常染色体显性多囊肾病（ADPKD）是导致遗传性肾衰竭的主要病因之一，目前仍缺乏有效的手段来逆转其疾病进展。干细胞疗法因其在组织修复和免疫调节方面的潜力，成为研究的热点领域。本研究系统阐述了造血干细胞（HSCs）通过旁分泌作用、代谢重塑及免疫调控干预ADPKD病理进程的机制，并总结了其在急性肾损伤和慢性肾病中的临床转化证据。此外，文章比较分析了间充质干细胞（MSCs）和诱导多能干细胞（iPSCs）在ADPKD治疗中的独特优势与面临的挑战，为多模态干细胞疗法的开发提供理论支持。

    Autosomal dominant polycystic kidney disease（ADPKD）stands as a leading cause of inherited renal failure，with current therapeutic strategies lacking effective means to reverse disease progression．Stem cell therapy，owing to its potential in tissue repair and immunomodulation，has emerged as a focal point of research．This review systematically elucidates the mechanisms by which hematopoietic stem cells（HSCs）intervene in ADPKD pathology through paracrine effects，metabolic reprogramming，and immune regulation．Furthermore，it summarizes clinical translational evidence of HSCs in both acute kidney injury and chronic kidney disease．This article also comparatively analyzes the unique advantages and challenges of mesenchymal stem cells（MSCs）and induced pluripotent stem cells（iPSCs）in the context of ADPKD treatment，thereby providing theoretical support for the development of multimodal stem cell therapies．

       自闭症谱系障碍（ASD）是一类神经发育障碍性疾病，其核心临床表现为社交行为障碍、语言沟通困难以及重复刻板行为。早期诊断并进行早期行为干预，是目前能改善患者临床症状且减少终身残疾的主要措施。但早期诊断困难，因为目前所采用的行为量表，比如ABC（异常行为检查表）等，在儿童生命早期阶段，如2岁左右，很难准确地反应出被试者的社交行为或者语言交流能力；而且，其判断也非常依赖于医生的经验，具有一定的主观性。近年来，随着脑影像技术，比如核磁共振（MRI），特别是功能性核磁共振（fMRI），以及人工智能技术（AI）的飞速发展，为ASD的早期诊断，从无创、客观、以及神经活动异常-行为异常偶联的角度，展示了一种新的机遇。本文比较系统地介绍了ASD的临床基础与诊断挑战，并详细阐述了AI在ASD早期诊断中的数据来源、核心算法和典型研究案例。通过分析当前技术面临的挑战与局限性，提出未来研究方向与临床转化路径，以期进一步加强AI在ASD早期诊断中的临床使用研究，使之最终能高效的服务于临床。

   Autism spectrum disorder（ASD）is a group of neurodevelopmental disorders clinically characterized by deficits in social interaction and verbal communication，along with repetitive behaviors．Early diagnoses，followed by early behavioral interventions，are currently effective strategies to attenuate clinical symptoms and improve patient outcomes in ASD; however，early diagnosis remains challenging at present．Current diagnostic tools，such as the Aberrant Behavior Checklist（ABC），have difficulty in accurately evaluating social engagement and verbal communication in early childhood（e.g. ，at 2 years of age）．Furthermore，such evaluations may be somewhat subjective，as they rely，at least partially，on clinicians’ experience．Recently，with the rapid development of brain imaging techniques（e.g. ，MRI，especially fMRI）and artificial intelligence（AI），a significant opportunity has emerged to develop novel early-diagnostic tools for ASD．These tools exhibit clear advantages，including being non-invasive，more objective，and focusing on the coupling of abnormalities in both neuronal activity and behavioral responses．Here，we systematically introduce the clinical features of ASD，discuss the challenges in early diagnosis，and review the current status of AI-driven diagnostic tool development in detail，including data acquisition methods，computational architectures，and typical clinical applications．Through a detailed analysis of the technical challenges，advantages，and limitations of these tools，we propose future research directions，aiming to eventually establish highly valuable AI-based diagnostic approaches for clinical use in ASD care．

       目的 探讨血浆细胞周期依赖性激酶9（CDK9）水平与大动脉粥样硬化（LAA）型脑梗死病情进展及预后的相关性，评估其作为疾病风险分层及预后评估生物标志物的临床价值。方法 选取2020年1月—2024年12月期间于本院就诊的400例急性LAA型脑梗死患者作为观察组，并同期纳入100名健康体检者作为对照组。发病90 d后，采用改良Rankin量表（mRS）对所有患者进行预后评估。根据评估结果，将观察组进一步划分为预后不良组（152例）与预后良好组（248例）。检测患者血浆CDK9水平并收集临床资料。分析CDK9水平与美国国立卫生研究院卒中量表（NIHSS）评分、梗死灶体积的相关性；分析预后不良的影响因素。结果 观察组CDK9水平高于对照组［（185.6±42.3） pg/mL vs （62.4±18.5） pg/mL，P＜0.001］，且与梗死体积（r=0.586）、NIHSS评分（r=0.628）、高敏C反应蛋白（r=0.452）及白介素6（r=0.418）呈正相关（均P＜0.001）。多因素Logistic回归分析显示，CDK9升高是90天预后不良的独立危险因素。受试者工作特征曲线（ROC）曲线分析显示，CDK9预测预后不良的曲线下面积（AUC）为0.854（最佳截断值为198.6 pg/mL，灵敏度为78.3%，特异度为82.5%），联合NIHSS评分及梗死体积后AUC提升至0.912（P＜0.001）。结论 血浆CDK9水平可作为急性LAA型脑梗死病情进展及预后的独立预测标志物，联合传统指标可提高预后评估效能。

