目的 探讨肺癌根治术后患者康复期的症状体验与心理感受, 为完善症状管理和制定个性化康复干预方案提供依据。方法 采用现象学研究法,对15例肺癌根治术后康复期患者进行半结构式访谈, 运用Colaizzi 7步分析法进行归纳和提炼主题。结果 归纳出5个主题, 12个亚主题：多重躯体症状负担持续存在（术后疼痛综合征、顽固性刺激性咳嗽、劳力性呼吸困难、持续性疲劳感）; 负性心理情绪困扰（病耻感、疾病不确定感与复发恐惧）; 心理调适过程（诊断冲击与认知失调、角色适应与主动应对）; 创伤后成长与健康行为转变（生命意义感提升、健康促进行为强化）; 强烈的康复信息支持需求（自我保健知识需求、结构化康复锻炼指导需求）。结论 医护人员应关注肺癌根治术后患者康复期的症状体验, 动态评估患者的身心状况, 制定精准、有效的个性化干预方案, 帮助患者树立康复信心, 改善术后康复体验和提高生活质量。

       Objective  To explore the symptom experience and psychological feelings of patients during the rehabilitation period after radical resection of lung cancer, aiming to provide a basis for improving symptom management and formulating personalized rehabilitation interventions．Methods The phenomenological research method was used to conduct semi-structured interviews with 15 patients in the rehabilitation period after radical surgery for lung cancer．Colaizzi's 7-step analysis method was used to summarize and extract themes．Results Five themes and 12 sub-themes were summarized：Persistent burden of multiple physical symptoms（postoperative pain syndrome, refractory irritative cough, exertional dyspnea, persistent fatigue）; negative emotional experiences（stigma of illness, illness uncertainty and fear of recurrence）; psychological adjustment processes（diagnostic shock and denial, role acceptance and active coping）; post-traumatic growth and health behavior transformation（enhanced sense of meaning in life, strengthened health-promoting behaviors）; strong demand for rehabilitation information support（self-care knowledge, rehabilitation exercise knowledge）．Conclusions Medical staff should pay attention to the symptom experience of patients during the recovery period after radical lung cancer surgery, dynamically assess their physical and mental conditions, develop precise and effective personalized intervention plans, help patients build confidence in recovery, and thereby improve their postoperative rehabilitation experience and quality of life．

       文章围绕康复治疗学专业创新创业人才培养模式展开研究，讨论了国内外高校创新创业人才培养现状。从教育理念、课程体系、师资力量、资源配套等方面探讨了人才培养所面临的问题。结合广东药科大学康复治疗学专业培养现状，从管理、教学、平台、服务四大体系明确了具体要求，有望为其他高校康复治疗学专业培养模式改革提供思路。

  The article focuses on innovative and entrepreneurial talent-cultivation models in the Rehabilitation Therapy specialty，discussing the current status of such cultivation in domestic and international universities．It explores challenges in talent development from perspectives including educational philosophy，curriculum system，faculty resources，and resource allocation．Based on the current training status of Guangdong Pharmaceutical University’s Rehabilitation Therapy Program，the study specifies detailed requirements through four major systems：management，teaching，platform，and service．This  research is expected to provide valuable insights for the  reform of talent cultivation models in  rehabilitation therapy programs at other higher education 

institutions．

        目的   观察桂枝加芍药汤个体化干预治疗儿童功能性腹痛的临床疗效。方法   选取2023年100名在广东省妇幼保健院门急诊就诊确诊为儿童功能性腹痛患儿。100名儿童随机分为两组，益生菌组50名、益生菌+中药个体化干预组50名。连续治疗1周。记录两组患儿卧立位心率、卧立位血压、Rutter 儿童行为量表和中医临床症状的改善情况。结果   益生菌+中药个体化干预组患儿治疗后卧立位心率和Rutter儿童行为量表中N行为评分比益生菌组下降，中医临床症状评分的有效率优于益生菌组。结论   桂枝加芍药汤个性化干预治疗儿童功能性腹痛疗效显著。

