RESUMEN
PURPOSE: To evaluate the diagnostic performance of contrast-enhanced (CE) ultrasound using Sonazoid (SNZ-CEUS) by comparing with contrast-enhanced computed tomography (CE-CT) and contrast-enhanced magnetic resonance imaging (CE-MRI) for differentiating benign and malignant renal masses. MATERIALS AND METHODS: 306 consecutive patients (from 7 centers) with renal masses (40 benign tumors, 266 malignant tumors) diagnosed by both SNZ-CEUS, CE-CT or CE-MRI were enrolled between September 2020 and February 2021. The examinations were performed within 7 days, but the sequence was not fixed. Histologic results were available for 301 of 306 (98.37%) lesions and 5 lesions were considered benign after at least 2 year follow-up without change in size and image characteristics. The diagnostic performances were evaluated by sensitivity, specificity, positive predictive value, negative predictive value, and compared by McNemar's test. RESULTS: In the head-to-head comparison, SNZ-CEUS and CE-MRI had comparable sensitivity (95.60 vs. 94.51%, P = 0.997), specificity (65.22 vs. 73.91%, P = 0.752), positive predictive value (91.58 vs. 93.48%) and negative predictive value (78.95 vs. 77.27%); SNZ-CEUS and CE-CT showed similar sensitivity (97.31 vs. 96.24%, P = 0.724); however, SNZ-CEUS had relatively lower than specificity than CE-CT (59.09 vs. 68.18%, P = 0.683). For nodules > 4 cm, CE-MRI demonstrated higher specificity than SNZ-CEUS (90.91 vs. 72.73%, P = 0.617) without compromise the sensitivity. CONCLUSIONS: SNZ-CEUS, CE-CT, and CE-MRI demonstrate desirable and comparable sensitivity for the differentiation of renal mass. However, the specificity of all three imaging modalities is not satisfactory. SNZ-CEUS may be a suitable alternative modality for patients with renal dysfunction and those allergic to gadolinium or iodine-based agents.
Asunto(s)
Medios de Contraste , Compuestos Férricos , Hierro , Neoplasias Renales , Imagen por Resonancia Magnética , Óxidos , Tomografía Computarizada por Rayos X , Ultrasonografía , Humanos , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Masculino , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Ultrasonografía/métodos , Tomografía Computarizada por Rayos X/métodos , Imagen por Resonancia Magnética/métodos , Anciano , Diagnóstico Diferencial , Adulto , Anciano de 80 o más AñosRESUMEN
In recent years, the research of mitochondrial dysfunction in depression has drawn the focus of researchers. Our research group previously found that Xiaoyao San (XYS) has improved the mitochondrial structure and the blocked tricarboxylic acid cycle (TCA cycle) in the hippocampal tissue of chronic unpredictable mild stress (CUMS) rats. However, the specific targets and active components of XYS remain unclear, and the potential to improve hippocampal mitochondrial TCA cycle disorder was also unexplored. In this research, a strategy to combine stable isotope-resolved metabolomics (SIRM), network pharmacology and transmission electron microscopy (TEM) was used to explore the potential, targets of action, and active components of XYS to improve hippocampal mitochondrial TCA cycle disorder of CUMS rats. The results of TEM showed that the ultrastructure of hippocampal mitochondria could be improved by XYS. A combination of SIRM and molecular docking showed that pyruvate carboxylase (PC), ATP citrate lyase (ACLK), glutamate dehydrogenase (GLDH), glutamate oxaloacetate transaminase (GOT) and pyruvate dehydrogenase (PDH) were targets of XYS to improve TCA cycle disorder. In addition, troxerutin was found to be the most potential active component of XYS to improve TCA cycle disorder. The above research results can provide new insights for the development of antidepressant drugs.
