In the past 2013,American Diabetes Association (ADA),American Association of Clinical Endocrinologists(AACE),Chinese Society of Endocrinology,etc.published some guidelines and consensuses on topics such as clinical diagnnsis,treatment,integrated management,and the relationship between reducing body weight and complications.Characters of blood pressure control in diabetic patients were also announced by the Eighth Joint National Committee (JNC 8).Meanwhile,Food and Drug Administration (FDA) declared the statements on safety of several hypoglycemic agents.These guidelines and consensuses will play key roles in standardizing clinical diagnosis,treatment,and medication.

Diabetes is characterized by glycemic disorders which play a key role in the risk for complications of diabetes.Glucose variability is an important parameter of glycometabolism.The study of none evidence-based medicine(EBM) has investigated the relationship among glycemic variability and vascular injury and the subsequent development of diabetes complications.Due to deficiency of large clinical interventional tests,this relationship lack the evidence of EBM.In conclusion,particular attention should be paid to glucose variability in our clinical work and meanwhile the EBM studies should also be conducted.

[Summary] Thyroid nodules are the most common endocrine and metabolic diseases,and most of them are accidental nodules.How to distinguish the state between benign and malignant thyroid nodules is the clinical core problems in diagnosis and treatment.In addition to detailed history collecting and physical examination,highresolution ultrasound,serum thyrotrophin levels,and fine needle aspiration biopsy (FNAB) form the basis for the diagnosis of thyroid nodules.Endocrinologists should grasp the indications of FNAB.When the pathological finding is unable to distinguish between benign and malignant nodules,molecular or genetic diagnosis should be adopted for further diagnosis.Appropriate treatment is selected according to the definitive results.In this article,we share the whole process that one case with thyroid nodule was diagnosed as papillary thyroid carcinoma and eventually treated with surgery,so as to make clinicians pay more attention to thyroid nodules with standardized clinical diagnosis and treatment.

In 2015, American College of Endocrinology ( ACE), American Association of Clinical Endocrinologists ( AACE ) , European Association for the Study of Diabetes ( EASD ) , Chinese Society of Endocrinology, American Diabetes Association ( ADA ) , American Association of Diabetes Educators ( AADE ) , Academy of Nutrition and Dietetics(AND), etc. published several guidelines and statements on diabetes and its complications. The selection of hypoglycemic drugs, diabetes self-management education and support, the characteristics of blood pressure and blood lipid, the efficacy and adverse reaction of hypoglycemic drugs were also suggested and recommended. These guidelines and statements will play key roles in the clinical diagnosis and treatment of diabetes mellitus, which is reviewed in this article.

Objective:To investigate the cardiac presentations and the possible influencing factors of severe and critical coronavirus disease 2019 (COVID-19).Methods:A retrospective study was conducted. Patients with severe and critical COVID-19 admitted to the Eighth People's Hospital of Guangzhou from January 21st to February 24th 2020 were enrolled. According to the clinical classification, the patients were divided into severe group and critical group. The myocardial injury markers, such as lactate dehydrogenase (LDH), aspartate aminotransferase (AST), creatine kinase (CK), cardiac troponin I (cTnI), myoglobin (MYO), MB isoenzyme of creatine kinase (CK-MB), B-type natriuretic peptide (BNP) and electrocardiogram (ECG) changes were compared between the two groups.Results:A total of 55 COVID-19 patients were selected, including 15 critical cases and 40 severe cases. The patients with severe and critical COVID-19 were male-dominated (61.8%), the average age was (61.2±13.0) years old, 83.6% (46 cases) of them had contact history of Hubei, 38.2% (21 cases) of them were complicated with hypertension. There was no significant difference in baseline data between the critical group and the severe group. Myocardial injury markers of critical and severe COVID-19 patients were increased in different proportion, LDH increased in most patients (20 severe cases and 7 critical cases), followed by AST (16 severe cases and 5 critical cases). There was significant difference in the number of patients with elevated CK between severe group and critical group (cases: 1 vs. 4, P = 0.027). Abnormal ECG was found in 39 of 42 patients with ECG examination. Nonspecific change of T wave was the most common. Before and after treatment, 9 of 15 patients with changes of ECG and myocardial injury markers had oxygenation index less than 100 mmHg (1 mmHg = 0.133 kPa), and the prominent changes of ECG were heart rate increasing and ST-T change. Conclusions:The increase of myocardial injury markers and abnormal ECG were not specific to the myocardial injury of severe and critical COVID-19 patients. At the same time, the dynamic changes of myocardial injury markers and ECG could reflect the situation of myocardial damage.

