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The worldwide spread of coronavirus disease 2019 (COVID-19) has caused a heavy burden on the public health of all countries. As the specific antiviral treatment is not available, it is necessary to monitor various clinical indicators, and minimize the risk factors related to poor outcomes in the management of COVID-19. COVID-19 is often presented with hyponatremia which is frequently associated with prolonged hospitalization, increased rate of intensive care unit transfer, higher risk of severe pneumonia and mortality. Hyponatremia is an important index for early identification of patients with poor prognosis. COVID-19 related hyponatremia is mainly caused by inappropriate antidiuretic hormone secretion syndrome and hypovolemia. If hyponatremia can be diagnosed and corrected in time, the poor clinical outcomes related to hyponatremia can be prevented.

Acromegaly is usually caused by pituitary adenomas that secrete growth hormone (GH). The disease is prone to be complicated with hypertension and thus aggravates the state of the illness and increase the disease burden. This paper summarized the prevalence, clinical characteristics, pathophysiological mechanism, diagnosis and treatment of hypertension in patients with acromegaly and potential influence of the disease control on acromegaly on hypertension, in order to deepen the understanding of the disease and provide evidence for good prevention and control of hypertension in patients with acromegaly.

Computer clinical thinking training is a teaching method that uses the computer technology to simulate real clinical scenarios. Compared with the traditional clinical thinking training mode, it has its unique advantages. This article introduces the current status of computer clinical thinking training as well as its application values in rare diseases teaching, existing problems and solutions. And we emphasize its potential in clinical thinking teaching. This new method guaranteeing the homogeneity of physician training will advance the progress of medical teaching reformation.

In winter of 2020, government delayed the opening of schools because of the pandemic of COVID-19. In order to regulate children's mood, parents provided their children with the chance to use electronic products such as mobile phones. Educational systems across the country organized students to take part in online learning. Screen teaching is helpful for children to complete learning. But some children require an additional use of mobile phones or electronic products for entertainment and games. However, a longtime screen use will bring negative influence on psychological behaviors of children and affect their growth. In order to protect children, schools should set up online courses reasonably according to children's physical and mental characteristics. And parents should enrich home activity to meet the needs of children and take effective measures to minimize negative impact to children.

Objective To retrospectively analyze the clinical characteristics of patients with Cushing's syndrome (CS) complicated with perioperative pulmonary embolism (PE). Methods Depending on Chinese Pituitary Disease Registry Network (CPDRN) and Pituitary Tumor Database in Peking Union Medical College Hospital, 20 patients with CS complicated perioperative PE were collected from January 1, 2013 to September 30, 2020, and the clinical manifestations and laboratory examination data of the patients were investigated. The clinical characteristics were compared between ectopic adrenocorticotropic hormone syndrome (EAS) and CS with PE during the perioperative period. In addition, clinical characteristics were also studied in these patients before and after the operation. Results According to etiology, they were divided into CS (7 cases), EAS (9 cases) and adrenal adenoma (4 cases). The course of CS was longer than EAS (t = ⁃ 2.938, P = 0.011). According to the occurrence time of PE, the patients were divided into preoperative PE (13 cases) and postoperative PE (7 cases). The patients with postoperative PE had a lower body mass index (t = 2.427, P = 0.026) and a higher fibrinogen (t = ⁃ 2.162, P = 0.047). The patients with PE before surgery included 5 cases of CS, 5 cases of EAS, and 3 cases of adrenal adenomas, while those who with PE after surgery included 2 cases of CS, 4 cases of EAS, and one case of adrenal adenoma. Among the 7 patients with PE after surgery, 5 cases did not get remission. Compared with preoperative examination, the erythrocyte count (t = ⁃ 2.032, P = 0.042) and hemoglobin (t = 9.807, P = 0.001) were decreased after operation, the prothrombin time (t = ⁃ 2.847, P = 0.047) and international normalized ratio (t = ⁃ 3.059, P = 0.038) were increased after operation. Conclusions Longer course of disease and no remission hypercortisolemia after surgery may be the risk factors for perioperative PE in CS patients. Patients with elevated fibrinogen before surgery and reduced red blood cell count and hemoglobin after surgery should be alert to the risk of PE. doi：10.3969/j.issn.1672⁃6731.2021.03.009

