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Clinical and CT features of non-small cell lung cancer SMARCA4 expression deficiency ZHANG Xuekun, CHEN Xiaoyan, XIA Xinyun, CHENG Zenghui Journal of Internal Medicine Concepts & Practice    2025, 20 (04): 282-288.   DOI: 10.16138/j.1673-6087.2025.04.04 Abstract （173）   HTML （12）    PDF（pc） （2743KB）（538）       Knowledge map    Save Objective To explore the clinical and CT features of SMARCA4-deficient non-small cell lung cancer (SMARCA4-dNSCLC ). Methods SMARCA4-dNSCLC cases confirmed histopathologically were enrolled and analyzed retrospectively in our hospital from January 2018 to January 2022. Using SMARCA4-intact NSCLC (SMARCA4-iNSCLC) cases admitted during the same period as control, the clinical characteristics and CT features of SMARCA4-dNSCLC cases were observed, recorded and compared. Results There were 42 cases in the SMARCA4-dNSCLC group and 43 cases in SMARCA4-iNSCLC control group, respectively. Compared with the control, the SMARCA4-dNSCLC group had a higher proportion of males, smokers, and chronic obstructive pulmonary disease (COPD). Clinically, the SMARCA4-dNSCLC group exhibited a higher incidence of superior vena cava syndrome, while the SMARCA4-iNSCLC group presented with hemoptysis more frequently. On CT imaging, tumors in the SMARCA4-dNSCLC group showed relatively homogeneous density, fewer cystic changes, necrosis, or calcification, more ill-defined borders, and a lower rate of associated obstructive pneumonia/atelectasis. Conclusions SMARCA4-dNSCLC was more frequently seen in elderly males and heavy smokers and was frequently accompanied by COPD. Occasionally, it could present with superior vena cava syndrome. The tumors were prone to locate in the upper lobes of both lungs. On CT imaging, it mostly presented as a soft tissue mass with relatively homogenous density, ill-defined boundaries, without cystic changes or cavities, and calcification was rare. The vast majority showed significant heterogenous enhancement after contrast. Mediastinal lymph node metastasis was common. This unique subtype of NSCLC should be considered in patients with the above clinical and CT features. 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 （334）   HTML （4）    PDF（pc） （936KB）（445）       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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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 （269）   HTML （3）    PDF（pc） （1489KB）（399）       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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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 （411）   HTML （11）    PDF（pc） （878KB）（368）       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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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 （280）   HTML （3）    PDF（pc） （941KB）（332）       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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Construction of competency index system for research nurses in lymphoma clinical study QIN Liyuan, ZHU Weiyi, HE Yang Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 167-172.   DOI: 10.16138/j.1673-6087.2025.02.12 Abstract （199）   HTML （0）    PDF（pc） （845KB）（321）       Knowledge map    Save Objective To construct the competency index system for research nurses in lymphoma clinical study and provide scientific basis for establishing the nurse training system for lymphoma clinical study.Methods Based on the iceberg theory, the first draft of the index system was constructed by literature analysis, and the final draft was constructed by Delphi method and analytic hierarchy process.Results The expert authority coefficients were 0.934 and 0.948 respectively; The competency index system for research nurse in lymphoma clinical study determined after two rounds of consultation included 5 primary indexes, 14 secondary indexes and 51 tertiary indexes. The coefficient of variation of all levels of indicators was 0.00-0.16, and the coordination coefficient was 0.206-0.331.Conclusions The competency index for research nurses in lymphoma clinical study established in this study is scientific and practical and can provide a reference for the construction of the nurse training system for lymphoma clinical research. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Treatment strategies for renal impairment in multiple myeloma: a review of new drugs and novel therapies SHI Hao, WANG Zhaohui Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 185-190.   