Asunto(s)
Medicamentos Herbarios Chinos , Farmacología en Red , Ratas , Animales , Simulación del Acoplamiento Molecular , Antidepresivos/farmacología , Medicamentos Herbarios Chinos/farmacologíaRESUMEN
SARS-CoV-2 nsp13 helicase is an essential enzyme for viral replication and a promising target for antiviral drug development. This study compares the double-stranded RNA (dsRNA) unwinding activity of nsp13 and the Omicron nsp13R392C variant, which is predominant in currently circulating lineages. Using in vitro gel- and fluorescence-based assays, we found that both nsp13 and nsp13R392C have dsRNA unwinding activity with equivalent kinetics. Furthermore, the R392C mutation had no effect on the efficiency of the nsp13-specific helicase inhibitor SSYA10-001. We additionally confirmed the activity of several other helicase inhibitors against nsp13, including punicalagin that inhibited dsRNA unwinding at nanomolar concentrations. Overall, this study reveals the utility of using dsRNA unwinding assays to screen small molecules for antiviral activity against nsp13 and the Omicron nsp13R392C variant. Continual monitoring of newly emergent variants will be essential for considering resistance profiles of lead compounds as they are advanced towards next-generation therapeutic development.
Asunto(s)
Antivirales , Metiltransferasas , SARS-CoV-2 , Proteínas no Estructurales Virales , SARS-CoV-2/efectos de los fármacos , SARS-CoV-2/genética , Antivirales/farmacología , Proteínas no Estructurales Virales/genética , Proteínas no Estructurales Virales/antagonistas & inhibidores , Proteínas no Estructurales Virales/metabolismo , Humanos , ARN Bicatenario/genética , ARN Bicatenario/metabolismo , Mutación/genética , ARN Viral/genética , ARN Helicasas/antagonistas & inhibidores , ARN Helicasas/genética , ARN Helicasas/metabolismo , Replicación Viral/efectos de los fármacos , Replicación Viral/genética , COVID-19/virologíaRESUMEN
To improve nitrogen removal efficiency (NRE) and achieve homogenous distribution of anammox sludge and substrate, a new substrate equalization theory and a cumulative overload index was proposed for multifed upflow anaerobic sludge bed (MUASB) reactors with mature anammox granules. The performance and flow patterns of MUASB reactors were investigated under various influent conditions. The results showed that the nitrogen removal performance and stability of MUASB reactors could be optimized by minimizing the cumulative load. The NRE gradually increased from 83.3 ± 2.2 %, 86.8 ± 4.2 % to 89.3 ± 4.1 % and 89.7 ± 1.6 % in feeding flow tests and feeding port tests, respectively. Furthermore, the flow patterns were compared based on residence time distribution and computational fluid dynamics, indicating that a better equilibrium distribution of microorganisms and substrates could be achieved in the MUASB reactors under the lowest cumulative load. Therefore, substrate equalization theory can be used to optimize the nitrogen removal performance of MUASB reactors with low-carbon footprints.
Asunto(s)
Reactores Biológicos , Nitrógeno , Aguas del Alcantarillado , Aguas del Alcantarillado/microbiología , Anaerobiosis , Nitrógeno/metabolismo , Oxidación-Reducción , HidrodinámicaRESUMEN
Coding transcript-derived siRNAs (ct-siRNAs) produced from specific endogenous loci can suppress the translation of their source genes to balance plant growth and stress response. In this study, we generated Arabidopsis mutants with deficiencies in RNA decay and/or post-transcriptional gene silencing (PTGS) pathways and performed comparative sRNA-seq analysis, revealing that multiple RNA decay and PTGS factors impede the ct-siRNA selective production. Genes that produce ct-siRNAs often show increased or unchanged expression and typically have higher GC content in sequence composition. The growth and development of plants can perturb the dynamic accumulation of ct-siRNAs from different gene loci. Two nitrate reductase genes, NIA1 and NIA2, produce massive amounts of 22-nt ct-siRNAs and are highly expressed in a subtype of mesophyll cells where DCL2 exhibits higher expression relative to DCL4, suggesting a potential role of cell-specific expression of ct-siRNAs. Overall, our findings unveil the multifaceted factors and features involved in the selective production and regulation of ct-siRNAs and enrich our understanding of gene silencing process in plants.
