中华内科杂志最新文献

{"title":"[Analyses of the risk factors of delayed extubation after extended thymectomy in patients with myasthenia gravis].","authors":"M P Wang, X Q Sun, L Jiang, R Lou, Q Si, T T Wang, G J Lu","doi":"10.3760/cma.j.cn112138-20240905-00555","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240905-00555","url":null,"abstract":"<p><p><b>Objective:</b> To explore the risk factors of delayed extubation after expanded thymectomy in patients with myasthenia gravis. <b>Methods:</b> Patients with myasthenia gravis who underwent expanded thymectomy from May 2021 to January 2024 and were admitted to Intensive Care Unit (ICU) after surgery were retrospectively analyzed. Patients were divided in to the delayed extubation and successful extubation according to the length of mechanical ventilation whether exceeding than 48 hours. Multivariable logistics regression was used to explore the risk factors for delayed extubation after expanded thymectomy in patients with myasthenia gravis. <b>Results:</b> A total of 95 patients were included.15 (15.8%) of whom were delayed extubation. Compared with the successful extubation patients, the length of mechanical ventilation (94.0 h vs. 15.5 h, <i>P</i><0.001), ICU station (7.1 days vs. 1.7 days, <i>P</i><0.001), and hospitalization station (16.0 days vs. 9.1 days, <i>P</i><0.001) were significantly prolonged in the delayed extubation patients. Adjusted for age,gender, BMI, clinical classification, pathological classification of thymoma, dose of pyridostigmine preoperative, perioperative pneumonia, preoperative pulmonary dysfunction, SBT passing for the first time, neck lift time greater than 20 seconds, the multivariable logistic regression shown, the risk of delayed extubation increased by 29% (<i>OR</i>=1.290, 95%<i>CI</i> 1.090-1.714), 1% (<i>OR</i>=1.009, 95%<i>CI</i> 1.002-1.034), 3.9-fold (<i>OR</i>=4.977, 95%<i>CI</i> 1.486-10.939), and 64% (<i>OR</i>=1.635, 95%<i>CI</i> 1.396-2.682) for every 60 mg/day increase in preoperative dose of pyridostigmine, pathological classification of thymoma, perioperative pneumonia, and preoperative pulmonary dysfunction, respectively. Neck lift time greater than 20 seconds can reduce the risk of delayed extubation 48% (<i>OR</i>=0.524, 95%<i>CI</i> 0.322-0.794). <b>Conclusion:</b> Preoperative administration of a large dose of pyridostigmine, pulmonary dysfunction, pathological classification of thymoma, and perioperative pneumonia were risk factors for delayed extubation after thymectomy in these patients. And neck lift time greater than 20 seconds decreased the risk of delayed extubation. In the clinical practice,for high risk of MG patients with delayed extubation, the neck lifting test may be used to assess muscle strength and reduce the occurance of tracheal reintubation and its advise effects.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 1","pages":"52-59"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959661","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":"[Technical standards for performing radiofrequency catheter ablation for atrial fibrillation: a series of consortium standards].","authors":"","doi":"10.3760/cma.j.cn112138-20240907-00559","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240907-00559","url":null,"abstract":"<p><p>Atrial fibrillation (AF) has emerged as a major global cardiovascular disease in the 21st century. In China, there are greater than 12 million patients with AF, and its incidence continues to rise. AF affects patients' quality of life and significantly increases the risks of mortality, stroke, heart failure, cognitive impairment, and dementia. In recent years, multiple clinical guidelines have expanded the indications for catheter ablation and raised its level of recommendation. Concurrently, there has been a rapid and sustained increase in the number of AF ablation procedures performed across China. Among these, radiofrequency catheter ablation remains the most used method. Consequently, the Chinese Heart Rhythm Society of the Chinese Society of Biomedical Engineering, in collaboration with 40 arrhythmia centers and 60 leading clinical experts specializing in AF catheter ablation, developed a comprehensive set of standards. These standards were developed based on extensive clinical experience accumulated in recent years and the latest national and international AF guidelines and consensus documents. They address five critical domains: periprocedural management, intra-atrial septal puncture, anatomical reconstruction and electroanatomic mapping, ablation, and complication identification and management. By providing a structured framework, these standards aim to guide AF catheter ablation practice, thereby enhancing procedural safety and efficacy.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 1","pages":"23-35"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959667","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 diagnosis and treatment of chimeric antigen receptor T-cell associated hemophagocytic lymphohistiocytosis].","authors":"J L Hu, C C Feng, L B He, Y N Wang","doi":"10.3760/cma.j.cn112138-20240506-00284","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240506-00284","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 1","pages":"77-82"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959669","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 impact of frailty on the prognosis of chronic heart failure patients treated with cardiac resynchronization therapy defibrillator implantation].","authors":"L Gao, H S Lyu, B P Tang, X H Zhou, X C Cheng, Y Q Shi, Y D Li, J H Zhang, Q Xing, Tuerhong Zukela, Y M Lu","doi":"10.3760/cma.j.cn112138-20240827-00537","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240827-00537","url":null,"abstract":"<p><p><b>Objective:</b> The aim of this study was to assess the frailty status of patients with heart failure undergoing CRT-D and then explore the predictive value of frailty for all-cause mortality and heart failure-related readmissions in these patients. <b>Methods:</b> We retrospectively included 374 patients with chronic heart failure who underwent CRT-D treatment at the First Affiliated Hospital of Xinjiang Medical University between June 2020 and June 2024. Based on the Tilburg Debilitation Assessment Scale, 175 patients (46.8%) were classified as frail while 199 (53.2%) were classified as non-frail. The baseline data between