OBJECTIVE:The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease (CKD), cardiovascular disease (CVD), diabetes, osteoarthritis (OA), and gastrointestinal disorders. METHODS:This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO (population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. RESULTS:The guideline presents 26 evidence-based recommendations addressing seven clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage ≥ 3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases, and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. CONCLUSION:The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.
Acute intermittent porphyria(AIP) is a rare autosomal dominant disorder caused by reduced activity of hydroxymethylbilane synthase(HMBS), or porphobilinogen deaminase(PBGD), the third enzyme in the heme biosynthesis pathway, with very low penetrance. AIP mainly affects women and is triggered by various factors, leading to acute neurovisceral symptoms such as abdominal pain, nausea and vomiting, intestinal obstruction, constipation, and in severe cases, epilepsy, weakness of the limbs, and psychiatric disturbances. Recurrent attacks may result in chronic injuries. Due to nonspecific symptoms and limited clinical awareness, AIP is often misdiagnosed, contributing to high morbidity and mortality. To standardize diagnosis and treatment practices, the Chinese Society of Rare Diseases, in collaboration with the Study Group of Endocrinology Rare Diseases, the Chinese Society of Endocrinology, and the Chinese Pharmacists Association Rare Diseases Medication Working Committee, developed the Expert Consensus on the Diagnosis and Treatment of Acute Intermittent Porphyria in China(2024). This consensus was based on a review of 116 relevant studies, with a professional panel of 27 experts using the Delphi method to reach agreement on 23 key recommendations, aiming to guide standardized clinical practice in the diagnosis, treatment, evaluation, and prevention of AIP.
Polycystic ovary syndrome(PCOS) is a common endocrine disorder in gynecology and obstetrics, characterized by elevated androgen levels, abnormal ovulation, and polycystic ovarian morphology in women. Additionally, PCOS often accompanies high-risk factors for cardiovascular disease(CVD), such as obesity, insulin resistance, and abnormal glucose and lipid metabolism. Recent epidemiological studies suggest that even after adjusting for traditional high-risk factors associated with CVD, PCOS remains an independent risk factor for CVD. This article primarily introduces the results of a recent research published in the journal of Circulation titled " Polycystic ovary syndrome fuels cardiovascular inflammation and aggravates ischemic heart injury" [Gao L, Zhao Y, Wu H, et al. Circulation, 2023, 148(24): 1958-1973]. The study′s findings indicate that the chronic inflammatory state present in PCOS increases the risk of CVD beyond traditional risk factors. The main process involves excessive sympathetic nervous system activation in PCOS, promoting monocyte generation in spleen, mediating the accumulation of macrophages in the myocardium and blood vessels, and leading to severe cardiovascular damage.
Anaplastic thyroid carcinoma is one of the highly fatal cancers and poses a serious threat to human health. Ferroptosis has been widely studied and proved to have an important role in tumor suppression, providing new avenues for cancer therapy; glutathione peroxidase 4(GPX4) and selenoprotein thioredoxin reductase(TXNRD1) are important regulatory targets in ferroptosis.Warburg effect is one of the important energy sources for cancer hypermetabolism, and pyruvate kinase isoenzyme 2 (PKM2) is a key metabolism enzyme that is important in this effect. Shikonin(SKN) is a Chinese herb that has been extensively studied for its anti-tumor ability. The aim of this study was to investigate the mechanism of anti-tumor effect of SKN in ATC cells and to elucidate the role played by ferroptosis and glycolysis in this inhibitory mechanism. The effects of SKN in ATC cell lines CAL-62 and 8505C cells were detected by flow cytometry, Western blotting,real-time quantitative PCR and a fluorescent probe for reactive oxygen species (ROS) to detect changes in intracellular ROS positivity; glucose and lactate assay kits to detect the levels of the raw material of glucose metabolism, glucose (GLU), and the product of glucose metabolism, lactate (LD); and the establishment of the BALB/C nude mice subcutaneous tumor model to analyse the inhibitory effect of SKN on ATC in vivo. The present study demonstrated that SKN inhibits the expression of NF-κB,GPX4,TXNRD1,PKM2,GLUT1.SKN inhibits ATC cell growth by down-regulating the occurrence of intracellular ferroptosis and inhibiting glycolysis in ATC cells.
