Home Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
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Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature

  • Yuchen Zhang and Anxin Li EMAIL logo
Published/Copyright: April 23, 2025
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Open Medicine
From the journal Open Medicine Volume 20 Issue 1

Abstract

Background

Comorbid type 2 diabetes mellitus (T2DM), severe obesity, and chronic myeloid leukemia (CML) present therapeutic challenges, especially given the limited data on glucagon-like peptide-1 (GLP-1) receptor agonists in this setting.

Methods

We describe a 33-year-old female with poorly controlled T2DM (HbA1c 10.7%), severe obesity (BMI 47.05 kg/m2), and stable CML on tyrosine kinase inhibitor therapy. She received once-weekly semaglutide (0.5–1.5 mg) for 6 months, alongside insulin glargine and dapagliflozin/metformin. Clinical, biochemical, and molecular parameters were monitored.

Results

After 6 months, her HbA1c declined from 10.7 to 5.5%, fasting plasma glucose from 16.2 to 5.3 mmol/L, and body weight decreased by 18 kg. Lipid parameters improved, and molecular analysis confirmed continued CML remission (undetectable BCR-ABL1). The patient experienced only mild, transient gastrointestinal side effects.

Conclusion

In this complex case, semaglutide proved safe and effective for achieving glycemic control and weight reduction without compromising CML stability. These findings suggest that GLP-1 receptor agonists may be a viable therapeutic option for patients with coexisting T2DM, severe obesity, and stable CML, warranting further investigation in broader populations.

Keywords: type 2 diabetes mellitus; obesity; glucagon-like peptide-1 receptor agonists; chronic myelogenous leukemia; semaglutide

1 Introduction

Obesity is defined by the Obesity Medicine Association as a chronic, progressive, recurrent, and treatable multi-factorial neurobehavioral disease, with a body mass index (BMI) of 30 kg/m2 or greater. This condition is characterized by adipose tissue dysfunction and abnormal physical forces from excessive fat mass, leading to a spectrum of adverse metabolic, biomechanical, and psychosocial health outcomes [1]. Epidemiological evidence suggests a relentless increase in obesity prevalence, with rates more than doubling in over 70 countries since 1980 [2].

Chronic myeloid leukemia (CML) is primarily driven by the Philadelphia (Ph) chromosome, resulting from a translocation that fuses the BCR and ABL genes, producing the BCR-ABL1 fusion protein with enhanced tyrosine kinase activity [3,4]. The advent of tyrosine kinase inhibitors (TKIs) significantly improved survival rates and enabling patients to maintain chronic-phase disease with a normal life expectancy [3,5,6].

Obesity and type 2 diabetes mellitus (T2DM) significantly increase the risk and worsen the prognosis of various hematological malignancies. Obesity is associated with chronic inflammation and metabolic dysregulation, which can create a pro-inflammatory environment conducive to the development of blood cancers [7,8]. Similarly, T2DM contributes to cancer progression through hyperinsulinemia and hyperglycemia via activating pathways that enhance cancer cell proliferation and resistance to treatment [9,10]. The interplay between these metabolic disorders and cancer makes CML management complicate in patients with metabolic issues [7,11]. Thus, integrating metabolic health strategies into cancer care is crucial for optimizing patient prognosis.

Managing T2DM and severe obesity in patients with CML presents significant challenges due to the interplay between metabolic disorders and TKI therapy. CML patients often exhibit comorbidities such as hypertension, diabetes, and dyslipidemia, which can be exacerbated by TKI treatment [12]. The phenomenon of “diabesity,” where obesity and T2DM coexist, complicates management strategies, as many anti-diabetic medications can induce weight gain, further worsening insulin resistance [13,14]. Effective management necessitates the use of anti-diabetic and anti-obesity therapies that do not compromise leukemia control; glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown promise in achieving weight loss while improving glycemic control [15]. Additionally, addressing obesity through lifestyle modifications and pharmacotherapy is crucial, as obesity is linked to poorer leukemia outcomes and increased mortality [16]. Thus, a personalized, multimodal approach is essential for optimizing treatment in this patient population.

