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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 （652）   HTML （1）    PDF（pc） （930KB）（110）       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 （553）   HTML （3）    PDF（pc） （1058KB）（132）       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 （545）   HTML （2）    PDF（pc） （883KB）（142）       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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Predictive effect of estimated glomerular filtration rate on clinical prognosis of elderly hospitalized patients ZHANG Xiaoyan, XU Jing, QU Bin Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 132-139.   DOI: 10.16138/j.1673-6087.2025.02.06 Abstract （482）   HTML （4）    PDF（pc） （915KB）（125）       Knowledge map    Save 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-EPICr), CKD-EPI cystatin C formula( CKD-EPICys), the racially neutral CKD-EPICr-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-EPICys, CKD-EPICr-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-EPICr-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-EPICr(P=0.030) fit without race, CKD-EPICys (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-EPICr-Cys was more strongly associated with renal endpoint events. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Retrospective study of efficacy and safety of hetrombopag in treatment of chemotherapy-induced thrombocytopenia in patients with solid tumors CHEN Yong, CHEN Zixuan, WU Wenjuan, WANG Xiaoqing, CHEN Xiaojun, LI Ying, WANG Rui, LI Yue Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 126-131.   DOI: 10.16138/j.1673-6087.2025.02.05 Abstract （397）   HTML （6）    PDF（pc） （966KB）（131）       Knowledge map    Save 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. 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 （385）   HTML （2）    PDF（pc） （954KB）（159）       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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Pathogenesis and management principles of extraintestinal manifestations in inflammatory bowel disease CAO Zhijun, LU Juntao Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 112-119.   DOI: 10.16138/j.1673-6087.2025.02.03 Abstract （343）   HTML （11）    PDF（pc） （878KB）（262）       Knowledge map    Save 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. 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 （337）   HTML （5）    PDF（pc） （4329KB）（96）       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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Medicine de-escalation strategies in inflammatory bowel disease for remission maintenance GU Yubei, HONG Yu Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 101-106.   DOI: 10.16138/j.1673-6087.2025.02.01 Abstract （325）   HTML （16）    PDF（pc） （968KB）（194）       Knowledge map    Save 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. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Analysis of the mediating effect of intern nurses’ humanistic care quality on self-efficacy and clinical communication ability XU Qing, WU Shengjia, KANG Lei, WANG Minhui Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 162-166.   DOI: 10.16138/j.1673-6087.2025.02.11 Abstract （308）   HTML （4）    PDF（pc） （936KB）（265）       Knowledge map    Save 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. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Electrocardiographic and echocardiographic characteristics of patients with hypertrophic obstructive cardiomyopathy at one year after left ventricular outflow tract dredging WANG Hongzhen, LIU Xia Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 152-156.   DOI: 10.16138/j.1673-6087.2025.02.09 Abstract （297）   HTML （0）    PDF（pc） （2143KB）（162）       Knowledge map    Save 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. 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 （285）   HTML （1）    PDF（pc） （1052KB）（115）       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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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 （284）   HTML （11）    PDF（pc） （2933KB）（157）       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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Association between glucose metabolism and risk of all-cause mortality and cardio-cerebrovascular mortality in middle-aged and elderly populations ZHANG Jiwei, WU Xiaoqiong, CUI Jinhuang, YU Chunming, LI Yanyun Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 120-125.   DOI: 10.16138/j.1673-6087.2025.02.04 Abstract （277）   HTML （12）    PDF（pc） （939KB）（120）       Knowledge map    Save 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. 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 （268）   HTML （9）    PDF（pc） （1013KB）（115）       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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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 （267）   HTML （6）    PDF（pc） （5683KB）（168）       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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Application of medical situational simulation teaching in medical education of cardiovascular disease FAN Qin, TAO Rong Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 173-177.   DOI: 10.16138/j.1673-6087.2025.02.13 Abstract （262）   HTML （3）    PDF（pc） （941KB）（232）       Knowledge map    Save 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. Reference | Related Articles | Metrics | Comments（0）

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Transcriptional regulation of interleukin-6 receptor by PML::RARα fusion protein ZHAO Lingling, CUI Canqi, MI Jianqing Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 146-151.   DOI: 10.16138/j.1673-6087.2025.02.08 Abstract （256）   HTML （3）    PDF（pc） （1489KB）（235）       Knowledge map    Save 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. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Research progress on related markers and intestinal microorganisms in colorectal cancer liver metastasis GONG Yin, WANG Xueling Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 178-182.   DOI: 10.16138/j.1673-6087.2025.02.14 Abstract （236）   HTML （5）    PDF（pc） （925KB）（129）       Knowledge map    Save 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. 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 （233）   HTML （16）    PDF（pc） （892KB）（214）       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）