      Objective To investigate the correlation between plasma cyclin-dependent kinase 9（CDK9）level and disease progression and prognosis in patients with acute large artery atherosclerosis（LAA）cerebral infarction，and to evaluate its clinical value as a biomarker for disease risk stratification and prognostic assessment．Methods This study enrolled 400 patients with acute LAA-type cerebral infarction who visited our hospital between January 2020 and December 2024 as the observation group，along with 100 healthy individuals as the control group during the same period．After 90 days of symptom onset，all patients were assessed using the modified Rankin Scale（mRS）for prognostic evaluation．Based on the assessment results，the observation group was further divided into two subgroups：the poor prognosis group（152 cases）and the good prognosis group（248 cases）．Plasma CDK9 levels were measured，and clinical data were collected．The correlation between CDK9 level and National Institutes of Health Stroke Scale（NIHSS）score and infarct volume，and the factors affecting poor prognosis were analyzed．Results Plasma CDK9 levels in the observation group were higher than those in the control group（［185.6±42.3］ pg/mL vs ［62.4±18.5］ pg/mL，P＜0.001），and were positively correlated with infarct volume（r=0.586），NIHSS score（r=0.628），high-sensitivity C-reactive protein（r=0.452），and interleukin-6（r=0.418）（all P＜0.001）．Multivariate Logistic regression analysis showed that elevated CDK9 level was an independent risk factor for poor prognosis at 90 d．Receiver Operating Characteristic（ROC）curve analysis revealed that the area under the curve（AUC）of CDK9 for predicting poor prognosis was 0.854（optimal cut-off value：198.6 pg/mL，sensitivity：78.3%，specificity：82.5%），and the AUC increased to 0.912 when combined with NIHSS score and infarct volume（P＜0.001）．Conclusions Plasma CDK9 level may serve as an independent predictive biomarker for disease progression and prognosis in acute LAA cerebral infarction，and combining it with traditional indicators can improve the efficacy of prognostic assessment．

      目的 探究综合性口腔护理干预方案在机械通气患儿中的应用效果。方法 将2023年5月—12月泉州市妇幼保健院重症监护科接收的66例机械通气患儿选为研究对象。以密封信封抽签法分为综合干预组（n=33）及常规干预组（n=33）。常规干预组实施常规口腔护理，综合干预组实施综合性口腔护理模式干预。对比两组患儿口腔情况、并发症、静态全唾液流率（UWS）及机械通气时间。结果 干预后综合干预组Beck总分为（6.33±1.05）分，低于常规干预组的（8.55±1.85）分（t=6.069，P＜0.001）。综合干预组出现呼吸机相关肺炎（VAP）发生率较常规干预组更低（3.03% vs 18.18%）（χ²=3.995，P=0.046）。干预后综合干预组UWS为（0.37±0.09）mg/min，高于常规干预组的（0.29±0.09）mg/min（t=3.611，P=0.001）。结论 综合性口腔护理模式能较大程度改进机械通气患儿的口腔卫生问题，对菌斑、口腔异味及牙龈情况均有改善作用；也能减少并发症发生率，提升UWS，维持口腔卫生健康。

      Objective To explore the effect of comprehensive oral nursing intervention in children with mechanical ventilation．Methods A total of 66 mechanically ventilated children admitted to the intensive care department of the hospital from May 2023 to December 2023 were selected as the study objects．They were divided into comprehensive intervention group（n=33）and routine intervention group（n=33）by sealed envelope lottery method．The routine intervention group implemented routine oral care，and the comprehensive intervention group implemented comprehensive oral care mode intervention．Oral conditions，complications，unstimulated whole saliva（UWS）and mechanical ventilation time were compared between the two groups．Results After the intervention，the total Beck score of the comprehensive intervention group was（6.33±1.05），which was lower than that of the conventional intervention group（［8.55±1.85］，t=6.069，P＜0.001）．The incidence of ventilator-associated pneumonia（VAP）in the comprehensive intervention group was lower than that in the conventional intervention group（3.03% vs 18.18%）（χ²=3.995，P=0.046）．After the intervention，the UWS of the comprehensive intervention group was（0.37±0.09）mg/min，which was higher than that of the conventional intervention group（［0.29±0.09］ mg/min，t=3.611，P=0.001）．Conclusions The comprehensive oral care mode can improve the oral health of children with mechanical ventilation to a great extent，and can improve the plaque，oral odor and gingiva condition．It can also reduce the incidence of complications，improve UWS，and maintain oral health．

       狼疮性肾炎是系统性红斑狼疮最常见且最严重的并发症，也是导致终末期肾病的重要原因。王耀光教授结合临床经验认为狼疮性肾炎的核心病机为本虚标实，即以脾肾亏虚、气化不利为本，水湿、瘀血、痰浊搏结成形为标。在整个病程演变过程中，可划分为急性活动期、迁延转化期及慢性硬化衰竭期三个阶段。各期病机侧重点不同，治疗时应遵循分期辨治、动态调整的原则：急性活动期以清热解毒，凉血散结为主；迁延转化期注重健脾益肾，活血利湿；慢性硬化衰竭期则强调温肾化气，削癥通络削坚散结、通络，并适时选用虫类药以增强通络化瘀之效，以期达到控制疾病活动、减少复发、延缓疾病进展的目的。本文总结并体现了本文中医药在狼疮性肾炎治疗中的优势，为临床提供了一套较为完整的诊疗思路。

