中华内科杂志最新文献

Endovascular treatment has become the primary treatment for patients with acute ischemic stroke (AIS) due to large vessel occlusion. Its development and clinical application have expanded significantly in recent years. Imaging assessment plays a pivotal role in guiding both preoperative screening and postoperative management in AIS patients undergoing such interventions. However, updated expert consensus and standardized guidelines remain lacking. To address this gap, the Professional Committee of Interventional Neurology of the Chinese Research Hospital Association convened leading cerebrovascular disease experts to formulate consensus recommendations based on domestic clinical practice, aiming to provide authoritative guidance for imaging evaluation in this patient population.

Combination therapies involving oral anti-diabetic agents with complementary mechanisms of action are widely employed in the clinical management of type 2 diabetes mellitus (T2DM). Initiating combination therapy early-either at diagnosis or through timely escalation from monotherapy-can expedite achievement of individualized glycemic targets and slow disease progression in newly diagnosed patients. The inclusion of agents with weight-reducing properties is particularly beneficial for overweight or obese individuals, as it enhances insulin sensitivity and facilitates glycemic control. Moreover, selecting combinations with proven cardiovascular and renal benefits offers long-term organ protection and improves overall prognosis. This consensus statement provides guidance on the optimal use of oral combination therapies for effective and individualized management of T2DM in clinical practice.

Objective: To evaluate the quality of information on autoimmune liver disease in videos on the TikTok short video platform. Methods: The keyword "autoimmune liver disease" was used to search the top 200 videos on TikTok in the default sorting order. Using the DISCERN video quality assessment tool and the structured content integrity evaluation tool, we assessed the quality of the information in each video in relation to the pertinent disease guidelines. Furthermore, we investigated any relationships between the quality of the videos and their characteristics (likes, comments, retweets, days and duration of uploading). Results: A total of 140 videos were included, 96.4% of which were provided by medical professionals. The content completeness scores for each dimension were as follows: definition, 1.0 (0.0, 1.0); symptoms, 0.0 (0.0, 1.0); risk factors, 0.0 (0.0, 0.5); assessment, 0.5 (0.0, 1.5); management, 0.5 (0.0, 1.0); and outcome, 0.0 (0.0, 1.0). Furthermore, 91.4% of videos with DISCERN scores of ≤50 were of "fair" quality or below. Additionally, the difference in DISCERN scores between videos from different publishers was not statistically significant (P>0.05). The number of likes, comments, favorites, retweets, and video duration had a strong positive correlation with the overall DISCERN score (r=0.17, 0.18, 0.25, 0.26, 0.44, all P<0.05). Conclusions: The overall quality of videos related to autoimmune liver disease on the TikTok video platform is low. Therefore, publishers should focus on the comprehensiveness and accuracy of the information. Additionally, the TikTok platform should optimize its video review mechanism to provide the public with more accurate and reliable health information.

Objective: To explore the relationship between intestinal bacterial overgrowth (SIBO) and ulcerative colitis (UC). Methods: From December 2023 to June 2024, 85 patients with UC from the Gastroenterology Department of the Luquan branch of the Second Hospital of Hebei Medical University were enrolled. The lactulose hydrogen-methane breath test was performed to assess the prevalence of SIBO. Clinical data, including basic information, clinical manifestations, endoscopic manifestations, inflammatory indicators, current medication regimen, and past medical history, were collected. Furthermore, the body mass index (BMI), modified Mayo score, and patient-reported outcome (PRO2) score were calculated to evaluate disease activity in each patient. The Student's t-test, Chi-square test, non-parametric test, and multiple logistic regression were used to analyze the data and explore the relationship between SIBO and UC. Results: The incidence of abdominal pain and bloating in patients who were SIBO positive with UC was higher than in those who were SIBO negative [abdominal pain: 50.0%(10/20) vs. 23.1%(15/65), χ²=5.34, P=0.021; abdominal distension: 40.0% (8/20) vs. 13.8% (9/65), χ²=5.01, P=0.025]; the difference was statistically significant (P<0.05). Patients who were SIBO positive with UC were more likely to develop hypoproteinemia and anemia than those who were SIBO negative [hypoproteinemia: 50.0% (10/20) vs. 15.4% (10/65), χ²=8.35, P=0.004; anemia: 35.0% (7/20) vs. 9.2% (6/65), χ²=5.98, P=0.014]; the difference was statistically significant (P<0.05). In the intestinal methanogen overgrowth (IMO) positive group, the number of patients with UC with 1-2 stool times/day was higher, and the distribution of stool times between the IMO positive and IMO negative groups was significantly different (χ²=6.45, P=0.040). Furthermore, combined hypoproteinemia and anemia were risk factors for SIBO in patients with UC (hypoproteinemia OR=4.331, 95%CI 1.117-16.799, P=0.034; anemia OR=5.515, 95%CI 1.231-24.700, P=0.026). Conclusions: We observed a clinical overlap between SIBO and UC. SIBO could be targeted to optimize the treatment of patients with UC in the future.