the two groups was compared using Cox regression analysis and Kaplan-Meier curves were used for survival analysis. <i>P</i>-values of <0.05 indicated statistically significant differences. <b>Results:</b> A total of 374 patients aged 25-93 (68±11) years were enrolled in this study, 101 (27.0%) of which were female. Among these, 175 (46.8%) were categorized as frail, and 199 (53.2%) were classified as non-frail. Over a median follow-up time of 23 (5, 45) months, 35 (9.4%) patients experienced all-cause mortality, with 30 (17.1%) deaths occurring in the frail group and 5 (2.5%) in the non-frail group; meanwhile, readmission events due to heart failure occurred in a total of 174 (46.5%) patients, including 122 (70.1%) in the frail group, and 52 (29.9%) in the non-frail group. Cox analysis showed that frailty was a significant determinant of all-cause mortality (<i>HR</i>=21.25, 95%<i>CI</i> 3.99-113.30, <i>P</i><0.001) and readmission among heart failure patients receiving CRT-D (<i>HR</i>=2.52, 95%<i>CI</i> 1.73-3.68, <i>P</i><0.001). Log-rank tests showed that the survival rate of patients in the frail group was significantly lower than that of patients in the non-frail group (<i>HR</i>=7.22, 95%<i>CI</i> 2.80-18.60, <i>P</i><0.001) and the risk of readmission events due to heart failure was significantly higher among patients in the frail group than among those in the non-frail group (<i>HR</i>=2.75, 95%<i>CI</i> 1.98-3.81, <i>P</i><0.001). <b>Conclusions:</b> Frailty is an independent predictor of postoperative all-cause mortality and the occurrence of heart failure-related readmissions in patients with heart failure treated receiving CRT-D.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 1","pages":"45-51"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959671","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":"[Interpretation of the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis based on regression or machine learning methods (TRIPOD+AI)].","authors":"M H Yan, Y Y Zhao, X Liu, W Li, Y Wang","doi":"10.3760/cma.j.cn112138-20240926-00609","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240926-00609","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 1","pages":"4-10"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959573","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":"[Exploring the association between mental stress, lymphocyte subset variations, and coronary lesion severity].","authors":"Y P Chi, L J Zhang, X R Huang, X R Shen, P J Rao, Y W Li, H Y Chen, M Y Liu","doi":"10.3760/cma.j.cn112138-20240718-00461","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240718-00461","url":null,"abstract":"<p><p><b>Objectives:</b> This study aimed to explore the association between perceived mental stress (MS), lymphocyte subset variations, and coronary lesion severity in patients with coronary artery disease (CAD). <b>Methods:</b> Patients with CAD were enrolled in this study from September 2023 to May 2024. Perceived Stress Scale-14 (PSS-14) was used to evaluate MS during the last 1 month. Lymphocyte subsets were analyzed, including the percentage and absolute counts of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺, CD3^-CD19⁺, CD3^-CD56⁺16⁺, and the Th/Ts ratio. Statistical analysis was conducted using SPSS 24.0. <b>Results:</b> This study recruited patients with 323 CAD, with an average age of 61 (56, 68) years, including 203 males and 120 females. According to the PSS-14, a score of 14-42 and 43-70 were categorized as normal and increased MS, respectively. Patients with CAD with increased MS had significantly higher Gensini scores than those with normal MS [37(19,64) vs. 28(12,50), <i>Z</i>=-2.19,<i>P</i>=0.029]. Male CAD patients with increased MS exhibited significantly higher Gensini scores [39(20, 58) vs. 26(12, 45), <i>Z</i>=-2.37, <i>P</i>=0.018], levels of CD3⁺CD8⁺%[28.3%(23.6%,36.6%) vs. 25.9%(21.0%,32.4%), <i>Z</i>=-2.05, <i>P</i>=0.041], and CD3⁺CD8⁺absolute value [485 (346, 675) vs. 396 (309, 510) cells/μl, <i>Z</i>=-2.55,<i>P</i>=0.011] than those with normal MS. In male patients with CAD, a positive correlation was observed between Gensini scores (correlation coefficient: 0.181, <i>P</i>=0.011), PSS-14 scores, and CD3⁺CD8⁺absolute value (correlation coefficient: 0.162,<i>P</i>=0.038). <b>Conclusion:</b> This study reveals a positive correlation between MS and coronary stenosis severity, with notable sex differences. In male patients with CAD, higher levels of MS are associated with more severe coronary stenosis. The potential underlying mechanism may involve the regulation of lymphocyte subsets<b>.</b></p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 1","pages":"36-44"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959604","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":"[IgAκ monoclonal immunoglobulin deposition disease: a case report].","authors":"S X Ai, Y B Wen, G Chen, Y Qin, K Zheng, X M Li","doi":"10.3760/cma.j.cn112138-20240708-00432","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240708-00432","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 1","pages":"68-71"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959608","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 and hot topics of neurogenetic diseases in the past decade].","authors":"Z Y Wu","doi":"10.3760/cma.j.cn112138-20240603-00365","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240603-00365","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959578","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":"[Ovarian collision tumor with postmenopausal hyperandrogenism: a case report].","authors":"Z Xue, P Pang, Y Zhang, M H Zhang, Y Y Zhao, Y J Zhao, D Sun, L Y Song, Y Zhou, G Q Yang, Z H Lyu, J T Dou","doi":"10.3760/cma.j.cn112138-20240512-00298","DOIUrl":"10.3760/cma.j.cn112138-20240512-00298","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 12","pages":"1252-1256"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775075","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":"[Progress of type 2 diabetes in the past decade].","authors":"Y P Wang, Y M Mu","doi":"10.3760/cma.j.cn112138-20240904-00552","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240904-00552","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 12","pages":"1137-1143"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775117","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}