Liu Q, Shi PP, Chen X
… +5 more, Su YL, Xing XL, Wang ZX, Zhang W, Yuan Y
Zhonghua Nei Ke Za Zhi
· 2026 May · PMID 42103663
·
Publisher ↗
This article reports the case of a 58-year-old male patient who presented with a generalized rash, intermittent fever, and a concomitant perianal abscess, as well as mycoplasma pneumoniae psittacosis. The initial symptom...This article reports the case of a 58-year-old male patient who presented with a generalized rash, intermittent fever, and a concomitant perianal abscess, as well as mycoplasma pneumoniae psittacosis. The initial symptom was episodic slurred speech, which progressively developed into symptoms such as delayed responses and left-sided limb weakness. Cranial magnetic resonance imaging revealed gradually progressive intracranial lesions characterized primarily by asymmetric white matter damage, with no enhancement upon contrast administration. Serum HIV antibody testing was positive. Next-generation sequencing of pathogens in the cerebrospinal fluid detected DNA from hepatitis B virus, John Cunningham (JC) virus, and Epstein-Barr virus. The patient was ultimately diagnosed with AIDS combined with progressive multifocal leukoencephalopathy. This case highlights that for lesions predominantly involving the white matter with an asymmetric bilateral distribution, the possibility of progressive leukoencephalopathy should be considered, and HIV antibody screening is warranted.
Jin XX, Ding RJ, Guo F
… +8 more, He K, Cui LQ, Li X, Zhuang JL, Zhang MY, Shen M, Wang H, Dai JY
Zhonghua Nei Ke Za Zhi
· 2026 May · PMID 42103662
·
Publisher ↗
We reported a middle-aged man who initially presented with anhidrosis for 20 years and subsequently developed severe orthostatic hypotension, gastrointestinal dysmotility, and urogenital dysfunction. Due to progressive s...We reported a middle-aged man who initially presented with anhidrosis for 20 years and subsequently developed severe orthostatic hypotension, gastrointestinal dysmotility, and urogenital dysfunction. Due to progressive symptom aggravation, he was hospitalized and underwent comprehensive clinical assessment, neurophysiological studies, autonomic function tests, and multidisciplinary team (MDT) evaluation. The final diagnosis was pure autonomic failure (PAF). This case describes in detail the patient's long diagnostic course, differential diagnostic reasoning, the pivotal role of MDT management, and individualized treatment strategies and outcomes. The report aims to enhance the understanding of primary autonomic disorders characterized by neurogenic orthostatic hypotension for physicians, emphasizing the importance of systematic etiological screening and multidisciplinary collaboration in rare disease diagnosis and management to reduce misdiagnosis and improve prognosis and quality of life.
Yang WP, Guo R, Zhao SW
… +3 more, Zhou N, Xu XR, Liu CJ
Zhonghua Nei Ke Za Zhi
· 2026 May · PMID 42103655
·
Publisher ↗
This bidirectional cohort study included 452 patients with pneumonia (modeling cohort) from the Department of Respiratory and Critical Care Medicine at Jinan People's Hospital retrospectively enrolled between January 202...This bidirectional cohort study included 452 patients with pneumonia (modeling cohort) from the Department of Respiratory and Critical Care Medicine at Jinan People's Hospital retrospectively enrolled between January 2021 and December 2023, and 300 patients with newly diagnosed pneumonia (validation cohort) prospectively recruited from January to December 2024. The least absolute shrinkage and selection operator regression (10-fold cross-validation, =0.023) was initially applied for dimensionality reduction. Subsequently, Firth-penalized logistic regression was used to construct the predictive model, followed by the development of a P-Sep scoring system. The system was validated using the bootstrap method (500 resamples) and an independent prospective cohort. Multivariate analysis identified four independent predictors of interest: invasive mechanical ventilation (=5.12, 95% 3.05-8.61); positive blood culture (=4.23, 95% 2.38-7.51); lactate ≥ 2 mmol/L (=3.15, 95% 1.92-5.18); and serum amyloid A ≥100 mg/L (=2.58, 95% 1.52-4.39). The investigators established that the P-Sep score (0-12 points) was an independent predictor denoting low risk (0-5 points), intermediate risk (6-8 points), and high risk (≥9 points). In the modeling cohort, the area under the curve was 0.87 (95% 0.83-0.91; sensitivity: 85.2%; specificity: 89.3%). In the validation cohort, the area under the curve was 0.86 (95% 0.82-0.89; sensitivity: 84.8%; specificity: 89.1%). In addition, based on data from both cohorts, the predictive performance of the P-Sep score was compared with that of the Quick Sequential Organ Failure Assessment and CURB-65. The results demonstrated that the P-Sep score exhibited favorable predictive efficacy in the warning of secondary sepsis in patients with pneumonia.