Asunto(s)
Proteínas de Arabidopsis , Arabidopsis , Arabidopsis/metabolismo , ARN Interferente Pequeño/genética , ARN Interferente Pequeño/metabolismo , Proteínas de Arabidopsis/metabolismo , Interferencia de ARN , ARN Bicatenario/metabolismo , Plantas/metabolismoRESUMEN
Neonatal health is dependent on early risk stratification, diagnosis, and timely management of potentially devastating conditions, particularly in the setting of prematurity. Many of these conditions are poorly predicted in real-time by clinical data and current diagnostics. Umbilical cord blood may represent a novel source of molecular signatures that provides a window into the state of the fetus at birth. In this study, we comprehensively characterized the cord blood proteome of infants born between 24 to 42 weeks using untargeted mass spectrometry and functional enrichment analysis. We determined that the cord blood proteome at birth varies significantly across gestational development. Proteins that function in structural development and growth (e.g., extracellular matrix organization, lipid particle remodeling, and blood vessel development) are more abundant earlier in gestation. In later gestations, proteins with increased abundance are in immune response and inflammatory pathways, including complements and calcium-binding proteins. Furthermore, these data contribute to the knowledge of the physiologic state of neonates across gestational age, which is crucial to understand as we strive to best support postnatal development in preterm infants, determine mechanisms of pathology causing adverse health outcomes, and develop cord blood biomarkers to help tailor our diagnosis and therapeutics for critical neonatal conditions.
RESUMEN
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with enhanced transmissibility and immune escape have emerged periodically throughout the coronavirus disease 2019 (COVID-19) pandemic, but the impact of these variants on disease severity has remained unclear. In this single-center, retrospective cohort study, we examined the association between SARS-CoV-2 clade and patient outcome over a two-year period in Chicago, Illinois. Between March 2020 and March 2022, 14,252 residual diagnostic specimens were collected from SARS-CoV-2-positive inpatients and outpatients alongside linked clinical and demographic metadata, of which 2,114 were processed for viral whole-genome sequencing. When controlling for patient demographics and vaccination status, several viral clades were associated with risk for hospitalization, but this association was negated by the inclusion of population-level confounders, including case count, sampling bias, and shifting standards of care. These data highlight the importance of integrating non-virological factors into disease severity and outcome models for the accurate assessment of patient risk.
Asunto(s)
COVID-19 , Humanos , COVID-19/epidemiología , SARS-CoV-2/genética , Epidemiología Molecular , Estudios Retrospectivos , Prueba de COVID-19RESUMEN
Objective To observe the safety and effectiveness of ultrasound-guided femoral nerve combined with femoral artery block to reduce tourniquet reaction in patients undergoing knee arthroplasty.Methods 100 patients(18~75 years old,body mass index 18~30 kg/m2)who were classified as grade Ⅰ-Ⅲ according to ASA standard and received unilateral total knee arthroplasty.The patients were randomly divided into two groups,the ultrasound-guided femoral nerve combined with femoral artery block with general anesthesia was utilized in group NA with 50 cases,and femoral nerve block alone with general anesthesia was used in group N with 50 cases.The target nerve block was guided by ultrasound before induction of anesthesia in both two groups,and anesthesia induction was performed after the block effect was etermined.Patients in two groups underwent surgery under general anesthesia of the laryngeal mask,and all patients under went self-controlled intravenous analgesia(PCIA).If a patient had a visual analogue score(VAS)score>5 after surgery,flurbiprofenate 50 mg will be given intravenously as a remedy for anal-gesia.The patients'SBP,DBP and HR were recorded before anesthesia(T1),1 min before tourniquet inflation(T2),15 min after tourniquet inflation(T3),30 min(T4),45 min(T5),and 60 min(T6),the number of cases of tourniquet hypertension occurring in patients intraoperatively and the amount of nicardipine and esmolol were recorded,and the movement and static VAS scores at 2,6,12,and 24 h after surgery were recorded.the postoperative rescue analgesic requirements and the time of getting out of bed were recorded.The incidence of adverse reactions such as nausea,vomiting,deliriumand infection were also recorded.Results Compared with group N,SBP,DBP and HR were significantly lower in group NA at 45 and 60 min after tourniquet inflation,and the incidence of tourniquet hypertension and the amount of nicardipine and esmolol were also significantly lower(P<0.05),and the time of getting out of bed was advanced(P<0.05);the movement and static VAS scores,the time of the first remedial analgesia,and number of times of remedial analgesia,as well as the occurrence of nausea,vomiting,delirium and infection were not statistically significant.Conclusion Ultrasound-guided femoral nerve combined with femoral artery block can be safely and effectively used to reduce the reaction of tourniquet in patients with knee arthroplasty,and can shorten the time of getting out of bed after surgery,contributing to promoting postoperative rehabilitation.
