ObjectiveTo compare the efficacy and safety of cryoballoon ablation versus electrical cardioversion in patients with first-episode, untreated persistent atrial fibrillation. MethodsPatients with first-episode persistent atrial fibrillation who received cryoballoon ablation or electrical cardioversion in our hospital were enrolled. Propensity score matching was applied to balance baseline characteristics, and a total of 70 patients with atrial fibrillation duration <1 year were finally included, with 35 in the cryoballoon group and 35 in the cardioversion group. The primary efficacy endpoint was the freedom from atrial fibrillation recurrence at 1 year post-procedure, and the safety endpoint was the incidence of major complications. ResultsThe 1-year freedom from recurrence rate was significantly higher in the cryoballoon group than in the cardioversion group (76.6% vs. 45.0%, P<0.05). No significant difference was observed between the 2 groups in the incidence of severe complications such as stroke or cardiac tamponade. Left atrial diameter was identified as an independent risk factor for recurrence after cryoballoon ablation (hazard ratio=1.319, P=0.046), whereas atrial fibrillation duration was an independent risk factor for recurrence after cardioversion (hazard ratio=1.131, P=0.037).ConclusionsFor patients with first-episode persistent atrial fibrillation, cryoballoon ablation is superior to electrical cardioversion in maintaining sinus rhythm, with a favorable safety profile. Left atrial diameter and atrial fibrillation duration are important predictors of recurrence after each treatment modality, which may help guide individualized clinical decision-making.
ObjectiveTo summarize the clinical characteristics and treatment outcomes of patients with acquired immunodeficiency syndrome complicated with Rhodococcus equi infection. MethodsA retrospective analysis was conducted on the clinical data of 14 patients with acquired immunodeficiency syndrome complicated with Rhodococcus equi infection, who were admitted to the Public Health Clinical Center of Chengdu from September 2017 to September 2025. ResultsOf the 14 patients, 13 were male, with an age range of 23 to 55 years and a median age of 40 (37, 43) years. All patients reported a history of sexual exposure, among whom 1 reported male-to-male sexual contact and 1 had a history of intravenous drug use. The time from diagnosis of human immunodeficiency virus (HIV) infection to diagnosis of Rhodococcus equi infection ranged from 5 days to 7 years. Seven patients had not initiated antiretroviral therapy (ART). Among the 7 patients who had initiated ART, 3 had confirmed virological treatment failure and 2 had self-discontinuation of ART. At the time of diagnosis of Rhodococcus equi infection, the CD4+ T lymphocyte count was 26.0 (16.5, 47.5) cells/μL, and the CD4/CD8 ratio was 0.11 (0.06, 0.15). The main clinical manifestations included cough, sputum production, fever, chest pain, etc. Imaging findings predominantly showed pulmonary infiltration and consolidation, cavitary lesions, and pleural effusion. Rhodococcus equi-positive specimens included blood, sputum, bronchoalveolar lavage fluid, pharyngeal swabs, pleural effusion, etc., with multiple specimen types often collected from the same patient. Regarding treatment outcomes, 10 patients showed clinical improvement, 3 did not receive or abandoned treatment, and 1 patient died. ConclusionsRhodococcus equi infection is uncommon in patients with acquired immunodeficiency syndrome, but it often causes bacteremia and cavitary pneumonia. Selecting sensitive antibacterial agents for a full course of treatment based on antibacterial susceptibility test results as soon as possible after diagnosis, along with prompt initiation of ART, may improve patient prognosis.
Panvascular diseases refer to a group of vasculopathies sharing common etiological factors, characterized by atherosclerosis (AS), which can affect multiple essential sites including vital organs such as the brain, heart, and kidneys, as well as the limbs. Intermittent hypoxia (IH) can readily exacerbate the progression of panvascular diseases. In recent years, hypoxic burden (HB) has emerged as a novel metric for assessing IH severity, garnering increasing attention for its clinical value in evaluating panvascular diseases. This review synthesizes current research on the application value of HB in evaluating the pathogenesis, progression, and adverse clinical outcomes of panvascular diseases, including cardiovascular, cerebrovascular, and chronic kidney diseases.
