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    Therapeutic effect of theta burst transcranial magnetic stimulation combined with speech training on aphasia after stroke
    ZENG Zhen, LU Chunhua, WANG Kai, ZHANG Qin
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 231-235.   DOI: 10.16138/j.1673-6087.2024.04.03
    Abstract221)   HTML2)    PDF(pc) (3195KB)(1163)       Save

    Objective Analyzing the clinical treatment efficacy of continuous theta burst stimulation (cTBS), theta burst stimulation (TBS) combined with speech training on post stroke aphasia (PSA). Methods In this study, 90 PSA patients admitted to our hospital from February 2022 to January 2023 were divided into three groups according to different treatment methods, each 30 cases in each group. The basic group was given speech training, the observation group 1 was given cTBS combined speech training, and the observation group 2 was given iTBS combined speech training. The clinical efficacy, western aphasia battery (WAB) score, view naming test results, Boston diagnostic aphasia examination (BDAE) rating, stroke aphasia quality of life scale (SAQOL-39g) score were compared among the three groups. Results The total clinical effective rate (96.67%, 93.33%) in observation group 1 and observation group 2 were higher than that in basic group (60.00%) (P<0.05). After treatment, WAB score and correct number of view naming test in observation group 1 and observation group 2 were higher than those in basic group (P<0.05). The reaction time of view naming test in observation group 1 and observation group 2 were shorter than that in basic group (P<0.05). The improvement degree of BDAE grade in observation group 1 and observation group 2 after treatment were better than that in basic group (P<0.05). The SAQOL-39g score in observation group 1 and observation group 2 after treatment was higher than that in basic group (P<0.05). The total clinical response rate, WAB score after treatment, correct number of view naming tests, response time, improvement effect of BDAE classification, and SAQOL-39g score didn’t show significant difference between observation group 1 and group 2 (P>0.05). Conclusions Both cTBS and iTBS combined speech training can improve aphasia symptoms, view naming ability and quality of life in PSA patients. The clinical efficacy of them is comparable, and both are better than single speech training.

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    Bioinformatics analysis and identification of cuproptosis characteristic genes for acute pancreatitis by machine learning
    WANG Zhuoxin, HUANG Xinyang, JIN Yixun, WANG Lifu
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 224-230.   DOI: 10.16138/j.1673-6087.2024.04.02
    Abstract305)   HTML14)    PDF(pc) (1760KB)(1145)       Save

    Objective To discover the characteristic genes of cuproptosis in acute pancreatitis (AP). Methods The expression of cuproptosis-related genes (CRG) in the GSE1943 dataset was extracted and performed differential analysis and immune cell correlation analysis. The different subtypes were classified according to the expression of CRG, and metabolic pathway enrichment was performed using gene set variation analysis. Four machine learning algorithms, including generalized linear models, random forest, support vector machine and extreme gradient boosting were used to screen disease characteristic genes. Results A total of 13 CRG were differentially expressed in AP (P<0.05), and CRG were not only correlated to each other in different degrees, but also had correlation with multiple immune cells (P<0.05). There were four immune-related pathways among the two subtypes obtained by cluster analysis, in which the T-cell receptor signaling pathway was noteworthy. Further analysis revealed significant difference between the two subtypes of multiple T cells (P<0.05). Each machine learning algorithm screened out five characteristic genes, and dihydrolipoamide dehydrogenase (DLD) was obtained as the next target of research. Conclusions CRG-based machine learning and bioinformatics analyses could be used to explore CRG in AP to discover potential biomarkers.