       Lupus nephritis（LN）is the most common and serious complication of systemic lupus erythematosus（SLE）and a significant cause of end-stage renal disease．Based on his extensive clinical experience，Professor Wang Yaoguang proposes that the core pathogenesis of LN is characterized by a deficiency-root and excess-manifestation pattern．This manifests as spleen and kidney deficiency with impaired qi transformation as the root deficiency，while the combination of water-dampness，blood stasis，and phlegm-turbidity coalescing constitutes the manifest excess．The disease progression can be divided into three stages：the acute active phase，the protracted transformation phase，and the chronic sclerosing and failure phase．The pathological focus differs at each stage，necessitating stage-differentiated pattern identification and treatment and dynamic therapeutic adjustments．During the acute active phase，the treatment principle focuses primarily on clearing heat and resolving toxicity，and cooling blood to disperse nodules．The protracted transformation phase emphasizes fortifying the spleen and tonifying the kidney，combined with activating blood and draining dampness．In the chronic sclerosing and failure phase，the strategy shifts to warming the kidney，transforming qi and softening hardness，dispersing nodules，and unblocking collaterals；the timely application of insect drugs is also adopted to enhance the effect of unblocking collaterals and transforming stasis．This approach aims to control disease activity，reduce relapse，and delay progression．This approach highlights the advantages of traditional Chinese medicine in managing LN and providing a relatively comprehensive diagnostic and therapeutic framework for clinical practice．

      目的 系统比较小针刀、局部浸润麻醉及两者联合疗法治疗腰椎间盘突出症（LDH）的临床疗效。方法 采用前瞻性随机对照设计，选取2023年1月—2025年1月收治的120例保守治疗无效的LDH患者，随机分为小针刀组（A组，n=40）、局部浸润麻醉组（B组，n=40）和联合治疗组（C组，n=40）。A组实施标准化小针刀松解术，采用“三点九刀”布点法松解粘连组织；B组采用超声引导下椎间孔外口及关节突关节囊周围利多卡因联合曲安奈德浸润麻醉；C组实施“麻醉-松解序贯疗法”（即先B组方案，后A组方案）。比较三组治疗前后视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、腰椎活动度（ROM）、表面肌电图（sEMG）、疼痛压力阈值（PPT）及改良Macnab优良率。结果 治疗后，三组VAS、ODI评分均较治疗前下降（P＜0.001）。组间比较显示，C组VAS（2.08±0.90分）、ODI（14.65±3.70分）改善显著优于A组（3.80±1.20分，21.00±4.25分）和B组（3.93±1.15分，22.10±4.65分）（均P＜0.05），A、B两组间无统计学差异（P＞0.05）。C组在腰椎前屈ROM（67.78±9.18°）、竖脊肌静息sEMG比值（0.19±0.05）、腰椎旁PPT（4.60±0.91 kg/cm²）上亦显著优于A、B两组（均P＜0.05）。改良Macnab评价显示C组优良率达85.00%（34/40），高于A组的52.50%（21/40）和B组的55.00%（22/40）（P＜0.05）。结论 小针刀与局部浸润麻醉单一疗法对LDH均有效，但联合应用可产生多模式协同效应，通过阻断疼痛传导、调节炎性微环境和改善生物力学失衡，在缓解疼痛、促进功能恢复及改善客观生理指标方面均展现出显著优势，为中西医结合治疗LDH提供了更优化的创新性方案，具有重要临床推广价值。

      Objective To systematically evaluate and compare the clinical effectiveness and mechanistic actions of acupotomy，local infiltration anesthesia，and their combination in treating lumbar disc herniation（LDH）．Methods This prospective，randomized controlled trial included 120 LDH patients unresponsive to conservative management，admitted between January 2023 and January 2025．Participants were randomly allocated to three groups：the Acupotomy Group（Group A，n=40）receiving standardized acupotomy release with a “three-point nine-needle” technique to address adhesions；the Local Infiltration Anesthesia Group（Group B，n=40）receiving ultrasound-guided infiltration of lidocaine combined with triamcinolone acetonide around the extraforaminal outlet and facet joint capsule；and the Combined Therapy Group（Group C，n=40）undergoing a sequential “anesthesia-release” protocol（first applied Group B therapy then Group A therapy）．Assessments conducted before and after treatment included the Visual Analog Scale（VAS），Oswestry Disability Index（ODI），lumbar range of motion（ROM），surface electromyography（sEMG），pain pressure threshold（PPT），and the modified Macnab criteria．Results Following treatment，significant reductions from baseline were observed in VAS and ODI scores across all three groups（P＜0.001）．Between-group comparisons indicated that Group C achieved significantly greater improvement in VAS（2.08±0.90）and ODI scores（14.65±3.70）compared to Group A（3.80±1.20；21.00±4.25）and Group B（3.93±1.15；22.10±4.65）（all P＜0.05），with no significant difference between Groups A and B（P＞0.05）．Group C also showed superior outcomes in lumbar flexion ROM（67.78±9.18°），the resting sEMG amplitude ratio of the erector spinae muscles（0.19±0.05），and paravertebral PPT（4.60±0.91 kg/cm²）compared to the other two groups（all P＜0.05）．Based on the modified Macnab criteria，the excellent-good rate was 85.00%（34/40）in Group C，significantly higher than the rates of 52.50%（21/40）in Group A and 55.00%（22/40）in Group B（P＜0.05）．Conclusions While both acupotomy and local infiltration anesthesia as standalone treatments are effective for LDH，their combined application produces a multimodal synergistic effect．This integrated strategy，which concurrently interrupts pain signaling，modulates the local inflammatory milieu，and ameliorates biomechanical dysfunction，demonstrates significant advantages in pain relief，functional recovery，and normalization of objective physiological measures．The findings present an optimized and novel integrative approach for LDH management，highlighting its considerable potential for broader clinical adoption．

       目的 验证尿沉渣评分（USS）对肾前性急性肾损伤（AKI）与急性肾小管坏死（ATN）的鉴别价值，评估USS与AKI严重程度及预后的相关性，为优化AKI分层管理提供依据。方法 回顾性分析2021年3月至2022年2月在郑州市中医院治疗的120 AKI患者，根据肾组织活检及改良FENa-UA诊断标准分为肾前性AKI组（n=68）与ATN组（n=52），于入院日检测USS、血清胱抑素C（Cys-C）及尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL），分析USS诊断效能。结果 ATN组USS高于肾前性组（P＜0.001），且评分随AKI分期升高而增加（P＜0.001）。USS诊断肾前性AKI的ROC曲线下面积（AUC）为0.892，联合Cys-C与NGAL后AUC提升至0.941，灵敏度与特异度分别达90.12%和88.51%。结论 USS通过量化肾小管结构性损伤，可早期鉴别肾前性AKI与ATN，其与Cys-C、NGAL的联合应用提高诊断准确性，且对AKI预后具有重要价值，为临床分层管理提供客观依据。