Importance Obesity has become a global public health concern and China has the largest number of affected people worldwide. Objective To assess the efficacy and safety of treatment with tirzepatide for weight reduction in Chinese adults with obesity or overweight and weight-related comorbidities. Design, Setting, and Participants This randomized, double-blind, placebo-controlled, phase 3 clinical trial conducted at 29 centers in China from September 2021 to December 2022 included Chinese adults (aged >= 18 years) with a body mass index (BMI) greater than or equal to 28 or greater than or equal to 24 and at least 1 weight-related comorbidity, excluding diabetes. Interventions Participants were randomly assigned (1:1:1) to receive once-weekly, subcutaneous 10-mg (n = 70) or 15-mg (n = 71) tirzepatide or placebo (n = 69), plus a lifestyle intervention, for 52 weeks. Main Outcomes and Measures Co-primary end points were the percent change in body weight from baseline and weight reduction of at least 5% at week 52. Efficacy and safety analyses were performed on an intention-to-treat population. Results Of 210 randomized participants (103 [49.0%] female; mean [SD] age, 36.1 [9.1] years; body weight, 91.8 [16.0] kg; BMI, 32.3 [3.8]), 201 (95.7%) completed the trial. The mean change in body weight at week 52 was -13.6% (95% CI, -15.8% to -11.4%) with tirzepatide 10 mg, -17.5% (95% CI, -19.7% to -15.3%) with tirzepatide 15 mg, and -2.3% with placebo (difference between 10 mg and placebo, -11.3% [95% CI, -14.3% to -8.3%; P < .001]; difference between 15 mg and placebo, -15.1% [95% CI, -18.2% to -12.1%; P < .001]). The percentage of participants achieving body weight reductions of 5% or greater was 87.7% with tirzepatide 10 mg, 85.8% with tirzepatide 15 mg, and 29.3% with placebo (P < .001 for comparisons with placebo). The most frequent treatment-emergent adverse events with tirzepatide were gastrointestinal. Most were mild to moderate in severity, with few events leading to treatment discontinuation (<5%). Conclusions and Relevance In Chinese adults with obesity or overweight, once-weekly treatment with tirzepatide 10 mg or 15 mg resulted in statistically significant and clinically meaningful weight reduction with an acceptable safety profile. Trial RegistrationClinicalTrials.gov Identifier: NCT05024032
Objective:To screen highly expressed inflammatory factors in diabetic nephropathy models using protein microarray, analyze differential genes and their regulatory networks, and predict potential therapeutic small molecular compounds.Methods:The inflammatory factor microarray was used to screen the inflammatory factors with the same tendency in the cell model and animal model of diabetic nephropathy. The differential genes screened by R language were enriched and analyzed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG). STRING builds a protein interaction network online, Cytoscape software analyzes the core subnetwork, and Connectivity Map searches for and predicts small molecule compounds.Results:Diabetic nephropathy model was established using 16-week-old db/db mice and mesangial cells stimulated with high glucose, and the expression of C-X-C motif chemokine ligand 1(CXCL1) was elevated in both models. Multiple GEO datasets indicated a strong association between the high expression of CXCL1 and diabetic nephropathy. Specifically, GSE30122 showed an upregulation of 30 genes and a downregulation of 23 genes. GO enrichment analysis focused on biological processes such as humoral immunity and lipopolysaccharide response; While KEGG enrichment was mainly in pertussis and coagulation cascade pathways. CytoHubba identified 10 hub genes, such as ALB, LUM, and CXCL1. In addition, 10 small molecule compounds were predicted as potential therapeutic drugs using Connectivity Map.Conclusions:CXCL1 may serve as a key gene in the occurrence and development of diabetic nephropathy. ALB, LUM, CXCL1, MMP7, TGFBI, CCL2, S100A4, SOX9, VCAN, and CLU may participate in the regulatory network centered around CXCL1. There are 10 small molecular compounds demenestrating the potential to be therapeutic agents.
