, and social burdens on patients, families, and society. Reflecting this burden in China, the average total cost per patient with DFU soared from RMB 15,535.58 in 2014 to RMB 42,040.60 in 2020.5 Consequently, preventing amputations has become a pivotal goal in the comprehensive management of type 2 diabetes mellitus (T2DM).

    Vitamin D deficiency remains a significant public health concern, particularly in China where its prevalence reaches 34.3%.6 Vitamin D is not only essential for calcium and phosphorus metabolism, but also participates in suppressing inflammation and autoimmune responses, alleviating insulin resistance, and enhancing insulin synthesis and secretion.7,8 Preclinical studies demonstrate that 25-(OH)D exerts multiple effects, specifically protecting β cells via attenuation of oxidative stress, inhibiting inflammation through regulation of pancreatic stellate cells, and enhancing insulin signaling by promoting receptor gene transcription.9–11 Consequently, Vitamin D deficiency may reduce insulin sensitivity and exacerbates glucose dysregulation, increasing the risk of diabetic complications.12 Notably, Vitamin D plays a direct role in the occurrence and development of diabetic microvascular and macrovascular complications. Observational studies reveal that decreased serum 25-(OH)D concentrations correlate with increased incidence of both microvascular and macrovascular diabetic complications.13 In microvascular pathophysiology (retinopathy, neuropathy, nephropathy), Vitamin D deficiency potentiates endothelial dysfunction through upregulated pro-inflammatory cytokines (IL-6, TNF-α) and dysregulated angiogenesis via impaired VEGF signaling pathway.14–17Regarding macrovascular complications (such as myocardial infarction and stroke), insufficient 25-(OH)D levels associate with increased arterial calcification, impaired nitric oxide-mediated vasodilation, and hyperactivation of the renin-angiotensin-aldosterone system (RAAS), accelerating atherosclerosis progression.18 Current evidence suggests that maintaining adequate vitamin D status is beneficial to prevent diabetic vascular complications.

    Vitamin D deficiency may further elevate DFU risk by impairing immune function and delaying ulcer healing, potentially culminating in amputation. Serum 25-(OH)D levels negatively correlate with novel inflammatory markers,19 such as the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), which are reliable predictors of post-amputation mortality.20 25-(OH)D enhances wound healing through stimulating cell differentiation, suppressing hyperproliferation, and modulating critical repair mechanisms. Adequate 25-(OH)D concentrations not only curb pro-inflammatory cytokines and boost anti-inflammatory responses to fortify infection defense, but also improve endothelial function to enhance foot perfusion and accelerate tissue repair.21 For example, vitamin D can induce antimicrobial peptides (AMPs) in DFU cells, strengthening skin barrier function and facilitating ulcer healing.

    Despite possible associations between 25-(OH)D and DFU, data on 25-(OH)D deficiency and DFU minor amputation in Chinese diabetic patients remain scarce. Therefore, this study aimed to compare 25-(OH)D levels in Chinese patients with DFU minor amputation and controls and to explore the role of 25-(OH)D deficiency in DFU and its association with minor amputation.

    Materials and Methods

    Patients and Samples

    This study retrospectively analyzed the clinical characteristics of 185 patients with T2DM hospitalized in the Second Affiliated Hospital of Soochow University from January 2023 to June 2024. All patients in the control group met the following inclusion criteria: (1) Diagnosis of type 2 diabetes mellitus; (2) Age above 18 years; (3) Complete and reliable clinical history and clinical data; (4) Serum 25-(OH)D level was measured during hospitalization; (5) Follow-up data. All patients in the surgical group met the following inclusion criteria: (1) Diagnosis of DFU as defined by the International Working Group on the Diabetic Foot (IWGDF); (2) Diagnosis of type 2 diabetes mellitus; (3) Age above 18 years; (4) Complete and reliable clinical history and clinical data; (5) Serum 25-(OH)D level was measured during hospitalization; (6) Follow-up data. While the exclusion criteria included: (1) Diagnosis of type 1 diabetes; (2) Patients with severe systemic immunodeficiency; (3) Patients with malignant tumors; (4) Patients who died during hospitalization. Ninety-four patients without DFU in the control group received general treatment for diabetes in the endocrinology department and the other ninety-one patients with DFU in the surgical group received minor lower limb amputation in the orthopedics department. Besides, 40 healthy controls were included. This study was approved by the Second Affiliated Hospital of Soochow University. Written informed consent was obtained from all patients in accordance with the Declaration of Helsinki.