    Objective  To observe the clinical efficacy of individualized intervention with Guizhi plus Shaoyao Decoction in children with functional abdominal pain disorders（FAPDs）．Methods  A total  of  100  children  diagnosed with  FAPDs at the outpatient and emergency departments of Guangdong Women and Children Hospital were selected．These children were randomly divided into two groups：the probiotics group（50 cases）and the probiotics+traditional Chinese medicine individualized intervention group（50 cases）．Both groups received continuous treatment for 1 week．Parameters including  supine/upright heart rates，supine/upright blood pressure，Rutter Children’s Behavior Questionnaire，and improvements in traditional Chinese clinical symptom scores were recorded．Results  The probiotics+traditional Chinese medicine individualized intervention group exhibited significantly greater reductions in supine/upright heart rates and N-behavior scores compared to the probiotics group．The effective rate of Chinese clinical symptom scores was also significantly higher in the individualized intervention group．Conclusions  Individualized intervention of Guizhi plus Shaoyao Decoction has a remarkable efficacy in treating FAPDs in children．

       目的   评估ChatGPT 4与Llama 3微调模型在乳腺癌诊断中的应用效果，特别是在超声、钼靶及超声联合钼靶的非结构化报告和影像诊断方面。方法   回顾性收集了689例同时接受乳腺超声和钼靶检查的患者数据，比较两种模型在文本和图像模态下的诊断性能，并探讨乳腺密度对模型表现的影响。结果   在文本模态下，微调Llama 3表现优异，联合诊断准确率达91.7%，优于ChatGPT 4的71.7%。图像模态中两模型准确率均低于70%，但ChatGPT 4灵敏度较高（78.3%），Llama 3特异度突出（98.3%）。分组分析表明，在非致密型乳腺中钼靶表现更佳，而致密型乳腺中超声诊断更具优势。结论   大语言模型在医学图像处理和多模态整合方面仍需进一步优化，医学领域微调的大语言模型在处理非结构化临床文本方面具有潜力。

       Objective  To evaluate the application effectiveness of ChatGPT 4 and the fine-tuned Llama 3 model in breast cancer diagnosis，particularly in processing unstructured reports and diagnostic imaging of ultrasound，mammography，and their combined modalities．Methods  Retrospective data from 689 patients who underwent both breast ultrasound and mammography examinations were collected．The diagnostic performance of the two models was compared across text and image modalities，and the impact of breast density on model performance was explored．Results  In the text modality，the fine-tuned Llama 3 model performed excellently，achieving a combined diagnostic accuracy of 91.7%，outperforming 71.7% of ChatGPT 4．In the image modality，both models had accuracies below 70%，but ChatGPT 4 exhibited higher sensitivity（78.3%），while Llama 3 demonstrated outstanding specificity（98.3%）．Subgroup analysis indicated that mammography performed better in non-dense breasts，whereas ultrasound was more advantageous in dense breasts．Conclusions  The large language models  still  require further optimization in medical image processing and multimodal integration，but fine-tuned large language models in the medical field show potential in handling unstructured clinical texts．

       目的   针对孤独症多模态证据融合与定量化辨识的关键问题，本研究提出基于图卷积神经网络（GCN）的孤独症谱系障碍（ASD）诊断模型研究思路。方法  通过对来源于ABIDE的ASD儿童脑部fMRI数据进行整理和筛选，提取脑区功能连接矩阵作为图结构的邻接矩阵，并融合临床表型数据，构建了ASD多模态关联网络。通过网络特征比较分析，识别出了ASD与典型发育组的脑功能连接网络组间差异。进一步地构建一个端到端的GCN模型，并尝试引入注意力机制，提高模型决策的可解释性。结果  该模型在诊断性能指标优于传统机器学习方法（准确率=0.710，精确率=0.709，召回率=0.780，F1=0.743，曲线下面积=0.746）。背侧注意网络与边缘系统-颞极枢纽的功能连接减弱是模型做出判断的最主要依据。结论  以异质图为多模态数据整合的基本架构，本模型为ASD的潜在病理机制探索提供了新的方法学范例。

      Objective   To develop a quantitative model for autism spectrum disorder（ASD）integration multimodal evidences．Methods The fMRI  dataset from ABIDE was  used for extracting connectivity function  network of ASD after  data preprocessing．Difference between ASD and typical development about their brain connectivity function was evaluated with t-test．Integrating phenotypic data and fMRI dataset，an graph convolutional neural network （GCN）with attention module was estimated and compared against benchmark models about their efficiency and interpretability．Results  The GCN model was evaluated outperformed other models with better accuracy indices．And regions from Dorsal Attention Network and Limbic-Temporal Pole were ranked as the highest weights for the differentiation in the model．Conclusions  This study provided a novel paradigm for quantitative diagnosis and exploring pathogenesis of ASD．

