协和医学杂志

The Core Methods and Key Models in Evidence-based Medicine

CHEN Yaolong, SUN Yajia, LUO Xufei, YU Xuan

2023, 14(1): 1-8. doi: 10.12290/xhyxzz.2022-0686

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This study reviews the core methods and models that have emerged from the development of evidence-based medicine over the past 30 years, including the PICO question model, systematic reviews, grading of evidence quality and strength of recommendations, reporting guidelines, the 5S pyramid of evidence resources, and evidence ecosystem. The above methods and models constitute the theoretical system, promote the progress of evidence-based medicine and provide the internal impetus for its development. The clarification of the core methods and key models of evidence-based medicine will help scholars and researchers fully understand its scientific philosophy, explore its future direction in light of current development trends, achieve its renewal and iteration, and further promote the construction of evidence-based science and the development of multidisciplinary integration.

A New Chapter in the COVID-19 Pandemic: the Characteristics of Omicron Variant and A New Step for Scientific Epidemic Prevention and Control

LI Yi, XU Yingchun

2023, 14(1): 9-17. doi: 10.12290/xhyxzz.2022-0697

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Since the outbreak of COVID-19, SARS-CoV-2 has continued to evolve. As the fifth variants of concern (VOCs) announced by the World Health Organization, Omicron has significantly changed from previous VOCs in terms of genome, biological and epidemiological characteristics. Although the severe illness and mortality caused by Omicron infection are significantly lower than those caused by the previous VOCs, Omicron's strong transmission ability has continued to break through the epidemic prevention barrier and human immunity barrier established by prior infections and vaccines. Omicron has opened a new chapter in the COVID-19 pandemic. In this paper, we review the changes in genome and biological characteristics of Omicron and its subspecies as well as the differences in epidemiological characteristics between Omicron and influenza viruses in order to provide scientific basis for the optimization of epidemic prevention and control.

Resident-attending-professor Rounds of Consultation-liaison Psychiatry Service to Provide the Hospitalized Care of Psychiatric Comorbidities of General Hospital Inpatients

CAO Jinya, DUAN Yanping, WEI Jing

2023, 14(1): 18-21. doi: 10.12290/xhyxzz.2022-0578

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There is a high prevalence of psychiatric comorbidity in general hospital inpatients of various physical departments. Psychiatric comorbidity may result in the difficulty in clinical communication, longer hospitalization, worse clinical outcomes and higher costs. However, psychiatric comorbidities are often neglected and left untreated. We believe this phenomenon is caused by complex problems including, but not limited to, insufficient recognition, insufficient invitation for consultation, clinical challenge of complex multiple-comorbidi-ties, and insufficient treatment. To address these problems, we developed consultation-liaison psychiatry system of resident-attending-professor rounds with fixed follow-ups to provide standardized care to general hospital inpatients with psychiatric comorbidity.

Rethinking and Exploring the Comprehensive Evaluation of Clinical Practice Guidelines

SUN Yajia, SHI Qianling, YANG Nan, GUO Qiangqiang, SU Renfeng, CHEN Ze, ZHANG Guangxin, CAO Xichao, CHEN Yaolong

2023, 14(1): 22-30. doi: 10.12290/xhyxzz.2022-0612

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A comprehensive evaluation of clinical practice guidelines (CPGs) is essential to measure their quality. This study introduces the function and meaning of the systematic review of CPGs and combs the development and current status of guideline appraisal tools. On this basis, we expound the content and characteristics of the Scientific, Transparent, and Applicable Rankings Tool (STAR) for Guidelines in depth, with the hope of providing reference for the improvement of the compressive guideline assessment system and the development of high-quality guidelines in the future.

Development of the Implementation Framework of Integrative Chinese Medicine Clinical Practice Guideline

LAI Honghao, SUN Mingyao, HUANG Jiajie, LI Ying, NING Jinling, ZHAO Weilong, TANG Wenjing, YANG Shuihua, TIAN Jinhui, CHEN Yaolong, SHANG Hongcai, Yang Kehu, GE Long

2023, 14(1): 31-38. doi: 10.12290/xhyxzz.2022-0667

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As an important guidance of medical practice, clinical practice guideline of integrative Chinese medicine (ICM-CPG) plays an extremely important role in showing the respective advantages of Chinese and Western medicine and in promoting the integrated Chinese and Western medicine. However, the research status on ICM-CPG is faced with the problem of emphasizing development but neglecting implementation. The establishment of ICM-CPG implementation model based on the theoretical framework of implementation science is conducive to promoting the implementation of ICM-CPG and advancing the integration and development of Chinese and Western medicine. In this paper, by sorting out and analyzing the knowledge to action (KTA) framework, we discuss the implementation framework development of ICM-CPG in order to provide reference for future research.

Research on High Quality Evidence Acquisition and Application of Evidence-based Medicine

FAN Meiyu

2023, 14(1): 39-43. doi: 10.12290/xhyxzz.2022-0202

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With the advent of the era of medical big data, new changes have occurred in the development of evidence-based medicine. This paper defines data-driven evidence-based medicine, and explains the changes it brings to evidence-based medicine. The intelligent evidence acquisition and utilization process of evidence-based medicine is discussed from more and more scientific original evidence sources, intelligent evidence-based medicine literature information extraction, AI-based real-world health and medical data analysis, innovative clinical research disease database, and AI-based clinical guidelines and other scenarios. The main factors affecting the evidence production of evidence-based medicine may involve data integration, data quality, technical deviation, data security and ethics, talent team and so on.