Background Lead exposure induces microglial cell death, of which the mechanism is unclear. Ferroptosis is a new death form and its role in microglia death has not been reported. Objective To investigate the role of ferroptosis in microglia following lead exposure in order to provide a theoretical basis for the mechanism of lead neurotoxicity. Methods Microglial cell line BV-2 cells were co-cultured with 0, 10, 20 and 40 μmol·L⁻¹ lead acetate for 24 h. The 40 μmol·L⁻¹ lead acetate group with iron chelator (DFO) was named the 40+DFO group. Changes in BV-2 cell morphology after lead exposure were observed under an inverted microscope; tissue iron kit and glutathione kit were used to detect intracellular iron and glutathione (GSH) respectively; flow cytometry was applied to detect lipid reactive oxygen species (lipid ROS) immunofluorescence intensity. Western blotting and qPCR were adopted to detect the expressions of glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), transferrin receptor 1 (TFR-1), divalent metal transporter 1 (DMT1), ferroportin 1 (FPN1) protein and mRNA. Results Compared with the control group, the number of BV-2 cells decreased with increasing doses of lead and the cells showed a large, round amoeboid shape. The intracellular levels of iron of BV-2 cells were (1.08±0.04), (1.29±0.03), and (1.72±0.10) mg·g⁻¹ (calculated by protein, thereafter) in the 10, 20, and 40 μmol·L⁻¹ lead acetate groups, respectively, significantly higher than that in the control group (P<0.05), and the intracellular level of iron in the 40+DFO group, (1.34±0.10) mg·g⁻¹, was lower than that in the 40 μmol·L⁻¹ lead acetate group, (1.72±0.03) mg·g⁻¹ (P<0.05). Compared with the control group, the TFR-1 and DMT1 protein and mRNA expressions were increased in BV-2 cells in the 10, 20, 40 μmol·L⁻¹ lead acetate groups (P<0.05), especially in the 40 μmol·L⁻¹ lead acetate group; the FPN1 protein expression did not change significantly, but the FPN1 mRNA expressions in BV-2 cells in the 10, 20, 40 μmol·L⁻¹ lead acetate groups were significantly decreased (P<0.05). Compared with the control group, the intracellular GSH level decreased and the lipid ROS content increased in all three lead acetate groups; compared with the 40 μmol·L⁻¹ lead acetate group, the GSH level increased by 12.30% and the lipid ROS content decreased by 13.00% in the 40+DFO group (P<0.05). The expressions of GPX4 protein were reduced to 50.00%, 35.00%, and 17.00% of that of the control group in the 10, 20, and 40 μmol·L⁻¹ lead acetate groups respectively, while the expressions of GPX4 mRNA were also significantly reduced; the expressions of SLC7A11 protein and mRNA in the 20 and 40 μmol·L⁻¹ lead acetate groups were lower than that in the control group, with the most significant decrease in the 40 μmol·L⁻¹ lead acetate group (P<0.05). Conclusion Lead exposure could induce ferroptosis in BV-2 cells, in which iron transport imbalance and oxidative damage might be involved.

To investigate the effects of Losartan,an angiotensinⅡ(AngⅡ)receptor(AT_1) antagonist,on pancreatic stellate cells(PSCs)and its possible mechanisms.Methods (1)PSCs were isolated from pancreatic cancerous samples to test the expressions of AT_1 and collagenⅠafter incubated with AngⅡor/and Losartan.(2)Ninety S-D rats were divided into normal group,control group and treatment group,with 30 rats in each.The rats in control and treatment groups were induced pancreatic fibrosis by injection of 2% trinitrobenenze sulfonic acid(TNBS)into biliopancreatic duct.Rats in treat- ment group were then treated with Losartan by garage daily and rats in control group were only given distilled water.The rats were sacrificed on day 3,7,14,21 and 28,respectively,and pancreas were removed.The histological abnormalities were observed by electron microscope.The mRNAs of trans- forming growth factor?_1(TGF?_1)and procollagenⅠwere detected by reverse transcription-polymerase chain reaction(RT-PCR).The expression of TGF?_1 and?-smooth muscle actin(?-SMA)proteins was assessed by immunohistochemistry and the level of?-SMA protein was quantified by Western blot. Results In vitro,there existed AT_1 expression in PSCs,and Losartan reduced expression of collagenⅠ.Losartan treatment reversed the histological abnormalities observed by electron microscope,com- pared to treatment with distill water.The expression of?-SMA,TGF?_1 and procollagenⅠwere signifi- cantly higher in the control group than those in normal group and were reduced by Losartan to different extent in treatment group.Conclusion AT_1 antagonist can inhibit the activation and the profibrogenic action of PSCs by blocking AT_1 receptor-mediated pathways.

