Sensor-augmented pump (SAP) therapy has evolved sequentially, but long-term clinical evidence supporting these advances has remained limited. We here evaluated the impact of updates to SAP therapy on glycemic outcomes in individuals with type 1 diabetes. This retrospective observational study (SAP-J T1D) included Japanese individuals with type 1 diabetes receiving SAP therapy. Treatment efficacy of the MiniMed 620G, 640G, and 770G systems (Medtronic) was evaluated at three predefined time points: baseline (before the switch from 620G to 640G), before the switch from 640G to 770G, and 1 year after the switch to 770G. The primary outcome was the change in time in range (TIR) for continuous glucose monitoring from baseline to 1 year after the transition to the MiniMed 770G system. A total of 47 participants were included in the analysis. The median age was 45 years (interquartile range, 33-56 years), and the median body mass index was 22.3 kg/m2 (20.4-23.7 kg/m2). TIR increased progressively with each system update, from 69.0% (61.5-75.5%) with MiniMed 620G, to 72.0% (63.5-79.0%) with MiniMed 640G, and to 77.0% (73.0-80.5%) with MiniMed 770G. Time below range decreased after the switch to MiniMed 640G, whereas time above range decreased after that to MiniMed 770G. Time in tight range increased after the transition to the MiniMed 770G system. Sequential updates in SAP therapy were associated with stepwise improvements in glycemic management, reflecting the distinct functional characteristics of each system.
The role of the nurse in the heart failure (HF) multi-disciplinary team (MDT) has become well-established, with clear evidence of improved patient outcomes and recommended by professional guidelines. Recognizing the change in the HF landscape since the publication of the first Heart Failure Association (HFA) of the European Society of Cardiology (ESC) HF nurse curriculum in 2016, and the expanding role of HF nurses of in the HF MDT, the HFA in collaboration with the Association of Cardiovascular Nursing and Allied Professions (ACNAP) of the ESC prioritized this update to the curriculum. Standardized training programmes for HF nurses improve the quality of care provided to patients with HF and their caregivers. Recognizing the variability of education background and clinical autonomy across Europe and beyond, this curriculum is designed in a flexible way to be able to be adapted and adjusted based on individual country regulations and forms. Endorsement of this curriculum from national professional bodies or Nursing Councils would ensure uniformity and enhance the profession's contribution to HF care. The updated specialist HF nurse curriculum provides the basis for the advanced level of knowledge, skills and attitudes required for the appropriate expansion of the role of the HF nurse that can be adapted across Europe and beyond, while complying with professional legislation of different healthcare systems and supporting nurses who move between countries.
Sugar sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and fruit and vegetable juices are consumed worldwide, yet their associations with cancer remain unclear. Within World Cancer Research Fund International's Global Cancer Update Programme (CUP Global), we conducted a systematic review by searching PubMed and Embase until September 2024 for cohort studies of SSBs, ASBs, and juices and cancer risk. Meta-analyses were conducted to calculate the relative risks (RRs) and 95% CIs per 1 serving/day (355 mL for SSBs/ASBs; 177 mL for juices). Evidence was graded by the CUP Global Expert Panel. The CUP Global standard protocol was registered at: https://osf.io/7utbm/ . We identified 158 publications from 51 cohorts. There was evidence of a probable causal positive association for SSBs, including carbonated SSBs, with pancreatic cancer incidence (RR 1.09 [95% CI 1.01-1.16]; I 2 =8%, n=18 studies), and for SSBs with colorectal cancer incidence (RR 1.07 [95% CI 1.00-1.14]; I 2 =41%, n=13). Limited suggestive evidence supported positive associations of SSBs with ovarian (RR 1.61 [95%CI 1.03-2.53]; I 2 =0%, n=2), endometrial (RR 1.21 [95%CI 1.03-1.42]; I 2 =0%, n=3), and postmenopausal breast cancer incidence (RR 1.05 [95%CI 1.00-1.10] ; I 2 =0%, n=6), and of carbonated ASBs with leukaemia incidence (RR 1.29 [95%CI 1.01-1.64]; I 2 =0%, n=2). There was evidence of a probable causal positive association for orange juice with different types of skin cancer including melanoma (RR 1.21 [95%CI 1.08-1.34]; I 2 =0%, n=4), and basal (RR 1.12 [95%CI 1.06-1.17]; I 2 =46%, n=2) and squamous cell carcinoma (RR 1.13 [95%CI 1.04-1.24]; I 2 =0%, n=2). An interactive evidence platform is available at: https://teacup.cc.ic.ac.uk/soft-drinks-cancer.html . This review provides evidence supporting probable causal associations of SSBs with pancreatic and colorectal cancers, and of orange juice with skin cancers, with additional suggestive evidence for SSBs with other obesity-related cancers, extending concerns about sugary drink consumption beyond cardiometabolic health to cancer risk. World Cancer Research Fund network of charities (American Institute for Cancer Research; World Cancer Research Fund; Wereld Kanker Onderzoek Fonds).