GLP-1 RAs, including semaglutide enhance insulin secretion, suppress glucagon release, slow gastric emptying, and promote satiety, contributing to glycemic control and weight reduction. Given that CML treatment with TKIs can exacerbate metabolic dysfunction, leading to increased cardiovascular risk, integrating semaglutide into the management of such patients may improve overall health outcomes and quality of life [17]. Additionally, anti-inflammatory properties of semaglutide may modulate the tumor microenvironment and influence CML progression [18]. However, concerns regarding the potential oncogenic effects of GLP-1 RAs highlight the need for careful evaluation in this patient population [19]. Given these multifaceted considerations, documenting and analyzing semaglutide’s effects in patients with stable CML, T2DM, and severe obesity could provide valuable insights into optimizing metabolic and oncologic care in complex clinical scenarios.

In this case report we described the safety, efficacy, and potential benefits of semaglutide in the management of T2DM and obesity in a patient with CML, without compromising the remission status of CML.

2 Case presentation

2.1 Background

A 33-year-old female was admitted to our institution presenting with recurrent polydipsia over 2 years and worsening glycemic control for 1 month.

2.2 Case presentation

Initially, the patient was diagnosed with low-risk CML 4 years prior, exhibiting a EUTOS long-term survival score of 1.502. Her treatment included Imatinib mesylate, and flumatinib mesylate, complicated by elevated transaminase levels. Notably, the BCR-ABL1 p210 fusion gene, initially positive, was undetectable by quantitative reverse transcription polymerase chain reaction (qRT-PCR) a month prior to admission, indicating molecular remission. The patient’s polydipsia was overlooked; however, it worsened over time, leading to a diagnosis of T2DM 1 year ago. She was treated with insulin glargine (28 U, daily), dapagliflozin (10 mg, daily), and metformin (850 mg, twice daily). Dapagliflozin was selected for its glycemic, weight management, and cardiorenal benefits. Despite this regimen, routine glucose monitoring was not performed. Recently, she reported increased appetite and postprandial glucose levels of 18 mmol/L, along with a weight gain of 10 kg within the last year.

Upon admission, the patient weighed 125 kg, with a BMI of 47.05 kg/m2 and an abdominal circumference of 138.2 cm. Laboratory tests showed a fasting glucose of 16.2 mmol/L, urine glucose of 3+, and an HbA1c of 10.7%. Body composition analysis indicated a visceral fat area of 194.8 m2, total body fat of 54 kg, and a body fat percentage of 45%. The admitting diagnoses included T2DM, CML in remission, class III obesity, hyperlipidemia, and non-alcoholic fatty liver disease. The patient expressed a strong desire for non-surgical weight management. The clinical characteristics are summarized in Table 1.

Table 1

Indicators before semaglutide treatment

Test value Reference Test value Reference
Fasting plasma glucose (mmol/L) 16.2 3.9–6.1 WBC (G/L) 9.25 3.50–9.50
Hemoglobin A1c (%) 10.7 4.0–6.5 Neutrophil count (G/L) 5.91 1.8–6.3
Fasting C-peptide(ng/mL) 3.26 1.10–4.40 Lymphocyte percentage (%) 33 20–50
Urine glucose 3+ Negative Basophilic granulocyte (%) 0.4 0.0–1.0
Blood β-hydroxybutyric acid (mmol/L) 0.3 <0.9 Immature granular cells — —
Blood chemistry RBC (T/L) 4.94 3.8–5.1
TC (mmol/L) 6.07 0.00–5.18 Hemoglobin (g/L) 146 115–150
TG (mmol/L) 11.51 0.00–1.70 Platelet count (G/L) 226 125–350
HDL (mmol/L) 1.02 1.29–1.55 BCR-ABL1 (p210) — —
LDL (mmol/L) 1.34 0.00–3.37 Obesity
AST (U/L) 39 7–40 Abdominal circumference (cm)/WHR 138.2/1.01
ALT (U/L) 35 13–35 BMI (kg/m2) 47.05
GGT (U/L) 102 7–45 Visceral fat area (m2) 194.8 0–80
Creatinine (µmol/L) 76 35.0–81.0 Body fat content (kg) 54 11.7–18.45
Blood uric acid (µmol/L) 450 155–357 Body fat percentage (%) 45 21–33

TC, total cholesterol; TG, triglyceride; HDL, high density lipoprotein; LDL, low density lipoprotein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, γ-glutamyl transferase; RBC, red blood cell; WBC, white blood cell; G/L, 109/L; T/L, 1012/L; −, negative; BMI, body mass index; WHR, waist hip ratio.