Bachmann bundle, which connects the left and right atria, serves as the preferential pathway for interatrial electrical conduction. Conduction disorder within this bundle is an important mechanism of interatrial block and is closely related to the initiation and progression of atrial fibrillation. Bachmann bundle pacing can improve interatrial conduction delay, restore atrial synchrony, and reduce the risk of atrial fibrillation in some observational studies. Although Bachmann bundle pacing has certain clinical application prospects, its identification criteria need to be further clarified. This article reviews the research progress on Bachmann bundle and Bachmann bundle pacing, so as to provide a reference for future studies.
Cognitive motor dissociation (CMD) is a distinct clinical phenomenon in patients with disorders of consciousness after brain injury. It refers to the condition in which patients show no definite behavioral response to commands in bedside behavioral assessments, but command-related covert consciousness can be detected through neurofunctional testing, manifested as dissociation between task-related brain response and motor control. Compared with unresponsive patients without CMD, patients with CMD usually have a relatively favorable clinical prognosis, so early identification and assessment are of great significance. This article reviews the concept, mechanism and major advances in assessment techniques of CMD, so as to provide a reference for the early identification of covert consciousness in patients with disorders of consciousness.
Antisynthetase syndrome (ASS) is a clinical subtype of idiopathic inflammatory myopathy, and interstitial lung disease is a common complication. The 44-year-old male patient had been treated for coronavirus disease 2019 (COVID-19) complicated by severe pneumonia 8 months earlier, and the pulmonary lesions worsened again after glucocorticoid tapering and discontinuation. Clinical manifestations included recurrent cough, sputum production, and shortness of breath, with diffuse ground-glass opacities in both lungs. After admission, a thorough medical history, comprehensive physical examination, and auxiliary tests including autoantibody profiles confirmed a diagnosis of ASS with positive anti-threonyl-tRNA synthetase (PL-7) antibodies, along with ASS-related nonspecific interstitial pneumonia. Community-acquired pneumonia patients with onset of interstitial lung disease should be clinically differentiated to rule out the possibility of connective tissue diseases. Respiratory viral infections may contribute to acute exacerbations of interstitial lung disease associated with connective tissue diseases, but their pathogenesis requires further exploration.
The full-course management of chronic obstructive pulmonary disease (COPD) requires breaking through the traditional static nursing model and establishing a precise intervention system due to the dynamic progression characteristics of the disease. Based on the core framework of "phase adaptability" and "time sensitivity" of Cameron's timing it right (TIR) theory, this article systematically integrates domestic and international research evidence, focuses on the two major disease phases (acute exacerbation and stability) of COPD, and summarizes the application progress in key steps including smoking cessation intervention, respiratory training, exercise rehabilitation, health education, and home care, so as to provide a dynamic nursing reference pathway of "precise timing and phase-appropriateness" for the full-course management of COPD patients.
Coronary slow flow (CSF) refers to a distinct clinical phenomenon in which coronary angiography reveals no obvious stenotic lesions, yet distal blood flow perfusion is delayed. It is closely associated with atherosclerosis, inflammatory responses, and endothelial dysfunction. Atrial fibrillation (AF), a common cardiac arrhythmia, exhibits a certain clinical correlation with CSF: the incidence of CSF is notably higher in patients with AF than in those with sinus rhythm. This article reviews the associations between AF and CSF at 3 levels — epidemiological, hemodynamic, and pathophysiological — and identifies microcirculatory dysregulation as an essential pathological link connecting the two conditions, primarily manifested as microvascular endothelial dysfunction and hemorheological abnormalities. It also elaborates on how macroscopic hemodynamic disturbances gradually evolve into structural microcirculatory remodeling through biomechanical signals. By clarifying the interaction between endothelial dysfunction and hemorheological abnormalities in AF complicated with CSF, this review aims to provide a theoretical basis for early clinical intervention.
