中华内科杂志最新文献

{"title":"[Clinical, imaging, and pathological characteristics of 35 cases of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome].","authors":"S Xu, L J Qu, X Chen, X L Zhu, F N Niu","doi":"10.3760/cma.j.cn112138-20231227-00411","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20231227-00411","url":null,"abstract":"<p><p><b>Objective:</b> To summarize the clinical, imaging, and pathological characteristics of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS) to improve the diagnosis of this rare disease. <b>Methods:</b> A retrospective case series was conducted to collect the clinical data and results of genetic testing, muscle biopsy, and imaging studies including computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS) of 35 patients with MELAS admitted to the Nanjing Drum Tower Hospital from 2012 to 2021. Descriptive statistical analysis including mean, standard deviation, and frequency percentage were carried out. <b>Results:</b> The average age of onset of the patients was 30.2±2.3 years; the prevalence of family history was 20%. The two main initial symptoms were limb weakness and convulsions. The clinical manifestations of the neuromuscular system were proximal muscle weakness and exercise intolerance. The endocrine system is the most affected outside the neuromuscular system, with diabetes being the most common condition. Among the five patients who underwent brain CT, four showed hypodense lesions and two had calcified lesions. Brain MRI in 26 patients showed that the lesions more often affected the parietal lobe, basal ganglia, temporal lobe, occipital lobe, and frontal lobe than the infratentorial areas. Twelve of these individuals exhibited different levels of brain atrophy. Among the 10 patients who underwent ¹H-MRS, nine showed a decrease in N-acetylaspartate (NAA) levels, eight exhibited abnormal lactate elevation (Lac peaks), whereas six had both reduced NAA levels and the presence of Lac peaks. Thirty-one patients underwent genetic testing; among them, 25 were found to have the mt.3243A>G mutation, while the remaining six exhibited rare gene alterations. Muscle biopsies were performed in 21 patients, and 15 showed abnormal mitochondrial proliferation manifested by ragged red fibers and defective oxidative phosphorylation manifested by cytochrome C oxidase (COX) enzyme-deficient muscle fibers. <b>Conclusion:</b> The clinical manifestations of MELAS syndrome are variable and complex, and early atypical symptoms could be missed or misdiagnosed. A detailed clinical history, imaging MRS analysis, muscle biopsy, and genetic testing are necessary to confirm the accurate diagnosis of MELAS.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478078","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":"[Research progresses on the regulation of apoptosis in fibrotic diseases].","authors":"S C Zhang, R H Guo, T T Zhang, H Y Wen","doi":"10.3760/cma.j.cn112138-20230929-00173","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20230929-00173","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478084","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":"[Progresses and hot spots of gastroenteropancreatic neuroendocrine neoplasms].","authors":"T M Xu, J N Li","doi":"10.3760/cma.j.cn112138-20231229-00415","DOIUrl":"10.3760/cma.j.cn112138-20231229-00415","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478081","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":"[Consensus on clinical drug therapy for knee osteoarthritis in China (2023)].","authors":"","doi":"10.3760/cma.j.cn112138-20240402-00215","DOIUrl":"10.3760/cma.j.cn112138-20240402-00215","url":null,"abstract":"<p><p>Osteoarthritis (OA) is a heterogeneous disease that involves structural alterations in the articular cartilage, synovium, ligaments, subchondral bone, and the surrounding bone tissue. Among the various types of OA, knee osteoarthritis (KOA) is the most prevalent, presenting with symptoms such as joint pain, swelling, stiffness, and functional limitations. And its high disability rate places a significant burden on both individuals and society. Pharmacological intervention plays a crucial role in the comprehensive management of KOA. However, the establishment of standardized treatment protocols for the accurate and appropriate selection of medications for patients remain pressing clinical challenges. The Osteoarthritis Group of the Rheumatology and Immunology Physicians Branch of the Chinese Medical Doctor Association has developed this expert consensus by drawing upon current research findings, relevant guidelines, and consensus statements from both domestic and international sources. This consensus adheres to international standards for consensus development and incorporates input from a diverse panel of experts.The consensus encompasses six aspects: disease prevention, treatment goals, clinical typing, therapeutic drugs, follow-up and evaluation, and medication for comorbid populations. A total of 27 recommendations are put forward, aiming to provide clinicians with guidance for the safe and standardized use of drugs, thereby improving the diagnosis and treatment level of KOA and benefiting patients.