When a dependent variable exceeds a certain threshold, a significant change in its magnitude and/or direction is called a threshold effect. As a statistical tool, threshold effect analysis can predict the occurrence, development, and prognosis of a disease, which is highly important. However, there is currently a lack of open-source, free, simple, and effective tools to implement threshold effect analysis. The process of determining thresholds is complex and labor intensive, requiring high programming skills. Therefore, this study demonstrates how to simplify this process and reduce programming skill requirements via the self-developed R package "thresholdanalysis", which enables nonstatistical professionals to conduct threshold effect analysis. First, smooth curve fitting is used to observe whether there is a nonlinear relationship between the dependent variable and the independent variable. If a threshold is visually observed, the maximum likelihood method, recursive method, piecewise linear model, and likelihood ratio test are used to determine the threshold, the effect sizes before and after the threshold, and whether the effect sizes of the two segments are significant.

Vertebral artery dissection (VAD) is an acute vascular condition characterized by intimal tearing that leads to the formation of intramural hematomas or pseudoaneurysms.[1,2]The pathogenesis of VAD involves a multifactorial interplay of genetic susceptibility,structural vessel wall abnormalities,and mechanical stressors.[3]We present a case of VAD triggered by cervical mechanical stress,and explore the diagnostic workup and the role of multidisciplinary coordination in therapeutic decision-making.

Sepsis is one of the major challenges in intensive care units, characterized by the complexity of the host immune status. To gain a deeper understanding of the pathogenesis of sepsis, it is crucial to study the phenotypic changes in immune cells and their underlying molecular mechanisms. We conducted Summary data-based Mendelian randomization analysis by integrating genome-wide association studies data for sepsis with expression quantitative trait locus data, revealing a significant decrease in the expression levels of 17 biomarkers in sepsis patients. Furthermore, based on single-cell RNA sequencing data, we elucidated potential molecular mechanisms at single-cell resolution and identified that LGALS9 inhibition in sepsis patients leads to the activation and differentiation of monocyte and T-cell subtypes. These findings are expected to assist researchers in gaining a more in-depth understanding of the immune dysregulation in sepsis.

脓毒症是一种严重危及生命的器质性功能障碍疾病,其发生发展过程中身体对感染的反应是造成组织损伤和器官功能衰竭的重要原因.脓毒症诱导的心功能障碍(SIMD)是脓毒症的常见并发症,约 50％的脓毒症患者会出现心肌功能障碍的表现.心功能受损程度对于脓毒症至关重要,因为它是疾病治疗方法选择及预后的重要评价指标.古代医籍多将SIMD归属于"温热病"的范畴,后世医家对该病病因病机和治则治法提出了诸多理论,临证中取得了良好的临床效果.随着医学的发展,中医药在SIMD治疗中越来越发挥重要作用.现从心肌肾上腺素能反应、能量代谢、收缩功能改变等方面阐述SIMD的发病机制,并对SIMD中西医治疗进行初步探讨,以期为SIMD的治疗提供参考.

Abstract Background Charlson Comorbidity Index (CCI) is positively associated with all-cause readmission in patients with heart failure (HF) in western countries. However, there is a scarcity of strong scientific evidence supporting the correlation in China. This study aimed at testing this hypothesis in Chinese. Methods We conducted a secondary analysis of 1,946 patients with HF in Zigong Fourth People’s Hospital in China between December 2016 to June 2019. Logistic regression models were used to study the hypotheses, with adjustments for the four regression models. We also explore the linear trend and possible nonlinear relationship between CCI and readmission within six months. We further conducted subgroup analysis and tests for interaction to examine the possible interaction between CCI and the endpoint. Additionally, CCI alone and several combinations of variables based on CCI were used to predict the endpoint. Under the curve (AUC), sensitivity and specificity were reported to evaluate the performance of the predicted model. Results In the adjusted II model, CCI was an independent prognostic factor for readmission within six months in patients with HF (OR = 1.14, 95% CI: 1.03–1.26, P = 0.011). Trend tests revealed that there was a significant linear trend for the association. A nonlinear association was identified between them and the inflection point of CCI was 1. Subgroup analyses and tests for interaction indicated that cystatin played an interactive role in the association. ROC analysis indicated neither CCI alone nor combinations of variables based on CCI were adequate for prediction. Conclusion CCI was independently positively correlated with readmission within six months in patients with HF in Chinese population. However, CCI has limited value on predicting readmission within six months in patients with HF.

