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    Expert consensus on diagnosing and evaluating sacroiliitis using magnetic resonance imaging
    DAI Shengming, BAO Chunde, ZOU Hejian, et al
    Journal of Internal Medicine Concepts & Practice    2023, 18 (02): 65-69.   DOI: 10.16138/j.1673-6087.2023.02.001
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    Ruijin Hospital recommendations for diagnosis and treatment of novel coronavirus infection in chronic kidney disease population (2023)
    OUYANG Yan, CHEN Zijin, ZHANG Qianying, et al
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 28-33.   DOI: 10.16138/j.1673-6087.2023.01.009
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    Recommendations on diagnosis and treatment of myocarditis associated with novel coronavirus infection
    JIN Wei, YANG Chendie, WANG Lingjie, et al
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 5-9.   DOI: 10.16138/j.1673-6087.2023.01.002
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    Concise protocol for the diagnosis and treatment of novel coronavirus pneumonia of Ruijin Hospital (January 2023 edition)
    QU Jieming, SHI Guochao, LI Qingyun, et al
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 1-4.   DOI: 10.16138/j.1673-6087.2023.01.001
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    Efficacy and safety of selective granulocyte and monocyte adsorptive apheresis in treatment of moderate to severe inflammatory bowel disease
    CHEN Ying, ZHANG Chenli, YAO Weiyan
    Journal of Internal Medicine Concepts & Practice    2022, 17 (06): 441-446.   DOI: 10.16138/j.1673-6087.2022.06.004
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    Objective To explore the efficacy and safety of granulocyte and monocyte apheresis(GMA) in the patients of moderate to severe inflammatory bowel disease(IBD). Methods Thirty-eight patients of moderate to severe IBD received GMA treatment at our hospital from May 2013 to September 2021 were enrolled, which included 28 cases of ulcerative colitis(UC) and 10 cases of Crohn disease(CD); and the data were analyzed retrospectively. The indexes including patients’ disease clinical activity scores [Mayo score, CD activity index(CDAI) score], endoscopic activity scores [UC endoscopic index of severity (UCEIS) score, Mayo endoscopic (MES) score, Baron score, CD endoscopic index of severity(CDEIS) score], changes in laboratory tests, and adverse events were compared before and 2 weeks after GMA treatment. Results After GMA treatment, the overall clinical response rate in 38 patients was 79% and remission rate was 42%; in which, the efficacy rate in 28 UC patients was 82%(n=23), and 10(36%) patients were in remission; the efficacy rate in 10 CD patients was 70% (n=7), and 6 (60%) cases were in remission. In UC patients, GMA significantly decreased Mayo score, UCEIS score, MES and Baron score. In CD patients, GMA significantly decreased CDAI score and CDEIS score(P<0.05). In all patients with IBD, GMA significantly increased the level of hemoglobin (Hb) and albumin (Alb), and reduced C-reactive protein (CRP) levels and defecate frequency (P<0.05). There was no significant difference in white blood cell (WBC), neutrophil (N)%, lymphocyte(L)%, monocyte (M)%, platelet (PLT) and erythrocyte sedimentation rate(ESR) level before and after treatment. The GMA-related severe adverse events were not observed. Conclusions GMA was effective and highly safe for the patients of moderate to severe IBD, while further randomized controlled trials in larger samples still need to be done as considering small case number in our research.

