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Application in evidence-based predictive nursing on patients with relapsed/refractory B-cell lymphoma receiving chimeric antigen receptor T-cell immunotherapy ZHENG Xin, CHEN Lian Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 248-253.   DOI: 10.16138/j.1673-6087.2025.03.10 Abstract （727）   HTML （1）    PDF（pc） （930KB）（217）       Knowledge map    Save Objective To explore the clinical application and effectiveness of evidence-based predictive nursing on patients with relapsed/refractory B-cell lymphoma undergoing chimeric antigen receptor (CAR) T-cell therapy. Methods Eighty patients with relapsed/refractory B-cell lymphoma who underwent CAR T-cell therapy at Ruijin Hospital between January 2022 and May 2023 were enrolled in the study. Using the envelope method, the patients were randomly assigned to either a control group (n=40), receiving standard nursing care, or an intervention group (n=40), receiving predictive nursing based on evidence-based practice. The intervention included structured problem identification, targeted evidence collection, and implementation of proactive nursing strategies. Clinical outcomes which were compared between the two groups included psychological status, fatigue severity, and treatment-related complications. Results Before nursing intervention, there were no significant differences in anxiety or depression scores between the two groups. After intervention, the intervention group showed significantly lower anxiety and depression scores (P<0.05). Fatigue levels and related dimensions (behavioral, emotional, cognitive, and sensory) also improved significantly in the intervention group compared with the control group (P<0.05). The incidence of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) was lower in the intervention group (65.00% and 15.00%, respectively) than that in the control group (82.50% and 27.50%). There was no significant difference in the overall rate of adverse events between the two groups. There was one case of grade 3-4 CRS and none grade 3-4 ICANS in the intervention group, while there were three cases of grade 3-4 CRS and one case of grade 3-4 ICANS in the control group. Conclusions Evidence-based predictive nursing demonstrates clear clinical value in the management of patients undergoing CAR T-cell therapy with relapsed/refractory B-cell lymphoma. It effectively alleviates psychological distress, reduces fatigue, lowers the risk of severe toxicities, and enhances overall safety and quality of care. These findings support its broader implementation in clinical practice. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clostridioides difficile toxin positivity prolongs hospital stay and increases costs for critically ill patients in emergency patients YU Meiling, LI Jiaoyan, LI Jian, CHEN Ying, ZHAO Bing, MAO Enqiang, YANG Zhitao Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 216-223.   DOI: 10.16138/j.1673-6087.2025.03.06 Abstract （603）   HTML （5）    PDF（pc） （1058KB）（305）       Knowledge map    Save Objective To explore the influence of Clostridioides difficile (C. difficile)positivity on clinical outcomes and identify associated risk factors in intensive care unit（ICU） patients. Methods A retrospective analysis was conducted on 2 036 patients admitted to the emergency ICU of Ruijin Hospital from 2013 to 2022, comparing outcomes between C. difficile-positive (n=225) and C. difficile negative (n=1 811) groups. Multivariate regression analysis was used to identify risk and protective factors. Results Significantly prolonged hospital stays (B=18.734 d, 95% CI: 14.683-22.785) and higher treatment costs (B=68 854.912, 95% CI: 46 579.159-91 130.665) in the C. difficile-positive group, with no statistically significant difference in mortality between groups. Multivariate analysis identified carbapenem use (OR=1.58, 95% CI: 1.16-2.15), bloodstream infection (OR=1.77, 95% CI: 1.17-2.66), and biliary tract infection (OR=1.79, 95% CI: 1.03-3.10) as risk factors for C. difficile positivity. Protective factors included metronidazole use (OR=0.58, 95% CI: 0.40-0.84), cephalosporin use (OR=0.54, 95% CI: 0.39-0.74), and female sex (OR=0.60, 95% CI： 0.44-0.83). Conclusions C. difficile positivity in critically ill patients did not affect mortality but prolonged hospitalization and increased costs. Both risk and protect factors for C. difficile are identified. