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 对川南地区重症专科联盟认知与需求进行调查，为该地区重症专科联盟建设提供参考。方法 采用分层随机抽样，在川南地区（乐山、宜宾、泸州、自贡）31个区县的二级医院内随机抽取213名医务人员作为调查对象。采用自制问卷收集调查对象基本情况，并评估其对重症医学专科联盟概念的认知情况，通过开放式问卷收集调查对象对重症医学专科联盟的需求。根据认知评估结果将研究对象分为了解充分组与了解不充分组，比较两组基本情况，并用多因素Logisitic回归筛选出独立性影响因素。结果 在纳入的213名医护人员中有68名（31.92%）对重症专科联盟了解不充分，单因素分析显示：两组在性别、年龄、工作岗位、职务及职称差异均具有统计学意义（P＜0.05）。多因素Logistic回归分析显示：性别、学历为本科 、学历为博/硕士研究生、工作岗位、职务为中层干部、院领导职务及职称为川南地区重症专科联盟认知的独立性影响因素（P＜0.05）。川南地区重症专科联盟需求排名前9位依次：派出专家技术指导、派出管理干部开展业务管理、接收联盟单位人员培训、协助开展新技术、为联盟单位成员开展培训与讲座、业务资源共享、接收联盟单位转诊、开展远程医疗、科研项目申报指导。结论 川南地区重症专科联盟认知情况主要与性别、学历、工作岗位、职务、职称及基层对于专家技术指导、管理干部业务指导及技能培训的需求较大。

      Objective To investigate the awareness and demand for the Critical Care Specialty Alliance in Southern Sichuan，providing a reference for the development of the alliance in this region．Methods Using stratified random sampling，213 medical staff were randomly selected from secondary hospitals in 31 districts/counties of the Southern Sichuan region（Leshan，Yibin，Luzhou，Zigong）as survey subjects．A self-designed questionnaire was used to collect basic information from the respondents，assess their understanding of the concept of the Critical Care Specialty Alliance，and gather their demands for the alliance through open-ended questions．Based on the assessment results，respondents were divided into a well-informed group and a poorly informed group．The basic characteristics of the two groups were compared，and multivariate logistic regression was used to identify independent influencing factors．Results Among the 213 medical staff included in the study，68（31.92%）had insufficient understanding of the Critical Care Specialty Alliance．Univariate analysis revealed statistically significant differences（P＜0.05）in gender，age，job position，administrative role，and professional title between the group with sufficient understanding and the group with insufficient understanding．Multivariate Logistic regression analysis showed that gender，undergraduate education，master’s/doctoral education，job position，middle management role，hospital leadership role，and professional title were independent influencing factors for the awareness of the Critical Care Specialty Alliance in the Southern Sichuan region（P＜0.05）．The top nine demands for the alliance in Southern Sichuan were dispatching experts for technical guidance，sending management cadres for operational management，providing training for personnel from alliance units，assisting in the development of new technologies，organizing training and lectures for alliance unit members，sharing business resources，accepting referrals from alliance units，implementing telemedicine，and providing guidance on research project applications．Conclusions Awareness of the Critical Care Specialty Alliance in Southern Sichuan is primarily associated with gender，educational background，job position，and professional title．There is significant demand at the primary level for expert technical guidance，operational management guidance from cadres，and skills training．

