中西医结合型公共卫生人才培养是应对复杂公共卫生挑战的重要方向，但国内外普遍存在整合医学与群体健康脱节、实践薄弱及标准缺失等问题。大连医科大学依托其国家重点学科及国家中西医协同“旗舰”医院，探索构建了以问题导向模块化课程、“临床—社区”双轨实践体系及量化评价追踪机制为核心的系统化培养模式。数据显示，新模式培养后学生“治未病”应用认知优秀率从28%提升至65%；社区老年高血压管理项目中，患者血压达标率提高25%；毕业1-3年的学生中93%认为该模式对处理复杂公共卫生问题“至关重要”。该模式直面国内外双重困境，实现了从知识拼接向能力融合、从理论讲授向实践闭环、从主观评价向数据追踪的三大创新，在系统性、实操性和可评估性上形成独特优势，为我国新医科背景下中西医结合型公共卫生人才培养提供了可复制、可量化的范式参考。

目的 探讨密室逃脱教学法运用于急诊护理教学查房的效果。方法 选取2024年6月—2025年6月在本院急诊科的新入职护士76人作为研究对象,按随机数字表法将所有护士分为对照组和观察组（n均=38）。对照组采用传统模式护理教学查房,观察组采用密室逃脱教学法教学查房。培训后对两组护士采用理论及操作技能考核、批判性思维能力量表-中文版进行考核，并调查两组护士对两种教学模式的满意度。结果 与对照组比较，观察组的理论知识成绩及操作技能成绩明显提升（P＜0.05）；另外，观察组的批判性思维能力量表-中文版得分比对照组明显提升（P＜0.05）。观察组的非常满意、比较满意例数（率）及总满意度均比对照组明显增加（P＜0.05）。结论 密室逃脱教学法可有效提高急诊护理教学查房效果，值得在临床教学实践中进一步推广。

Objective: To investigate the effectiveness of the escape room teaching method in emergency nursing teaching rounds. Methods: A total of 76 newly hired nurses in the Emergency Department of our hospital between June 2024 and June 2025 were selected as study subjects. Using a random number table, all nurses were divided into a control group and an observation group (n = 38 each). The control group underwent traditional nursing teaching rounds, while the observation group participated in teaching rounds using the escape room teaching method. After training, both groups were assessed using theoretical and practical skill examinations, as well as the Critical Thinking Skills Scale (Chinese Version), and their satisfaction with the two teaching models was surveyed. Results: Compared with the control group, the observation group showed significant improvements in theoretical knowledge and practical skill scores (P < 0.05); Additionally, the scores on the Critical Thinking Skills Scale (Chinese Version) in the observation group were significantly higher than those in the control group (P < 0.05). The number (and rate) of nurses in the observation group who reported being “very satisfied” or “fairly satisfied,” as well as the overall satisfaction rate, were significantly higher than those in the control group (P < 0.05). Conclusion: The escape room teaching method can effectively enhance the effectiveness of emergency nursing teaching rounds and is worthy of further promotion in clinical teaching practice.

目的：初步探索羧基麦芽糖铁（FCM）治疗非透析慢性肾脏病（ND-CKD）贫血患者的有效性与安全性，为FCM在我国ND-CKD贫血患者中的临床应用提供参考。方法：本研究为单中心、前瞻性、单臂研究，纳入25例ND-CKD贫血患者，给予FCM 500 mg或1000 mg单次静脉输注，分别于基线和 FCM治疗的1周后、1月后采集患者外周血，检测血红蛋白、血清铁蛋白、转铁蛋白饱和度，同时观察、记录不良事件发生情况。结果：（1）患者经FCM单次输注后，1周后及1月后的血红蛋白、血清铁蛋白、转铁蛋白饱和度均显著升高（P<0.05）。与FCM治疗1周后相比，1月后的血红蛋白显著升高（P<0.05），血清铁蛋白、转铁蛋白饱和度均显著降低（P<0.05）。（2）2例患者发生低磷血症，1例患者出现过敏性皮疹，1例患者出现输注侧上肢酸胀不适。结论：FCM作为新型快速补铁制剂，可有效改善ND-CKD患者的贫血及铁代谢，短期安全性整体可控。