Weight Control and Non-alcoholic Fatty Liver Disease: Evidence from China

YANG Chenlu, ZHAO Xinyu, HU Shiqi, LAN Yanqi, FENG Baoyu, WANG Li

2023, 14(1): 44-49. doi: 10.12290/xhyxzz.2022-0691

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Based on the clinical trials and cohort studies in the Chinese population, this paper systematically summarized the association between weight/ body mass index (BMI) and their changes in preventing non-alcoholic fatty liver disease (NAFLD) and its adverse outcomes. The results showed that BMI was positively correlated with NAFLD risk, but for those with NAFLD, BMI was negatively related to the remission of NAFLD and there was a non-linear dose-response relationship between BMI and adverse outcomes. The lean NAFLD group had a higher risk of all-cause death, liver-related death, digestive system tumors, and obesity-related tumors than the overweight or obese NAFLD and lean non-NAFLD group. Additionally, the association between baseline BMI levels and adverse outcomes in NAFLD populations may be affected by other metabolic indicators. After controlling for baseline BMI, most studies suggested that weight loss could reduce the NAFLD risk. However, there is no consistent conclusion on how to control weight to prevent NAFLD because the methods and the time windows to assess BMI changes vary in different studies. Moreover, for those with NAFLD, limited evidence suggested the different relationship between weight loss and different outcomes. Therefore, we call for conducting multi-center cohort and experimental studies to verify the effect of weight control on NAFLD and its related adverse outcomes after considering the heterogeneity of NAFLD, so as to propose precision weight control recommendations.

Diagnosis and Clinical Management of COVID-19 Infection in Adults: Operational Recommendations of Peking Union Medical College Hospital (2023)

Multi-disciplinary Expert Team for COVID-19, Peking Union Medical College Hospital

2023, 14(1): 50-59. doi: 10.12290/xhyxzz.2023-0003

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With the adjustment of China's COVID-19 policies and measures, the treatment of infected patients, especially the severe and critically ill patients, has become the focus of all medical staff at this stage. Since the outbreak of the pandemic, Peking Union Medical College Hospital has accumulated rich experience in this field. Based on the updated international evidence-based knowledge, the multidisciplinary expert group of COVID-19 at Peking Union Medical College Hospital has compiled a set of operational recommendations. Adhering to the evidence-based, concise, and clinically operable principles, these recommendations for diagnosis and treatment integrate the latest research evidence. For clinical issues that lack evidence, certain recommendations are given based on the frontline clinical working experience and expert opinions. The purpose is to enhance medical staff's understanding of COVID-19 infection and its critical illness and improve patient care.

Practical Recommendations of Peking Union Medical College Hospital for Assessment and Management of COVID-19 in Primary Care (2023)

Multi-disciplinary Expert Team for Primary Care COVID-19 Practice, Peking Union Medical College Hospital

2023, 14(1): 60-74. doi: 10.12290/xhyxzz.2023-0014

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Following the recent adjustments to coronavirus disease 2019 (COVID-19) prevention and control policies, an increasing number of medical staffs, especially those in primary care facilities are confronted with rapid growth of COVID-19 patients. Peking Union Medical College Hospital (PUMCH) has therefore compiled this recommendation for COVID-19 primary care practices based on a patient-centered perspective and following recommendations from domestic and international guidelines as well as the latest Chinese government policies. Further, PUMCH's conception and compilation of this recommendation strictly adhere to evidence-based, concise and clinically applicable principles of practice. For the critical clinical questions with insufficient medical evidence, the recommendation offers insights on the basis of experience from PUMCH multi-disciplinary expert team and first-line medics' practices. Emphasizing on screening community residents with higher risk of severe illness, implementing early interventions including pharmaceutical treatment, enhancing nutritional support and improving sleep quality, we aim to construct a "Household-Community-Hospital" tertiary defense, with the hope of promoting health and reducing severe cases.

Recommendations of Nutritional Treatment for Patients with COVID-19 Infection (2023)

KANG Junren, YU kang, LIU Yanping, YAN Jie, DOU Pan, HUA Xin, Beijing Quality Control and Improvement Center for Clinical Nutrition Therapy

2023, 14(1): 75-80. doi: 10.12290/xhyxzz.2023-0019

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The standardized nutrition support therapy can improve the nutritional status, immunity, quality of life, and clinical outcomes of patients with novel coronavirus disease (COVID-19) infection. The latest Chinese government policy also clearly states that nutrition support therapy should be included in the whole process of treatment and recovery of patients with COVID-19. Therefore, the Beijing Quality Control and Improvement Center for Clinical Nutrition Therapy has organized relevant experts to formulate the Recommendations of Nutritional Treatment for Patients with COVID-19 Infection (2023), following the latest clinical nutrition guidelines, research evidence and clinical practice of nutrition support of COVID-19. The recommendations suggest that individualized nutrition management be implemented by following the standardized pathway of nutrition management, which includes nutrition-risk screening, malnutrition diagnosis, nutrition treatment and nutrition monitoring, and by taking into account the clinical characteristics of patients with COVID-19.