自2023 年春季以来,流行性感冒发病在我国各地呈上升趋势,本病属于中医"疫病""时行感冒"范畴,中医药在减轻、消除流感症状、缩短病程方面疗效显著,为有效防治当前春季流感,提高中医药治疗流感的诊疗水平,世界中医药学会联合会急症专业委员会和呼吸病专业委员会、中华中医药学会肺系病分会、中华医学会急诊分会中西医结合急救学组、中国医师协会急诊医师分会中西医结合急救医学专业委员会、上海中医药学会急诊分会、上海中医药大学急危重研究所等学术组织与机构组织全国中医一线防治专家在就流感发病特点、证候规律及治疗原则等开展调研与讨论,进而形成本《2023 年春季成人流行性感冒中医药防治专家共识》,以期对当前春季流行性感冒中医药防治起到临床指导作用.

Atherosclerotic plaque rupture and subsequent cardiovascular complications threaten the population's health worldwide. The polymorphism of miR-146a rs2910164 was significantly associated with the risk of vulnerable plaques. However, it remains unclear whether the circulating miR-146a is differentially expressed in stable and vulnerable plaques and thus, serves as a potential biomarker.This study aims to analyze the differential expression of circulating miR-146a between patients with stable and vulnerable plaques to explore the potential molecular mechanisms.Public databases were searched from their inception up to November 2022. A study reporting the specific circulating miR-146a levels between patients with stable and vulnerable plaques was included. The study quality was assessed using the modified genetic 8-stars Newcastle-Ottawa scale. The differential expression levels of miR-146a were evaluated using the standardized mean difference (SMD).Eight studies with 978 patients were included and analyzed. The results showed that miR-146a expression levels were significantly higher in the vulnerable plaque population than in the stable plaque population (SMD: 1.91; 95% confidence interval: 1.35, 2.47; P < 0.01). A similar statistical significance was found in subgroup analyses regarding sample source, disease type, and vulnerable plaque characteristics. Sensitivity analysis suggested the robustness of the results. Analysis of downstream genes suggested that miR-146a-targeted regulation of ACTN4, SARM1, and ULK2 may affect intraplaque hemorrhage.Patients with vulnerable plaque have higher circulating miR-146a levels than those with stable plaque. However, based on the limitations of this study, high-quality studies are still needed to confirm the results.

目的 基于CiteSpace知识图谱探讨国内急诊教学的研究现状和热点.方法 通过知网、万方、维普检索建库日起至 2022 年 12 月 31 日急诊教学相关文献,应用文献计量学研究方法和CiteSpace软件对国内急诊教学文献年产出、期刊发表、作者发文、研究机构发文频次,关键词频次、中介中心性、突现词和高被引文献频次,构建研究机构网络、关键词双图叠加网络和时间线网络并以知识图谱的形式进行呈现,探讨国内急诊教学领域的研究现状和热点.结果 研究共纳入 262 篇文献,分析表明国内急诊教学领域文献逐年增长,2005 年开始文献产出激增.急诊教育领域期刊以非核心杂志为主,从研究机构和作者发文看,国内急诊教学领域内科研力量分散,还未形成较为稳定、密切的机构合作关系.急诊教学热点关键词包括急诊教学、急诊医学、急诊、临床教学、教学、教学方法和翻转课堂等.高被引文献提示在现有的教学体系和方法基础上,正在从理论和实践上不断探索新的科学合理的急诊临床教学途径与方法.结论 基于CiteSpace对国内急诊教学领域的文献进行计量学分析,可以更加清晰、直观地了解到国内急诊教学的研究现状,有助于总结该领域的研究现状,推动该领域的发展.

