Zhonghua Nei Ke Za Zhi
· 2026 Jan · PMID 41506735
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Antiphospholipid antibodies (aPLs) are a group of autoantibodies that target phospholipids and/or phospholipid-binding proteins. aPLs are serum markers for antiphospholipid syndrome (APS) and are crucial indicators for p...Antiphospholipid antibodies (aPLs) are a group of autoantibodies that target phospholipids and/or phospholipid-binding proteins. aPLs are serum markers for antiphospholipid syndrome (APS) and are crucial indicators for predicting risks and managing anticoagulant therapy in APS and aPLs related diseases. Developing clinical guidelines for aPLs in China can further standardize laboratory testing and improve the ability to interpret results, thereby playing a critical role in enhancing the diagnostic, treatment, and management capabilities of clinicians involved in APS. National Clinical Research Center for Rheumatic and Autoimmune Diseases, collaborating with Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, China Rheumatism Data Center, Chinese Systemic Lupus Erythematosus Treatment and Research Group, strictly adhering to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the reporting items for practice guidelines in Healthcare (RIGHT) checklists. This guideline includes 10 recommendations on the clinical application of aPLs, aiming to standardize their clinical use and laboratory testing, and to provide references for the clinical diagnosis, treatment, and management of APS and aPLs related diseases.
Sleep Disorder Group of Chinese Society of Neurology, Sleep Medicine Group, China Neurologist Association
Zhonghua Nei Ke Za Zhi
· 2026 Jan · PMID 41506734
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Chronic insomnia frequently co-occurs with common neuropsychiatric disorders, including migraine, stroke, Alzheimer's disease, Parkinson's disease, epilepsy, generalized anxiety disorder, depressive disorder, body distre...Chronic insomnia frequently co-occurs with common neuropsychiatric disorders, including migraine, stroke, Alzheimer's disease, Parkinson's disease, epilepsy, generalized anxiety disorder, depressive disorder, body distress disorder, post-traumatic stress disorder, and disorders due to use of alcohol. The prevalence of these neuropsychiatric disorders is hiher among patients with chronic insomnia than in the general population, and the conditions mutually exacerbate each other. Comorbidities not only exacerbate the severity and increases the relapse risk of each condition but also lead to a poorer prognosis, more severe impairment of social functioning, a higher all-cause mortality risk, and greater treatment challenges. Therefore, the Sleep Disorders Group, Chinese Society of Neurology and Sleep Medicine Group,China Neurologist Association have convened experts in relevant fields, based on current medical evidence, to establish guideline for the management of Chinese adults with chronic insomnia comorbid with the aforementioned 10 categories of common neuropsychiatric disorders. The aim is to standardize clinical practice and improve treatment effectiveness and cure rates.
Office for Primary Diabetes Care of the National Basic Public Health Service Program, Chinese Diabetes Society, National Clinical Research Center for Endocrine and Metabolic Diseases
… +1 more, National Society of Cardiometabolic Medicine
Zhonghua Nei Ke Za Zhi
· 2026 Jan · PMID 41506733
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In patients with diabetes, dyslipidemia plays a crucial role in the development and progression of atherosclerotic cardiovascular disease (ASCVD), and what's more, diabetes is a significant independent risk factor for AS...In patients with diabetes, dyslipidemia plays a crucial role in the development and progression of atherosclerotic cardiovascular disease (ASCVD), and what's more, diabetes is a significant independent risk factor for ASCVD. Currently, in China, the rate of dyslipidemia among patients with diabetes is high, while the control rate remains low. Therefore, it is essential to screen for dyslipidemia and enhance its management in patients with diabetes at the primary care level. This guideline includes the following: basic requirements for the management of dyslipidemia, lipid testing items, management goals, lipid-lowering strategies and referral criteria. It aims to provide comprehensive guidance for the management of dyslipidemia in patients with diabetes at the primary care level.
