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.

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 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.

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.

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.

BACKGROUND: Cognitive impairments are often accompanied in patients with silent cerebral infarction (SCI) and depression, and there is still no reliable objective assessing method for the evaluation.OBJECTIVE: The purpose of this study was to probe into the value of auditory P300 in detecting the cognitive impairment in SCI patients with depression.DESIGN: A golden standard control study.SETTING: Department of Neurology, Xi 'an Central Hospital; Department of Neurology, the Second Hospital of Xi' an Jiao Tong University.PARTICIPANTS: Thirty-eight SCI patients were selected from the Outpatient Department of Neurology, the Second Hospital of Xi' an Jiao Tong University between January 2002 to May 2003, including 10 got dizziness,11 got poor concentration, 8 got headache, 5 got numbness of extremities and 4 got syncope. Among them, 26 were detected by CT and 12 by MRI.The patients'aged 45 to 63 years with mean age of (57.3±5.1) years, including 20 males and 18 females.METHODS: The existence of depressive symptoms was measured with the 17-item Hamilton depression scale (HAMD). In this scale, the total score ranged from 0 to 52, with higher score indicating more severe depressive symptoms, and the patient was considered as having depression if the HAMD score was ≥ 9. HAMD tests were administered by two psychiatrists,who were experienced in psychiatric disorders in stroke and other somatic diseases, and the two psychiatrists had a better coincidence (Kappa=0.86 -0.91). The auditory event related potential was detected with MYTO serial cerebra induced potential meter, while lying in a bed placed in a sound-attenuated room. Auditory stimuli were delivered binaurally through headphones. The subject was required to distinguish between the tones by noting the occurrence of the target and not to respond to the standard. All patients underwent a routine experimental test at first, and then a normal test was performed to obtain a better coincidence. Mini-mental state examination (MMSE) was conducted for the 38 patients by specialized training neurologist to assess the cognitive impairment, in which the total score ranged from 0 to 30, with lower score indicating greater impairment. The criteria of intellectual deterioration was defined on the basis of educational level:MMSE score of 17 for illiterate, 20 for primary school and 24 for middle school and above.MAIN OUTCOME MEASURES: The score of MMSE, latent period of P300 wave and amplitude of P300 wave were mainly observed.RESULTS: All the 38 cases were involved in the final statistical analyhave depressive symptoms (47%, depression group) and 20 had no depresindexes and score of MMSE between the SCI patients with and without depression: As compared with the SCI patients without depression, the P300 latent period was obviously prolonged, the P300 amplitude and MMSE score were markedly decreased in the SCI patients with depression [(383.3±31.1), (347.2±37.3) ms; (5.6±0.7), (9.9±1.6) μV; (15.2±1.1),and P300 indexes: In the SCI patients with depression, the P300 latent period had significant negative correlation with the MMSE score (r=-0.549, P ＜ 0.05), the P300 amplitude had significant positive correlation with the MMSE score (r =0.525, P ＜ 0.05). However, there was no correlation between the latent period and amplitude of P300 and the MMSE score in the SCI patients without depression (r=-0.349 to 0.065, P ＞ 0.05).CONCLUSION: Depression and cognitive impairments may have the same pathophysiological basis in SCI patients. P300 can be used as a referential and objective method to analyze the cognitive function in SCI patients with depression.

A mathematical model of determining the injury of human knee joint was established by using structural dynamics method. The results showvered the corresponding shearing displacement and bending angle of the knee joint on the occasion of ligament avulsion, and the shearing force and bending moment which caused tibial condylar fractures under purest shearing and bending condition. The calculated results consisted with the experimental results greatly, suggesting that using mathematical method to determine the injury is feasible and this kind of method can do good to lots of subjects, such as pedestrian protection, athletic medicine and rehabilitation engineering.
Humans ; Knee Injuries ; Leg Injuries ; Models, Theoretical ; Multiple Trauma ; Tibial Fractures