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31 July 2025, Volume 20 Issue 04 Previous Issue   

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Attention to renal damage in rheumatic autoimmune diseases: diagnostic challenges and management strategies LI Huilin 2025, 20 (04):  267-271.  DOI: 10.16138/j.1673-6087.2025.04.01 Abstract ( 26 )   HTML ( 6 )   PDF (953KB) ( 9 )   Rheumatic autoimmune diseases often lead to kidney injury, presenting diverse manifestation and complex conditions, ranging from mild proteinuria to severe glomerulonephritis and even renal failure, which has significant impact on patient’s prognosis and quality of life. Because renal damage often has an insidious onset, early diagnosis and intervention are crucial, and development of non-invasive biomarkers is urgently needed. The pathological mechanisms of the disease often involve multiple system; multidisciplinary collaboration including rheumatologists and nephrologists is crucial. The continuous development of biomarkers has made earlier detection and intervention of the disease, bringing new hope for improving patient prognosis. This article discusses the pathogenesis, diagnosis and treatment strategies of renal damage associated with rheumatic autoimmune diseases, emphasizes the importance of multidisciplinary collaboration in disease management. Through precise immunotherapy, appropriate drug adjustments, and kidney protection strategies, the disease can be effectively controlled, and kidney damage can be alleviated and the quality of life of patients will be improved in the future. References | Related Articles | Metrics

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Progress in clinical diagnosis and treatment of blood type Behcet syndrome SHEN Yan, GUAN Jianlong 2025, 20 (04):  272-275.  DOI: 10.16138/j.1673-6087.2025.04.02 Abstract ( 38 )   HTML ( 5 )   PDF (830KB) ( 6 )   Behcet syndrome is a multi-system involved vascular inflammatory disease, it is called blood type Behcet syndrome as it involves the blood system. This type of disease is rare, and the prognosis is poor. Medical staff’s awareness of the disease is relatively insufficient, which may lead to misdiagnosis. This article reviews the clinical phenotypic characteristics and treatment strategies of blood type Behcet syndrome. References | Related Articles | Metrics

Original article

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Clinical application of renal artery ultrasound monitoring hemodynamic parameters and non-contrast-enhanced magnetic resonance angiography in evaluation of renal artery stenosis and anatomic abnormalities SUN Jie, XIE Jie, MA Hongkun, LIU Baolian, CHEN Xueying, HUANG Wenjie, HE Shuilin, CHEN Zijin, ZHANG Wen 2025, 20 (04):  276-281.  DOI: 10.16138/j.1673-6087.2025.04.03 Abstract ( 26 )   HTML ( 4 )   Objective To compare the clinical value of renal artery ultrasound hemodynamic parameters and non-enhanced magnetic resonance in evaluating renal artery stenosis and anatomical abnormalities. Methods A total of 149 patients with chronic kidney disease(CKD) were enrolled. Renal artery stenosis and anatomical variations were evaluated by non-enhanced renal artery magnetic resonance angiography (NEC-MRA). Color Doppler ultrasound was used to detect hemodynamic parameters of each segment of the renal artery. Renal function assessment was conducted through two methods: radionuclide renal dynamic imaging and the calculation of the estimated glomerular filtration rate (eGFR) using the CKD Epidemiology Collaboration (CKD-EPI) study equation formula. Results Among the 149 patients in this study, 17 cases (11.4%) were at CKD stage 1, 39 cases (26.2%) at stage 2, 44 cases (29.5%) at stage 3, 17 cases (11.4%) at stage 4, and 32 cases (21.5%) at stage 5. The resistance index (RI) of patients with initial renal artery stenosis was significantly higher than that of patients without stenosis (P=0.000), while there was no statistically significant difference in peak systolic velocity (PSV) (P= 0.443). There was no statistical difference in PSV and RI between the two groups with or without midstream stenosis (P=0.190, P=0.088). There was no significant difference in PSV and RI between the initial and middle segments of the anatomical variation group and the non-variation group (P > 0.05). The eGFR on the non-stenotic side of the initial segment of the renal artery was significantly higher than that on the stenotic side (Z=2.98, P=0.029), and eGFR on the non-stenotic side in the middle segment was significantly higher than that on the stenotic side (Z=4.025, P=0.001). There was no statistical difference in eGFR between the anatomical variant side and the non-variant side (Z=0.579, P=0.550). Conclusions Color Doppler ultrasound PSV and RI show higher value in diagnosing initial renal artery stenosis than middle renal artery stenosis and have no diagnostic value for anatomic variation of renal artery. Both initial and middle renal artery stenosis leads to a decrease in the ipsilateral renal GFR, while variations in renal artery anatomy does not affect ipsilateral renal GFR. Figures and Tables | References | Related Articles | Metrics