Interpretation of Guidance for the Design and Implementation of Drug Clinical Studies: Based on E8 (R1): General Considerations for Clinical Trials

BAI Xiaoyin, YANG Hong

2023, 14(1): 81-85. doi: 10.12290/xhyxzz.2022-0611

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As clinical research and drug development in China continue to advance, greater attention has been paid to the value of clinical research guidelines. The first revision of the original E8 recommendations (R1), "General Considerations for Clinical Research" was made by the International Council for Harmonization in October 2021. Our National Medical Products Administration has recently opted to implement the rules beginning from July 2023. In order to provide useful references for improved design and execution of drug clinical studies in China, this paper primarily interprets the fundamental background and revision of E8 (R1) from the perspective of clinical workers. It also analyzes and discusses the application of the current clinical study guidelines in China.

Interpretation on Management Guideline for the Off-label Use of Drugs in China(2021 Edition)

ZUO Wei, LIU Rongji, SUN Yajia, ZHANG Bo, CHEN Yaolong, ZHANG Shuyang

2023, 14(1): 86-93. doi: 10.12290/xhyxzz.2022-0588

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Off-label drug use represents a reasonable need for diagnosis and treatment in some cases, but it faces potential risks with drug safety and legal challenges. However, there was no guideline on how to manage the off-label drug use in China. Therefore, Peking Union Medical College Hospital, in cooperation with Evidence-based Medicine Center of Lanzhou University, established a working group and an expert group consisting of multidisciplinary group of experts to develop the Management Guideline for the Off-label Use of Drugs in China (2021). The Guideline is guided by the Law on Doctors of the People's Republic of China and the World Health Organization Guideline Development Manual. This is the first management guideline on the off-label use of drugs, aiming to improve the stakeholders' understanding of this topic and establish a standardized management procedure in China. This guideline has determined nine questions and proposed a total of twenty-three recommendations. The English version of the guideline was published in September 2022. This paper offers a detailed interpretation of the key points of the guidelines in order to provide suggestions and references for the management of off-label drug use.

Interpretation on the Chinese Guideline for Diagnosis and Treatment of Neuroendocrine Neoplasms from The China Anti-Cancer Association(2022)

LIANG Yun, WU Wenming, NIE Yongzhan, CHEN Jie

2023, 14(1): 94-100. doi: 10.12290/xhyxzz.2022-0607

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Neuroendocrine neoplasms (NENs) are a group of malignancies arising from neuroendocrine cells and peptidergic neurons. The high heterogeneity of NENs leads to challenges and complexities in its diagnosis and treatment. Experts from relevant disciplines were convened by the Society of Neuroendocrine neoplasm of China Anti-Cancer Association to develop this first edition of the Chinese Guideline for diagnosis and treatment of NENs (2022) based on existing evidence combined with domestic and international guidelines and consensus. In this article, we summarize the important contents of this guideline and make further discussion on some controversial issues, with the aim to provide treatment reference in clinical practice.

Development and Validation of A Prognosis Prediction Model for Esophageal Squamous Cell Carcinoma Patients Treated with Esophagectomy: A Multicenter Real-world Cohort Study

YANG Wenlei, LIU Fangfang, XU Ruiping, YANG Wei, HE Yu, LIU Zhen, ZHOU Fuyou, HENG Fanxiu, HOU Bolin, ZHANG Lixin, CHEN Lei, ZHANG Fan, CAI Fen, XU Huawen, LIN Miaoping, LIU Mengfei, PAN Yaqi, LIU Ying, HU Zhe, CHEN Huanyu, HE Zhonghu, KE Yang

2023, 14(1): 101-113. doi: 10.12290/xhyxzz.2022-0496

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Objective To construct and validate a prognosis prediction model and a risk stratification tool for more precise and individualized evaluation of prognosis for patients following resection of esophageal squamous cell carcinoma (ESCC), and provide real-world evidence for informing optimal decision-making about adjuvant therapy. Methods The comprehensive clinical data and follow-up data were collected from consecutive patients with ESCC in the Anyang Cancer Hospital (Anyang center) from May 31, 2011 to July 31, 2018, and in the Cancer Hospital of Shantou University Medical College (Shantou center) from August 1, 2009 to December 31, 2018. Patients from the Anyang center formed the training cohort, and a two-phase selection based on backward stepwise multivariable Cox proportional hazard regression and minimization of AIC was used to construct prediction model for overall survival (OS). Bootstrap with 1 000 resamples was used for internal validation, and cohort from the Shantou center was used for external validation. Furthermore, a risk stratification tool was constructed according to the tertiles of the total points derived from nomogram in the training cohort. Results A total of 4 171 eligible patients were included in the training cohort, and 1 895 patients were included in the validation cohort. The final model incorporated nine variables: age, sex, primary tumor location, T stage, N stage, number of lymph nodes harvested, tumor size, adjuvant treatment, and preoperative hemoglobin level. A significant interaction was observed between N stage and adjuvant treatment (P < 0.001), which means that N+ stage patients were likely to benefit from addition of adjuvant therapy as opposed to surgery alone, but adjuvant therapy did not improve OS for N0 stage patients. The C-index of the model was 0.728 (95% CI: 0.713-0.742) in the training cohort, 0.722 (95% CI: 0.711-0.739) after bootstrapping, and 0.679 (95% CI: 0.662-0.697) in the external validation cohort. Calibration plots demonstrated favorable agreement between model prediction and actual observation for 1-, 3- and 5-year OS. In both training and validation cohorts, this model outperformed the seventh edition of the AJCC TNM (tumor, lymph node, and metastasis) staging system in terms of the accuracy of prognostic prediction (P < 0.05). Moreover, within each TNM staging group, this model achieved ideal risk stratification. Conclusions The prediction model constructed in this study may provide individualized survival prediction for patients with resected ESCC in China. This study also demonstrated that the N stage may be a fundamental determinant in planning postoperative adjuvant therapy for ESCC patients.

