Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn disease (CD), requires long-term medication to maintain remission. Developing a medicine de-escalation strategies during remission is crucial for reducing side effects and alleviating economic burdens, but the risks and benefits of medicine discontinuation remain controversial. The dose of 5-aminosalicylic acid (5-ASA) can be reduced in partial UC patients during remission, but the risk of relapse increases after medicine discontinuation. Long-term use of immunomodulators such as azathioprine has safety issues, but safe discontinuation of the medicine can be achieved through a medicine monitoring systems. The relapse rate after discontinuation of biologics agents during remission is high, especially in patients who have not achieved deep remission. The medicine de-escalation strategy for patient receiving combination therapy requires comprehensive assessment. Relapse monitoring after medicine discontinuation is critical, endoscopy and biomarkers such as C-reactive protein (CRP) and fecal calprotectin (FCP) can be used as effective predictive tools. This review summarizes recent studies on medicine de-escalation in IBD remission to provide reference for clinical practice and promote shared decision-making between patients and physicians.

Inflammatory bowel disease (IBD) is a chronic and recurrent gastrointestinal inflammatory disorder, often accompanied by extraintestinal manifestations (EIM), which can seriously affect the quality of life of IBD patients and sometimes even threaten their lives. Lung injury is a rare and easily overlooked EIM of IBD. IBD combined with lung injury includes airway diseases, interstitial lung diseases, pulmonary embolism, pleural diseases, and drug-related lung injury. This article summarizes the progress in the types, clinical characteristics, and treatment of IBD combined with lung injury, aiming to provide a strategy for its diagnosis and treatment. In the future, multidisciplinary collaboration will become the main diagnosis and treatment mode of IBD combined with lung injury.

Inflammatory bowel disease (IBD) is a group of chronic relapsing inflammatory gastrointestinal diseases, including Crohn disease (CD) and ulcerative colitis (UC). 30%-50% of IBD patients develop extraintestinal manifestations (EIM), which affect multiple organs such as the musculoskeletal, skin, eyes, and hepatobiliary systems. The occurrence of some EIM parallels the activity of IBD inflammation, while others may progress independently. The pathogenesis of EIM involves multiple factors, including genetic susceptibility, dysbiosis of the gut microbiota, and immune dysregulation. The diagnosis and management of EIM require multidisciplinary team (MDT) collaboration. EIM associated with IBD activity can be alleviated by controlling the underlying IBD, while EIM with independent progression requires individualized treatment strategies according to its pathogenesis. In addition to conventional treatments, tumor necrosis factor (TNF)-α inhibitors are core biological agents suitable for the treatment of most EIM. In the future, precision diagnosis, personalized treatment, and multidisciplinary collaboration will be essential directions in EIM research.

Objective To explore the association between different glucose metabolism status and death from all causes, cardio-cerebrovascular diseases in middle-aged and elderly population. Methods Totally 981 community residents aged 35 years and above in Qingpu district, Shanghai were enrolled in 2009 and a 15-year follow-up study of epidemiological survey on type 2 diabetes mellitus (T2DM) among them were conducted. Cox proportional hazards regression model was used to analyze hazard ratio (HR) of all-cause mortality, cardio-cerebrovascular mortality and their 95%CI in middle-aged and elderly population with different glucose metabolism status. Results The cumulative follow-up period was 14 464.01 person-years. During this period, 114 subjects died, and all-cause death density were 788.16/100 000 person-years. In which, 30 patients were dead from cardio-cerebrovascular diseases, and its death density was 207.41/100 000 person-years. Compared with the population with normal sugar metabolism, the risk of all-cause death in patients with prediabetes increased 77%, all- cause death and cardio- cerebrovascular diseases cause death in T2DM patients increased 155% (HR=2.55, 95%CI: 1.53-4.25) and 299% (HR=3.99, 95%CI:1.52-10.45), respectively. Stratified by age, the risk of cardio - cerebrovascular disease caused death in people under 60 years with prediabetes was higher than that in people with normal glucose metabolism (HR=6.91, 95%CI：1.19-40.07), and the risk of all - cause death and cardio - cerebrovascular death in T2DM patient over 60 years was higher than that in people with normal glucose metabolism (HR=2.64，95%CI：1.42-4.90；HR=4.87，95%CI：1.62-14.62). Conclusions Prediabetes and T2DM were important risk factors for all - cause death and cardio - cerebrovascular diseases death in middle-aged and elderly people. Targeted classified prevention and early intervention of blood sugar should be implemented to reduce all-cause death and cardio-cerebrovascular diseases death.