       Objective To validate the discriminative value of urinary sediment score（USS）in differentiating prerenal acute kidney injury（AKI）from acute tubular necrosis（ATN），and to evaluate the correlation between USS and AKI severity/prognosis，providing evidence for optimizing stratified AKI management．Methods A retrospective analysis was conducted on 120 AKI patients treated at Zhengzhou Traditional Chinese Medicine Hospital from March 2021 to February 2022．According to renal tissue biopsy and modified FENa-UA diagnostic criteria，patients were divided into a prerenal AKI group（n=68）and an ATN group（n=52）．On the day of admission，USS，serum cystatin C（Cys-C），and urinary neutrophil gelatinase-associated lipocalin（NGAL）were measured to analyze the diagnostic performance of USS．Results USS was significantly higher in ATN group than prerenal group（P＜0.001），and increased with advancing AKI stages（P＜0.001）．The area under the ROC curve（AUC）of USS for diagnosing prerenal AKI was 0.892，which improved to 0.941 when combined with Cys-C and NGAL，yielding sensitivity and specificity of 90.12% and 88.51%，respectively．Conclusions USS quantifies structural damage to the renal tubules，allowing for early differentiation between prerenal AKI and ATN．Its combined use with Cys-C and NGAL improves diagnostic accuracy and is of significant value in predicting AKI prognosis，providing an objective basis for clinical stratified management．

       目的 探讨基于肺康复的阻抗训练联合营养支持对老年慢性阻塞性肺疾病（COPD）衰弱患者肌少症及运动耐量的影响。方法 将2024年1月—2025年5月收治的80例老年COPD衰弱合并肌少症患者，分为对照组、观察组，各40例。所有患者均采取常规药物治疗，对照组予以营养支持，观察组在对照组基础上增加基于肺康复的阻抗训练。比较两组治疗前、治疗3个月后肌少症改善情况，运动耐量，肺功能指标，衰弱状态及生活质量。结果 治疗3个月后，观察组骨骼肌指数、握力、股四头肌肌厚度均较治疗前提高，且与对照组相比，观察组更高（P＜0.05）；治疗3个月后，两组6 min步行距离、日常活动代谢当量均较治疗前提高，Borg量表评分降低，且与对照组相比，观察组改善幅度更大（P＜0.05）；治疗3个月后，两组第一秒用力呼气容积（FEV1）、FEV1/用力肺活量（FVC）、最大通气量（MVV）均较治疗前改善，且与对照组相比，观察组更优（P＜0.05）；治疗3个月后，两组Fried衰弱表型评分、COPD评估测试（CAT）总分、圣乔治呼吸问卷（SGRQ）总分均较治疗前降低，且与对照组相比，观察组更低（P＜0.05）。结论 老年COPD衰弱合并肌少症患者采取基于肺康复的阻抗训练联合营养支持可改善其肌少症情况，提升运动耐量，并且提升患者肺功能水平，改善衰弱状态，提升生活质量。

       Objective To explore the effects of impedance training based on pulmonary rehabilitation combined with nutritional support on sarcopenia and exercise tolerance in elderly patients with chronic obstructive pulmonary disease（COPD）and frailty．Methods Eighty elderly patients with COPD and frailty complicated by sarcopenia，admitted from January 2024 to May 2025，were selected as the study subjects and divided into a control group and an observation group，with 40 patients in each group．All patients received conventional drug therapy．The control group received nutritional support，while the observation group received additional impedance training based on pulmonary rehabilitation on top of the matched group’s treatment．The improvement of sarcopenia，exercise tolerance，pulmonary function index，weakness status and quality of life before and 3 months after treatment were compared between the two groups．Results After 3 months of treatment，the skeletal muscle index，grip strength and quadriceps thickness of the observation group increased compared with that before treatment，and compared with the control group，the observation group was higher（P＜0.05）．After 3 months of treatment，the 6 min walking distance and daily activity metabolic equivalent of both groups increased compared with that before treatment，and the Borg Scale score decreased．Compared with the control group，the improvement of the observation group was better（P＜0.05）．After 3 months of treatment，Forced Expiratory Volume in one second（FEV1），FEV1/Forced Vital Capacity（FVC）and Maximal Voluntary Ventilation（MVV）of both groups improved compared with that before treatment，and the observation group  was better than that of the control group（P＜0.05）．After 3 months of treatment，the Fried weakness phenotype score，COPD Assessment Test（CAT）total score and St. George’s Respiratory Questionnaire（SGRQ）total score of both groups were lower than that before treatment，and the observation group  was lower than that of the control group（P＜0.05）．Conclusions Impedance training based on pulmonary rehabilitation combined with nutritional support can improve sarcopenia，enhance exercise tolerance，and improve pulmonary function levels，frailty status，and quality of life in elderly patients with COPD and frailty complicated by sarcopenia．

       目的 探讨营养风险管理结合分期饮食指导对溃疡性结肠炎（UC）患者营养状况的影响。方法 选择郑州市大肠肛门病医院收治的90例UC患者，纳入时间为2024年1月—2025年1月，按照计算机分组法分为对照组（45例），给予分期饮食指导，观察组（45例），在对照组的基础上增加营养风险管理，观察两组患者症状改善情况、营养状况、生活质量。结果 干预后，观察组Mayo评分（4.30±1.14）分、主观整体营养状况评价表（PG-SGA）评分（1.74±0.38）分低于对照组（5.48±1.33、2.28±0.43）分（P＜0.05）；观察组血红蛋白（HB）、前白蛋白（PA）、白蛋白（ALB）水平高于对照组（P＜0.05），IBDQ各维度评分及总分更高（P＜0.05）。结论 对UC患者应用营养风险管理结合分期饮食指导，能够减轻临床症状，改善营养状况，促进生活质量的提升。