    Data Collection

    General clinical characteristics including sex, age, height, weight, medical history and compliance were directly extracted from electronic medical record system. Laboratory data were obtained within 24 hours of hospitalization, included white blood cell (WBC), neutrophil count, lymphocyte count, monocyte count, platelet (PLT) count, C-reactive protein (CRP), D-dimer, serum albumin (ALB), serum creatine (Scr), serum calcium, serum phosphorus, glycosylated hemoglobin (HbA1c), and 25-(OH)D. In addition, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), and systemic inflammatory response index (SIRI) was calculated, respectively. Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease (MDRD) equation: 186×(Scr)−1.154×(age)−0.203×(0.742 if female).

    25-(OH)D Measurements

    After hospitalization, fasting blood samples from patients were collected after hospitalization and centrifuged at 4000 r/min for 10 min to separate the serum, which was used to measure 25-(OH)D2 and 25-(OH)D3 levels. Stable isotope dilution-high performance liquid chromatography-tandem mass spectrometry was used to detect the levels of 25-(OH)D2 and 25-(OH)D3, and the sum of the two was taken as the total serum 25-(OH)D level. Meanwhile, we supplemented the matching samples of serum calcium, phosphorus and renal function. The normal range of 25-(OH)D is 20.0–100.0 ng/mL, and 25-(OH)D deficiency is defined as serum 25-(OH)D levels below the lower limit of normal range.

    Pathogen Detection

    The lesion site was cleaned and rinsed with sterile saline. Secretions, lesion tissue or bone fragments were scraped from the wound base and deep sinus tract with cotton swabs during the surgery. The specimens were immediately sent to clinical laboratory center for bacterial identification through routine culture methods and drug sensitivity analysis.

    Statistical Analysis

    Statistical analysis was performed in SPSS 27.0 (Armonk, NY, USA) software and GraphPad software 9.0 (La Jolla, CA, USA). The Kolmogorov–Smirnov test was used to determine the normality of continuous variables. Normally distributed variables are reported as mean ± standard deviation (SD), while non-normally distributed variables are expressed as median (interquartile range, IQR). Categorical variables were presented as absolute frequencies with relative proportions N (%). Homogeneity of variance was determined using the Levene test. Student’s t test was applied to analyze normally distributed variables with homogeneity of variance, while Mann–Whitney U-test was used to analyze variables with non-normal distribution or heterogeneity of variance. Categorical variables were analyzed by the chi-square test. Receiver operating characteristic (ROC) curve analysis with area under the curve (AUC) quantification was performed for diagnostic accuracy evaluation. Logistic regression analysis was used to identify the interrelationships between the variables. A two-tailed P<0.05 defined statistical significance for all analyses.

    Results

    Clinical Characteristics of Patients with T2DM Enrolled in This Study

    In total, 185 patients with T2DM and 40 healthy donors were retrospectively enrolled in this study. As is shown in Figure 1A, 25-(OH)D levels in patients with diabetes decreased compared with normal controls (P<0.001). The median age of the study was 64 years (range: 22–89 years), of which 58.4% were elderly people over 60 years old. The entire T2DM cohort was divided into two groups. The control group consisted of 94 patients diagnosed T2DM without DFU, while the surgical group consisted of patients with DFU accompanied by minor amputation. Male patients predominated, with a male to female ratio of 2.96:1 in the surgical group and 1.14:1 in the control group (P=0.002). The median age was 60 years (range: 28–79 years) in the surgical group and 66 years (range: 22–89 years) in the control group. The comparison of the baseline clinical characteristics of the two groups is shown in Table 1. Compared with the control group, the patients in the surgical group showed significantly lower 25-(OH)D levels (P<0.001), serum calcium (P<0.001), and albumin levels (all P<0.001). Meanwhile, the white blood cell count, platelet count, and inflammatory markers (including CRP, NLR, PLR, SII, and SIRI) in the surgical group were significantly higher than those in the control group (all P<0.001). Glycosylated hemoglobin is an important indicator reflecting short-term blood sugar control. The proportion of patients with HbA1c>7% in the two groups was similar (79.8% vs 73.6%), reflecting the poor blood sugar control, but no statistical difference was observed between the two groups (P=0.321). In addition, we found no significant differences in LDH, serum phosphorus, eGFR, and BMI.