Objective:To investigate the mediating effect of inflammatory factors in the association between low density lipoprotein-cholesterol(LDL-C) and thyroid associated ophthalmopathy(TAO).Methods:This study was a prospective study, which icluded a total of 86 patients with Graves′ disease who attended the Department of Endocrinology of the First Affiliated Hospital of Zhengzhou University from January 2021 to June 2022. Among them, there were 56 patients with Graves′ disease accompanied by TAO, including 30 cases in the inactive group and 26 in the active group. Additionally, there were 30 cases having Graves′ disease alone. The relationship between LDL-C, inflammatory factors, and the onset and activity of TAO were analyzed using binary logistic regression. Mediation analysis was used to explore the mediating effect of inflammatory factors in the association between LDL-C and TAO onset and activity.Results:Interleukin(IL) -6 was a potential mediator that linking the association between LDL-C and TAO onset: LDL-C had a direct effect on TAO(Total effect value=0.274, 95% CI 0.161-0.386), while IL-6(mediated effect=0.067, 95% CI 0.011-0.123) and IL-17(mediated effect=0.042, 95% CI 0.007-0.077) partially mediated the effect of LDL-C on TAO, accounting for 24.45% and 15.33% of the total effect, respectively. IL-6 was a potential mediator of the association between LDL-C and TAO activity: LDL-C had a direct effect on TAO activity(Total effect value=0.320, 95% CI 0.204-0.435), and IL-6(mediated effect=0.103, 95% CI 0.021-0.185) partially mediated the effect of LDL-C on TAO activity, with a mediation effect of 32.19%. Conclusion:IL-6 plays a partiall mediating role in the association of LDL-C with TAO onset and activity.
Objective:To detect the incidence of muscle mass loss in the adults and explore its relevant influencing factors.Methods:A total of 1 503 participants aged between 18 and 65 years old were collected from the Department of Preventive Treatment of Disease and Health Management Center of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from March 2019 to October 2021. All subjects completed physical and laboratory examination and bioelectrical impedance analysis. According to the cutpoint of plasma triglycerides concentration≥1.7 mmol/L, waist circumference≥85 cm in men or≥80 cm in women, 1 503 subjects were divided into four groups: normal triglycerides and waist circumference group, normal waist circumference and hypertriglyceridemia group, abdominal obesity and normal triglycerides group, and hypertriglyceridemic-waist phenotype(HTWC) group. Subjects were also divided into 4 groups according to age. Skeletal muscle mass index(ASMI) was calculated according to the skeletal muscle mass of the limbs. Differences of the ASMI and other relevant indicators among the above four groups were analyzed, and body composition was compared among four age groups. Then explore whether HTWC phenotype was an independent risk factor for the occurrence of sarcopenia in different age groups of different gender.Results:The level of triglycerides, fasting blood glucose, systolic blood pressure, and diastolic blood pressure in HTWC group were higher than those in the normal group(all P<0.001). But the incidence of the muscle mass loss in the HTWC group was much lower than that in the other three groups( P<0.001). The incidence of muscle mass loss in overall subjects was 9.2%, in which man was 2.05 times higher than women(12.9% vs 6.3%). There is no statistically significant difference in the incidence of muscle mass loss between the 18-35 age group and the 56-65 age group. Multivariate logistic regression analysis revealed that body mass index, body fat percentage, bone mineral content were independent factors affecting muscle loss in 18-45 year-old adults. After adjustment for other risk factors, HTWC phenotype was still not an independent influencing factor of sarcopenia( OR=1.679, 95% CI 0.523-5.386, P=0.384). Conclusion:HTWC phenotype was not an independent influencing factor of sarcopenia. To prevent the occurrence of sarcopenia in middle-aged and young adults, in addition to assessing the muscle mass, attention should also be given to the measurement of body mass index, bone mineral content, and body fat percentage.