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    Mechanism of mitochondrial autophagy in myocardial ischemia-reperfusion injury
    GAO Yue, XING Shifeng
    Journal of Internal Medicine Concepts & Practice    2024, 19 (05): 328-332.   DOI: 10.16138/j.1673-6087.2024.05.08
    Abstract392)   HTML7)    PDF(pc) (828KB)(987)       Save

    Cardiovascular disease is still one of the most common causes of death in the world. In the past, timely reperfusion treatment has greatly reduced the death rate of the disease while promoting blood recovery and cardiomyocyte recovery. Ischemia reperfusion (IR) injury is an inevitable pathological process in many clinical practices. The mechanisms of myocardial IR injury include a variety of pathological processes such as mitochondrial autophagy and apoptosis, and these signaling pathways are interrelated and act on each other. Among them, mitochondrial autophagy has attracted wide attention as a selective autophagy. Mitochondrial autophagy maintains the normal operation of cardiomyocytes by regulating the quality and quantity of mitochondria. However, as stimulated by oxidative stress, ischemia and hypoxia, excessive mitochondrial autophagy or insufficient mitochondrial autophagy can affect the function of cardiomyocytes and even lead to the death of cardiomyocytes. Therefore, the activation degree of mitochondrial autophagy in cardiomyocytes should be strictly controlled. This article reviews the mechanism and progress of mitochondrial autophagy in myocardial IR injury, aiming to provide some assistance in the study of myocardial IR injury.

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    Research progress on mechanism of traditional Chinese medicine in treating Parkinson disease by interfering with ferroptosis
    LI Yuanyuan, YAO Xiaoling, QU Yanjie, CHEN Jingxian
    Journal of Internal Medicine Concepts & Practice    2024, 19 (05): 351-356.   DOI: 10.16138/j.1673-6087.2024.05.13
    Abstract332)   HTML1)    PDF(pc) (1005KB)(687)       Save

    Ferroptosis is a newly recognized form of programmed cell death in recent years, and its core mechanism mainly involves the accumulation of iron-dependent lipid peroxides in cells. More and more studies suggest that ferroptosis plays a critical role in the onset and progression of Parkinson disease (PD). This article aims to review the molecular regulatory mechanism of ferroptosis in detail and the latest research progress on ferroptosis in treatment of PD and the therapeutic methods of traditional Chinese medicine for it. Through in-depth discussion of this emerging research field, the current status and progress of active ingredients and compounds of traditional Chinese medicine intervening process of PD through ferroptosis pathway were summarized, which was expected to provide a solid theoretical basis and innovative ideas for the application of targeting ferroptosis in the PD treatment.

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    Research progress of Hashimoto thyroiditis
    TIAN Limin, FENG Jing
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 217-223.   DOI: 10.16138/j.1673-6087.2024.04.01
    Abstract2213)   HTML36)    PDF(pc) (973KB)(685)       Save

    Hashimoto thyroiditis (HT) is a very common organic autoimmune thyroid disease, and its incidence is increasing year by year. It not only causes hypothyroidism in clinical practice, but also has many connections with a variety of immune diseases, endocrine diseases, rheumatic diseases and thyroid cancer. Although the exact etiology of HT has not been fully clarified, the mainstream treatment is still based on management and alternative treatment of hypothyroidism. However, as the research further deepens, more clinical variants have been gradually discovered, more and more factors have been found to be related to the onset of HT, and new discoveries have been made in treatment methods. This article reviews the research progress on clinical manifestations, pathological features, diagnosis, pathogenesis, relationship with other diseases and treatment of HT.

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    Study on efficacy and safety of Dioscorea bublifera L. in treatment of Graves disease
    CUI Yifan, ZHANG Ruixiang, WEI Xiao, LIU Chao
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 273-277.   DOI: 10.16138/j.1673-6087.2024.04.11
    Abstract1487)   HTML1)    PDF(pc) (955KB)(563)       Save

    Hyperthyroidism is most common in Graves disease (GD), and traditional antithyroid medicine are often difficult to achieve satisfactory efficacy, and high recurrence rate and long course of treatment are the most prominent problems. Huangyaozi(Dioscorea bublifera L.), a traditional Chinese medicine, has the effect of “Xiao Ying” and has been widely used in the treatment of GD in recent years, but long-term use may cause liver and kidney damage. Therefore, more research on the efficacy and safety of Huangyaozi need to be done in the treatment of GD.