Zhonghua Nei Ke Za Zhi
· 2025 Dec · PMID 41338563
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A 72-year-old male patient presented with dry mouth and dry eyes, accompanied by decreased vision for more than 3 months, and the symptoms worsened over 5 weeks with parotid gland enlargement. PET/CT revealed increased m...A 72-year-old male patient presented with dry mouth and dry eyes, accompanied by decreased vision for more than 3 months, and the symptoms worsened over 5 weeks with parotid gland enlargement. PET/CT revealed increased metabolic activity in multiple nodules involving the lymph nodes, lacrimal glands, parotid glands, lungs, spleen, and muscles. Serum angiotensin-converting enzyme was significantly elevated. Biopsies of the parotid gland and lymph nodes revealed a large number of granulomatous lesions. The patient was given prednisone tablets combined with mycophenolate mofetil immunotherapy. Subsequently, the bilateral parotid gland swelling subsided, and the pulmonary patchy shadows, splenic nodules, and muscular nodules all either regressed or disappeared. A diagnosis of sarcoidosis involving multiple organs was established. However, during treatment, the pulmonary patchy shadows reappeared. After increasing the hormone dose, the pulmonary imaging manifestations again diminished or vanished, indicative of recurrent sarcoidosis. Therefore, atypical pulmonary manifestations of sarcoidosis may easily result in missed or incorrect diagnoses, emphasizing the importance of multisite histopathological biopsy. Besides, a favorable treatment response serves as additional supportive evidence for the diagnosis. Maintaining vigilance for disease recurrence is essential during hormone and immunosuppressive therapy.
Zhang YR, Wang ZX, Jiang Y
… +3 more, Liu WJ, Zhou RN, Chi Y
Zhonghua Nei Ke Za Zhi
· 2025 Dec · PMID 41338562
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A 44-year-old male presented with a 19-year history of urinary calculi and a 1-year history of polydipsia and weight loss. Laboratory tests revealed hyperparathyroidism and evidence of glucagonoma-associated diabetes. Im...A 44-year-old male presented with a 19-year history of urinary calculi and a 1-year history of polydipsia and weight loss. Laboratory tests revealed hyperparathyroidism and evidence of glucagonoma-associated diabetes. Imaging studies identified masses in the pancreatic head and body/tail, suggestive of glucagonoma and a parathyroid adenoma. Furthermore, the patient exhibited hypercalcitoninemia and elevated cortisol and adrenocorticotropic hormone levels. Genetic testing revealed a heterozygous MEN1 mutation [c.65T>G (p.Leu22Arg)], confirming the diagnosis of multiple endocrine neoplasia type 1 (MEN-1). The patient subsequently underwent near-total parathyroidectomy and total pancreatectomy. Postoperative immunohistochemical staining of the pancreatic tail tumor was positive for glucagon and calcitonin. The patient's postoperative hormone levels (calcitonin, glucagon, adrenocorticotropic hormone, cortisol) normalized, suggesting a rare pancreatic neuroendocrine tumor (pNET) that was co-secreting multiple hormones. Postoperative management included pancreatic enzyme supplementation, calcium supplementation, vitamin D supplementation, and insulin for glycemic control. Follow-up evaluations at 10 months demonstrated a stable clinical condition, well-controlled blood glucose and biochemical parameters, and an acceptable quality of life. This case study highlights that the presence of pNETs should be considered in patients with MEN-1 and multiple abnormal hormone levels. Timely surgical management of the involved glands and postoperative complications can effectively improve prognosis.
Zhonghua Nei Ke Za Zhi
· 2025 Dec · PMID 41338559
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To assess the emotional characteristics, specifically anxiety and depression, in children with vertigo and their association with the subtypes of vertigo. This retrospective analysis was conducted on 189 children (103 m...To assess the emotional characteristics, specifically anxiety and depression, in children with vertigo and their association with the subtypes of vertigo. This retrospective analysis was conducted on 189 children (103 male and 86 female children; age, 7-14 years; median, 10 years) who visited the Department of Otorhinolaryngology-Head and Neck Surgery at the Capital Institute of Pediatrics, Capital Medical University, between February 2021 and February 2024, with complaints of dizziness or vertigo. The participants comprised 44 children with recurrent vertigo, 127 with vestibular migraine, and 18 with possible vestibular migraine (PVMC). The participants' demographic and clinical data were collected, and emotional assessments, including anxiety and depression, were performed. Anxiety was assessed using the Children's Self-Rating Anxiety Scale, while depression was assessed using the Children's Self-Rating Depression Scale. Statistical analysis was performed using SPSS version 29.0 software to compare the clinical characteristics and correlations of anxiety and depression in children with vertigo. Overall, 48.7% (92/189) of children with vertigo had anxiety, and 34.9% (66/189) had depression, indicating that anxiety was more prevalent than depression. Additionally, children in all groups had varying degrees of emotional problems. In the vestibular migraine group, 52.0% (66/127) had anxiety, while 36.2% (46/127) had depression. In the recurrent vertigo group, 38.6% (17/44) had anxiety and 31.8% (14/44) had depression. In the PVMC group comprising 18 children, 9 had anxiety while 6 had depression. Overall, the proportion of children with anxiety was higher than that of those with depression in all the groups; however, there was no statistically significant difference between the groups (anxiety score, =0.877, =0.645; depression score, =0.524, =0.770). Furthermore, there was a positive correlation between anxiety scores and depression scores in the recurrent vertigo group, vestibular migraine group, and PVMC group (=0.71, =0.012; =0.59, <0.001; =0.70, =0.001, respectively). Children with common vertigo have emotional problems, including anxiety and depression, which should be considered during diagnosis and treatment.