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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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 Journal of Internal Medicine Concepts & Practice    2025, 20 (04): 306-311.   DOI: 10.16138/j.1673-6087.2025.04.08 Abstract （570）   HTML （2）    PDF（pc） （883KB）（296）       Knowledge map    Save 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. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Application of cloud visitation in the transformation of emergency integrated nursing mode JU Wang, CHEN Yu, YU Jie Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 254-258.   DOI: 10.16138/j.1673-6087.2025.03.11 Abstract （437）   HTML （2）    PDF（pc） （954KB）（243）       Knowledge map    Save Objective To explore the effect of cloud visitation in patients receiving emergency integrated nursing mode. Methods Patients in our hospital from January 1, 2023 to June 30, 2023 were selected as the study objects. A total of 120 patients admitted from January 1, 2023 to March 31, 2023 were enrolled as the observation group, adopting the cloud visitation method. 120 patients admitted from April 1, 2023 to June 30, 2023 were enrolled as the control group, adopting the traditional visitation method. The anxiety degree, medication compliance and nursing satisfaction degree of the two groups were compared during the study period. Results The anxiety score of the observation group was 59 (57,63) points, was significantly lower than that in the control group [69 (67,71) points (P<0.01)], the medication compliance of observation group was significantly higher than that in the control group (P<0.01), and the satisfaction degree of nursing work of the observation group was significantly higher than that in the control group (P<0.01). Conclusions The implementation of cloud visitation mode in the integrated nursing management mode for emergency patients is conducive to optimizing visitation management, improving patients’ anxiety, ameliorating patients’ medication compliance, and enhancing their satisfaction with nursing work. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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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 Journal of Internal Medicine Concepts & Practice    2025, 20 (04): 319-321.   DOI: 10.16138/j.1673-6087.2025.04.11 Abstract （373）   HTML （7）    PDF（pc） （4329KB）（209）       Knowledge map    Save 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. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical features, diagnosis and phenotype and genotype analysis of a family with a mitochondrial DNA A3243G gene mutation CHEN Ruihua, DING Xiaoying, LIU Fang, WANG Qingguo, WANG Yufan Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 204-209.   DOI: 10.16138/j.1673-6087.2025.03.04 Abstract （332）   HTML （13）    PDF（pc） （2933KB）（361）       Knowledge map    Save Objective To analyze the clinical and imaging characteristics of a patient with maternally inherited diabetes and deafness syndrome (MIDD) complicated with cerebral artery occlusion and explore the trend of mitochondrial gene mutations in her pedigree. Methods The study reviewed a patient with diabetes, deafness, dizziness and stroke like attack, who was diagnosed as mitochondrial encephalomyopathy with lactic acidosis and stroke-like episode (MELAS) syndrome and the medical history of her family members. Based on medical history, laboratory examinations, imaging examinations, genetic tests, and existing literature reports, the relationship between clinical characteristics of the patients in this family and pathogenic gene heterogeneity was analyzed. Results The proband presented typical clinical manifestations of MIDD, and the results of first-generation mitochondrial gene sequencing showed a chrM: 3243A>G (tRNA Leu1) mutation. Subsequently, next generation sequencing was performed using the blood of the proband and their maternal relatives, and the results showed that the blood mutation rate of proband was 42.15%, and most of the maternal relatives also exhibited different degrees of 3243A>G mutations. Conclusions The clinical manifestations of MIDD patients are complicated, and they are prone to brain atrophy and cerebrovascular occlusion. Sequencing analysis and early brain imaging evaluation is recommended to perform in diabetic patients with extreme emaciation and progressive hearing loss. Next-generation sequencing could help to clarify mutation heterogeneity. The higher heterogeneity and earlier onset age might indicate the more serious condition of the disease, which needs early prevention and diagnosis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Prognostic factor analysis of sarcopenia in elderly patients with heart failure and preserved ejection fraction YANG Qirui, BAI Tingting, JIANG Qianwen, ZHANG Weiqi, LU Yiyin, ZHAO Wei, WU Fang, LI Feika Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 210-215.   