RESUMEN
Objective:To explore the expression of OGDHL and AU element-rich RNA-binding protein 1 (AUF1) in patients with non-small cell lung cancer (NSCLC) and their correlation with the prognosis of patients.Methods:The clinical data of 96 patients with NSCLC who were diagnosed and underwent surgical treatment in Guang'an People's Hospital from February 2018 to February 2019 were retrospectively analyzed. The surgically resected NSCLC tissues and the paracancerous tissues (4 cm from the tumor edge) were taken, and the immunohistochemical staining was used to detect the protein expressions of OGDHL and AUF1 in all specimens. The relationship between OGDHL and AUF1 proteins and clinicopathological characteristics of NSCLC was analyzed. The 3-year overall survival (OS) rate of patients with different expressions of OGDHL and AUF1 proteins were compared by using Kaplan-Meier method. Multivariate Cox proportional hazards model was used to explore the influencing factors for the prognosis of NSCLC patients.Results:The high expression rate of OGDHL protein in the cancer tissues of NSCLC patients was lower than that in the paracancerous tissues [32.3% (31/96) vs. 62.5% (60/96), χ2 = 45.21, P < 0.001], and the high expression rate of AUF1 protein was higher than that in the paracancerous tissues [68.8% (66/96) vs. 34.4% (33/96), χ2 = 42.36, P < 0.001]. The high expression rate of OGDHL protein in patients with TNM stage Ⅰ-Ⅱ was higher than that in patients with stage Ⅲ-Ⅳ [39.1% (25/64) vs. 18.8% (6/32)], and the high expression rate of OGDHL protein in patients with lymph node metastasis was lower than that in patients without lymph node metastasis [10.3% (3/29) vs. 41.8% (28/67)] (both P < 0.05). The high expression rate of AUF1 protein in patients with stageⅠ-Ⅱ was lower than that in patients with stage Ⅲ-Ⅳ [59.4% (38/64) vs. 87.5% (28/32)], and the high expression rate of AUF1 protein in patients with lymph node metastasis was higher than that in patients without lymph node metastasis [86.2% (25/29) vs. 61.2% (41/67)] (both P < 0.05). The 3-year OS rate of all NSCLC patients was 62.50%. The 3-year OS rate of patients with high expression of OGDHL protein after surgery was higher than that of patients with low expression of OGDHL protein (80.66% vs. 53.33%, P < 0.05), and the 3-year OS rate of patients with high expression group of AUF1 protein after surgery was lower than that of patients with low expression of AUF1 protein (50.00% vs. 76.52%, P < 0.05). The difference in 3-year OS rate of patients with different TNM stage and lymph node metastasis was statistically significant (both P < 0.05), and the 3-year OS rate of patients with TNM stage Ⅲ-Ⅳ and lymph node metastasis was lower than that of patients with stage Ⅰ-Ⅱ and no lymph node metastasis (both P < 0.05). Low expression of OGDHL ( HR = 3.78, 95% CI 1.72-8.31) and high expression of AUF1 ( HR = 3.67, 95% CI 1.73-7.80) were both independent risk factors for the prognosis of NSCLC patients (both P < 0.001). Conclusions:The expression of OGDHL protein is decreased and the expression of AUF1 protein is increased in NSCLC tissues. The expression levels of OGDHL and AUF1 proteins are related to the prognosis of NSCLC patients.
RESUMEN
Portal vein thrombosis is one of the common complications of liver cirrhosis, and anticoagulation is currently the main treatment method for this disease. Since low-molecular-weight heparin must be injected and vitamin K antagonists require regular monitoring of international normalized ratio (INR), direct oral anticoagulants have become a research hotspot in replacement therapy with the advantages of convenient oral administration, no need for INR monitoring, and high recanalization rate. This article summarizes the advances in direct oral anticoagulants in the treatment of cirrhosis-associated portal vein thrombosis, in order to lay a foundation for further clinical studies.