To update the pooled diagnostic accuracy and safety of cone-beam computed tomography (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) for pulmonary lesions. PubMed, Embase, and Cochrane CENTRAL were searched through April 2026 for studies of CBCT-guided PTNB including ≥ 10 patients. Sensitivity and specificity were pooled using a bivariate random-effects model. Complication rates (pneumothorax and pulmonary hemorrhage, encompassing both clinically significant hemoptysis and radiographic perilesional change) were pooled using generalized linear mixed models. Heterogeneity and publication bias were assessed. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies, used the Quality Assessment of Diagnostic Accuracy Studies 2, and was prospectively registered in PROSPERO (CRD420261370382). Twenty-four studies were eligible (k: 22 with extractable 2 × 2 data; n = 3,681; 2010-2026). Pooled sensitivity was 92.2% [95% confidence interval (CI): 90.4-93.7] and pooled specificity was 96.7% (95% CI: 94.3-98.2). The summary receiver operating characteristic area under the curve was 0.974. Pneumothorax incidence was 18.4% [95% CI: 15.5-21.7; prediction interval (PI) 8.3-35.8%]. Hemorrhage incidence (k: 19) pooled at 6.1% (95% CI: 3.5-10.6); high heterogeneity (I2: 90.9%) reflected variation in outcome definitions. CBCT-guided PTNB demonstrates high diagnostic accuracy for pulmonary lesions. The pooled specificity should be interpreted as a plausible upper-bound estimate because of universal differential verification bias across the included studies. The wide pneumothorax PI (8-36%) indicates that complication rates may vary substantially across centers despite the precise pooled estimate.
High levels of sedentary behaviour are an emerging global public health concern, but its impact on cancer risk remains unclear. Within the Global Cancer Update Programme (CUP Global), we systematically searched the literature in PubMed and Embase until September 2024 for observational cohort studies on sedentary behaviour and adult cancer risk. Using dose-response meta-analyses, we investigated sedentary behaviour domains (total, occupational, recreational, transportation, and/or other) and dimensions (duration, frequency), and additionally pooled across domains. The quality of evidence was graded by the CUP Global Expert Panel (protocol registration: https://osf.io/7utbm/ ). We identified 62 publications from 27 cohorts comprising 162,902 incident cancer cases across 19 anatomical sites. There was evidence for a probable causal positive association between sedentary time (mixed definitions) and breast (RR per 2 hours/day =1.03; 95%CI=1.02-1.05; I 2 =10%; n=11 studies) and colon (RR=1.05; 95%CI=1.03-1.07; I 2 =0%; n=9) cancer risk, and between television watching time and colon cancer risk (RR per 2 hours/day =1.08; 95%CI=1.05-1.11; I 2 =0%; n=6). Limited suggestive evidence supported positive associations between sedentary time (mixed definitions) and lung (RR=1.04; 95%CI=1.00-1.09; I 2 =69%; n=7), ovarian (RR=1.06; 95%CI=1.01-1.10; I 2 =0%; n=7), premenopausal (RR=1.03; 95%CI=0.99-1.08; I 2 =20%; n=7) and postmenopausal breast (RR=1.02; 95%CI=1.00-1.04; I 2 =7%; n=11), and colorectal (RR=1.02; 95%CI=1.00-1.04; I 2 =47%; n=11) cancers, and between occupational sitting time and breast (RR per 2 hours/day =1.05; 95%CI=1.01-1.09; I 2 =0%; n=4) and colon (RR=1.08; 95%CI=1.02-1.15; I 2 =28%; n=2) cancers. An interactive evidence platform is available at: https://teacup.cc.ic.ac.uk/sedentary-behaviour-cancer.html . Evidence supports that prolonged sedentary behaviour is probably a cause of breast and colon cancers, while limited suggestive evidence supports positive associations for several other exposure-cancer pairs, including lung and ovarian cancers. This evidence should lead to revised cancer prevention recommendations. Future research should focus on device-based exposure assessments, repeated measurements, exposure substitution models, inclusion of diverse populations and investigation of biological mechanisms. World Cancer Research Fund network of charities (American Institute for Cancer Research; World Cancer Research Fund; Wereld Kanker Onderzoek Fonds).