2.3 Intervention

A GLP-1 RA, semaglutide, was initiated at a dose of 0.5 mg once weekly, in addition to the patient’s existing insulin and oral antidiabetic regimens. Fenofibrate was prescribed for hyperlipidemia management.

2.4 Outcome

After 1 month of semaglutide treatment, the patient demonstrated marked improvements in body weight, BMI, fat mass, and visceral fat area, along with effective glycemic control (Table 2). No hematological abnormalities were detected (Table 3). Over the next 6 months, the semaglutide dose was gradually increased to 1.5 mg weekly, resulting in further weight reduction, normalization of blood glucose and lipid profiles, and a decrease in HbA1c to 5.5%. The patient tolerated the therapy well, reporting only minor gastrointestinal side effects that resolved without additional intervention. Meanwhile, her CML remained in remission, as indicated by stable BCR-ABL1 (IS) levels.

Table 2

Indicators of obesity and T2DM after semaglutide treatment

Reference Before semaglutide 1 month 3 months 6 months
Weight (kg) 125 120 118 107
Body mass index (kg/m2) 47.05 45.17 43.66 40.27
Abdominal circumference (cm) 138.2 135.1 130.2 128.3
Waist hip ratio 1.01 1 0.97 0.96
Visceral fat area (m2) 0–80 194.8 189.8 183.3 178.9
Body fat content (kg) 11.7–18.45 54 50.9 52.6 48.3
Body fat percentage (%) 21–33 45 44.1 45.7 43.2
Fasting plasma glucose (mmol/L) 1.10–4.40 16.2 7.9 6.4 5.3
Glycosylated hemoglobin (%) 4.0–6.5 10.7 8 6.6 5.7
Fasting C-peptide (ng/mL) 3.9–6.1 3.26 Not detected 3.24 Not detected
Total cholesterol (mmol/L) 0.00–5.18 6.07 1.91 2.04 2.05
Low density lipoprotein (mmol/L) 0.00–3.37 1.34 2.35 2.28 1.79
Table 3

Indicators of CML

Reference 4 years ago (at the onset) 3 years ago (MMR) 1 month post-treatment 3 months post-treatment 6 months post-treatment
WBC (G/L) 3.50–9.50 34.17 10.34 9.24 9.02 9.42
Neutrophil count (G/L) 1.8–6.3 30.45 6.18 6.29 5.69 5.92
Neutrophils percentage (%) 40–75 89.1 59.8 63.7 60.9 62.8
Lymphocyte percentage (%) 20–50 7 33.3 29.9 32.8 30.1
Basophilic granulocyte (%) 0.0–1.0 5 0.3 0.3 0.4 0.4
Immature granular cells (%) 0 7 0 0 0 0
RBC (T/L) 3.8–5.1 5.24 4.58 4.8 4.71 4.92
Hemoglobin (g/L) 115–150 164 144 139 139 148
Platelet count (G/L) 125–350 463 249 325 298 343
BCR-ABL1 (p210) Negative Positive Negative Not detected Negative Negative
BCR-ABL1 (IS) % 0 3.578 0 Not detected 0 0

RBC, red blood cell; WBC, white blood cell; G/L, 109/L; T/L, 1012/L; MMR, major molecular response.

2.5 Conclusion

This case illustrates the potential role of semaglutide in managing complex patients with T2DM, severe obesity, and CML. The results suggest that GLP-1 RAs can be safely and effectively incorporated into therapeutic regimens for such patients, offering substantial metabolic benefits while maintaining oncologic control. Further research is warranted to investigate the broader applicability of this treatment strategy in similar clinical contexts.

  1. Informed consent: The patient provided written informed consent for her clinical details to be published in this study.

  2. Ethical approval: All procedures performed in this case report were in accordance with the institutional research ethics standards and with Helsinki Declaration.