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    Ketogenic diet promotes hepatic lipid accumulation in db/db mice
    ZHANG Mengxiao, SUN Shuoshuo, WEI Xiao, ZHANG Shaohong, CHEN Guofang, LIU Chao
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 56-63.   DOI: 10.16138/j.1673-6087.2023.01.018
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    Objectives To study the effect of ketogenic diet (KD) on liver lipid deposition in db/db mice, and to investigate the safety of KD treatment and molecular mechanism in db/db mice. Methods Twenty eight-week-old db/db male mice of obesity type 2 diabetes mellitus(T2DM) were selected. After 3 weeks of adaptive feeding, 18 mice were enrolled and randomly divided into 3 groups: normal feeding (ND) group (n=6), KD group (n=6) and 75% caloric restriction (CR) group(n=6). In addition, 6 eight-week-old C57BL/6 male mice were fed with standard control diet and considered as normal (C) group. C and ND groups were free to get the standard feed, KD group was free to get the ketogenic feed, and CR group was the positive control group, which consumed 75% of standard feed calories of ND group each day. After 4 weeks of diet treatment, 2 mice in KD group and 1 mouse in CR group died. Three mice in each group were randomly included for statistical analysis, and the levels of fasting triglyceride(TG), total cholesterol(TC) and low-density lipoprotein cholesterol(LDL-C) in each group were detected and compared. The morphology and structure of liver were observed by hematoxylin and eosin(HE) staining. The size and number of lipid droplets in liver tissue of mice were observed by oil red O staining. The quantitative polymerase chain reaction (qPCR) was used to detect the expression of sterol regulatory element-binding protein 1C (SREBP1C), stearoyl-CoA desaturase 1 (SCD1), acyl-CoA oxidase 1 (ACOX1), peroxisome proliferator-activated receptor α (PPARα), cluster of differentiation 36 (CD36), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-), matrix metalloproteinase-13 (MMP13), matrix metalloproteinase-inhibitor 1(TIMP1), collagen type Ⅲ alpha 1 (COL3a1) and collagen type Ⅰ alpha 1 (COL1a1) in liver. Immunohistochemistry (IHC) and western blot (WB) were used to detect the expression of fatty acid translocase (CD36) in liver tissues. Results After 4 weeks of dietary intervention, compared with ND group, the level of TG, TC and LDL-C in KD group was not improved, but the level of TG in CR group was significantly decreased (P<0.05). HE and oil red O staining showed that liver vacuolar degeneration and lipid deposition increased in KD group compared with ND and CR groups. qPCR showed that compared with ND group, lipid-catabolism genes such as PPARα and ACOX1 showed decreased trend in KD group without significant difference; the expression of CD36, IL- and TNF-α was significantly increased (P<0.05). The expression of MMP13 was significantly decreased(P<0.05), while the expression of other hepatic fibrosis related genes was not changed. IHC showed that compared with ND group, the expression level of CD36 protein in KD group was significantly increased(P<0.05). Conclusions KD could induce liver lipid deposition, aggravate liver inflammation in db/db mice. Therefore, in the treatment of obesity with KD, the changes of liver function should be closely observed to prevent the occurrence of adverse reactions.

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    Guidelines for clinical management of abnormal thyroid function in patients with novel coronavirus infection
    Chinese Society of Endocrinology
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 13-15.   DOI: 10.16138/j.1673-6087.2023.01.004
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    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 15-15.  
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    The current status of intensive care unit competency and infectious disease emergency response capability of nurses involved in the critical care of COVID-19 in Shanghai
    CUI Jiasong, ZHANG Enming, WANG Suxing, GAN Lu, DAI Zhengyue, FANG Qiong
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 43-47.   DOI: 10.16138/j.1673-6087.2023.01.015
    Abstract89)   HTML5)    PDF (537KB)(22)      

    Objective To investigate the current status of intensive care unit (ICU) competency and infectious disease emergency response capability of nurses involved in the critical care of corona virus disease 2019 (COVID-19) in Shanghai and to analyze the influencing factors. Methods A convenience sampling method was used to select 234 nurses from six tertiary care hospitals ICU coping with COVID-19 coping ICU in Shanghai as study subjects. According to the ICU working experience prior to the pandemic, the nurses were divided into ICU and non-ICU groups. All the subjects were surveyed with the ICU nurse competency questionnaire and the health care workers’ infectious disease emergency response competency questionnaire. Results Of the 234 valid questionnaires returned, 44 belonged to the ICU group and 190 were from the non-ICU group. Although both groups performed well on ICU competency, the score of ICU group (82.23±10.02) was significantly higher than that of the non-ICU group (71.14 ±11.36) (P<0.05), with 70.5% of the ICU group maintaining at the good level and above, while only 56.9% of the non-ICU group reaching that level. The infectious disease emergency response competency score was (3.62±0.70) in the ICU group and (3.50±0.65) in the non-ICU group.The ICU group had slightly higher prevention, preparedness, rescue and overall response capabilities than the non-ICU group. Multiple linear regression showed that the infectious disease emergency response competency level and the presence of emergency response experience were the main factors contributing to the competency of nurses involved in the critical care of COVID-19 (P<0.05). Conclusions The total nursing competency score and overall professionally were higher in the ICU group than in the non-ICU group, but there were still some nurses with lower competency in the ICU group requiring further training. The infectious disease emergency response ability was at an intermediate level in both groups. The competency of ICU nurses could be attributed to multiple factors, such as extended work experience, particularly on infectious disease emergency.