Zhonghua Nei Ke Za Zhi
· 2026 May · PMID 42103654
·
Publisher ↗
To analyze and summarize the clinical and pathological characteristics, therapeutic strategies, and prognostic outcomes of adult patients with Castleman disease. In this single-center case series, clinical data from 13...To analyze and summarize the clinical and pathological characteristics, therapeutic strategies, and prognostic outcomes of adult patients with Castleman disease. In this single-center case series, clinical data from 13 adult patients treated for confirmed Castleman disease at Zhongda Hospital Affiliated with Southeast University between April 2020 and December 2024 were retrospectively analyzed. Primary observation indicators included demographic characteristics, clinical manifestations, histological classification, and findings from laboratory and imaging examinations. Treatment modalities and prognostic outcomes were also assessed. Fisher's exact test was used for group comparisons. Among the 13 patients, 7 were male and 6 were female, with a median age at onset of 49 years (range, 22-71 years). Three patients were diagnosed with unicentric Castleman disease (UCD), whereas 10 presented with multicentric Castleman disease (MCD). Most UCD patients were asymptomatic systemically (2/3), while one patient presented with paraneoplastic pemphigoid (PNP). All MCD patients exhibited generalized lymphadenopathy at multiple sites; seven had serous cavity effusions, and three demonstrated renal involvement. Diagnosis was confirmed via lymph node or mass biopsy, with pathological classification revealing seven cases of hyaline vascular type, five cases of plasma cell type, and one case of mixed type. No statistically significant differences were observed in pathological subtypes or immunohistochemical staining results between MCD and UCD patients (all >0.05). Laboratory findings showed that only the median levels of C-reactive protein and the median percentage of reticulocytes in MCD patients were above the normal reference range, while the median or mean levels of all other detectable indicators were within normal limits in both MCD and UCD patients. Treatment was tailored to clinical subtype, surgical feasibility, and disease characteristics. Five patients with localized disease and no systemic symptoms (2 UCD, 3 MCD) underwent surgery alone; two with localized disease and comorbidities (1 UCD with PNP, 1 human herpesvirus 8-positive MCD) received surgery plus pharmacotherapy; four MCD patients with multicentric lymphadenopathy and multiorgan involvement received pharmacotherapy alone; and two MCD patients with superficial lesions and no systemic symptoms were managed by observation alone. All patients improved and were discharged. At a median follow-up of 12 months (range, 6-17 months), all remained alive with no recurrence. Adult UCD was predominantly asymptomatic systemically or localized, whereas MCD was associated with generalized lymphadenopathy and multisystem involvement. Treatment for UCD primarily involved surgical resection, while MCD required comprehensive pharmacotherapy. Prognosis was favorable for UCD, and MCD patients also achieved remission following treatment; however, long-term follow-up remains essential.