DOI: 10.16138/j.1673-6087.2025.03.01 Abstract （276）   HTML （17）    PDF（pc） （892KB）（299）       Knowledge map    Save Multiple myeloma (MM) is associated with a high incidence of renal impairment, which correlates with decreased overall survival and increased risk of early mortality in these patients. In recent years, there has been great progress in the treatment of MM, and new drugs and therapies have improved prognosis of the patients. However, the prognosis of MM patients with concurrent renal impairment remains poorer compared with those with normal renal function. This article reviews the advancements in treatment and relevant strategies for MM patients with renal impairment. Current research supports the regime of combining monoclonal antibodies with proteasome inhibitors or immunomodulatory drugs in MM treatment. Chimeric antigen receptor T cells therapy, T-cell directing bispecific antibodies and antibody-drug conjugates have only been evaluated in small-scale retrospective studies for patients with renal impairment. Although the benefits of mechanical approaches aiming at rapid clearance of free light chains, such as plasmapheresis and high-cutoff hemodialysis, have not been confirmed, they may provide opportunities for renal recovery as combing with chemotherapy. The efficacy and safety of treatment in MM patients with renal impairment should be proactively assessed in prospective randomized controlled trials. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Advances in age-associated B cell in systemic lupus erythematosus FAN Yuxin, BIN Zexuan, ZHANG Xin, LUO Jing, WANG Caihong Journal of Internal Medicine Concepts & Practice    2025, 20 (04): 328-333.   DOI: 10.16138/j.1673-6087.2025.04.13 Abstract （191）   HTML （3）    PDF（pc） （969KB）（282）       Knowledge map    Save Age associated B cell (ABC) is a new type of effector B cell subset, which is characterized by continuous expansion with age. However, it is abnormally expressed prematurely in patients with certain autoimmune diseases and/or infectious diseases. ABC highly expresses CD11c and transcription factor T-bet in mice and human, and lowly expresses CD21. ABC is considered a memory B cell subtype driven by autoantigen and has the potential to differentiate into plasmablasts and produce autoantibodies. In systemic lupus erythematosus (SLE), ABC is abnormally amplified and correlated with disease activity and organ involvement. An important mechanism to promote the production of autoantibodies and accelerate disease progression is the single gene mutation inducing the proliferation and differentiation of ABC into extrafollicular effector B cell. Recent studies have revealed that zinc finger E-box binding homeobox 2 (ZEB2) is a key transcription factor for the specialization of the ABC cell lineage, and the ZEB2-Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway play a core role in their differentiation. Further study on the role of ABC in the pathogenesis of SLE will help to provide new targets for clinical treatment. 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 （388）   HTML （17）    PDF（pc） （968KB）（273）       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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Clinical features, diagnosis and phenotype and genotype analysis of a family with a mitochondrial DNA A3243G gene mutation CHEN Ruihua, DING Xiaoying, LIU Fang, WANG Qingguo, WANG Yufan Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 204-209.   DOI: 10.16138/j.1673-6087.2025.03.04 Abstract （332）   HTML （11）    PDF（pc） （2933KB）（247）       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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Construction of necroptosis-related lncRNA risk model of pancreatic cancer based on bioinformatics YANG Ziyun, YAO Weiyan Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 232-241.   DOI: 10.16138/j.1673-6087.2025.03.08 Abstract （156）   HTML （8）    PDF（pc） （3972KB）（246）       Knowledge map    Save Objective To construct a prognostic risk model for pancreatic cancer based on necroptosis-related long non-coding RNA (NRL). Methods The gene expression data and clinical data were from the Cancer Genome Atlas (TCGA) and GTEx databases, including 171 normal pancreas and 178 pancreatic cancer samples. LASSO regression and Cox regression analysis were used to identify NRL associated with pancreatic cancer prognosis to construct the risk model. The predictive value of the model was evaluated using receiver operating characteristic (ROC) curves and validated in the Clinical Proteomic Tumor Analysis Consortium (CPTAC) database. Gene enrichment analysis, immune infiltration analysis, and chemotherapy drug sensitivity analysis were also conducted. Results The eight NRL (LINC01559, TMEM161B-AS1, AL157392.3, AC099850.3, AC136475.3, AL162274.2, MIR217HG, UNC5B-AS) were screened for constructing the NRL risk model. Survival analysis indicated that patients in the high-risk group had poorer prognosis (P<0.001). ROC curves were both >0.6, confirming the accuracy of the model. Regression analysis confirmed that the model was an independent prognostic factor for pancreatic cancer patients (P<0.05), and CPTAC data showed that the effectiveness of this model was good. Additionally, there were significant differences (P<0.05) in pathway enrichment, immune cell infiltration, tumor mutation burden, expression of immune checkpoints, and chemotherapy drug sensitivity between the high risk and low risk groups. Conclusions The risk model constructed based on 8 NRL can effectively predicts the prognosis of pancreatic cancer, and strongly correlated with the level of immune infiltration in pancreatic cancer which may provide new reference for immunotherapy and chemotherapy drug selection. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Heavy and light chain renal amyloidosis with biclonal paraproteinemia: a case study and literature review TIAN Xiaofang, LIU Liping, YUAN Liying, REN Hong, WANG Zhaohui, SHI Hao Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 191-197.   DOI: 10.16138/j.1673-6087.2025.03.02 Abstract （168）   HTML （10）    PDF（pc） （3558KB）（221）       Knowledge map    Save Objective To explore the diagnostic and therapeutic strategies for non-traditional immunoglobulin-related renal amyloidosis by analyzing the clinical management of a patient with heavy and light chain renal amyloidosis and biclonal paraproteinemia. Methods The clinical data of a patient diagnosed with biclonal paraproteinemia and renal amyloidosis at the Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine and long-term follow-up from 2021 to 2024 were collected and analyzed, and relevant domestic and foreign literature was reviewed. Results The main symptoms in a 72-year-old male presented with foamy urine, facial and bilateral lower limb edema. Biclonal (IgM κ and IgA, λ) gammopathy were detected, heavy and light-chain renal amyloidosis (IgA-λ) was diagnosed by renal biopsy. There was no obvious involvement in the heart. A small number of monoclonal CD38+ B cells were detected through immunophenotyping in bone marrow, while the L265P mutation of the MYD88 gene was negative in it. There was no lymph node enlargement or extranodal lesions, the underlying hematological disease was a B-lymphocyte proliferative disorder. After initial treatment with a rituximab-based regimen, the treatment was adjusted to daratumumab combined with lenalidomide which was targeting CD38. The patient quickly achieved complete hematological remission and a renal response, and complete renal remission was achieved during subsequent treatment. Literature review showed that there are only a few case reports on biclonal paraprotein associated with renal amyloidosis, and only one case of renal amyloidosis associated with heavy and light-chain. In amyloidosis caused by B cell or lymphoplasmacytic clones, rituximab-based regimens are the main treatment, but hematological and organ responses are not ideal. The daratumumab combination regimen may be effective for patients with pathogenic clones of CD38+ B cells. Conclusions There is no consensus or guideline for the diagnosis and treatment of light-chain amyloidosis with biclonal paraprotein. Accurately identifying the pathogenic clone, determining the treatment target, and formulating individualized combination drug regimens are helpful for patients to achieve more profound remission of hematology and organs. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Correlation study on circadian rhythm disturbance and pathological characteristics of non-alcoholic fatty liver disease HUANG Lei, ZHANG Chenli, YAN Hua, SHI Dongmei Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 224-231.   DOI: 10.16138/j.1673-6087.2025.03.07 Abstract （283）   HTML （6）    PDF（pc） （5683KB）（218）       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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Intervention effect of five senses awakening nursing mode based on the circadian rhythm on the conscious state of hospitalized patients with cerebral coma LYU Zhuobei, ZHU Lin, RONG Lan, LYU Xiaoqiong, CHU Jiani, CHENG Zhiying Journal of Internal Medicine Concepts & Practice    2025, 20 (04): 306-311.   DOI: 10.16138/j.1673-6087.2025.04.08 Abstract （570）   HTML （2）    PDF（pc） （883KB）（211）       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 （544）   HTML （5）    PDF（pc） （915KB）（210）       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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Prognostic factor analysis of sarcopenia in elderly patients with heart failure and preserved ejection fraction YANG Qirui, BAI Tingting, JIANG Qianwen, ZHANG Weiqi, LU Yiyin, ZHAO Wei, WU Fang, LI Feika Journal of Internal Medicine Concepts & Practice    2025, 20 (03): 210-215.   DOI: 10.16138/j.1673-6087.2025.03.05 Abstract （332）   HTML （9）    PDF（pc） （1013KB）（206）       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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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 （395）   HTML （0）    PDF（pc） （2143KB）（204）       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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Interaction between bile acids and gut microbiota and their role in Parkinson disease LIU Shumeng, AI Penghui, XIAO Qin, YANG Xiaodong Journal of Internal Medicine Concepts & Practice    2025, 20 (04): 345-350.   