        目的   分析广州番禺地区鹦鹉热衣原体肺炎患者临床表现、实验室及胸部CT特征、并发症以及治疗方案，为其临床诊治提供参考。方法   回顾性分析2022年1月—2024年7月在广州市番禺区何贤纪念医院通过二代测序技术确诊的10例鹦鹉热感染患者的临床资料。结果  5例（5/10）患者有明确的鸟类或禽类接触史，8例（8/10）患者以发热为首发症状，发热（10/10）、咳嗽、咳痰（10/10）、呼吸困难（7/10）、相对缓脉（8/10）是主要临床表现。患者白细胞计数通常正常或轻微升高；多数患者存在有不同程度的电解质紊乱（10/10）及肝功能损伤（8/10）、乳酸脱氢酶升高（8/10），白蛋白显著降低（8/10）和C反应蛋白显著升高（10/10）。最常见的胸部CT异常为多肺叶受累的斑片状或片状实变，而重症患者多合并双侧胸腔积液。大多数患者经四环素或喹诺酮类单用，或者四环素联用β-内酰胺类抗菌药物治疗，预后良好。结论   有鸟类或禽类接触史、以发热为首发或主要症状、存在相对缓脉、白细胞计数升高不明显等临床特征可有助于区分鹦鹉热衣原体肺炎与其他传统细菌性肺炎，但这并不能确诊。二代测序技术是确诊鹦鹉热衣原体感染的很好方法，可以缩短诊断延误时间并改善患者预后。

       Objective  To describe the clinical，laboratory and chest CT characteristics as well as the complications and treatments of Chlamydia psittaci pneumonia patients in Panyu district of Guangzhou，to provide  reference for clinical diagnosis and treatment．Methods  A retrospective study was conducted on the clinical characteristics of Chlamydia psittaci pneumonia patients who were diagnosed by next-generation sequencing in Panyu Hexian Memorial Hospital of Guangzhou form January 2022 to July 2024．Results  Half patients had a definite history of bird or poultry exposure．Fever（100%），cough，sputum（100%），dyspnea（70%），relative bradycardia（80%）were the main clinical presentation．The total white cell counts were usually normal or slightly increased．Most patients had electrolyte disturbance（100%），liver function impairment（80%），lactic dehydrogenase increased（80%），albumin decreased（80%）and C reactive protein increased remarkably（100%）．The most common chest CT abnormality was patchy or flaky hyper densities and consolidation，bilateral pleural effusion was common in severe patients．All patient exhibited good recovery after being treated with tetracycline or quinolone alone，or tetracycline in combination with other antibiotics．Conclusions  These characteristics may help distinguish Chlamydia psittaci pneumonia from other traditional bacterial pneumonia，but they are not definitive．Next-generation sequencing may be a promising approach to confirm Chlamydia psittaciinfection，which can shorten the diagnostic delay time and improve the prognosis of patients．

       为规范广州地区“港澳药械通”伦理审查工作，满足临床用药用械需求，保障患者用药用械安全，广州市医学会医学伦理分会、广州市医院协会“港澳药械通”工作专业委员会组织行业专家，结合相关政策法规要求与本地实践经验，广泛征求专家意见，经多次讨论，形成《广州地区“港澳药械通”伦理审查共识》。共识涵盖适用范围、术语和定义、伦理审查的原则、伦理审查的类别、伦理审查的流程、伦理审查的方式及多医疗机构申请的伦理审查等方面。共识旨在为广州地区“港澳药械通”指定医疗机构的伦理审查工作提供指导，统一审查标准，提高审查效率与质量，切实保护患者的合法权益，促进临床急需进口港澳药械的安全合理使用，从而促进粤港澳大湾区医疗健康事业发展。

       To standardize the ethical review process of the “Hong Kong and Macao Drugs and Medical Devices Access” in Guangzhou，meet the clinical demand for drugs and medical devices，and ensure the safety of patients’ use of drugs and medical devices，the Medical Ethics Branch of Guangzhou Medical Association and the “Hong Kong and Macao Drugs and Medical Devices Access” Professional Committee of Guangzhou Hospital Association organized industry experts，combined with  relevant policy and regulatory requirements and local practical experience，widely solicited expert opinions，the “Consensus on Ethical Review of Drugs and Medical Devices for Hong Kong and Macao in Guangzhou” were formed after several discussions．The consensus content covers aspects such as the scope of application，terms and definitions，principles of ethical review，categories of ethical review，procedures of ethical review，methods of ethical review，and Ethical Review for Multi-institutional Applications．The consensus aims to provide guidance for the ethical review work of designated medical institutions for the “Hong Kong and Macao Drugs and Medical Devices Access” in the Guangzhou area，unify the review standards，improve the efficiency and quality of the review，effectively protect the legitimate rights and interests of patients，promote the safe and rational use of clinically urgently imported medicines and medical devices Hong Kong Macao，and thereby promote the development of medical and health care in the Guangdong-Hong Kong-Macao Greater Bay Area．

