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OBJECTIVES Studies have shown that metabolic abnormalities influence the immune system. Because the prevalence of metabolic and autoimmune thyroid diseases has increased synchronously, the correlation between them was worth exploring. The study objective was to investigate the relationship between metabolic disorders and thyroid autoantibodies in euthyroid subjects. METHODS Data were obtained from a TIDE project survey of 55,891 subjects from 31 provinces in China. The body mass index(BMI), waist circumference(WC), blood pressure(BP), TPOAb, TgAb, TSH, UIC, blood glucose, lipid profile, uric acid(UA) levels were evaluated. FT4 and FT3 levels were measured in patients with abnormal serum TSH levels. RESULTS In males, the BMI, WC, SBP, DBP, and OGTT2hPG of the TPOAb/TgAb-positive groups were significantly higher than those of the TPOAb/TgAb-negative groups. In females, the BMI, WC, SBP, DBP, TC, and LDL-C in the TPOAb/TgAb-positive groups were significantly increased compared to those in the TPOAb/TgAb-negative groups. Multivariate analysis showed that, in males, the OR of positive TgAb in the abdominal obesity group was 1.175 (95% CI 1.016-1.359, P for difference= 0.03), and the OR of positive TPOAb in the hyperuricemia group was 1.195 (95% CI 1.041-1.372, P for difference = 0.011). In females, the OR of positive TgAb was 1.19 (95% Cl 1.068-1.326, P for difference= 0.002) in the high LDL-C group. CONCLUSIONS Obesity, high LDL-C and hyperuricemia were positively correlated with the prevalence of positive thyroid autoantibodies in euthyroid subjects in a gender-dependent manner. Summary This cross-sectional survey showed that metabolic disorders are associated with increased positive thyroid autoantibody levels in euthyroid subjects in a gender-dependent manner.Context The prevalence of adrenal tumors in congenital adrenal hyperplasia (CAH) is uncertain. Objective To estimate the prevalence and characteristics of adrenal tumors and myelolipoma in CAH, and investigate clinical features of this population. Data Sources Methods Systematically searches in Medline Ovid and Embase for articles published until January 2020. Study Selection Studies with confirmed CAH, biochemically and/or genetically, were included. Data Extraction The two authors independently extracted data from each study. Results Six cohort studies were included in the prevalence calculation. In addition, 32 case reports on adrenal myelolipomas and CAH were included. The prevalence of adrenal tumors in CAH was 29.3%. When only studies with genetically verified CYP21A2 mutations were included the prevalence was 23.6%. The prevalence of myelolipoma in CAH was 7.4% (verified CYP21A2 mutations 8.6%). The proportion of myelolipoma in the adrenal tumors was 25.4% (genetically verified 36.6%). The median (range) age at tumor diagnosis was 36.0 (12-60) years and there were more tumors in males than in females (37.9% vs. 22.1%, P less then 0.05). In patients with myelolipomas 93.5% had an undiagnosed or poorly managed CAH. Conclusion Patients with CAH had a high prevalence of adrenal tumors, particularly myelolipoma. Those with myelolipomas had a high frequency of late diagnosed or poorly controlled CAH. Adrenal imaging may be considered in patients with CAH, especially if abdominal pain is present.Objective The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPG). Methods Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results The Executive Summary of this 2020 updated guideline contains 52 recommendations 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations 123 (33.5%) EL 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very high-risk features, a new dual action therapy option, and transitions from therapeutic options. Conclusion This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of postmenopausal osteoporosis.Objective We prospectively investigated the accuracy of the seated saline suppression test (SSST) in 113 patients with hypertension (including 93 PA and 20 essential hypertension (EH)) in the Department of Endocrinology and Metabolism. Methods Each patient underwent an recumbent saline suppression test (RSST) and SSST. The accuracy of the SSST for a confirmative primary aldosteronism (PA) diagnosis and subtype classification was evaluated and compared with the RSST. Results The area under the receiver operating characteristic (ROC) curve (AUC) of plasma aldosterone concentration (PAC) for the SSST was significantly greater than that for the RSST (0.945±0.0199 vs 0.828±0.0404; P less then 0.05). The ROC analysis showed that the optimal PAC cutoff values were 12.94 ng/dl for the SSST (sensitivity 86.02%, specificity 95%; Youden index (YI)=0.810) and 12.04 ng/dl for the RSST (sensitivity 83.15%, specificity 57%; Youden index (YI)=0.401). The optimal PAC cutoff value for classifying aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) was 18.12 ng/dl for the SSST (sensitivity 73.5%, specificity 79.5%). No patients experienced adverse events during the SSST. Conclusions The SSST was safe and convenient for PA diagnosis. The accuracy of the SSST for a confirmatory diagnosis of PA was better