Objective To evaluate efficacy and safety of hetrombopag in the treatment of chemotherapy-induced thrombocytopenia (CIT) in patients with solid tumors. Methods From September 2021 and June 2022, patients with CIT who were treated with hetrombopag from four hospitals were enrolled. The clinical efficacy of either hetrombopag monotherapy or hetrombopag combined with recombinant human thrombopoietin (rhTPO)/ recombinant human interleukin (rhIL)-11 and the efficacy of different doses of hetrombopag were analyzed. The frequency of platelet transfusions and the incidence of adverse events were also analyzed. Results A total of 57 patients were included, in which 12 patients were in the monotherapy group (83.3% with Ⅰ-Ⅱ CIT) and 45 patients were in the combination group (64.5% with Ⅰ-Ⅱ CIT). The proportion of patients who received thrombopoietic therapy during the CIT period was significantly higher in the combination group compared to the monotherapy group (66.7% vs. 0.0%, P < 0.001). The overall responses rate was 89.5%, and responses rates at 7, 14 and 21 days after treatment were 40.4%, 77.2% and 87.7%, respectively. The responses rate was 91.7% in the monotherapy group and 88.9% in the combination group, which had no significant difference between the two groups (P = 1.000). The median peak platelet count after treatment was significantly higher in the combination group compared to the monotherapy group (151.5×10⁹/L vs. 126.0×10⁹/L, P = 0.013). In the monotherapy groups, the responses rates of 2.5 mg/d and 5 mg/d were 100.0% and 85.7%, respectively. In the combination therapy groups, the responses rates of 2.5, 5 and 7.5 mg/d were 71.4%, 91.7% and 100.0%, respectively. The response rates had no significant differences among different doses of hetrombopag in both the monotherapy and combination therapy groups (P > 0.05). After treatment, one patient need a platelet transfusion, and 4 patients in the combination group developed thrombocytosis. Conclusions Hetrombopag is effective and safe for treating CIT, in which monotherapy shows significant efficacy in mild to moderate cases, and hetrombopag combin with rhTPO or rhIL-11 is effectiveness in moderate to severe or refractory cases. However, the optimal dosage and combination regimen still need further investigation.

Objective To investigate the association of several commonly used estimated glomerular filtration rate (eGFR) formula and urinary albumin to creatinine ratio (UACR) with cardiovascular events, renal endpoint events, and mortality in an elderly population.Methods The patients aged ≥ 65 who were treated and had follow-up data more than 1 year in the Department of Geriatrics of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2015 to December 2018 were selected. Logistic regression analyses were used to evaluate the association of eGFR derived by chronic kidney disease epidemiology collaboration(CKD-EPI) creatinine（Cr） formula (CKD-EPI_Cr), CKD-EPI cystatin C formula( CKD-EPI_Cys), the racially neutral CKD-EPI_Cr-Cys formula and Berlin Initiative Study (BIS) formula 2 (based on Cr and cystatin C) with prognosis.Results Totally 475 elderly patients were recruited with a median age of 83(76-87) years and a follow-up time of 76(68-91) months. Before adjustment, those with a decreased eGFR[<60 mL/(min·1.73 m²)] had a higher risk of death when eGFR estimated by CKD-EPI_Cys, CKD-EPI_Cr-Cys, and BIS2, but the association was negative after adjusting by multiple covariates. Before adjustment, those with a decreased eGFR by all equations had a significantly higher risk of cardiovascular events. The odds ratio was highest for eGFR estimated by BIS2. After adjusting for gender, age, and past medical history, the association remains statistically significant between eGFR estimated by BIS2 and cardiovascular events(P=0.038). After adjusting for gender, age, and past medical history, the risk of renal endpoint events was higher in those with decreased eGFR estimated by CKD-EPI_Cr-Cys (P=0.023). None of the other equations showed a significant correlation with renal endpoint events. Before adjustment, those with a decreased eGFR by all equations had a significantly higher risk of composite events. The odds ratio was highest for eGFR estimated by BIS2. After adjusting for gender and age, the association remains statistically significant between composite events and eGFR estimated by CKD-EPI_Cr(P=0.030) fit without race, CKD-EPI_Cys (P=0.044) and BIS2(P=0.034). After multivariate adjustment, those with UACR ≥ 30 mg/g had a significantly higher risk of death, cardiovascular events, renal endpoint events, and composite endpoints compared with those with UACR < 30 mg/g. Elevated UACR was more strongly associated with outcomes than decreased eGFR but not with renal endpoint events.Conclusions Elevated UACR was strongly associated with death, cardiovascular events, and composite endpoints. Among different eGFR formations, decreased eGFR using BIS2 was more strongly associated with cardiovascular events, whereas CKD-EPI_Cr-Cys was more strongly associated with renal endpoint events.