Evaluation of the Effectiveness of Colonoscopy, Fecal Immunochemical Test and Risk-adapted Screening Strategies in Population-based Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial

CHEN Hongda, LIAO Xianzhen, DU Lingbin, DONG Dong, WEI Donghua, GAO Yi, ZHENG Weifang, CHEN Jingjun, LU Ming, ZHANG Yuhan, LU Bin, LUO Chenyu, LI Na, ZHOU Yueyang, LUO Jiahui, CAI Jie, SHI Jufang, DAI Min

2023, 14(1): 114-123. doi: 10.12290/xhyxzz.2022-0537

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Objective To evaluate the feasibility and effectiveness of colonoscopy, fecal immunochemical test(FIT) and risk-adapted screening strategies in population-based colorectal cancer screening. Methods Based on the randomized controlled trial of colorectal cancer screening(TARGET-C) which was carried out in 6 centers of 5 provinces in China from May 2018 to May 2021, the participants who met the inclusion criteria of the study were randomly assigned to one of the following screening intervention groups in a ratio of 1∶2∶2, which were colonoscopy group, FIT group and risk-adapted screening group(participants evaluated to be at high risk were recommended to undertake colonoscopy, those at low risk were recommended to undertake FIT and FIT positive people received colonoscopy). The 3 groups received different schemes of colorectal cancer screening, in which the colonoscopy group only received baseline screening, whereas the FIT group and the risk-adapted screening group received annual follow-up screening on the basis of baseline screening. The main outcome was the detection rate for advanced colorectal neoplasm(including colorectal cancer and advanced adenoma). The participation rate, detection rate for any neoplasm and resource load of colonoscopy among different screening groups were further analyzed. Results A total of 19 373 participants meeting the inclusion and exclusion criteria were enrolled, including 8082 males(41.7%) and 11 291 females(58.3%), with an average age of (60.5±6.5) years. Among them, 3883 were in the colonoscopy group, 7793 in the FIT group, and 7697 in the risk-adapted screening group. After 1 or 3 rounds of screening(2 rounds of follow-up screening completed in FIT group and risk-adapted screening group), the overall participation was the highest for the FIT group(99.3%), followed by the risk-adapted screening group(89.2%) and the coloscopy group(42.3%). According to the intention-to-treat analysis, the detection rates of advanced neoplasm in the colonoscopy group was higher than that in the FIT group(2.76% vs. 2.17%, OR_{colonoscopy vs FIT}=1.30, 95% CI: 1.01-1.65, P=0.037); there were no statistically significant differences regarding the detection rates of advanced neoplasm between the colonoscopy group and the risk-adapted screening group(2.76% vs. 2.35%, OR_{colonoscopy vs risk-adapted screening}=1.19, 95% CI: 0.93-1.51, P=0.156), and between the risk-adapted screening group and the FIT group(2.35% vs. 2.17%, OR_{risk-adapted screening vs FIT}=1.09, 95% CI: 0.88-1.34, P=0.440). The number of colonoscopies needed to be performed to detect one advanced neoplasm was used as an indicator to evaluate the resource load of colonoscopy. The number was the highest for the coloscopy group(15.4), followed by the risk-adapted screening group(10.2) and the FIT group(7.8). Conclusions The risk-adapted screening strategy is feasible and effective in population-based colorectal cancer screening, and could serve as an effective supplement to the traditional colonoscopy and FIT-based colorectal cancer screening strategies.

Investigation and Risk Factors of Helicobacter pylori Infection in Patients with Inflammatory Bowel Disease

ZHOU Runing, ZHANG Li, MA Kaiyu, BAO Xiuqi, WANG Weiguo, RUAN Gechong, YANG Hong

2023, 14(1): 124-130. doi: 10.12290/xhyxzz.2022-0639

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Objective To investigate the rate and risk factors of Helicobacter pylori(Hp) infection in patients with inflammatory bowel disease(IBD). Methods A survey was conducted from January 1, 2020 to December 31, 2020 by sending an electronic questionnaire to long-term follow-up IBD patients of Peking Union Medical College Hospital and age-sex-matched Beijing community residents. General information, information related to Hp infection and environmental factors were collected from the two groups. The differences in Hp positivity rates between the two groups and IBD patients with different clinical profiles were compared. Results After propensity score matching, 122 patients with IBD and 1739 community residents were finally included in this study. The histograms of propensity score values were highly consistent between the two groups. The ratio of Hp infection was significantly lower in IBD patients than in the community residents (13.1% vs. 42.7%, P < 0.001). The ratio of Hp infection in both groups increased with age but showed no statistical significance (all P > 0.05). Univariate analysis showed that the IBD patients with Hp positive co-diners had a significantly higher ratio of Hp infection than those with Hp negative co-diners (43.8% vs. 18.9%, P=0.006). Conclusions The Hp infection rate was lower in IBD patients than in community residents. The possible risk factor may be co-dining with Hp positives.