than that of the RSST. The SSST is a reliable alternative for PA confirmation in Chinese individuals.Estrogen appears to play a role in minimizing skeletal muscle damage as well as regulating the expression of the protective heat shock proteins (HSPs). To clarify the relationship between estrogen, muscle HSP content, and muscle damage, tibialis anterior (TA) muscles from ovary-intact (OVI; n = 12) and ovariectomized (OVX; 3 weeks, n = 12) female Sprague-Dawley rats were subjected to either 20 or 40 lengthening contractions (LCs). Twenty-four hours after stimulation, TA muscles were removed, processed, and assessed for HSP25 and HSP72 content as well as muscle (damage) morphology. No differences in muscle contractile properties were observed in TA muscles between OVI and OVX animals for peak torque during the LCs. In unstressed TA muscles, the basal expression of HSP72 expression was decreased in OVX animals (P less then 0.05) while HSP25 content remained unchanged. Following 20 LCs, HSP25 content was elevated (P less then 0.05) in TA muscles from OVX animals but unchanged in muscles from OVI animals. Following 40 LCs, HSP25 content was elevated (P less then 0.01) in TA muscles from both OVI and OVX animals while HSP72 content was elevated only in TA muscles from OVI animals (P less then 0.05). BLU-554 mw Taken together, these data suggest the loss of ovarian hormones, such as estrogen, may impair the skeletal muscle cellular stress response thereby rendering muscles more susceptible to certain types of contraction induced damage. Novelty Ovariectomy alters muscle HSP72 content. Muscle contractile measures are maintained following ovariectomy.The COVID-19 pandemic has strained global health care systems in ways that simply could not have been imagined just several months ago. Writing from the heart of New York City - the unfortunate new epicenter of this pandemic - we have been confronted with this new reality head-on. As directors of two major academic cardiac catheterization laboratories in the city, we both have had to operationalize logistical planning of physician and staff redeployments as well as modification of our respective hospital units including conversion of large portions of the catheterization laboratory into COVID-19 intensive care units in order to deal with the surge of COVID-19 patients within the hospital.Introduction Assessment of intraocular pressure (IOP) is a core diagnostic tool in management of glaucoma. All established ways to measure IOP use indirect approaches through ocular tissues, mainly the cornea or the sclera. Telemetric IOP measurement with an implantable device could eliminate bias caused by indirect techniques and could allow continuous monitoring. A favorable safety profile, high efficacy and good tolerability are key requirements.Areas covered The Eyemate-IO™ system (Implandata Ophthalmic Products GmbH, Hannover, Germany) is a novel CE-marked implantable medical device for direct measurement of IOP. It consists of an intraocular sensor ring and an external reading device. This review presents the mechanism of telemetric IOP measurement and summarizes the available clinical data. Twelve months follow-up data of two clinical trials provide support for the efficacy and safety of this device.Expert opinion The implantable Eyemate-IO™ in keratoprosthesis was well tolerated; recorded adverse events were known complications of standalone surgery. The system had a good agreement with other IOP measuring modalities, including intraoperative manometry. In glaucoma patients, the Eyemate-IO™ could be implanted safely and showed a favorable efficacy and safety profile in the first twelve months postoperatively. The potential to achieve IOP monitoring with the Eyemate-IO™ seems promising.Root cause analyses were intended to search for system vulnerabilities rather than individual errors, using a human factors engineering approach. In practice, root cause analyses done in the NHS may generally fail to identify components where there are organisational failures, as there may be an inherent desire to protect institutional reputation. A human factors approach to root cause analysis looks at system vulnerabilities, considering the entirety of the environment in which an individual works and taking into account factors such as the physical environment and individual mental characteristics. Other human factors include group dynamics, task complexity and concurrent tasks. It is time that the growing evidence of the potential shortcomings of root cause analysis, especially as frequently applied within the NHS, is heeded. At present, rather than assisting learning it may be an impediment to patient safety. The authors propose that root cause analyses should be performed by a group of people who are not managing the service. External organisations such as the General Medical Council, Nursing and Midwifery Council, Care Quality Commission and Practitioner Performance Assessment are heavily reliant on this tool when concerns are raised. If the flaws in root cause analysis can be eliminated, drawing on the available evidence, cases such as those of Dr Hadiza Bawa-Garba and Mr David Sellu might be avoided.