ObjectiveTo discuss the efficacy, safety and prognosis of ablation at the right-left subvalvular interleaflet triangle as the primary strategy for refractory premature ventricular contractions originating from the left ventricular summit. Methods21 patients with frequent symptomatic left-ventricular-summit-originated premature ventricular contractions who underwent ablation at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between March 2022 and February 2024 were included. In all these cases, no satisfactory target potential was identified by activation mapping of the supra-valvular and sub-valvular positions of the bilateral ventricular outflow tracts. Ablation was then prioritized to be performed at the right-left subvalvular interleaflet triangle, and its acute efficacy, ablation parameters and long-term prognosis were recorded. ResultsWhile the surface electrocardiograms of the 21 patients showed heterogeneous characteristics, ablation at interleaflet triangle achieved acute success in 19 patients (90.5%). During a 12-month follow-up, 17 patients (81.0%) had no recurrence of premature ventricular contractions. No surgical complications occurred. ConclusionsFor left-ventricular-summit-originated premature ventricular contractions with no satisfactory target through activation mapping, ablation at the right-left subvalvular interleaflet triangle can be applied as the primary strategy.
ObjectiveTo compare the effects of regular inhaled corticosteroids (ICS) using different inhalation devices combined with on-demand short-acting β2-receptor agonist (SABA) on symptoms, respiratory impedance, lung function and airway inflammation in newly diagnosed patients with mild bronchial asthma. MethodsA total of 53 patients with newly diagnosed mild bronchial asthma were prospectively enrolled. Using SAS software (version 9.4), the participants were randomly assigned in a 1:1 ratio to a pressurized metered-dose inhaler (pMDI) group of 26 patients and a dry powder inhaler (DPI) group of 27 patients. Both groups received budesonide 200 μg per dose twice daily for 4 weeks. Asthma control test (ACT) scores, lung function, impulse oscillometry (IOS) parameters, fractional exhaled nitric oxide (FeNO) and blood eosinophil (EOS) levels were assessed before and after treatment. ResultsThere were no significant differences in baseline data, lung function, IOS, FeNO or EOS between the 2 groups (P>0.05). IOS parameters were correlated with lung function indicators. After 4 weeks of treatment, ACT scores increased, while FeNO and EOS decreased, and peak expiratory flow (PEF) increased compared with baseline in both groups (all P<0.05). The improvement in forced expiratory flow at 25% of forced vital capacity (FEF25%) in the pMDI group was significantly greater than that in the DPI group (P<0.05). Stratified analysis showed that in patients with small airway dysfunction (SAD), FeNO≥25 ppb, or EOS≥150 cells/μL, the pMDI group exhibited more significant FEF25% improvement after treatment (P<0.05). The proportion of patients achieving an ACT score of 25 in the pMDI group was significantly higher than that in the DPI group. ConclusionsAfter 4 weeks of budesonide treatment in patients with newly diagnosed mild asthma, the change in FEF25% and the proportion with well-controlled symptoms were higher in the pMDI group than in the DPI group, while both are comparable in terms of airway inflammation improvement and safety. Baseline FEV1 reversibility and abnormalities in small airway function may predict a better therapeutic effect of pMDI.
Objective To understand the epidemiological characteristics of hyperuricemia(HUA)in Yun County,Lincang City,Yunnan Province,and to compare the differences in fasting blood glucose(FBG),blood lipid,and liver function indicators between the HUA and non-HUA groups.Methods Data from 17 313 individuals with uric acid(UA)test results from the Department of Laboratory Medicine at Yun County Hospital of Traditional Chinese Medicine between January and December 2024 were retrospectively collected to describe the detection status of HUA and its distribution across gender and age groups.Among them,8 864 cases with complete UA,FBG,blood lipid,and liver function tests data were included to compare relevant biochemical indicators between the HUA and non-HUA groups.Results Among the 17 313 subjects,a total of 3 551 cases of HUA were identified,with a detection rate of 20.51%.The detection rate of HUA in males was 32.87%,higher than that in females(7.01%),with a statistically significant difference(P<0.01).The detection rate of HUA in males was highest in the 20-29 age group(48.33%),whereas in females,the rate was highest in the≥70 age group(11.51%).Individuals with HUA exhibited abnormally elevated levels of triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and FBG.Conclusions The detection rate of HUA in the UA testing population in Yun County is relatively high,with a significantly higher detection rate in males than in females.Young males and elderly females are the groups with high HUA detection rates.It is recommended to carry out blood UA screening,health education,and lifestyle interventions for key populations to reduce the risk of HUA and related metabolic disorders.