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    Characteristics of traditional Chinese medicine syndromes in mild cases of coronavirus Omicron variant infection
    ZHANG Weiyu, ZHENG Lan, ZHENG Weihua, LIU Jialin, LÜ Lingling, LU Lingyun, YANG Cuiping, LI Qiong
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 48-50.   DOI: 10.16138/j.1673-6087.2023.01.016
    Abstract89)   HTML4)    PDF (396KB)(28)      

    Objective: To characterize the traditional Chinese medicine (TCM) syndromes of mild corona virus di-sease 2019(COVID-19) cases infected with Omicron variant for better prevention and treatment of COVID-19 infection. Methods A total of 188 mild covid -19 patients infected with Omicron variant infection in the northern section of Ruijin Hospital affiliated to Shanghai Jiao Tong university school of medicine and Jiahe Xinyuan shelter from March 24 through April 24, 2022 were enrolled, the tongue manifestation features, basic information, TCM syndrome and the time of negative turning were collected by the questionnaires. Results The mild cases were generally in good health status, with less than 20% patients having other major diseases. There was statistical significance in the median time of turning negative among different tongue shapes. The tongue coating indicated that the syndrome of cold-dampness stagnating, of evil-heat accumulating and dampness blocking in the lung pattern accounted for 38.8%, 34.5% and 23.4% of all cases. The syndrome of cold-dampness stagnating in the lung pattern and the syndrome of evil-heat accumulating in the lung pattern were found in majority of patient investigated. It took similar time for patients with different syndrome types to become COVID-19 virus negative (P>0.05). Conclusions The cold dampness was most common among mild COVID-19 patients with Omicron infection, who predominately presented syndrome of cold-dampness stagnating in the lung pattern.

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    Geometric deep learning and computational medicine research prospects of “preventing disease” in pre diabete
    RUAN Ming, HOU Tianzhichao, WANG Haiyan, et al
    Journal of Internal Medicine Concepts & Practice    2022, 17 (06): 475-481.   DOI: 10.16138/j.1673-6087.2022.06.011
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    Establishment of an evaluation system for competency of nurses coping with public health emergency in tertiary hospitals
    ZHAO Junjie, ZHU Weiyi, ZHA Qinghua
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 51-55.   DOI: 10.16138/j.1673-6087.2023.01.017
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    Objective To establish an evaluation system for competency of nurses coping with public health emergency in tertiary hospitals. Methods An evaluation system was developed theoretical analysis with reference to the relevant literatures. Delphi method was employed to conduct 2 rounds of consultations among 13 experts to revise the draft. Average distribution method were used to calculate weight of each index at all levels. Results The response rates of the 2 rounds of expert consultation questionnaire were 87% and 100%, with an effective rates of 100%. The whole expert authority coefficient was 0.91; Kendall’s coefficients of concordance were 0.178 and 0.289 (all P<0.001). The final evaluation system was comprised with 4 first level indexes (public health emergency prevention capacity, preparedness capacity, rescue capacity and recovery capacity), 10 second-level indexes, and 27 third-level indexes. Conclusions The evaluation system for competency of nurses established in current study provides a scientific tool to appraisal the capability of nurses coping with public health emergency in tertiary hospitals, and a reference for further optimize the emergency protocol and training of nurses in tertiary hospitals.

