中华内科杂志最新文献

Objective: To explore the value of the artificial intelligence (AI)-assisted recognition system in the detection quality of colonoscopy. Methods: From January 2023, the data on 700 patients who underwent colonoscopy in the Digestive Endoscopy Center of the First Affiliated Hospital of Zhejiang Chinese Medical University were collected prospectively. Based on a computerized number method, patients were divided into the AI assistance group and control group. The detection rate of adenomas (ADR) and polyps, number and size of adenomas, Boston bowel preparation scale (BBPS), intubation time, withdrawal time, and cecal intubation rate were compared between groups. Normally distributed data were analyzed with the t-test for independent samples. Non-normally distributed data were analyzed with the Rank sum test. Categorical data were analyzed with the Chi-square test. Results: In total, 691 patients were included in the analysis. According to the intention to treat (ITT) analysis and per-protocol (PP) analysis, the withdrawal time of the AI group was higher than that of the control group (ITT:436 (305, 620) vs 368 (265, 510) s, Z=-4.24, P<0.001;PP:439 (306, 618) vs 364 (262, 500) s,t=-4.50, P<0.001); however, there were no significant differences in the ADR (ITT:123(35.5%) vs 111(32.2%), χ²=0.88, P=0.349;PP:108(34.2%) vs 99(31.1%), χ²=0.67, P=0.414), the number of adenomas (ITT:0(0, 1) vs 0(0, 1),Z=-1.08, P=0.282;PP:0(0, 1) vs 0(0, 1),Z=-0.87, P=0.387), the polyp detection rate (ITT:85(24.6%) vs 85(24.6%),χ²=0.001, P=0.983;PP:79(25.0%) vs 77(24.2%),χ²=0.05, P=0.818), BBPS (ITT:6.5±0.9 vs 6.5±0.7,t=-0.59, P=0.555;PP:6.7±0.6 vs 6.6±0.6,t=-1.83, P=0.068), and cecal intubation rate (ITT:346(100.0%) vs 343(99.4%), χ²=0.50, P=0.478) between these two groups. After excluding inadequate bowel preparation and failed cecal intubation cases, the AI-assisted system was found to significantly improve the detection rate of small adenomas (≤5 mm) (PP:27.8%(88/316)vs 21.1%(67/318), χ²=3.94, P=0.047). Conclusions: The application of an AI-assisted system in colonoscopy can increase the withdrawal time and improve the detection rate of small adenomas.

In order to improve the quality of clinical therapy and nursing care for patients with lung tumors undergoing Co-Ablation System and standardize perioperative management, the Committee of Ablation Therapy in oncology, Chinese Anti-Cancer Association, and the Expert committee on Ablation Therapy and the Committee of Interventional Perioperative, Interventional Physician Branch of Chinese Medical Doctor Association organized medical and nursing experts in China. Based on the clinical practice of Co-Ablation System therapy in China and relevant domestic literature, a perioperative management expert consensus was developed. The expert consensus included the key points of perioperative nursing care, prevention and intervention of complications, and discharge guidance for Co-Ablation System therapy of lung tumors, to provide reference for the standardization and development of clinical management for lung tumors.

Rheumatoid arthritis(RA) is an autoimmune disease characterized by erosive arthritis, which is an important cause of disability in Chinese population. It is of great significance to formulate and update RA diagnosis and treatment guidelines that meet the standards of international guidelines and clinical practice in China. The update of the Chinese guidelines for the diagnosis and treatment of RA was initiated by National Clinical Research Center for Dermatologic and Immunologic Diseases, jointly with the Chinese Association of Rheumatology and Immunology Physicians, the Rheumatology and Immunology Professional Committee of Chinese Rehabilitation Medical Association, the Rheumatology and Immunology Professional Committee of Chinese Research Hospital Association, and the Rheumatology and Immunology Branch of Beijing Association of Holistic Integrative Medicine. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist were followed to update the guidelines. The guidelines provide evidence-based recommendations on 10 clinical issues which were concerned by Chinese rheumatologists. The aim is to improve the level of diagnosis and standard treatment of RA in China, and to improve the quality of life and prognosis of patients.

Objective: To investigate vitamin D levels and the effect of exogenous vitamin D supplementation in the first trimester among pregnant women in our center. Methods: This was a prospective cohort study. A total of 98 women in the first trimester who were followed-up regularly in Peking Union Medical College Hospital from December 1^st 2020 to December 1^st 2021 were enrolled. Subjects who had medical conditions that affect vitamin D absorption or metabolism were excluded. Questionnaires were administered, and 25-hydroxyvitamin D [25(OH)D] levels were detected using liquid chromatography tandem mass spectrometry (LC/MS/MS) method. According to the basic 25(OH)D level, different dosages of exogenous vitamin D were supplemented. After 4 weeks, 25(OH)D levels were detected again to evaluate the effect of supplementation. T test, analysis of variance, χ² test, and multiple linear regression analysis were used for analysis. Results: The mean age of enrolled subjects was (33.5±4.0) years. The baseline 25(OH)D level was (41.2±20.0) nmol/L. Briefly, 70.4% (69/98) subjects were deficient in vitamin D, and 42.9% (42/98) patients were using vitamin D supplementation at the time of 25(OH)D testing. Single-factor analysis showed that vitamin D supplementation (t=-4.21, P<0.001), season (t=2.59, P=0.011), and nut-eating frequency (t=2.67, P=0.009) were related to 25(OH)D levels. Multiple linear regression analysis showed that only vitamin D supplementation had a relationship with 25(OH)D level (B=13.84, P=0.006). According to the baseline 25(OH)D level, 400-5 000 U/d vitamin D3 was supplemented regularly for (4.1±2.5) weeks, and 25(OH)D levels significantly increased after supplementation [(64.1±18.1) vs (37.3±16.6) nmol/L, t=-9.36, P<0.001]. The ascending range was negatively associated with basic 25(OH)D level (B=-0.66, P<0.001) and positively associated with supplementary dosage (B=0.51, P<0.001). 25(OH)D levels increased by 0.51 nmol/L on average per 1 μg (40 U) of vitamin D supplementation daily. Conclusions: The proportion of vitamin D deficiency was high in the first trimester among pregnant women in our center. Exogenous vitamin D supplementation could significantly increase 25(OH)D levels, and the effect was negatively associated with basic 25(OH)D level but positively associated with supplementary dosage.