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 探究肺泡灌洗液靶向高通量测序（tNGS）在鹦鹉热衣原体肺炎中应用效果。方法 选取2021年5月—2025年3月我院收治的35例鹦鹉热衣原体肺炎患者进行研究，患者均接受肺泡灌洗液tNGS检测、肺泡灌洗液常规病原检测，以病原学为金标准，分析肺泡灌洗液tNGS对鹦鹉热衣原体肺炎的诊断效能。结果 金标准对鹦鹉热衣原体阳性检出35例，检出率100.00%，肺泡灌洗液tNGS阳性检出率高于传统病原检测，检测结果回报耗时短于肺泡灌洗液传统病原检测（P＜0.05）。结论 鹦鹉热衣原体肺炎临床症状缺乏特异性，容易转为重症肺炎，肺泡灌洗液tNGS可提高鹦鹉热衣原体肺炎检出率且结果回报较快，采用四环素类、喹诺酮类抗生素有助于改善患者预后。

     Objective To investigate the application effect of targeted next-generation sequencing（tNGS）of bronchoalveolar lavage fluid（BALF）in Chlamydia psittaci pneumonia．Methods Thirty-five patients with Chlamydia psittaci pneumonia admitted to our hospital from May 2021 to March 2025 were selected for the study．All patients underwent BALF tNGS and conventional BALF pathogen detection．With etiology as the gold standard，the diagnostic efficacy of BALF tNGS for Chlamydia psittaci pneumonia was analyzed．Results The gold standard detected 35 cases of Chlamydia psittaci positive，with a detection rate of 100.00%．The positive detection rate of tNGS in alveolar lavage fluid was higher than that of traditional pathogen detection，and the results report time of tNGS was shorter than that of traditional pathogen detection（P＜0.05）．Conclusions Chlamydia psittaci pneumonia lacks specificity in clinical symptoms and is easy to turn into severe pneumonia，bronchoalveolar lavage fluid tNGS can improve the detection rate of Chlamydia psittaci pneumonia and the results return quickly，and the use of tetracyclines and quinolones antibiotics can help improve the prognosis of patients．

       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 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 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 通过年龄、性别等多方面研究各亚型注意缺陷多动障碍（ADHD）儿童的智力结构分布特征的临床研究，为ADHD的个体化干预提供科学依据。方法 实验组纳入ADHD儿童754例，其中注意缺陷型（ADHD-I）280例（37.13%）、多动-冲动型（ADHD-HI）212例（28.12%）、混合型（ADHD-C）262例（34.75%），按年龄分为三组：低龄组（6~8岁）、中龄组（9~11岁）及高龄组（12~14岁）；对照组为正常儿童412例，为同期选择的性别、年龄相匹配的儿童。选择采用韦氏智力评估等方法分别对两组儿童进行评估等，对评估结果进行比较和综合分析。结果 ADHD儿童的智力评估结果低于对照组（P＜0.01），且在言语智商方面表现更为明显，在各分测验中以A因子（言语理解）和C因子（记忆/注意集中）为主，而B因子（知觉组织能力）方面则无差异。ADHD-HI型及ADHD-C型的总智商及操作智商均高于ADHD-I型，ADHD-C型言语智商和A因子均高于ADHD-I型（P＜0.01），ADHD-HI型的智力水平最高，而ADHD-I型与ADHD-C型的智力水平差异无统计学意义（P＞0.05）。各年龄段ADHD儿童的智力发育均受到不同程度的影响，尤其是中龄组儿童及高龄组女童所受影响更明显；低、中龄组儿童的智力发育水平均高于高龄组儿童，提示ADHD儿童的智力损害随年龄增长而加重；同一年龄段ADHD女童的智力损害较男童更为严重。结论 本地区6~14岁ADHD儿童的智力水平较低，以言语智商低下更为明显，ADHD-HI型在3个亚型中智力损害最小，ADHD儿童的智力损害随年龄增长而加重，同一年龄段ADHD女童的智力损害较男童更为严重。

