Introduction: Ectopic adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome is a rare but important cause of hypercortisolism and can be difficult to diagnose, particularly in the presence of incidental pituitary lesions. Case: A 21-year-old patient presented with recurrent severe hypokalemia, normotension, and rapid weight gain. The hypokalemia was persistent, requiring multiple hospital admissions and ongoing potassium supplementation. Biochemical evaluation confirmed ACTH-dependent Cushing syndrome with elevated ACTH (27.4 pmol/L), elevated late-night salivary cortisol, and failure of suppression on low-dose dexamethasone suppression testing (cortisol 875 nmol/L). Pituitary magnetic resonance imaging demonstrated a 0.5 × 0.3 cm microadenoma, raising suspicion for a pituitary source. However, inferior petrosal sinus sampling (IPSS) showed no central-to-peripheral ACTH gradient, excluding Cushing disease. Computed tomography of the thorax revealed a 0.6 cm right middle lobe pulmonary nodule. Gallium-68 DOTATATE PET-CT demonstrated increased somatostatin receptor uptake, confirming the lesion as the likely ectopic ACTH source. The lesion was not amenable to bronchoscopic resection, and the patient was referred for cardiothoracic surgical excision. During the course of illness, the patient developed resistant hypertension and worsening hypokalemia requiring high-dose potassium supplementation and multiple antihypertensive agents. Medical therapy with ketoconazole and metyrapone was initiated for cortisol control while awaiting definitive surgical resection. Conclusion This case highlights an aggressive and atypical presentation of ectopic ACTH syndrome in a young patient, initially presenting with isolated hypokalemia but rapidly progressing to severe hypercortisolism. It underscores the importance of early recognition, appropriate localization with IPSS, and timely initiation of medical therapy to control cortisol excess prior to definitive surgery.
Cushing Syndrome ; Adrenocorticotropic Hormone

Introduction: Type 2 diabetes mellitus is a major healthcare problem worldwide, yet high percentage of patients are undiagnosed. There is a dire need for effective screening strategies. We examine the use of modified Asian FINDRISC (M-FINDRISC) and POCT random capillary blood glucose (rCBG) for the detection of dysglycemia Methodology: This cross-sectional, observational study included 151 adults aged ≥30 years without a prior history of diabetes in healthcare and community settings. Hemoglobin A1c of ≥6.3% was used for the diagnosis of diabetes, and 5.7– 6.2% for prediabetes. Areas under the receiver operating curve (ROC-AUC) for M-FINDRISC were analyzed. The sensitivity and specificity of the combined use of M-FINDRISC and rCBG for the detection of dysglycemia were evaluated. Results: The mean age of the participants was 44.6 ± 11.0 years. They had high body mass index (27.8 ± 4.9 kg/m²). Most were sedentary (only 25.2% reported physical activities of ≥30 min/day). A total of 52.3% had first-degree relatives with diabetes, but less than 12% were taking antihypertensive medication. Out of 151 participants, 3.3% (n = 5) were diagnosed with diabetes mellitus and 37.7% (n = 57) with prediabetes, giving an overall prevalence of 41.1% for dysglycemia. The mean age of participants with dysglycemia was significantly older (47.9 vs. 42.3 years, p-value 0.002). Other parameters were not statistically different for the two groups. Mean M-FINDRISC score was 9.7 ± 3.9 in the normal and 10.8 ± 4.0 in the dysglycemic group, while rCBG was 6.4 ± 1.1 mmol/L and 7.1 ± 3.1 mmol/L, respectively. ROC-AUC of M-FINDRISC for dysglycemia was 0.561. A combined screening strategy (M-FINDRISC score ≥7.5 and CBG ≥7.8 mmol/L) yielded high specificity (89.9%) but low sensitivity (17.7%) for dysglycemia. Conclusion While the combined screening strategy utilizing M-FINDRISC and POCT random CBG improves specificity, M-FINDRISC showed limited predictive value for dysglycemia in this specific cohort, making it a less ideal tool for screening.