DOI: 10.16138/j.1673-6087.2025.04.16 Abstract （118）   HTML （5）    PDF（pc） （1002KB）（203）       Knowledge map    Save Bile acids are amphipathic molecules derived from cholesterol, which facilitate the absorption of lipids, and also serve as signaling molecules in regulating metabolic homeostasis and immune response. Bile acid is modified by intestinal flora, and on the other hand, it alters the composition of gut microbiota and exerts potential effects on the microbiota-gut-brain axis(MGBA). Through this bidirectional communication system, bile acid signaling homeostasis plays a modulatory role for maintaining the physiological function of nervous system. In recent years, increasing evidence indicates that the bile acid associated with dysbiosis in gut microbiota may be an early sign of Parkinson disease (PD), which triggered the exploration of new pathological mechanisms and diagnostic biomarkers for PD. This article reviews the relationship between abnormal bile acid metabolism and PD as well as its potential role in PD treatment from the perspective of interaction between bile acids and intestinal microorganism. Reference | Related Articles | Metrics | Comments（0）

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Effect of optimizing insulin dosage in insulin-induced hypoglycemia-growth hormone stimulation test in patients with hypopituitarism JIANG Chunhong, SHI Jia Journal of Internal Medicine Concepts & Practice    2025, 20 (02): 157-161.   DOI: 10.16138/j.1673-6087.2025.02.10 Abstract （235）   HTML （1）    PDF（pc） （992KB）（191）       Knowledge map    Save Objective To investigate the effect of optimizing calculation method of insulin dosage in hypoglycemia growth hormone stimulation test [insulin tolerance test (ITT)] in patients with hypopituitarism.Methods Totally 106 patients with hypopituitarism admitted from February 2021 to March 2023 were selected for ITT, including 79 males and 27 females aged 14 to 61 years. Insulin dosage obtained by insulin optimization formula was used in the test, which is, insulin dosage (U) = body weight ×{-0.034+0.000 176×[0.5×(fasting insulin +180 min insulin)+60 min insulin +120 min insulin]+0.009 846×body mass index (BMI)}. The blood glucose changes of patients were monitored 30 min before the test, immediately after intravenous infusion and 30, 45, 60, 90 and 120 min after intravenous infusion, respectively, and the main complaints of patients were recorded.Results All 106 patients completed the test without any severe clinical reactions such as hypoglycemic coma or pituitary crisis. Among them, 76 patients (71.70%) experienced hypoglycemia within 30 min after the start of the test, 22 patients (20.75%) experienced hypoglycemia at 45 min, and the remaining 8 patients (7.55%) did not achieve a successful stimulation response. Comparison of the area under the glucose curve (AUCGlu) among the 106 patients revealed that patients with simultaneous deficiencies in two hormones (growth hormone and cortisol) had lower overall blood glucose levels than those with a single hormone (growth hormone) deficiency. All patients’ blood glucose levels returned to normal by the end of the test.Conclusions The use of an optimized insulin dosage calculation method in ITT results in an earlier onset of hypoglycemia. This underscores the importance of thorough pre-test assessment by nurses, close monitoring of patients’ subjective complaints and blood glucose levels during the test, and proper nursing care to ensure the safety and success of the procedure. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical evaluation of the modified open wound sutureless labial gland biopsy technique for patient with Sjögren syndrome CHEN Yabing, GAO Jie, XU Xia, ZHAO Dongbao Journal of Internal Medicine Concepts & Practice    2025, 20 (04): 312-315.   DOI: 10.16138/j.1673-6087.2025.04.09 Abstract （261）   HTML （5）    PDF（pc） （855KB）（189）       Knowledge map    Save Objective To explore the clinical value of modified open-wound sutureless labial gland biopsy for patients with Sjögren syndrome. Methods A total of 24 patients who underwent labial gland biopsy in our department from March 2023 to April 2025 were divided into the sutureless labial gland biopsy (SLSGB) group and the traditional labial salivary gland biopsy (TLSGB) group. The numerical rating scale (NRS) 0-10 was used to evaluate the postoperative recovery time and incision pain at 2 h, 1 d, and 7 d after surgery in both groups. Results The postoperative recovery time score was (6.67±0.82) points in the TLSGB group and (2.00±0.00) points in the SLSGB group (P< 0.001). The NRS scores at 2 h, 1 d, and 7 d after surgery were (5.83±0.98), (2.67±0.52), and (2.00±0.63) points in the TLSGB group, and (1.72±0.46), 0, and 0 points in the SLSGB group, respectively. There were significant differences between the two groups at 2 h and 1 d after surgery (both P<0.05), but there was no statistical difference at 7 d after surgery (P>0.05). Conclusions Open incision labial gland biopsy is less invasive, less prone to secondary injury, does not require suture removal, is easy to operate, and rarely causes complications. It can reduce significantly the economic and time costs and it’s more easily accepted by patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）