DOI: 10.16138/j.1673-6087.2025.03.05 Abstract （332）   HTML （9）    PDF（pc） （1013KB）（283）       Knowledge map    Save Objective To explore the prognosis and related risk factors of sarcopenia in elderly patients with heart failure and preserved ejection fraction (HFpEF) in some areas of Shanghai. Methods A total of 261 elderly patients (age ≥60 years) with HFpEF were consecutively enrolled from January 2018 to June 2020 at Ruijin Hospital，Shanghai Jiao Tong University School of Medicine and collaborating community health service centers/nursing homes. The subjects were grouped according to the presence of sarcopenia, and the relevant clinical data were collected. The follow-up endpoint was subject’s readmission for heart failure and (or) all-cause death, and the deadline of follow-up was December 2022. The Kaplan-Meier survival analysis curve and Log-Rank test were performed to compare the outcome between the two groups, and univariate and multivariate Cox proportional hazards regression models were applied to analyze the relevant risk factors of adverse outcome. Results The average time of follow-up was (38.6±11.5) months in the two groups, was (37.4±13.0) months in the sarcopenia group and (39.1±9.3) months in the control group, respectively. The results of Kaplan-Meier survival analysis curve showed that the sarcopenia group had significantly worse prognosis than that in the control group (P<0.05), and multivariate Cox regression analysis showed that sarcopenia was an independent risk factor for poor prognosis in elderly patients with HFpEF (P<0.05). Conclusions This study indicates that sarcopenia was an independent predictor of adverse prognosis in elderly patients with HFpEF. These findings highlight the clinical importance of early identification and management of sarcopenia in these patients, which may help improve clinical outcomes. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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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 Journal of Internal Medicine Concepts & Practice    2025, 20 (04): 296-300.   DOI: 10.16138/j.1673-6087.2025.04.06 Abstract （312）   HTML （1）    PDF（pc） （1052KB）（204）       Knowledge map    Save 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. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Progress in diagnosis and treatment of primary mediastinal large B-cell lymphoma CAI Lu, YI Hongmei, WANG Chaofu Journal of Internal Medicine Concepts & Practice    2025, 20 (06): 490-494.   DOI: 10.16138/j.1673-6087.2025.06.11 Abstract （306）   HTML （5）    PDF（pc） （452KB）（115）       Knowledge map    Save Primary mediastinal large B-cell lymphoma (PMBCL) is an aggressive non-Hodgkin lymphoma originating from thymic B cells. It typically presents as a rapidly growing anterior mediastinal mass, often accompanied by local symptoms such as chest tightness and shortness of breath, as well as systemic symptoms like fever and night sweats. R-CHOP (rituximab + cyclophosphamide + doxorubicin + vincristine + prednisone) and R-EPOCH (etoposide + prednisone + vincristine + cyclophosphamide + doxorubicin + rituximab) are the commonly used first-line treatments. Formulating precise diagnostic and therapeutic strategies requires a comprehensive understanding of its unique clinical, pathological, and molecular characteristics. This review delivers a comprehensive overview of the clinical features, pathological characteristics, molecular mechanisms, differential diagnosis, and recent advances in treatment of PMBCL, aiming to provide a reference for accurate diagnosis, optimized patient management, and improved therapeutic outcomes. Reference | Related Articles | Metrics | Comments（0）

