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．

       本文概述了传统日间腹腔镜胆囊切除术患者术后早期康复质量存在的问题，IMB模型通过向患者提供科学的疾病知识，改变其疾病认知与态度，最终促使其采纳并维持健康行为。本文还介绍了IMB模型在日间腹腔镜胆囊切除术后患者早期康复质量中应用涉及的相关概念、研究背景和国内外的研究现状以及未来发展趋势与挑战。研究结果显示，IMB模型可显著降低患者术后疼痛发生率，并提高患者参与治疗决策的程度，为后期关于IMB模型在日间腹腔镜胆囊切除术患者术后早期康复质量的相关研究提供借鉴与参考，以便后期实施相关个性化干预措施，并提供相关理论依据。

       This paper summarizes the problems existing in the early postoperative rehabilitation quality of patients undergoing traditional ambulatory laparoscopic cholecystectomy．The IMB model changes patients’ disease cognition and attitude by providing them with scientific disease knowledge，and ultimately promotes their adoption and maintenance of healthy behaviors．It also introduces the relevant concepts involved in the application of the IMB model in the early postoperative rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy，the research background of this study，the current research status at home and abroad，as well as the future development trends and challenges．The research results show that the IMB model can significantly reduce the incidence of postoperative severe pain in patients and the degree of patient participation in treatment decision-making．This provides reference and guidance for subsequent studies on the early rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy using the IMB model，so as to implement relevant personalized intervention measures in the future and provide relevant theoretical basis．

       目的 构建首发脑出血患者并发卒中相关性肺炎的风险预测模型并验证模型的预测性能。方法 回顾性分析2012年1月—2022年12月广州市第一人民医院治的419例首发脑出血患者的临床资料，按照7︰3比例随机化分为训练列（293例）和验证队列（126例）。统计基于开发队列数据，采用Logistic回归模型分析首发脑出血患者并发卒中相关性肺炎的影响因素，并构建风险预测模型。基于开发队列和验证队列数据，采用校准曲线、受试者操作特征（ROC）曲线下面积和决策曲线分析模型的预测性能。结果 419例首发脑出血患者中有113例发生卒中相关性肺炎，发生率为26.97%。美国国立卫生研究院卒中量表（NIHSS）评分、吞咽困难、初始血肿体积、中性粒细胞百分比与白蛋白比值（NPAR）、中性粒细胞计数与淋巴细胞计数比值（NLR）、手术治疗、气管插管、留置胃管均是首发脑出血患者并发卒中相关性肺炎的影响因素（P＜0.05）。基于上述影响因素构建了首发脑出血患者并发卒中相关性肺炎的风险预警模型，校准曲线显示模型在开发队列和验证队列中预测卒中相关性肺炎发生率均与实际发生率相近；ROC曲线显示此模型在开发队列、验证队列中预测的曲线下面积分别为0.906（95%CI：0.867~0.937）、0.884（95%CI：0.815~0.934）；决策曲线分析显示当开发队列阈概率在3%~80%内、验证队列阈概率在2%~76%内使用此模型干预比全/无干预更有临床价值。结论 基于NIHSS评分、吞咽困难、初始血肿体积、NPAR、NLR、手术治疗、气管插管、留置胃管构建的首发脑出血患者并发卒中相关性肺炎的风险预测模型具有良好预测性能和临床应用价值。

      Objective To construct a risk prediction model for stroke associated pneumonia in patients with initial cerebral hemorrhage（ICH）and validate the predictive performance of the model．Methods A retrospective analysis was conducted on the clinical data of 419 patients with ICH admitted to our hospital from January 2012 to December 2022．They were randomly divided into a development cohort（293 cases）and a validation cohort（126 cases）according to a 7∶3 ratio．The Logistic regression model was used to analyze the influencing factors of stroke related pneumonia in patients with ICH based on the development cohort data，and a risk prediction model was constructed．Based on the development cohort data and validation cohort data，the predictive performance of the model was analyzed using calibration curves，receiver operating characteristic（ROC）curve，and decision curve analysis．Results Among 419 patients，113 developed stroke associated pneumonia，with a rate of 26.97%．The National Institutes of Health Stroke Scale（NIHSS）score，swallowing difficulties，initial hematoma volume，neutrophil percentage to albumin ratio（NPAR），neutrophil count to lymphocyte count ratio（NLR），surgical treatment，endotracheal intubation，and indwelling gastric tube were all independent influencing factors for stroke associated pneumonia in patients with ICH（P＜0.05）．Based on the above influencing factors，a risk prediction model for stroke associated pneumonia in patients with ICH was constructed．The calibration curve showed that the predicted incidence of stroke associated pneumonia by the model in both the development and validation cohorts was close to the actual incidence．The ROC curve showed that the predicted area under the curve for this model in the development cohort and validation cohort was 0.906（95%CI：0.867-0.937）and 0.884（95%CI：0.815-0.934），respectively．The decision curve analysis showed that when the threshold probability of the development cohort was between 3%-80%，and the threshold probability of the validation cohort was between 2%-76%，the intervention using this model was more clinically valuable than all/no intervention．