Introduction: The 2021 IDF-DAR risk calculator had been previously evaluated in multiple studies and subsequently widely accepted and applied in clinical practice as a practical standardized tool for patient risk stratification. Recently updated, the 2026 IDF-DAR Risk calculator enables a more individualized, evidence-related evaluation of patientrelated and disease-related risk factors, incorporating modern diabetes technologies, including continuous glucose monitoring (CGM), automated insulin delivery (AID) systems, and advanced insulin formulations to enhance risk stratification. This tool allows medical professionals to tailor Ramadan practices based on overall factors toward promoting safe fasting. Methodology: This prospective multicentre observational study recruited adults with Type 1 and Type 2 diabetes attending public hospitals nationwide. People with diabetes (PwD) intending to perform Ramadan fasting were invited to participate and assessed using the 2026 IDF-DAR Risk Calculator in the 6-week pre-Ramadan period between 30th January and 19th March 2026. Results: A total of 458 PwD were evaluated and stratified into low (15.7%), moderate (41%), and high risk (43.3%) categories. Most participants had Type 2 diabetes (83.6%), with 60.3% having a disease duration exceeding 10 years and 43% exhibiting poor glycemic control (hemoglobin A1c >9%). Insulin therapy was used by 76.4% of participants, including two individuals with Type 1 diabetes using AID systems. Most participants reported no recent hypoglycemia (76.4%), 81.0% performed glucose monitoring, and 3.3% used CGM. Severe comorbidities were uncommon, with 1.1% having unstable macrovascular disease and 4.4% advanced chronic kidney disease (estimated glomerular filtration rate <30). Notably, 72.2% received structured Ramadan education. Conclusion Majority of PwD attending tertiary diabetes clinics were in the moderate- to high-risk category and intended to fast despite medical advice against fasting in some cases. Although most participants were on insulin therapy, hypoglycemia was low in the pre-Ramadan period. Integration of modern technologies, advanced insulin therapies, and structured education may support safer fasting practices.
Risk Assessment ; Diabetes Mellitus ; Hospitals ; Fasting

Aberrant activation of glycolysis represents a key metabolic mechanism underlying the initiation and progression of nasal inflammation. Allergic rhinitis, chronic rhinosinusitis, and vasomotor rhinitis exhibit distinct etiologies, yet all are characterized by inflammatory responses, impaired epithelial barrier function, and neurovascular dysregulation, in which glycolytic metabolic reprogramming acts as a central hub connecting immunometabolism and inflammatory regulation.Recent evidence indicates that glycolysis-dependent activation of immune cells provides the essential energy basis for inflammatory onset. In dendritic cells, eosinophils, mast cells, and Th2 cells, the expression of key glycolytic enzymes including HK2, PKM2, and LDHA is upregulated, thereby promoting cellular activation and proinflammatory cytokine release via the mTOR-HIF-1α signaling axis. Notably, the metabolic reprogramming of eosinophils prolongs their survival and enhances the release of cytotoxic granules, while in mast cells, enhanced glycolysis facilitates IgE-mediated degranulation and histamine release. Furthermore, glycolysis also influences the Th17/Treg balance, with enhanced glycolytic flux promoting Th17 differentiation and contributing to the heterogeneous inflammatory profiles observed across different rhinitis subtypes.As a central metabolite, lactate contributes to the formation of a metabolism-inflammation vicious cycle through multiple mechanisms. Lactate acidifies the local microenvironment to activate TRPV1 channels and facilitate neuropeptide release, mediates immune cell chemotaxis through GPR81, and regulates gene expression via histone lactylation, thereby sustaining proinflammatory gene transcription. These lactate-mediated processes collectively amplify local inflammation and contribute to the persistence of nasal symptoms.Glycolytic reprogramming in epithelial cells is modulated by the EGF/EGFR pathway, and its dysregulation may result in disrupted tight junctions, abnormal goblet cell hyperplasia, and subsequent tissue remodeling. Substance P and calcitonin gene-related peptide released from sensory neurons, in conjunction with metabolic products, synergistically maintain persistent inflammatory stimulation by activating mast cells, forming a neuro-immune-metabolic regulatory network that drives disease chronicity.From a therapeutic perspective, glycolytic inhibitors such as 2-deoxyglucose, FX11, and 3-bromopyruvate exert anti-inflammatory effects by targeting key enzymes including HK2 and LDHA, each with distinct mechanisms: 2-DG competitively inhibits hexokinase, FX11 selectively targets LDHA to reduce lactate production, and 3-BrPA modulates multiple glycolytic enzymes. Moreover, traditional Chinese medicine formulas, monomeric active components, and small-molecule compounds have shown promising potential in alleviating nasal inflammation by regulating the mTOR-HIF-1α axis, exerting antioxidant effects, and modulating endoplasmic reticulum stress pathways. The multi-target characteristics of these natural products offer advantages in addressing the complex pathophysiology of nasal inflammatory diseases.Despite these advances, several challenges remain. The non-selective inhibition of glycolysis may interfere with epithelial repair and mucosal regeneration, leading to delayed wound healing. Technical limitations in dynamic metabolic monitoring and sampling precision hinder the accurate assessment of local nasal metabolism. Furthermore, current animal models, which predominantly rely on acute stimulation protocols, inadequately recapitulate the chronic tissue remodeling processes characteristic of human rhinitis.This review systematically summarizes glycolysis as a common metabolic node shared by different rhinitis subtypes, offering a novel theoretical basis for the development of precision therapeutic strategies targeting metabolic reprogramming.