RESUMEN
Schizophrenia (SCZ) is a highly destructive and complex psychiatric disorder illness, accompanied by a variety of positive and negative symptoms along with cognitive impairment, which brings a heavy social burden. Elucidation of the pathogenesis and therapeutic development is challenging because the complex interplay between genetic risk factors and environmental factors in essential neurodevelopmental processes. Therefore, preparing appropriate animal models can help people better understanding the neurobiological basis of SCZ and provide theoretical basis for finding new treatments. In order to provide reference for the application and improvement of SCZ animal models, this commentary reviewed several main modeling methods for animal models of SCZ, including neurodevelopmental models, drug-induced animal models, and genetic models, and the behavioral evaluation, histological analysis and possible molecular mechanisms of SCZ animal models were also outlined.
RESUMEN
Objective: To investigate the neural connections between Shenmen (HT7)-heart and the brain by observing the tracing viruses co-labeled brain nuclear groups after injection of the pseudorabies viruses (PRV), the reverse transsynaptic virus tracer carrying different fluorescent protein genes, into the myocardium and Shenmen (HT7) point, respectively.Methods: Pseudorabies virus 531 (PRV531) carrying the green fluorescent protein gene and pseudorabies virus 724 (PRV724) carrying the red fluorescent protein gene were injected into the left ventricular wall and Shenmen (HT7) point area of the left forelimb of six C57BL/6 mice, respectively. After 120 h, whole brain tissue was extracted under 4% paraformaldehyde perfusion to prepare brain sections. Neuronal co-labeling with the tracing viruses was observed under fluorescence microscopy. Results: Co-labeled signals from the mouse ventricular wall and Shenmen (HT7) point region were found at all levels of the mouse central nervous areas, such as the cerebral cortex, hypothalamus, midbrain, pons, and medulla oblongata. The number of co-labeled neurons was higher in the primary motor area, the hypothalamic paraventricular nucleus, the subceruleus nucleus, and the paramedian reticular nucleus. Conclusion: There is a neural connection between Shenmen (HT7), the heart, and the brain, which may be most closely related to the autonomic nervous system.
RESUMEN
ObjectiveTo investigate whether the whole intestinal microbiota transplantation in Alzheimer's disease (AD) model mice has more significant effects on ileum intestinal microenvironment in normal mice under the guidance of the theory of traditional Chinese medicine that "interior-exterior relationship exists between the heart and small intestine". MethodsThe whole intestinal microbiota of fourteen 6-month-old specific pathogen free male APP/PS1 double-transgenic AD model mice was transplanted into the gut of six normal C57BL/6J mice of the same age and background treated with mixed antibiotics for 14 days. Then, after 14 days of normal rearing, the mice were sacrificed. Next, the pathological changes in the ileum and colon were observed, and the composition and diversity of the ileal and colonic microbiota was analyzed by sequencing. ResultsAfter the whole intestinal microbiota of AD mice was transplanted into normal mice, pathological analysis showed that only the ileum tissue had mucosal damage and crypt gland epithelial cell degeneration, necrosis, and shedding. Moreover, the microbiota analysis found that only the number of genera (P<0.01), Chao1 index (P<0.01) and Simpson index of ileal microbiota in normal mice decreased (P<0.01), and the composition of intestinal microbiota was quite similar to that of AD model mice. ConclusionUnder the effect of whole gut microbiota transplantation in AD mice, the diversity and composition of ileal microbiota change more than that of colonic microbiota in normal mice, and at the same time, it results in pathological damage to the ileal mucosa, indicating that the ileal microenvironment may be more closely related to the occurrence and development of AD, which is highly consistent with the traditional Chinese medicine theory of "interior-exterior relationship between heart and small intestine".
RESUMEN
Aim To explore the effect of artesunate (ART) on the function of breast cancer cells during the progression of breast cancer and the possible mechanism of action. Methods MCF-7 (30 μmol • L-
RESUMEN
Aim To clarify the regulatory effect of Artesunate(ART) on tumor cell function and cell cycle in the pathological process of esophageal squamous cell carcinoma(ESCC). Methods KYSE450 and TE14 cells were treated with different concentrations of ART. The cells treated with 0 mg •L
RESUMEN
Stable isotope tracer metabolomics tracks and analyzes the whole metabolic process of the body through the tracer atoms, which belongs to the frontier technology in the field of biomedicine. This technology is of great significance and value for explaining the pathogenesis of diseases, finding biomarkers of diseases and drug action targets. Taking the mechanism of glucose catabolism disorder in depression as an example, this paper systematically expounds the stable isotope tracer metabolomics technology and its application. The research idea of stable isotope tracer metabolomics based on unmarked metabolomics was put forward, and the research strategy of biological significance interpretation from four dimensions of metabolite isotope abundance, key metabolic enzymes, metabolic flow direction and metabolite flow was given, which broke through the bottleneck of stable isotope tracer metabolomics research technology based on overall animal experiment, and provided scientific basis for the promotion and application of this technology.