OBJECTIVE:To provide the evidence for the efficacy of acupoint application (AA) for patients with diarrhea in a real-world setting. METHODS:This study is a national multicenter retrospective cohort study. Our study consecutively collected outpatient medical records of patients with diarrhea from hundreds of primary hospitals nationwide registered in Chun Bo Wan Xiang cloud platform from 22nd August, 2020 to 5th November, 2020. The patients were divided into the treatment group and the control group according to patient's condition and willingness. The control group was treated with Western Medicine, oral Chinese Medicine decoction, or both. The treatment group was added with AA based on the control group. Multiple logistic regression was used to evaluate the independent efficacy of AA in diarrheal recovery on the 3rd, 7th, 14th and 28th day. As a next step, we also performed stratified analysis and likelihood ratio test (LRT). Sensitivity analyses included propensity score matching (PSM), four PSM-related analyses and E-value. RESULTS:The treatment group showed better efficacy than the control group on the 14th and 28th day [the 14th day: = 1.58, 95% (1.15, 2.19), 0.005; the 28th day: = 2.03, 95% (1.43, 2.88), < 0.001]. No difference was observed in efficacy of AA for the treatment of diarrhea among the subgroups ( > 0.05). PSM-related analyses confirmed the efficacy of AA in diarrheal recovery. The findings are unlikely to be nullified by an unmeasured confounding variable according to the results of E-values. CONCLUSIONS:The efficacy in the treatment group was significantly more improved than that in the control group on the 14th and 28th day.

目的 基于交互式网页计算器建立重症监护病房(ICU)28 d内输血的预测模型并进行内部验证.方法 前瞻性连续收集2016年1月至2017年9月在日本千叶大学附属医院外科/内科ICU收治的符合纳入排除标准的患者121例.原始研究收集了性别、年龄、体重指数(BMI)、ICU入院途径、序贯器官衰竭评分(SOFA)和脓毒症诊断等资料,以及ICU入院日采集的12项贫血相关生化指标和ICU住院期间输血前累积采血量.数据按4:1比例随机拆分成建模组和验证组,使用Lasso回归和共线性筛查筛选建模变量,应用Logistic回归和R shiny构建28 d输血预测模型和交互式网页计算器,然后从模型校准度(hosmer-lemeshow检验)、区分度(受试者工作特性曲线下面积)和有效性(决策曲线分析)三方面评价建模组和验证组模型性能.结果 建模变量为SOFA评分、转铁蛋白(TRF)和累积采血量,模型Logit(Y)=-1.54480+0.21694×SOFA评分-0.02274×TRF(mg/dL)+0.00707×累积采血量(mL),基于R shiny建立的交互式网页计算器访问网址为https://shengsong.shinyapps.io/BLOOD_TRANSFUSION.建模组和验证组模型经校准度、区分度和有效性评价性能较好.结论 本研究建立的预测模型可以优化ICU危重症患者输血策略,并且具有良好的预测性能.

ObjectiveBased on a secondary analysis of a retrospective cohort study， our study aimed to investigate the effects of urine output at 2-hours after initiation of continuous renal replacement therapy （CRRT） on the mortality at 28 and 90 days in sepsis patients with acute kidney injury （SA-AKI）.MethodsThis study was conducted using a retrospective cohort design， with secondary use of electronic medical records data which retrospectively collected SA-AKI patients undergoing CRRT in the ICU of Health System Severance Hospital and Ilsan Hospital in Korea from January 2009 to September 2016. Kaplan-Meier （K-M） curve， log-rank test， proportional hazard regression model （Cox） and trend test were performed to analyze the independent effects of UO2 h on mortality at 28 and 90 days. Also， stratified analysis and interaction test were conducted for subgroup analysis. Finally， we examined the possible nonlinear threshold effects of UO2 h on mortality by smooth curve fitting， piecewise linear model， recursive method et al.ResultsA total of 789 SA-AKI patients was included in our study. K-M curve and log-rank test found the mortality rate in patients with high UO2 h was significantly lower than that in patients with low UO2 h on 28 and 90 days. Adjusted Ⅱ Cox model revealed UO2 h was independently negatively associated with mortality at 28 and 90 days （mortality risk at 28 days： HR = 0.84，95% CI：0.75~0.94，P = 0.003； mortality risk at 90 days ： HR = 0.88，95% CI：0.79~0.97，P = 0.009） . In addition， there was a significant linear trend correlation between the two （P for trend < 0.05）. The stratification and interaction test indicated that serum albumin and UO2 h had a significant interaction effect on mortality at 90 days. The threshold effect analysis demonstrated that the nonlinear correlation between UO2 h and mortality was not significant and no threshold effect exist between them.ConclusionsUO2 h was independently negatively correlated with mortality at 28 and 90 days in SA-AKI patients undergoing CRRT. No evidence of a non-linear relationship between them was detected.