Objective To analyze the epidemiological and spatial clustering characteristics of varicella in Changzhou from 2018 to 2024, and to provide a theoretical support for the formulation of prevention and control measures. Methods The reported case information of varicella in Changzhou from 2018 to 2024 was collected through the China Information System for Disease Control and Prevention, and the three-dimensional distribution characteristics were analyzed. The incidence trend was analyzed by Joinpoint regression, and the spatial autocorrelation analysis was performed by Arc GIS 10.5 software. The spatiotemporal scanning analysis was carried out with SaTScan 10.1.2 software. Results From 2018 to 2024, a total of 42,132 cases of varicella were reported in Changzhou, with an average annual incidence of 116.25/100,000. The reported incidence showed a downward trend, with an annual percentage change (APC) of -21.96% (95%C1: -32.63%~-9.33%, P<0.01). The incidence showed a ^“bimodal distribution^”, and the age group was mainly under 15 years old (29,086 cases, accounting for 69.04%). The difference in incidence between men and women was statistically significant (χ²= 92.83, P<0.001), and the incidence gradually decreased with age ( χ²_trend=112771.44, P<0.001). Global autocorrelation analysis showed that there was spatial aggregation in the six years (P<0.05), and local autocorrelation analysis showed that most of the towns (streets) in the three central urban areas of Tianning District, Zhonglou District, and Xinbei District, as well as some towns (streets) in Liyang City, Wujin District, and Economic Development Zone were high-high aggregation areas. Spatiotemporal scanning analysis showed that the first type of aggregation area was most of the towns (streets) in Tianning District, Zhonglou District and Xinbei District (23, accounting for 92%), and some towns (streets) in Wujin District and Economic Development Zone (RR=3.76, P<0.001), and the second type of aggregation area was most of the towns (streets) in Liyang City (7, accounting for 70%) (RR=3.66, P<0.001). Conclusion The reported incidence of varicella in Changzhou City shows a downward trend, with multiple spatial and temporal clusters. The prevention and control of varicella in high-risk clustering areas, peak hours and high-risk populations should be strengthened, and intervention measures should be taken as soon as possible.

Aberrant activation of glycolysis represents a key metabolic mechanism underlying the initiation and progression of nasal inflammation. Allergic rhinitis, chronic rhinosinusitis, and vasomotor rhinitis exhibit distinct etiologies, yet all are characterized by inflammatory responses, impaired epithelial barrier function, and neurovascular dysregulation, in which glycolytic metabolic reprogramming acts as a central hub connecting immunometabolism and inflammatory regulation.Recent evidence indicates that glycolysis-dependent activation of immune cells provides the essential energy basis for inflammatory onset. In dendritic cells, eosinophils, mast cells, and Th2 cells, the expression of key glycolytic enzymes including HK2, PKM2, and LDHA is upregulated, thereby promoting cellular activation and proinflammatory cytokine release via the mTOR-HIF-1α signaling axis. Notably, the metabolic reprogramming of eosinophils prolongs their survival and enhances the release of cytotoxic granules, while in mast cells, enhanced glycolysis facilitates IgE-mediated degranulation and histamine release. Furthermore, glycolysis also influences the Th17/Treg balance, with enhanced glycolytic flux promoting Th17 differentiation and contributing to the heterogeneous inflammatory profiles observed across different rhinitis subtypes.As a central metabolite, lactate contributes to the formation of a metabolism-inflammation vicious cycle through multiple mechanisms. Lactate acidifies the local microenvironment to activate TRPV1 channels and facilitate neuropeptide release, mediates immune cell chemotaxis through GPR81, and regulates gene expression via histone lactylation, thereby sustaining proinflammatory gene transcription. These lactate-mediated processes collectively amplify local inflammation and contribute to the persistence of nasal symptoms.Glycolytic reprogramming in epithelial cells is modulated by the EGF/EGFR pathway, and its dysregulation may result in disrupted tight junctions, abnormal goblet cell hyperplasia, and subsequent tissue remodeling. Substance P and calcitonin gene-related peptide released from sensory neurons, in conjunction with metabolic products, synergistically maintain persistent inflammatory stimulation by activating mast cells, forming a neuro-immune-metabolic regulatory network that drives disease chronicity.From a therapeutic perspective, glycolytic inhibitors such as 2-deoxyglucose, FX11, and 3-bromopyruvate exert anti-inflammatory effects by targeting key enzymes including HK2 and LDHA, each with distinct mechanisms: 2-DG competitively inhibits hexokinase, FX11 selectively targets LDHA to reduce lactate production, and 3-BrPA modulates multiple glycolytic enzymes. Moreover, traditional Chinese medicine formulas, monomeric active components, and small-molecule compounds have shown promising potential in alleviating nasal inflammation by regulating the mTOR-HIF-1α axis, exerting antioxidant effects, and modulating endoplasmic reticulum stress pathways. The multi-target characteristics of these natural products offer advantages in addressing the complex pathophysiology of nasal inflammatory diseases.Despite these advances, several challenges remain. The non-selective inhibition of glycolysis may interfere with epithelial repair and mucosal regeneration, leading to delayed wound healing. Technical limitations in dynamic metabolic monitoring and sampling precision hinder the accurate assessment of local nasal metabolism. Furthermore, current animal models, which predominantly rely on acute stimulation protocols, inadequately recapitulate the chronic tissue remodeling processes characteristic of human rhinitis.This review systematically summarizes glycolysis as a common metabolic node shared by different rhinitis subtypes, offering a novel theoretical basis for the development of precision therapeutic strategies targeting metabolic reprogramming.