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    Research progress of the association between intra-pancreatic fat deposition and atherosclerosis
    LI Chenxi, HU Yun, WU Wenjun
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 278-282.   DOI: 10.16138/j.1673-6087.2024.04.12
    Abstract206)   HTML2)    PDF(pc) (881KB)(490)       Save

    Intra-pancreatic fat deposition (IPFD) is the most common disease of pancreas in our country. In recent years, there has been increasing evidence that IPFD is closely related to atherosclerosis. However, some studies do not support the correlation between them, which may be affected by differences in study population, atherosclerosis detection methods, and IPFD diagnostic criteria. Therefore, large-sample prospective studies are urgently needed to further clarify the correlation between IPFD and atherosclerosis. The mechanisms involved in correlation between them may be related to inflammation, oxidative stress, hypoadiponectinemia and glucose metabolism. There is currently no specific treatment for IPFD, while weight loss has been shown to significantly reduce the amount of fat deposited in the pancreas. In addition to the treatment of IPFD itself, clinicians should also pay attention to the assessment of the risk of cardiovascular disease in IPFD patients to facilitate early diagnosis and early intervention.

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    Discussion on understanding of the essence of chronic obstructive pulmonary disease from the definitions of chronic obstructive pulmonary disease in GOLD over the years
    HE Quanying
    Journal of Internal Medicine Concepts & Practice    2024, 19 (05): 289-294.   DOI: 10.16138/j.1673-6087.2024.05.01
    Abstract217)   HTML3)    PDF(pc) (887KB)(268)       Save

    This article reviewed the definition of chronic obstructive pulmonary disease (COPD) in Global Initiative for Chronic Obstructive Lung Disease (GOLD) over the years, from which it can be seen that our understanding of the nature of COPD has gradually deepened and comprehensively. However, there are still some deficiencies in definition of COPD, including airway inflammation, etiology, disease heterogeneity, etc. The comorbid diagnosis and intervention of COPD requires multidisciplinary collaboration.

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    Rehabilitation efficacy of aerobic exercise on patients with overlap syndrome of chronic obstructive pulmonary disease and obstructive sleep apnea
    LIU Jie, ZHANG Yin, XU Yiming, REN Lei, SHEN Honghua
    Journal of Internal Medicine Concepts & Practice    2024, 19 (05): 295-302.   DOI: 10.16138/j.1673-6087.2024.05.02
    Abstract253)   HTML2)    PDF(pc) (939KB)(255)       Save

    Objective To evaluate the rehabilitation efficacy of moderate intensity aerobic exercise on patients with chronic obstructive pulmonary disease (COPD)-obstructive sleep apnea (OSA) overlap syndrome. Methods A retrospective cohort study was used in the study. The patients who were diagnosed with COPD-OSA overlap syndrome and applied positive airway pressure (PAP) from January 2021 to December 2023 were selected in the Department of Respiratory Rehabilitation, at the Fourth Rehabilitation Hospital of Shanghai. A total of 29 patients [aged (62.2±5.9) years, male 65.5%] with overlap syndrome received moderate intensity aerobic training for 20 weeks were enrolled as the intervention group (IG). At the same time, 29 patients [(64.6±6.9) years, male 62.1%] with overlap syndrome who didn’t receive aerobic training were selected as the control group (CG). The differences in motor function, daily living abilities, body composition, respiratory function, psychological state and sleep parameters between two cohorts of patients before and after treatment were compared. Results After 20 weeks of aerobic exercise, the various parameters of IG demonstrated significant improvement compared with those before treatment: a notable increase in the 6 min walk distance (6MWD) [(268.62±47.02) m vs (316.97±58.44) m], quadriceps muscle strength [22.40 (20.40, 27.45) kg vs 25.40 (20.00, 30.45) kg], Barthel index (BI) scores [(66.03±12.42) vs (76.72±11.82)], a reduction in the 5 times sit-to-stand test (5TSTS) [19.50 (15.94, 31.10) s vs 13.50 (11.75, 18.50) s], body mass index (BMI) [(25.16±3.17) kg/m2 vs (22.31±2.16) kg/m2] and fat mass (FM) [(24.13±9.22) kg vs (20.47±8.32) kg]. Additionally, there were significant enhancements observed in PSG parameters, blood gas analysis results, Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) scores after training in IG (all P<0.05). In contrast, the CG exhibited improvements in quadriceps muscle strength and the modified Medical Research Council (mMRC) as well as PSG parameters and psychological state; while there was an FM increase in this group (all P<0.05). Compared with the CG, the 6MWD [(316.97±58.44) m vs 239.93±37.80) m], quadriceps muscle strength [25.40 (20.00, 30.45) kg vs 23.70 (20.50, 25.60) kg], 5TSTS [13.50 (11.75, 18.50) s vs 19.50 (17.60, 23.12) s], BI [(76.72±11.82) vs (67.59±10.74)], mMRC, pH, PaO2, TS90%, BMI [(22.31±2.16) kg/m2 vs(26.17±3.83) kg/m2], FM, HAMD, HAMA of the IG patients showed significant improvement (all P<0.05). However, there were no significant differences observed between the two groups in terms of percentage of predicted forced expiratory volume in one second (FEV1%) (43.72%±9.49% vs 43.97%±7.22%), PaCO2, apnea hypopnea index, pulse oxygen saturation (L-SpO2)%, fat free mass and fat free mass index (P>0.05). Conclusions The combination of a 20-week moderate-intensity aerobic training and PAP demonstrates significant improvements in motor function, reduction in body fat, alleviation of hypoxia and respiratory difficulties, enhancement of psychological state and daily life abilities. This intervention may be considered suitable for patients with COPD-OSA overlap syndrome.