Objective To summarize the clinical features of adrenocorticotropic hormone (ACTH)⁃dependent Cushing's syndrome (CS) with multiple endocrine neoplasia (MEN). Methods Based on the pituitary tumor database of Peking Union Medical College Hospital of China Pituitary Disease Register Network (CPDRN), 18 patients with ACTH ⁃ dependent CS complicated with MEN from January 1984 to September 2020 were collected. The clinical manifestations, involved other endocrine glands, laboratorial and imageological examinations were analyzed. Results Among 18 patients, 13 cases were Cushing's disease and 5 cases were ectopic ACTH syndrome (EAS); 15 cases were MEN1 type, 2 cases were MEN2 type and one case was MEN4 type. The clinical manifestations were subclinical CS in 6 cases and overt CS in 12 cases. All cases had osteopenia or osteoporosis. Urolithiasis accounted for 11/18 cases. Regarding the involved endocrine glands, pituitary ACTH adenoma accounted for 13/18 cases, prolactinoma accounted for 4/18 cases, hyperparathyroidism accounted for 15/18 cases, pancreatic neuroendocrine tumors accounted for 13/18 cases and adrenal adenomas and hyperplasia accounted for 10/18 cases. Laboratorial examinations showed the average morning serum cortisol was (652.90 ± 254.90) nmol/L, the morning ACTH was (13.38 ± 8.73) pmol/L and the 24 h urinary free cortisol was 446.35 (233.08, 531.10) µg. Serum prolactin was elevated in 2 cases, parathyroid hormone was elevated in 13 cases and serum calcium was elevated in 11 cases. In imageological examinations, there were pituitary microadenoma in 12 cases, pituitary macroadenoma in 3 cases, adrenal adenoma in 8 cases, thickened adrenal in 4 cases, adrenal pheochromocytoma in 2 cases, and paraganglioma in one case. Genetic test showed 3 cases had MEN1 gene mutation including c.1183C ＞ T, c.1579C ＞ T and c.1174G ＞ T. Conclusions ACTH⁃dependent CS with MEN is a rare disease with complex manifestations. The most common symptom is osteopenia/osteoporosis. The most common cause of CS is pituitary microadenoma. MEN1 is the most common MEN type, and primary hyperparathyroidism is the most common type of affected endocrine glands, followed by pancreatic neuroendocrine tumors. doi：10.3969/j.issn.1672⁃6731.2021.03.008

Objective To investigate the effects of adiponectin on human FAS and HSL gene promoter activities in human hepatocarcinoma cell line HepG2 transfected with plasmids containing human FAS or HSL promoters fused to a luciferase reporter gene. Methods The luciferase reporter gene expression plasmids pGL3-hFAS625-Luc(hFAS 625-Luc) and pGL3-hHSL750-Luc (hHSL 750-Luc) were constructed. HepG2 cells were then transfected with these plasmids by lipofectamine method. The FAS and HSL promoter activities was evaluated by testing the luciferase activity through incubation with 0.5-10.0 μg/mL adiponectin) for 24 h or 5 μg/mL adiponectin for 2-32 h. Results Both hFAS 625-Luc and hHSL 750-Luc plasmids were well expressed in HepG2 cells. 1.0-10.0 μg/mL adiponectin could progressively increase the luciferase expression in HepG2 cells transfected with hFAS 625-Luc and hHSL 750-Luc plasmids with the maximum effect of 1.76 folds (P＜0.01) and 1.37 folds of the controls, respectively, at the concentration of 10.0 μg/mL(P＜0.01). Moreover, 5 μg/mL adiponectin promoted the expression of luciferase in HepG2 cells transfected with hFAS 625-Luc plasmids at 4 h and 8 h (P＜0.01), and inhibited the expression of luciferase at 16 h and 32 h (P＜0.01). Adiponectin promoted the expression of luciferase in HepG2 cells transfected with HSL 750-Luc within different durations(2~32 h), and the highest was 1.37 times of the control group at 2 h (P＜0.01). Conclusions The luciferase reporter gene plasmids containing human FAS and HSL promoters are successfully constructed. Adiponectin promotes FAS and HSL promoter activities in HepG2 cells with a dose-dependent manner. Adiponectin has a double effect on FAS promoter activity in different times, while it has a promoting effect on HSL promoter activity with different incubation durations.