Changes of Peripheral Blood Lymphocyte Subsets in 212 Active Tuberculosis Patients: A Uni-centered Descriptive Study

XIE Lantian, RUAN Guiren, LIU Xiaoqing, ZHANG Lifan, ZHANG Yueqiu, QIU Zhifeng, SHI Xiaochun

2023, 14(1): 131-138. doi: 10.12290/xhyxzz.2022-0645

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Objective To explore the characteristics and their significance of peripheral blood lymphocyte subsets in patients with active tuberculosis(ATB), based on a relatively large sample. Methods Clinical data were retrospectively collected from patients with ATB hospitalized in Peking Union Medical College Hospital (June 2012-January 2022) and the healthy population matched with age and sex (March 2019-May 2022). The characteristics of changes in peripheral blood lymphocyte subsets in ATB patients were analyzed using the healthy population as controls, and group comparisons were made between ATB patients with different modes of diagnosis and sites of involvement. Results A total of 212 ATB patients and 200 healthy participants were included. ATB patients consisted of 82 cases (38.7%) without etiological evidence and 130 cases(61.3%) with etiological evidence (77 with pulmonary tuberculosis, 21 with extrapulmonary tuberculosis, and 32 with pulmonary and extrapulmonary tuberculosis). Compared to healthy population, ATB patients had significantly lower counts and percentages of multiple peripheral blood lymphocyte subsets indicators, significantly higher percentage in T lymphocyte, CD8⁺T lymphocyte as well as higher memory CD4⁺T lymphocyte/CD4⁺T lymphocyte ratio and CD38⁺CD8⁺T lymphocyte/CD8⁺T lymphocyte ratio(all P < 0.05). Lymphocyte, B-cell, natural killer (NK) cell, T-lymphocyte, CD4⁺T-lymphocyte, and CD8⁺T-lymphocyte counts were lower in patients with pathogenetically confirmed ATB than in those with clinically confirmed ATB (all P < 0.05). There were no significant differences in the counts of memory CD4⁺T lymphocytes, naïve CD4⁺T lymphocytes, CD28⁺T lymphocytes and activated CD8⁺T lymphocyte subpopulations and their percentages in patients with different tuberculosis infection sites (all P > 0.05). Compared to pulmonary tuberculosis alone, patients with pulmonary and extrapulmonary tuberculosis had lower B-cell counts[23(10, 69)cells/μL vs. 73(25, 133)cells/μL, P=0.003] and patients with extrapulmonary tuberculosis alone had higher percentages of NK cells[16.7%(10.8%, 23.6%) vs. 10.6% (5.3%, 17.4%), P=0.042]. Conclusion ATB patients manifested a reduction in peripheral blood lymphocyte subset, indicating remarkable dysfunction of immune system.

Fungal Microscopic Image Classification Based on Multi-scale Attention Mechanism

ZHANG Xueyuan, XU Hongyan, DONG Yueming, LIU Danfeng, SUN Pengrui, YAN Rui, CUI Hongliang, LEI Hong, REN Fei

2023, 14(1): 139-147. doi: 10.12290/xhyxzz.2022-0169

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Objective To establish a fungal image-assisted classification model using deep learning technology. Methods The microscope images of people infected with Aspergillus, Saccharomyces and Cryptococcus neoformans were retrospectively collected from the Eighth Medical Center of PLA General Hospital from September 2020 to April 2021. The images were randomly divided into training set, validation set and test set according to the ratio of 7∶1.5∶1.5. The improved MobileNetV2 network structure was trained using the training set, a convolutional neural network (CNN) fungal image 11 classification model based on multi-scale attention mechanism was constructed and the parameters were debugged based on the validation set. Machine identification results were taken as the gold standard, the performance of the model on 11 fungal image classification tasks was evaluated, and the results were shown by precision, recall and F1 value. In addition, the performance of the proposed model with 5 classic CNN models were compared, and the results were measured in terms of model parameters, memory usage, frames per second (FPS), accuracy, and area under the curve (AUC) of receiver operating characteristic curve. Results A total of 7666 fungal microscope images were collected, including 2781, 4115, and 770 images of Aspergillus, Saccharomyces, and Cryptococcus neoformans, respectively. Among them, there were 5366 training images, 1150 validation images, and 1150 test images. The improved MobileNetV2 model had high performance for the classification of 11 fungal images in the test set. The precision rate was distributed between 96.36% and 100%, the recall rate was distributed between 96.53% and 100%, and the F1 value was distributed between 97.01% and 100%. The parameters, memory usage, FPS, accuracy, and AUC of the improved MobileNetV2 model were 4.22 M, 356.89 M, 573, (99.09±0.18)%, and 0.9944±0.0018, respectively, and the comprehensive performance was better than 5 kinds of classical networks. Conclusion The proposed fungal image classification model based on the improved MobileNetV2 can obtain higher fungal image recognition ability while maintaining low computational cost, with an overall performance better than classical CNN model.