Li WP, Li SY, Ma XF
… +6 more, Lu H, Chen Q, Shen PH, Lu JM, Zhang X, Zhang B
Zhonghua Nei Ke Za Zhi
· 2025 Dec · PMID 41338558
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To investigate the relationship between alterations in dynamic functional connectivity (dFC) and spatial navigation abilities in individuals with subjective cognitive decline (SCD) across different Traditional Chinese Me...To investigate the relationship between alterations in dynamic functional connectivity (dFC) and spatial navigation abilities in individuals with subjective cognitive decline (SCD) across different Traditional Chinese Medicine (TCM) constitutions. Seventy-five participants with SCD, comprising 34 individuals with balanced constitutions and 41 individuals with biased constitutions, were recruited from the Affiliated Drum Tower Hospital of Nanjing University Medical School between August 2022 and January 2025. The participants underwent TCM constitution assessment, spatial navigation ability testing, and neuropsychological scale evaluation. Additionally, each participant was assessed using 3.0 T resting-state functional magnetic resonance imaging (rs-fMRI) and high-resolution T1-weighted imaging scans. Based on prior research, 20 spatial navigation-related regions of interest (ROIs) were defined. Afterwards, rs-fMRI time series were segmented using a sliding time window approach before calculating the dFC within the spatial navigation brain network. Compared to the balanced constitution group, the biased constitution SCD group showed significantly lower scores on the Mini-Mental State Examination (MMSE) (=-3.05, =0.002) and the Auditory Verbal Learning Test (AVLT) measures: immediate recall (=-2.12, =0.035), short-delay recall (=-2.22, =0.026), long-delay recall (=-2.88, =0.004), cued recall (=-2.91, =0.004), and recognition (=-2.20, =0.028). They also exhibited significantly higher average error distances in ego-allocentric navigation (=-2.28, =0.023), egocentric navigation (=-2.31, =0.021), and delayed navigation (=-2.02, =0.043). Participants with SCD who had a biased constitution also demonstrated significantly reduced dFC between the left parahippocampal gyrus (PHG) and left prefrontal cortex (PFC) (2.43), right precuneus and right retrosplenial cortex (RSC) (=2.96), and left inferior parietal lobule (IPL) and left hippocampus (=2.42) (all <0.05, Bonferroni-corrected). Conversely, the dFC was significantly increased between the right PHG and left PFC (=-2.29, <0.05, Bonferroni-corrected). Significant correlations were also found in participants with SCD who had biased constitutions: the dFC between the left PHG and left PFC positively correlated with the egocentric navigation average total error (=0.34, =0.030) and negatively correlated with the visuospatial memory cognitive domain (=-0.35, =0.026); the dFC between the left IPL and left hippocampus negatively correlated with the egocentric navigation average total error (=-0.32, =0.043); and the dFC between the right PHG and left PFC positively correlated with the delayed navigation average total error (=0.33, =0.037). The area under the ROC curve for the combined differences in cognitive assessments, spatial navigation behavior, and navigation-related brain network dFC was 0.966 in predicting biased constitution versus balanced constitution in participants with SCD. Individuals with SCD and biased constitutions demonstrated poorer spatial navigation ability, possibly due to altered dFC within the spatial navigation brain network. Furthermore, the integrated model based on spatial navigation behaviors and dFC exhibited a high predictive value in distinguishing between individuals with SCD who had balanced and biased constitutions.