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201370","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":"[Experimental study on evaluating renal redox metabolism in renal ischemia-reperfusion injury using GluCEST imaging with 3.0 T MRI].","authors":"W W Mi, Z Y Xing, L Pan, X T Yu, J Chen, W Xing","doi":"10.3760/cma.j.cn112138-20240123-00064","DOIUrl":"10.3760/cma.j.cn112138-20240123-00064","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the feasibility of 3.0 T glutamate chemical exchange saturation transfer (GluCEST) imaging in evaluating renal redox metabolism in renal ischemia-reperfusion injury (IRI). <b>Methods:</b> Rabbits in the IRI group (<i>n</i>=56) underwent surgery by clamping the left renal artery for 45 min and then releasing to establish IRI. Rabbits in the sham group (<i>n</i>=8) underwent the same operation without clamping the left renal artery. GluCEST MRI was performed before and at 1 h, 12 h, 1 day, 3 days, 7 days, and 14 days after the operations, with eight rabbits in the IRI group sacrificed immediately after each scanning and eight in the sham group sacrificed at 14 days after scanning. The left kidneys were removed for histopathological examination and reactive oxygen species (ROS) fluorescence staining. Differences in the magnetic resonance ratio asymmetry (MTR_asym) of the renal cortex and outer medulla among different groups were compared. Correlations between the MTR_asym and ROS were analyzed. <b>Results:</b> The MTR_asym of the renal cortex in the sham and IRI subgroups were higher than that of the outer medulla (<i>t</i>=8.16, <i>P</i><0.001; <i>t</i>=4.78, <i>P</i>=0.002; <i>t</i>=4.94, <i>P</i>=0.002; <i>t</i>=5.76, <i>P</i>=0.001, <i>t</i>=6.68, <i>P</i><0.001; <i>t</i>=6.40, <i>P</i><0.001; <i>t</i>=5.16, <i>P</i>=0.001; <i>t</i>=3.30, <i>P</i>=0.013). The MTR_asym of the renal cortex and outer medulla in the IRI-1h, IRI-12h, IRI-1d, IRI-3d, IRI-7d, and IRI-14d groups were lower than in the sham and IRI-pre groups (all <i>P</i><0.05). The MTR_asym of the renal cortex and outer medulla in the IRI-1h group were lower than in the IRI-12h, IRI-1d, IRI-3d, IRI-7d, and IRI-14d groups (all <i>P</i><0.05). The MTR_asym of the renal cortex in the IRI-12h group was lower than in the IRI-7d and IRI-14d groups (1.84%±0.09% vs.2.42%±0.19%, 2.41%±0.31%, all <i>P</i><0.05). The MTR_asym of the renal cortex in the IRI-1d group was lower than in the IRI-7d group (1.99%±0.17% vs. 2.42%±0.19%, <i>P</i>=0.008). The MTR_asym of the outer medulla in the IRI-12h group was lower than in the IRI-3d, IRI-7d, and IRI-14d groups (1.32%±0.27% vs. 1.79%±0.31%, 1.98%±0.18%, 1.66%±0.40%, respectively, all <i>P</i><0.05]. The MTR_asym of the outer medulla in the IRI-7d group was higher than in the IRI-1d and IRI-14d groups (1.98%±0.18% vs. 1.52%±0.31%, 1.66%±0.40%, all <i>P</i><0.05). The MTR_asym of the renal cortex and outer medulla had a strong negative correlation with the mean fluorescence intensity of ROS (<i>ρ</i>=-0.889, <i>P</i><0.001; <i>ρ</i>=-0.784, <i>P</i><0.001). <b>Conclusion:</b> 3.0 T GluCEST imaging can indirectly reflect the changes of renal redox metabolism in renal IRI.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201373","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":"[The effect of hypoglycemic drugs on bone metabolism in type 2 diabetes mellitus].","authors":"Y Q Chen, X Z Zhang","doi":"10.3760/cma.j.cn112138-20231110-00312","DOIUrl":"10.3760/cma.j.cn112138-20231110-00312","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201391","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":"[Impact of autologous hematopoietic stem cell transplantation on the efficacy of CAR-T treatment of relapsed/refractory multiple myeloma].","authors":"M J Ding, X X Jie, H J Li, Z Y Xu, L Nian, K M Qi, Z L Yan, F Zhu, J Cao, H X Zhang, K L Xu, H Cheng, Z Y Li","doi":"10.3760/cma.j.cn112138-20231207-00368","DOIUrl":"10.3760/cma.j.cn112138-20231207-00368","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the effect of autologous hematopoietic stem cell transplantation (ASCT) on the treatment of relapsed/refractory multiple myeloma (RRMM) with chimeric antigen receptor T cell (CAR-T) therapy. <b>Methods:</b> A retrospective cohort study. The clinical data of 168 patients with RRMM who underwent CAR-T therapy at the Department of Hematology, Xuzhou Medical University Hospital from 3 January 2020 to 13 September 2022 were analyzed. Patients were classified into a transplantation group (TG; <i>n</i>=47) and non-transplantation group (NTG; <i>n</i>=121) based on whether or not they had undergone ASCT previously. The objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and the levels of CD3, CD4, CD8, CD19, CD56 and natural killer (NK) cells before CAR-T infusion were analyzed by <i>χ</i>² test, Kaplan-Meier method and independent sample <i>t</i>-test. <b>Results:</b> Among 168 patients with RRMM, 98 (58.3%) were male. The median age of onset was 57 (range 30-70) years. After CAR-T therapy, the ORR of patients was 89.3% (92/103) in the NTG and 72.9% (27/73) in the TG. The ORR of the NTG was better than that of the TG (<i>χ</i>²=5.71, <i>P</i>=0.017). After 1 year of CAR-T therapy, the ORR of the NTG was 78.1% (75/96), and that of the TG was 59.4% (19/32). The ORR of the NTG was better than that of the TG (<i>χ</i>²=4.32, <i>P</i>=0.038). The median OS and PFS in the NTG were significantly longer than those in the TG (OS, 30 vs. 20 months; PFS, 26 vs. 12 months; both <i>P</i><0.05). The CD4 level before CAR-T infusion in the TG was significantly lower than that in the NTG (25.65±13.56 vs. 32.64±17.21; <i>t</i>=-2.15, <i>P</i>=0.034), and there were no significant differences in the counts of CD3, CD8, CD19, CD56, and NK cells between the TG and NTG (all <i>P</i>>0.05). <b>Conclusion:</b> Among patients suffering from RRMM who received CAR-T therapy, patients who did not receive ASCT had significantly better outcomes than those who had received ASCT previously, which may have been related to the CD4 level before receiving CAR-T therapy.