Liu C, Ma A, Shi JH
… +5 more, Zhao YZ, Wang WY, He L, Zhao XP, Ma CS
Zhonghua Nei Ke Za Zhi
· 2026 May · PMID 42103653
·
Publisher ↗
To investigate the impact of adding an early proactive telephone follow-up (2-4 weeks post-ablation) to routine follow-up on perioperative medication adherence, incidence of clinical outcome events, and re-consultation i...To investigate the impact of adding an early proactive telephone follow-up (2-4 weeks post-ablation) to routine follow-up on perioperative medication adherence, incidence of clinical outcome events, and re-consultation in patients with atrial fibrillation undergoing catheter ablation. This study employed a prospective cohort design. The intervention group included 554 patients who underwent catheter ablation for atrial fibrillation at our hospital in January 2025, receiving an additional telephone follow-up within 2-4 weeks post-ablation. The control group included 910 patients who underwent catheter ablation at our hospital in February 2025, receiving only routine first outpatient follow-up at 3 months post-ablation. The telephone follow-up content included verifying comprehension of medical orders, guiding medication administration, answering questions, assessing postoperative recovery, identifying abnormal symptoms, providing medical advice, and offering psychological support. The primary outcome measure was medication adherence at 3 months post-ablation. Secondary outcome measures included the incidence of thromboembolic events, bleeding events, and re-consultation within 3 months post-ablation. All data were statistically analyzed using SPSS 26.0; -values<0.05 indicated statistical significance. Baseline characteristics were comparable between the two groups (all -values>0.05). Regarding medication adherence at 3 months post-ablation, the proportion of patients regularly taking anticoagulants in the intervention group (56.50%) was significantly higher than that in the control group (44.07%) (=21.30, <0.001); the proportion of patients who self-discontinued medication in the intervention group (27.26%) was significantly lower than that in the control group (41.87%) (=31.78, <0.001). For the incidence of thromboembolic and bleeding events, no statistically significant differences were observed between the two groups (all values>0.05). Specifically, the incidence of thromboembolic events was 1.08% (=6) in the intervention group and 1.65% (=15) in the control group (=0.77, 0.379); the incidence of bleeding events was 0.18% (=1) and 0.22% (=2), respectively (=0.19, 0.664). The overall incidence of any thromboembolic or bleeding event was 1.26% (=7) and 1.76% (=16), respectively, and this difference was not statistically significant (=0.54, 0.460). Regarding re-consultation, the incidence of outpatient visits due to cardiovascular disease was significantly lower in the intervention group (2.53%, =14) than in the control group (6.81%, =62) (=12.84, <0.001). No statistically significant differences were observed between the two groups for emergency visits due to cardiovascular disease (<0.01,0.975), hospitalization due to cardiovascular disease (<0.01,0.985), or re-consultation/hospitalization for any reason (=0.95, 0.329). Early proactive telephone follow-up can significantly improve perioperative medication adherence in patients with atrial fibrillation undergoing catheter ablation and effectively reduce postoperative outpatient visits. This simple and feasible intervention has positive clinical application value for improving short-term patient outcomes and optimizing medical resource allocation.