Zhonghua Nei Ke Za Zhi
· 2025 Dec · PMID 41338557
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To investigate the effect of semaglutide on the metabolomics of obese patients with type 2 diabetes mellitus (T2DM) complicated by metabolic-associated fatty liver disease (MAFLD). A prospective non-randomized controlle...To investigate the effect of semaglutide on the metabolomics of obese patients with type 2 diabetes mellitus (T2DM) complicated by metabolic-associated fatty liver disease (MAFLD). A prospective non-randomized controlled study was conducted. Obese patients with T2DM complicated by MAFLD who attended the Department of Endocrinology of Shijiazhuang People's Hospital from October 2022 to June 2023 were selected as the semaglutide group, and healthy individuals from the physical examination center were selected as the control group. Clinical data of both groups were collected. The semaglutide group was subcutaneously injected with semaglutide following a basic hypoglycemic regimen (starting dose of 0.25 mg once a week, which was changed to 0.5 mg once a week after 1 week for 12 weeks). Liquid chromatography-tandem mass spectrometry was used for qualitative and quantitative analyses of plasma metabolites, and multivariate analysis methods were used to analyze the metabolomics data. In total, 69 patients in the semaglutide group completed the treatment, with 49 males (71%) and a median age of 46 (36, 54) years, and the healthy control group consisted of 100 individuals, with 38 males (38%) and a median age of 40 (35, 45) years. The body mass index and levels of fasting blood glucose, alanine aminotransferase, and interleukin-6 (IL-6) in the semaglutide group before treatment were significantly higher than those in the control group (all <0.001). The body mass index [23.65 (22.33, 24.45) vs. 28.72 (27.50, 32.07) kg/m], liver stiffness measurement [1.61 (0.91, 2.00) vs. 5.78 (5.51, 6.10) kPa], and homeostasis model assessment of insulin resistance index [5.10 (2.90, 7.95) vs. 9.00 (6.25, 11.80)] in the semaglutide group were significantly lower after treatment than before treatment (all <0.001), and the blood glucose, blood lipid, liver function indicator, and IL-6 levels all significantly decreased after treatment. Metabolomics analysis revealed that there were 219 differential metabolites (131 up-regulated and 88 down-regulated) between the semaglutide group (=27) before treatment and the control group (=12), with glycerophospholipids and free fatty acids being significantly up-regulated. The semaglutide group showed 203 differential metabolites (121 up-regulated and 82 down-regulated) after treatment compared with before, with significant down-regulation of long-chain fatty acids and significant up-regulation of metabolites including carnitines, branched-chain amino acids, and taurine. Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that the differential metabolites identified before and after semaglutide treatment were involved in several signaling pathways, such as biosynthesis of unsaturated fatty acids, linoleic acid metabolism, aldosterone synthesis and secretion, and the mTOR signaling pathway, etc. Semaglutide alters the serum metabolite levels in obese patients with T2DM complicated by MAFLD.
Gong YL, Pan SY, Xing TY
… +6 more, Yin H, Shen HR, Wang L, Liang JH, Li JY, Xu W
Zhonghua Nei Ke Za Zhi
· 2025 Dec · PMID 41338556
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To evaluate the efficacy and safety of the Chi-BEAM regimen (chidamide combined with carmustine, etoposide, cytarabine, and melphalan) followed by autologous hematopoietic stem cell transplantation (ASCT) in patients wit...To evaluate the efficacy and safety of the Chi-BEAM regimen (chidamide combined with carmustine, etoposide, cytarabine, and melphalan) followed by autologous hematopoietic stem cell transplantation (ASCT) in patients with high-risk or relapsed/refractory lymphoma. This retrospective case series included 78 patients with newly treated high-risk or relapsed/refractory lymphoma who underwent ASCT with the Chi-BEAM conditioning regimen in the Department of Hematology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), from June 2021 to May 2024. Descriptive statistics were employed to evaluate clinical characteristics, efficacy, and adverse events. The Kaplan-Meier method was applied to calculate cumulative progression-free survival (PFS) and overall survival (OS) rates. The median age of the 78 evaluable patients was 47 years (range 16-68), with 8 patients (10.3%) aged ≥60 years. At the first post-transplant assessment (3 months), the objective response rate was 94.9% (74/78). The median follow-up was 20.1 months (range 2.9-44.9). The median PFS time was 20.1 months (range 1.6-45.1), with a 2-year cumulative PFS rate of 81.8%. The median OS time was 20.6 months (range 3.1-45.1), with a cumulative 2-year OS rate of 93.2%. The regimen was well-tolerated; mild-to-moderate hypocalcemia within 1 week post-infusion and transient mild erythrocyturia on the infusion day were the primary adverse reactions. The Chi-BEAM regimen combined with ASCT demonstrates both safety and clinical benefit in patients with high-risk or relapsed/refractory lymphoma.
National Clinical Research Center for Dermatologic and Immunologic Diseases (Peking Union Medical College Hospital), Chinese Association of Rheumatology and Immunology Physicians, Dermatology Professional Committee of Chinese Rehabilitation Medical Association
Zhonghua Nei Ke Za Zhi
· 2025 Dec · PMID 41338555
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In recent years, Janus kinase (JAK) inhibitors have been gradually approved for the treatment of immune-mediated inflammatory diseases (IMIDs), including rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis...In recent years, Janus kinase (JAK) inhibitors have been gradually approved for the treatment of immune-mediated inflammatory diseases (IMIDs), including rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, juvenile idiopathic arthritis, giant cell arteritis, atopic dermatitis, alopecia areata, psoriasis, and inflammatory bowel disease. To standardize the application of JAK inhibitors in IMIDs, the expert group of this consensus has formulated the Chinese expert consensus on the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors, based on the latest research data, relevant guidelines, domestic and international literature, and clinical practice experience of the experts. This consensus provides a comprehensive introduction to treatment regimens, safety management, and medication use in specific populations, aiming to assist clinicians in making reasonable clinical decisions.