目的 比较喀什地区和广州地区健康体检儿童维生素D3水平和缺乏率。方法 纳入2019年1月—2020年12月喀什地区第一人民医院、广州市番禺区中心医院健康体检儿童,比较汉族儿童不同地区间以及比较喀什儿童不同民族间的维生素D3水平和缺乏率,分析了性别、年龄和季节对血清维生素D3水平的影响。结果 喀什汉族儿童维生素D3低于广州汉族儿童,缺乏率更高（均P<0.05）。喀什维族儿童的维生素D3水平低于喀什汉族儿童,缺乏率更高（均P<0.05）。同一地区、同一民族不同年龄段儿童间维生素D3缺乏率和水平比较差异均有统计学意义（均P<0.05）,维生素D3缺乏率随年龄增加而升高,水平则显著下降。同一地区、同一民族儿童不同季节间维生素D3缺乏率和水平比较差异均有统计学意义（均P<0.05）,冬季的缺乏率最高、水平最低。同一地区、同一民族儿童不同性别间维生素D3缺乏率和水平比较差异均无统计学意义（P>0.05）。结论 健康体检儿童血清维生素D3水平,喀什维族低于喀什汉族,喀什汉族低于广州汉族,缺乏率间差异明显。健康体检儿童血清维生素D3水平和缺乏率与年龄、季节有关,与性别无关。

目的 探究高原地区世居居民与常住居民的心脏结构和功能的差异性。方法 选择2022年6月—2023年8月在西藏林芝市人民医院体检的200例世居居民与常住居民作为研究对象,将世居居民和常住居民按照性别分为男女亚组,按照年龄段分为18~31岁、31~40、41~50岁亚组。比较各亚组心脏结构参数、左心功能参数、多普勒超声检测参数差异。结果 与高原常住居民男性和女性比较,世居居民男性和女性的左房内径、右房内径、右室内径、肺动脉内径、升主动脉内径、主动脉根径、室间隔厚度、左室后壁厚度、左室舒张末内径、左室收缩末内径、左室射血分数、二尖瓣 A 峰流速指标比较差异均无统计学意义（P>0.05）;而主动脉瓣口流速、肺动脉瓣口流速、二尖瓣 E 峰流速增加,两组间比较差异具有统计学意义（P<0.05）。18~31岁、31~40、41~50岁组世居居民和常住居民左房内径、右房内径、右室内径、肺动脉内径、升主动脉内径、主动脉根径、室间隔厚度、左室后壁厚度、左室舒张末内径、左室收缩末内径、左室射血分数、二尖瓣 A 峰流速指标等指标比较差异均无统计学意义（P>0.05）,但世居居民主动脉瓣口流速、肺动脉瓣口流速、二尖瓣 E 峰流速均高于常住居民,差异具有统计学意义（P<0.05）。结论 高原地区世居居民和常住居民心脏结构参数和左心功能参数无明显差异。但世居居民主动脉瓣口流速、肺动脉瓣口流速、二尖瓣 E 峰流速均高于常住居民。