3 Discussion

CML primarily affects white blood cells and is characterized by the excessive proliferation of granulocytes. Remarkably, it is the first cancer found to be associated with a specific genetic abnormality [20,21]. The defining feature of CML is the Ph chromosome, resulting from the t(9;22)(q34;q11.2) translocation, which produces the BCR-ABL1 fusion gene. Approximately 98% of CML patients present with the BCR-ABL1 p210 isoform, while the remaining 2% have p230, p190, or other rare variants [22]. The fusion gene involves a disrupted regulatory element linked to a myristoyl group, leading to continuous tyrosine kinase activation – an essential driver of CML pathogenesis [23].

TKIs such as imatinib, dasatinib, nilotinib, and bosutinib serve as first-line therapies for patients with chronic-phase CML [23]. When CML patients have consistent access to TKIs and respond favorably, their life expectancy can be comparable to that of individuals without CML [20].

Monitoring TKI therapy involves assessing hematologic response, cytogenetic changes, molecular dynamics, and ABL kinase domain mutations [21]. Among these, molecular monitoring – primarily performed through qRT-PCR on peripheral blood samples – is crucial. This technique quantifies BCR-ABL1 transcript levels and is considered both the most widely used and the most sensitive method for determining disease burden in CML, with a detection sensitivity ranging from 0.001 to 0.01% [21].

Both diabetes mellitus and obesity are linked to an increased risk of CML. Meta-analyses indicate that patients with T2DM have a 22–33% higher risk of developing leukemia compared to healthy controls [24,25]. In addition, obesity is associated with a 2–5-fold increased risk of CML compared to individuals with a normal BMI [26–28]. Another meta-analysis of prospective studies found that for every 5 kg/m2 increase in BMI, the risk of CML rises by 13% [29]. Among patients with CML, approximately 30% have coexisting obesity and hypertension, 11% have diabetes mellitus, and 18% experience dyslipidemia [30].

The coexistence of obesity or T2DM in patients with leukemia is associated with worse prognoses and higher mortality rates compared to leukemia alone [31–33]. Notably, the relative risk of mortality from leukemia increases by 1.17 for every 5 kg/m2 increment in BMI [29]. Patients with CML who also present with abnormal glucose and lipid metabolism, as well as hypertension, face an even greater risk of relapse and mortality than those with CML and obesity alone [34], underscoring the critical impact of metabolic disorders on CML outcomes.

There is growing evidence of therapeutic interactions between CML and DM medications. TKIs such as imatinib and dasatinib have been shown to improve pre-existing diabetes and modestly lower blood glucose levels [35–37]. These effects may be partly attributed to elevated plasma adiponectin levels [38]. Adiponectin, a protein secreted by white adipose tissue, appears to be a molecular link between adiposopathy and leukemia development [39]. It possesses anti-inflammatory properties, enhances insulin sensitivity, prevents atherosclerosis, offers cardioprotection, and regulates apoptosis while inhibiting cell proliferation in the myeloid lineage [39,40]. Collectively, these findings underscore adiponectin’s multifaceted role in both metabolic regulation and cancer pathogenesis. Effective weight management in obese individuals delays the progression from prediabetes to diabetes [41] and provides significant therapeutic benefits for T2DM [42]. Building on these observations, it is postulated that weight control may reduce the incidence of CML and improve the prognosis of patients diagnosed with this condition.

Several pharmacological agents, including GLP-1RAs, dual glucose-dependent insulinotropic polypeptide (GIP) inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors, metformin, and amylin mimetics, have demonstrated efficacy in weight management. In overweight or obese individuals with T2DM, GLP-1RAs such as semaglutide or dual GIP inhibitors like tirzepatide are recommended due to their effectiveness in weight control as well as their glycemic and cardiometabolic benefits [43]. The most common adverse effects associated with GLP-1RAs are nausea and diarrhea; however, these symptoms are typically short-lived, mild to moderate in severity, and resolve spontaneously without requiring additional intervention [44].

In this case report, we present a patient with T2DM, severe obesity (BMI 47.05 kg/m2), and CML, who was treated with insulin glargine, dapagliflozin, and metformin. Despite these interventions, the patient’s glycemic control remained suboptimal. She expressed a strong desire to lose weight but declined bariatric surgery, prompting consideration of alternative weight-management strategies such as GLP-1RAs, specifically semaglutide.

