To compare glycemic and weight effects of fixed-ratio combinations (FRCs) of basal insulin (BI) and glucagon-like peptide-1 receptor agonists (GLP1RAs) in adults with type 2 diabetes (T2D). Randomized controlled trials of BI–GLP1RA FRCs in adults with T2D were identified across major databases through 20 December 2025. Co-primary outcomes were changes in glycated hemoglobin (HbA1c) and body weight. A frequentist random-effects network meta-analysis, with BI as the reference, was conducted in R using netmeta. Certainty was assessed using Confidence in Network Meta-Analysis (CINeMA). Thirty trials involving 17,862 participants were included. All FRCs reduced HbA1c and body weight more than BI alone. For HbA1c, HR17031 had the largest estimated reduction (mean difference [MD]: -0.72
To assess whether transcription factor (TF)- and hormone-defined pathological subtypes of pituitary neuroendocrine tumors (PitNETs) are associated with postoperative biochemical remission in acromegaly. Consecutive acromegaly patients who underwent surgery between January 2015 and October 2025 with a minimum 3-month follow-up were enrolled. Patients were classified by TF and hormone expression patterns: pure vs. non-pure PIT-1 positive, and pure vs. non-pure GH positive. Drawing on target trial emulation-derived design principles, propensity score overlap weighting (OW) balanced six prespecified confounders and covariate balance was confirmed after weighting. Associations between pathological subtypes and postoperative biochemical remission were examined using weighted Kaplan–Meier and Cox proportional hazards analyses. Overall, 93.4
Ectopic Cushing syndrome is a potentially life-threatening disorder most caused by thoracic or pancreatic neuroendocrine tumors. Intestinal neuroendocrine tumors are an exceptionally uncommon and poorly characterized source, creating important diagnostic and therapeutic challenges. We aimed to systematically characterize the clinical presentation, diagnostic pathways, treatment strategies, and outcomes of ectopic Cushing syndrome caused by intestinal neuroendocrine tumors. Systematic review of published case reports, complemented by an illustrative unpublished case. Four electronic databases were searched from inception to February 2026 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Individual patient data on clinical presentation, tumor localization, treatment, and outcomes were extracted and analyzed descriptively. Twenty-four published cases were identified. Ectopic Cushing syndrome was the initial manifestation in 87.5
Denosumab is a human monoclonal antibody that binds receptor activator of nuclear factor-κB ligand, leading to marked and sustained reductions in fracture risk in osteoporosis. Due to its reversible mechanism and lack of skeletal retention, treatment interruption causes rebound bone turnover, accelerated bone mineral density (BMD) loss, and increased vertebral fracture risk. Optimising denosumab therapy therefore requires a long-term management strategy incorporating uninterrupted dosing and planned sequential antiresorptive therapy. This expert narrative review summarises evidence on denosumab pharmacology, efficacy, safety, and discontinuation management and provides practical recommendations informed by the published literature and the clinical experience of the author panel. No formal Delphi process, voting procedure, evidence-grading framework, or predefined consensus threshold was used. Main topics discussed included transition strategies after withdrawal, particularly alendronate (or zoledronic acid), timing of initiation, and biomarker-guided monitoring using serum C-terminal telopeptide (CTX). This paper also addresses management in special populations (chronic kidney disease, glucocorticoid exposure, malignancy, endocrine disorders) and evaluates health-system factors including infusion capacity, adherence, and coordinated primary–specialist care. Denosumab should not be discontinued without subsequent potent antiresorptive therapy. Sequential alendronate or zoledronic acid within six to seven months of the final injection, guided by CTX and BMD monitoring, is likely to be the most effective strategy in preventing rebound bone loss. Structured transition pathways are essential for sustained skeletal protection.
Maternal high-fat diet (HFD) exposure induces sex-dependent cardiac hypertrophy in adult offspring, but the underlying mechanisms remain unclear. This study investigated the role of miR-493-3p in maternal HFD-induced cardiac hypertrophy and its potential association with estrogen regulation and PI3K/AKT/mTOR signaling. Pregnant rats were fed either a standard chow diet or HFD (60