Objective:To identify the clinical and pathological characteristics of adrenocortical carcinoma(ACC) with hypercortisolism and analyze the prognostic factors.Methods:Clinical data of ACC patients between January 2003 and December 2022 from Nanjing Drum Tower Hospital were collected retrospectively. Clinical and pathological characteristics were compared between ACC patients with hypercortisolism and nonfunctional ACCs. Kaplan-Meier method was used for survival analyses and Cox regression models were performed to analyze prognostic factors for ACC patients.Results:In 61 cases of ACC patients, the average age was (49.33±16.32) years. After a median follow-up of 77 months(95% CI 47.49-106.51 months), median overall survival and progression-free survival were 50 months(95% CI 20.44-79.56 months) and 29 months(95% CI 22.87-35.13 months), respectively. Among 36 patients with complete endocrinologic evaluations, 19(52.77%) were diagnosed with hypercortisolism. Compared with nonfunctional ACC, patients with hypercortisolism had more hypokalemia(42.11% vs 6.25%, P=0.022), capsular invasion(68.42% vs 25.00%, P=0.018), and distant metastases(73.68% vs 25.00%, P=0.007). Median overall survival and progression-free survival were significantly shorter than nonfunctional ACC(overall survival: 39 months vs 67 months, P=0.009; progression-free survival: 30 months vs 51 months, P=0.040) as well. Multivariate Cox regression analyses indicated that Ki67 index( HR=1.078, P=0.024) was an independent risk factor for overall survival. Hypercortisolism( HR=71.112, P=0.006), Ki67 index( HR=1.345, P=0.003), adjuvant therapy( HR=176.652, P=0.012), and operation( HR=0.020, P=0.003), were associated with disease progression. Conclusion:ACC accompanied by hypercortisolism is more prone to invasion and distant metastasis, resulting in shorter survival. Hypercortisolism is an independent prognostic factor for ACC patients.
The concentration of extracellular sodium ion is an important component in the formation of plasma osmotic pressure. Hyponatremia is currently defined as a serum sodium concentration of less than 135 mmol/L and is the most common electrolyte disorder in clinical practice. The mortality rate of hyponatremia is significantly higher compared to individuals with normal sodium levels, and it often accompanies various adverse clinical outcomes, making its diagnosis and treatment challenging. Currently, there is no consensus or clinical guidelines for the management of hyponatremia in China. This consensus, based on the latest research findings as well as empirical experience, summarizes the classification, common causes, diagnosis and assessment, clinical intervention and treatment, and lifestyle intervention of hyponatremia. The aim is to improve the diagnosis and therapeutic landscape for patients in China.
This article reports a case of oligomenorrhea accompanied by acne over several years. The patient presented with hyperandrogenism and insulin resistance. The initial diagnosis considered polycystic ovary syndrome(PCOS) and was treated with oral medication for 2 months, with no significant improvement. Further ultrasound examination revealed a right ovarian heterogeneous mass (3.2 cm×3.0 cm). The patient underwent laparoscopic resection of the right ovarian lesion. Postoperative pathology revealed ovarian sex cord-stromal cell tumor, adult granulosa cell tumor(diffuse type). Testosterone levels decreased to the normal 3 days after the surgery, and menstruation resumed within 2 months. This article summarizes the presented case and reviews the relevant literature. For women with severe hyperandrogenism and masculinization, it is recommended to thoroughly assess the possibility of androgen-secreting tumors.
Objective:To explore the relationship between the long-term dynamic change in alanine aminotransferase(ALT) level and metabolic associated fatty liver disease(MAFLD).Methods:A retrospective study was conducted on 6 864 subjects who underwent four consecutive physical examinations from 2017 to 2020 in a cohort study of physical examination population in Henan Province. The relation between ALT level and the shift of MAFLD risk was analyzed using a multi-state Markov model, and the bidirectional relationship between ALT level and MAFLD was explored using a random intercept cross-lagged model.Results:Multi-state Markov model after adjusting for confounding factors showed that the risk of MAFLD in ALT Q2, Q3, Q4 group was gradually higher than that in Q1 group; Compared with health status, non-alcoholic fatty liver disease and MAFLD status gradually increased the risk of ALT shifting from normal to abnormal. The random intercept cross-lagged model after adjusting for confounding factors showed that there was a significant positive bidirectional relationship between MAFLD and ALT level. The cross-lag effect of MAFLD→ALT level was 0.083(95% CI 0.078-0.087), and the cross-lag effect of ALT→MAFLD was 0.044(95% CI 0.039-0.050). And with the extension of time, the cross-lag effect gradually decreased. Conclusions:There is a significant bidirectional relationship between the long-term dynamic change of ALT level and MAFLD. The occurrence of MAFLD is more likely to increase the risk of elevated ALT level, emphasizing the need for enhanced early prevention and treatment of MAFLD.