OBJECTIVE To explore the antidepressant mechanism of Wenyang jieyu granules （WYJYG） via the NOD-like receptor thermal protein domain associated protein 3 （NLRP3）/apoptosis-associated speck-like protein containing a CARD （ASC）/Caspase-1 pathway. METHODS A rat model of depression was established by chronic unpredictable mild stress combined with single-housing for 42 consecutive days.The experiment set up blank group， model group， MCC950 （NLRP3 inflammasome inhibitor） group （10 mg/kg）， fluoxetine group （positive control，2.08 mg/kg），low-dose WYJYG（3.78 g/kg） and high-dose WYJYG group （7.56 g/kg），with 10 rats in each group. From the 22nd day of the experiment， rats in the fluoxetine group， low-dose and high-dose WYJYG groups were intragastrically administered with the corresponding drugs and intraperitoneally injected with an equal volume of normal saline. Rats in the MCC950 group were intraperitoneally injected with MCC950 at the corresponding concentration and intragastrically administered with an equal volume of distilled water. Rats in the blank group and model group were given an equal volume of distilled water by gavage and an equal volume of normal saline by intraperitoneal injection. All interventions were performed once a day for 21 consecutive days. Behavioral tests were conducted once a week. After the last administration， the contents of ASC， ionized calcium binding adaptor molecule 1 （Iba1）， interleukin-1β （IL-1β）， and IL-18 in hippocampal tissues were detected. The protein expressions of NLRP3， cluster of differentiation 68 （CD68）， Caspase-1， B-cell lymphoma-2 （Bcl-2）， and Bcl-2-associated X protein were determined， and neuronal apoptosis was observed. RESULTS After the last administration， compared with the model group， the open-field activity time was significantly prolonged （ P ＜0.05）， and the latency to feed in a novel environment was significantly shortened （ P ＜0.05） in rats of the high-dose WYJYG group. In hippocampal tissue， the contents of ASC， Iba1， IL-1β， and IL-18， as well as the protein expression levels of NLRP3， Caspase-1， and CD68， and the positive rate of neuronal apoptosis were all significantly decreased/downregulated （ P ＜0.05）. Bcl-2 protein expression was significantly upregulated （ P ＜0.05）， and the density of neuronal apoptosis-positive cells was significantly reduced （ P ＜0.05）. CONCLUSIONS WYJYG play on antidepressant role by inhibiting the NLRP3/ASC/Caspase-1 pathway， reducing microglia-mediated neuroinflammation， and inhibiting hippocampal neurons apoptosis.