    Table 1 Clinical Characteristics of 185 Patients with Diabetes in the Study

    Figure 1 (A) 25-(OH)D levels of type 2 diabetes mellitus (T2DM) group and in healthy donor group. (B). 25-(OH)D levels of patients in the control group and surgical group. **** means that P value <0.001.

    The overall incidence of 25-(OH)D deficiency (defined as the value <20 ng/mL) was 73.0%. Amputation group exhibited significantly higher prevalence versus control group (85.7% vs 60.6%, P<0.001), indicating that 25-(OH)D deficiency was more common and severe in the surgical group. As is shown in Figure 1B, the median 25-(OH)D level in the surgical group (10.71 ng/mL; range: 2.47–29.78 ng/mL) was significantly lower than that in the control group (18.98 ng/mL; range: 10.30–51.24 ng/mL) (P<0.001). This further confirms that the significant decrease in Vitamin D levels is associated with the risk of DFU and subsequent amputation in diabetic patients.

    Comparison of the Correlation Between 25-(OH)D Deficiency, Serum 25-(OH)D Levels and Clinical Characteristics in the DFU Surgical Group

    We systematically analyzed the effects of 25-(OH)D deficiency and 25-(OH)D levels on patients with DFU in the surgical group. Based on the standard vitamin D deficiency threshold (serum 25(OH)D <20 ng/mL), surgical patients were stratified into 25-(OH)D normal group (N=13) and 25-(OH)D deficiency group (N=78). The analysis revealed that 25-(OH)D deficiency was not significantly associated with gender, age, CRP, LDH, BMI, albumin levels, eGFR, or other inflammatory markers (all P >0.05), except for SII. However, significant differences were found with elevated WBC count (P =0.002), platelet count (P=0.011), D-dimer (P=0.041), HbA1c (P=0.033), and SII (P=0.023) (Table 2), indicating a potential link between vitamin D deficiency and abnormalities in infection control or glucose metabolism in DFU. To further investigate the clinical relevance, we utilized the median of 25-(OH)D levels (10.71ng/mL) as the optimal cutoff value to stratify patients in the surgical group. Subgroup analysis of minor amputation cases demonstrated that the low 25-(OH)D group exhibited significantly higher WBC (P=0.016), D-dimer (P=0.004), and SIRI (P=0.042), along with lower albumin levels (P=0.009) compared to the high-expression group (Table 3). This also reinforced the association between hypovitaminosis D and systemic inflammatory. Overall, the results revealed consistent trend with 25-(OH)D deficiency.

    Table 2 Relationship Between Clinical Characteristics and 25-(OH)D Deficiency in 91 DFU Patients with Minor Amputation

    Table 3 Clinical Characteristics of 91 Patients with Minor Amputation in Relation to the Level of 25-(OH)D

    ROC curve analysis demonstrated superior diagnostic accuracy of serum 25-(OH)D for predicting minor amputation risk in DFU patients compared to inflammatory markers. 25-(OH)D achieved the highest discrimination (AUC=0.798; 95% CI 0.734–0.861) with optimal cutoff=11.12 ng/mL (P< 0.05). By comparison, the predictive performance of the inflammatory markers NLR, PLR, SII, and SIRI was as follows: PLR: AUC=0.782 (95% CI: 0.715–0.849), SII: AUC=0.779 (95% CI: 0.711–0.846), NLR: AUC=0.748 (95% CI: 0.677–0.820), SIRI: AUC=0.695 (95% CI: 0.621–0.774) (Figure 2). These results establish Serum 25-(OH)D as potential biomarker for minor amputation risk stratification in DFU.

    Figure 2 The ROC curve of 25-(OH)D, NLR, PLR, SII, and SIRI to indicate minor amputation in DFU patients.

    Through univariate and multivariate regression analysis, potential influencing factors affecting the amputation group were screened out. In the univariate analysis, age>60 years, male, elevated WBC, NLR, CRP, elevated D-dimer, HbA1c>7, and 25-(OH)D deficiency were statistically significantly associated with surgery. Then these factors were included in the multivariate analysis, the six variables of age, gender, CRP, HbA1c, D-dimer and 25-(OH)D deficiency were significantly associated with amputation (Table 4). In summary, 25-(OH)D deficiency is a risk factor for minor amputation in DFU.