Conclusions The risk prediction model for stroke associated pneumonia in patients with ICH based on NIHSS score，swallowing difficulties，initial hematoma volume，NPAR，NLR，surgical treatment，tracheal intubation，and indwelling gastric tube has good predictive performance and clinical application value．

       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．

       癫痫是一种由多种病因引起的慢性脑部疾病，其患者死亡风险为一般人群的2~3倍。我国农村地区，受多种因素的影响，约2/3的癫痫患者未得到合理的治疗，给患者及其家庭和社会带来沉重负担。顺德区积极响应“中国农村地区癫痫防治管理项目”，成立癫痫专科医联体，构建三级诊疗体系，开展了一系列实践探索。本文旨在总结顺德区专科医联体管理模式下的癫痫综合管理实践，分析管理现状，并提出改进路径，以期为癫痫患者提供更优质的服务，改善患者生活质量。

      Epilepsy is a chronic brain disorder caused by various etiologies，the mortality risk of epilepsy patients is 2 to 3 times higher than that of the general population．In rural areas of China，due to multiple influencing factors，approximately two-thirds of epilepsy patients receive inadequate or no proper treatment，imposing a heavy burden on patients，their families，and the society．Shunde District has actively responded to the “China Rural Epilepsy Prevention and Management Project” by establishing an epilepsy specialty medical consortium and building a three-tiered diagnostic and treatment system，conducting a series of practical explorations．This article aims to summarize the comprehensive epilepsy management practices under the specialty medical consortium model in Shunde District，analyze the current management status，and propose improvement strategies to provide better services for epilepsy patients and enhance their quality of life．

       医疗质量管理是医院的核心任务，医疗质量管理在医院内具体落实到各个专科的管理，口腔门诊（不含住院部）作为一个特殊的专科，广泛存在于一、二级医疗机构，也存在于部分三级医疗机构，普通住院科室或门诊专科的医疗质量管理模式均不适用于口腔门诊，需要专属的医疗质量管理方式。医疗质量管理常以质控检查与指标监测为抓手，本文综合目前关于口腔门诊质控的研究，系统梳理口腔门诊的质控检查项目与指标，为口腔门诊医疗质量管理模式提供科学依据。

      Medical quality management is the fundamental task of hospitals，and it is specifically implemented in the management of various specialties within hospitals．As a special specialty，dental outpatient clinics（excluding inpatient departments） exist in most primary and secondary medical institutions，as well as some tertiary medical institutions．The medical quality management methods of general inpatient departments or outpatient specialties are not applicable to dental outpatient clinics，which require a dedicated medical quality management approach．Quality control inspections and monitoring of quality control indicators are focuses of medical quality management．This article synthesizes current research on quality control in dental outpatient clinics，systematically sorts out quality control inspection items and quality control indicators for dental outpatient clinics，and provides a scientific basis for medical quality management model in dental outpatient clinics．

       目的 探讨基于德尔菲法构建专科护士能力分层管理模式。方法 通过查阅文献，并结合半结构式访谈，初步梳理出评价指标的条目集合。随机抽取20名权威护理临床实践专家，运用德尔菲专家函询法，依据专家反馈，确定评价指标体系。结果 共进行2轮专家函询，积极系数均为100%。专家权威系数分别为 0.83、 0.85。专家意见肯德尔系数分别为0.350、0.340。最终构建专科护士临床实践能力的分层级评价管理模式包括3项一级指标，8项二级指标，23项三级指标。结论 基于德尔菲法构建的专科护士能力分层管理模式，对于提升护理服务质量、推动护理学科发展具有积极的指导意义。