Objective To explore the ethnic differences in heart structure and function between aborigines and long term residents in the plateau area. Methods A total of 200 aborigines and long term residents who underwent physical examination in our hospital from June 2022 to August 2023 were selected as the study subjects,and the aborigines and long term residents were divided into male and female subgroups,and subgroups aged 18-30 years,31-40 years and 41-50 years．The differences of cardiac structure parameters,left ventricular function parameters and Doppler parameters were compared among subgroups. Results The left atrial diameter,right atrial diameter,right ventricular diameter,pulmonary artery diameter,ascending aorta diameter,aortic root diameter,interventricular septal thickness,left ventricular posterior wall thickness,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left ventricular ejection fraction mitral valve A peak velocity were compared between Aborigines and plateau Long Term Residents,which were no significant difference（P>0.05）．However,the velocity of aortic valve orifice,pulmonary valve orifice and mitral valve E peak velocity increased,and the differences were statistically significant（P<0.05）．There were no significant differences in left atrial diameter,right atrial diameter,right ventricular diameter,pulmonary artery diameter,ascending aorta diameter,aortic root diameter,interventricular septal thickness,posterior left ventricular wall thickness,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left ventricular ejection fraction,left ventricular diameter,left ventricular diameter,and left ventricular ejection fraction mitral valve A peak velocity indexes in aborigines and long term residents between among aged 18-30 years,31-40 years,41-50 years（P>0.05）,but the differences of aortic valve orifice velocity,pulmonary valve orifice velocity and mitral valve E peak velocity were statistically significant（P<0.05）. Conclusions There were no significant difference in cardiac structure parameters and left heart function parameters between aborigines and long term residents in plateau area．However,the aortic orifice velocity,pulmonary orifice velocity and mitral E-peak velocity of aborigines were higher than those of long term residents．

目的 通过分析2019—2021年广州地区保密性弃血工作情况,完善献血者献血后回告受理和保密性弃血管理。方法 通过分析广州市血液中心2019年1月—2021年12月期间受理的无偿献血者献血后保密性弃血回告记录,统计分析无偿献血者要求保密性弃血的各种原因,以及保密性弃血施行程序中出现的新情况。结果 2019年、2020年、2021年保密性弃血人数分别占当年献血人数的0.156‰,0.090‰,0.091‰。2020年之后出现接触或疑似接触新型冠状病毒患者的回告案例;在这3年间,87.6%的保密性弃血在72小时内完成回告。结论 无偿献血者保密性弃血回告以及血液屏蔽是保障血液用血安全的重要举措之一,目前广州市回告率相对较低,提示要强化血液保密性弃血回告及方法途径指引宣传,注意对新回告原因的收集以有针对性开展献血前征询工作,从源头筛选出合格、低风险的无偿献血者,同时完善长时间(72小时以上)才回告的血液保密性弃血处理程序。

目的 探讨我国南方地区鲍曼不动杆菌流行株ST457毒力进化方向。方法 收集南方地区5家大型三甲医院2012年—2015年血和/或痰标本来源的鲍曼不动杆菌菌株,运用不同毒力实验,比较ST457与其他CC92流行克隆株与非流行克隆株的毒力差异。结果 ST457感染患者早期死亡率高;ST457菌株平均产生物膜能力低于ST195和ST208;83.3%的鲍曼不动杆菌临床分离菌株在血清的存活率大于60%,其中43.3%的菌株可在血清内快速繁殖,不同ST型组间、菌血症组和非菌血症组间无差异;不同ST型菌株竞争后,ST457未展现出竞争优势。结论 与传统CC92流行株相比,ST457毒力表型与传统的CC92流行株类似,提示CC92克隆株共进化能力。部分流行株短时间内在血清中快速繁殖,提示其条件致病后潜在的血流感染的能力。

Objective To investigate the virulence of the prevalent clone ST457 of Acinetobacter baumannii in Southern China. Methods Isolates from sputum and/or blood samples from 2012 to 2015 in 5 large differences between clonal complex 92(CC92) and non-CC92 were estimated by biofilm assay, competition assay and serum assay. Results Patients with ST457 infection had high early mortality. The average biofilm production of ST457 was significantly lower than that of ST195 and ST208. In serum assay, 83.3% isolates survived in the serum with over 60% survival rate, of which 43.3% strains reproduced in the serum, with no difference between STs or between bacteremia and non-bacteremia group. After competing with different ST strains, ST457 shows no competitive advantage. Conclusions ST457 had a similar virulence phenotype with the traditional prevalent CC92 clone, suggesting the co-evolutionary ability for CC92 clone. Some clinical isolates were survived in human serum, suggesting the potential capacity of bloodstream infection.