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Construction of sensitivity indicators for perioperative nursing quality in percutaneous coronary intervention WU Shengjia, HUANG Sichao, KANG Lei, ZHU Weiyi, ZHA Qinghua, NI Xueping Journal of Internal Medicine Concepts & Practice    2025, 20 (06): 469-476.   DOI: 10.16138/j.1673-6087.2025.06.07 Abstract （295）   HTML （3）    PDF（pc） （550KB）（98）       Knowledge map    Save Objective To develop a scientifically reasonable set of sensitivity indicators for perioperative nursing quality in percutaneous coronary intervention (PCI). Methods Domestic and international literature was retrieved, and the Johns Hopkins evidence-based nursing practice model was employed to appraise the literature and grade the evidence. Indicators were screened and integrated to form a preliminary pool of sensitivity indicators for PCI perioperative nursing quality. Based on the theoretical basis of the Donabedian three-dimensional quality model, the Delphi method was utilized for expert consultation to construct the final indicator set. Results The response rates for both rounds of the expert consultation were 100%. The expert authority coefficients were both 0.889. The overall Kendall’ s coefficient of concordance were 0.496 and 0.523, respectively (P < 0.001). The final set of PCI perioperative nursing quality sensitivity indicators comprises 3 first-level, 13 second-level and 36 third-level indicators.Conclusions The developed sensitivity indicators for PCI perioperative nursing quality encompass multiple dimensions, including human resources, management systems, medical specialty training, nursing competency, medication and facility management, health education, preoperative/intraoperative/postoperative management, patient satisfaction, incidence of adverse events, nursing efficiency, and continuity of care. This indicator system can comprehensively measure PCI perioperative nursing quality and serves as a valuable tool for improving the overall standard of PCI perioperative nursing services. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Correlation study on circadian rhythm disturbance and pathological characteristics of non-alcoholic fatty liver disease HUANG Lei, ZHANG Chenli, YAN Hua, SHI Dongmei Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 224-231.   DOI: 10.16138/j.1673-6087.2025.03.07 Abstract （283）   HTML （7）    PDF（pc） （5683KB）（308）       Knowledge map    Save Objective To investigate the key signal molecules in the regulation of biological clock and lipid metabolism of non-alcoholic fatty liver disease（NAFLD）and its effect on lipid metabolism, to provide insights for the prevention and treatment of NAFLD. Methods The animal models with NAFLD were established and classified, including circadian rhythm disorder + high-fat diet(HFC) group, circadian rhythm disorder + normal diet(NC) group, high-fat diet (HF) group and normal diet (N) group. Hematoxylin and eosin (HE) and oil red O staining were used to detect the fat deposition in the model liver tissues; enzyme-linked immunosorbent assay(ELISA) was used to detect the serum lipids in the mice; immunoblotting was performed to detect the protein expression of brain and muscle arnt-like 1(BMAL1) gene，and the correlation between BMAL1 gene and the liver pathological features was estimate. For the HFC and HF groups, mRNA bioinformatics analysis was performed to identify key circadian clock genes in NAFLD. Results Circadian rhythm disturbance increased body weight and induced obesity in mice. At week 15, the HFC group showed significantly higher weight than the HF group (t=23.18, P<0.000 1), and the NC group exceeded the N group (t=5.24, P<0.000 1). It also promoted hepatic lipid deposition: lipid content progressively increased in the HFC group (F=10.13, P<0.05) and NC group (F=8.89, P<0.05) over time. Moreover, it exacerbated dyslipidemia: TC and LDL-C levels in the HFC group were significantly higher than the HF group at ZT0, ZT8 and ZT16 (F=23.3, P<0.0001; F=68.1, P<0.000 1); similarly, the NC group had elevated TC and LDL-C versus the N group (F=3.9, P<0.000 1; F=5.8, P<0.000 1). BMAL1 expression exhibited rhythmic fluctuations, with higher protein levels at ZT16 than ZT8 in HFC and NC groups, showing a significant positive correlation with fatty liver severity (r=0.995, P=0.022). Conclusions A high-fat diet causes abnormal lipid metabolism in mice; the disturbance of circadian rhythm exacerbates the abnormal lipid metabolism in mice, increases lipid deposition in the liver, and promotes the progression of fatty liver. The biological clock gene BMAL1 is closely related to the metabolism of non-alcoholic fatty liver disease. High expression of BMAL1 may induce fat accumulating in the liver. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Treatment strategies for renal impairment in multiple myeloma: a review of new drugs and novel therapies SHI Hao, WANG Zhaohui Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 185-190.   