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Clinical and CT features of non-small cell lung cancer SMARCA4 expression deficiency ZHANG Xuekun, CHEN Xiaoyan, XIA Xinyun, CHENG Zenghui 2025, 20 (04):  282-288.  DOI: 10.16138/j.1673-6087.2025.04.04 Abstract ( 23 )   HTML ( 2 )   PDF (2743KB) ( 2 )   Objective To explore the clinical and CT features of SMARCA4-deficient non-small cell lung cancer (SMARCA4-dNSCLC ). Methods SMARCA4-dNSCLC cases confirmed histopathologically were enrolled and analyzed retrospectively in our hospital from January 2018 to January 2022. Using SMARCA4-intact NSCLC (SMARCA4-iNSCLC) cases admitted during the same period as control, the clinical characteristics and CT features of SMARCA4-dNSCLC cases were observed, recorded and compared. Results There were 42 cases in the SMARCA4-dNSCLC group and 43 cases in SMARCA4-iNSCLC control group, respectively. Compared with the control, the SMARCA4-dNSCLC group had a higher proportion of males, smokers, and chronic obstructive pulmonary disease (COPD). Clinically, the SMARCA4-dNSCLC group exhibited a higher incidence of superior vena cava syndrome, while the SMARCA4-iNSCLC group presented with hemoptysis more frequently. On CT imaging, tumors in the SMARCA4-dNSCLC group showed relatively homogeneous density, fewer cystic changes, necrosis, or calcification, more ill-defined borders, and a lower rate of associated obstructive pneumonia/atelectasis. Conclusions SMARCA4-dNSCLC was more frequently seen in elderly males and heavy smokers and was frequently accompanied by COPD. Occasionally, it could present with superior vena cava syndrome. The tumors were prone to locate in the upper lobes of both lungs. On CT imaging, it mostly presented as a soft tissue mass with relatively homogenous density, ill-defined boundaries, without cystic changes or cavities, and calcification was rare. The vast majority showed significant heterogenous enhancement after contrast. Mediastinal lymph node metastasis was common. This unique subtype of NSCLC should be considered in patients with the above clinical and CT features. Figures and Tables | References | Related Articles | Metrics

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Effects of prior COVID-19 infection on autologous hematopoietic stem cell transplantation in multiple myeloma patients JIN Shiwei, PAN Mengmeng, XU Jie, GAO Shan, WANG Yan, LIU Yuanfang, TAO Yi, ZHANG Weiping, MI Jianqing 2025, 20 (04):  289-295.  DOI: 10.16138/j.1673-6087.2025.04.05 Abstract ( 19 )   HTML ( 2 )   PDF (1016KB) ( 4 )   Objective To assess the impact of prior COVID-19 infection on clinical outcomes in terms of engraftment, treatment emergent complications, and immune reconstitution in multiple myeloma (MM) patients after autologous hematopoietic stem cell transplantation (auto-HSCT). Methods Data of MM patients who underwent auto-HSCT from July 1, 2022, to July 31, 2023, in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The clinical indices including engraftment time, transplant-related infection, engraftment syndrome, immunoglobulin reconstitution, circulating lymphocytes composition, and short-term efficacy were compared in the two cohorts who had or had not been infected by COVID-19 prior to auto-HSCT. Results Sixty-three patients were included. Thirty-two recovered from COVID-19 before auto-HSCT and the remaining 31 did not show evidence of COVID-19 infection. No differences were observed across the two groups in the rates of infections, neutrophil engraftment, platelet engraftment, as well as the incidence of engraftment syndrome. Preceding auto-HSCT, the numbers of CD3+T, CD3+CD8+T and CD19+B lymphocytes in patients recovered from COVID-19 were significantly higher than those in COVID-19-free group (P<0.05); however, such a disparity was not present after auto-HSCT. At day 8 post-infusion, interferon(IFN)-γ level of COVID-19 group was higher as compared with that of non-infected group (P=0.011).The rate of polyclonal immunoglobulins recovery in COVID-19-affected cohort was 3.1%, which was lower than that in non-infected patients three months post auto-HSCT (P=0.026), while there was no difference in depth of therapeutic response between the two groups. Conclusions The data indicates that auto-HSCT can be safely administered in MM patients who completely recovered from COVID-19, but their immunoglobulins reconstitution was relatively delayed upon adoptive transfer. Timely and routine intravenous immunoglobin supplements are recommended for minimizing the risk of infection. Figures and Tables | References | Related Articles | Metrics