    Table 4 Univariate and Multivariate Logistic Regression Analysis of Patients

    Pathogen Distribution and Association Between 25-(OH)D Levels and DFU in the Surgical Group

    All patients’ specimens were collected during the operation for culture and pathogen detection. In order to clarify the etiology of tissue infection, we further compared the pathogen spectrum. As detailed in Table 5, bacterial or fungal pathogens were identified in 93.4% of surgical specimens, with sterile cultures observed in 6.6% of cases. Bacterial species predominated (96.5%) while fungal species accounted for 3.5% among pathogen-positive cases. Among bacterial infections, Gram-negative bacilli accounted for 52.4%, primarily represented by Pseudomonas aeruginosa, while Gram-positive cocci accounted for 47.6%, with Staphylococcus aureus as the predominant isolate. Moreover, 24 patients (26.4%) had complicated infection (two or more pathogens). The specific pathogens are shown in Figure 3A.

    Table 5 Distribution of Characteristics of Pathogen Spectrum Features in the Minor Amputation Group

    Figure 3 (A) Distribution of pathogens in DFU patients in the surgical group. (B) Differences in 25-(OH)D levels between patients with single or no infection and patients with complicated infection in the surgical group. ****means that P value <0.001.

    We further compared the 25-(OH)D levels in the complicated infection group with those in the single pathogen or no infection group and found that the level of 25-(OH)D was significantly lower in the complicated infection group (P<0.001) in Figure 3B as expected. As for treatment, patients in the surgical received systemic antibiotic therapy based on the antimicrobial susceptibility profiles. Moreover, Vancomycin-impregnated bone cement implantation and Negative pressure wound therapy (NPWT) were implemented beyond minor amputations for patients with osteomyelitis. The preoperative and postoperative conditions of minor lower limb amputation group were presented in Figure 4.

    Figure 4 Preoperative and postoperative conditions of two DFU patients with minor lower limb amputation in the surgical group (A and B).

    Discussion

    25-(OH)D deficiency adversely affects the progression of diabetes and its complications, especially DFU. Because of amputation represents one of the most severe outcomes of DFU, understanding the role of Vitamin D in this pathologic cascade is critical. In this study, we analyzed the clinical characteristics of 185 diabetic patients stratified by 25-(OH)D levels and explored the relationship between 25-(OH)D deficiency and amputation risk of DFU.

    Our data reveal markedly depleted serum 25-(OH)D levels in T2DM versus healthy controls, with further reduction in DFU patients relative to non-DFU diabetics (median: 10.71 vs 18.98 ng/mL, P<0.001). This deficiency of 25-(OH)D correlates with diabetes progression and DFU complications, confirming prior epidemiological patterns.22–24Vitamin D deficiency correlated with elevated amputation risk in the surgical group, consistent with other cohort studies showing higher all-cause mortality in DFU patients with hypovitaminosis D and increased amputation rates in peripheral arterial disease cohorts.25,26 Several studies have shown that the incidence of Vitamin D deficiency in patients with DFU is significantly higher than that in ordinary diabetic patients or diabetic patients without foot ulcers.23,27 This study revealed Vitamin D deficiency in 85.7% of amputated DFU patients, aligning with published deficiency rates (55.7–86.8%),28–30 confirming its strong association with DFU severity. Retrospective analyses indicate that 25-(OH)D insufficiency elevates osteomyelitis risk.31 Consistently, our minor amputation cases progressed to Wagner grade of 3–4 with concurrent osteomyelitis. This condition may be exacerbated by 25-(OH)D deficiency through disruption of calcium homeostasis and impaired bone remodeling. Mechanistically, related studies have shown that Vitamin D levels are negatively correlated with ulcer severity and healing time, which may be related to the fact that Vitamin D deficiency weakens the function of immune cells or affects vascular endothelial repair, aggravates inflammatory response, enhance microcirculation disorders, and delays ulcer healing. Overall, these findings underscore that measures should be taken to prevent vitamin D deficiency in T2DM patients to reduce the risk of potential complications, especially the risk of amputation in DFU.