Zhao SS, Wang H, Wang R
… +7 more, Qiao C, Chen X, Hong M, He GS, Shen WY, Fan L, Wang Y
Zhonghua Nei Ke Za Zhi
· 2026 May · PMID 42103652
·
Publisher ↗
To explore the clinical characteristics and prognosis of acute erythroid leukemia (AEL). A retrospective case series study was conducted. Clinical data from 23 patients with AEL admitted to the Department of Hematology...To explore the clinical characteristics and prognosis of acute erythroid leukemia (AEL). A retrospective case series study was conducted. Clinical data from 23 patients with AEL admitted to the Department of Hematology at the First Affiliated Hospital of Nanjing Medical University from January 2015 to May 2025 were collected. Laboratory features and prognostic outcomes were summarized. Overall survival (OS) was analyzed using the Kaplan-Meier method, and log-rank test was used for comparisons between groups. Among the 23 patients with AEL, 13 were male (56.5%) and 10 were female (43.5%), with a median age of 62 years (range: 13-80 years). Of these patients, 10 (43.5%) had primary AEL, 5 (21.7%) had treatment-related AEL, and 8 (34.8%) had AEL secondary to other myeloid diseases. Among the secondary AEL cases, 5 were associated with myelodysplastic syndrome, 2 with chronic myeloid leukemia, and 1 with aplastic anemia. Regarding TP53 abnormalities, 38.1% (8/21) of patients had TP53 deletions, and among the 16 patients who underwent next-generation sequencing, all had TP53 mutations. The most frequent TP53 mutation sites were R248Q/W/L/P (3/16), H193R/D/L (2/16), and C242 frameshift mutations (2/16). The median OS was 1.23 months (range: 0.27-13.53 months). The median OS was 1.00 month (95% 0.77-1.23) in patients with TP53 mutation frequency >40% (=8), compared with 3.07 months (95% 0-6.81) in those with TP53 mutation frequency ≤40% (=8). The difference in OS between the two groups was statistically significant (=7.65, =0.006). There was no statistically significant difference in OS between patients receiving intensive chemotherapy and those receiving low-intensity chemotherapy (=0.161). The median OS was 2.20 months (95% 1.06-3.34) in the primary group, 7.20 months (95% 0-20.01) in the treatment-related group, and 0.93 months (95% 0.66-1.21) in the secondary group. Survival differed significantly among the three etiological groups (=11.53, =0.003). AEL is a subtype of acute myeloid leukemia with extremely poor prognosis that is highly associated with TP53 gene abnormalities.
Chen LF, Wang XC, Wang XT
… +10 more, Chao YG, Gao JQ, Lin YY, Xu JQ, Li M, Hong YX, Liu YQ, Yao YQ, Fan WX, Shang XL
Zhonghua Nei Ke Za Zhi
· 2026 May · PMID 42103651
·
Publisher ↗
To develop an ultra-low-frequency pressure reactivity index (PRx) (EL-PRx) based on hourly data (0.000 28 Hz) as an alternative to the conventional PRx, which requires high-frequency sampling, and provide a prognostic to...To develop an ultra-low-frequency pressure reactivity index (PRx) (EL-PRx) based on hourly data (0.000 28 Hz) as an alternative to the conventional PRx, which requires high-frequency sampling, and provide a prognostic tool for traumatic brain injury (TBI) in resource-limited settings. This multicenter retrospective cohort study included 473 participants, including patients with TBI who were identified from the MIMIC-Ⅳ and eICU-CRD databases and those admitted to Fujian Provincial Hospital affiliated with Fuzhou University between April 2018 and April 2025. They were divided into survival (=360) and non-survival (=113) groups based on in-hospital all-cause mortality data. EL-PRx was calculated using 9-23 h moving windows. Propensity score matching (1∶1, caliper width 0.1×logit standard deviation) was performed to adjust for confounders, including demographics, vital signs, laboratory findings, comorbidities, supportive therapies, and IMPACT model variables. Restricted cubic spline analysis, univariate logistic regression, and receiver operating characteristic curve analysis were used to evaluate the association between EL-PRx and outcomes and its predictive performance. The optimal clinical threshold was determined using sequential Chi-squared testing. A total of 473 patients were included (360 survivors and 113 non-survivors). EL-PRx was significantly higher for non-survivors than for survivors. The values were 0.14 (0.00, 0.30) and 0.07 (-0.10, 0.16) (=0.003), respectively, within the 9-h window, and consistent differences were observed across other time windows (all <0.05). Restricted cubic spline analysis demonstrated a non-linear positive association between EL-PRx and mortality risk. Univariate logistic regression showed that EL-PRx was significantly associated with mortality across different time windows, with odds ratios ranging from 3.825 to 8.073 (all <0.05); the strongest effect was observed within the 17-h window (=8.073, 95% 2.053-35.697). Receiver operating characteristic curve analysis indicated that predictive performance was optimal on days 5-6 with a maximum AUC of 0.667. Sequential Chi-squared testing identified 0.15 as the optimal clinical threshold for EL-PRx, which became stable when monitoring duration was≥3-4 days. EL-PRx, which is derived from routinely collected hourly data, can effectively predict in-hospital mortality for patients with TBI. Its threshold is comparable to that of conventional PRx, making it suitable for intensive care settings with limited monitoring resources.