To summarize the clinical manifestations of a case with 46, XY sex development disorder caused by myelin regulatory factor(MYRF) gene mutation and review the literature to deepen the specialists′ understanding of the clinical disease spectrum resulting from MYRF gene variations. The child had a female phenotype with mild masculinity, chromosome 46, XY, sex-determining region of Y gene(SRY gene) positive, laboratory tests were consistent with primary hypogonadism, ultrasound did not detect the gonads, but the residual reproductive tract was visible, and echocardiography suggested coarctation of the aorta, MYRF gene c. 2518C>T(p.R840*) heterozygous variant. The father did not carry this variant. The mother was untraceable, and genetic testing had not been completed. It was analyzed as pathogenic variation according to American College of Medical Genetics and Genomics(ACMG) guidelines. Sixteen cases of disorders of sex development caused by MYRF gene variation reported from 2018 to 2021 were reviewed, MYRF gene variants, 46, XY, and 46, XX individuals can be pathogenic, can affect the gonad and reproductive tract at the same time, and can also affect multiple systems. In this case, the patient presents with 46, XY sex development disorder due to MYRF gene mutation, accompanied by rare cardiovascular complications. When encountering 46, XY primary hypogonadism without well-developed Müllerian duct structures, this condition should be considered. Following confirmation, a comprehensive assessment of multi-organ function is necessary.
Objective:To explore the anti-aging effects of berberine hydrochloride and underlying mechanism.Methods:Twelve 4-week-old C57BL6/J mice were divided into aging group (fed with normal chaw), aging+ BBR intervention group(fed with normal chaw containing 1 g/kg berberine hydrochloride). At the age of 64 weeks, all the experimental mice were executed. The liver tissues were made into paraffin sections for HE staining to observe the morphological and structural integrity of liver parenchymal cells for pathological evaluation. Immunofluorescence was used to detect p16 protein expression levels in liver. The expression levels of malondialdehyde(MDA), superoxide dismutase(SOD), and glutathione peroxidase(GSH-Px) were detected by colorimetry. The expression levels of interleukin(IL)-1β, IL-6, and tumor necrosis factor-α(TNF-α) in liver tissues and IL-8 in serum were detected by enzyme linked immunosorbent assay(ELISA) technique. The p16, p21, nuclear factor erythroid-2 related factor 2(Nrf2), nuclear factor-κB(NF-κB), phospho(p-)NF-κB, inhibitory κB(IκB)α, p-IκBα, and p38 mitogen-activated protein kinase(MAPK) protein expression levels in liver were detected by Western blotting. The same indices were tested in the 16-week-old mice as the young control group.Results:Compared with the young control group, the liver tissue in the aging control group exhibited morphological aging and antioxidant capacity were reduced( P<0.01), and inflammatory factors were increased( P<0.05 or P<0.01). Compared with the aging group, the liver tissues in the aging+ BBR intervention group were still maintain regular arrangement of hepatocytes, the p16 and p21 protein expression levels were significantly increased( P<0.05 or P<0.01), the antioxidant capacity were increased( P<0.05 or P<0.01), the level of inflammatory factors were decresed( P<0.05 or P<0.01), and the p38 MAPK/NF-κB pathway and Nrf2 pathway were inhibited( P<0.001). Conclusion:Berberine hydrochloride improves the aging morphology of the liver, potentially by suppressing the p38 MAPK/NF-κB pathway to reduce inflammation levels and inhibiting the Nrf2 pathway to ameliorate oxidative stress.
Obesity has become a growing epidemic that seriously affects the quality of human life. Obesity not only adds the burden to the body but may have negative impacts on various body systems and organs, such as the cardiovascular and metabolic systems. In recent years, some studies have shown that obesity also negatively affects the reproductive system and influences male reproductive health. Male reproductive health is not only related to the normalization of male reproductive function but also plays a role in the ability to conceive healthy offspring. This article summarizes research progress on the effects of obesity on male reproductive health, including endocrine hormone disruption, reproductive organ structural damage, increased oxidative stress, and reproductive cell epigenetic alterations, providing insights for a deeper understanding of the influence of obesity on male reproduction and potential treatments.
