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28 June 2025, Volume 20 Issue 03 Previous Issue   

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Treatment strategies for renal impairment in multiple myeloma: a review of new drugs and novel therapies SHI Hao, WANG Zhaohui 2025, 20 (03):  185-190.  DOI: 10.16138/j.1673-6087.2025.03.01 Abstract ( 13 )   HTML ( 7 )   PDF (892KB) ( 2 )   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. Figures and Tables | References | Related Articles | Metrics

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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 2025, 20 (03):  191-197.  DOI: 10.16138/j.1673-6087.2025.03.02 Abstract ( 12 )   HTML ( 3 )   PDF (3558KB) ( 1 )   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. Figures and Tables | References | Related Articles | Metrics

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Application of endoscopic retrograde cholangiopancreatography in treatment of adolescent patients with chronic pancreatitis and complications HUANG Yun, BIELIKE Kouken, HUANG Jia, YAO Weiyan, ZHU Yin 2025, 20 (03):  198-203.  DOI: 10.16138/j.1673-6087.2025.03.03 Abstract ( 6 )   HTML ( 2 )   PDF (2961KB) ( 1 )   Objective To explore the clinical application value of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of chronic pancreatitis and its complications in adolescents. Methods The clinical data of 104 adolescent patients with chronic pancreatitis and complications who were admitted to the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2023 to December 2024 were collected and a retrospective analysis was conducted. The patients were divided into the ERCP group (receiving ERCP treatment) and the control group (receiving conventional treatment) based on the treatment methods. The treatment effects, safety indicators, recurrence rates within six months, and scores of quality of life were compared between the two groups. Results There were 68 cases in the ERCP group and 36 cases in the control group. The two groups showed no significant differences in age, disease characteristics, and pre-treatment visual analogue scale (VAS) scores (P=0.080, 0.386, and 0.185, respectively), while the difference in 12-item short form health survey (SF-12) scores before treatment were significant (P=0.025). Before treatment, the VAS scores of the two groups were 6.63±1.74 and 6.26±1.08, respectively (P>0.05). After treatment, the VAS score in the ERCP group (2.57±0.64) was significantly lower than that in the control group (4.63±0.79) (P<0.001). Before treatment, the SF-12 scores of the two groups were 44.57±8.09 and 49.36±11.02, respectively (P>0.05); after treatment, the SF-12 score in the ERCP group (84.65±9.27) was significantly higher than that in the control group (69.16±7.75) (P<0.001). In addition, the recurrence rates within six months were 14.08% (ERCP group) and 36.11% (control group), and complication rates were 1.47% (ERCP group) and 8.33% (control group), which showed significant differences. Conclusions For adolescent patients with cholangiopancreatography and its complications, ERCP (especially pancreatic duct stone removal and stent placement) effectively alleviates clinical symptoms, improves quality of life, and shows high success rates with a low incidence of complications. Figures and Tables | References | Related Articles | Metrics

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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 2025, 20 (03):  204-209.  DOI: 10.16138/j.1673-6087.2025.03.04 Abstract ( 10 )   HTML ( 6 )   PDF (2933KB) ( 2 )   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. Figures and Tables | References | Related Articles | Metrics

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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 2025, 20 (03):  210-215.  DOI: 10.16138/j.1673-6087.2025.03.05 Abstract ( 10 )   HTML ( 2 )   PDF (1013KB) ( 1 )   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. Figures and Tables | References | Related Articles | Metrics

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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 2025, 20 (03):  216-223.  DOI: 10.16138/j.1673-6087.2025.03.06 Abstract ( 6 )   HTML ( 2 )   PDF (1058KB) ( 2 )   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. Figures and Tables | References | Related Articles | Metrics

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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 2025, 20 (03):  224-231.  DOI: 10.16138/j.1673-6087.2025.03.07 Abstract ( 9 )   HTML ( 2 )   PDF (5683KB) ( 2 )   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. Figures and Tables | References | Related Articles | Metrics

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Construction of necroptosis-related lncRNA risk model of pancreatic cancer based on bioinformatics YANG Ziyun, YAO Weiyan 2025, 20 (03):  232-241.  DOI: 10.16138/j.1673-6087.2025.03.08 Abstract ( 11 )   HTML ( 7 )   PDF (3972KB) ( 2 )   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. Figures and Tables | References | Related Articles | Metrics