    25(OH)D deficiency amplifies infection-driven inflammation through dysregulated myeloid activation, correlating with elevated markers across multiple hematologic axes. In this study, patients in the surgical group were diagnosed with osteomyelitis by imaging and eventually performed minor amputation of lower limb. We included several easily accessible inflammatory biomarkers to assess infection of DFU and found that patients undergoing minor amputation demonstrated significantly elevated systemic inflammatory markers than those in the control group, including WBC, CRP, NLR, PLR, SII, and SIRI. In the surgical DFU cohort, 25-(OH)D deficiency was associated with increased WBC and SII and the low 25-(OH)D expression group was significantly related to elevated WBC and SIRI. These findings indicate that composite inflammatory indices may offer superior amputation risk stratification over isolated WBC evaluation. Su et al proposed that NLR can objectively reflect the inflammatory indicators of patients with DFU and the higher the preoperative NLR value may indicate worse disease outcomes in patients with diabetic foot, including amputation and death.32 Combined with the data in our amputation group, we tend to believe that different inflammatory markers may be more valuable for the prognosis of patients with DFU. In subsequent studies, we can also include novel indicators such as PHR and NHR to further explore the in-depth relationship between infection and 25-(OH)D deficiency in the diabetic foot amputation group, which were also explored in other studies.19

    Given that the microbiota of DFU wounds presents dynamic changes, timely and accurate identification of pathogenic bacteria in clinical practice is a favorable factor for implementing precise and individualized treatment. Pathogen analysis revealed polymicrobial infections in 26.4% of DFU cases, predominantly Staphylococcus aureus and Escherichia coli.33,34 Patients with polymicrobial infections exhibited lower 25-(OH)D levels compared to those with single-pathogen or no infections. Severe infections in DFU patients with 25-(OH)D deficiency may be attributable to arise from interdependent immunological and metabolic disruptions. For example, the lower level of 25(OH)D is associated with impaired innate immune defense, macrophage dysfunction, cytokine dysregulation, enhanced pathogen virulence, and increased risk of refractory osteomyelitis, thereby increasing susceptibility to systemic infection.31,35,36 While conventional culture methods often miss pathogens in severe cases of DFU, metagenomic next-generation sequencing (mNGS) significantly enhances detection sensitivity, underlining its value for managing recalcitrant infections.37 Despite its efficacy, the high cost of mNGS limits widespread clinical adoption, reserving its use primarily for suspected false-negative scenarios as a supplementary tool. Vancomycin proves particularly effective against common DFU pathogens, such as Staphylococcus and Enterobacter species, which remain largely show no drug resistance as reported.38,39 To enhance local infection control and efficacy, surgical interventions included Vancomycin-impregnated bone cement implantation and Negative pressure wound therapy. Comprehensive approach addresses both systemic and localized aspects of DFU management.

    Considering that Hb1Ac is closely related to short-term average serum glucose levels, despite over 50% of patients with HbA1c>7%, patients in the amputation group did not show higher HbA1c than controls, which seems to contradict existing studies.40,41 The difference may stem from health care disparities. For example, rural patients often present with advanced disease due to delayed diagnosis and irregular monitoring, masking true glycemic trajectories. Notably, when analyzing amputated subgroups exclusively, lower level of 25-(OH)D strongly correlated with elevated HbA1c (P=0.033), supporting the Vitamin D’s role in glucose metabolism.42,43

    Circulating serum 25-(OH)D levels exhibit variability due to age, skin pigmentation, adiposity, and latitude-dependent sun exposure. Crucially, no universal consensus exists on optimal thresholds of 25-(OH)D for clinical outcomes. Divergent recommendations impede clinical practice, for example in patients with diabetes comorbidities such as DFU. To resolve this ambiguity, our study implemented a dual-threshold strategy: Initial stratification using conventional cutoffs (20 ng/mL [IOM standard] and 10.17 ng/mL [population median]), ROC-derived optimization establishing 11.12 ng/mL as the evidence-based diagnostic threshold. This methodology transcends prespecified deficiency definitions by integrating population characteristics and clinical outcomes.

    Inevitably, our research has some limitations. Firstly, due to the less abundant data content of samples in the cohort, there was some potential selection bias. Secondly, patients with confirmed 25-(OH)D deficiency have received standard supplementation to increase serum 25(OH)D concentration. However, therapeutic efficacy was not evaluated. Meanwhile, we did not further compare the relationship between the 25-(OH)D levels of the patients and the depth, grade and healing time of the ulcer according to the Wagner grade due to sample data limitations. In the future, prospective randomized trials are needed to confirm our findings and further analyze the role of Vitamin D in wound healing in DFU patients. Moreover, we also need to conduct more mechanistic investigation to delineate the pathobiological impact of Vitamin D deficiency on DFU progression.