Office for Primary Diabetes Care of the National Basic Public Health Service Program, Chinese Diabetes Society
Zhonghua Nei Ke Za Zhi
· 2025 Dec · PMID 41338554
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In China, the prevalence of diabetes has increased significantly, and rigorous challenges exist in diabetes prevention and glycemic control, especially in primary medical care. Under the guidance of the National Health C...In China, the prevalence of diabetes has increased significantly, and rigorous challenges exist in diabetes prevention and glycemic control, especially in primary medical care. Under the guidance of the National Health Commission of the People's Republic of China and the Chinese Medical Association, the Office for Primary Diabetes Care of the National Basic Public Health Service Program issued the "National guidelines for the prevention and control of diabetes in primary care (2018)" in 2018. The present guideline, which incorporates the latest advances in diabetes research and practice from the 2018 and 2022 editions, aims to improve primary health facilities and provide standardized basic public health and medical services throughout China. It applies to healthcare providers who provide primary care to patients with type 2 diabetes aged 18 or older. It primarily includes basic management requirements; workflow of health management; diagnosis; classification; monitoring, screening, and assessment; treatment; identification and management of diabetic acute and chronic complications; traditional Chinese medicine; referral; health management; and health education.
Chinese Association Hematologists, Chinese Invasive Fungal Infection Working Group
Zhonghua Nei Ke Za Zhi
· 2025 Dec · PMID 41338553
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In 2005, the Chinese Invasive Fungal Infection Working Group published the first guidelines for the diagnosis and treatment of invasive fungal disease (IFD) in patients with hematological disorders and cancers, with the...In 2005, the Chinese Invasive Fungal Infection Working Group published the first guidelines for the diagnosis and treatment of invasive fungal disease (IFD) in patients with hematological disorders and cancers, with the sixth revision released in 2020. Numerous advances in the fields of hematological oncology treatment and the diagnosis and management of IFD have significantly influenced the corresponding strategies. Therefore, the Chinese Invasive Fungal Infection Working Group has reviewed key research advances from 2020 to 2024 and released the seventh revision of the Chinese guidelines. Major revisions include: changes in the epidemiology of IFD; evaluation of novel diagnostic methods (especially PCR and metagenomic next-generation sequencing); updated recommendations on therapeutic drug monitoring and drug sensitivity test; management of breakthrough IFD; targeted therapy of pneumonia and cryptococcosis; and updated recommendation on the duration of antifungal therapy.
Qumu MSW, Wang B, Liu M
… +3 more, Li M, Zhou GW, Chen WH
Zhonghua Nei Ke Za Zhi
· 2025 Nov · PMID 41218884
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A 67-year-old male had undergone bilateral lung transplantation for chronic obstructive pulmonary disease 11 months before the current presentation. He was admitted with a 5-day history of cough with sputum, and a 2-day...A 67-year-old male had undergone bilateral lung transplantation for chronic obstructive pulmonary disease 11 months before the current presentation. He was admitted with a 5-day history of cough with sputum, and a 2-day history of fever. Computed tomography (CT) of the chest revealed rapidly progressive bilateral diffuse "ground glass" opacities. Despite anti-infective therapy and methylprednisolone pulse therapy, his condition deteriorated, necessitating endotracheal intubation with mechanical ventilation and veno-venous extracorporeal membrane oxygenation (V-V ECMO) for life support. A bedside cryobiopsy was undertaken, with pathology confirming the organizing pneumonia diagnosis. Comprehensive treatment was continued: methylprednisolone, tacrolimus for immunosuppression, and prophylactic anti-infectives. His partial pressure of oxygen in the blood by the fraction of inspired oxygen ratio and imaging findings improved gradually. ECMO support was discontinued after 2 weeks, and he was discharged 1-month later, resuming normal daily activities. At 2-month follow-up, he exhibited improved exercise tolerance. Chest CT showed bilateral upper-lobe emphysema (predominantly upper-lobe reticular shadows) and significant bilateral upper-lobe pleural thickening. After 12 months of fllow-up, a diagnosis of chronic lung allograft dysfunction was made based on imaging findings and the trajectory of pulmonary function.