Objective To investigate the correlation between the distribution of critical differential bacterial populations and lymphocyte subsets in systemic lupus erythematosus （SLE） patients by detecting the abundance changes of intestinal microbiota and lymphocyte subsets. Methods Twenty-three SLE patients and 16 healthy controls (HC) were included. Flow cytometry was used to detect the number of peripheral blood lymphocyte subsets, and 16S rRNA technology was used to detect the diversity and abundance of intestinal microbiota. The correlation between peripheral blood lymphocyte subsets and intestinal microbiota was investigated, and the experimental data were analyzed using SPSS 26.0. Results Compared with HC, the numbers of regulatory T（Treg） cells, initial CD4⁺T cells, and interferon（IFN）γ-secreting γδT cells in SLE patients were significantly reduced (t=-2.284, P=0.022; t=-2.084, P=0.037; t=-2.370, P=0.017), and follicular regulatory T （Tfr）, follicular helper T （Tfh）, germinal center B （GC-B）and B lymphocytes showed a downward trend. The relative abundance of Firmicutes in SLE patients was significantly decreased (t=-2.323, P=0.020) and was positively correlated with Tfr (r=0.544, P=0.029) and GC-B cells (r=0.518, P=0.040). The abundance of Bacteroidetes was positively correlated with Tfr cells (r=0.521, P=0.039). Conclusions The peripheral blood lymphocyte subsets and intestinal microbiota levels of SLE patients are significantly different from those of HC, there was a correlation between the intestinal flora and lymphocyte subpopulations in the intestinal tract of SLE patients, especially the Firmicutes and Bacteroidetes are positively correlated with Tfr, Tfh and GC-B cells, suggesting that the structural changes of intestinal microbiota may affect lymphocyte subsets and mediate the progression of the disease.