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Age-period-cohort analysis and prediction of burden of asthma attributed to tobacco in China from 1990 to 2019 KANG Min, SHI Jing 2025, 20 (03):  242-247.  DOI: 10.16138/j.1673-6087.2023.03.09 Abstract ( 10 )   HTML ( 8 )   PDF (2266KB) ( 2 )   Objective To study the burden of asthma attributed to tobacco in China from 1990 to 2019, and to provide scientific basis for asthma prevention and control. Methods Using the Global Burden of Disease (GBD) 2019 database, we analyzed the trends of standardized mortality rates and standardized disability-adjusted life year(DALY) rates of asthma attributed to tobacco in China from 1990 to 2019. An age-period-cohort model was utilized to analyze the age, period, and birth cohort effects of the mortality rate of tobacco - related asthma, and an autoregressive integrated moving average model(ARIMA) was adopted to forecast the standardized mortality rates and standardized DALY rates of tobacco-related asthma for the next 5 years (2020-2024). Results Compared to 1990, the total number of deaths attributed to tobacco-related asthma in China was 5 037 in 2019, decreased 30.40% (7 237). The total DALY in 2019 were 200 700 person - years, decreased 13.54% compared to 231 000 person - years in 1990. From 1990 to 2019, the standardized mortality rate of the total population showed a decreasing trend, with an average annual decrease rate of 4.40% (95% CI: -4.63% - -4.16%), and the standardized DALY rate of the total population also showed a downward trend, with an average annual decrease of 3.43% (95% CI: -3.80% - -3.06%). The results of age effect indicated that the mortality rate of tobacco-related asthma increased with age (35-85 years) for males and the total population, reached peak in 85-89 age group, while female’s peak was in the 95 and over age group. From the perspective of period and cohort effects, the risk of death of tobacco-related asthma decreased over time in females, males, and the total population. The forecast results showed that the standardized mortality rate would decrease from 0.17/100 000 in 2020 to 0.05/100 000 in 2024, and the standardized DALY rate would decrease from 6.61/100 000 in 2020 to 3.65/100 000 in 2024. Conclusions The burden of asthma attributed to tobacco in China has shown a downward trend in the past few decades, which is closely related to health education, medical technology progress and the implementation of public health policies. In the future, it is necessary to adjust prevention and control strategies according to the actual situation to further reduce the disease burden of asthma. Figures and Tables | References | Related Articles | Metrics

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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 2025, 20 (03):  248-253.  DOI: 10.16138/j.1673-6087.2025.03.10 Abstract ( 9 )   HTML ( 1 )   PDF (930KB) ( 1 )   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. Figures and Tables | References | Related Articles | Metrics

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Application of cloud visitation in the transformation of emergency integrated nursing mode JU Wang, CHEN Yu, YU Jie 2025, 20 (03):  254-258.  DOI: 10.16138/j.1673-6087.2025.03.11 Abstract ( 9 )   HTML ( 1 )   PDF (954KB) ( 1 )   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. Figures and Tables | References | Related Articles | Metrics

Case report

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Secuchiumab in treatment of plaque psoriasis complicated with renal insufficiency: a case analysis ZHOU Ting, XIE Peitao, ZHANG Liang 2025, 20 (03):  259-261.  DOI: 10.16138/j.1673-6087.2025.03.12 Abstract ( 9 )   HTML ( 4 )   PDF (5900KB) ( 2 )   The 45-year-old male patient had uremia due to gout and hypertension in the past and underwent kidney transplantation, currently complicated with renal insufficiency. To prevent rejection, the patient administrated mycopherol sodium enteric-covered tablets 540 mg，twice a day, tacrolimus 1 mg in the morning and 2 mg in the evening and methylprednisolone 4 mg orally for long-term. Nifedipine controlled release tablets (30 mg, twice a day) were used for hypertension. Following a diagnosis of depression 3 years ago， medication was commenced with trazodone (50 mg, twice a day) and quetiapine fumarate (200 mg, twice a day) orally. The patient got novel coronavirus infection and was cured in December 2022. The plaque psoriasis was diagnosed in January 2023, and the treatment effect of oral anti-allergy drugs and topical hormone symptomatic treatment was not good for him. After being admitted to the hospital and receiving treatment of secukinumab 300 mg, psoriasis area and severity index (PASI) score and dermatology life quality index(DLQI) score of the patient were significantly improved, and he also showed well tolerated. The treatment of the case provides reference for the similar patients with psoriasis complicated with renal insufficiency. Figures and Tables | References | Related Articles | Metrics

Medical education

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Integration of modern technologies in cardiological education: applications and prospects JIANG Jie, CHEN Yanjia, SUN Zhuoyan, QIU Zeping, HUA Sha, JIN Wei 2025, 20 (03):  262-266.  DOI: 10.16138/j.1673-6087.2025.03.13 Abstract ( 19 )   HTML ( 10 )   PDF (893KB) ( 3 )   With the rapid progress of technology, cardiovascular education is undergoing unprecedented transformation. The introduction of augmented reality (AR), virtual reality (VR), artificial intelligence (AI), and medical simulation technologies offers new possibilities for innovation in teaching methods. These advanced technologies not only enhance the effectiveness of teaching and students’ learning experiences, but also effectively promote the development of clinical skills. However, despite the enormous potential for these technologies, various challenges persist in practical teaching applications, including technological costs, insufficient teacher training, and difficulties in integrating teaching content. This paper aims to review the integration of these technologies in cardiovascular education, analyze their respective advantages and limitations, and explore future development directions, thereby providing valuable insights for educators and researchers in the field of medical education. References | Related Articles | Metrics