Zhonghua nei ke za zhi最新文献

{"title":"[Acute kidney injury caused by chemotherapy and immune checkpoint inhibitors in non-small cell lung cancer: a case report].","authors":"X F Zheng, Y C Dong, Q Bian","doi":"10.3760/cma.j.cn112138-20220520-00392","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220520-00392","url":null,"abstract":"患者男性，67岁。因肺腺癌行卡铂-培美曲塞方案化疗，联合免疫检查点抑制剂（ICIs）治疗肿瘤2个疗程后血肌酐252 μmol/L，肾组织活检病理提示急性肾小管坏死合并局灶性急性间质性肾炎，肾间质和肾小管淋巴细胞CD4浸润强阳性，程序性死亡受体1（PD-1）阳性，考虑为化疗药联合ICIs相关肾损伤。停用化疗及免疫治疗，予患者口服甲泼尼龙20 mg/d治疗4周后，规律减量至第9周停药，复查血肌酐98 μmol/L。恢复卡铂-培美曲塞联合化疗，后续培美曲塞单药化疗维持。肾组织活检是明确诊断及指导后续治疗的重要手段。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"556-559"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Characteristics and management of mitochondrial stroke-like episodes].","authors":"Y Z Shi, Z Q Zhang","doi":"10.3760/cma.j.cn112138-20220509-00353","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220509-00353","url":null,"abstract":"卒中样发作见于多种类型的线粒体疾病，具有扩散、消退或复发的特点。严重的卒中样发作危及生命。本文就线粒体疾病患者卒中样发作事件的临床特点、致病基因、发病机制、治疗以及疾病管理等方面的研究证据和进展进行综述。为线粒体疾病患者卒中样发作的疾病管理提供依据。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"576-580"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical features of primary sclerosing cholangitis and inflammatory bowel disease].","authors":"X Y Cheng,&nbsp;R Jin,&nbsp;Y Y Yang,&nbsp;J Wang,&nbsp;J N Li","doi":"10.3760/cma.j.cn112138-20220425-00309","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220425-00309","url":null,"abstract":"<p><p><b>Objective:</b> To explore disease characteristics of primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) and compare the differences between PSC with and without IBD. <b>Methods:</b> Study design was cross sectional. Forty-two patients with PSC who were admitted from January 2000 to January 2021 were included. We analyzed their demographic characteristics, clinical manifestations, concomitant diseases, auxiliary examination, and treatment. <b>Results:</b> The 42 patients were 11-74(43±18) years of age at diagnosis. The concordance rate of PSC with IBD was 33.3%, and the age at PSC with IBD diagnosis was 12-63(42±17) years. PSC patients with IBD had higher incidences of diarrhea and lower incidences of jaundice and fatigue than in those without IBD (all <i>P</i><0.05). Alanine aminotransferase, total bilirubin, direct bilirubin, total bile acid and carbohydrate antigen 19-9 levels were higher in PSC patients without IBD than in those with IBD (all <i>P</i><0.05). The positive rates for antinuclear antibodies and fecal occult blood were higher in PSC patients with IBD than in those without IBD (all <i>P</i><0.05). Patients with PSC complicated with ulcerative colitis mainly experienced extensive colonic involvement. The proportion of 5-aminosalicylic acid and glucocorticoid application in PSC patients with IBD was significantly increased compared with that of PSC patients without IBD (<i>P</i>=0.025). <b>Conclusions:</b> The concordance rate of PSC with IBD is lower at Peking Union Medical College Hospital than in Western countries. Colonoscopy screening may benefit PSC patients with diarrhea or fecal occult blood-positive for early detection and diagnosis of IBD.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"532-538"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Treatment of immune thrombocytopenia in pregnancy].","authors":"Q Chen,&nbsp;X H Zhang","doi":"10.3760/cma.j.cn112138-20230206-00062","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20230206-00062","url":null,"abstract":"约5%~10%的女性在怀孕期间会出现血小板减少，妊娠期血小板减少的病因复杂，其中免疫性血小板减少症（ITP）是妊娠早期及中期最常见的引起血小板减少的原因。早期识别和合理诊治妊娠合并ITP对孕产妇及胎儿的安全至关重要。本文将对近年来妊娠合并ITP的诊治进展进行阐述。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"563-567"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A case of multiple endocrine neoplasia syndrome type 2A combined with autoimmune polyendocrine syndrome type Ⅲ].","authors":"K Y Wang,&nbsp;M Luo,&nbsp;M J Luo,&nbsp;Q Chen,&nbsp;X M Liu,&nbsp;X Y Zhu,&nbsp;L X Shi,&nbsp;Q Zhang","doi":"10.3760/cma.j.cn112138-20221020-00769","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20221020-00769","url":null,"abstract":"报道1例51岁女性患者，以阵发性头痛、心悸、大汗1年，腰背胀痛2周入院。检测血浆游离甲氧基肾上腺素、游离甲氧基去甲肾上腺素、降钙素明显升高；先后行双侧肾上腺占位及甲状腺结节手术，术后组织病理学诊断分别为嗜铬细胞瘤及甲状腺髓样癌，基因检测示RET基因11号外显子634密码子处基因点突变，考虑为多发性内分泌腺肿瘤综合征2A型。患者存在1型糖尿病及自身免疫性甲状腺炎，考虑为自身免疫性多内分泌腺病综合征Ⅲ型。