Lin JF, Hu XD, Kang SY
… +5 more, Jia XM, Xu HJ, Xu ZX, Chen RH, Lyu ZH
Zhonghua Nei Ke Za Zhi
· 2026 May · PMID 42103650
·
Publisher ↗
To characterize the longitudinal evolution of thyroid nodules across ultrasound-based American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) categories with respect to nodule size, ultrasono...To characterize the longitudinal evolution of thyroid nodules across ultrasound-based American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) categories with respect to nodule size, ultrasonographic features, and the presence of abnormal cervical lymph nodes. A single-center retrospective cohort study. Clinical and follow-up data were collected for patients with thyroid nodules who initially attended the Endocrinology Outpatient Clinic of the First Medical Center of Chinese PLA General Hospital from January 2018 to March 2022 (the first month of each quarter served as the enrollment period). Collected variables included gender, age, nodule size, number of nodules, and ultrasonographic features. Nodules were classified according to the ACR-TIRADS criteria. Generalized estimating equations were used to compare changes in indicators such as nodule size and ultrasonographic features during follow-up. In total, 5 467 patients with 12 668 nodules were included. The mean age of the enrolled patients was (49.6±13.0) years, and 76.2% (4 164/5 467) were female. Multiple nodules were present in 83.7% (4 575/5 467) of patients. Among the 12 668 nodules at baseline, the proportions of nodules in ACR-TIRADS categories 1-2, 3, 4, and 5 were 70.7% (8 957/12 668), 19.6% (2 485/12 668), 6.1% (769/12 668), and 3.6% (457/12 668), respectively. The mean follow-up duration was (48.2±3.8) months. During follow-up, regardless of the ACR-TIRADS category, only 25.6% (3 246/12 668) of nodules showed significant enlargement, and most remained stable in size. The difference in nodule size changes across different ACR-TIRADS categories was statistically significant (Wald ²=126.37, 0.001). ACR-TIRADS category 5 nodules had the highest proportion of stable size, reaching 75.7% (346/457), while ACR-TIRADS category 3 nodules had the highest proportion of enlargement (29.2%, 726/2 485). Overall, 12.7% (1 605/12 668) and 3.9% (490/12 668) of nodules were upgraded or downgraded, respectively, due to changes in ultrasonographic features. The difference in ultrasonographic feature changes across different categories was statistically significant (Wald ²=1 872.45, 0.001). The highest rates of classification upgrade and downgrade were observed in ACR-TIRADS category 4 nodules (25.9%, 199/769) and category 5 nodules (21.4%, 98/457), respectively; ACR-TIRADS categories 1-2 nodules had the highest proportion of stable classification (87.4%, 7 826/8 957). During follow-up, the papillary thyroid carcinoma (PTC) detection rates for nodules that underwent fine-needle aspiration biopsy due to simple enlargement, classification upgrade alone, or enlargement combined with classification upgrade were 21.8% (47/216), 35.7% (71/199), and 41.8% (41/98), respectively. The overall difference in PTC detection rates among the three biopsy indications was statistically significant (Wald ²=18.62, 0.001), and the detection risk showed a significant increasing trend with the elevation of ACR-TIRADS category, with the highest risk observed in the enlargement combined with classification upgrade (2.78, 95 2.15-3.59, 0.001). Among the 5 467 patients with thyroid nodules, 102 had abnormal cervical lymph nodes on ultrasound at baseline. During follow-up, abnormal lymph nodes resolved spontaneously in 42 cases, while 53 patients developed new abnormal lymph nodes. For thyroid nodules with different ultrasound-based ACR-TIRADS categories, most clinical characteristics including nodule size and ultrasonographic features remain stable during approximately 4 years of follow-up. The overall incidence of abnormal cervical lymph nodes is low and some can resolve spontaneously. Both nodule enlargement and classification upgrade indicate an increased probability of malignancy of thyroid nodules, and the malignant risk is higher when ACR-TIRADS classification upgrade occurs alone or in combination with nodule enlargement.