However, semaglutide’s prescribing information does not explicitly address its use in patients with leukemia, and its safety profile in individuals with concurrent CML, T2DM, and obesity has not been fully investigated. Existing data regarding semaglutide and cancer risk primarily focus on solid tumors, with limited information on hematological malignancies. One systematic review and meta-analysis of 13,330 patients found no association between semaglutide use and increased cancer risk [45]. Additionally, a multicenter, prospective, observational study (SURE Denmark/Sweden) designed to evaluate the real-world effectiveness and safety of once-weekly semaglutide in clinical practice [43]. In this study, a total of 331 adults with T2DM were recruited. These individuals were initiating or continuing semaglutide treatment as part of routine care. Key inclusion criteria typically included a diagnosis of T2DM and a clinical decision (by the treating physician) to start or maintain semaglutide, independent of the study protocol. Patients were followed to assess changes in glycemic control, body weight, and occurrence of adverse events. During the observation period, one case of B-cell lymphoma was documented among these 331 patients. Investigators assessed this event and deemed it unlikely to be related to semaglutide based on temporal factors, clinical judgment, and the patient’s underlying medical history [43]. Nonetheless, more research focusing on hematological malignancies is warranted.

Managing patients with both T2DM and CML involves balancing effective leukemia treatment with metabolic control. TKIs such as nilotinib, imatinib, and dasatinib are standard therapies for CML but have varying effects on glucose metabolism. Studies indicate that nilotinib is associated with an increased risk of diabetes due to its adverse metabolic effects, including insulin resistance and hyperglycemia [46]. A recent study found that 23.8% of patients on nilotinib developed diabetes within 2 years of treatment [47]. On the other hand, dasatinib has shown potential benefits in T2DM patients by reducing insulin resistance and improving glycemic control, potentially facilitating insulin production and decreasing insulin requirements [36]. Therefore, for diabetic patients requiring CML treatment, dasatinib may be a more favorable TKI, while nilotinib should be used with caution and under strict glucose monitoring. First-line T2DM management with metformin is generally safe alongside TKIs, but insulin and sulfonylureas may require dose adjustments. Given the increased cardiovascular risks associated with both T2DM and CML therapies, routine monitoring of blood glucose, HbA1c, and lipid profiles is essential. A multidisciplinary approach involving oncologists, endocrinologists, and primary care providers is crucial in optimizing treatment strategies while minimizing adverse effects.

Given the absence of evidence suggesting an elevated risk of hematological cancer and in light of the patient’s need for effective weight management, semaglutide appeared to be a viable treatment option. After thorough discussions about potential benefits and risks, semaglutide was initiated alongside continued therapy with dapagliflozin and metformin. The dose of insulin glargine was adjusted in response to the patient’s blood glucose measurements. Clinical indicators – including fasting and postprandial glucose levels, as well as HbA1c – were monitored monthly for the first 3 months of treatment. During this period, all measured glycemic parameters showed significant improvement. The patient’s ongoing regimen included semaglutide (1.0 mg weekly), dapagliflozin (10 mg daily), and metformin (0.85 g three times daily). The inclusion of dapagliflozin aligns with international guidelines for T2DM management, particularly in patients with obesity or cardiovascular comorbidities. Its approval in China, the US, and the EU underscores its role as a standard-of-care agent, not an experimental therapy. Notable reductions in body weight, waist circumference, body fat mass, and visceral fat area were observed. Early in the treatment, the patient experienced mild hiccups, which resolved spontaneously without additional intervention. At the 3-month follow-up, a molecular reassessment of the BCR-ABL gene confirmed the absence of leukemic gene mutations or abnormalities, indicating a stable CML profile under semaglutide therapy. After 6 months of continuous treatment, the patient maintained effective glycemic control and achieved further reductions in body weight, waist circumference, body fat mass, and visceral fat area, with a marked improvement in insulin resistance. Repeated genetic testing consistently showed no evidence of the leukemia gene, suggesting that semaglutide therapy did not adversely impact her CML status.