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    The response plan of Ruijin Hospital emergency department architectural design at the peak of the COVID-19 pandemic
    YU Pei, ZHOU Shuai, CHENG Jie, et al
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 38-39.   DOI: 10.16138/j.1673-6087.2023.01.012
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    Protocol of in-hospital expert inspection and diagnosis of patients infected with novel coronavirus in Ruijin Hospital
    ZHUANG Lei, JIN Rui, GAO Weiyi, et al
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 36-37.   DOI: 10.16138/j.1673-6087.2023.01.011
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    COVID-19 vaccine induced thyroid disease: challenges and strategies
    YUAN Li, XIANG Pingping, CHEN Guofang, et al
    Journal of Internal Medicine Concepts & Practice    2023, 18 (02): 121-123.   DOI: 10.16138/j.1673-6087.2023.02.012
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    Risk analysis of malignant tumor incidence in pre-diabetes patients in Shanghai
    MIAO Ya, LIU Lili, HOU Tianzhichao, YAN Qinghua, PANG Yi, WU Chunxiao, CHENG Minna, SHI Yan, LI Yanyun, TIAN Jingyan
    Journal of Internal Medicine Concepts & Practice    2022, 17 (06): 435-440.   DOI: 10.16138/j.1673-6087.2022.06.003
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    Objective To explore the risk of incidence of over all cancer and site-specific cancers in patients with pre-diabetes. Methods From 2011 to 2018, 31 568 pre-diabetes patients aged 20 years and above who were newly diagnosed and registered in the community diabetes management information system of Shanghai were used as the unique identifier to link data with the Shanghai Malignant Tumor Registration System to obtain their malignant tumor incidence, to calculate the incidence of all causes and the top ten malignant tumors of pre-diabetes patients of different sexes and ages standardized incidence rate and standardized incidence ratio (SIR). Results The crude incidence rate of all cause tumors in pre-diabetes patients was 868.1/100 000 person years, 1 099.48/100 000 person years for male and 729.19/100 000 person years for female. The standardized incidence rate was 567.49/100 000 person years, 512.15/100 000 person years for male and 597.91/100 000 person years for female. The SIR of all cause tumors was 0.97, 0.99 for male and 0.99 for female, respectively. The relative incidence risk of all cause tumors in pre-diabetes patients gradually decreased with age, and the SIR of pre-diabetes patients in the 20-49, 50-59, 60-69, 70-79 and ≥80 age groups was 3.04, 1.21, 1.00, 0.92 and 0.66, respectively. The incidence risk of thyroid cancer in the 20-49 and 50-59 year old pre-diabetes patients were 4.85 and 1.86 times higher than that of the total population of the same age, respectively, and the incidence risk of thyroid cancer in the 20-49 and 50-59 year old female pre-diabetes patients were 4.46 and 1.53 times higher than that of the total population of the same sex and age, respectively. The risk of bladder cancer and kidney cancer in male under 50 years of age with pre-diabetes were 36.34 and 13.49 times higher than that in the total population of the same sex and age, respectively. The risk of prostate cancer in male aged 60 to 69 years in pre-diabetes was 2.66 times higher than that in total population of the same sex and age. Conclusions The risk of all-cause cancer in pre-diabetes patients was not significantly higher than that in the total population. The relative risk of all-cause cancer and site-specific cancers of the population decreased with age. It is necessary to increase the screening of specific cancer species in specific gender and age groups. For newly diagnosed pre-diabetes patients over 80 years old, it is recommended to reevaluate the risk of disease diagnosis and prognosis.

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    Journal of Internal Medicine Concepts & Practice    2022, 17 (06): 467-467.  
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    Traditional Chinese medicine differentiation and treatment of novel coronavirus disease in Ruijin Hospital
    LU Lingyun, ZHENG Lan
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 40-41.   DOI: 10.16138/j.1673-6087.2023.01.013
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    Guidelines for clinical management of novel coronavirus infection in elderly and children and adolescents with diabetes
    Chinese Society of Endocrinology
    Journal of Internal Medicine Concepts & Practice    2023, 18 (01): 10-12.   DOI: 10.16138/j.1673-6087.2023.01.003
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    A retrospective study on prediction of neurological outcome in cardiac arrest patients of out-hospital
    LI Yongde, WANG Yang, LI Xiang, LI Wenjie, XIE Di, JIANG Shaowei, GE Xiaoli, WANG Hairong, GAO Chengjin, PAN Shuming
    Journal of Internal Medicine Concepts & Practice    2022, 17 (06): 447-452.   DOI: 10.16138/j.1673-6087.2022.06.005
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    Objective To investigate the predictive power of neurological examination results and serum neuron specific enolase(NSE) concentration for the neurological outcome of cardiac arrest patients. Methods All cardiac arrest patients were retrospectively analyzed. They were divided into good outcome group [cerebral performance category (CPC)≤2] and poor outcome group (CPC≥3) according to CPC scores on day 30. According to Glasgow coma scale (GCS), serum NSE concentration, pupil light reflex, eye opening score (eGCS), limb movement score (mGCS) and the sum of two (emGCS) were compared between two groups. Repeated measures were used to evaluate the correlation, and Logistic regression analysis was used to explore the univariate and multivariate predictors. Results The serum NSE concentration in poor outcome group was significantly higher than that in good outcome group (P<0.01). The change of mGCS (Δ mGCS) and emGCS (Δ emGCS) within first 3 days in good outcome group was significantly higher than that in poor outcome group (P<0.05). Repeated measures ANOVA showed eGCS, mGCS and emGCS were significantly correlated with CPC grades(P<0.001). The analysis of generalized linear mixed model showed there was a significant correlation between absent of pupillary light reflex and poor neurological outcome (P=0.002). The eGCS, mGCS and emGCS in first 3 days, and presence of pupil light reflex on the second and third day, Δ mGCS, Δ emGCS and serum NSE levels were univariate predictors (P<0.05). Male and mGCS on day 3 were multivariate predictors (P<0.05). Conclusions The combination of male and mGCS on the 3rd day could be used to predict the poor neurological outcome in cardiac arrest patients.

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