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.

Objective:To explore the efficacy and safety of sirolimus in the treatment of diazoxide unresponsive congenital hyperinsulinism(CHI) and summarize the single-center experience.Methods:A retrospective analysis was conducted on the clinical data of 5 cases of CHI treated with sirolimus after ineffective treatment with diazoxide, admitted to the Children′s Hospital Affiliated to Zhengzhou University from January 2017 to December 2022. The efficacy and safety of sirolimus in the treatment of CHI were evaluated.Results:The study included 5 patients, 3 males and 2 females. The age of onset ranged from 1 to 90 days. Initial symptoms included poor mental state(2/5) and convulsions(3/5). Blood glucose levels were 1.1 to 2.3 mmol/L, and insulin levels ranged from 13.52 to 70.53 μIU/mL. Two cases were classified as diffuse type, and the histological type of 3 cases was unknown. Genetic testing confirmed the diagnosis, with whole-exome sequencing revealing an unreported novel mutation in 1 case(ABCC8 exon 25_28del). Of the five patients, three patients were treated with sirolimus after diazoxide and octreotide failed, one patient was treated after unresponsive diazoxide, and the other one was treated after diazoxide, octreotide, and even near-total pancreatectomy failed. The onset age of sirolimus therapy ranged from 1 to 20 months. The maximum dosage of sirolimus was 1.2-3.2 mg·m -2·d -1, and the duration of medication ranged from 2 to 12 months. One patient was fully responsive to sirolimus, and the other four patients were partially responsive. All patients achieved euglycemia with sirolimus alone or in combination with standard CHI treatment. During follow-up, non-infectious diarrhea, elevated carcinoembryonic antigen, elevated triglycerides, and elevated liver enzymes were observed. Conclusion:This study indicates that sirolimus has a certain degree of efficacy in CHI patients for whom diazoxide treatment is ineffective. However, the long-term efficacy and safety warrant further multicenter trials.

BACKGROUND: Patients with pulmonary nodules are treated by minimally invasive surgery, and postoperative symptoms have become the main factors affecting patients' emotion and quality of life. This study aimed to analyze the changes of postoperative symptoms in lung cancer patients with pulmonary nodules. METHODS: The clinical data of eighty-eight lung cancer patients admitted to the same medical group of Department of Thoracic Surgery, West China Hospital of Sichuan University from June 2021 to September 2021 were prospectively collected and analyzed. The types and severity of clinical symptoms before operation, on discharge day, 30-day and 90-day after operation were analyzed. RESULTS: The incidence of postoperative symptoms in lung cancer patients was 79.5%, and most patients suffered from mild (54.3%) and moderate (32.9%) symptoms. The main postoperative symptoms of lung cancer patients were pain (55.7%) and cough (37.2%). The incidence of pain at discharge (55.7%) was significantly higher than that at 30-day (23.7%, P=0.01) and 90-day (12.0%, P=0.01) after discharge. The incidence of cough was significantly higher at 30-day (66.1%) and 90-day (66.0%) than that at discharge (37.2%) (P=0.01, P=0.04). CONCLUSIONS The main postoperative symptoms of lung cancer patients with pulmonary nodules are pain and cough. The incidence and severity of pain decreases with time, and the incidence of cough increases but the severity decreased gradually.
Cough/etiology* ; Humans ; Lung Neoplasms/surgery* ; Pain/etiology* ; Pneumonectomy/adverse effects* ; Quality of Life ; Thoracic Surgery, Video-Assisted/adverse effects*

Objective To observe the effects of dietary nursing based on macroscopic and microscopic syndrome differentiation on the compliance, clinical efficacy and quality of life (QOL) of ulcerative colitis patients with damp-heat in large intestine. Methods One hundred and ten cases meeting the diagnostic criteria of ulcerative colitis patients with damp-heat in large intestine were divided into routine group and observation group, 55 cases in each group. Both groups were given oral use of Sulfasalazine Tablets, and routine health education and dietary nursing for ulcerative colitis patients with damp-heat in large intestine. Additionally, the observation group was given dietary nursing based on macroscopic syndrome differentiation and colonoscopic microscopic syndrome differentiation. One month constituted a treatment course. After 6 courses of treatment, the compliance, clinical efficacy and QOL of the two groups were compared. Results (1) The incidence of medication missing or suspension in the routine group was 14.55%, while the incidence of diet missing or suspension in the observation group was 1.82%, the difference between the two groups being statistically significant (P < 0.01). (2) In the routine group, the cure rate was 5.5% and the total effective rate was 81.8%; in the observation group, the cure rate was 12.7% and the total effective rate was 92.7%. The differences between the two groups were statistically significant(P<0.05).(3) The scores of each dimension of QOL scale in the observation group were higher than those of the routine group (P < 0.05) , indicating that the improvement of QOL in the observation group was superior to that of the routine group. Conclusion The compliance, clinical efficacy and QOL of ulcerative colitis patients with damp-heat in large intestine are enhanced after treatment with dietary nursing based onmacroscopic and microscopic syndrome differentiation.

A random sample survey was conducted in 17 community medical institutes in 4 districts in Beijing.Among an effective sample of 385 residents.47.5％ (n =183)of community residents chose community medical institutes for first contact care while 52.5％ (n =202) opted for class other hospitals.Residents with lower education levels tended to choose community medical institutes (P =0.01).And those with chronic diseases preferred to choose communities (P=0.00).

Objective To evaluate the 64-slice CT angiography in characterizing the coronary venous anatomy and the arterio-venous relationship.Methods Sixty-four slice CT coronary veins angiography images of 300 patients(187 men and 113 women,)were analyzed.The visibility of the coronary veins and arterio-venous spatial relationship were assessed qualitatively on two-and three-dimensional displays.The diameter of the coronary sinus ostium(CSO),middle cardiac vein ostium(MCVO)and posterior vein of left ventricle ostium(PVLVO)were measured.All data was statistically processed with SPSS for Windows.Results The CS,great cardiac vein(GCV)and MCV could be clearly visualized in all of the images.1-3 branches of PVLV could be observed in 273 patients(91.0%).Small cardiac vein(SCV)and Marshall vein were found in 56(18.7%)and 24(8.0%)cases respectively.Three patients had permanent vena cava superior on the left and one patient had a CS diverticulum.Posterior descending artery(PDA)was concomitant with MCV in 189 cases(63.0%)and intersected with MCV in 96 cases(32.0%).Left circumflex artery(LCX)was concomitant with CS in 122 cases(40.7%),intersected with MCV in 15 cases(5.0%),and intersected with PVLV in 104 cases(34.7%).There were no significant differences in age,sex and CHD groups among CSO,MCV,PVLV value.The supero-inferior diameter of CSO had a significant difference between male and female(F=6.67,P＜0.05).Conclusion Sixty-four slice CT venous angiography is able to be used for guiding electrophysiological procedures,which is especially useful due to the considerable variations in venous anatomy.