Objective: To preliminarily explore the efficacy and safety of ferric carboxymaltose (FCM) in the treatment of anemia in patients with non-dialysis chronic kidney disease (ND-CKD), and to provide a reference for the clinical application of FCM in Chinese ND-CKD patients with anemia. Methods: This was a single-center, prospective, single-arm study. A total of 25 ND-CKD patients with anemia were enrolled and received a single intravenous infusion of FCM at a dose of 500 mg or 1000 mg. Peripheral blood samples were collected from the patients at baseline, 1 week, and 1 month after FCM treatment to measure hemoglobin, serum ferritin, and transferrin saturation. Meanwhile, adverse events were observed and recorded. Results: (1) After a single infusion of FCM, the levels of hemoglobin, serum ferritin, and transferrin saturation were significantly increased at one week and one month post-treatment (P<0.05). Compared with the values at one week after FCM treatment, hemoglobin levels at one month were significantly higher (P<0.05), while serum ferritin and transferrin saturation levels were significantly lower (P<0.05). (2) Two patients developed hypophosphatemia, one patient experienced an allergic rash, and one patient reported soreness and discomfort in the upper limb on the infusion side. Conclusion: As a novel and rapid iron supplement preparation, FCM can effectively improve anemia and iron metabolism in patients with ND-CKD, with overall manageable short-term safety.

目的 探讨达格列净在行经皮冠状动脉介入治疗（Percutaneous Coronary Intervention，PCI）后2型糖尿病（Type 2 Diabetes Mellitus,T2DM）伴不稳定型心绞痛（Unstable Angina，UA）患者中的应用价值及短期心功能改善效果。方法 本研究为单中心、随机对照试验，纳入90例PCI术后2型糖尿病合并不稳定型心绞痛患者，随机分为达格列净组（n=43）和二甲双胍组（n=47），规范调整降糖药物保证降糖强度一致。治疗期间及治疗后6-12个月通过心脏彩超测量左心室射血分数（Left Ventricular Ejection Fraction，LVEF）、左室舒张末期内径（Left Ventricular End-Diastolic Diameter，LVEDD），并采集静脉血样检测N端B型利钠肽前体（N-terminalpro-Brain Natriuretic Peptide，NT-proBNP）水平，以评估心功能变化。 结果 PCI治疗后的6-12个月随访中，观察组NT-proBNP（P<0.01）显著降低，左心室射血分数LVEF（P<0.01）显著提升。与对照组相比：观察组NT-ProBNP水平明显下降（P<0.01），且低于对照组。结论 在PCI术后合并不稳定型心绞痛的T2DM患者中，加用达格列净治疗可显著改善NT-proBNP和LVEF等心功能替代指标，且安全性良好。

Objective:To explore the application value of dapagliflozin and its short-term cardiac function improvement effect in patients with type 2 diabetes mellitus (T2DM) combined with unstable angina (UA) after percutaneous coronary intervention (PCI). Methods: This was a single-center, randomized controlled trial. A total of 90 patients with type 2 diabetes mellitus (T2DM) complicated with unstable angina (UA) after percutaneous coronary intervention (PCI) were enrolled and randomly assigned to a dapagliflozin group (n=43) and a metformin group (n=47). Hypoglycemic agents were adjusted routinely to ensure consistent glycemic control intensity between the two groups. During treatment and at 6–12 months after treatment, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were measured by echocardiography, and venous blood samples were collected to determine the level of N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) for the evaluation of cardiac function changes. Results: During the 6-month follow-up after PCI treatment, the N-terminal pro-brain natriuretic peptide (NT-proBNP) level in the observation group decreased significantly (P<0.01), and the left ventricular ejection fraction (LVEF) increased significantly (P<0.01).Compared with the control group, the NT-proBNP level in the observation group was notably lower (P<0.01) and also remained below that of the control group. Conclusion: For type 2 diabetes mellitus (T2DM) patients complicated with unstable angina pectoris after PCI, adjuvant treatment with dapagliflozin for 6 months can significantly improve cardiac function surrogate markers such as NT-proBNP and LVEF, with favorable safety profile.