Influencing Factors of Hospital Costs for Pituitary Tumor Under DRG Payment

YANG Lang, WEI Junji, YIN Rui, WEN Junxian, CHANG Jianbo, CHEN Yihao, ZHANG Xiao, ZHANG Guojie, LI Chunhou, MA Wenbin, WANG Renzhi

2023, 14(1): 148-152. doi: 10.12290/xhyxzz.2022-0068

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Objective To analyze the influencing factors of hospitalization expenses of patients treated in the KC19 group by the neurosurgery department of a tertiary hospital in Beijing, and provide reference for the refinement of diagnosis related groups(DRG). Methods The medical records of 3809 patients from January 1, 2017 to November 30, 2021 were reviewed, and relevant influencing factors were determined using descriptive statistics, univariate analysis, and multivariate linear regression. Results Among the 3809 patients included in this study, the average total hospitalization cost was 36 166.82 yuan, and the average hospital stay was 9.42 days. Neuroendoscopy accounted for 35.2%, while major complications or comorbidities (MCC) and complications or comorbidity (CC) accounted for 40%. Univariate analysis found that hospitalization costs were associated with gender, length of hospital stay, number of other diagnoses, number of surgical procedures, use of neuroendoscopy, and the presence of MCC or CC. Multivariate analysis found that the main influencing factors were the length of hospital stay, followed by the number of other diagnoses, the number of surgical operations, whether neuroendoscopy was used, whether there was MCC or CC, and gender. Conclusion In the follow-up fine grouping of KC19, the above influencing factors should be considered, and the use of neuroendoscopy and the presence of MCC or CC should be included in the grouping criteria.

Analysis of Influencing Factors for High-risk Human Papillomavirus Infection

WANG Xiaodan, ZHANG Zhan, LIU Zhaohui

2023, 14(1): 153-158. doi: 10.12290/xhyxzz.2022-0193

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Objective To investigate the relevant risk factors of high-risk human papillomavirus(HR-HPV) infection. Methods From October 2020 to January 2021, the cases of positive HR-HPV test were selected as the infection group, and the cases of negative HR-HPV test were selected as the control group. Both groups of patients filled in self-designed "survey of HR-HPV infection-related factors" in order to explore the relevant risk factors. Results A total of 125 patients in the infection group and 53 patients in the control group were included. Univariate analysis showed that there were statistically significant differences between the two groups in the following factors: unemployed or low socioeconomic status, vulva cleaning with lotion, high frequency of vaginal irrigation, homosexual orientation, production number, history of vaginitis, large amount of vaginal secretions, abnormal characteristics of vaginal secretion and chlamydia trachomatis infection(all P < 0.05). Logistic regression analysis showed that production number(OR=5.106, 95% CI: 1.521-17.145, P=0.008), previous history of vaginitis (OR=3.910, 95% CI: 1.167~13.099, P=0.027) and abnormal vaginal secretion (OR=758.313, 95% CI: 58.151~9888.714, P < 0.001) were risk factors for HR-HPV infection. In addition, the habit of using lotion to clean the vulva or vagina(OR=2.004), homosexual orientation (OR=13.972), and chlamydia trachomatis infection (OR=15.058) all showed a strong association with HR-HPV, but due to the small number of samples in the control group, no conclusions with statistical significance were drawn. Conclusions HR-HPV papillomavirus infection is associated with a variety of factors. Production number, history of vaginitis and abnormal characteristics of vaginal secretion are risk factors for HR-HPV infection. It is therefore recommended to pay attention to the characteristics of vaginal secretions, and timely seek medical treatment if there is any abnormality. If possible, cervical HR-HPV screening should be added to the vaginal microecological examination. If there are reproductive tract inflammatory diseases, it should be treated in time, so as to prevent HR-HPV infection from many aspects and reduce the risk of continuing infection of HR-HPV.

Image Recognition Method of Cervical Adenocarcinoma in Situ Based on Deep Learning

