This article presents a case study of a patient who visited the Geriatric Department of Peking Union Medical College Hospital due to "palpitations, shortness of breath for more than 2 years, limb weakness for 6 months, edema, and nocturnal dyspnea for 2 months". The patient exhibited decreased muscle strength in the limbs and involvement of swallowing and respiratory muscles, alongside complications of heart failure and various arrhythmias which were predominantly atrial. Laboratory tests revealed the presence of multiple autoantibodies and notably anti-mitochondrial antibodies. Following a comprehensive multidisciplinary evaluation, the patient was diagnosed with anti-mitochondrial antibody-associated inflammatory myopathy. Treatment involved a combination of glucocorticoids and immunosuppressants, along with resistance exercises for muscle strength and rehabilitation training for lung function, resulting in significant improvement of clinical symptoms. The case underscores the importance of collaborative multidisciplinary approaches in diagnosing and treating rare diseases in elderly patients, where careful consideration of clinical manifestations and subtle abnormal clinical data can lead to effective interventions.

Objective To investigate the role and underlying mechanisms of oxoglutarate dehydrogenase-L(OGDHL)in renal fibrosis.Methods Twelve male wild-type C57BL/6J mice(8 weeks old,weighting about 25 g)were randomly divided into control group and model group(n=6).A mouse model of renal fibrosis was established by unilateral ureteral obstruction(UUO).HE staining,immunofluorescence assay,and immunohistochemical and Masson staining were applied to assess the extent of renal fibrosis.Human kidney-2 proximal tubule cell line(HK-2)were randomly divided into blank plasmid group(Vector),OGDHL overexpression group(OGDHL OE),blank plasmid+TGF-β1 treatment group(TGF-β1+Vector),TGF-β1 treatment and OGDHL overexpression group(TGF-β1+OGDHL OE).Transmission electron microscopy(TEM)was employed to observe mitochondrial morphology.RT-qPCR,Western blotting and immunofluorescence assay were used to detect the expression levels of OGDHL and mitochondrial metabolism-related genes.Adenosine triphosphate(ATP)level,oxygen consumption rate(OCR),extracellular acidification rate(ECAR)and other mitochondrial metabolism-related indicators were detected with corresponding reagent kits and Agilent Seahorse.Results UUO operation resulted in obvious thinning of the renal cortex,significant hydronephrosis.HE staining revealed that tubular atrophy accompanied by dilated tubular lumens in the kidneys.Immunofluorescence,immunohistochemical and Masson staining showed obvious renal fibrosis after UUO operation.In the mouse model of renal fibrosis,the expression of OGDHL was decreased by 82.9%at mRNA level(P<0.001)and 81.9%at protein level(P<0.001),the production of mitochondrial ATP was reduced by 0.970±0.151 μmol/L(P<0.01),and notable damaged mitochondrial structure was observed,with maximum breathing capacity decreased by 25.260±1.920 pmol/min(P<0.001),expression levels of fatty acid oxidation-related genes were declined by 50.2%(P<0.05),while glycolysis was enhanced,with the genes related to glycolysis increased by 2.5 times when compared with those in the control group(P<0.05).After OGDHL overexpression,mitochondrial morphological damage was significantly improved,ATP production was increased by 0.980±0.090 μmol/L(P<0.05),with significantly alleviated energy metabolism disorder and renal fibrosis(P<0.05).Conclusion OGDHL regulates mitochondrial metabolic reprogramming of renal tubular epithelial cells to alleviate fibrosis,suggesting that OGDHL may be a new therapeutic target for renal fibrosis.

To investigate the clinical value of cardiac magnetic resonance feature tracking (CMR-FT) technology in the assessment of the right ventricle function in patients with immune checkpoint inhibitor (ICIs)-related myocarditis.

