insulin Aspart (NovoMix 30 Penfill / NovoMix 30 FlexPen / NovoRapid 30 Mix)

Designing de novo metalloproteases.

Guo Huijuan H

De novo ABL1 missense variant in congenital heart defects and skeletal malformations syndrome with EDS-like cutaneous laxity.

Nanda Arti A, Hsu Sharon Nienyun SN, Cheng Hui-Ching HC, Huang Hsin-Yu HY et al.

Changes in Circulating Insulin and Glucose Homeostasis After Portosystemic Shunt Creation and Obliteration: A Systematic Review.

Garg Tushar T, Putman Melissa S MS, Adams Ryan R, Wu Vincent V et al.

The liver removes about half of secreted insulin on first pass. Transjugular intrahepatic portosystemic shunt creation diverts portal blood past the liver; endovascular shunt obliteration restores it. We systematically reviewed glycaemic and insulin outcomes after both. PubMed, Embase and Web of Science were searched through September 2026 for paired glucose or insulin measurements before and after either intervention. Ratios of post-intervention to pre-intervention means were pooled by random effects with Hartung-Knapp adjustment, excluding cohorts at critical risk of bias. Fifteen cohorts (17 records) were included. After shunt creation, fasting insulin rose 49% (95% confidence interval 24% to 80%; 6 cohorts) and the homeostasis model assessment of insulin resistance rose 55% (5% to 129%; 4 cohorts), whereas fasting glucose (2.5%; -0.3% to 5.4%; 5 cohorts), glycated haemoglobin, and fructosamine were unchanged. Glucose tolerance worsened in one of two cohorts tested (area under the curve +14%). Insulin rose more than C-peptide or proinsulin in four cohorts; clamp-measured insulin sensitivity was unchanged. After obliteration, fasting insulin fell 15% (one cohort) and insulin area under the curve 17% and 19% (two cohorts). Antihyperglycaemic requirements changed in both directions after shunt creation and fell after obliteration. Shunt creation raises insulin by nearly half without changing fasting glucose or glycation markers, and obliteration reverses the pattern. Secretion markers change less than insulin, indicating altered first-pass hepatic insulin extraction rather than secretion. Insulin-based resistance indices may mislead after shunting, and the consequences of chronic shunt-induced hyperinsulinemia need prospective study.

Cardiovascular Outcomes of Triglyceride-Targeting Lipid-Lowering Therapies in Patients with CKD.

Naim Mohammad Abdullah Al Zubair MAAZ, Thomas Fridtjof F, Streja Elani E, Davis Robert Lowell RL et al.

In patients with chronic kidney disease (CKD), atherogenic lipid profiles, characterized by hypertriglyceridemia and impaired high-density lipoprotein cholesterol (HDL-C) metabolism, contribute to adverse cardiovascular disease (CVD) outcomes. Since evidence on CVD outcomes of triglyceride-targeting lipid-lowering therapies (LLTs), such as fibrates and niacin, remains limited, kidney disease guidelines recommend further investigation. We designed this retrospective cohort study using a target trial emulation framework and leveraged data from a nationwide cohort of 3,562,882 US Veterans to identify 46,904 patients with incident CKD initiating de novo fibrate, niacin, or statin therapy. We compared the risk of major adverse cardiovascular events (MACE; composite of acute myocardial infarction, ischemic stroke, congestive heart failure, or all-cause death) using Cox proportional hazards models adjusted for baseline covariates during follow-up of up to 10 years. 16,191 patients (event rate, 79.2; 95% confidence interval [CI], 78.0-80.4 per 1000 person-years) experienced MACE after a median follow-up of 3.70 years. The risk of MACE was significantly lower (hazard ratio [HR], 0.93 [95% CI, 0.86-0.99]; P = 0.03) in de novo fibrate users compared with statin users. Niacin users, however, did not have a significantly different risk of MACE (1.03 [0.95-1.12]; P = 0.42) than statin users. The result was largely attributable to the association between fibrate use and congestive heart failure (CHF)-a statistically significant 13% lower hazard (0.87 [0.78-0.96]; P = 0.005) compared with statin use. In this large nationwide cohort of patients with nonkidney replacement therapy-dependent CKD, de novo fibrate use, but not niacin use, was associated with a lower risk of MACE than de novo statin use.