目的 探讨非重型肺源性急性呼吸窘迫综合征（ARDS）患者发生肺纤维化的影响因素，并构建Logistic回归模型，以筛选高危患者，指导临床制定针对性干预方案。方法 前瞻性选取2022年1月～2024年12月于本院诊治的134例非重型肺源性ARDS患者为研究对象，依据发病后30 d内是否发生肺纤维化将其分为发生组58例、未发生组76例。比较两组临床资料，并通过多因素Logistic回归分析肺纤维化发生的影响因素。构建Logistic回归模型，并分析该模型对肺纤维化发生的预测价值。结果 多因素Logistic回归分析显示病程中出现休克、脓毒症、吸烟史、肺动脉高压及血清白细胞介素-8（IL-8）、低氧诱导因子-1α（HIF-1α）、Clara细胞分泌蛋白16（CC-16）、成纤维细胞生长因子（FGF-2）水平为肺纤维化发生的独立危险因素（P＜0.05）；Logistic回归模型预测肺纤维化发生的AUC值为0.871，敏感度、特异度分别为77.59%、84.21%，Hosmer-Lemeshow检验该模型与观测值拟合度良好，且Bootstrap检验显示该模型具有良好的区分度。结论 病程中出现休克、脓毒症、吸烟史、肺动脉高压及血清IL-8、HIF-1α、CC-16、FGF-2水平为非重型肺源性ARDS患者发生肺纤维化的独立危险因素，基于上述危险因素构建Logistic回归模型，该模型预测肺纤维化发生具有良好的预测效能，临床可依据上述因素采取针对性干预方案，以降低肺纤维化发生率。

目的 探讨不同剂量左甲状腺素钠联合二甲双胍治疗妊娠期糖尿病（GDM）并发甲状腺功能减退症（简称“甲减”）患者的临床疗效，并分析其对甲状腺激素水平、妊娠结局的影响。方法 选取2023年1月～2025年1月于本院诊治的92例GDM并发甲减患者为研究对象，依据治疗方案不同将其分为2组，对照组采用左甲状腺素钠、二甲双胍治疗，观察组采用维生素D联合左甲状腺素钠、二甲双胍治疗。比较2组临床疗效及治疗前后甲状腺激素[促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺激素（FT4）]、糖脂代谢指标[空腹血糖、胰岛素抵抗指数（HOMA-IR）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）]、血管内皮功能[一氧化氮（NO）、内皮素-1（ET-1）、一氧化氮合酶（NOS）、非对称性二甲基精氨酸（ADMA）]、病情进展相关指标[成纤维细胞生长因子-21（FGF-21）、视黄醇结合蛋白4（RBP4）、脂蛋白相关磷脂酶A2（Lp-PLA2）]。比较2组妊娠结局。结果 观察组总有效率高于对照组（P＜0.05）；观察组治疗后TSH水平低于对照组，FT3、FT4水平高于对照组（P＜0.05）；观察组治疗后空腹血糖水平、TC、TG、LDL-C水平及HOMA-IR低于对照组（P＜0.05）；观察组治疗后NO、NOS水平高于对照组，ET-1、ADMA水平低于对照组（P＜0.05）；观察组治疗后血清FGF-21、RBP4、Lp-PLA2水平低于对照组（P＜0.05）；2组流产、胎盘早剥、新生儿窒息发生率比较无明显差异（P＞0.05），观察组早产发生率低于对照组（P＜0.05）。结论 维生素D联合左甲状腺素钠、二甲双胍治疗GDM并发甲减患者的效果显著，可更好地维持甲状腺功能正常，纠正糖脂代谢，改善血管内皮功能，控制疾病进展，并可在一定程度上改善妊娠结局。