       Objective To explore the influence of nutritional risk management combined with staged dietary guidance on the nutritional status of ulcerative colitis（UC）patients．Methods A total of 90 UC patients admitted to our hospital were selected and included from January 2024 to January 2025．According to the computer grouping method，45 cases were divided into control group with staged dietary guidance，and 45 cases were divided into observation group with nutritional risk management．The symptoms improvement，nutritional status，and quality of life of the two groups were observed．Results After intervention，the observation group had lower Mayo score（4.30±1.14）and Patient?Generated Subjective Global Assessment（PG-SGA）score（1.74±0.38）than the control group（5.48±1.33 and 2.28±0.43，respectively）（P＜0.05）；the observation group had higher levels of hemoglobin（HB），prealbumin（PA），and albumin（ALB）than the control group（P＜0.05），and also had higher scores in all dimensions and total score of the Inflammatory Bowel Disease Questionnaire（IBDQ）（P＜0.05）．Conclusions The application of nutrition risk management combined with staged dietary guidance in UC patients can reduce clinical symptoms，improve nutritional status，promote the improvement of life quality．

       目的 构建与验证回肠造口术后造口周围皮炎发生的列线图预测模型。方法 回顾性分析广州市中山大学附属第六医院2022年7月—2023年7月收治的441例回肠造口术患者资料。通过单因素Logistic回归确定影响因素，基于训练队列建立列线图模型，并采用受试者操作特征（ROC）曲线和校准曲线分别评估模型的区分度与校准能力，同时通过决策曲线分析（DCA）评估临床实用性。在内部验证队列进行模型性能验证。结果 单因素Logistic回归确定6个危险因素，最终选取其中5个（是否糖尿病、造口定位、是否接受造口护理宣教、造口皮肤凹陷、性别）构建预测模型。训练队列中，模型校准曲线显示良好拟合优度（Hosmer and Lemeshow检验P = 0.976），ROC曲线下面积为0.672；决策曲线证实模型具有临床应用价值，预测模型在验证集上有类似结果。结论 本研究建立的5参数列线图模型具有良好的区分度、校准能力和临床实用价值，可为造口周围皮炎的预测提供量化工具。

       Objective To establish a predictive nomogram for peristomal dermatitis after ileostomy．Methods This study analyzed 441 patients who underwent ileostomy at a third-class premium hospital．The risk factors of peristomal dermatitis were determined by univariate binary Logistics regression．Then a predictive nomogram was established with the risk factors in the training cohort．The discrimination and calibration ability of the nomogram was demonstrated by receiver operating characteristic curves and calibration curves，respectively．Besides，a testing cohort was utilized to validate the nomogram model．To reflect the clinical utility of the model，we also performed decision curve analysis．Results A total of six parameters was determined as the risk factors of peristomal dermatitis．Finally，five of them（whether diabetes，stoma location，whether to receive stoma care education，stoma skin depression，gender）were chosen to establish the nomogram．The calibration curve showed favorable calibration ability in the training cohort with a Hosmer and Lemeshow goodness of fit test P-value of 0.976 and the area under the curve of the nomogram is 0.672．The decision curve showed nomogram had potential clinical utility．These results were consistent with the testing cohort．Conclusions The nomogram established by five parameters was capable of predicting the occurrence of peristomal dermatitis with favorable discrimination and calibration ability and shows potential clinical utility．

       目的 探讨瑞马唑仑复合瑞芬太尼在无痛支气管镜检查中的应用。方法 选取2023年1月1日—2024年12月31日我院86例进行无痛支气管镜检查的患者。随机分为两组，对照组给予瑞芬太尼+丙泊酚麻醉，试验组加用瑞马唑仑。比较两组麻醉效果、血流动力学及不良反应。结果 试验组诱导麻醉时间、离室时间短于对照组（t分别为6.052、5.702，P＜0.05）；气管插管时试验组HR水平短于对照组（t分别为2.582，2.601，P＜0.05），试验组SpO2水平高于对照组（t=8.968，P＜0.05）；试验组不良反应总发生率短于对照组（χ²=6.198，P＜0.05）。结论 在无痛支气管镜检查时，瑞马唑仑与瑞芬太尼联合展现出良好效果，能有效提升麻醉质量，并可维持血流动力学的平稳状态，安全性较高。

       Objective To investigate the application of remimazolam combined with remifentanil in sedation for bronchoscopy．Methods Eighty-six patients who underwent painless bronchoscopy in our hospital from January 1，2023，to December 31，2024，were selected．They were randomly divided into two groups．The control group received a combination of remifentanil and propofol for anesthesia，while the experimental group was additionally administered remimazolam．The anesthesia status，hemodynamic parameters，and adverse reactions were compared between the two groups．Results The experimental group demonstrated significantly shorter induction anesthesia durations and recovery times compared to the control group（t=6.052，5.702，P＜0.05）．At tracheal intubation，the experimental group exhibited notably lower HR than the control group（t=2.582，2.601，P＜0.05），while their SpO2 levels were significantly higher（t=8.968，P＜0.05）．The total incidence of adverse reactions in the experimental group was significantly lower than that in the control group（χ²=6.198，P＜0.05）．Conclusions The combination of remimazolam and remifentanil demonstrates favorable outcomes in painless bronchoscopy，effectively improving anesthesia quality，maintaining hemodynamic stability，and with a favorable safety profile．