       目的   通过总结分析我国华东五省市紧密型城市医疗集团的实践经验，为全面推进紧密型城市医疗集团建设，促进区域内医疗资源的优化整合和高效利用提供借鉴和参考。方法   采用内容分析法从责权协同、资源协同、业务协同和机制协同四个维度对上海闵行、浙江湖州、江苏淮安、安徽铜陵、山东青岛五个紧密型医疗集团建设的实践经验进行梳理和对比分析。结果   各地区医疗集团建设总体具备政府主导，集团共建，一体化管理、同质化服务等紧密型医疗集团特点，但存在权责归属失配、利益分配机制缺失、信息化建设不均衡、基层服务能力不足、一体化管理不全面、机制协同有待加强等问题。结论   建议通过完善治理体系、均衡利益分配、强化数字赋能、推进强基提能、落实配套政策等措施，切实推动紧密型城市医疗集团高质量发展。

       Objective  To  summarize  and  analyze the  practical  experience  of  compact  city medical  groups in five provinces and cities in East China，for reference of promoting the construction of compact city medical groups，and promoting the optimization，integration and efficient utilization of medical resources in the region．Methods  The content analysis method was used to sort out and compare the practical experience of building such compact medical groups in Shanghai Minhang，Zhejiang Huzhou，Jiangsu Huai’an，Anhui Tongling and Shandong Qingdao from the four dimensions of responsibility and power synergy，resource synergy，business synergy and mechanism synergy．Results  Such medical groups are characterized by government-led，group co-construction，integrated management，and homogeneous services．However，there are such problems as mismatched ownership of rights and responsibilities，lack of interest distribution mechanism，unbalanced information construction，insufficient primary service capacity，incomplete integrated management，and mechanism coordination to be strengthened．Conclusions  It is recommended to effectively promote the high-quality development of compact city medical groups by improving the governance system，balancing the distribution of interests，strengthening digital empowerment，promoting the strengthening of energy，and implementing supporting policies．

       目的   探讨医院药房外包代煎代送服务的质量管理。方法   成立中药代煎质量控制管理小组，研究给出完善质量控制体系的策略，涉及建立标准化操作流程、加强人员培训、优化信息化管理系统以及健全监督评估机制。结果   通过对中药库房的采购、入库验收、在库管理、调剂环节的审方、调剂、煎药质量管理以及物流、发药人员全流程管理，提高了患者的满意度，更多的患者选择了中药代煎服务。结论   实施有效的质量控制措施可提高代煎代送服务的质量，为医院药房提升服务质量给予理论依据与实践指导。

       Objective  To explore quality management of outsourced decoction preparation and delivery services in hospital pharmacies．Methods  A quality control management team for traditional Chinese medicine（TCM）decoction preparation was established to develop strategies for improving the quality control system．These strategies involved establishing standardized operating procedures，strengthening personnel training，optimizing the information management system，and improving the supervision and evaluation mechanism．Results  Through comprehensive process management，covering procurement，warehouse acceptance，inventory management，prescription review in the dispensing stage，dispensing itself，quality control of decoction preparation，logistics，and management of dispensing personnel，patient satisfaction was enhanced，leading more patients to opt for the TCM decoction service．Conclusions  Implementing effective quality control measures can improve the quality of decoction preparation and delivery services，providing a theoretical basis and practical guidance for hospital pharmacies to enhance their service quality．

      目的   残余胆固醇（RC）是反映动脉粥样硬化性血脂异常的重要指标，其在糖尿病合并冠心病患者中的临床意义尚不明确。本研究旨在探讨RC水平对糖尿病合并冠心病患者心力衰竭风险的预测价值，并分析其相关性。方法   本研究为回顾性横断面研究，纳入2021年1月—2024年1月期间在鹤壁市人民医院接受诊治的292例糖尿病合并冠心病患者。根据是否存在心力衰竭分为心力衰竭组（128例）和无心力衰竭组（164例）。对基线特征进行比较，采用单因素和多因素Logistic回归分析RC与心力衰竭的相关性。同时，通过限制性立方样条（RCS）分析探讨RC与心力衰竭风险的线性关系，并通过受试者操作特征（ROC）曲线和曲线下面积（AUC）评估RC的预测价值。结果   心力衰竭组患者的男性比例、高血压患病率、RC水平等高于无心力衰竭组，而估算肾小球滤过率水平显著降低（P＜0.05）。单因素分析显示，RC＞0.7 mmol/L显著增加心力衰竭风险（OR=1.854，95%CI：1.161~2.960，P=0.010）。多因素Logistic回归分析中，全调整模型结果显示，RC作为分类变量时，RC＞0.7 mmol/L的患者心力衰竭风险显著增加1.891倍（OR=1.891，95%CI：1.047~3.415，P=0.035）；作为连续变量时，RC每增加1单位，心力衰竭风险增加2.464倍（OR=2.464，95%CI：1.495~4.064，P＜0.001）；Log₁₀RC的风险比为6.411（95%CI：2.246~18.302，P=0.001）；标化RC的风险比为1.687（95%CI：1.262~2.255，P＜0.001）。限制性立方样条分析表明RC与心力衰竭风险呈线性正相关，ROC分析显示RC预测心力衰竭的AUC为0.621（95%CI：0.555~0.687，P＜0.001）。结论  RC水平与糖尿病合并冠心病患者心力衰竭风险显著相关，且呈线性正相关。RC具有一定的预测价值，可作为该人群心力衰竭风险评估的潜在指标。