Objective To explore the clinical features,imaging and pathological characteristics of the patients with congenital liver fibrosis(CHF).Methods The medical case data of 6 patients with pathological-ly diagnosed CHF in this hospital from January 2011 to June 2021 were retrospectively analyzed,and the clini-cal menifastations,laboratory indicators,imaging characteristics,pathological manifestations,treatment and outcomes were summarized.Results The clinical classification in 6 cases of CHF was mainly portal hyperten-sion(66.67％),and the most common clinical manifestations and signs were hepatosplenomegaly(83.33％),melena(50.00％)and abdominal distension(33.33％).Total bil irubin was normal,and only 2 cases(33.33％)were mildly elevated.The prothrombin time was in the normal range in 4 cases(66.67％),and mild abnormality in 2 cases(33.33％).Imaging showed abnormal liver morphology in 6 cases,spleen enlarge-ment in 5 cases(83.33％),portal vein widening in 3 cases(50.00％),diffuse dilatation of intrahepatic bile ducts in 2 cases(33.33％),and complicating Caroli disease in 1 case(16.67％).The pathological manifesta-tions were normal liver parenchymal cells,periportal fibrosis,and manifold-manifold bridging-like fibrosis.Six cases received the conventional liver protection therapy,3 cases underwent splenectomy+pericardia vascular dissection,the median follow-up time was 68.2 months,1 case died due to liver failure,and 5 cases were rela-tively stable.Conclusion The patients with hepatic disease whose portal hypertension is inconsistent to the degree of hepatic function damage,especially those complicating polycystic kidney disease should perfect the liver puncture pathological examination and genetic testing to clarify the diagnosis,and conduct the genetic counseling and intervention treatment as soon as possible.

Objectives:Fenofibric acid is extracted from the widely used hypolipemic fenofibrate,nowadays being approved for marketing around numerous nations and regions,nonetheless not in China.Present trial evaluated the efficacy and safety in the Chinese hypertriglyceridemia population. Methods:This is a multi-center,randomized,double-blind,placebo-controlled phase Ⅲ clinical trial.Patients from 3 different cohorts,including severe hypertriglyceridemia(HTG),moderate HTG and mixed-dyslipidemia(MD),were randomized at 1:1 ratio to receive fenofibric acid 135 mg or placebo daily for 12 weeks.The primary endpoint was the percentage change of triglyceridemia(TG)from baseline at week 12.Secondary endpoints were the percentage changes of other blood lipid indexes.At the same time,the incidence of medical adverse events was observed. Results:Among the three cohorts of patients with severe HTG(n=52),moderate HTG(n=23)and MD(n=52),the TG levels in the fenofibric acid-treated group decreased by(49.12±29.19)%,(49.95±25.19)%and(49.79±19.28)%,respectively from baseline to 12 weeks,while the corresponding placebo groups decreased by(18.88±40.69)%,(8.11±29.86)%and increased by(10.42±73.04)%,respectively from baseline to 12 weeks.The differences between treatment and placebo groups were statistically significant(P<0.017 for severe HTG cohort,P<0.05 for moderate and MD cohort).The high-density lipoprotein cholesterol(HDL-C)in the fenofibric acid-treated group increased by(25.51±21.45)%,(24.55±24.73)%,and(23.60±27.38)%,and the placebo group increased by(1.91±20.42)%,(2.40±9.32)%and(7.13±19.12)%,respectively,the differences between the two groups were statistically significant(all P<0.05).In the fenofibric acid group,adverse events with incidence>5%included upper respiratory tract infection(10.9%),abdominal pain(6.3%),and increased serum creatinine levels(6.3%),rates of adverse events were similar between the two groups(P>0.05). Conclusions:Fenofibric acid can significantly reduce triglycerides and elevate HDL-C levels safely in Chinese patients with severe to moderate HTG without statin or MD patients on top of statin therapy.

To improve the standard screening, diagnosis, and treatment of hypertension in patients in China; realize the standardization of clinical practice of hypertension; and improve the prevention and control level of hypertension in China, it is both important and necessary to develop a clinical practice guideline for hypertension according to a recognized methodology. Jointly sponsored by the National Center for Cardiovascular Diseases, Chinese Medical Doctor Association, Hypertension Committee of the Chinese Medical Doctor Association, Chinese Society of Cardiology, and Hypertension Committee of Cross-Straits Medicine Exchange Association, the "Chinese Clinical Practice Guidelines of Hypertension" was proposed. Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences, Guideline and Standards Research Centre of Chinese Medical Association Publishing House, Lanzhou University Institute of Health Data Science, and Lanzhou University GRADE Center will provide methodological support for the guidelines.

To improve the standard screening, diagnosis, and treatment of hypertension in patients in China; realize the standardization of clinical practice of hypertension; and improve the prevention and control level of hypertension in China, it is both important and necessary to develop a clinical practice guideline for hypertension according to a recognized methodology. Jointly sponsored by the National Center for Cardiovascular Diseases, Chinese Medical Doctor Association, Hypertension Committee of the Chinese Medical Doctor Association, Chinese Society of Cardiology, and Hypertension Committee of Cross-Straits Medicine Exchange Association, the "Chinese Clinical Practice Guidelines of Hypertension" was proposed. Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences, Guideline and Standards Research Centre of Chinese Medical Association Publishing House, Lanzhou University Institute of Health Data Science, and Lanzhou University GRADE Center will provide methodological support for the guidelines.