Neurodegeneration with Brain Iron Accumulation (NBIA) is a heterogeneous group of heritable, mostly recessive, progressive neurodegenerative diseases characterized by iron deposition in the basal ganglia and brainstem. There are no solid global epidemiological data on prevalence and incidence of NBIA subtypes, but registry data and expert opinion suggest PKAN, BPAN, PLAN, and MPAN are the most common subtypes. NBIA disorders present with a wide spectrum of clinical symptoms, including movement disorders (dystonia, parkinsonism, chorea), pyramidal involvement (eg, spasticity), speech and cognitive deficits, motor and cognitive slowing, and ocular abnormalities. Treatment remains symptomatic, though several new drugs are in development. Following our review published in 2021, this article provides an updated summary of recent developments. We discuss the rationale of new compounds, summarize clinical trials or-in their absence-preclinical studies for NBIA subtypes. The article is divided into two sections: one section on general approaches based on the shared feature of increased iron in the brain; and the second section on tailor-made, mechanistic treatments for the various NBIA subtypes targeting the specific molecular and cellular pathways of the affected enzyme including gene therapy. In summary, randomized controlled trials in NBIA have not yet demonstrated substantial benefit, neither for iron removal, in general, which appears to be clinically ineffective in most subtypes, except aceruloplasminemia; nor for subtype-specific approaches. Several ongoing studies are exploring more dedicated compounds in this exciting field.
PurposeTo evaluate the efficacy and safety of triple antithrombotic therapy (TT) versus dual antiplatelet therapy (DAPT) for prevention of left ventricular thrombus (LVT) following anterior myocardial infarction.MethodsWe conducted a systematic review and meta-analysis of randomized and observational studies comparing TT (DAPT plus anticoagulation) versus DAPT alone. The primary outcome was LVT formation. Secondary outcomes included all-cause mortality, stroke, systemic embolism, composite thromboembolism, bleeding, and net adverse clinical events (NACE). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. The protocol was registered in PROSPERO (CRD420261343867).ResultsSeven studies (2 randomized, 5 observational), including 2,273 patients (949 TT, 1,324 DAPT), were analyzed. TT was not associated with a reduction in LVT (OR 0.56, 95% CI 0.21-1.49; p=0.25; I2=59%). There was no significant difference in all-cause mortality (OR 0.75, 95% CI 0.27-2.06; p=0.58), ischemic cerebrovascular accidents (OR 1.17, 95% CI 0.20-6.79), systemic embolism (OR 0.69, 95% CI 0.27-1.75), or composite thromboembolism (OR 0.96, 95% CI 0.42-2.19). TT was associated with increased major bleeding (OR 2.82, 95% CI 1.40-5.68; p=0.004) and any bleeding (OR 2.58, 95% CI 1.73-3.85; p<0.001). There was no significant difference in NACE (OR 1.15, 95% CI 0.58-2.29).ConclusionIn anterior myocardial infarction, available evidence did not demonstrate a statistically significant reduction in LVT or thromboembolic events with TT compared with DAPT, while bleeding risk was increased. Given moderate heterogeneity, limited randomized evidence, and potential imaging-related under-detection of LVT, these findings do not support routine prophylactic TT and favor individualized risk-benefit assessment.