Hepatorenal syndrome (HRS) is a common complication of decompensated cirrhosis and is traditionally defined as progressive oliguria or anuria, azotemia, dilutional hyponatremia, and hyponatremia, while renal insufficiency without marked organic lesions in the kidney is the typical manifestation of HRS. Recent studies have found that besides the abnormalities in hemodynamics, inflammatory response, oxidative stress, and direct renal tubular toxicity of bile salts are jointly involved in the development and progression of HRS. HRS is not the only renal complication in patients with liver cirrhosis, and it is only a functional form of acute kidney injury (AKI). HRS meeting the criteria for AKI is called HRS-AKI, which is formerly known as HRS-Ⅰ type. For cirrhotic patients with acute kidney disease or chronic kidney disease, if they meet the criteria for HRS, they can be diagnosed with HRS-NAKI, which is formerly known as HRS-Ⅱ type. The most common risk factors for HRS are infection, digestive bleeding, and large-volume paracentesis without transfusion of human serum albumin for volume expansion.

Objective: To analyze the clinical features of death cases of dengue fever and the causes of their deaths. Methods: The clinical data and death reports of nine death cases of dengue fever in Guangdong Province from June 23, 2014 to September 10, 2019 were retrospectively analyzed. All of nine cases were positive for serum dengue virus RNA as confirmed by reverse transcription polymerase chain reaction, and some of the virus strains were serotyped. Results: The median age of the nine patients was 57.5 (range: 18-80) years. Among them, six patients were females; eight patients were local cases and one was imported case; all of nine cases occurred in September and October. The median time from onset to visit hospital and diagnosis was three and four days, respectively. Three of the nine patients had underlying diseases. All of nine cases had fever, including three with double-peak fever. Eight of the cases had three or more severe dengue fever warning indexes before admission. Three cases had severe bleeding upon admission, one case had shock, and six cases had organ failure. Three cases underwent invasive examination, including arterial puncture catheterization, endoscopic titanium clip hemostasis, and percutaneous transluminal coronary angiography. Two cases developed malignant arrhythmia and one had massive hemorrhage of subcutaneous soft tissue after operation. The death cases included four cases of cardiogenic shock and fatal arrhythmia, three cases of encephalitis and encephalopathy, one case of refractory shock, and one case of acute liver failure. Among the six cases that underwent serological typing, four were identified as dengue virus type 1 (DEN-1) and two were DEN-2. Conclusions Severe organ failure is the major cause of dengue fever-related death, especially fulminant myocarditis, and DEN-1 is most common. Early diagnosis and treatment, and avoidance of invasive procedures can effectively reduce the mortality rate of the severe dengue fever patients.

Objective Based on the technology acceptance model,to explore the influence mechanism of technical support,perceived interactivity,perceived usefulness,perceived ease of use and perceived risk on medical staff's report intention on adverse events,and to provide path suggestions for improving medical staff's report intention adverse events.Methods The multi-stage sampling method was used to select 637 medical staffs of tertiary public hospitals in Hangzhou who used the information-based platform to report adverse events as the research respondents,and the self-developed scale of report intention on adverse events was used as the research tool,monofactor analysis were conducted by Wilcoxon rank-sum test,and the structural equation model was used to analyze the influence path of their report intention on adverse events.Results Perceived ease of use and perceived usefulness have positive effects on medical staff's report intention on adverse events(β=0.264,0.658;P＜0.001);Perceived risk negatively affected the medical staff's report intention on adverse events(β=-0.143,P＜0.001).The indirect effects of perceived usefulness and perceived ease of use on medical staff's report intention on adverse events are 0.538 and 0.205,respectively.Conclusion Perceived usefulness and perceived ease of use plays a mediating role in perceived interactivity and medical staff's report intention on adverse events.