目的 探讨吲哚布芬联合智能抗阻训练对急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）术后血小板功能及心功能的影响。方法 选取2024年1月至2025年12月在本院接受PCI支架植入术的60例ACS患者，随机分为观察组和对照组，每组30例。对照组给予常规治疗联合氯吡格雷75 mg/d治疗，观察组给予常规治疗联合吲哚布芬（100mg/次，2次/d）+智能抗阻训练干预，两组均连续干预3个月。比较两组患者干预前、干预1个月、3个月时花生四烯酸（AA）诱导和二磷酸腺苷（ADP）诱导的血小板聚集率，随访3个月不良心血管事件（MACE）发生率，以及干预前后心功能指标[左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）]。结果 干预前两组血小板聚集率、LVEF、LVEDD比较差异无统计学意义（P＞0.05）；干预1个月、3个月时，观察组AA诱导和ADP诱导的血小板聚集率降低幅度均显著大于对照组（P＜0.05）；干预3个月后，观察组LVEF显著高于对照组，LVEDD显著低于对照组（P＜0.05）；随访3个月，两组MACE发生率比较差异无统计学意义（P＞0.05）。结论 吲哚布芬联合智能抗阻训练可更显著地抑制ACS患者PCI术后血小板聚集，更有效地改善心功能指标，且安全性良好。

Objective To explore the effect of indobufen combined with intelligent resistance training on platelet function and cardiac function in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods A total of 60 ACS patients who underwent PCI stent implantation in our hospital from January 2024 to December 2025 were selected and randomly divided into an observation group and a control group, with 30 patients in each group. The control group was given conventional treatment combined with clopidogrel 75 mg/d, while the observation group was given conventional treatment combined with indobufen (100 mg/time, twice a day) + intelligent resistance training intervention. Both groups received continuous intervention for 3 months. The arachidonic acid (AA)-induced and adenosine diphosphate (ADP)-induced platelet aggregation rates were compared between the two groups before intervention, 1 month and 3 months after intervention. The incidence of major adverse cardiovascular events (MACE) was followed up for 3 months, and the cardiac function indexes [left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD)] were compared before and after intervention. Results Before intervention, there were no significant differences in platelet aggregation rates, LVEF and LVEDD between the two groups (P > 0.05); at 1 month and 3 months after intervention, the reduction amplitudes of AA-induced and ADP-induced platelet aggregation rates in the observation group were significantly greater than those in the control group (P < 0.05); after 3 months of intervention, LVEF in the observation group was significantly higher than that in the control group, and LVEDD was significantly lower than that in the control group (P < 0.05); after 3 months of follow-up, there was no significant difference in the incidence of MACE between the two groups (P > 0.05). Conclusion Indobufen combined with intelligent resistance training can more significantly inhibit platelet aggregation, more effectively improve cardiac function indexes in ACS patients after PCI, and has good safety.

登革热是由登革病毒引起、经伊蚊叮咬传播的急性传染病，近年来已在全球热带和亚热带地区广泛流行，严重威胁公共卫生安全。目前临床上尚缺乏特异性抗病毒药物和高效的疫苗，临床治疗主要以中西医结合为主要模式，且两者在发病机制阐释、诊疗策略制定等方面各有侧重且互为补充。本文系统梳理登革热西医领域的流行病学特征、病理基础与发病机制及现代医学治疗现状，同时深入阐述中医对该病的病因病机与病位认知、辨证论治体系及中医药治疗进展，旨在为临床诊疗优化与科研方向拓展提供参考。