       Objective  Residual cholesterol（RC）is  an important marker  reflecting  dyslipidemia  associated with atherosclerosis．Its clinical significance in patients with diabetes and coronary heart disease（CHD）remains unclear．To explore the predictive value of RC level for the risk of heart failure（HF）in patients with diabetes and CHD and analyze their association．Methods  This retrospective cross-sectional study included 292 patients with diabetes and CHD who were treated at Hebi People’s Hospital between January 2021 and January 2024．Patients were divided into the HF group（128 cases）and the non-HF group（164 cases）based on the presence of HF．Baseline characteristics were compared，and univariate and multivariate Logistic  regression analyses were performed to assess the association between RC and HF．Additionally，restricted cubic spline（RCS）analysis was used to explore the linear relationship between RC and HF risk，and the predictive value of RC was evaluated using receiveroperating characteristic（ROC）curves and the area under the curve（AUC）．Results  The HF group had significantly higher proportions of males，hypertension prevalence and RC levels，while estimated glomerular filtration rate were significantly lower compared to the non-HF group（P＜0.05）．Univariate analysis showed that RC＞0.7 mmol/L significantly increased the risk of HF（OR=1.854，95%CI：1.161–2.960，P=0.010）．In the fully adjusted multivariate Logistic regression model，RC（RC＞0.7 mmol/L）was associated with a 1.891-fold increased risk of HF as a categorical variable（OR=1.891，95%CI：1.047–3.415，P=0.035）．As a continuous variable，each increased unit in RC was associated with a 2.464-fold increased risk of HF（OR=2.464，95%CI：1.495–4.064，P＜0.001）．The odds ratios for Log₁₀RC and standardized RC were 6.411（95%CI：2.246–18.302，P=0.001）and 1.687（95%CI：1.262–2.255，P＜0.001），respectively．ROC analysis indicated a linear positive association between RC and HF risk（P=0.002）．ROC analysis showed that RC had predictive value for HF，with an AUC of 0.621（95%CI：0.555–0.687，P＜0.001）．Conclusions  RC levels are significantly associated with the risk of HF in patients with diabetes and CHD，demonstrating a linear positive correlation．RC has potential predictive value and may serve as a useful indicator for assessing HFrisk in this population．

       目的   调查老年人照护服务需求现状并分析其影响因素，为构建基于需求为导向的老年照护服务体系提供参考依据。方法  采用便利抽样法，选取广州市某三甲医院212名老年人作为调查对象，采用日常生活能力量表、Fried衰弱评估量表及自行编制的老年人需求评估问卷进行调查。结果   老年人对运动与营养（1.96±0.90分）、心理慰藉（2.63±0.85分）、安宁服务（2.73±1.07分）的需求水平较高。多因素线性回归分析结果显示养老方式、日常生活活动能力、爱好数量、性别、衰弱等级、有无主要照顾者是照护服务需求的影响因素（P均＜0.05），可解释61.5%的变异量。结论   老年人的照护服务需求受多种因素的影响。应根据老年人的不同特征，构建供需匹配的多元化，多层次照护体系。