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Screening of risk or protective factors for prognosis and their interaction in elderly patients with stroke XU Ting, RONG Jieli, GU Renli, XU Yang, LIU Xiaojiang 2025, 20 (04):  296-300.  DOI: 10.16138/j.1673-6087.2025.04.06 Abstract ( 28 )   HTML ( 1 )   PDF (1052KB) ( 3 )   Objective To explore the risk or protective factors and their interactions for recurrence after acute ischemic stroke (AIS). Methods A total of 143 AIS patients admitted in our hospital from March 2020 to March 2023 were selected and followed up, and general clinical data were collected. Twelve patients were lost to follow-up. The end point of follow-up was stroke recurrence. The risk factors of stroke recurrence were screened by COX analysis, and the interaction between risk factors was analyzed. Results Univariate COX analysis showed that age, modified Rankin scale (mRS) score, the National Institutes of Health stroke scale (NIHSS) score, activated partial thrombin time and diabetes history were risk factors for poor prognosis in elderly patients with AIS [hazard ratio (HR) > 1, P < 0.05]. Montreal cognitive assessment scale (MoCA) score and fibrinogen are protective factors for good prognosis in elderly patients with AIS (HR < 1, P > 0.05). Multivariate COX analysis showed that mRS score and NIHSS score were independent risk factors for poor prognosis in elderly patients with AIS (HR > 1, P > 0.05). MoCA score and fibrinogen are protective factors for good prognosis in elderly patients with AIS (HR < 1, P > 0.05). Patients with high mRS score and high NIHSS score had worse prognosis (P < 0.001). Patients with high MoCA score and high fibrinogen level had better prognosis (P < 0.001). mRS score, NIHSS score, MoCA score and fibrinogen level had no significant interaction. Conclusions mRS score and NIHSS score are independent risk factors for poor prognosis in elderly patients with AIS. MoCA score and independent protective factor of good prognosis in elderly patients with AIS of fibrinogen. There was no significant interaction between these risk factors and protective factors. Figures and Tables | References | Related Articles | Metrics