Objective To investigate the regulatory mechanism of PML::RARα fusion protein on interleukin-6 receptor (IL-6R) and the effects of IL-6R on the proliferation and differentiation of acute promyelocytic leukemia (APL) cells.Methods The expression levels of IL-6R in APL cells were analyzed using the GSE12662 and GSE10358 datasets. Reverse transcription quantitative real-time quantitative PCR（RT-qPCR） was performed to detect IL-6R mRNA expression in NB4 cells before and after all-trans retinoic acid (ATRA) treatment, as well as in PR9 cells before and after Zn²⁺ induction. Chromatin immunoprecipitation (ChIP)-seq data analysis, ChIP-qPCR experiments, and luciferase reporter gene activity assays were performed to explore the regulatory mechanism of PML::RARα on IL-6R. An IL-6R expression plasmid was constructed for NB4 cells via retrovirus. Cell proliferation was assessed using the cell counting kit-8 (CCK-8) assay, and CD11b expression was detected by flow cytometry.Results Analysis of the GSE12662 dataset revealed that the expression level of IL-6R in APL cells (12.20 ± 0.41) was significantly lower than that in normal promyelocytes (13.14 ± 0.47, t = 4.289, P < 0.001) and polymorphonuclear cells (14.82 ± 0.40, t = 12.35, P < 0.001). Moreover, analysis of the GSE10358 dataset showed that IL-6R expression in APL patients (5.93 ± 0.84) was significantly lower than that in non-APL AML patients (6.50 ± 0.87, t = 3.91, P < 0.001). PML::RARα directly bound to the promoter region of IL-6R to inhibit its transcriptional activity resulting in the low expression. Overexpression of IL-6R in the APL-derived NB4 cells significantly inhibited cell proliferation. Four days after transfection, the optical density values measured by the CCK-8 assay were 0.86 ± 0.01 and 0.40 ± 0.01, respectively (t = 32.66, P < 0.001). Simultaneously, cell differentiation was significantly enhanced. The ratio of the CD11b positive cells increased from 3.10 % ± 1.22 % to 14.4 % ± 1.11 % (t = 11.84, P < 0.001).Conclusions IL-6R is a target gene of PML::RARα, demonstrating that PML::RARα can suppress IL-6R transcription by binding to its promoter region. It is illustrated that IL-6R inhibited the cell proliferation and induced partial differentiation in APL cells.

Objective To investigate the changes and characteristics of electrocardiogram and echocardiography in patients with hypertrophic obstructive cardiomyopathy at 1 year after left ventricular outflow tract dredging.Methods To investigate patients diagnosed with hypertrophic obstructive cardiomyopathy who underwent left ventricular outflow tract dredging surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 1 to December 31 in 2018. A total of 38 cases were enrolled, the clinical features, electrocardiogram and echocardiography data before, 1 year after surgery were collected for comparative analysis and summarizations.Results There were significant statistical differences in the proportion of left ventricular hypertrophy (LVH) and complete left bundle branch block (CLBBB) on electrocardiogram (52.6% vs 12.9%, P<0.01) and (2.6% vs 58.1%, P<0.01), respectively. Echocardiography showed a significant reduction in left ventricular ejection fraction (LVEF) (68.50%±4.11% vs 63.87%±4.00%, P<0.01). In post-surgery patients with CLBBB (67.46%±2.96% vs 64.83%±4.20%, P=0.082), there was a significant reduction in LVEF (69.39%±5.29% vs 63.40%±4.15%, P<0.01), while there was no statistical difference in patients without CLBBB.Conclusions Left ventricular outflow tract dredging surgery could effectively reduce the proportion of LVH in patients with hypertrophic obstructive cardiomyopathy and alleviate outflow tract obstruction. However, patients who developed CLBBB after surgery showed a tendency of reduced LVEF.

Objective To investigate the effect of optimizing calculation method of insulin dosage in hypoglycemia growth hormone stimulation test [insulin tolerance test (ITT)] in patients with hypopituitarism.Methods Totally 106 patients with hypopituitarism admitted from February 2021 to March 2023 were selected for ITT, including 79 males and 27 females aged 14 to 61 years. Insulin dosage obtained by insulin optimization formula was used in the test, which is, insulin dosage (U) = body weight ×{-0.034+0.000 176×[0.5×(fasting insulin +180 min insulin)+60 min insulin +120 min insulin]+0.009 846×body mass index (BMI)}. The blood glucose changes of patients were monitored 30 min before the test, immediately after intravenous infusion and 30, 45, 60, 90 and 120 min after intravenous infusion, respectively, and the main complaints of patients were recorded.Results All 106 patients completed the test without any severe clinical reactions such as hypoglycemic coma or pituitary crisis. Among them, 76 patients (71.70%) experienced hypoglycemia within 30 min after the start of the test, 22 patients (20.75%) experienced hypoglycemia at 45 min, and the remaining 8 patients (7.55%) did not achieve a successful stimulation response. Comparison of the area under the glucose curve (AUC_Glu) among the 106 patients revealed that patients with simultaneous deficiencies in two hormones (growth hormone and cortisol) had lower overall blood glucose levels than those with a single hormone (growth hormone) deficiency. All patients’ blood glucose levels returned to normal by the end of the test.Conclusions The use of an optimized insulin dosage calculation method in ITT results in an earlier onset of hypoglycemia. This underscores the importance of thorough pre-test assessment by nurses, close monitoring of patients’ subjective complaints and blood glucose levels during the test, and proper nursing care to ensure the safety and success of the procedure.