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    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 287-288.  
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    Research progress on agranulocytosis caused by antithyroid drugs
    TIAN Ruochen, LI Jing
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 264-268.   DOI: 10.16138/j.1673-6087.2024.04.09
    Abstract1657)   HTML6)    PDF(pc) (970KB)(168)       Save

    In China, antithyroid drugs are the first choice of treatment for hyperthyroidism. However, their side effects may result in agranulocytosis, which has an insidious onset and requires urgent treatment. Up to date,the mechanisms of agranulocytosis caused by antithyroid drugs is still unclear. Herein, the article reviewed the direct toxic activities, the immune effects, and the genetic susceptibility of antithyroid drugs, which may be helpful to provide better clinical treatment options and improve the prognosis of agranulocytosis caused by the drugs.

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    Role of heart rate variability in patients with hypertensive cerebral hemorrhage complicated by pulmonary infection after tracheotomy
    CHEN Li, WANG Shaowei, WANG Yunqi
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 249-253.   DOI: 10.16138/j.1673-6087.2024.04.06
    Abstract182)   HTML6)    PDF(pc) (904KB)(158)       Save

    Objective To investigate the relationship between heart rate variability (HRV) and pulmonary infection after tracheotomy in patients with hypertensive cerebral hemorrhage (HICH), to provide reference for clinical diagnosis and treatment. Methods The clinical data of 101 HICH patients who underwent tracheotomy from February 2018 to December 2022 were analyzed retrospectively. The patients were divided into infection group and non-infection group according to the complicated pulmonary infection. The general data, inflammatory markers and HRV indexes of the two groups were compared. Pearson correlation was used to analyze the relationship between HRV and pulmonary infection after tracheotomy in HICH patients. Results In 101 patients with HICH, there were 54 cases (53.5%) developed pulmonary infection within 7 d after tracheotomy. There was a statistically significant difference in preoperative Glasgow coma scale (GCS) between the two groups (P<0.05). The cytokines such as interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and procalcitonin (PCT) in the infected group were higher than those in the non-infection group. The HRV indexes including the standard deviation of RR interval for all sinus beats within 24 h standard deviation of normal to normal interval (SDNN), 24 h average SDNN (SDANN), the root mean square of successive differences in adjacent RR interval(RMSSD), the percentage of beats with percentage of adjacent normal to normal intervals differing by more than 50 ms(PNN50), high frequency power (HF) low frequency power (LF) were all lower than those of non-infection group (P<0.05). The Pearson correlation test showed that HRV was negatively correlated with IL-6, CRP, TNF-α and PCT (P<0.05). Conclusions HRV in patients with HICH is associated with pulmonary infection after tracheotomy. The lower values of SDNN, SDANN, RMSSD, PNN50, HF, LF suggest an increased risk of pulmonary infection.