目的 基于一项回顾性队列研究的二次分析探讨连续性肾脏替代治疗(continuous renal re-placement therapy,CRRT)启动后2 h尿量(2-hour urinary output,UO2 h)对脓毒症合并急性肾损伤(sepsis associated acute kidney injury,SA-AKI)患者第28天和第90天的死亡的影响.方法 本研究为一项回顾性队列数据的二次分析,原队列中连续收集了 2009年1月至2016年9月韩国Health System Severance医院和Ilsan医院重症监护室中接受CRRT的SA-AKI患者.本研究采用Kaplan-Meier(K-M)生存曲线、log-rank检验、比例风险回归模型(Cox)和趋势性检验研究UO2h对第28天和第90天死亡的独立作用,同时采用分层分析和交互作用检验进行亚组分析.最后我们通过平滑曲线拟合、分段线性模型和递归法等对UO2 h和死亡的关联关系进行了饱和阈值效应分析.结果 本研究共纳入789例接受CRRT的SA-AKI患者.K-M曲线和log-rank检验显示高UO2 h患者第28天和第90天死亡风险显著低于低UO2 h患者.Cox调整Ⅱ模型显示UO2 h与第28天和第90天死亡风险呈独立负相关(28 d死亡HR = 0.84,95％CI:0.75～0.94,P =0.003,90d死亡HR = 0.88,95％CI:0.79～0.97,P=0.009),且两者之间存在显著线性趋势关系(趋势性检验P＜0.05).分层和交互作用检验发现白蛋白与UO2h对第90天死亡存在显著交互作用.饱和阈值效应分析提示UO2h与死亡之间的非线性关系是不显著的,两者之间不存在饱和阈值效应.结论 UO2h与接受CRRT的SA-AKI患者第28天和第90天的死亡呈独立负相关,且两者之间为直线关系.

骨桥蛋白(osteopontin,OPN)是细胞外基质中一种重要的功能性蛋白质,参与人体多种生理与病理过程,其表达增加也是血管性疾病预后的重要预测因子.本文从OPN在心室重构、动脉粥样硬化、高血压形成及心力衰竭等多个心血管疾病病理生理过程中的预测价值和作用机制进行综述,以期为心血管疾病治疗提供新的思路.

目的 研究常见纤溶和凝血指标在急性脑梗死(acute cerebral infarction,ACI)和非急性脑梗死(non acute cerebral infarction,Non-ACI)鉴别诊断中的预测价值.方法 选取2018年10月至2019年10月中国中医科学院西苑医院急诊科收治的100例ACI患者为试验组,另选100例Non-ACI患者为对照组,进行回顾性分析.检测患者入院后48 h内D-二聚体(D-dimer,D-D)、纤维蛋白原(fibrinogen,Fbg)、纤维蛋白原降解产物(fibrinogen degradation products,FDP)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)和抗凝血酶Ⅲ(antithrombinⅢ,AT-Ⅲ)的血浆水平,并计算D-D/Fbg和D-D/FDP比值,分析比较各指标在两组间以及在不同性别和年龄段之间的差异.结果 ACI组中D-D、Fbg、FDP、D-D/Fbg、D-D/FDP和PT的水平明显高于Non-ACI组(P<0.05).ACI组中,女性患者D-D、FDP、D-D/Fbg和PT水平高于男性患者,而APTT在男性患者中呈现较高水平;>70岁患者D-D、FDP和D-D/Fbg的水平高于≤70岁的患者.在Non-ACI组中,仅男性患者的APTT高于女性患者;>70岁患者D-D、FDP、D-D/Fbg、D-D/FDP和PT的水平均高于≤70岁患者,而AT-III则相反(P<0.05).D-D、FDP、D-D/Fbg、D-D/FDP、PT和Fbg的ROC曲线下面积依次为:0.82、0.79、0.79、0.75、0.64、0.61,其中D-D对预测ACI的灵敏度为95％,特异性为68％.结论 D-D、Fbg、FDP、D-D/Fbg、D-D/FDP和PT在ACI和Non-ACI患者以及不同性别和年龄的ACI患者中存在一定差异,因此对ACI和Non-ACI患者的鉴别诊断有一定价值.