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"550-553"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[CT perfusion combined with energy spectrum imaging to evaluate the short-term efficacy of bronchial arterial chemoembolization for lung cancer].","authors":"L Q Lai,&nbsp;G H Lin,&nbsp;W Y Chen,&nbsp;J F Tu,&nbsp;J S Ji","doi":"10.3760/cma.j.cn112138-20220513-00366","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220513-00366","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the clinical value of dynamic volumetric CT perfusion combined with energy spectrum imaging in bronchial arterial chemoembolization (BACE) in patients with lung cancer. <b>Methods:</b> The data of 31 patients with lung cancer confirmed by pathology and treated with BACE in Lishui Central Hospital from January 2018 to February 2022 were retrospectively collected, including 23 men and 8 women, aged 31-84 (67) years. All patients received perfusion scans of lesion sites within 1 week before surgery and 1 month after surgery. We collected and compared the changes in preoperative and postoperative perfusion parameters such as blood flow (BF), blood volume (BV), mean through time (MTT), permeability surface (PS) and energy spectrum parameters including arterial phase CT value (CTA), venous phase CT value (CTV), arterial phase iodine concentration (ICA), venous phase of iodine concentration (ICV), arterial standardization iodine concentration (NICA), and intravenous standardized iodine concentration (NICV) to confirm the significance of these parameters in evaluating the short-term efficacy of BACE in the treatment of advanced lung cancer. Data normality was tested using the Kolmogorov-Smirnov test and normally distributed measurement data are expressed here as mean ± standard deviation; the independent-samples <i>t</i>-test was used for comparisons between two groups. The measurement data that were not normally distributed are expressed as median (interquartile interval) [<i>M</i> (<i>Q</i>₁, <i>Q</i>₃)], and the comparison between the two groups used the Kruskal-Wallis test. Count data are expressed as cases (%), and comparisons between groups used the <i>χ</i>² test. <b>Results:</b> The objective response rate (ORR) and disease control rate (DCR) at 1 month after BACE were 54.8% (17/31) and 96.8% (30/31), respectively. CT perfusion parameters and energy spectrum parameters of patients before and after BACE treatment were compared. The results showed that BF, BV, MTT, ICA, ICV and NICV were significantly decreased after BACE treatment compared with before treatment, and the differences were statistically significant[58.06 (40.47,87.22) vs.23.57(10.92, 36.24) ml·min^-1·100g^-1,3.33(2.86,6.09) vs.2.12(1.96,3.61)ml/100g,2.70(2.19,3.88) vs.1.53 (1.12,2.25)s, 3.51 (3.11,4.14)vs.1.74 (1.26,2.50)mg/ml,2.00 (1.30,2.45) vs.1.32(0.92,1.76)mg/ml,0.51(0.42,0.57) vs.0.33(0.23,0.39)](all <i>P<</i>0.05). At the same time, compared with the non-remission group, the study results showed that the difference of parameters in remission group before and after BACE was more obvious, including ΔBF, ΔBV, ΔMTT, ΔPS, ΔCTA, ΔCTV, ΔICA, ΔICV, ΔNICA, ΔNICV were significantly increased, and the difference was statistically significant [36.82(32.38, 45.34) vs.9.50(-1.43, 12.34) ml·min^-1·100g^-1,4.46(2.52, 5.79) vs.0.22(-0.76, 4.09) ml/100g,4.22(2.25, 6.77) vs.0.43(-2.53, 1.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"539-544"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9759698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Expert consensus on the medical quality evaluation and improvement suggestions of in patients with chronic migraine].","authors":"","doi":"10.3760/cma.j.cn112138-20220922-00708","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220922-00708","url":null,"abstract":"<p><p>Migraine is a highly disabling primary headache disease, accompanied by nausea, emesis, photophobia and phonophobia. Chronic migraine is usually developed from episodic migraine, and usually comorbids with anxiety, depression, and sleep disorders, further aggravating the disease burden. At present, the clinical diagnosis and treatment of migraine in China are not standard, and the migraine medical quality control evaluation system is lacking. In order to achieve standardized diagnosis and treatment of migraine, headache collaborators of Chinese Society of Neurology, based on national and international clinical research on diagnosis and treatment of migraine and combined with the current situation of China's medical system, drafted the expert consensus on the medical quality evaluation of inpatients with chronic migraine.