Objective To examine the association between flourishing and benefit finding among patients with type 2 diabetes mellitus(T2DM)and the chain mediation roles of perceived social support and coping styles between them based on the triadic reciprocal determinism theory,so as to provide a reference for improving the benefit finding level of patients.Methods Using the convenience sampling method,207 T2DM outpatients and inpatients were recruited from the department of endocrinology at a tertiary grade-A hospital in Shanghai from June 2025 to October 2025.The general information questionnaire,flourishing scale,multidimensional scale of perceived social support,coping style questionnaire,and benefit finding scale were used to conduct the survey.Univariate analysis,correlation analysis,and chain mediation effect testing were performed using SPSS 26.0 and PROCESS 3.2.Results A total of 207 valid questionnaires were collected,effective response rate 100.00%.The total scores of benefit finding,flourishing,perceived social support,and coping styles in T2DM patients were(51.11±11.07)(45.80±7.70)(65.26±14.47)and(0.00±1.40)points,respectively.There were statistically significant differences in benefit finding scores among T2DM patients with varied education levels,primary caregivers,marital status,living status,and glycated hemoglobin levels(all P<0.05).Flourishing,perceived social support,and coping styles were positively correlated with benefit finding(r=0.517～0.672,P<0.01).The total effect of flourishing on benefit finding was 0.744,with a direct effect of 0.227.The indirect effects were mediated through 3 pathways:"perceived social support → benefit finding""coping styles →benefit finding"and"perceived social support → coping styles → benefit finding",with indirect effects of 0.022,0.090,and 0.206,respectively.The total indirect effect accounted for 69.5%of the total effect.Conclusions The benefit finding level of T2DM patients needs to be improved.Medical staff should implement intervention measures based on the triadic reciprocal determinism theory after understanding their characteristics and influencing factors of benefit finding,so as to enhance their benefit finding level.
The rapid advancements of neuroimaging have provided support for characterizing structural and functional brain abnormalities associated with systemic lupus erythematosus (SLE). This article reviews the research progress of neuroimaging techniques in SLE from a “structure-function” integration perspective, aiming to consolidate the existing research approaches to SLE-related brain injury and to promote the development of multimodal research integrating clinical characteristics, brain structure and brain function.
Atrial fibrillation is one of the most common arrhythmias in clinical practice. Its high prevalence, high disability rate, and high mortality have become a major challenge in the field of global cardiovascular health. With the intensification of population aging and the rising prevalence of cardiovascular risk factors in China, the atrial fibrillation patient population continues to expand, imposing a heavy burden on the healthcare system. In August 2025, the Chinese guidelines for the management of atrial fibrillation (2025) jointly issued by the Chinese Society of Pacing and Electrophysiology (CSPE) and the Chinese Society of Arrhythmias (CSA), fully incorporates the latest domestic and international basic and clinical research achievements, combined with China's practical experience in atrial fibrillation management, to form atrial fibrillation management guidelines that are tailored to the characteristics of clinical practice in China. The guidelines cover a wide range of topics, including the definition and classification of atrial fibrillation, epidemiology and hazards, screening and prevention, clinical assessment, management models, comorbidity and risk factor management, stroke and thromboembolism, and rhythm control. This article aims to briefly interpret the key updates of the guidelines, so as to provide a reference for clinicians to standardize atrial fibrillation management.