       Objective  To investigate the status quo of care service needs of the elderly and analyze its influencing factors，so as to provide a reference for the construction of a needs-oriented care service system for the elderly．Methods  A total of 212 elderly people from a tertiary hospital in Guangzhou were selected by convenience sampling method and investigated with the Activity of Daily Living scale，Fried frailty scale and the self-designed elderly needs assessment questionnaire．Results  Elderly patients had higher demands for exercise，nutrition，psychological comfort and hospice services．The results of multivariate analysis showed that the influencing factors of care service demand included pension style，activities of daily living，number of hobbies，gender，frailty level，and having main caregivers（all P＜0.05），which could explain 61.5% of the variation．Conclusions  The care needs of elderly patients are affected by many factors．A diversified and multi-level care system with matching supply and demand should be constructed according to the different characteristics of the elderly．

       目的   探讨经颅多普勒超声（TCD）参数联合屏气指数在颈内动脉（ICA）狭窄或闭塞所致急性脑梗死的评估价值。方法   选择2022年1月—2024年12月，在广州市花都区人民医院连续入组发病72 h内ICA狭窄或闭塞所致的急性脑梗死患者。记录患者人口统计学资料、临床资料及TCD相关参数，包括搏动指数（PI）、阻力指数（ RI）、大脑中动脉平均血流速度（Vm）及屏气指数等。依据患者数字减影血管造影（DSA）结果分为侧支循环良好组及侧支循环不良组。比较两组人口统计学、临床资料及TCD相关参数，采用单因素分析、多因素Logistic回归分析及ROC曲线。结果   共纳入ICA狭窄或闭塞所致急性脑梗死共136例，其中侧支循环良好组46例，侧支循环不良组90例。单因素分析提示：侧支循环良好组与侧支循环不良组在PI［0.95（0.80，1.03）vs 1.01（0.88，1.13）］、RI［0.58（0.51，0.62）vs 0.60（0.54，0.65）］、Vm［57（44，65）vs 50.5（41，63）］及屏气指数［0.78（0.75，0.85）vs 0.72（0.59，0.79）］方面，差异具有统计学意义（P＜0.05）。多因素Logistic回归分析提示Vm（OR=1.029，95%CI：1.006~1.053，P=0.014）、屏气指数（OR=723.401，95%CI：14.524~3 6031.859，P＜0.001）是侧支循环不良的独立危险因素。屏气指数和Vm评估侧支循环情况的ROC曲线下面积（AUC）分别为0.713（95%CI：0.627~0.799）和0.605（0.505~0.705），两者的AUC值比较差异无统计学意义（P＞0.05）。结论   屏气指数和Vm可以评估ICA狭窄或闭塞所致急性脑梗死的侧支循环，屏气指数和Vm的评估效能相当。

       Objective  To explore the evaluation value of transcranial Doppler ultrasound（TCD）in acute cerebral infarction caused by internal carotid artery（ICA）stenosis or occlusion．Methods  From January 2022 to December 2024，patients with acute cerebral infarction caused by ICA stenosis or occlusion within 72 hours of onset were enrolled in our hospital．Patient’s demographic data，clinical data，and TCD related parameters，including pulsatility index（PI），resistance index（RI），average blood flow velocity（Vm）of the middle cerebral artery，and breath holding index（BHI）were recorded．According to the results of digital silhouette angiography（DSA），patients were divided into good collateral group and poor collateral group．Demographic，clinical data，and TCD related parameters were compared between two groups using univariate analysis，multivariate Logistic regression analysis and ROC curve．Results  A total of 136 cases of acute cerebral infarction caused by  ICA stenosis or occlusion were included，including 46 cases in the collateral good group and 90 cases in the collateral poor group．Univariate analysis showed that the good collateral group and the poor collateral group were different in PI（0.95［0.80，1.03］vs 1.01［0.88，1.13］），RI（0.58［0.51，0.62］vs 0.60［0.54，0.65］），Vm（57［44，65］vs 50.5［41，63］），BHI（0.78［0.75，0.85］ vs 0.72［0.59，0.79］）（P＜0.05）．Multivariate Logistic regression analysis showed that Vm（OR=1.029，95%CI：1.006-1.053，P=0.014）and BHI（OR=723.401，95%CI：14.524-36 031.859，P＜0.001）were independent risk factors for collateral circulation disorders．The area under the ROC curve（AUC）for predicting collateral circulation using BHI and Vm were 0.713（95%CI：0.627~0.799）and 0.605（0.505~0.705），respectively．There was no statistically significant difference in AUC values between the BHI and Vm．Conclusions  The BHI and Vm can predict the collateral circulation of acute cerebral infarction caused by ICA stenosis or occlusion，and their predictive power is comparable．