This meta-analysis compares the efficacy and safety of catheter ablation with antiarrhythmic therapy for atrial fibrillation (AF) in randomized controlled trials (RCTs) We systematically searched PubMed, Web of Science, Google Scholar, Embase, and Cochrane Library for RCTs published in English. Studies comparing catheter ablation (radiofrequency or cryoablation) with antiarrhythmics for rate or rhythm control in adults with AF were included. Data were independently extracted by two investigators. The quality of evidence was assessed using GRADE analysis. 18 RCTs involving 3725 patients were included. The overall risk of bias was adjudicated to be "low." On meta-analysis, catheter ablation significantly increased the likelihood of being free from recurrent atrial arrhythmia, with a 49% reduction rate over a median follow-up of 12 months (RR: 0.51; 95% CI: 0.42-0.63; P < 0.00001). The risk of developing serious adverse events was similar in patients undergoing catheter ablation or receiving antiarrhythmics (RR: 0.88; 95% CI: 0.77-1.01; P = 0.06). However, the mortality risk over a median follow-up of 12 months was higher in patients with AF receiving antiarrhythmic drugs than in those undergoing catheter ablation (RR: 0.74; 95% CI: 0.58-0.94; P = 0.01). The evidence was found to be of "high" quality on GRADE analysis. It was concluded that catheter ablation is more effective than antiarrhythmic drugs in managing AF due to a lower risk of recurrence. Although it has a similar likelihood of serious adverse effects, the mortality risk is lower over a median follow-up of 12 months.
The treatment landscape for relapsed or refractory multiple myeloma (RRMM) has evolved significantly with the introduction of T cell-redirecting therapies. This review details key pharmacology, clinical efficacy, and safety information for bispecific antibodies (bsAbs) approved or under investigation for RRMM. Multiple myeloma eventually relapses in nearly all patients, necessitating the continuous development of novel therapeutics. The 3 main targets for bsAbs on multiple myeloma cells are B cell maturation antigen (BCMA), G-protein-coupled receptor family C group 5 member D (GPRC5D), and Fc receptor homolog 5 (FcRH5). Clinical trials have demonstrated robust single-agent efficacy in patient populations with difficult-to-treat RRMM, including in patients with penta-refractory disease. However, these therapies are associated with unique toxicities, including cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, as well as significant infection risks. Risk can be reduced through close monitoring, optimized premedication regimens, and step-up dosing strategies. The remarkable efficacy of bsAbs in RRMM combined with a maturing understanding of their toxicity profiles is fundamentally reshaping the RRMM treatment landscape.
In recent years, biopesticides have emerged as a transformative approach to mosquito vector control, offering an eco-friendly alternative that addresses both the growing challenge of insecticide resistance and ecological concerns. Biopesticides extracts from natural sources or their secondary metabolites, botanical extracts, entomopathogenic fungi, and biocides from a broad class of bacteria, including Bacillus thuringiensis israelensis (Bti), have shown high efficacy against a variety of mosquito species, including those that are multiple or cross-resistant to conventional chemical insecticides. Microbial biopesticides, including bacterial agents such as Bacillus bassiana (Bs) and Metarhizium anisopliae, and viral pathogens, disrupt the life cycle of mosquitoes by specific modes of action: Bti produces cry and cyt toxins that lyse midgut epithelium, and neem-extract azadirachtin inhibits ecdysone signaling, reducing fecundity. Novel microbial biopesticides not only kills insecticide-resistant mosquitoes but also acts synergistically with chemical insecticides, disrupting mosquito host-seeking behavior and pathogen transmission. Field trials demonstrate 80-100% larval reduction with Bti in treated water bodies with effects 2-4 weeks, and fungi achieve 60-85% adult mortality. Recent advances include the development of novel formulations, such as combining Bti with a fungal pathogen such as Lagenidium giganteum to increase larvicidal activity and reduce the likelihood of resistance. These biopesticides minimize non-target effects and support sustainable disease management in the face of an increasing malaria burden. This comprehensive review focused on biopesticides which are more effective, safer and eco-friendly and provides a recent integrated framework that links human, animal and environmental health and improves the effectiveness of mosquito control. © 2026 Society of Chemical Industry.