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    Research progress on biomarkers for chronic obstructive pulmonary disease complicated with obstructive sleep apnea
    QIANG Shihao, DAI Qingxia, HUANG Lina, GUO Hua, CUI Xiaochuan
    Journal of Internal Medicine Concepts & Practice    2024, 19 (05): 322-327.   DOI: 10.16138/j.1673-6087.2024.05.07
    Abstract278)   HTML2)    PDF(pc) (902KB)(145)       Save

    The coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is referred to as COPD-OSA overlap, also known as overlap syndrome (OS). OS patients are more severe and have worse prognosis than those with OSA and COPD alone. Because pulmonary function and polysomnography cannot be conducted widely for patients, at present, there are many research to explore the clinical value of immunology, blood cell, gene protein,body fluid and other related biomarkers related to OS in assisting diagnosis, predicting the risk and severity of disease. This article reviews the recent research progress on OS-related biological markers.

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    Recent advances in diagnosis and treatment of subacute thyroiditis
    LI Yajie, CUI Dai
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 259-263.   DOI: 10.16138/j.1673-6087.2024.04.08
    Abstract1465)   HTML24)    PDF(pc) (939KB)(144)       Save

    Subacute thyroiditis (SAT) is a common thyroid inflammatory disease that is frequently prone to misdiagnosis or underdiagnosis, which impact the quality of life for patients adversely. In this review, we summarize the pathogenesis, clinical manifestations, diagnosis, and treatment of SAT, aiming to improve clinician’s understanding of the disease.

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    Clinical effect of Shexiang Baoxin pill combined with sacubitril/valsartan in the treatment of acute myocardial infarction after percutaneous coronary intervention
    FANG Chunmei, LI Feng, SHEN Tongtong, ZHOU Yang
    Journal of Internal Medicine Concepts & Practice    2024, 19 (05): 310-313.   DOI: 10.16138/j.1673-6087.2024.05.04
    Abstract248)   HTML2)    PDF(pc) (825KB)(110)       Save

    Objective To investigate the clinical effect of Shexiang Baoxin pill combined with sacubitril/valasrtan in the treatment of acute myocardial infarction after percutaneous coronary intervention(PCI).Methods A total of 120 patients with acute myocardial infarction from January 2021 to November 2023 after PCI were selected and randomly assigned to observation group (60 cases) and control group (60 cases) in Chuzhou First People’s Hospital. The patients in both groups were given anticoagulation, antiplatelet, lipid-regulating, and other conventional treatment, while the control group was treated with sacubitril/valsartan, and the observation group was treated with sacubitril/valsartan combined with Shexiang Baoxin pill. The indexes including the changes of C-reactive protein(CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), blood pressure, left ventricular end-diastolic diameter(LVEDD), left ventricular end-systolic diameter(LVESD), fractional shortening(FS) rate, left ventricular ejection fraction (LVEF) were compared between the two groups. The incidence of arrhythmia and length of stay during hospitalization and the rate of re-hospitalization within six months due to adverse cardiac events were also compared between the two groups. Results After 4-week treatment, the levels of CRP and NT-proBNP in the observation group were significantly lower than those in the control group (all P<0.05). After 6-month treatment, the cardiac color ultrasound ultrasonography indexes (LVEDD, LVESD, FS, LVEF) in the observation group were better than those in the control group (all P<0.05). The incidence of atrial and ventricular arrhythmias in the observation group was lower than that in the control group duration of hospital stay (P<0.05), and length of hospitalization in the observation group was shorter than that in the control group (P<0.05). At the 6-month follow-up, the rate of rehospitalization in the observation group was lower than that in the control group (5.1% vs 26.3%, P<0.05).Conclusions The combination of Shexiang Baoxin pill and sacubitri/valsartan can effectively inhibit inflammatory response, reverse ventricular remodeling, improve cardiac function, reduce complications and improve prognosis in patients with acute myocardial infarction after PCI.

