0% among respondents reporting diabetes and 8.0% without diabetes). Only 54-55% of these respondents claimed to consistently practice preventive measures, including wearing face masks. Almost 60% of those with diabetes experienced food or medication shortages during the quarantine period, which was much higher than those without diabetes. Importantly, respondents who experienced medication shortages reported a 63% higher COVID-19 infection rate. Diabetes was associated with an increased risk of self-reported personal and family member COVID-19 infection, which is mitigated by consistent use of face masks.Irisin, an emerging adipokine, has been involved in the pathogenesis of type 2 diabetes mellitus (T2DM). However, previous studies evaluating the association between irisin and diabetic nephropathy (DN) showed inconsistent results. We performed a meta-analysis to evaluate the above association. Matched case-control studies evaluating the difference of serum irisin between T2DM patients with and without DN were identified via systematic search of PubMed, Embase, Cochranes' Library, China National Knowledge Infrastructure, and WanFang databases from inception to December 5, 2020. A random-effects model or a fixed-effects model was used to pool the results according to the heterogeneity. Overall, thirteen matched case-control studies including 1735 T2DM patients were included. Results of meta-analysis showed that compared to T2DM patients with normoalbuminuria, those with microalbuminuria [10 studies, standard mean difference (SMD) 1.12, 95% confidence interval (CI) 0.48-1.77, p less then 0.001; I2=94%] and macroalbuminuria (10 studies, SMD 1.86, 95% CI 0.93-2.79, p less then 0.001; I2=97%) had significantly lower serum irisin. Besides, the serum level of irisin was significantly lower in T2DM patients with macroalbuminuria than those with microalbuminuria (10 studies, SMD 0.91, 95% CI 0.44-1.38, p less then 0.001; I2=90%). In addition, patients with estimated glomerular infiltration rate (eGFR) less then 60 ml/min 1.73 m2 had lower serum irisin compared to those with eGFR≥60 ml/min 1.73 m2 (4 studies, SMD 0.89, 95% CI 0.32-1.46, p=0.002; I2=91%). In conclusion, serum irisin may be associated with albuminuria and reduced eGFR in T2DM patients.Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. For stage I and II tumors, surgery is a curative option, but even in these cases recurrence is frequent. Practical guidelines advocate a combination of mitotane with etoposide, doxorubicin, and cisplatin as first-line therapy for metastatic adrenocortical carcinoma. However, this scheme presents limited efficacy and high toxicity. The use of Immune Checkpoint Inhibitors (ICI) and multi-Tyrosine Kinase Inhibitors (mTKI) has modified the approach of multiple malignancies. The expectation of their applicability on advanced adrenocortical carcinoma is high but the role of these new therapies persists unclear. This article provides a short summary of last years' findings targeting outcomes, limitations, and adverse effects of these new therapeutic approaches. The results of recent trials and case series pointed pembrolizumab as the most promising drug among these new therapies. It is the most often used ICI and the one presenting the best results with less related adverse effects when in comparison to the standard treatment with mitotane. Hereafter, the identification of specific molecular biomarkers or immune profiles associated with ICI or mTKI good response will facilitate the selection of candidates for these therapies. So far, microsatellite instability and Lynch Syndrome related germline mutations are suggested as predictive biomarkers of good response. Contrarywise, cortisol secretion has been associated with more aggressive ACC tumors and potentially poor responses to immunotherapy.Venous thromboembolism (VTE) is a leading cause of morbidity and preventable harm among noncritically ill hospitalized children. Several clinical factors relevant to the noncritically ill hospitalized child significantly increase the risk of VTE including the presence of central venous catheters, systemic inflammation, and prolonged immobilization. Although risk mitigation strategies have been described, the diagnosis, treatment, and prevention of VTE require standardization of institutional practices combined with multidisciplinary collaboration among pediatric hospitalists, hematologists, and other care providers. In this narrative review, we summarize the epidemiology of VTE, risk models identifying high-risk conditions associated with VTE, and prevention and treatment strategies. We further describe successful quality improvement efforts implementing institutional VTE risk stratification and thromboprophylaxis procedures. Finally, we highlight unique challenges facing pediatric hospital medicine specialists in the era of the COVID-19 pandemic, including caring for adults admitted to pediatric hospital units, and describe future research opportunities for VTE in the noncritically ill hospitalized child.Extracellular vesicles (EVs) play a crucial role in feto-maternal communication and provide an important paracrine signaling mechanism in pregnancy. We hypothesize that fetal cells-derived exosomes and microvesicles (MVs) under oxidative stress carry unique cargo and traffic through feto-maternal interface, which cause inflammation in uterine cells associated with parturition. Exosomes and MVs, from primary amnion epithelial cell (AEC) culture media under normal or oxidative stress (OS)-induced conditions, were isolated by optimized differential centrifugation method followed by characterization for size (nanoparticle tracking analyzer), shape (transmission electron microscopy), and protein markers (western blot and immunofluorescence).  https://www.selleckchem.com/products/VX-770.html  Cargo and canonical pathways were identified by mass spectroscopy and Ingenuity Pathway Analysis. Myometrial, decidual, and cervical cells were treated with 1x107 control/OS-derived exosomes/MVs. Pro-inflammatory cytokines were measured using a Luminex assay. Statistical significance was determined by paired T-test (p less then 0.05). AEC produced cup-shaped exosomes of 90-150 nm and circular MVs of 160-400 nm. CD9, HSP-70, and Nanog were detected in exosomes while OCT-4, HLA-G, and calnexin were found in MVs. MVs, but not exosomes, were stained for phosphatidylserine. The protein profiles for control versus OS-derived exosomes and MVs were significantly different. Several inflammatory pathways related to OS were upregulated that were distinct between exosomes and MVs. Both OS-derived exosomes and MVs significantly increased pro-inflammatory cytokines (GMCSF, IL-6, and IL-8) in maternal cells compared to control (p less then 0.05). Our findings suggest that fetal-derived exosomes and MVs under OS exhibited distinct characteristics and a synergistic inflammatory role in uterine cells associated with the initiation of parturition.