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Metabolic dysfunction-associated steatotic liver disease (MASLD) and male hypogonadism are increasingly prevalent, metabolically interrelated conditions. Testosterone (T) deficiency has been implicated in hepatic lipid dysregulation, insulin resistance, and visceral adiposity, whereas MASLD may impair the hypothalamic-pituitary-gonadal axis. We conducted a systematic review and meta-analysis to evaluate the bidirectional association between circulating T levels and MASLD in adult men. Following PRISMA guidelines, a literature search was performed from inception to July 31, 2025. Twenty-eight studies met the inclusion criteria (9 comparing hypogonadal vs. eugonadal men; 19 comparing MASLD vs. non-MASLD men). Random-effects models were used to pool effect sizes for dichotomous and continuous outcomes. Meta-regression analyses assessed the influence of age, anthropometric features, glycemic markers, liver enzymes, and hormonal parameters. Hypogonadal men showed a significantly higher prevalence of MASLD than eugonadal men (p = 0.001) and exhibited higher fatty liver index scores (p < 0.001). Total T concentrations were significantly lower in men with MASLD than in controls (p = 0.014). Meta-regression analyses did not identify significant effects of study-level differences in age, body mass index, or biochemical variables on the observed associations. Sex hormone-binding globulin levels were also significantly reduced in MASLD (p < 0.001), with age emerging as the only significant modifier. No significant differences were observed for luteinizing hormone, estradiol, or fibrosis-4 index. Across studies evaluating MASLD severity, moderate-to-severe disease was associated with lower T levels, particularly in analyses based on imaging. This meta-analysis supports a clinically relevant association between testosterone deficiency and MASLD, although evidence for the bidirectional nature of this relationship remains asymmetric but supports a clinically relevant endocrine-hepatic axis. T deficiency appears independently linked to MASLD onset and severity beyond the effects of age and adiposity. These findings underscore the need for reciprocal screening of liver health and gonadal status in at-risk men and highlight the importance of prospective studies and randomized trials to determine whether correcting T deficiency may modify MASLD progression.
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The aim of this paper is to evaluate fellowship outcomes 10 years after implementation of the European Association of Urology Robotic Section (ERUS) structured curriculum for robot-assisted radical prostatectomy (RARP), with a focus on completion rates and reasons for non-completion. Data were obtained from institutional records and a trainee survey. The primary outcome was fellowship completion (i.e., Certificate of Excellence achievement). Secondary outcomes included reasons for non-completion and satisfaction. Completion rates were analysed annually, with trends assessed using the Cochran-Armitage test and log-linear regression for the Estimated Annual Percentage Change (EAPC). Comparisons before and after introduction of a procedural diary (2023) and between pandemic and non-pandemic years used Fisher's Exact Test. Among 126 fellows, a total of 42 (33%) completed the fellowship by achieving the Certificate of Excellence. The trainee survey achieved a response rate of 77%, supporting the representativeness of the collected data. The main barriers to fellowship completion included limited console access (49%), insufficient programme duration (20%), logistical difficulties (20%) and COVID-19-related disruptions (11%). Despite these limitations, overall satisfaction with the fellowship was high (83%), with particularly strong approval of the ORSI hands-on training week (100%). Completion rates demonstrated a progressive increase over time, rising from 20% in 2018 to 52% in 2023. The Cochran-Armitage test confirmed a statistically significant upward trend in completion rates over the study period (p < 0.001), while log-linear regression analysis showed a numerical but non-significant EAPC of 13% (95% CI -0.6 to 28.6). Although 2023 represented the highest observed completion rate, this peak was not significantly different from previous years (OR 2.63, 95% CI 0.91-7.63). The RARP ERUS Fellowship remains a benchmark in robotic training, but unsatisfactory completion rates highlight the need for improvement. Recent reforms, including the procedural diary, show promise and warrant expansion.