      Objective To explore the construction of a hierarchical management model for the clinical practice ability of specialist nurses based on the Delphi method．Methods By reviewing literature and conducting semi-structured interviews，we initially sorted out a collection of evaluation indicator items．Twenty authoritative nursing clinical practice experts were randomly selected．The Delphi expert consultation method was employed，and based on the experts’ feedback，the evaluation indicator system was determined．Results A total of two rounds of expert consultations were conducted，with a 100% positive response rate in both rounds．The expert authority coefficients were 0.83 and 0.85，respectively．The Kendall’s coefficient of concordance for expert opinions was 0.350 and 0.340，respectively．The final hierarchical evaluation and management model for the clinical practice ability of specialist nurses included 3 first-level indicators，8 second-level indicators，and 23 third-level indicators．Conclusions The hierarchical management model for the ability of specialist nurses constructed based on the Delphi method has positive guiding significance for improving nursing service quality and promoting the development of the nursing discipline．

       目的 探究血脂异常对左心室结构的影响及其与微循环损伤之间的关联。方法 将20只新西兰大白兔随机划分为血脂异常组和正常对照组。饲养8周后获取所有实验兔的离体心肌组织，测量左心室心肌结构评估指标（包括心肌质量、心腔内径大小以及室壁厚度）和病理学指标（心肌微血管密度和胶原体积百分比）；另外，通过对心肌组织氧化应激标记物的测定，评估实验兔心肌组织中一氧化氮（NO）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）以及丙二醛（MDA）等生化指标。结果 对于左心室结构指标，血脂异常组的左心室心肌质量及室间隔厚度较正常对照组显著增加（P均＜0.001）；对于组织病理学指标，血脂异常组的心肌微血管密度显著降低，而胶原体积百分比则显著升高（P均＜0.001）。对于生化指标，血脂异常组NO、SOD以及GSH-Px水平均显著降低，MDA水平显著升高（P均＜0.001）。室间隔厚度与心肌组织胶原体积百分比、MDA水平呈正相关，与心肌组织微血管密度、NO、SOD、以及GSH-Px水平呈负相关（P均＜0.001）。与正常对照组对比，血脂异常组心肌组织出现明显脂肪变性、炎细胞浸润以及心肌纤维组织增生、排列紊乱。结论 血脂异常可导致新西兰大白兔左心室不良重塑，且与心肌微循环损伤之间存在密切关联，这提示血脂异常早期防控可能有助于改善心血管事件不良预后。

      Objective To explore the impact of dyslipidemia on left ventricular（LV） structure and its association with myocardial microcirculatory injury．Methods Twenty New Zealand white rabbits were randomly divided into the dyslipidemia group and the normal control group．After 8 weeks of feeding，the isolated myocardial tissues of all experimental rabbits were obtained．The LV myocardial structure assessment indicators（including myocardial mass，heart cavity diameter and ventricular wall thickness） and pathological indicators（myocardial microvascular density and collagen volume fraction［CVF］） were measured．Additionally，the biochemical indicators such as nitric oxide（NO），superoxide dismutase（SOD），glutathione peroxidase（GSH-Px） and malondialdehyde（MDA） in the myocardial tissues of the experimental rabbits were evaluated by measuring the oxidative stress markers in the myocardial tissues．Results For the LV structural indicators，the myocardial mass and interventricular septal thickness in the dyslipidemia group were significantly increased compared with the normal control group（P＜0.001 for both）．For the histopathological indicators，the myocardial microvascular density in the dyslipidemia group was significantly decreased，while the CVF was significantly increased（P＜0.001 for both）．For the biochemical indicators，the levels of NO，SOD，and GSH-Px in the dyslipidemia group were significantly decreased，while the MDA level was significantly increased（P＜0.001 for all）．The interventricular septal thickness was positively correlated with the CVF and MDA level in myocardial tissue，and negatively correlated with the myocardial microvascular density，NO，SOD，and GSH-Px levels（P＜0.001 for all）．Compared with the normal control group，the myocardial tissue in the dyslipidemia group showed obvious fatty degeneration and inflammatory cell infiltration，as well as myocardial fibrous tissue hyperplasia and disordered arrangement．Conclusions Dyslipidemia can lead to adverse LV remodeling in New Zealand white rabbits and is closely related to myocardial microcirculatory injury．This suggests that early prevention and control of dyslipidemia may help improve the poor prognosis of cardiovascular events．