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Study on brain protective effect of 20% lipid emulsion combined with pralidoxime and atropine on organophosphate poisoning mice GAO Hui, YANG Chao, HU Xiaofeng 2025, 20 (04):  301-305.  DOI: 10.16138/j.1673-6087.2025.04.07 Abstract ( 20 )   HTML ( 1 )   PDF (2697KB) ( 3 )   Objective To investigate the therapeutic effect of pralidoxime combined with atropine and lipid emulsion on a mouse model of organophosphate poisoning. Methods Eighty C57/BL6 strain experimental mice were randomly divided into four groups of 10 each using a digital randomization method. A mouse organophosphate poisoning model was established using organophosphate pesticides. Pralidoxime combined with atropine and lipid emulsion was used for treatment. Results The results showed that compared with the poisoning group, the mice in the treatment group showed significant improvement in physiological indexes such as fasciculation tremor intensity and anti-reflex disappearance time (all P<0.001). In particular, the effect was more pronounced in the combination treatment group with pralidoxime, atropine, and lipid emulsion. In addition, the combination therapy effectively improve the serum levels of acetylcholinesterase (AchE), malondialdehyde (MDA) and S100 calcium binding protein B (S100B) in the poisoning mice (all P<0.001) and promoted the recovery of these biochemical indicators to normal levels after 7 days. In the behavioral test, the number of correct responses in the Y-maze test was significantly higher in the treatment group than in the poisoning group, especially in the mice receiving the combination treatment (all P<0.001). Histopathological examinations showed that the combination of clofosidine and atropine could significantly reduce the brain tissue damage caused by poisoning, and the effect was more significant after the addition of lipid emulsion. Conclusions Pralidoxime combined with atropine can effectively alleviate the symptoms of organophosphate poisoning in mice, and the addition of lipid emulsion can further optimize the therapeutic effect, providing a new treatment strategy for clinical practice. Figures and Tables | References | Related Articles | Metrics

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Intervention effect of five senses awakening nursing mode based on the circadian rhythm on the conscious state of hospitalized patients with cerebral coma LYU Zhuobei, ZHU Lin, RONG Lan, LYU Xiaoqiong, CHU Jiani, CHENG Zhiying 2025, 20 (04):  306-311.  DOI: 10.16138/j.1673-6087.2025.04.08 Abstract ( 21 )   HTML ( 0 )   PDF (883KB) ( 3 )   Objective To explore the impact of five senses awakening nursing mode based on the circadian rhythm in conscious hospitalized patients with cerebral coma. Methods Using convenience sampling method, a total of 43 patients with cerebral coma admitted to the Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from May 2023 to April 2024 were selected. The patients in the even-numbered wards were set as the observation group (n=22), and those in the odd-numbered wards were set as the control group (n=21). The control group received routine nursing mode while the observation group received five-sense awakening nursing mode in addition to routine nursing. A comparison was made between the two groups at different periods regarding Glasgow coma score (GCS), coma recovery scale-revised (CRS-R), recovery efficiency and recovery time. Results There was an interaction between the group factor and the time factor in the GCS score and the CRS-R score in the two groups (F=9.765, P<0.001; F=12.846, P<0.001). After the intervention, there were significant differences in the changes of the GCS and the CRS-R score at different time points between the two groups (F=243.934, P<0.001; F=239.111, P<0.001). There were statistical differences in the changes of the GCS and the CRS-R score between the two groups (F=5.040, P<0.05;F=7.779, P<0.05).The recovery rate of the observation group was higher than that of the control group (P<0.05), and the recovery time was shorter than that of the control group (P<0.01). Conclusions The five- sensory stimulation nursing approach based on the circadian rhythm, can improve the consciousness state of patients with cerebral coma and facilitate their awakening. Figures and Tables | References | Related Articles | Metrics

Research report

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Clinical evaluation of the modified open wound sutureless labial gland biopsy technique for patient with Sjögren syndrome CHEN Yabing, GAO Jie, XU Xia, ZHAO Dongbao 2025, 20 (04):  312-315.  DOI: 10.16138/j.1673-6087.2025.04.09 Abstract ( 16 )   HTML ( 4 )   PDF (855KB) ( 4 )   Objective To explore the clinical value of modified open-wound sutureless labial gland biopsy for patients with Sjögren syndrome. Methods A total of 24 patients who underwent labial gland biopsy in our department from March 2023 to April 2025 were divided into the sutureless labial gland biopsy (SLSGB) group and the traditional labial salivary gland biopsy (TLSGB) group. The numerical rating scale (NRS) 0-10 was used to evaluate the postoperative recovery time and incision pain at 2 h, 1 d, and 7 d after surgery in both groups. Results The postoperative recovery time score was (6.67±0.82) points in the TLSGB group and (2.00±0.00) points in the SLSGB group (P< 0.001). The NRS scores at 2 h, 1 d, and 7 d after surgery were (5.83±0.98), (2.67±0.52), and (2.00±0.63) points in the TLSGB group, and (1.72±0.46), 0, and 0 points in the SLSGB group, respectively. There were significant differences between the two groups at 2 h and 1 d after surgery (both P<0.05), but there was no statistical difference at 7 d after surgery (P>0.05). Conclusions Open incision labial gland biopsy is less invasive, less prone to secondary injury, does not require suture removal, is easy to operate, and rarely causes complications. It can reduce significantly the economic and time costs and it’s more easily accepted by patients. Figures and Tables | References | Related Articles | Metrics