Dengue fever is an acute infectious disease caused by the dengue virus. In recent years, it has prevailed widely in tropical and subtropical regions, posing a severe threat to public health security. Given the lack of specific antiviral drugs and high-efficiency vaccines for dengue fever, its clinical treatment is predominantly based on integrated traditional Chinese and Western medicine. The two medical systems exhibit distinct focuses and complementary advantages in the interpretation of pathogenesis and the formulation of diagnosis and treatment strategies. This paper systematically reviews the epidemiological characteristics, pathological basis, pathogenesis and current Western medical treatment status of dengue fever, and further elaborates the etiology, pathogenesis, lesion location, syndrome differentiation and treatment system, as well as research progress of traditional Chinese medicine for this disease. It aims to provide references for the optimization of clinical diagnosis and treatment and the expansion of scientific research directions on dengue fever.

目的：探讨免气腹、免全身麻醉腹腔镜辅助下腹股沟疝无张力修补术对患者术中生命体征稳定性及术后恢复的影响。方法：选取广州市从化区中医医院及花都区人民医院于2023年7月至2025年6月收治的腹股沟疝患者，按照手术方式的不同分为研究组与对照组。对照组行传统气腹全身麻醉腹腔镜下腹股沟疝无张力修补术（TEP 或 TAPP 术式），研究组行免气腹、免全身麻醉腹腔镜辅助下腹股沟疝无张力修补术。比较两组患者术中呼吸、循环功能变化，术后并发症发生情况，以及术后肛门排气时间、住院时间和住院费用。结果：两组患者一般资料比较，差异无统计学意义。研究组术中血压波动幅度小于对照组（P＜0.05），心率及血氧饱和度变化与对照组比较差异无统计学意义。亚组分析显示，研究组中采用 TAPP 术式的患者呼吸波动大于对照组中采用 TAPP 术式的患者（P＜0.05），而两组中采用 TEP 术式的患者呼吸波动差异无统计学意义（P＞0.05）。研究组手术时间短于对照组，术中出血量高于对照组（P＜0.05）。两组住院时间比较差异无统计学意义（P＞0.05），但研究组术后肛门排气时间更短、总住院费用更低（P＜0.05）。结论：免气腹、免全身麻醉腹腔镜辅助下腹股沟疝无张力修补术有助于缩短手术时间，促进术后胃肠功能恢复，并降低住院费用，具有一定的临床应用价值。

【摘要】 目的 系统分析音乐干预对眼科手术患者围手术期焦虑与生理反应的影响，为其临床应用提供参考。方法 系统检索国内外相关文献，从患者焦虑特征、理论基础、实施方法、干预效果及影响因素等方面进行综合分析。结果 眼科手术患者围术期焦虑发生率较高，焦虑可降低术中配合度、增加麻醉用药等风险。音乐干预通过调节边缘系统及自主神经系统发挥作用，术前、术中持续应用可显著降低焦虑评分，稳定心率、降低血压。听觉敏感性、基线焦虑水平、年龄及干预方案特征是影响干预效果的关键因素。结论 音乐干预能有效缓解眼科手术患者围手术期焦虑，具有良好应用潜力。未来需开展大样本随机对照试验，结合人工智能等技术开发个性化方案，并建立标准化实施方法。

【Abstract】Objective To systematically evaluate the effects of music intervention on perioperative anxiety and physiological responses in ophthalmic surgery patients, and to provide evidence for clinical practice. Methods Domestic and international literature on anxiety characteristics, mechanisms, implementation, efficacy, and influencing factors was systematically searched and reviewed. Results Perioperative anxiety is common in ophthalmic surgery patients and may reduce intraoperative cooperation and increase anesthetic consumption. Music intervention acts on the limbic system and the autonomic nervous system, and can effectively reduce anxiety scores, stabilize heart rate, and lower blood pressure when applied preoperatively and intraoperatively. Key influencing factors include auditory sensitivity, baseline anxiety, age, and intervention features. Conclusions Music intervention safely and effectively relieves perioperative anxiety in ophthalmic surgery patients. Further large-sample randomized controlled trials, AI-based personalized programs, and standardized protocols are needed.