    In conclusion, this study found that 25-(OH)D deficiency occurs in 85.7% of patients with minor amputation in DFU, and the decreased levels of 25(OH) D was significantly associated with several clinical characteristics. 25-(OH)D deficiency is a vital risk factor for minor amputation and measures should be taken to prevent 25-(OH)D deficiency in T2DM patients with DFU.

    Data Sharing Statement

    The authors declare that all data and materials are available on reasonable request.

    Ethics Approval and Consent to Participate

    This study was approved by the Second Affiliated Hospital of Soochow University. And written informed consent was obtained from all patients according to the Declaration of Helsinki.

    Acknowledgments

    We would like to acknowledge the patients who volunteered to participate in this study.

    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 work was funded by the National Natural Science Foundation of China (82472515), open projects of the State Key Laboratory of Radiation Medicine and Radiation Protection jointly built by the province and the ministry (GZK12024049, GZK1202304), support project for the standardized training capacity building of resident doctors in the Second Affiliated Hospital of Suzhou University (ZPTJ-TD202405) and special project of education and teaching reform of Suzhou Medical College (MX12301923).

    Disclosure

    The authors declare no conflicts of interest in this work.

    References

    1. Ganesan O, Orgill DP. An Overview of Recent Clinical Trials for Diabetic Foot Ulcer Therapies. J Clin Med. 2024;13(24):7655. doi:10.3390/jcm13247655

    2. Armstrong DG, Tan TW, Boulton AJM, Bus SA. Diabetic Foot Ulcers: a Review. JAMA. 2023;330(1):62–75. doi:10.1001/jama.2023.10578

    3. McDermott K, Fang M, Boulton AJM, Selvin E, Etiology HCW. Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care. 2023;46(1):209–221. doi:10.2337/dci22-0043

    4. Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003;361(9368):1545–1551. doi:10.1016/S0140-6736(03)13169-8

    5. Lu Q, Wang J, Wei X, et al. Cost of Diabetic Foot Ulcer Management in China: a 7-Year Single-Center Retrospective Review. Diabetes Metab Syndr Obes. 2020;13:4249–4260. doi:10.2147/DMSO.S275814

    6. Chen J, Yun C, He Y, Piao J, Yang L, Yang X. Vitamin D status among the elderly Chinese population: a cross-sectional analysis of the 2010-2013 China national nutrition and health survey (CNNHS). Nutr J. 2017;16(1):3. doi:10.1186/s12937-016-0224-3

    7. Usluogullari CA, Balkan F, Caner S, et al. The relationship between microvascular complications and vitamin D deficiency in type 2 diabetes mellitus. BMC Endocr Disord. 2015;15(1):33. doi:10.1186/s12902-015-0029-y

    8. Kaur J, Khare S, Sizar O, Givler A. Vitamin D Deficiency. In: StatPearls. 2025.

    9. Taneera J, Yaseen D, Youssef M, et al. Vitamin D augments insulin secretion via calcium influx and upregulation of voltage calcium channels: findings from INS-1 cells and human islets. Mol Cell Endocrinol. 2025;599:112472. doi:10.1016/j.mce.2025.112472

    10. Liu J, Zhang Y, Shi D, He C, Xia G. Vitamin D Alleviates Type 2 Diabetes Mellitus by Mitigating Oxidative Stress-Induced Pancreatic beta-Cell Impairment. Exp Clin Endocrinol Diabetes. 2023;131(12):656–666. doi:10.1055/a-2191-9969

    11. Zhou Z, Zhang L, Wei X, et al. 1,25(OH)(2)D(3) inhibits pancreatic stellate cells activation and promotes insulin secretion in T2DM. Endocrine. 2024;85(3):1193–1205. doi:10.1007/s12020-024-03833-0

    12. Mitri J, Pittas AG. Vitamin D and diabetes. Endocrinol Metab Clin North Am. 2014;43(1):205–232. doi:10.1016/j.ecl.2013.09.010

    13. Zhong P, Zhu Z, Wang Y, Huang W, He M, Wang W. Cardiovascular and microvascular outcomes according to vitamin D level and genetic variants among individuals with prediabetes: a prospective study. J Transl Med. 2023;21(1):724. doi:10.1186/s12967-023-04557-x