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201378","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":"[The effect of glycopyrrolate on intestinal spasm and hemodynamics in painless colonoscopy].","authors":"Y Zhang, M Y Yi, C F Fang, L Zhang, J Zheng, Y X Lu, Q Ye, Z J Ye, T Fang","doi":"10.3760/cma.j.cn112138-20240314-00164","DOIUrl":"10.3760/cma.j.cn112138-20240314-00164","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the effects of glycopyrrolate on intestinal spasm and hemodynamics in painless colonoscopy. <b>Methods:</b> A total of 100 patients who were scheduled to undergo painless colonoscopy were selected as the study subjects and randomly divided into two groups by a computerized number method. Ten patients in both groups dropped out because of disruption of the study protocol, and 45 patients from each group were included in the final analysis. Before anesthesia induction, patients in group glycopyrrolate (group G) were injected with 0.2 mg glycopyrrolate, while those in congtrol group (group C) were injected with an equal amount of saline. The heart rate, systolic blood pressure, and diastolic blood pressure were recorded at T₀ (baseline period), T₁ (after anesthesia induction), T₂ (colonoscopy over sigmoid colon), T₃ (colonoscopy over the liver region), T₄ (after the end of examination), and T₅ (at the awakening phase), and the degree of intestinal spasm was assessed intraoperatively using the Likert's four-point scale. The numerical rating scale (NRS) was used to assess preoperative and postoperative pain. The incidence of adverse events was recorded. <b>Results:</b> The general data at baseline were not statistically different between the two groups (<i>P</i>>0.05). During the procedure, patients in group G had lower intraoperative intestinal spasm scores than those in group C (<i>P</i>=0.028). Intraoperative hypotension and bradycardia occurrence were lower in group G than in group C (<i>P</i><0.05), and intraoperative norepinephrine use was also lower than in the group C (<i>P</i>=0.034). Postoperative visual analog scale pain scores were lower in group G (<i>P</i>=0.047), but patients who used glycopyrrolate had a higher proportion of dry mouth (<i>P</i>=0.035). <b>Conclusion:</b> During painless colonoscopy, preoperative administration of glycopyrrolate significantly improved intraoperative hemodynamic fluctuations, reduced the incidence of hypotension and bradycardia, and relieved postoperative pain. However, glycopyrrolate use resulted in the risk of dry mouth.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201389","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":"[Non-surgical management of thyroid nodules].","authors":"X D Hu, Z H Lyu","doi":"10.3760/cma.j.cn112138-20240311-00157","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240311-00157","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201379","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 ultrasound guided thyroid and neck lymph node puncture (2023 edition)].","authors":"","doi":"10.3760/cma.j.cn112138-20240426-00122","DOIUrl":"10.3760/cma.j.cn112138-20240426-00122","url":null,"abstract":"<p><p>Thyroid nodule and cervical lymph node biopsy is the main clinical method for evaluating the condition and determining the follow-up treatment plan. The literature on thyroid nodule puncture predominantly focuses on thyroid fine needle puncture, and there are limited systematic articles on coarse needle aspiration for thyroid-related diseases and needle biopsy of thyroid-related cervical lymph node diseases. However, this shortage of articles does not reflect the diagnostic value of coarse needle aspiration in thyroid biopsy and cervical lymph node-related diseases. Currently, different departments of many hospitals in China are conducting or planning to perform needle biopsy of thyroid and cervical lymph node-related diseases to improve the standardization and safety of related operations. Standardization is needed for the indications, contraindications, perioperative period, postoperative complications management, puncture specimen processing, and related genetic analysis of thyroid and cervical lymph node puncture. For this purpose, Interventional Ultrasound Committee of Chinese College of Interventionalists organized a panel of domestic experts in the field of thyroid diseases to discuss and formulate a consensus. Based on the latest research progress, combined with the clinical realities in China, this Expert Consensus on Ultrasound Guided Thyroid and Neck Lymph Node Puncture (2023 edition) is released.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201374","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}