Diabetes is a common health challenge. Previous studies have established that diabetes is often associated with low circulating magnesium status. As evidence from randomized controlled trials (RCTs) on the effect of magnesium supplementation on insulin resistance remains inconsistent, and the influence of baseline status is not fully understood, this systematic review and meta-analysis evaluated the effects of magnesium supplements, compared with placebo, on insulin resistance in individuals with diabetes and pre-diabetes. A comprehensive search based on the PRISMA 2020 guidelines was conducted in PubMed, Web of Science, and Scopus until 24 April 2026. Randomized controlled trials with a population of individuals with diabetes and pre-diabetes that received any magnesium supplements compared to a placebo group, evaluating insulin and the HOMA-IR index as the primary outcome, were included in our study. Secondary outcomes were serum magnesium level, HbA1c, and fasting blood glucose (FBG). We pooled data using a random-effects model to estimate changes in outcomes. Subgroup analyses were conducted based on dosage (> 250 and ≤ 250 mg/day) and follow-up duration (under or over 12 weeks). Meta-regression, publication bias, and sensitivity analysis were performed as well. Fifteen RCTs involving 1,085 participants met the criteria. Overall, the oral magnesium supplementation did not result in a statistically significant change in insulin levels (MD = - 1.73; 95% CI: -3.73 to 0.27; p-value = 0.09) and HOMA-IR (MD = - 0.74; 95% CI: -1.58 to 0.09; p-value = 0.08) in people with diabetes. Similar non-significant findings were observed in individuals with prediabetes (p > 0.05). However, meta-regression analysis demonstrated that baseline insulin level and HOMA-IR index significantly modified the intervention effect (p = 0.01), suggesting differential responsiveness across patient subgroups. No significant associations were observed for baseline HbA1c, fasting blood glucose, magnesium levels, age, or BMI. Subgroup analysis based on doses and duration of follow-up did not change the significance of the result. Magnesium supplementation does not appear to improve insulin resistance in individuals with diabetes or prediabetes significantly. However, its effects may depend on baseline insulin status, highlighting the need for targeted interventions in individuals with higher insulin resistance. Future well-designed trials with larger sample sizes are needed to clarify baseline insulin effects.
[This corrects the article DOI: 10.1177/1759720X261436463.].
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, represents the leading cause of chronic liver disease globally. The increasing prevalence of the metabolic syndrome has driven a parallel rise in MASLD-related morbidity and mortality. Accurate assessment of liver fibrosis remains crucial, as liver fibrosis stage is the strongest predictor of adverse clinical outcomes. Liver biopsy, considered the gold standard for assessing liver fibrosis, is invasive and has limitations, prompting the need for reliable noninvasive alternatives. Serum-based biomarkers have emerged as practical tools for assessing liver fibrosis in MASLD. Conventional indices, including the Fibrosis-4 Index, Nonalcoholic Fatty Liver Disease Fibrosis Score, and aspartate aminotransferase-to-platelet ratio index, are widely used for initial risk stratification due to their simplicity and accessibility. Advanced panels, such as the Enhanced Liver Fibrosis test and the PRO-C3-based ADAPT score, offer improved diagnostic performance but face barriers of cost and limited availability. Novel assays, including the NIS2+™ panel, demonstrate high accuracy for identifying patients with at-risk metabolic dysfunction-associated steatohepatitis. Some biomarkers are currently incorporated in clinical guidelines, though many emerging biomarkers need further validation. There is promise that serum biomarkers can be effectively used to monitor long-term liver disease progression and regression in the future. Serum biomarkers provide an effective, noninvasive approach for evaluating liver fibrosis in MASLD. Continued refinement and validation of these assays are essential to standardize cutoff thresholds and improve clinical applicability.