Historically, up to 15–20% of chronic-phase CML cases progressed to accelerated or blast phase annually prior to the era of TKIs. However, with first- and second-generation TKIs, the risk of progression has been substantially reduced, to about 1–2% per year in patients who maintain deep molecular responses [48,49]. In this case, the patient remained on stable TKI therapy, and her BCR-ABL1 transcripts remained undetectable throughout the semaglutide treatment period. From a mechanistic standpoint, GLP-1RAs do not interfere with BCR-ABL1 signaling and have not been linked to increased transformation risk in patients with CML. Indeed, most documented CML transformations arise from underlying disease evolution or TKI resistance rather than from co-administered metabolic agents [50]. Thus, the introduction of semaglutide for obesity and hyperglycemia management does not appear to elevate the likelihood of CML progression in a patient whose disease is molecularly well-controlled. Nonetheless, close monitoring of CML status via regular qRT-PCR assessments remains essential whenever new therapies are added to a treatment regimen.

Previous observational studies and case reports have examined how CML-directed therapies can intersect with diabetes control. Imatinib and dasatinib, for instance, have been linked to modest improvements in hyperglycemia, potentially through mechanisms involving elevated adiponectin levels and enhanced insulin sensitivity. However, other TKIs (e.g., nilotinib, bosutinib) may exacerbate hyperglycemia or dyslipidemia. In terms of antidiabetic regimens, most published cases describe metformin, insulin, or SGLT2 inhibitors in patients with stable CML. These studies generally report that co-treatment is feasible and can help maintain better glycemic control, sometimes facilitated by TKI-induced improvements in insulin sensitivity. Semaglutide (a GLP-1 RA), specifically, has not been extensively studied in this population, making our report one of the few to detail its safe and effective use. Our findings align with the principle that managing obesity and dysglycemia can be crucial to optimizing outcomes in individuals with hematologic malignancies such as CML. Nevertheless, larger observational cohorts and comparative studies are needed to clarify the long-term effects of combining various novel antidiabetic agents with TKIs on both metabolic control and leukemia progression.

4 Conclusion

These findings demonstrate that semaglutide can be successfully incorporated into the treatment regimen for patients with coexisting T2DM, severe obesity, and CML, delivering significant metabolic improvements without compromising leukemia control. This case supports the broader applicability of GLP-1 RAs in managing complex patient profiles, while underscoring the necessity of individualized treatment plans and meticulous monitoring of both oncological and metabolic markers.

  1. Funding information: The study was funded by Traditional Chinese Medicine Research Program of Chongqing Municipal Health Commission (2024WSJK167) and General Research Projects of Chongqing Sports Bureau (B202471).

  2. Author contributions: Conceptualization, data curation, and manuscript draft: Y.Z.; Supervision and manuscript editing and revision: A.L. All authors read and approved the final manuscript.

  3. Conflict of interest: The authors declare no potential conflict of interest.

  4. Data availability statement: All data supporting the findings of this study are available within the article. Further details or additional data are available from the corresponding author on reasonable request.

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Received: 2024-09-22
Revised: 2025-02-23
Accepted: 2025-03-25
Published Online: 2025-04-23

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/med-2025-1184
Keywords for this article
type 2 diabetes mellitus; obesity; glucagon-like peptide-1 receptor agonists; chronic myelogenous leukemia; semaglutide
Creative Commons
BY 4.0