DOI: 10.16138/j.1673-6087.2025.03.01 Abstract （276）   HTML （20）    PDF（pc） （892KB）（448）       Knowledge map    Save Multiple myeloma (MM) is associated with a high incidence of renal impairment, which correlates with decreased overall survival and increased risk of early mortality in these patients. In recent years, there has been great progress in the treatment of MM, and new drugs and therapies have improved prognosis of the patients. However, the prognosis of MM patients with concurrent renal impairment remains poorer compared with those with normal renal function. This article reviews the advancements in treatment and relevant strategies for MM patients with renal impairment. Current research supports the regime of combining monoclonal antibodies with proteasome inhibitors or immunomodulatory drugs in MM treatment. Chimeric antigen receptor T cells therapy, T-cell directing bispecific antibodies and antibody-drug conjugates have only been evaluated in small-scale retrospective studies for patients with renal impairment. Although the benefits of mechanical approaches aiming at rapid clearance of free light chains, such as plasmapheresis and high-cutoff hemodialysis, have not been confirmed, they may provide opportunities for renal recovery as combing with chemotherapy. The efficacy and safety of treatment in MM patients with renal impairment should be proactively assessed in prospective randomized controlled trials. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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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 Journal of Internal Medicine Concepts & Practice    2025, 20 (04): 312-315.   DOI: 10.16138/j.1673-6087.2025.04.09 Abstract （261）   HTML （5）    PDF（pc） （855KB）（283）       Knowledge map    Save 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. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Development of a questionnaire on adult artificial airway management competence for ICU nurses and tests of its reliability and validity CHEN Hui, ZHANG Yin, QIAN Zhuping, YAO Yijin Journal of Internal Medicine Concepts & Practice    2025, 20 (06): 462-468.   DOI: 10.16138/j.1673-6087.2025.06.06 Abstract （258）   HTML （1）    PDF（pc） （525KB）（94）       Knowledge map    Save Objective To develop a questionnaire on adult artificial airway management competence for intensive care unit (ICU) nurses. Methods A preliminary questionnaire on the competence of ICU nurses in managing adult artificial airways was formulated through literature review, Delphi expert consultation and a pilot survey. Using convenience sampling, 366 ICU nurses from two tertiary grade A hospitals in Shanghai and Harbin were surveyed from April to June 2024. Item analysis, exploratory factor analysis, confirmatory factor analysis and reliability test were conducted. Results The final questionnaire consisted of 32 items across 4 dimensions: artificial airway suctioning, endotracheal tube cuff management, prevention of artificial airway complications and artificial airway extubation care. Exploratory factor analysis extracted four common factors, with item factor loadings ranging from 0.403 to 0.968, and the cumulative variance contribution rate was 68.97%. Confirmatory factor analysis results showed that the model fit indices met acceptable standards, indicating a stable questionnaire structure. The overall content validity index of the questionnaire was 1.00, the total Cronbach's α coefficient was 0.98, the split-half reliability was 0.93, and the test-retest reliability was 0.99. Conclusions The questionnaire on adult artificial airway management competence for ICU nurses demonstrates good reliability and validity, and can be used as a tool to evaluate the corresponding competence of ICU nurses. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Roxadustat-induced central hypothyroidism in hemodialysis patients: a report of two cases XIA Yumiao, FU Peng, WU Hao Journal of Internal Medicine Concepts & Practice    2025, 20 (06): 487-489.   DOI: 10.16138/j.1673-6087.2025.06.10 Abstract （254）   HTML （3）    PDF（pc） （449KB）（144）       Knowledge map    Save Hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) is a novel class of oral medications for treating renal anemia, but adverse drug events have been reported both in China and internationally in recent years. This article reports two cases of reversible central hypothyroidism following the administration of the HIF-PHI roxadustat in patients undergoing regular hemodialysis with end-stage renal disease. Both patients gradually developed non-specific discomfort symptoms after one year of oral roxadustat treatment. Laboratory tests revealed abnormal thyroid function, while cranial magnetic resonance imaging showed no abnormalities. After discontinuation of roxadustat, thyroid function returned to normal and the symptoms resolved. These two cases suggest that it is necessary to monitor thyroid function in patients receiving oral roxadustat for renal anemia. Reference | Related Articles | Metrics | Comments（0）