    14. Petrea CE, Ghenciu LA, Iacob R, Stoicescu ER, Sandesc D. Vitamin D Deficiency as a Risk Factor for Diabetic Retinopathy: a Systematic Review and Meta-Analysis. Biomedicines. 2024;13(1):68. doi:10.3390/biomedicines13010068

    15. Chackochan A, Rashid M, Reghunath SR, et al. Role of vitamin D in the development and progression of diabetic kidney disease: an overview of meta-analyses. Ther Adv Endocrinol Metab. 2025;16:20420188251319476. doi:10.1177/20420188251319476

    16. Hong SH, Kim YB, Choi HS, Jeong TD, Kim JT, Sung YA. Association of Vitamin D Deficiency with Diabetic Nephropathy. Endocrinol Metab. 2021;36(1):106–113. doi:10.3803/EnM.2020.826

    17. Sun X, Yang X, Zhu X, et al. Association of vitamin D deficiency and subclinical diabetic peripheral neuropathy in type 2 diabetes patients. Front Endocrinol. 2024;15:1354511. doi:10.3389/fendo.2024.1354511

    18. Renke G, Starling-Soares B, Baesso T, Petronio R, Aguiar D, Paes R. Effects of Vitamin D on Cardiovascular Risk and Oxidative Stress. Nutrients. 2023;15(3):769. doi:10.3390/nu15030769

    19. Zhao H, Zhao Y, Fang Y, Zhou W, Zhang W, Peng J. The Relationship Between Novel Inflammatory Markers and Serum 25-Hydroxyvitamin D Among US Adults. Immun Inflamm Dis. 2025;13(1):e70115. doi:10.1002/iid3.70115

    20. Chen W, Chen K, Xu Z, et al. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict Mortality in Patients with Diabetic Foot Ulcers Undergoing Amputations. Diabetes Metab Syndr Obes. 2021;14:821–829. doi:10.2147/DMSO.S284583

    21. Tiwari S, Pratyush DD, Gupta SK, SK S. Vitamin D deficiency is associated with inflammatory cytokine concentrations in patients with diabetic foot infection. Br J Nutr. 2014;112(12):1938–1943. doi:10.1017/S0007114514003018

    22. Li XH, Luo YZ, Mo MQ, Gao TY, Yang ZH, Pan L. Vitamin D deficiency may increase the risk of acute kidney injury in patients with diabetes and predict a poorer outcome in patients with acute kidney injury. BMC Nephrol. 2024;25(1):333. doi:10.1186/s12882-024-03781-x

    23. Tang W, Chen L, Ma W, et al. Association between vitamin D status and diabetic foot in patients with type 2 diabetes mellitus. J Diabetes Investig. 2022;13(7):1213–1221. doi:10.1111/jdi.13776

    24. Todorova AS, Jude EB, Dimova RB, et al. Vitamin D Status in a Bulgarian Population With Type 2 Diabetes and Diabetic Foot Ulcers. Int J Low Extrem Wounds. 2022;21(4):506–512. doi:10.1177/1534734620965820

    25. Tang W, Chen L, Ma W, et al. Association of vitamin D status with all-cause mortality and outcomes among Chinese individuals with diabetic foot ulcers. J Diabetes Investig. 2023;14(1):122–131. doi:10.1111/jdi.13917

    26. Gaddipati VC, Bailey BA, Kuriacose R, Copeland RJ, Manning T, Peiris AN. The relationship of vitamin D status to cardiovascular risk factors and amputation risk in veterans with peripheral arterial disease. J Am Med Dir Assoc. 2011;12(1):58–61. doi:10.1016/j.jamda.2010.02.006

    27. Dai J, Yu M, Chen H, Chai Y. Association Between Serum 25-OH-Vitamin D and Diabetic Foot Ulcer in Patients With Type 2 Diabetes. Front Nutr. 2020;7:109. doi:10.3389/fnut.2020.00109

    28. Greenhagen RM, Frykberg RG, Wukich DK. Serum vitamin D and diabetic foot complications. Diabet Foot Ankle. 2019;10(1):1579631. doi:10.1080/2000625X.2019.1579631