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  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
  8. CMSP exerts anti-tumor effects on small cell lung cancer cells by inducing mitochondrial dysfunction and ferroptosis
  9. Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
  52. rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
  53. Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
  63. Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
  64. MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
  66. Trends in research on preterm birth in twin pregnancy based on bibliometrics
  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
  68. Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
  69. Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
  70. Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
  71. Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
  72. CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. FAHD1 prevents neuronal ferroptosis by modulating R-loop and the cGAS–STING pathway
  126. Association of placenta weight and morphology with term low birth weight: A case–control study
  127. Investigation of the pathogenic variants induced Sjogren’s syndrome in Turkish population
  128. Nucleotide metabolic abnormalities in post-COVID-19 condition and type 2 diabetes mellitus patients and their association with endocrine dysfunction
  129. TGF-β–Smad2/3 signaling in high-altitude pulmonary hypertension in rats: Role and mechanisms via macrophage M2 polarization
  130. Ultrasound-guided unilateral versus bilateral erector spinae plane block for postoperative analgesia of patients undergoing laparoscopic cholecystectomy
  131. Profiling gut microbiome dynamics in subacute thyroiditis: Implications for pathogenesis, diagnosis, and treatment
  132. Delta neutrophil index, CRP/albumin ratio, procalcitonin, immature granulocytes, and HALP score in acute appendicitis: Best performing biomarker?
  133. Anticancer activity mechanism of novelly synthesized and characterized benzofuran ring-linked 3-nitrophenyl chalcone derivative on colon cancer cells
  134. H2valdien3 arrests the cell cycle and induces apoptosis of gastric cancer
  135. Prognostic relevance of PRSS2 and its immune correlates in papillary thyroid carcinoma
  136. Association of SGLT2 inhibition with psychiatric disorders: A Mendelian randomization study
  137. Motivational interviewing for alcohol use reduction in Thai patients
  138. Luteolin alleviates oxygen-glucose deprivation/reoxygenation-induced neuron injury by regulating NLRP3/IL-1β signaling
  139. Polyphyllin II inhibits thyroid cancer cell growth by simultaneously inhibiting glycolysis and oxidative phosphorylation
  140. Relationship between the expression of copper death promoting factor SLC31A1 in papillary thyroid carcinoma and clinicopathological indicators and prognosis
  141. CSF2 polarized neutrophils and invaded renal cancer cells in vitro influence
  142. Proton pump inhibitors-induced thrombocytopenia: A systematic literature analysis of case reports
  143. The current status and influence factors of research ability among community nurses: A sequential qualitative–quantitative study
  144. OKAIN: A comprehensive oncology knowledge base for the interpretation of clinically actionable alterations
  145. The relationship between serum CA50, CA242, and SAA levels and clinical pathological characteristics and prognosis in patients with pancreatic cancer
  146. Identification and external validation of a prognostic signature based on hypoxia–glycolysis-related genes for kidney renal clear cell carcinoma
  147. Engineered RBC-derived nanovesicles functionalized with tumor-targeting ligands: A comparative study on breast cancer targeting efficiency and biocompatibility
  148. Relationship of resting echocardiography combined with serum micronutrients to the severity of low-gradient severe aortic stenosis
  149. Effect of vibration on pain during subcutaneous heparin injection: A randomized, single-blind, placebo-controlled trial
  150. The diagnostic performance of machine learning-based FFRCT for coronary artery disease: A meta-analysis
  151. Comparing biofeedback device vs diaphragmatic breathing for bloating relief: A randomized controlled trial
  152. Serum uric acid to albumin ratio and C-reactive protein as predictive biomarkers for chronic total occlusion and coronary collateral circulation quality
  153. Multiple organ scoring systems for predicting in-hospital mortality of sepsis patients in the intensive care unit
  154. Single-cell RNA sequencing data analysis of the inner ear in gentamicin-treated mice via intraperitoneal injection
  155. Review Articles
  156. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  157. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  158. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  159. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  160. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  161. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  162. The application of augmented reality in robotic general surgery: A mini-review
  163. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  164. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  165. Plant polyphenols, terpenes, and terpenoids in oral health
  166. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  167. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  168. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  169. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  170. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  171. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  172. Giant borderline ovarian tumours – review of the literature
  173. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  174. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  175. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  176. Supplement strategies for infertility in overweight women: Evidence and legal insights
  177. Scurvy, a not obsolete disorder: Clinical report in eight young children and literature review
  178. A meta-analysis of the effects of DBS on cognitive function in patients with advanced PD
  179. Protective role of selenium in sepsis: Mechanisms and potential therapeutic strategies
  180. Strategies for hyperkalemia management in dialysis patients: A systematic review
  181. C-reactive protein-to-albumin ratio in peripheral artery disease
  182. Case Reports
  183. Delayed graft function after renal transplantation
  184. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  185. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  186. Giant right atrial hemangioma presenting with ascites: A case report
  187. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  188. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  189. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  190. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  191. Rapid Communication
  192. Biological properties of valve materials using RGD and EC
  193. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  194. Letter to the Editor
  195. Role of enhanced external counterpulsation in long COVID
  196. Expression of Concern
  197. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  198. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  199. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  200. Corrigendum
  201. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  202. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  203. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  204. Retraction
  205. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  206. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  207. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  208. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  209. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  210. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  211. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  212. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  213. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  214. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  215. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  216. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  217. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  218. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  219. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  220. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  221. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  222. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  223. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  224. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  225. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  226. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  227. A review of brain research on T2DM-related cognitive dysfunction
  228. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  229. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  230. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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