ObjectiveTo investigate the clinical application effect of a new type of peritoneal dialysis (PD) catheter holder belt. MethodsFrom July 2023 to April 2024, 100 long-term follow-up PD patients in a tertiary hospital in Shanghai were randomly divided into an observation group of 50 patients and a control group of 50 patients. In the observation group, the novel PD belt was used to secure the catheter, and the exit site was covered with a sterile gauze with an opening. In the control group, a traditional PD belt was used to secure the catheter, and the exit site was covered with a sterile dressing (6 cm×7 cm). The 2 groups were evaluated at 1, 7, 30, and 90 days after intervention using the exit-site scoring system and the "Clinical Application Questionnaire of the PD Catheter Holder Belt". ResultsThe observation group was significantly superior to the control group in terms of the incidence of medical adhesive-related skin injury (MARSI) around the exit site, the incidence of catheter bending and catheter traction, the convenience of PD fluid exchange, and the cost of consumables (all P<0.05). ConclusionsThe use of the novel PD belt can reduce the incidence of MARSI around the exit site, effectively ensure the safety of the PD catheter, and reduce the economic cost of PD catheter exit-site care.
This article reviews the research progress on tezepelumab, an anti-thymic stromal lymphopoietin (TSLP) monoclonal antibody, in the treatment of severe asthma. Asthma is a chronic inflammatory airway disease with high global prevalence and low control rate, especially in patients with severe asthma who respond poorly to conventional therapies. TSLP, an epithelial-derived alarmin, sits at the apex of the inflammatory cascade and drives the pathological processes of multiple asthma phenotypes. Tezepelumab, a fully human anti-TSLP monoclonal antibody, specifically binds TSLP and prevents its interaction with TSLP receptor (TSLPR), thereby reducing the production of type 2 inflammatory cytokines such as interleukin (IL)-4, IL-5, and IL-13. Multiple animal experiments and clinical trials have shown that anti-TSLP antibodies can significantly alleviate airway inflammation, reduce airway hyperresponsiveness, inhibit airway remodeling, decrease annualized rate of acute asthma exacerbation, prolong time to first exacerbation, improve lung function [e.g., forced expiratory volume in the first second (FEV1)], lower blood eosinophil count, fractional exhaled nitric oxide (FeNO) as well as total immunoglobulin E (IgE) level, and demonstrate efficacy across patients with different inflammatory phenotypes.
ObjectiveTo analyze the clinical risk factors and prognosis of elderly peritoneal dialysis patients with peritonitis. MethodsA retrospective analysis was conducted on the data of patients who underwent peritoneal dialysis and developed peritonitis at this peritoneal dialysis center between January 2020 and November 2022. Patients were divided into 2 groups according to their age at peritonitis onset: an elderly peritonitis group (age≥65) and a non-elderly peritonitis group (age<65). General information and peritonitis-related data were collected, and the clinical risk factors and prognosis of peritonitis between the 2 groups were compared. ResultsA total of 62 patients with peritonitis were enrolled, including 26 in the elderly peritonitis group, where the median age was 71 (range 65-88), 12 patients were male (46.2%), and 5 patients had diabetic nephropathy complicated by diabetes mellitus (19.2%); 36 in the non-elderly peritonitis group, where the median age was 48 (range 26-63), 23 patients were male (63.9%), and 5 patients had diabetic nephropathy complicated by diabetes mellitus (13.9%). The elderly peritonitis group exhibited a worse prognosis than the non-elderly peritonitis group (mortality 30.8% vs. 2.8%; technique failure rates 23.1% vs. 16.7%, P=0.004). The elderly peritonitis group had a higher proportion of patients with education level of middle school or below (72.2% vs. 53.8%, P=0.038), a higher proportion requiring caregivers (100% vs. 83.3%, P=0.035), a higher frequency of operator changes (38.5% vs. 11.1%, P=0.011), longer initial training time (4 d vs. 3 d, P<0.01), and longer dialysis duration (70.5 months vs 29.5 months, P=0.002). The non-elderly peritonitis patients had better nutritional status: both normalized protein catabolic rate (nPCR) (0.90 vs. 0.79, P=0.007) and plasma albumin (34.78 g/L vs. 30.77 g/L, P<0.01) were higher. The elderly peritonitis group had lower levels of blood creatinine (872.42 μmol/L vs. 1053.69μmol/L, P<0.01), blood uric acid (345.0 μmol/L vs. 372.0 μmol/L, P=0.023), blood potassium (3.65 mmol/L vs. 3.95 mmol/L, P=0.012), blood phosphorus (1.54 mmol/L vs. 1.80 mmol/L, P=0.022), intact parathyroid hormone (iPTH) (227.2 pg/mL vs. 414.0 pg/mL, P=0.037), and 25-hydroxyvitamin D3 (17.95 nmol/L vs. 22.57 nmol/L, P=0.007). ConclusionsElderly patients with peritonitis had a poorer prognosis. Compared with younger patients with peritonitis, elderly patients had lower education levels, longer dialysis duration, worse nutritional status, poorer operational ability, and a greater need for caregivers.