Objective The purpose of this study was to explore the mediating effect of intern nurses’ humanistic care quality on self-efficacy and clinical communication ability. Methods Convenience sampling method was used to select 211 intern nurses from six tertiary hospitals in Shanghai from September 2023 to February 2024 as research subjects. A survey was conducted using a general demographic data questionnaire, a general self-efficacy scale, a nursing student clinical communication ability scale, and a nursing humanistic care quality scale. A total of 211 valid questionnaires (100.00%) were collected. Results The study showed that the self-efficacy score of intern nurses was (28.85 ± 3.88) points, the total score of clinical communication ability was (86.01 ± 7.36) points, and the total score of humanistic care quality was (116.74 ± 11.16) points. The predictive effect of self-efficacy on clinical communication ability was significant (t=10.673, P<0.01), and after incorporating humanistic care qualities, the predictive effect of self-efficacy on clinical communication ability was still significant (t=4.685, P<0.01). The indirect effect value was 1.129, the direct effect accounts for 55.98% of total effect, and indirect effect accounts for 44.02%. Conclusions In this study, the quality of humanistic care played a partial mediating role between self-efficacy and clinical communication ability in intern nurses. Therefore, nursing educators should adopt multiple strategies to enable intern nurses to better understand the feelings of patients, improve the quality of humanistic care, to enhance their clinical communication ability.

Objective To construct the competency index system for research nurses in lymphoma clinical study and provide scientific basis for establishing the nurse training system for lymphoma clinical study.Methods Based on the iceberg theory, the first draft of the index system was constructed by literature analysis, and the final draft was constructed by Delphi method and analytic hierarchy process.Results The expert authority coefficients were 0.934 and 0.948 respectively; The competency index system for research nurse in lymphoma clinical study determined after two rounds of consultation included 5 primary indexes, 14 secondary indexes and 51 tertiary indexes. The coefficient of variation of all levels of indicators was 0.00-0.16, and the coordination coefficient was 0.206-0.331.Conclusions The competency index for research nurses in lymphoma clinical study established in this study is scientific and practical and can provide a reference for the construction of the nurse training system for lymphoma clinical research.

The complexity and high risk of cardiovascular diseases make it difficult to meet the needs of modern medical education using traditional teaching methods. Medical simulation teaching is a novel teaching method that simulates real medical environment and scene, allowing students to perform practical operations and decision-making training in a safe environment. Its teaching principles and advantages include active learning, a safe environment and interdisciplinary collaboration, covering role playing, case discussion and skill manipulation, and focusing on quantitative and qualitative assessment. This teaching method focuses on the cultivation of students’practical operation ability and comprehensive quality, emphasizes the close combination of theory and practice, and plays an important role in the diagnosis, treatment, prevention and rehabilitation of cardiovascular diseases. Medical simulation teaching has important application value and broad application prospects in the teaching of cardiovascular diseases and will play a more important role in clinical medical education.

Colorectal cancer (CRC) is one of the common malignant tumors in the digestive tract, and its liver metastasis is the main cause of death for patients. Due to the lack of typical clinical symptoms in patients with liver metastasis in the early stage, the study of biomarkers is crucial for predicting treatment response, monitoring disease progression, and formulating personalized treatment plans. In recent years, significant progress has been made in the research of CRC liver metastasis biomarkers to achieve the goals of early detection, early diagnosis and early treatment. This article summarizes various biomarkers related to CRC liver metastasis in previous studies, aiming to explore their application value in the early diagnosis of CRC liver metastasis, in order to provide a reference for clinical practice.