       目的 评估过去30年，204个国家和地区非酒精性脂肪性肝病（NAFLD）伤残调整生命年（DALYs）的变化趋势，以及年龄-时期-队列效应。方法 所有数据来源于全球疾病负担研究（GBD）数据。针对1990—2019年204个国家和地区NAFLD的DALYs趋势进行分析，采用折点回归模型评估年龄标化DALYs率年均百分比变化（APC）；同时，利用年龄-时期-队列模型评估年龄、时期及出生队列对NAFLD的DALYs的影响。结果 1990—2019年，NAFLD的DALYs总量增加了62.92%，全人群DALYs率（每10万人）也增加了12.65%，而年龄标化DALYs率则由1990年的63.28（95%UI：48.58，80.86）下降至2019年的53.33（95%UI：40.73，68.29），降幅约为15.72%。全球范围内，APC模型估算的DALYs净漂移为每年-0.88%（95%CI：-0.91~ -0.85）。无论是DALYs总量、全人群DALYs率还是年龄标化DALYs率，其在女性和男性中的变化趋势与总体趋势一致。尽管全球及按社会人口学指数（SDI）分组的5个区域中，≥80岁人群的DALYs时间趋势逐步上升，但仅高SDI区域的上升趋势较为明显。折点回归分析显示，1990—2019年，年龄标化DALYs率呈现“先缓慢上升、后下降、再上升、最终下降”的波动趋势，总体为下降趋势，1990—2019年平均APC为-0.58%。年龄-时期-队列模型表明，全球、各区域及国家均存在不利的年龄效应，而时期效应与出生队列效应在不同区域总体呈有利趋势，但也存在一定差异。结论 1990—2019年，全球NAFLD的DALYs总量和全人群DALYs率上升，而年龄标化DALYs率总体下降，高SDI地区老年人负担上升更明显。年龄-时期-队列分析显示全球普遍存在不利的年龄效应，时期和出生队列效应总体有利但区域差异显著。

      Objective To evaluate the trends in the disability-adjusted life years（DALYs）of nonalcoholic fatty liver disease（NAFLD）and the effects of age-period-cohort in 204 countries and regions in the past 30 years．Methods All data were obtained from the Global Burden of Disease Study 2019．Trends in DALYS for NAFLD were assessed in 204 countries and territories from 1990 to 2019，and trends in the annual percentage change（APC）of age-standardized DALY rate were assessed by a joinpoint regression model．And age-period-cohort models were used to assess the effects of age-period-cohort on DALYs for NAFLD．Results From 1990 to 2019，the number of DALYs due to NAFLD increased by 62.92%，and all-age DALY rate per 100，000 population also increased by 12.65%，while the age-standardized DALY rate decreased from 63.28（48.58，80.86）in 1990 to 53.33（40.73，68.29）in 2019，a decrease of about 15.72%．Globally，the APC model estimated a net drift for DALYs of -0.88%（95%CI：-0.91，-0.85）per year，and for the number of DALYs，all-age DALYs rate，age-standardized DALY rate and net drift in female and male，the change trend of all regions over the past 30 years were consistent with the total population．Although the time trend of NAFLD DALYs among people over 80 years old was gradually rising in the world and five regions grouped according to socio‐demographic index（SDI），only the high SDI region had a more obvious time trend．Globally，the joinpoint regression analysis showed the age-standardized DALY rate appeared a trend of first gradually upward and then downward and then upward and finally downward during 1990-2019．Overall there was a downward trend，with an average APC of -0.58 during 1990 to 2019．Age-period-cohort model showed that unfavourable age effects were found in the world，all regions and countries，while the period and birth cohorts effects in different regions were favorable，but there were also some differences．Conclusions From 1990 to 2019，the global DALYs and all-age DALY rates of NAFLD increased，whereas the age-standardized DALY rate showed an overall decline，with a more pronounced burden among older adults in high-SDI regions．The age-period-cohort analysis revealed unfavorable age effects worldwide，while period and birth cohort effects were generally favorable but varied considerably across regions．

       目的 评估使用炎症、免疫及营养指标对于胃癌根治术后发生腹膜转移的预测作用，并建立适用于术前风险评估的预测模型。方法 回顾性收集2022—2024年苏州市立医院85例晚期胃癌患者的临床资料，按术后是否发生腹膜转移分为转移组44例与非转移组41例。通过分析比较两组间的营养参数［血清白蛋白、纤维蛋白原及预后营养指数（PNI）］、炎症指标［中性粒细胞计数、C反应蛋白、中性粒细胞与淋巴细胞比值（NLR）及全身免疫炎症指数（SII）］、肿瘤标志物以及免疫功能指标（淋巴细胞计数、IL-2、IL-6、TNF-α和IFN-γ）等。使用单因素及多因素Logistic回归分析确定独立预测因子，并构建预测模型，采用Bootstrap法内部验证，计算校正后的曲线下面积及收缩因子，以优化模型性能。结果 多因素分析结果显示，IL-6（OR=1.116，95%CI：1.020~1.224）与CA125（OR=1.016，95%CI：1.006~1.026）为术后腹膜转移的独立预测因素，构建的预测模型区分能力良好，初始AUC为0.801（95%CI：0.702~0.900），经Bootstrap校正后AUC为0.797，模型校准度理想，具有良好的临床稳健性。结论 基于术前IL-6和CA125水平的预测模型，可用于评估胃癌患者根治术后发生腹膜转移的风险。该模型可在术前阶段有效识别高风险病例，为临床制定个体化辅助治疗方案及随访策略提供关键参考，并具有改善患者预后的潜在价值。