Chronic Q fever is caused by Coxiella burnetii infection. There are few clinical cases of chronic Q fever, and cases complicated with renal insufficiency are even more rarely reported. At present, there are few reports about this disease both domestically and internationally, and its clinical characteristics and pathogenesis remain unclear. This article reports a case of a chronic Q fever patient with clinical manifestations of nephrotic syndrome and impaired renal function, whose renal biopsy revealed membranoproliferative glomerulonephritis. After treatment with glucocorticoid, cyclophosphamide, hydroxychloroquine combined with doxycycline, the patient’s renal function improved.
Drug-induced liver injury (DILI) is a common and highly heterogeneous adverse drug reaction in clinical practice. Drug-induced fatty liver disease (DIFLD) is a distinct subtype of DILI characterized primarily by abnormal hepatic lipid accumulation. Meanwhile, pre-existing metabolic dysfunction-associated steatotic liver disease (MASLD) may serve as a susceptible background that increases the risk of DILI and influences clinical outcomes. Accordingly, DIFLD and DILI occurring in the setting of MASLD are related, while differing in their pathologic basis and clinical features. Current research suggests that the development and progression of both reactions involve multiple mechanisms, including mitochondrial dysfunction, dysregulation of nuclear receptors and transcriptional control, imbalance between lipid synthesis and export, oxidative stress, and activation of inflammatory pathways. This article reviews the epidemiologic characteristics, interaction mechanisms, and clinical outcomes associated with lipid metabolism disorders and DILI, with the aim of providing a basis for identification of high-risk populations, individualized drug therapy, and safety evaluation of new drugs.
The comorbidity rate of metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic hepatitis B (CHB) is steadily increasing. Both MASLD and CHB can independently lead to adverse outcomes, including cirrhosis and hepatocellular carcinoma (HCC). However, the impact of coexisting MASLD on HCC risk in CHB patients shows high heterogeneity across current studies: some studies suggest that MASLD may accelerate disease progression through mechanisms such as metabolic inflammation, lipotoxicity, and insulin resistance, interacting with the chronic inflammation induced by hepatitis B virus (HBV); conversely, some studies report that hepatic steatosis is associated with lower viral replication levels and a higher rate of hepatitis B surface antigen (HBsAg) clearance, indicating a potential protective effect. This review outlines the potential mechanisms underlying MASLD and CHB interactions, focuses on the divergent findings from existing clinical research regarding whether MASLD exerts a “promoting” or “protective” effect on HCC risk in CHB patients, and summarizes factors that may contribute to this heterogeneity, including the definition evolvement of fatty liver disease, differences in virological status and antiviral treatment, degree of liver fibrosis, and inconsistency in diagnostic methods and population characteristics. In the future, active intervention should be taken to address metabolic abnormalities in patients with the aforementioned comorbidities. Meanwhile, studies based on unified definitions, precise stratification, and methodological standardization should be conducted to clarify the true impact of different metabolic phenotypes on CHB progression and HCC risk, thereby providing evidence-based support for precise risk prediction and integrated intervention.