Case report

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A case of neuropsychiatric lupus successfully treated with sequential therapy of rituximab and belimumab therapy CHEN Xue, SUN Mingfang, DAI Huanzi 2025, 20 (04):  316-318.  DOI: 10.16138/j.1673-6087.2025.04.10 Abstract ( 17 )   HTML ( 1 )   PDF (1781KB) ( 3 )   Neuropsychiatric lupus erythematosus (NPSLE) is a severe complication of systemic lupus erythematosus, it leads to a significantly increased mortality rate when it affects the central nervous system. Currently, there is no established standard treatment regimen for this condition. This article reports a case study of a patient with NPSLE, who primarily presented abnormal mental and behavioral and incoherent speech. Following sequential treatment with rituximab and belimumab, the patient’s symptoms were relieved and laboratory imaging indicators were significantly improved, which provided a new potential therapeutic strategy for NPSLE. Figures and Tables | References | Related Articles | Metrics

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A case of Sjögren syndrome with intestinal pseudo-obstruction as the initial symptom LIU Meilan, WANG Ling, YANG Rong, WANG Jiale, TU Huimin, LI Huilin 2025, 20 (04):  319-321.  DOI: 10.16138/j.1673-6087.2025.04.11 Abstract ( 15 )   HTML ( 1 )   PDF (4329KB) ( 2 )   Sjögren syndrome (SS) is a systemic autoimmune disease primarily affecting exocrine glands. It has diverse clinical manifestations and is easily misdiagnosed. This article reports a case of SS presenting with intestinal pseudo-obstruction (IPO) as the initial symptom. A 31-year-old female presented with nausea, vomiting and bowel movement cessation. Imaging revealed colonic fecal impaction without mechanical obstruction. Serological tests showed positive anti-SSA/SSB/Ro-52 antibodies, and labial gland biopsy confirmed SS. The patient’s symptoms were relieved after receiving glucocorticoid and immunomodulatory therapy. This case highlights that SS may present with atypical gastrointestinal and neurological symptoms, suggesting the importance of multidisciplinary evaluation and autoantibody screening for early diagnosis. Figures and Tables | References | Related Articles | Metrics

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Renal thrombotic microangiopathy associated with chemotherapy: two case reports WANG Yining, CHEN Nannan, CHENG Lin, LIU Zhenhua, ZHENG Xiaoyan, XU Jing, PAN Xiaoxia, CHEN Yongxi, CHEN Xiaonong 2025, 20 (04):  322-327.  DOI: 10.16138/j.1673-6087.2025.04.12 Abstract ( 10 )   HTML ( 0 )   PDF (3798KB) ( 2 )   Patient 1 was a 68-year-old male who had been diagnosed with a malignant lung tumor for three years. This case developed proteinuria during bevacizumab treatment and had normal renal function. Patient 2 was a 70-year-old male diagnosed with gastric adenocarcinoma for two years, this case developed proteinuria after three months chemotherapy with oxaliplatin, leucovorin, and fluorouracil, but his renal function was normal. Renal biopsy of the two patients showed thrombotic microangiopathy. After treatment with sacubitril/valsartan sodium combined with dapagliflozin, proteinuria in two patients decreased, and their renal function was still stable. Figures and Tables | References | Related Articles | Metrics