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Secuchiumab in treatment of plaque psoriasis complicated with renal insufficiency: a case analysis ZHOU Ting, XIE Peitao, ZHANG Liang Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 259-261.   DOI: 10.16138/j.1673-6087.2025.03.12 Abstract （247）   HTML （11）    PDF（pc） （5900KB）（234）       Knowledge map    Save The 45-year-old male patient had uremia due to gout and hypertension in the past and underwent kidney transplantation, currently complicated with renal insufficiency. To prevent rejection, the patient administrated mycopherol sodium enteric-covered tablets 540 mg，twice a day, tacrolimus 1 mg in the morning and 2 mg in the evening and methylprednisolone 4 mg orally for long-term. Nifedipine controlled release tablets (30 mg, twice a day) were used for hypertension. Following a diagnosis of depression 3 years ago， medication was commenced with trazodone (50 mg, twice a day) and quetiapine fumarate (200 mg, twice a day) orally. The patient got novel coronavirus infection and was cured in December 2022. The plaque psoriasis was diagnosed in January 2023, and the treatment effect of oral anti-allergy drugs and topical hormone symptomatic treatment was not good for him. After being admitted to the hospital and receiving treatment of secukinumab 300 mg, psoriasis area and severity index (PASI) score and dermatology life quality index(DLQI) score of the patient were significantly improved, and he also showed well tolerated. The treatment of the case provides reference for the similar patients with psoriasis complicated with renal insufficiency. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical characteristic and treatment progress of neurologic immune-related adverse events associated with immune checkpoint inhibitors XIE Chong, WAN Wenbin, YAO Xiaoying, ZHANG Ying, WANG Gang Journal of Internal Medicine Concepts & Practice    2025, 20 (05): 359-364.   DOI: 10.16138/j.1673-6087.2025.05.02 Abstract （237）   HTML （8）    PDF（pc） （479KB）（150）       Knowledge map    Save In recent years, immune checkpoint inhibitor (ICI) has achieved remarkable success in cancer therapy. However, the occurrence of immune-related adverse event (irAE) has increasingly attracted attention. Among them, neurologic immune-related adverse event (n-irAE) is relatively uncommon, but can cause severe outcomes. n-irAE can involve multiple regions of the nervous system, including the peripheral nerves, neuromuscular junction, and central nervous system (CNS), and lead to myositis, myasthenia gravis, encephalitis, myelitis, and other disorders. The diagnosis of n-irAE requires a combination of evaluating the time correlation between symptoms and ICI medication, neurological localization assessments (neuroimaging, cerebrospinal fluid analysis, and electrophysiological studies), and the exclusion of alternative etiologies such as metastatic disease or infection. n-irAE is graded and treated based on clinical severity, and the common therapeutic approaches include corticosteroids, intravenous immunoglobulin, and plasma exchange. Multidisciplinary collaboration and early intervention are crucial for improving patient outcomes. Future efforts should focus on optimizing risk prediction models to achieve individualized management of n-irAE. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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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 Journal of Internal Medicine Concepts & Practice    2025, 20 (04): 276-281.   DOI: 10.16138/j.1673-6087.2025.04.03 Abstract （227）   HTML （13）          Knowledge map    Save 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. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Sodium-glucose linked transporter 2 inhibitors reduce serum uric acid in type 2 diabetic mellitus patients with early nephropathy WU Qianqian, GUO Jie, WANG Yifan, LIU Li, WANG Feng Journal of Internal Medicine Concepts & Practice    2025, 20 (05): 371-375.   