Hopfield networks retrieve stored patterns through recurrent nonlinear updates, and later associative-memory variants broaden this design space through alternative nonlinear retrieval rules. Resonator networks use an analogous iterative procedure to solve vector-symbolic factorization: each factor estimate is updated by unbinding the current estimates of the other factors and applying a cleanup rule against the corresponding codebook. This perspective suggests a family of resonator networks indexed by the cleanup nonlinearity. We study four variants-sign cleanup, ReLU cleanup, polynomial cleanup, and softmax cleanup-and compare their factorization capacity, terminal failure modes, convergence behavior, empirical complexity, hyperparameter sensitivity, matched-dimensionality FHRR behavior, sign-projection choices, internal update noise, and neural-output decomposition on visual scene data. Across these evaluations, the cleanup nonlinearity changes both the capacity transition and the dominant failure mode. These results motivate treating resonator networks as a family of modern Hopfield-inspired factorization dynamics rather than as a single update rule.
Endometriosis is a chronic estrogen-dependent gynecological disorder characterized by the ectopic growth of endometrial-like tissue outside the uterine cavity, affecting approximately 10% of women of reproductive age worldwide. It is a leading cause of chronic pelvic pain, dysmenorrhea, and infertility, imposing a substantial burden on individual health and healthcare systems. Despite decades of research, the pathogenesis of endometriosis remains incompletely elucidated, and clinical management is often limited by delayed diagnosis and suboptimal treatment efficacy. This review provides a comprehensive and updated overview of endometriosis, covering its updated epidemiology, established and emerging risk factors, and key molecular mechanisms including inflammation, epigenetic regulation, hormonal imbalance, oxidative stress, and abnormal cell invasion and proliferation. We further summarize current diagnostic approaches, including imaging modalities, laparoscopy, and biomarkers, as well as clinical management strategies such as hormonal therapy, surgical intervention, and emerging targeted treatments. Finally, we discuss existing diagnostic and therapeutic challenges, unresolved questions, and future directions toward precision medicine and noninvasive management. This review aims to integrate recent advances and provide an updated framework for understanding and improving the clinical care of endometriosis. This review also highlights actionable translational directions for noninvasive early diagnosis, precision targeted therapy, and postoperative recurrence prevention, providing a key theoretical framework for translating basic research findings into clinical practice.
Cardiovascular genomics is producing rapidly expanding genetic, molecular, phenotypic and clinical data, yet relevant evidence remains fragmented across resources and difficult to translate into actionable biological and ultimately translational knowledge. HeartBioPortal (HBP) is a browser-based cardiovascular knowledge environment that was developed to address this problem by organizing omics, variant, phenotype and clinical evidence centered around gene queries. Here we describe HBP 3.0, a major update that expands both the data architecture and interpretive interface. This update introduces DataHub, a reproducible data-engineering layer for source ingestion, standardization, variant-centered aggregation, provenance tracking and compact serving artifacts. The release integrates cardiovascular clinical practice guideline context through a graph-backed clinical knowledge layer; incorporates cardiovascular summary statistics from the Million Veteran Program and public aggregate resources; expands source-preserving population frequency, variant annotation and structural-variant; and adds gene profile, drug-discovery and protein-context layers. HBP 3.0 incorporates 594.3 million allele-frequency observations across 18.1 million rsIDs, 3.04 million exon-enriched structural-variant records, 66.9 thousand protein isoforms with 3.26 million non-exon protein feature annotations, 17,128 gene-drug records, and a clinical guideline knowledge graph with 42,895 entities and 106,304 relationships. The redesigned gene dossier view combines phenotype filtering, annotation composition, persistent selected-detail panels and exportable chart data in one workflow. HBP 3.0 is designed to help cardiovascular and eventually cardiometabolic researchers move from a genetic or genomic signal to biological knowledge and potentially clinical and therapeutic context while preserving source provenance and interpretive boundaries. Database URL: https://www.heartbioportal.com/.