   Objective To investigate the distribution characteristics of intellectual structure in children with different subtypes of attention deficit hyperactivity disorder（ADHD）by age and gender，providing scientific basis for individualized treatment and intervention of ADHD．Methods The experimental group consisted of 754 children with ADHD，including 280 cases（37.13%）of inattentive type（ADHD-I），212 cases（28.12%）of hyperactivity impulsive type（ADHD-HI），and 262 cases（34.75%）of combined type（ADHD-C）．They were divided into three groups by age：young group（6-8 years old），middle group（9-11 years old），and older group（12-14 years old）．The control group consisted of 412 normal children with matched sex and age recruited during the same period and had similar sex ratio．The specific methods of Wechsler Intelligence Scale were mainly applied to evaluate normal children and children with ADHD，and the evaluation results were subjected to multidimensional analysis and comparison．Results The intelligence assessment results of ADHD children were significantly lower than those of the control group（P＜0.01），with a more pronounced performance in verbal intelligence．In various sub tests，factors A（verbal comprehension）and C（memory and attention concentration）were the main factors，while there was no difference in factor B（perceptual organization ability）．The ADHD-HI and ADHD-C types had higher total intelligence and operational intelligence than the ADHD-I type，and the ADHD-C type had higher verbal intelligence and factor A than the ADHD-I type（P＜0.01）．The intelligence level of the ADHD-HI type is the highest，while there is no statistically significant difference in intelligence level between the ADHD-I type and the ADHD-C type．The intellectual development of children in different age groups was affected to varying degrees，especially in the middle and older groups of girls．This study found that the intellectual development of children in the young and middle group was higher than that of children in the older group，indicating that the intellectual development of ADHD children will be increasingly damaged with age．At the same time，it was also found that ADHD girls in the same age group had more severe intellectual development impairment than boys．Conclusions The intelligence level of children with ADHD aged 6-14 in this region is relatively low，with verbal intelligence quotient being more pronounced．ADHD-HI has the smallest intellectual impairment among the three subtypes，and the intellectual development of ADHD children becomes more severe with age．ADHD girls in the same age group have more severe intellectual development impairment than boys．

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．

在按病种分值付费（DIP）模式深化实施的背景下，医用耗材管理作为医院成本控制与医疗质量保障的核心环节，其监督效能直接影响医院运营效益。本文基于供应链溢出视角，以某医院医用耗材信息化管理实践为案例，从技术溢出、管理溢出、风险溢出三个维度，探讨信息技术对医院内部医用耗材监督管理的优化路径。研究表明，通过构建医疗器械唯一标识（UDI）系统、收拾耗占比动态监控、专项议价管控等措施，可实现监督技术跨环节渗透、管理标准全链条协同、风险防控全周期覆盖。实践表明，该模式有效控制了医院耗材的整体运营成本，并显著提升了高值耗材的用后结算管理水平，为公立医院构建精准、高效的内部监管机制提供了有价值的实践路径。

Under the deepening implementation of the diagnosis-intervention packet（DIP） payment model，the management of medical consumables serves as a core aspect of hospital cost control and medical quality assurance，with its supervision efficiency directly impacting hospital operational benefits．Based on the perspective of supply chain spillover，this paper takes the informatization management practices of medical consumables in a hospital as a case study，exploring the optimization paths of information technology in the internal supervision and management of medical consumables from three dimensions：technological spillover，managerial spillover，and risk spillover．The research shows that by establishing a unique device identification（UDI） system，implementing dynamic monitoring of the consumption ratio of medical consumables，and conducting special negotiation controls，cross-process penetration of supervision technology，full-chain coordination of management standards，and comprehensive risk prevention and control throughout the entire cycle can be achieved．Practice demonstrates that this model has reduced the hospital’s overall cost of medical consumables by 2.75%，increased the post-use settlement rate of high-value consumables to 80%，and provided practical references for public hospitals to establish a precise and efficient internal supervision system．

       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．