Volume 105 · Issue 03 · 2025

Sarcopenia, an aging-related geriatric syndrome, is characterized by decreased muscle mass, declined muscle strength, and/or physical dysfunction. It is associated with significantly increased risks of falls, frailty, disability, and even death, placing a heavy burden on individuals and society. Standardized diagnosis and treatment of sarcopenia are of paramount importance for clinical practice and the development of healthy aging in China. However, to date, there is a lack of evidence-based clinical practice guideline for the diagnosis and treatment therapy of sarcopenia in China. Therefore, the National Clinical Research Center for Geriatric Diseases (Xiangya Hospital) has initiated the development of this guideline for sarcopenia, with the approval of Geriatrics Branch of the Chinese Medical Association. Development of this guideline adhered to the Guiding principles for development/revision of clinical practice guidelines in China (2022 version) and the Reporting Items for Practice Guidelines in Healthcare (RIGHT). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the strength of evidence. The Delphi technique was used to determine the strength of recommendations. Finally, a total of 18 evidence-based recommendations for the diagnosis and treatment of sarcopenia were formulated in response to 12 most concerned important clinical questions about sarcopenia. This guideline aims to enhance the scientific approach to sarcopenia diagnosis and treatment in China, promote the in-depth development of sarcopenia research, and ultimately improve the quality of patient-centered healthcare services.

Mild cognitive impairment (MCI) is a state of objective cognitive decline that falls between normal aging and dementia, with a high prevalence among the elderly in China. Cognitive impairments in MCI patients involve multiple cognitive domains such as memory, language, attention, executive, visuospatial functions, and social cognition, as well as non-cognitive domains such as neuropsychiatric, mood, sleep, daily living activities, and frailty. The assessment and clinical diagnosis of MCI highly rely on neuropsychological testing. In order to standardize the neuropsychological assessment of MCI, the Dementia and Cognitive Disorders Group of the Chinese Society of Neurology formulated this consensus document. It recommends tools for assessing global cognition, various cognitive domains, and non-cognitive functions suitable for both clinical and research settings. The consensus proposes assessment procedures and precautions based on the experiences of domestic researchers. Based on the latest international and domestic research advancements, using the Delphi method and the GRADE evidence system, 24 recommendations were formulated in 5 aspects of MCI: global cognitive function assessment, various cognitive domains assessment, non-cognitive assessment, the use of neuropsychological scales, and precautions in neuropsychological assessment, aiming to improve the diagnosis and management of MCI in China.

To investigate the effect of ten-eleven translocation methylcytosine dioxygenase 2 (TET2) gene mutations on the secondary myelofibrosis (SMF) of JAK2^V617F+ myeloproliferative neoplasms (MPN) patients.

A retrospective collection was conducted on MPN patients with JAK2^V617F mutation detected by second-generation sequencing in the Department of Hematology, the Second Hospital of Tianjin Medical University. TET2⁺JAK2^V617F+ MPN patients were selected as the mutant group, and TET2^-JAK2^V617F+ MPN patients matched for age and gender were selected as the non-mutant group. The differences in mortality and SMF between the two groups were followed up until November 11, 2022. The second-generation sequencing technology was used to detect 325 mutated genes in hematological malignancies, in order to determine the differences between two groups of mutated genes. Enzyme linked immunosorbent assay (ELISA) was used to detect and compare the levels of cytokines such as transforming growth factor (TGF)-β1, interleukin (IL)-17, interferon (IFN)-γ in the bone marrow supernatant of the both groups. Multivariate Cox regression analysis was used to investigate the influencing factors of SMF in JAK2^V617F+ MPN patients.

A total of 96 patients were included, with 32 in the mutant group, including 16 males and 16 females, aged [M (Q₁, Q₃)] 61 (53, 70) years, and 64 in the non-mutant group, including 32 males and 32 females, aged 58 (51, 68) years. After a follow-up of 61(43, 116) months, the mortality rate of patients in the mutant group [15.6% (5/32) vs 1.6% (1/64), P=0.007] and the proportion of SMF [43.8% (14/32) vs 14.1% (9/64), P=0.001] were higher than those in the non-mutant group. The proportion of FAT1 [25.0% (8/32) vs 7.8% (5/64), P=0.028], U2AF1 [15.6% (5/32) vs 0, P=0.003], and KMT2D [15.6% (5/32) vs 3.1% (2/64), P=0.039] gene mutations in the mutant group was higher than that in the non-mutant group. The mutant group had higher levels of TGF-β1 [13 837(8 298, 17 509) vs 7 915 (3 586, 10 545) ng/L, P=0.016], IL-17 [7.4 (6.3, 7.5) vs 6.1 (5.9, 7.1) ng/L, P=0.007], and IFN-γ[8.5 (8.1, 9.1) vs 8.0 (7.5, 8.3) ng/L, P=0.007] compared to the non-mutant group. The results of multivariate Cox regression analysis showed that TET2 mutation (HR=8.483, 95%CI: 1.278-56.330) was a risk factor of SMF in JAK2^V617F+ MPN patients.