Zhang L, Chen ZY, Peng DQ
… +19 more, Guo YL, Xu HX, Gan W, Wang ZW, Wang Z, Luo SX, Wu NQ, Cong HL, Wu GF, Hu M, Ma GS, Song HQ, Zhou SD, Chen H, Zhou ZH, Yan H, Li JP, Ma CS, Expert Group of Expert Guidance and Consensus for Standardization of Lipid Profile Testing Report in China
Zhonghua Nei Ke Za Zhi
· 2026 May · PMID 42103649
·
Publisher ↗
Domestic and international guidelines focusing on ASCVD risk stratification and precision treatment of dyslipidemia emphasize the formulation of individualized LDL-C targets based on risk stratification. However, in curr...Domestic and international guidelines focusing on ASCVD risk stratification and precision treatment of dyslipidemia emphasize the formulation of individualized LDL-C targets based on risk stratification. However, in current clinical practice in China, most lipid profile testing reports adopt a single presentation format, with the indicated reference ranges only applicable to the general healthy population, which fails to meet the needs of stratified treatment for patients with varying risk levels.To promote the precise diagnosis and assessment of dyslipidemia, and improve the treatment rate and long-term compliance rate of dyslipidemia, the Expert Group of Expert guidance and consensus for standardization of lipid profile testing report in China has organized multidisciplinary experts to formulate and issue Expert guidance and consensus for standardization of lipid profile testing report in China. This document provides guidance for the clinical reform of lipid profile testing reports. Through the reform and standardization of lipid profile testing reports, it aims to raise the awareness and attention of cardiologists, non-cardiovascular specialists, and patients with dyslipidemia, improve the awareness and diagnosis rates of dyslipidemia among different populations, and facilitate the implementation of individualized risk assessment and precision treatment regimens. It will also help establish a more scientific and efficient system for lipid management, enhance the efficiency of medical resource utilization, reduce the risk of CVD and the associated burden on medical insurance expenditures, and yield greater public health and economic benefits.
Zhang S, Ai SX, Sun X
… +9 more, Chang L, Shi JY, Zheng WY, Zhou YZ, Liu HT, Ma N, Zheng K, Zhang L, Xia P
Zhonghua Nei Ke Za Zhi
· 2026 Apr · PMID 41942330
·
Publisher ↗
A 25-year-old male patient presented with diarrhea, elevated serum creatinine, and thrombocytopenia for six months, with a recurrence for one month. He developed a systemic hyperinflammatory state following SARS-CoV-2 in...A 25-year-old male patient presented with diarrhea, elevated serum creatinine, and thrombocytopenia for six months, with a recurrence for one month. He developed a systemic hyperinflammatory state following SARS-CoV-2 infection, involving the renal, gastrointestinal, and hematologic systems. Although glucocorticoid therapy initially demonstrated efficacy, the patient experienced disease relapse post-gastrointestinal infection, complicated by recurrent cerebral infarctions. Through multidisciplinary collaboration and integrated assessment of clinical manifestations and lymph node biopsy pathology, a diagnosis of idiopathic multicentric Castleman disease (iMCD) with TAFRO syndrome was established. Following aggressive treatment targeting the primary disease, the patient achieved complete remission. This case illustrates that the complex clinical presentation of iMCD-TAFRO syndrome requires early intervention and rigorous multidisciplinary cooperation to improve patient prognosis.