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"507-512"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9759704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Expert consensus on late stage of critical care management].","authors":"B Tang,&nbsp;W J Chen,&nbsp;L D Jiang,&nbsp;S H Zhu,&nbsp;B Song,&nbsp;Y G Chao,&nbsp;T J Song,&nbsp;W He,&nbsp;Y Liu,&nbsp;H M Zhang,&nbsp;W Z Chai,&nbsp;M G Yin,&nbsp;R Zhu,&nbsp;L X Liu,&nbsp;J Wu,&nbsp;X Ding,&nbsp;X L Shang,&nbsp;J Duan,&nbsp;Q H Xu,&nbsp;H Zhang,&nbsp;X M Wang,&nbsp;Q B Huang,&nbsp;R C Gong,&nbsp;Z Z Li,&nbsp;M S Lu,&nbsp;X T Wang","doi":"10.3760/cma.j.cn112138-20221005-00731","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20221005-00731","url":null,"abstract":"<p><p>We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical ","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"480-493"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Expert consensus on clinical trials of preventive treatment of adult migraine in China].","authors":"","doi":"10.3760/cma.j.cn112138-20221031-00805","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20221031-00805","url":null,"abstract":"<p><p>Migraine is the most common disabling primary headache with a significant socioeconomic burden. At present, some emerging drugs for migraine preventive treatment are under investigation internationally, which significantly promote the progress of migraine treatment. However, only few of this trial for migraine treatment are explored in China. In order to promote and standardize controlled clinical trials of migraine preventive therapy in China, and to provide methodological guidance for the design, implementation and evaluation of clinical trials, the Headache Collaborators of Chinese Society of Neurology formulated this consensus.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"494-506"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9759705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical features and prognosis of patients hospitalized with heart failure and low T₃ syndrome].","authors":"P Zhou,&nbsp;L Y Huang,&nbsp;M Zhai,&nbsp;Y Huang,&nbsp;X F Zhuang,&nbsp;H H Liu,&nbsp;Y H Zhang,&nbsp;J Zhang","doi":"10.3760/cma.j.cn112138-20230210-00078","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20230210-00078","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the association between triiodothyronine (T₃) and inflammatory factors, and its potential effect on long-term outcomes in hospitalized patients with heart failure (HF). <b>Methods:</b> A total of 2 475 patients with HF admitted in Heart Failure Care Unit were consecutively enrolled in this retrospective cohort study from December 2006 to June 2018. Patients were divided into low T₃ syndrome group (<i>n</i>=610, 24.6%) and normal thyroid function group (<i>n</i>=1 865, 75.4%). The median follow-up time was 2.9 (1.0, 5.0) years. A total of 1 048 all-cause deaths were recorded at the final follow-up. The effects of free T₃ (FT₃) and high-sensitivity C-reactive protein (hsCRP) on the risk of all-cause death were evaluated by Cox regression analysis and Kaplan-Meier analysis. <b>Results:</b> The age of the total population was 19-95 (57±16) years, 1 823 cases (73.7%) were male. Compared to those with normal thyroid function, albumin [(36.5±5.4) vs. (40.7±4.7) g/L], hemoglobin [(129.4±25.1) vs. (140.6±20.6) g/L], total cholesterol [3.6 (3.0, 4.4) vs. 4.2 (3.5, 4.9) mmol/L] (all <i>P</i><0.001) were lower, Whereas age [(60.5±16.0) vs. (55.2±15.4) years], creatinine [105.0 (83.6, 137.0) vs. 87.8 (75.6, 106.3) mmol/L], log N-terminal B-type natriuretic peptide [(8.2±1.3) vs. (7.2±1.4) ng/L] were higher in LT₃S patients (all <i>P</i><0.001). In Kaplan-Meier survival analysis, patients with lower FT₃ and higher hsCRP had significantly lower cumulative survival (<i>P</i><0.001), lower FT₃ combined with higher hsCRP subgroup had the highest risk of all-cause death (<i>P</i>_trend<0.001). In multivariate Cox regression analysis, LT₃S was an independent predictor of all-cause mortality (<i>HR</i>=1.40, 95%<i>CI</i> 1.16-1.69, <i>P</i><0.001). <b>Conclusion:</b> LT₃S is an independent predictor of poor prognosis in patients with heart failure. FT₃ combined with hsCRP improve the predictive value of all-cause death in hospitalized patients with heart failure.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 5","pages":"526-531"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9759706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}