       目的 探讨自回归求和时间序列模型（ARIMA）在耐碳青霉烯类肺炎克雷伯菌（CRKP）医院感染预测中的应用，为CRKP感染的科学防控提供策略。方法 选取贾汪区人民医院住院患者2018年1月—2024年12月共7年每月CRKP医院感染率，应用SPSS 19.0建立ARIMA模型，利用该模型对2024年1—12月每月CRKP医院感染数据进行验证，以评价模型的预测性能。结果 用2018—2024年住院患者每月CRKP医院感染率建模、拟合，建立最优模型ARIMA（1，1，1），模型拟合值与实际值较吻合，模型对CRKP医院感染率实际值与预测值吻合度较高，平均相对误差为5.40%。结论 用ARIMA模型可有效拟合、预测CRKP医院感染情况，为CRKP防控提供科学指导。

     Objective To explore the value of auto regressive integrated moving average（ARIMA）model in predicting theinfection rate of carbapenem-resistant Klebsiella pneumoniae（CRKP）．Methods The monthly incidence of nosocomial infection of CRKP in Jiawang District People’s Hospital from 2018 to 2024 was selected，and the ARIMA model was established by19.0 SPSS to analyze the fitting and prediction value of the model．Results The ARIMA was established based on the monthly CRKP infection rate from January 2018 to December 2024．The fitted value of the ARIMA（1，1，1）model was in good agreement with the actual value．The incidence of CRKP infection were in good agreement with the predicted value．The average relative errors were 5.40%．Conclusions The ARIMA model can effectively fit and predict the CRKP infection rate，providing scientific guidance for the prevention and control of CRKP infection．

       目的 探究1990—2023年中国人群下背痛（LBP）疾病负担，并预测2024—2040年LBP疾病负担发展趋势，为公共卫生政策制定提供数据支撑。方法 基于GBD2023数据库，采用Joinpoint模型、分解分析（decomposition analysis）量化我国LBP负担变化趋势，最后通过ARIMA（autoregressive integrated moving average model）模型预测未来趋势。结果 2023年我国LBP患病人数达9 532.40万人，发病人数为4 138.36万人，伤残调整生命年（DALYs），虽然患病人数、发病人数及DALYs绝对数较1990年显著增长，但年龄标准化率（ASR）均呈显著下降趋势（AAPC依次为-0.90%、-0.84%、-0.89%）。分解分析表明，人口年龄结构是我国LBP疾病负担增长的主要正向驱动因素，流行病学趋势变化对患病率和DALYs起关键抑制作用，且存在明显性别差异。ARIMA模型预测显示，2024—2040年男性和女性LBP相关ASR将持续下降，但我国女性LBP负担仍高于男性。结论 我国LBP负担沉重，受人口结构、性别差异、行为与职业等多方面因素影响，未来需通过分人群、分职业精准干预及多部门协同，持续降低疾病负担。

     Objective To explore the characteristics of disease burden of low back pain（LBP） in the Chinese population from 1990 to 2023，and predict its development trend from 2024 to 2040，so as to provide data support for the formulation of public health policies．Methods Based on the Global Burden of Disease Study 2023（GBD 2023） database，the Joinpoint model and decomposition analysis were adopted to quantify the changing trend of LBP burden in China．The autoregressive integrated moving average（ARIMA） model was used to predict the future trend，with the data for prediction stratified by gender and age group．Results In 2023，the number of LBP patients in China reached 95.3240 million，the number of incident cases was 41.3836 million，and the disability-adjusted life years（DALYs） were 10.6359 million person-years．Although the absolute numbers of prevalent cases，incident cases，and DALYs increased significantly compared with 1990，the age-standardized rates（ASRs） all showed a significant downward trend（average annual percentage changes were -0.90%，-0.84%，and -0.89%，respectively）．Decomposition analysis revealed that population age structure was the primary positive driving factor for the growth of LBP disease burden in China，while changes in epidemiological trends played a key inhibitory role in prevalence and DALYs，with significant gender differences．ARIMA model prediction indicated that the LBP-related ASRs would continue to decrease in both males and females from 2024 to 2040，but the LBP burden in females would remain higher than that in males in China．Conclusions The baseline burden of LBP in China is heavy，affected by multiple factors such as population structure，gender differences，behavioral and occupational factors．In the future，targeted interventions for specific populations and occupations，as well as multi-sectoral collaboration，are needed to continuously reduce the disease burden．