Abstract Background Heart failure (HF) is one of the most prevalent diseases in China and worldwide with poor prognosis. A prognostic model for predicting readmission for patients with HF could greatly facilitate risk stratification and timely identify high-risk patients. Various HF prediction models have been developed worldwide; however, there is few prognostic models for HF among Chinese populations. Thus, we developed and tested an eXtreme Gradient Boosting (XGBoost)model for predicting 90-day readmission for patients with HF. Methods Clinical data for 1,532 HF patients retrospectively admitted to Zigong Fourth People’s Hospital in Sichuan Province from December 2016 to June 2019 were used to develop and test two prognostic models: XGBoost and logistic models. The least absolute shrinkage and selection operator (LASSO) regression method was applied to filter variables and select predictors. The XGBoost model tuning was performed in a 10-fold cross validation and tuned models were validated in test set (7:3 random split). The performance of the XGBoost model was assessed by accuracy (ACC), kappa, area under curve (AUC) and other metrics, and was compared with that of the logistic model. Results systolic blood pressure, diastolic blood pressure, type of HF, mean corpuscular hemoglobin concentration, total cholesterol were screened out as predictors through LASSO regression. In training set, we optimized four major parameters, max depth, eta, nrounds and early stopping rounds with optimal values of 6, 0.5, 1000 and 5 for XGBoost. In test set, we obtained a ACC of 0.99 with kappa of 0.98 and the AUC, sensitivity and specificity achieved were of 1.00, 1.00 and 0.99 in the XGBoost model, which has significantly higher prediction performance than the logistic model. Conclusion The XGBoost model developed in our study had excellent prediction performance in test set and the model can contribute to the assessment of 90-day readmission risk for patients with HF in Chinese population.

Circular RNA (circRNA) is a new endogenous transcription product, which has attracted significant attention in RNA biology research.CircRNA comprise exons or introns involved in regulation of various mechanisms.These molecules are stable and species-specific, as well as cell and tissue-specific.Cardiovascular diseases particularly myocardial ischemia and ageing-related diseases, pose a major health care burden and novel treatments and biomarkers should be explored.Recent findings indicate that circRNAs are implicated in biological processes, such as glucose metabolism, fatty acid oxidation, mitochondrial biosynthesis, implying that they are potential targets for myocardial ischemia treatment.In the present review, the functions of circRNAs in the heart are described, with emphasis given on in the relationship with myocardial ischemia and cardiac aging-related diseases.Directions for future research are also summarized.

目的 探讨血磷对接受连续肾脏替代治(CRRT)的脓毒症合并急性肾损伤(SI-AKI)患者90天死亡的预测价值.方法 回顾性连续收集2009年1月至2016年9月韩国Health System Severance医院和Ilsan医院ICU中接受CRRT的SI-AKI患者.原始研究收集了CRRT启动时患者的人口学资料、临床信息、生化指标、CRRT相关信息、CRRT启动时血磷(P3-)、CRRT启动后24 h血磷(24 h P3-)和两者差值(ΔP3-).本研究采用Kaplan-Meier生存曲线、log-rank检验、比例风险回归模型(Cox)和趋势性检验探究P3-、24 h P3-和ΔP3-对90天死亡的独立作用,同时对P3-、24 h P3-和ΔP3-和90天死亡进行饱和阈值效应分析.分别构建P3-、24 h P3-和ΔP3-预测90天死亡的预测模型,计算受试者工作特征曲线下面积(AUC)和一致性指数(Harrell′s C-index).结果 K-M曲线和log-rank检验、Cox回归和趋势性检验显示,三种血磷水平均和90天死亡独立正相关(HR=1.10,95％CI 1.05～1.14,P<0.001;HR=1.17,95％CI 1.13～1.21,P<0.001;HR=1.07,95％CI 1.02～1.11,P=0.002).随着三种血磷三分组等级增加,患者90天死亡风险逐渐增加且增加趋势是显著的(趋势性检验P<0.05).饱和阈值效应分析提示,24 h P3-与90天死亡间存在饱和阈值效应,饱和折点为7.5 mg/dL.P3-、24 h P3-和ΔP3-单独预测该类患者的90天死亡准确度较差.结论 在韩国人群中血磷与接受CRRT的SI-AKI患者90天死亡独立正相关,但预测死亡的准确度较差.