TET2 mutation is a risk factor for SMF in JAK2^V617F+ MPN patients.

This study aims to analyze the etiology and short-term prognosis of childhood arterial ischemic stroke (AIS) in Chinese children, based on the COIST classification system.

A total of 380 pediatric patients with a first-ever diagnosis of AIS treated at Beijing Children′s Hospital between September 2015 and April 2024 were retrospectively included. Etiology was analyzed according to COIST classification. The patients were categorized into infant and toddler group with 117 cases (>28 days to≤3 years), preschool group with 90 cases (>3 years to≤7 years), school-age group with 90 cases (>7 years to≤11 years), and adolescent group with 83 cases (>11 years to≤18 years). The etiological distribution across age groups and the short-term prognosis of patients with different etiologies were further analyzed.

Among the 380 patients, 235 were male (61.8%) and 145 were female (38.2%), with a mean age at presentation of(6.6±4.6)years. Approximately 2/3 of the patients were admitted in the Department of Neurology, with a mean hospital stay of (13.2±6.7)days. (1) Etiological analysis: "Vascular structural abnormalities" were the most common cause, accounting for 38.2% (145/380), followed by "Inflammatory" causes at 31.1% (118/380), "Undetermined" at 11.1% (42/380), "Other identifiable causes" at 9.2% (35/380), "Cardiac diseases" at 6.3% (24/380), and "thrombophilia" at 4.2% (16/380). (2) Etiological distribution by age group: in the infant and toddler group, "vascular structural abnormalities" were 47.9% (56/117), with basal ganglia infarction following minor trauma(combined with basal ganglia calcification) being the most common (40/117). In the preschool group, there were 34 cases (34/90) of "inflammatory" and 33 cases (33/90) of "vascular structural abnormalities", with Moyamoya disease being the most frequent cause (15/90). In the school-age group, there were 37(37/90) cases of "vascular structural abnormalities", with arterial dissection (12/90)being the most common, followed by FCA-i (11/90), and Moyamoya disease (11/90). In the adolescent group, there were 34 cases of "inflammatory"(34/83), with the highest proportion of FCA-i (13/83) in the subgroup, followed by thrombophilia (9/83) and systemic lupus erythematosus (8/83). (3) Short-term prognosis: based on the PSOM scale, 188 cases had good prognosis, accounting for 49.5% (188/380), while 192 cases had poor prognosis, accounting for 50.5% (192/380). According to the mRS score, 207 cases had good prognosis (54.5%) and 173 cases had poor prognosis (45.5%). Subtypes such as "Inflammatory-noninfectious, " FCA-i, Moyamoya disease, and arterial dissection were associated with relatively better outcomes. Less than 1/3 of patients in the "other identifiable causes" group had favorable prognosis. The in-hospital mortality rate was 3.7% (14/380).

Vascular structural abnormalities and inflammatory (including infectious and non-infectious) factors are the predominant causes of pediatric AIS; Approximately half of children with AIS had a favorable short-term outcome.

To evaluate the efficacy of domestic and imported sugammadex for reversal of rocuronium-induced deep neuromuscular block (NMB) in adult patients.

The clinical data of adult patients who scheduled for elective surgery with general anesthesia that required muscle relaxants in Peking University First Hospital from June 2023 to June 2024 were prospectively included. The patients were devided into domestic group and imported group according to random number table method. Anesthetized patients received rocuronium for intubation and muscle relaxation, and anesthesia was maintained with propofol, sevoflurane, and remifentanil. The effect of neuromuscular block was monitored. During deep muscle relaxation (with a single stimulation muscle twitch count of 1-2 after tetanic stimulation), domestic and imported sugammadex 4 mg/kg was given, respectively. The primary outcome was the recovery time from sugammadex injection to return of the train-of-four ratio (TOFr) to 0.9, with a non-inferiority margin of 1 minute (the range of non-inferiority boundary value is ±1 minute). The secondary outcome included the ratios of TOFr to 0.9 at different times and adverse effects.

A total of 70 patients were included, including 35 patients in the domestic group (13 males and 22 females), aged (46.9±12.7) years, and 35 patients in the imported group (13 males and 22 females), aged (45.7±11.5) years. There was no statistically significant difference in demographic characteristics, surgical time, anesthesia time, total rocuronium dose, and extubation time between two groups. All patients recovered to a TOFr of 0.9 within 5 minutes. Reversal time was 1.8 (1.3, 2.6) minutes in the domestic sugammadex group and 2.0 (1.7, 2.9) minutes in the imported sugammadex group respectively. The difference in reversal times between two groups was -0.40 minutes (95%CI:-0.75 to -0.02, P=0.039), which was within the range of non-inferiority threshold. Within 5 minutes of administration of antagonists, the incidence of bradycardia was 14% (5/35 and 5/35) in both domestic and imported groups. The incidence of skin allergy in patients transported to the post-anesthesia recovery room (PACU) was 3% (3/35) and 0 in both groups, respectively, with no statistical significance (all P>0.05). There were no serious drug-related adverse events in both groups.