借中华医学会第20次全国内分泌学学术会议召开之际，《中华内分泌代谢杂志》编委会会议于2023年12月8日于山东青岛成功召开。
Objective:To investigate the clinical profile of primary bilateral macronodular adrenal hyperplasia(PBMAH) and sex difference.Methods:One hundred and forty cases of PBMAH were recruited in our center from 2014, and all patients were evaluated for hormone secretion, adrenal imaging, and metabolic parameters.Results:Overt Cushing′s syndrome accounted for 76.4% of PBMAH cohort and 47.9% were female. The overt group had higher serum cortisol and 24 h urinary free cortisol levels, lower adrenocorticotropic hormone, higher serum cortisol after low-dose dexamethasone suppression tests, larger total adrenal size, and a higher percentage of obesity, hypertension, diabetes mellitus, and hypokalemia than the subclinical group(all P<0.05). When compared with the male group, the female group had smaller adrenal size( P<0.001), lower HbA 1C( P=0.003), higher total cholesterol( P=0.005), and lower density lipoprotein-cholesterol levels( P=0.035). Further, 24 h urinary free cortisol in the male group was found to be positively correlated with diastolic blood pressure, fasting glucose, 2 h postprandial glucose after oral glucose tolerance test(OGTT), and HbA 1C after adjusted for age, body mass index, and onset duration, and was negatively correlated with body mass index and potassium levels. While 24 h urinary free cortisol in the female group was positively correlated only with diastolic blood pressure, fasting glucose, and 2 h postprandial glucose after OGTT(all P<0.05). During follow-up, 80.0% of patients achieved remission after unilateral adrenalectomy, with a recurrence rate of 17.9%. Conclusion:PBMAH related metabolic disorder is more pronounced in overt Cushing′s syndrome and males. Unilateral adrenalectomy as an effective treatment can benefit the majority of patients.
Objective:To explore the pathological characteristics of adrenal masses based on various tumor diameter and unenhanced computed tomography(CT) attenuation value, and evaluate the value of the two parameters in the assessment of the benign and malignant nature of adrenal masses.Methods:The data of 1 367 patients who underwent adrenalectomy in Nanjing Drum Tower Hospital from January 2017 to October 2022 were retrospectively collected. The adrenal masses were divided into four groups according to tumor diameter and unenhanced CT attenuation value, and the clinical and histopathological characteristics of the four groups were compared respectively. Logistic regression was used to analyze the correlation between tumor diameter, non-contrast CT attenuation value and malignant adrenal masses, and receiver operating characteristic(ROC) curve was used to assess the diagnostic value of both in benign and malignant adrenal masses.Results:The proportion of adrenocortical carcinoma and other malignant tumors increased with the rise of tumor diameter or unenhanced CT attenuation value. After adjusting for age and gender, tumor diameter( OR=1.624, 95% CI 1.464-1.803, P<0.001) and unenhanced CT attenuation value( OR=1.108, 95% CI 1.079-1.138, P<0.001) were predictors of malignant adrenal masses. The tumor diameter and unenhanced CT attenuation value in diagnosing malignant adrenal masses had area under the ROC curve(AUC) of 0.838 and 0.892, respectively. With the optimal cut-off values of >3.4 cm and >30 HU, the sensitivity was 75.5% and 83.7%, and the specificity was 80.5% and 84.4%, respectively. The combination of tumor diameter >3.4 cm and unenhanced CT attenuation value >20 HU had an AUC of 0.927, with a sensitivity of 71.4% and a specificity of 90.1% in diagnosing malignant adrenal masses. Conclusions:Tumor diameter and unenhanced CT attenuation value has important significance in the differential diagnosis of benign and malignant adrenal masses. A combination of tumor diameter (>3.4 cm) and unenhanced CT attenuation value (>20 HU) demonstrates best diagnostic efficiency. Clinical application of this combined index can effectively diagnose malignant adrenal masses while avoiding unnecessary investigations or surgery.
The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.