Objective To establish a simple scoring system for the diagnosis of liver fibrosis in chronic hepatitis B (CHB), and to observe its sensitivity and specificity. Methods Two hundred and thirty-three patients diagnosed as CHB by liver biopsy were divided into model group (N = 154) and validation group (N = 79). The general information, biochemical parameters and imaging data of all patients were observed. With hepatic fibrosis being obvious or not as the end point of primary study in the model group, we established a simple scoring system for the diagnosis. The cut-off, sensitivity and specificity of the system were tested in the model group by ROC curve, and its diagnostic efficacy was tested in the validation group. Results(1) A simple scoring system for the diagnosis of liver fibrosis called MDFS was established in the model group, and the dimensions of the system included sex, HBV-DNA, Fibroscan (FS) value and splenomegaly. In MDFS, male, HBV-DNA≥ 107 U/mL,FS value≥7.3 kPa, and splenomegaly were assigned 1 point, -2 points, 3 points, and 2 points respectively. (2) The best cut-off value in MDFS was 2 points.(3) ROC curve of the model group indicated that the specificity and sensitivity were 92.86% and 54.76% respectively, the area under curve(AUC) was 0.790, and the Youden index was 0.4762. In the validation group, the diagnostic cut-off value was over 2 points, and the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 52.17%, 82.35%, 2.96, and 0.58 respectively. (4) The scoring results of MDFS for different traditional Chinese medical syndromes of CHB showed that the scores of blood stasis blocking collaterals > damp-heat accumulation > deficiency of spleen and kidney yang> liver depression and spleen deficiency = stagnation of liver Qi. Conclusion The MDFS diagnostic scoring system has medium efficiency. The specificity of MDFS is relatively high and MDFs has a relatively low misdiagnosis rate for the diagnosis of obvious hepatic fibrosis in CHB. The MDFS is expected to be a noninvasive and simple diagnosing way for hepatic fibrosis in CHB.

Objective To assess the predictive value of short-latency somatosensory evoked potential (SSEP) in the acute phase of stroke regarding functional recovery. Methods One hundred and fifty stroke patients were included. SSEPs were recorded on the first 7 days after stroke, and the patients were then stratified into groups with absent, abnormal and normal responses. Clinical state was determined according to the NIH stroke scale (NIHSS), the Fugl-Meyer assessment (FMA), the modified Barthel index (MBI) and the modified Rankin scale (MRS). SSEP was followed up at 1, 3, 6 and 12 months. Results The NIHSS and FMA scores were significantly different comparing any two groups or at different times in the same group. The median SSEP N20 latency and tibial nerve SSEP P40 latency during stroke were positively correlated with MRS scores 12 months later but negatively correlated with MBI results. The ADL results 12 months after stroke were used to evaluate functional recovery, and the prediction rate of the SSEP results alone was 40.8% , however the rate improved to 44.2% when SSEP results were combined with FMA scores and became 46.1% when SSEP, FMA and MRS results were all considered. Conclusion SSEP has independent predictive value regarding functional recovery after stroke. Combined assessment of initial FMA, MRS and SSEP substantially improves the predictive power for stroke prognosis.

Objective To investigate the inpatients' evaluation of quality nursing care and disucss different data collecting methods on patients's evaluation of quality nursing care. Methods Patients measure up to standard (82 cases) were divided into the questionnaire group and the interview group with 41 patients in each group. The questionnaire investigation was carried out in the questionnaire group by applying 4 themes of quality nursing care. The interview group used structured interview instead. The results of the two methods were compared and analyzed. Results The score of quality nursing care of the questionnaire group was higher than that of the interview group (P<0.01) in evaluating health education method. In humanistic environment patients in the questionnaire group thought nurses could protect their privacy, respect their personality and treat them and their family members kindly. Besides visiting institution was reasonable. All of these were the demonstration of quality nursing care. The above results were different from those of the interview group (P<0.01). Conclusions Patients had comprehensive requirement on quality nursing care. Nurses should, use this as reference, regulate their service behavior and improve nursing quality.