LIU Chang, ZHENG Yuchao, XIE Wenqian, LI Chen, LI Xiaohan

2023, 14(1): 159-167. doi: 10.12290/xhyxzz.2022-0109

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Objective To construct a pathological image diagnostic model of cervical adenocarcinoma in situ(CAIS) based on deep learning algorithm. Methods Pathological tissue sections of CAIS and normal cervical canal and gland sections of chronic cervicitis stored in the Pathology Department of Shengjing Hospital, China Medical University from January 2019 to December 2021 were retrospectively collected. After image collection, they were randomly divided into training set, validation set and test set with a ratio of 4∶3∶3. The data of training set and validation set were used to conduct transfer learning training and parameter debugging for 6 network models, including VGG16, VGG19, Inception V3, Xception, ResNet50 and DenseNet201, and the convolutional neural network binary classification model that could recognize pathological images of CAIS was constructed. The models were combined to build the ensemble learning model. Based on the test set data, the performance of pathological image recognition of single model and ensemble learning model was evaluated. The results were expressed by operation time, accuracy, precision, recall, F1 score and area under the curve(AUC) of receiver operating characteristic. Results A total of 104 pathological sections of CAIS and 90 pathological sections of normal cervical duct and gland with chronic cervicitis were selected. A total of 500 pathological images of CAIS and normal cervical duct glands were collected, including 400 images of training set, 300 images of validation set and 300 images of test set, respectively. Among the 6 models, ResNet50 model, with the highest accuracy(87.33%), precision(90.00%), F1 score(86.90%) and AUC(0.87), second highest recall(84.00%) and shorter operation time(2062.04 s), demonstrated the best overall performance; VGG19 model was the second; and Inception V3 and Xception model had the worst performance.Among the 6 kinds of ensemble learning models, ResNet50 and DenseNet201 showed the best overall performance, and their accuracy, precision, recall, F1 score and AUC were 89.67%, 84.67%, 94.07%, 89.12% and 0.90, respectively. VGG19 and ResNet50 ensemble model followed. Conclusions It is feasible to construct CAIS pathological image recognition models by deep learning algorithm, among which ResNet50 models has higher overall performance. Ensemble learning can improve the recognition effect on pathological images by single model.

Data and Methods in Computer-aided Diagnosis Systems of Skin Diseases

YANG Yiguang, WANG Juncheng, XIE Fengying, LIU Jie

2023, 14(1): 168-176. doi: 10.12290/xhyxzz.2022-0413

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Skin diseases affect people's health and quality of life because of their high incidence, difficult diagnosis and apparent harm, coupled with insufficient medical resources. In recent years, with the development of computer-aided diagnosis (CAD) technology, single-modality CAD approaches have broken the limitations of traditional methods, such as strong subjectivity, and high missed-diagnosis and misdiagnosis rate, but failed to leverage the multi-modal information in real clinical scenarios. Multi-modality CAD methods help artificial intelligence models learn the clinical representations in a more complex and comprehensive manner, aiding dermatologists in making a more accurate diagnosis of skin diseases. This article introduces different types of skin lesion data commonly used in CAD methods, summarizes the single-modality/multi-modality methods based on related works in the field of CAD systems of skin diseases, and predicts possible future development trends of CAD technology, thus providing insights for mitigating the challenge on the diagnosis of skin diseases.

Clinical Trials and Current Progress in the Treatment of Triple-negative Breast Cancer

LI Linrong, LI Yan, SUN Qiang

2023, 14(1): 177-183. doi: 10.12290/xhyxzz.2022-0085

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This article enumerates the latest updates on clinical trials in triple-negative breast cancer (TNBC) in surgery, radiation, chemotherapy, targeted therapy and immunotherapy. Breast-conserving surgery and sentinel lymph node biopsy have become current trends in early-stage breast cancer, and breast reconstruction can significantly improve patients' quality life and mental health after mastectomy. The progress in radiotherapy includes regional lymph node radiation, intraoperative radiotherapy, hypofractionated radiation, and accelerated partial breast irradiation. In addition, olaparib, sacituzumab govitecan, halaven, utidelone, and Pembrolizumab have been applied in the treatment of TNBC, with promising efficacy and acceptable safety profiles. In the future, a better understanding of mechanisms involved in tumorigenesis, accompanied by individualized treatment, would improve the prognosis and life quality of patients with TNBC.

Big Data and Artificial Intelligence in Medicine

LI Yang, DU Leilei, XU Fei, LI Yixuan, QIAO En

2023, 14(1): 184-189. doi: 10.12290/xhyxzz.2022-0182

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With the development of information technology in medicine, the amount of medical data mainly characterized by unstructured data has increased dramatically. The massive data can be processed by big data technology to generate databases with different themes and create huge additional value. At the same time, with the rapid development of artificial intelligence technology centered on deep learning, diagnosis and treatment assisted by artificial intelligence has shown a huge development prospects, which is helpful to guide medical activities and improve the efficiency of medical processes. The combination of big data, artificial intelligence and medical industry will become an important development direction in the future. This paper summarizes the application of big data and artificial intelligence in medicine.

Advances in the Study of Lynch Syndrome Associated Endometrial Cancer

LIU Xiao, LI Yulan, MA Xing, XU Feixue

2023, 14(1): 190-195. doi: 10.12290/xhyxzz.2022-0189

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Lynch syndrome (LS), an autosomal dominant genetic disorder caused by mismatch repair gene defects, is characterized by the susceptibility to multi-system malignancies. LS associated endometrial cancer (LS-EC) is the most common extraintestinal sentinel cancer of LS. In the era of precision medicine, early screening of LS-EC is of great significance to preventing the occurrence of other LS related malignant tumors. This paper reviews the research progress on screening methods and prevention of LS-EC, in order to provide reference for precise diagnosis and prevention of LS-related tumors.