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    Study on the correlation between serum MG53 level and coronary artery calcification
    ZHANG Yu, ZHA Qing, YANG Ling, YE Jiawen, YANG Ke, LIU Yan
    Journal of Internal Medicine Concepts & Practice    2024, 19 (05): 303-309.   DOI: 10.16138/j.1673-6087.2024.05.03
    Abstract283)   HTML3)    PDF(pc) (1245KB)(109)       Save

    Objective To study the correlation between serum MG53 level and coronary artery calcification (CAC), and the correlation between serum MG53 level and the prognosis of patients with CAC. Methods A total of 195 patients admitted to the Department of Cardiovascular Medicine of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from 2016 to 2018 due to chest distress and other discomforts were selected. CAC was confirmed by coronary CT angiography (CTA) in all patients. Agatston integral was used to calculate CAC score, and serum MG53 level was detected by enzyme-linked immunosorbent assay. Patients were followed up for 5 years, and the endpoint events were recorded. Patients were grouped according to CAC score and serum MG53 level. Logistic regression was used to analyze the correlation between serum MG53 level and CAC level. Kaplan-Meier curve and COX proportional risk model were used to analyze the effect of serum MG53 level on the prognosis of CAC patients. The R software (4.2.2 version) was used to calculate the best cut-off value of serum MG53 level for predicting end-point events. Results Compared with the low-risk group,the serum MG53 level in the high-risk group was significantly lower [57.717 (28.548,139.965) pg/mL vs 33.553 (13.509,56.952) pg/mL, P<0.001]. Serum MG53 level was independently associated with the severity of CAC (OR=0.984, 95%CI:0.971-0.994, P<0.007). The risk of cardiovascular events was significantly increased in patients with low MG53 levels (OR=0.282, 95%CI:0.160-0.498, P<0.001). The cutoff value of MG53 was calculated as 18.36 pg/mL. Conclusions Serum MG53 level may be related to the degree of CAC and the prognosis of patients,suggesting that serum MG53 level may be a biomarker for predicting CAC and the prognosis of patients.

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    Ultrasound features and clinical manifestations of two cases of thyroid metastatic cancer: pay attention to abnormal thyroid ultrasound spectrum
    LI Yuanyuan, DING Wenbo, JIANG Ziyu, CHEN Xi, LIU Binbin, CHEN Guofang, LIU Chao
    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 254-258.   DOI: 10.16138/j.1673-6087.2024.04.07
    Abstract1236)   HTML18)    PDF(pc) (8859KB)(73)       Save

    Ultrasonography plays an important role in early screening of thyroid cancer. This article introduced two cases of thyroid metastatic carcinoma secondary to renal clear cell carcinoma and cervical squamous cell carcinoma respectively, analyzed their clinical diagnosis and treatment process, ultrasound characteristics, and prognosis, as well as reviewed the related literature. As atypical thyroid lesions were detected through the ultrasound spectrum in patients with a history of malignant tumors, it should be alert to the possibility of metastatic cancer. Ultrasound-guided core-needle biopsy combined with immunohistochemical testing can help early diagnosis and timely treatment.

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    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 248-248.  
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    Expert consensus on multidisciplinary diagnosis and treatment of primary Sjögren syndrome (2024 edition)
    CHENG Fang, ZHAO Futao, SHEN Xuemin, LI Jin, CHEN Xiangjun, WANG Guifang, LI Huilin, XUE Luan, QI Junyuan
    Journal of Internal Medicine Concepts & Practice    2024, 19 (06): 357-362.   DOI: 10.16138/j.1673-6087.2024.06.01
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    Primary Sjögren syndrome (PSS) is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands and other organs. PSS shows strong clinical heterogeneity, presents different degrees of topical and systemic damage, and multidisciplinary collaboration are required to develop PSS treatment strategies. However, our country currently has not unified diagnosis and treatment consensus for PSS. Based on domestic and foreign diagnosis and treatment experience, consensus and guideline, experts from multiple related disciplines achieved consensus using the nominal group technique, providing guidance and reference for standardized diagnosis and treatment of PSS.

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    Journal of Internal Medicine Concepts & Practice    2024, 19 (04): 277-277.  
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