       Objective To evaluate the predictive value of inflammatory，immune，and nutritional indicators for peritoneal metastasis after radical gastrectomy in gastric cancer and to establish a predictive model applicable for preoperative risk assessment．Methods Clinical data from 85 patients with advanced gastric cancer treated at Suzhou Municipal Hospital between 2022 and 2024 were retrospectively collected．Patients were divided into two groups based on postoperative peritoneal metastasis occurrence：a metastasis group（n=44）and a non-metastasis group（n=41）．Indicators analyzed and compared between groups included nutritional parameters（serum albumin，fibrinogen，PNI），inflammatory markers（neutrophil count，CRP，NLR，SII），tumor markers and immune indicators（lymphocyte count，IL-2，IL-6，TNF-α，IFN-γ）．Univariate and multivariate logistic regression analyses identified independent predictors for constructing the prediction model．Internal validation was performed using 1 000 bootstrap resamples to calculate the adjusted area under the curve（AUC）and shrinkage factor for model optimization．Results Multivariate analysis identified IL-6（OR=1.116，95%CI：1.020-1.224）and CA125（OR=1.016，95%CI：1.006-1.026） as independent predictors of postoperative peritoneal metastasis．The constructed predictive model demonstrated good discriminatory ability，with an initial AUC of 0.801（95%CI：0.702–0.900）and a bootstrap-corrected AUC of 0.797．The model exhibited ideal calibration and good clinical robustness．Conclusions This study established a predictive model based on preoperative IL-6 and CA125 levels to assess the risk of peritoneal metastasis after radical surgery in gastric cancer patients．The model effectively identifies high-risk cases preoperatively，providing critical guidance for developing individualized adjuvant treatment and follow-up strategies，with potential to improve patient prognosis．

      目的 评估在城市医疗集团模式下，于医院就诊人群中实施基于单导联心房颤动（房颤）检测棒的机会性房颤筛查的长期成本效益。方法 基于经广州市本地流行病学数据校准的Markov模型，比较未筛查与基于单导联房颤检测棒的不同筛查频率（季度、半年、年度）的机会性筛查策略，从卫生服务提供方视角评估成本与质量调整生命年（QALY），计算增量净货币收益（INMB）与成本效果比（ICER），并进行概率及情景敏感性分析。结果 所构建的房颤模型具有良好的预测效度。在基线假设下，季度筛查策略表现最优，相较未筛查组可增加0.525 5个QALY，节省成本15?626.61元，INMB为85 312.14元。敏感性分析显示，抗凝治疗依从性对成本效益影响最大。情景分析中，不同灵敏度与特异度假设未改变最优策略结论。结论 在城市医疗集团情境下，针对65岁及以上就诊老年人群的基于单导联房颤检测棒的季度机会性房颤筛查具备稳健的成本效益。结合分级诊疗体系和全流程管理，以依从性管理作为干预重点，能够最大化卒中预防收益并提高资源配置效率。

      Objective To evaluate the long-term cost-effectiveness of opportunistic atrial fibrillation（AF）screening using a single-lead handheld ECG device among hospital-attending adults within an urban medical consortium．Methods No screening and opportunistic screening at different frequencies（quarterly，semiannual，and annual）were compared by a Markov model calibrated to Guangzhou-specific epidemiological data．From the healthcare provider perspective，we estimated costs and quality-adjusted life-years（QALYs），calculated incremental net monetary benefit（INMB）and incremental cost-effectiveness ratio（ICER），and performed probabilistic and scenario sensitivity analyses．Results The AF model demonstrated good predictive validity．Under the baseline scenario，quarterly screening was the optimal strategy，yielding a gain of 0.525 5 QALYs，cost savings of CNY 15 626.61，and an INMB of CNY 85 312.14 versus no screening．Sensitivity analyses indicated that adherence to anticoagulation had the greatest impact on cost-effectiveness．Scenario analyses varying diagnostic sensitivity and specificity did not change the conclusion regarding the optimal strategy．Conclusions In the context of an urban medical consortium，quarterly opportunistic AF screening based on a single-lead handheld ECG device for hospital-attending adults aged ≥65 years is robustly cost-effective．Integrating screening into tiered care with end-to-end management，while prioritizing adherence management，can maximize stroke-prevention benefits and improve resource allocation efficiency．

      目的 探讨智能病案质控系统对病案质量及质控效率的影响，为优化病案管理模式提供依据。方法 选取2024年4月—9月传统人工质控病案2 000份（对照组）与2024年10月—2025年6月智能病案质控系统辅助质控病案2 000份（研究组），对比两组缺陷检出率、编码准确率、内涵质量达标率等病案指标，以及人均日均处理量、质控耗时、漏检率等效率指标。结果 研究组缺陷检出率（15.20%）高于对照组（8.30%）；编码准确率（95.70%）、内涵质量达标率（93.50%）高于对照组（86.50%、82.30%）（均P＜0.05）；研究组人均日均处理量较对照组提升；单份病案质控耗时（4.80 min）缩短；漏检率（3.00%）降低62.50%（均P＜0.05）。结论 智能病案质控系统可提升病案质量与质控效率，优化医疗资源配置，为DRG/DIP支付改革提供支持。

      Objective To explore the influence of intelligent medical record quality control system on medical record quality and quality control efficiency，so as to provide a basis for optimizing medical record management mode．Methods A total of 2 000 traditional manual quality control medical records（control group）from April to September 2024 and 2 000 intelligent medical record quality control system-assisted cases（experimental group）from October 2024 to June 2025 were selected．The study compared key indicators including defect detection rates，coding accuracy，and connotation quality compliance rates，along with efficiency metrics such as daily per capita processing volume，quality control time consumption，and missed detection rate between the two groups．Results The experimental group showed a significantly higher defect detection rate（15.20%）compared to the control group（8.30%）．The coding accuracy（95.70%）and connotation quality compliance rate（93.50%）were notably higher than the those of control group（86.50% and 82.30%，P＜0.05）．The experimental group demonstrated improved daily processing capacity per capita，with a significant reduction in quality control time for individual medical records（4.80 minutes）and a 62.50% decrease in missed detection rate（3.00%，P＜0.05）．Conclusions Intelligent medical record quality control system can significantly improve the quality and quality control efficiency of medical records，optimize the allocation of medical resources，and provide support for DRG/DIP payment reform．