Analysis on Prophylaxis of Pneumocystis Carini Pneumonia by Trimethoprim-Sulfamethoxazole in Patients with Autoimmune Diseases

QUE Yongtu, LI Pengchong, ZHANG Fengchun

2023, 14(1): 196-202. doi: 10.12290/xhyxzz.2022-0131

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The incidence of the opportunistic infection of pneumocystis carini pneumonia(PCP) in patients with autoimmune diseases has increased over recent years, because of the use of glucocorticoids, immunosuppressants, small molecule targeted drugs and biological agents. This group of patients show more rapid progress and higher mortality than human immunodeficiency virus positive patients with PCP. Sulfonamide is the first-line treatment for PCP. Many scholars advocate taking trimethoprim-sulfamethoxazole(TMP-SMZ) for prophylaxis of PCP. However, the adverse effects of sulfonamides and drug resistance cannot be ignored. This article reviews the risk factors for the development of PCP in patients with autoimmune diseases, the effectiveness of PCP prevention with TMP-SMZ, and adverse drug reactions, tolerance, and drug resistance.

Registration of Clinical Practice Guidelines

GUO Qiangqiang, XUN Yangqin, LIU Hui, LUO Xufei, YU Xuan, SHI Qianling, ZHOU Qi, WANG Zijun, CHEN Yaolong

2023, 14(1): 203-208. doi: 10.12290/xhyxzz.2022-0521

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The registration of the guidelines is not only the initial step in the development process, but also an important part of the quality control of the guidelines. Thus, we analyzed the establishment and evolution of registration systems, the current state of guideline registration platforms, and the use of the Practice guideline REgistration for transPAREncy(PREPARE), with the goal of improving the transparency and quality of guideline development.

Evidence-based Treatment with Chronic Colonic Diverticulitis: A Case Report

YU Ziqing, TANG Xiaoyan, WU Bin, YANG Hong

2023, 14(1): 209-214. doi: 10.12290/xhyxzz.2022-0585

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Colonic diverticulitis is a common gastrointestinal disease which can be acute or chronic in course. In this paper we report the management of a patient with chronic colonic diverticulitis. The patient had an atypical clinical presentation, whose imaging showed a high likelihood of occupying lesions. PET/CT showed hypermetabolism focus and colonoscopy saw mucosal thickening, pathological return of inflammation in the acute phase, which were difficult in differential diagnosis with colorectal cancer and inflammatory bowel disease. After comprehensive consideration, follow-up observation was recommended and the diagnosis was finally clarified. The management of this patient demonstrates the importance of evidence-based medicine in the diagnosis and treatment of diseases.

Application of All-elements Surgical Simulated Surgery Training in Surgical Skills Training for Interns

QIU Xiaoyuan, BAI Xueshan, LIU Yuxin, LIN Guole

2023, 14(1): 215-219. doi: 10.12290/xhyxzz.2021-0801

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Objective To develop a real and comprehensive all-elements surgical simulation teaching for clinical skills training, and observe the differences between this method and the traditional standardized training. Methods All interns were randomly divided into experimental group (all-elements surgical simulated surgery training group) and control group (traditional standardized training teaching group). The control group was trained according to the operating procedures in traditional textbooks, while the experimental group was trained according to the All-elements Surgical Simulated Surgery Tutorial compiled by the subject group. After the training was completed, the students took basic surgical skills assessment, and questionnaires was issued to investigate how they felt about the course. Results A total of 80 interns were included, with 40 each in the test and control groups. In the examination of surgical clinical skills, the scores of students in the experimental group were higher than those in the control group, including disinfection and drape, incision and suture, ligation and hemostasis, dressing and suture removal, debridement, abscess incision, thoracic drainage extraction. The differences between the two groups were statistically significant (all P < 0.01). In the questionnaire for feedback of teaching effect, the scores of students in the experimental group were higher than those in the control group, including self-operation ability, clinical self-thinking ability, self-learning efficiency, teaching methods acceptance, and the differences between the groups were statistically significant (all P < 0.05). Conclusions Compared with the traditional standardized training, the all-elements operation training can significantly improve the operation skill of interns. At the same time, interns have better acceptance and satisfaction with the new training method.

Application of Image Ward Round in Department of Critical Care Medicine

ZHOU Yuankai, HE Huaiwu, LONG Yun

2023, 14(1): 220-224. doi: 10.12290/xhyxzz.2021-0743

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The application of various bedside imaging monitoring techniques in critical care department makes the necessity of imaging ward round increasingly prominent. In terms of medical treatment, it is beneficial to increase the accuracy of intervention, improve the consistency of team working mode, and enhance the level of individualized and organ-targeted treatment. In terms of teaching, it helps to deepen the understanding of the physiological mechanism of diseases, promote the cultivation of critical clinical thinking, and improve the use of the monitoring equipment. In the aspect of scientific research, it facilitates the summary of image data and the development of scientific research ideas. At the same time, it is necessary to pay attention to data security, patient privacy and limitations of imaging data when ward rounds are conducted.

The Parasitologists and Medical Educators of Peking Union Medical College Shown on the Old Postcards

WEI Yuhang, LI Zeya, YANG Shuyue, ZHANG Weihua

2023, 14(1): 225-228. doi: 10.12290/xhyxzz.2021-0759

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The information on the two old postcards sent from Peking Union Medical College was studied. Henry E. Meleney and H.F. Hsü, the parasitologists and medical educators of Peking Union Medical College, were introduced. Their experiences in scientific research and achievements were reviewed. The professional ethics of serving patients and the scientific spirit with rigorous research of the medical scientists are of practical educational significance.

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2023 Vol. 14, No. 1

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