Introduction: Carcinoid syndrome is a hormonal complication accompanying neuroendocrine tumors (NETs) and is defined by chronic diarrhea and/or flushing in the presence of systemically elevated levels of serotonin or its metabolite 5-hydroxyindolacetic acid. The condition is often diagnosed late because of nonspecific symptoms, and many patients present with metastatic disease. This was a retrospective review of patients with carcinoid syndrome who were followed up at the Endocrine Clinic, Putrajaya Hospital, up to date. Case: Three women aged between 30 and 40 years were diagnosed with carcinoid syndrome secondary to metastatic NETs. Two cases were diagnosed before and during their pregnancies, resulting in one successful pregnancy while another required termination of pregnancy. All patients presented with symptomatic disease, predominantly flushing and chronic diarrhea and abdominal distension, leading to the diagnosis within the same year to as long as a decade after symptomatology. All were found to have extensive liver and nodal metastases at diagnosis. Liver biopsy showed tumor grade 1 in two of the cases, while the case with tumor grade 2 exhibited an aggressive disease course with carcinoid heart disease and bone metastases. None were amenable to surgery. Somatostatin analogues (SSAs) were the mainstay of treatment, administered every 2–4 weeks and titrated according to clinical response. Cytotoxic chemotherapy and bone-targeted agent were given for the case with rapid disease progression and skeletal-related event. Somatostatin analogue radiolabeled peptide therapy (PRRT) was reserved for symptom control in progressive disease refractory to first-line SSAs, after assessment with PET-Ga68 DOTATATE imaging. Conclusion This case series highlights delayed diagnosis and advanced presentation due to its nonspecific symptoms. The occurrence in young women, including during pregnancy, underscores the complexity of management and the need for individualized multidisciplinary care, with somatostatin analogues, systemic therapy, and PRRT playing key roles in symptoms control and disease progression.

Introduction: Palpation thyroiditis is an underrecognized condition that occurs after parathyroidectomy. Symptoms range from mild to overt thyrotoxicosis that may result in lifethreatening cardiac arrhythmias and acute coronary syndrome. Diagnosis is made by having suppressed thyroid-stimulating hormone (TSH) and elevated free thyroxine 4 (fT4) or free thyroxine 3 (fT3) and low radionuclide uptake on thyroid scan. Case: We report a case of a 72-year-old female with underlying end-stage renal disease on regular hemodialysis who underwent total parathyroidectomy for tertiary hyperparathyroidism. Her thyroid function test (TFT) preoperatively was normal, and cardiac assessment showed normal echocardiogram findings and sinus rhythm on electrocardiogram. Her operation was uncomplicated, involving neck exploration and all 4-gland removal. Postoperatively, she had new-onset atrial fibrillation (AF) with rapid ventricular response at day 5, requiring electrical and chemical cardioversion. She had recurrent tachyarrhythmias on day 6. Her repeated TFT showed suppressed TSH, 0.036 mIU/L (NR 0.38–5.33) and raised fT4, 35.4 pmol/L (NR 7.9–14.4), fT3–fT4 ratio 0.26 (<0.3), consistent with thyrotoxicosis. She was treated as thyroid storm (Burch-Wartofsky Point Scale 45), after ruling out other causes. She was started on glucocorticoids, propylthiouracil, and Lugol’s iodine. Despite biochemical improvement, she continued to develop recurrent AF up till Day 12 post-op, requiring multimodal treatment, including beta-blocker and antiarrhythmic agents. She was later discharged well on low-dose carbimazole. Her ultrasound neck showed a normal thyroid gland, and her thyroid antibodies were negative. Conclusion A high level of suspicion is needed to detect thyroiditis post-parathyroidectomy due to its potential adverse impact on surgical outcomes. Treatment is mainly symptomatic, and the disease is self-limiting. Risk factors identified include secondary/tertiary hyperparathyroidism and bilateral neck exploration that involves manipulation of the thyroid gland.

Objective To explore the feasibility and safety of ultrasound-guided percutaneous microwave ablation for unresectable pancreatic cancer.Methods Totally 84 patients who underwent ultrasound-guided percutaneous microwave ablation for unresectable pancreatic cancer were enrolled,and the technical success rate,complete ablation rate,complication rate,pain relief rate and survival time,etc.were observed.Results The median age of 84 cases was 61.5 years.Totally 86 tumors,including 44.19％(38/86)at the head/neck and 55.81％(48/86)at the body/tail of pancreas were detected,and a total of 85 ablation sessions were performed with the median ablation energy applied per tumor of 9.90(1.08,21.60)kJ and the complete ablation rate of 42.86％(36/84).The technical success rate was 100％(85/85).Thirty-nine complication events occurred in 25 cases,no ablation-related death.Among 34 patients underwent ablation mainly for pain symptoms,the pain score decreased from(6.22±1.12)points before treatment to(1.94±1.64)points after treatment(P＜0.001).During 6.8(3.3,12.9)months' follow-up,the mean survival time was(8.5±6.7)months,and all 47 patients died due to tumor progression.Conclusion Ultrasound-guided percutaneous microwave ablation was safe and feasible for unresectable pancreatic cancer.