Abstract Background Albumin (ALB) levels are negatively associated with mortality in patients with sepsis. However, among sepsis patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT), there has been no similar study on the correlation between ALB levels and mortality alone. This study tested the hypothesis that ALB levels are negatively associated with mortality among such patients. Methods We conducted a secondary analysis of 794 septic patients who were diagnosed with AKI and underwent CRRT in South Korea. For the Kaplan–Meier survival analysis, Cox proportional hazards models were used to study the hypotheses, with adjustments for the pertinent covariables. We also explore the possible nonlinear relationship and conducted sensitivity analyses including subgroup analyses and tests for interactions to investigate the association further. Additionally, ALB was used to construct model and we then compared the performance of ALB with that of APACHE II and SOFA in predicting mortality. Results The ALB level was an independent prognostic factor for death at 28 and 90 days after CRRT initiation (HR = 0.75, 95% CI: 0.62–0.90, P = 0.0024 for death at 28 days and HR = 0.73, 95% CI: 0.63–0.86, P < 0.0001 for death at 90 days). A nonlinear association was not identified between ALB levels and the endpoints. Subgroup analyses and tests for interactions indicated that HCO3 and CRP played an interactive role in the association. ROC analysis indicated ALB, SOFA and APACHE-II were separately inadequate for clinical applications. Conclusion A 1 g/dL increase in ALB levels was independently associated with a 25 and 27% decrease in the risk of death at 28 and 90 days, respectively. However, this conclusion needs to be taken with caution as this study has several limitations.

目的 采用Meta分析评价中医外治法联合西医常规治疗对机械通气重症患者镇静镇痛疗效的影响.方法 应用计算机检索中国知网(CNKI)、万方数据库、中国生物医学文献服务系统(SinoMed)、维普、中国临床试验中心数据库、美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库、Cochrane图书馆数据库以及美国临床试验中心关于中医外治法辅助机械通气治疗重症患者的随机对照试验(RCT)的文献,中文检索词为耳穴磁珠、耳穴、耳穴压豆、针刺、电针、经皮电穴位穿刺、重症监护病房(ICU)、镇静、镇痛、机械通气,英文检索词为auricular?magnetic?beads、acupuncture、auricular、respiration、artificial、mechanical?ventilation、?sedation、deep?sedation、conscious?sedation、analgesia、acupuncture?analgesia、transcutaneous?electric?nerve?stimulation、ICU,检索时间从建库至2021年1月29日.对照组干预措施为西医常规镇静镇痛治疗;试验组在对照组基础上加用中医外治法.由两名研究者独立筛选文献、提取资料并评价纳入文献的质量,以及进行偏倚风险评估后,采用RevMan?5.3软件进行Meta分析;绘制漏斗图分析纳入文献的发表偏倚.结果 最终纳入18篇RCT,试验组534例,对照组524例.Meta分析结果显示,与对照组比较,试验组机械通气时间、ICU住院时间均明显缩短〔机械通气时间:均数差(MD)=-2.48,95％可信区间(95％CI)为-3.35～-1.60,P<0.00001;ICU住院时间:MD=-20.45,95％CI为-34.17～-6.74,P=0.003〕,咪达唑仑用量显著减少(MD=-5.73,95％CI为-8.39～-3.07,P<0.0001);而两组Ramsay镇静评分比较差异无统计学意义(MD=-0.05,95％CI为-0.03～0.13,P=0.24).针对中医外治法联合西医常规治疗对重症患者机械通气时间的影响绘制漏斗图进行发表偏倚检验,结果显示,漏斗图左右分布对称,提示均不存在发表偏倚.结论 中医外治法联合西医常规治疗可提高机械通气重症患者的疗效,但尚需更多高质量研究加以验证.

The development and progression of the complications of chronic diabetes mellitus are attributed not only to increased blood glucose levels but also to glycemic variability. Therefore, a deeper understanding of the role of glycemic variability in the development of diabetic complications may provide more insight into targeted clinical treatment strategies in the future. Previously, the mechanisms implicated in glycemic variability-induced diabetic complications have been comprehensively discussed. However, endothelial dysfunction and platelet hyperactivation, which are two newly recognized critical pathogenic factors, have not been fully elucidated yet. In this review, we first evaluate the assessment of glycemic variability and then summarise the roles of endothelial dysfunction and platelet hyperactivation in glycemic variability-induced complications of diabetes, highlighting the molecular mechanisms involved and their interconnections.