Objective To explore the effect of case-based learning (CBL) combined with hypothalamus-pituitary MDT clinic in clinical teaching of hypothalamus pituitary diseases. Methods The trainees who participated in the hypothalamus-pituitary MDT discussion and CBL teaching in Peking Union Medical College Hospital from January to December 2019 were requird to fill in the questionnaire about the learning outcomes before and after participating in hypothalamus-pituitary MDT discussion and teaching. Likert 5 grade score method was used to evaluate the teaching effect. Results Among the 89 trainees,the degree of understanding of pituitary nonfunctional tumors, functional pituitary tumors, diabetes insipidus, differential diagnosis of pituitary stalk thickening, differential diagnosis of pituitary inflammatory diseases, and imaging knowledge of pituitary diseases before participating in hypothalamus-pituitary MDT were 41.57%, 48.31%, 49.44%, 12.36%, 12.36% and 23.60%, respectively. The degree of understanding increased to 74.16%, 76.40%, 82.02%, 73.03%, 78.65% and 86.52% respectively, and there was statistical difference after quantitative score (P＜0.01). Conclusions The teaching mode of hypothalamus-pituitary MDT based on CBL can improve the resident and attending physicians'knowledge about pituitary diseases. This teaching manner is expected to be applied in the clinical teaching of pituitary diseases.

Objective To compare the clinical characteristics between pituitary gigantism patients with different age of onset. Methods This study retrospectively summarized the clinical data of patients diagnosed with pituitary gigantism in Peking Union Medical College Hospital from 1990 to 2018. Patients were divided into two groups according to the age of disease onset: patients with the age range of onset between 10～15 years old and the rest of patients. Results A total of 28 patients with pituitary gigantism were included in the study. Among them, 22 patients were male, with a median duration of 11.0 years (7.0, 13.8). 78.5% of the patients had a rapid growth in height at the first consultation, with an average height of (190.2±17.5)cm and an average height SDS(Ht SDS) of +4.5± 1.6 at the time of diagnosis. The pituitary MRI of 92.9% of patients demonstrated pituitary macroadenomas, of which 42.9% were pituitary giant adenomas. This study showed that the maximum diameter of the tumor in group with the age of onset between 10 to 15 years was significantly higher than that of control group (the age of onset between 10 to 15 years old: 2.9±1.3 cm vs. control group: (1.9±0.8)cm, P＜0.05), the proportion of pituitary giant adenoma was also significantly higher than control group (the age of onset between 10 to 15 years old: 62.5% vs control group: 16.7%, P＜0.05). Long-term follow-up data showed that the proportion of combined treatment (surgery & medication & radiotherapy) in group with onset of age between 10 to 15 years old was higher than that of control group (the age of onset between 10 to 15 years old: 31.2% vs control group: 8.3%). However, the cure rate between two groups in the long-term follow-up did not reach statistical significance. Conclusions This study shows that pituitary gigantism patients during puberty are prone to have larger adenoma and are more likely to develop into a giant pituitary adenoma. It is recommended to focus on this population in clinical practice and more aggressive treatment should be considered if necessary.

Establishing correct clinical thinking is the core and foundation of improving doctors' clinical ability as well as the key and difficult point of medical education. Different from common diseases, the clinical thinking of rare diseases has its unique characteristics. Taking dwarfism as an example, this paper summarizes the characteristics of diagnosis reasoning for rare diseases in the aspects of data collection, logical reasoning, evidence-based teaching, multiple disciplinary team, molecular biology research and artificial intelligence, which is conducive to improving the efficiency of physicians and providing experience for clinical thinking training of rare diseases.