Objective: To examine the interaction between gender and the visceral adiposity index (VAI) in relation to the risk of type 2 diabetes mellitus (T2DM). Methods: This retrospective cohort study utilized data from the public Dryad database derived from the NAGALA (NAFLD in the Gifu Area, Longitudinal Analysis) project (1994-2016). Participants were stratified into quartiles based on VAI levels. A multivariate Cox proportional hazards regression model was employed to evaluate whether VAI independently predicts T2DM risk. Kaplan-Meier survival curves and receiver operating characteristic (ROC) curves were constructed for each VAI quartile. Subgroup analyses were conducted to examine associations across age and body mass index categories. Both multiplicative and additive interaction effects between gender and VAI were assessed. Additionally, gender-specific Cox models were fitted to further explore these associations. Results: A total of 15 453 participants [8 419 males and 7 034 females; mean age, (43.7±8.9) years] were included, with a median follow-up duration of 5.39 years. During follow-up, 373 participants (2.4%) developed T2DM. After adjustment for potential confounders, higher VAI levels were independently associated with increased T2DM risk (HR=1.16; 95%CI 1.11-1.21), consistent with the results across VAI quartiles. Kaplan-Meier analysis revealed a significant trend of increasing T2DM incidence across VAI quartiles (P<0.001). The area under the ROC curve for VAI in predicting T2DM at 3, 5, and 10 years was 0.755, 0.735, and 0.696, respectively. Sensitivity analyses showed that elevated VAI was associated with increased T2DM risk across all age and body mass index subgroups (all P<0.05). Regarding interaction analysis, the HR (95%CI) for the multiplicative interaction between VAI and gender was 1.22 (1.19-1.26). The relative excess risk of interaction was -1.08 (95%CI -2.96 to -0.06), the attributable proportion of interaction was -0.54 (95%CI -1.35 to -0.01), and the synergy index was 0.48 (95%CI 0.26-0.91), indicating a negative additive interaction. Using low-VAI women as the reference group, the risk of T2DM in high-VAI women was higher (HR=2.53, 95%CI 1.59-4.02) compared to high-VAI men (HR=2.01, 95%CI 1.49-2.72). In gender-specific analyses, increasing VAI remained significantly associated with elevated T2DM risk after adjustment in both females (HR=1.43, 95%CI 1.21-1.68) and males (HR=1.16; 95%CI 1.11-1.22), with consistent findings across VAI quartiles. Conclusions: VAI and gender demonstrated multiplicative and additive interaction in relation to T2DM risk. The association between increasing VAI and T2DM risk was more pronounced in women than in men.

Obesity is a significant public health problem in China. The development of a proactive and effective model to combat the obesity epidemic could alleviate the disease burden, improve population health, and ultimately support the achievement of the Healthy China goals. Obesity research has made significant progress domestically and internationally, resulting in continuous improvements in basic public health services within primary care. Therefore, the National Office of Basic Public Health Service Program for Primary Diabetes Care has organized experts to issue the National Guidelines for the Integrated Management of Obesity in Primary Care (2025). The aim of this guide is to assist primary care physicians with evidence-based recommendations for diagnosing and evaluating obesity, promoting standardized and integrated management for patients with obesity. It includes essential guidelines for patient management, an overview of obesity, diagnostic and evaluation criteria, integrated management strategies, and protocols for follow-up and referral.