目的 了解急诊科综合病区患者疾病分类构成的特点,为护士进行有针对性的培训,并为合理调配护理人员提供依据。方法 对2020年1月—2021年12月我院急诊科综合病区收治的1 901例患者疾病分类、收治时间等进行回顾性调查分析。结果 研究期间急诊综合病区共收治患者1 901例,收治患者以呼吸系统的患者居多,占比47.71%;以循环系统疾病的患者平均发病年龄最高,为(66.434±11.691)岁;全年各月以1月、12月收治病人居多。结论 根据调查分析,有针对性地对护士进行呼吸系统疾病护理技能培训,并在收治高峰期,合理调配护理人员,实施弹性排班,保障患者安全,提高护理质量。

Objective To understand the characteristics of disease classification and composition of patients in Comprehensive Ward of Emergency Department, provide targeted training for nurses, and provide basis for rational deployment of nursing staff. Methods A total of 1 901 patients in the Comprehensive Ward of Emergency Department of our hospital from January 2020 to December 2021 were investigated and analyzed retrospectively according to different diseases and time of admission. Results A total of 1 901 patients were treated in the Emergency Comprehensive Ward during the study period. Most of the patients were with respiratory system disease, accounting for 47.71%. The average onset age of patients with circulatory diseases was the oldest, which was (66.434±11.691). Most patients were admitted in January and December. Conclusions According to the investigation and analysis, nurses should be trained with the skills of respiratory diseases nursing, nursing staff should be reasonably allocated and flexible shift should be scheduled during the peak period of admission, so as to ensure the safety of patients and improve the quality of nursing.

目的 观察广州花都地区新冠疫情发生前后呼吸道肺炎支原体（MP）感染的流行病学特征,分析2018年—2019年（疫情前）和2020年—2021年（疫情后）期间的流行病学特点,为降低本地区的MP感染提供预防医学依据。方法 收集2018年1月—2021年12月于广州市中西医结合医院就诊的呼吸道感染患者51 005例,采用胶体金法检测血Mp- IgM抗体,对疫情前后年度、季节、性别和年龄段MP感染情况进行回顾性分析。结果 51 005例呼吸道感染患者中,MP感染总阳性率12.03%（6 134/5 1005）,新冠疫情发生前（2018—2019）阳性率为19.11%（5 161/27 010）,高于新冠疫情后（2020—2021）MP阳性率为4.06%（973/23 995）（χ²=2 721.32,P<0.001）。2018年和2019年（疫情前）不同季节MP检出率分别为：春季11.87%和17.76%,夏季13.26%和22.21%,秋季17.93%和24.59%,冬季14.20%和14.47%,以夏秋季阳性率高于春季和冬季;疫情后两年四季MP感染率均低于疫情前（P<0.001）,春季和冬季阳性率略高于夏秋季节。4年来呼吸道感染患者中MP感染率男性（13.87%）与女性（14.09%）比较差异无统计学意义。且疫情前（18.91%,19.28%）显著高于疫情后（2.49%,2.69%）,同时期不同性别阳性率比较差异无统计学意义。婴幼儿组（0~6岁）,学龄儿童组（>6~14岁）,青少年组（>14~30岁）,中青年组（>30~60岁）及老年组（>60岁）MP阳性检出率分别为20.89%、29.98%、9.29%、5.55%和4.57%,不同年龄组间MP感染率差异有统计学意义（P<0.05）,以学龄期儿童多见,其次为婴幼儿。结论 新冠疫情前后4年MP感染流行特点为：新冠疫情前后MP感染无性别差异;学龄期儿童和婴幼儿是高发人群;一年四季均可发病,疫情前两年夏秋季高发,疫情后两年四季发病率均较低且差异变小;新冠疫情下广州花都地区MP感染率显著低于疫情前,2019-nCov防控措施（佩戴口罩等）也减少了MP感染。