RESUMEN
OBJECTIVE@#To observe the effects of electroacupuncture (EA) pretreatment on cardiac function, sympathetic nerve activity, indexes of myocardial injury and GABAA receptor in fastigial nucleus in rats with myocardial ischemia reperfusion injury (MIRI), and to explore the neuroregulatory mechanism of EA pretreatment in improving MIRI.@*METHODS@#A total of 60 male SD rats were randomly divided into a sham operation group, a model group, an EA group, an agonist group and an agonist+EA group, 12 rats in each group. The MIRI model was established by ligation of the left anterior descending coronary artery. EA was applied at bilateral "Shenmen" (HT 7) and "Tongli" (HT 5) in the EA group and the agonist+EA group, with continuous wave, in frequency of 2 Hz and intensity of 1 mA, 30 min each time, once a day for 7 consecutive days. After intervention, the MIRI model was established. In the agonist group, the muscone (agonist of GABAA receptor, 1 g/L) was injected in fastigial nucleus for 7 consecutive days before modeling, 150 μL each time, once a day. In the agonist+EA group, the muscone was injected in fastigial nucleus 30 min before EA intervention. The data of electrocardiogram was collected by PowerLab standard Ⅱ lead, and ST segment displacement and heart rate variability (HRV) were analyzed; the serum levels of norepinephrine (NE), creatine kinase isoenzyme MB (CK-MB) and cardiac troponin I (cTnI) were detected by ELISA; the myocardial infarction area was measured by TTC staining; the morphology of myocardial tissue was observed by HE staining; the positive expression and mRNA expression of GABAA receptor in fastigial nucleus were detected by immunohistochemistry and real-time PCR.@*RESULTS@#Compared with the sham operation group, in the model group, ST segment displacement and ratio of low frequency to high frequency (LF/HF) of HRV were increased (P<0.01), HRV frequency domain analysis showed enhanced sympathetic nerve excitability, the serum levels of NE, CK-MB and cTnI were increased (P<0.01), the percentage of myocardial infarction area was increased (P<0.01), myocardial fiber was broken and interstitial edema was serious, the positive expression and mRNA expression of GABAA receptor in fastigial nucleus were increased (P<0.01). Compared with the model group, in the EA group, ST segment displacement and LF/HF ratio were decreased (P<0.01), HRV frequency domain analysis showed reduced sympathetic nerve excitability, the serum levels of NE, CK-MB and cTnI were decreased (P<0.01), the percentage of myocardial infarction area was decreased (P<0.01), myocardial fiber breakage and interstitial edema were lightened, the positive expression and mRNA expression of GABAA receptor in fastigial nucleus were decreased (P<0.01). Compared with the EA group, in the agonist group and the agonist+EA group, ST segment displacement and LF/HF ratio were increased (P<0.01), HRV frequency domain analysis showed enhanced sympathetic nerve excitability, the serum levels of NE, CK-MB and cTnI were increased (P<0.01), the percentage of myocardial infarction area was increased (P<0.01), myocardial fiber breakage and interstitial edema were aggravated, the positive expression and mRNA expression of GABAA receptor in fastigial nucleus were increased (P<0.01).@*CONCLUSION@#EA pretreatment can improve the myocardial injury in MIRI rats, and its mechanism may be related to the inhibition of GABAA receptor expression in fastigial nucleus, thereby down-regulating the excitability of sympathetic nerve.
Asunto(s)
Masculino , Animales , Ratas , Ratas Sprague-Dawley , Núcleos Cerebelosos , Electroacupuntura , Daño por Reperfusión Miocárdica/terapia , Receptores de GABA-A/genética , ARN MensajeroRESUMEN
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.