    29. Pena G, Kuang B, Cowled P, et al. Micronutrient Status in Diabetic Patients with Foot Ulcers. Adv Wound Care (New Rochelle). 2020;9(1):9–15. doi:10.1089/wound.2019.0973

    30. Wang F, Zhou L, Zhu D, Yang C. A Retrospective Analysis of the Relationship Between 25-OH-Vitamin D and Diabetic Foot Ulcer. Diabetes Metab Syndr Obes. 2022;15:1347–1355. doi:10.2147/DMSO.S358170

    31. Tang Y, Huang Y, Luo L, et al. Level of 25-hydroxyvitamin D and vitamin D receptor in diabetic foot ulcer and factor associated with diabetic foot ulcers. Diabetol Metab Syndr. 2023;15(1):30. doi:10.1186/s13098-023-01002-3

    32. Xu S, Wang Y, Hu Z, Ma L, Zhang F, Liu P. Effects of neutrophil-to-lymphocyte ratio, serum calcium, and serum albumin on prognosis in patients with diabetic foot. Int Wound J. 2023;20(5):1638–1646. doi:10.1111/iwj.14019

    33. Guo H, Song Q, Mei S, Xue Z, Li J, Ning T. Distribution of multidrug-resistant bacterial infections in diabetic foot ulcers and risk factors for drug resistance: a retrospective analysis. PeerJ. 2023;11:e16162. doi:10.7717/peerj.16162

    34. Morton KE, Coghill SH. Staphylococcus aureus Is the Predominant Pathogen in Hospitalised Patients with Diabetes-Related Foot Infections: an Australian Perspective. Antibiotics. 2024;13(7). doi:10.3390/antibiotics13070594

    35. Al-Shammri S, Chattopadhyay A, Raghupathy R. Vitamin D Supplementation Mediates a Shift toward Anti-Inflammatory Cytokine Response in Multiple Sclerosis. Med Princ Pract. 2025;1–9. doi:10.1159/000544106

    36. Riek AE, Oh J, Darwech I, Moynihan CE, Bruchas RR, Bernal-Mizrachi C. 25(OH) vitamin D suppresses macrophage adhesion and migration by downregulation of ER stress and scavenger receptor A1 in type 2 diabetes. J Steroid Biochem Mol Biol. 2014;144:172–179. doi:10.1016/j.jsbmb.2013.10.016

    37. Xie H, Chen Z, Wu G, et al. Application of metagenomic next-generation sequencing (mNGS) to describe the microbial characteristics of diabetic foot ulcers at a tertiary medical center in South China. BMC Endocr Disord. 2025;25(1):18. doi:10.1186/s12902-025-01837-z

    38. Davani F, Alishahi M, Sabzi M, Khorram M, Arastehfar A, Zomorodian K. Dual drug delivery of vancomycin and imipenem/cilastatin by coaxial nanofibers for treatment of diabetic foot ulcer infections. Mater Sci Eng C Mater Biol Appl. 2021;123:111975. doi:10.1016/j.msec.2021.111975

    39. Ghosh S, Sinha M, Samanta R, et al. A potent antibiotic-loaded bone-cement implant against staphylococcal bone infections. Nat Biomed Eng. 2022;6(10):1180–1195. doi:10.1038/s41551-022-00950-x

    40. Abdo B, Abdullah M, AlShoaibi IA, et al. Relationship Between Glycated Hemoglobin (HbA1c) and Vitamin D Levels in Type 2 Diabetes Patients: a Retrospective Cross-Sectional Study. Cureus. 2024;16(6):e62468. doi:10.7759/cureus.62468

    41. Lee JH, YA K, YS K, Lee Y, Seo JH. Association between Vitamin D Deficiency and Clinical Parameters in Men and Women Aged 50 Years or Older: a Cross-Sectional Cohort Study. Nutrients. 2023;15(13):1.

    42. Kostoglou-Athanassiou I, Athanassiou P, Gkountouvas A, Kaldrymides P. Vitamin D and glycemic control in diabetes mellitus type 2. Ther Adv Endocrinol Metab. 2013;4(4):122–128. doi:10.1177/2042018813501189

    43. Feldkamp J, Jungheim K, Schott M, Jacobs B, Roden M. Severe Vitamin D3 Deficiency in the Majority of Patients with Diabetic Foot Ulcers. Horm Metab Res. 2018;50(8):615–619. doi:10.1055/a-0648-8178

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