The effect of domestic sugammadex is not inferior to imported sugammadex in reversal of deep rocuronium-induced neuromuscular block in adult patients, and the incidence of postoperative adverse events is not increased.

The epidemiological characteristics and surgical treatment of inpatients with superficial hemangioma in Shandong province were investigated and analyzed. The first-page medical records of hospitalized patients with superficial hemangioma from 2019 to 2020 reported by all secondary and above medical institutions in Shandong province were selected from the National Health Information Platform of Shandong province to analyze their population characteristics and surgical treatment. A total of 3 775 patients with superficial hemangioma were included, with the age of [M(Q₁, Q₃)] 3.0(0, 33.0)years, including 1 419 males (37.6%) and 2 356 females (62.4%). The head and neck superficial hemangioma accounted for the highest proportion of 37.8% (1 425/3 775), followed by limbs 34.5% (1 302/3 775) and trunk 24.4% (922/3 775). Infants accounted for the highest proportion of 37.2% (1 406/3 775). There were 2 874 (76.1%) patients with superficial hemangioma received surgical treatment, and the proportion of male patients receiving surgery was higher than that of female patients[78.2%(1 110/1 419) vs 74.9%(1 764/2 356), P=0.019]. The proportion of patients receiving surgery increased with age (P_trend<0.001). In terms of different parts, the proportion of patients with superficial hemangioma in the limbs who received surgery was the highest at 86.2%(1 123/1 302) (P<0.001). The majority of the surgical operations were secondary surgery (55.8%, 1 110/1 988), elective surgery (91.4%, 1 818/1 988), class Ⅰ incision (53.5%, 1 338/2 501), and general anesthesia (50.9%, 1 219/2 397). The main treatment method was resection (48.1%, 1 816/3 775). The study found that the majority of inpatients with superficial hemangioma in Shandong province were mostly in head and neck, with more females than males, and infants being the main group, and surgical treatment was the main treatment.

This article reports a case of a 53-year-old male patient who went to the Seventh Medical Center of the People's Liberation Army General Hospital on May 24, 2017 due to "intermittent mucus, pus and blood for 15 years, aggravated for 3 months". The disease was diagnosed as "ulcerative colitis (UC)" in the other hospital. After symptomatic treatment, the condition was repeated. Colonoscopy revealed severe UC, and severe pulmonary infection and severe perianal lesions. After anti-infection, hormone combined with mesalazine (5-ASA), perianal seton, fecal bacteria transplantation and other treatments, the disease was aggravated, and hypovolemic shock, renal insufficiency and severe malnutrition occurred. After admission, gastroscopy showed longitudinal duodenal ulcer, pebble-like changes and stenosis; Colonoscopy showed diffuse congestion, edema and erosion of colorectal mucosa; Abdominal CT showed diffuse thickening of the colon wall, comprehensive diagnosis of UC (chronic recurrent type, extensive colon type, active stage, severe) involving the duodenum, combined with severe perianal lesions, etc., active anti-infection and symptomatic nutritional support treatment. After the condition stabilized, the primary disease was controlled with infliximab (IFX) at an unconventional dose (>5 mg/kg), and symptoms and endoscopic manifestations improved. However, the subsequent patient's condition recurred, and after IFX optimization, conversion of vedelizumab (VDZ) and other treatments, the patient finally turned the corner and achieved endoscopic mucosal healing. Since the follow-up, the patient has no discomfort symptoms, stools 1 to 2 times/d, no mucus, pus and blood, and has gained nearly 30 kg in weight.

Neonatal respiratory distress syndrome (NRDS) caused by lung dysplasia and surfactant deficiency is the main cause of death in premature infants. The normal lung development is a complex process which is influenced and regulated by multiple pathways. In-depth research on the mechanism of fetal lung maturation is of great significance for exploring new methods to promote fetal lung maturation and prevent NRDS. In this paper, the development process and regulatory mechanism of human fetal lung are reviewed in order to have a more comprehensive understanding of fetal lung maturation.

Irritable bowel syndrome (IBS) is a common clinical functional bowel disease. Psychological factors play an important role in the occurrence and development of IBS, which seriously affects the quality of life of patients with IBS. Serotonin norepinephrine reuptake inhibitors (SNRIs) can effectively treat IBS patients with psychological disorders, and can effectively relieve intestinal symptoms while improving the symptoms of depression and anxiety; It is also effective in patients with refractory IBS. This article will review the mechanism of SNRIs in the treatment of IBS from the aspects of improving mental and psychological abnormalities, visceral hypersensitivity, intestinal motility, regulating intestinal flora, inhibiting inflammatory response and the particularity of its effect on the central nervous system.