      目的 探讨加强医学影像学的教育在肝胆外科本科实习教育中的应用效果。方法 选择了2021年3月—2023年12月，在广州市花都区人民医院肝胆胰疝外科实习的80名本科实习生为研究对象，依据随机数字表法将全部实习生随机分为两组，每组各40例，研究组接受强化影像教育，参照组接受传统教学，并对教学效果进行统计分析。结果 两组实习生经过两种不同教学方法后，研究组的总体成绩优于参照组，满意度比例高于参照组，组间差异具有统计学意义。结论 在肝胆外科临床实习教学中，加强影像学教育，可显著提高实习生的总体成绩，获得更高的教学满意度。

      Objective To explore the application effect of strengthening medical imaging education in the undergraduate internship education of hepatobiliary surgery．Methods Eighty undergraduate interns who interned in the Department of Hepatobiliary，Pancreatic and Hernia Surgery of our hospital from March 2021 to December 2023 were selected as research subjects．Using a random number table method，the interns were evenly divided into two groups，with 40 interns in each group．The experimental group received enhanced imaging education，while the control group received traditional teaching．The teaching effects were statistically analyzed．Results After undergoing two different teaching methods，the experimental group had better overall scores than the control group，and a higher satisfaction rate than the control group ，with statistically significant differences between the groups．Conclusions Strengthening imaging education in clinical internship teaching of hepatobiliary surgery can significantly improve interns’ overall scores and achieve higher teaching satisfaction，indicating its value for promotion．

       目的 评价基于成果导向教育（OBE）理念的“赛教一体化”教学模式在健康教育课程实验教学中的应用效果。方法 选取我校2021级预防医学专业的81名学生为研究对象。采用整群随机分组的方法，将其分为观察组（n=29）和对照组（n=52），观察组采用基于OBE理念的“赛教一体化”教学模式，对照组采用传统教学模式。通过对实验教学质量的模糊综合评判以及期末考试成绩进行效果评价。结果 观察组和对照组实验教学质量的模糊综合评判结果均为“优秀”，最大隶属度分别为0.727和0.534，观察组优于对照组。在一级指标层面，观察组所有指标得分均高于对照组，5个一级指标的两组得分差值从大到小依次为潜能激发（0.80）、教师素养（0.77）、学习成效（0.74）、内容设计（0.70）和教学方法（0.59）。观察组和对照组的期末考试成绩差异无统计学意义（P＞0.05）。结论 基于OBE理念的“赛教一体化”教学模式应用于健康教育课程实验教学能够有效改善教学质量，在潜能激发和教师素养方面提升较为明显。

       Objective To evaluate the application effect of the “integration of competition and education” teaching model based on the（outcomes-based education，OBE） concept in the experimental teaching of health education courses．Methods A total of 81 students majoring in preventive medicine from the 2021 grade at our university were selected as the research objects．They were divided into an observation group（n=29）and a control group（n=52）using cluster randomization．The observation group adopted the “integration of competition and education” teaching model based on the OBE concept，while the control group adopted the traditional teaching model．The effectiveness was evaluated using the fuzzy comprehensive evaluation of experimental teaching quality and the final exam scores．Results The fuzzy comprehensive evaluation results of the experimental teaching quality in both the observation group and the control group were “excellent”，with the maximum membership degrees of 0.727 and 0.534，respectively，indicating that the observation group was superior to the control group．At the level of first-level indicators，all indicators of the observation group scored higher than those of the control group．The score differences between the two groups for the five first-level indicators，from largest to smallest，were：potential excitation（0.80），teacher literacy（0.77），learning effectiveness（0.74），content design（0.70），and teaching method（0.59）．No statistically significant difference was found in the final exam scores between the observation group and the control group（P＞0.05）．Conclusions The application of the “integration of competition and education” teaching model based on the OBE concept in the experimental teaching of health education courses can effectively improve teaching quality，with more obvious improvements in potential excitation and teacher literacy．

       在“健康中国2030”战略框架下，医工融合已成为推动医疗技术创新与复合型医学人才培养的关键路径。“三维协同”教育体系：课程维度打造“基础模块—交叉课程—项目实训”渐进式矩阵；实践维度建立校企共建实验室与临床转化基地的产教融合平台；师资维度创新“临床医师+工程师+科研导师”三师型导师协同机制。基于广州医科大学等高校的实证分析，该模式显著提升了学生跨学科创新能力与工程实践转化能力。研究进一步提出“政产学研用”五螺旋发展模型，倡导通过建立医工融合特区、构建智能医疗科研共享平台、完善学科交叉质量评价体系等策略，为“新医科”建设提供理论范式与实践路径。本研究为医学教育改革提供了系统化、可复制的解决方案，对推进健康中国战略实施具有重要理论与实践意义。

      Under the framework of the “Healthy China 2030” strategy，the integration of medicine and engineering has become a key path to promoting medical technological innovation and the cultivation of interdisciplinary medical talents．This study has constructed a “three-dimensional synergy” education system：in the curriculum dimension，a progressive matrix of “basic modules - cross-disciplinary courses - project training” is created；in the practical dimension，a platform for industry-education integration is established through the joint construction of university-enterprise laboratories and clinical transformation bases；in the faculty dimension，an innovative “Clinician + Engineer + Research mentor” tripartite mentorship collaboration mechanism is developed．Based on empirical analysis from universities such as Guangzhou Medical University，this model has significantly enhanced students’ cross-disciplinary innovation capabilities and engineering practice transformation abilities．The study further proposes a “government-industry-academia-research-application” five-spiral development model，advocating strategies such as establishing special zones for medicine-engineering integration，building intelligent medical research sharing platforms，and improving the quality evaluation system for interdisciplinary studies，to provide theoretical paradigms and practical paths for the construction of “new medicine”．This research offers a systematic and replicable solution for medical education reform and holds significant theoretical and practical significance for the implementation of the Healthy China strategy．