Objective Peking Union Medical College Hospital (PUMCH) introduced the Mentor Training Program (MTP) since 2018 to strengthen the system of faculty development. This study aims to investigate the effects of MTP training. Methods Questionnaire of pre-course, 1-week post-course, and 3-month post-course were collected among 18 trainees, the questions cover the degree of confidence, feedback and mentor behavior change after training. Non-parametric Kruskal-Wailis H test was used to assess confidence in mentoring skill, applying open coding to analyze the open questions. Results All trainees reported a significant increase in confidence in improving mentoring skills, becoming excellent mentors, strengthening contact among mentors and increasing career satisfac- tion. A variety of mentoring skill such as communication, long term career goals, making aligned goals with trainees, role modeling, and time managing significantly increased. The mentor's practice changes are reflected in the practical process of applying the instructor's philosophy, communication methodology, and personal development tools learned during MTP. Conclusions MTP training contributes to innovating mentoring concepts and improving mentoring skills,expansion and further progress are needed to develop the next generation of clinical-translational research mentors.

Objective To explore the effect of the feedback of competency-based training and its evaluation in the Clinical Postdoctoral Program of Peking Union Medical College Hospital. Methods Taking 2018 clinical postdoctoral feedback and evaluation as the object of study, collecting feedback results with the 5-point Likert Scale and reviewing the descriptive comments, to discuss the application of feedback evaluation. Results 13 clinical departments were rated above 4 on average in “individualization” “degree of recognition” “preparation”. “Feedback skill” was rated 3.6. The skills of feedback needed an improvement. Conclusions The feedback evaluation system will contribute to the improvement of feedback and competency-based training quality, and further modification is needed.

Objective In order to meet the needs of endocrinology and metabolism specialists and so to improve the level of diagnosis and treatment, short-term intensive training was organized and its outcome was evaluated. Methods A short-term intensive training course for endocrinologists was implemented and the course evaluation form was designed by vote of WeChat.The learning results were statistically analyzed. Results The short-term intensive training course for endocrinologists were divided into 6 categories and covered by courses, including thyroid diseases (4), metabolic bone diseases (4), glucose, lipid and uric acid metabolic diseases (8), hypothalamic-pituitary diseases (9), adrenal diseases (5), and clinical reasoning training courses (5). All courses were completed in 6 days. The results were presented in both categories and ratings. The results of the category included “very satisfied”, “average” and “unsatisfied”, and the percentage of the number of voters was counted respectively. The five-points system was adopted for ratings, and the average score of all voters was calculated. Participants generally had high satisfaction with the course (average score: ＞4.5), and the evaluation results were 78.2%~100% in “very satisfied” and 0~21.8% in “average” category. Higher requirements for the teaching quality of common diseases (dissatisfaction rate of the trainees: 1.19%~2.30%), higher satisfaction for difficult and rare diseases (average score of 7 courses: 5). Conclusions The curriculum of endocrinologist clinical training should be developed to meet the needs of clinical work. It is necessary to develop a stratified training syste, divrsified teaching forms and quantitative course evaluation methods.

This study introduces the practice of modularized teaching in “core competency” training of the Clinical Postdoctoral Program of the Peking Union Medical College Hospital; moreover, taking the example of medical humanities model course, to compare the 2016 and 2017 module courses outcome by questionnaire and interview. The result shows that set up the “medical humanities model course” and the continuous optimization have greatly improved the course satisfaction. The Clinical Postdoctoral trainees believe module course is helpful to the accomplishing the “core competency”, to identifying the goal of training and enhancing the process management. However, the improvement of course content, format and its long-term effect, needs further exploration and discussion.

Turner syndrome has characteristic maxillofacial abnormalities associated with a variety of diseases, including conductive hearing loss, feeding difficulties, sleep apnea, and vocal abnormalities. The maxillofacial characters of Turner syndrome can be quantitatively studied by cephalometric study. Prenatal diagnosis can also be performed by maxillofacial abnormalities. These abnormalities may be related to genes affecting the development of the first pharyngeal arch on the X chromosome, such as SHOX; may also be associated with genes on the X chromosome that affect histone modifications, such as HDAC8. Long-term growth hormone therapy has an enhanced effect on craniofacial development in patients with Turner syndrome, and a significant improvement on mandibular growth. However, growth hormone therapy can not completely normalize maxillofacial abnormalities. Maxillofacial abnormalities in patients with Turner syndrome should draw more attention due to its diagnostic value, associated disease risk and treatable potential.