Review

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Advances in age-associated B cell in systemic lupus erythematosus FAN Yuxin, BIN Zexuan, ZHANG Xin, LUO Jing, WANG Caihong 2025, 20 (04):  328-333.  DOI: 10.16138/j.1673-6087.2025.04.13 Abstract ( 22 )   HTML ( 1 )   PDF (969KB) ( 5 )   Age associated B cell (ABC) is a new type of effector B cell subset, which is characterized by continuous expansion with age. However, it is abnormally expressed prematurely in patients with certain autoimmune diseases and/or infectious diseases. ABC highly expresses CD11c and transcription factor T-bet in mice and human, and lowly expresses CD21. ABC is considered a memory B cell subtype driven by autoantigen and has the potential to differentiate into plasmablasts and produce autoantibodies. In systemic lupus erythematosus (SLE), ABC is abnormally amplified and correlated with disease activity and organ involvement. An important mechanism to promote the production of autoantibodies and accelerate disease progression is the single gene mutation inducing the proliferation and differentiation of ABC into extrafollicular effector B cell. Recent studies have revealed that zinc finger E-box binding homeobox 2 (ZEB2) is a key transcription factor for the specialization of the ABC cell lineage, and the ZEB2-Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway play a core role in their differentiation. Further study on the role of ABC in the pathogenesis of SLE will help to provide new targets for clinical treatment. References | Related Articles | Metrics

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Advances in understanding the association between hyperuricemia and cardiovascular diseases JIN Zhengyi, LIU Qilong, HU Jiaqi, XU Xia, GAO Jie 2025, 20 (04):  334-339.  DOI: 10.16138/j.1673-6087.2025.04.14 Abstract ( 28 )   HTML ( 2 )   PDF (983KB) ( 6 )   Hyperuricemia is a disease caused by abnormal purine metabolism. The prevalence of hyperuricemia is increasing annually in China. Elevated uric acid levels not only lead to gout attacks but are also associated with the occurrence and development of cardiovascular diseases. Research indicates that hyperuricemia can facilitate the onset and progression of cardiovascular diseases through promoting inflammation, causing endothelial dysfunction, and over activating the renin-angiotensin-aldosterone system. This review discusses the association between hyperuricemia and various cardiovascular diseases, including coronary atherosclerosis, atrial fibrillation, hypertension, and heart failure. References | Related Articles | Metrics

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Advances in stem cell therapy for scleroderma LIN Ruilian, MA Lili, CHEN Jia 2025, 20 (04):  340-344.  DOI: 10.16138/j.1673-6087.2025.04.15 Abstract ( 24 )   HTML ( 0 )   PDF (940KB) ( 2 )   Scleroderma is an autoimmune connective tissue disorder characterized by fibrosis of the skin and internal organs. Currently, there is no fully satisfactory treatment for this condition. In recent years, stem cells have emerged as a promising therapeutic strategy for a variety of diseases, owing to their capacities for self-renewal and multilineage differentiation. Substantial advances have been achieved in applying stem cell therapy to scleroderma. This review summarizes the mechanisms and clinical progress of stem cell-based treatments for scleroderma, with the aim of providing new insights for basic research and supporting evidence for future clinical applications. References | Related Articles | Metrics

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Interaction between bile acids and gut microbiota and their role in Parkinson disease LIU Shumeng, AI Penghui, XIAO Qin, YANG Xiaodong 2025, 20 (04):  345-350.  DOI: 10.16138/j.1673-6087.2025.04.16 Abstract ( 20 )   HTML ( 2 )   PDF (1002KB) ( 4 )   Bile acids are amphipathic molecules derived from cholesterol, which facilitate the absorption of lipids, and also serve as signaling molecules in regulating metabolic homeostasis and immune response. Bile acid is modified by intestinal flora, and on the other hand, it alters the composition of gut microbiota and exerts potential effects on the microbiota-gut-brain axis(MGBA). Through this bidirectional communication system, bile acid signaling homeostasis plays a modulatory role for maintaining the physiological function of nervous system. In recent years, increasing evidence indicates that the bile acid associated with dysbiosis in gut microbiota may be an early sign of Parkinson disease (PD), which triggered the exploration of new pathological mechanisms and diagnostic biomarkers for PD. This article reviews the relationship between abnormal bile acid metabolism and PD as well as its potential role in PD treatment from the perspective of interaction between bile acids and intestinal microorganism. References | Related Articles | Metrics