DOI: 10.16138/j.1673-6087.2025.05.04 Abstract （224）   HTML （9）    PDF（pc） （503KB）（144）       Knowledge map    Save Objective To explore the reducing serum uric acid (SUA) effects of dapagliflozin, a sodium-glucose linked transporter 2 (SGLT2) inhibitor in patients with type 2 diabetes mellitus (T2DM) with early nephropathy and hyperuricemia. Methods Sixty-five patients with early T2 diabetic nephropathy and hyperuricemia admitted to our hospital from June 2020 to June 2023 were enrolled. After 4 weeks of treatment with dapagliflozin, a paired-sample T-test was used to analyze the changes in SUA, glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), serum creatinine (SCr), total cholesterol (TC), triglyceride (TG), urine albumin-to-creatinine ratio (UACR), body weight and other clinical indexes. Linear regression analysis was performed to determine the relationship between the changes of SUA before (baseline) and after treatment. Results In this group of 65 T2DM patients with early nephropathy and hyperuricemia, 4 weeks of dapagliflozin reduced SUA [(436.1±39.5)vs (392.2±32.2) μmol/L,P<0.001], FPG [(7.66±2.23)vs (6.40±1.06) mmol/L,P<0.001], UACR [(211.3±73.2)vs (177.8±88.3) mg/g,P=0.005], and body weight [(63.1±9.7)vs (62.7±9.3) kg,P=0.038] significantly. Systolic blood pressure, diastolic blood pressure, HbA1c, TC, TG, SCr, estimated glomerular filtration rate (eGFR), and other levels were not changed (P>0.05). Linear regression analysis showed that the decreased levels of SUA positively correlated with the baseline levels of SUA (β=0.634,R2=0.401,P<0.001). Conclusions SGLT2 could effectively decrease blood glucose levels in patients with early T2DM nephropathy, and significantly reduce serum uric acid and urinary microalbumin. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Age-period-cohort analysis and prediction of burden of asthma attributed to tobacco in China from 1990 to 2019 KANG Min, SHI Jing Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 242-247.   DOI: 10.16138/j.1673-6087.2023.03.09 Abstract （224）   HTML （8）    PDF（pc） （2266KB）（217）       Knowledge map    Save Objective To study the burden of asthma attributed to tobacco in China from 1990 to 2019, and to provide scientific basis for asthma prevention and control. Methods Using the Global Burden of Disease (GBD) 2019 database, we analyzed the trends of standardized mortality rates and standardized disability-adjusted life year(DALY) rates of asthma attributed to tobacco in China from 1990 to 2019. An age-period-cohort model was utilized to analyze the age, period, and birth cohort effects of the mortality rate of tobacco - related asthma, and an autoregressive integrated moving average model(ARIMA) was adopted to forecast the standardized mortality rates and standardized DALY rates of tobacco-related asthma for the next 5 years (2020-2024). Results Compared to 1990, the total number of deaths attributed to tobacco-related asthma in China was 5 037 in 2019, decreased 30.40% (7 237). The total DALY in 2019 were 200 700 person - years, decreased 13.54% compared to 231 000 person - years in 1990. From 1990 to 2019, the standardized mortality rate of the total population showed a decreasing trend, with an average annual decrease rate of 4.40% (95% CI: -4.63% - -4.16%), and the standardized DALY rate of the total population also showed a downward trend, with an average annual decrease of 3.43% (95% CI: -3.80% - -3.06%). The results of age effect indicated that the mortality rate of tobacco-related asthma increased with age (35-85 years) for males and the total population, reached peak in 85-89 age group, while female’s peak was in the 95 and over age group. From the perspective of period and cohort effects, the risk of death of tobacco-related asthma decreased over time in females, males, and the total population. The forecast results showed that the standardized mortality rate would decrease from 0.17/100 000 in 2020 to 0.05/100 000 in 2024, and the standardized DALY rate would decrease from 6.61/100 000 in 2020 to 3.65/100 000 in 2024. Conclusions The burden of asthma attributed to tobacco in China has shown a downward trend in the past few decades, which is closely related to health education, medical technology progress and the implementation of public health policies. In the future, it is necessary to adjust prevention and control strategies according to the actual situation to further reduce the disease burden of asthma. Table and Figures | Reference | Related Articles | Metrics | Comments（0）