1型糖尿病（T1DM）是一种免疫介导的胰岛β细胞特异性破坏的自身免疫性疾病，全球发病率逐年上升。胰岛自身抗体（IAbs）是T1DM最可靠的生物标志物，用于早期预测和诊断。然而，传统的放射配体法（RBA）虽然具有高实验特异度，但在疾病特异度方面存在局限性，尤其是单抗体阳性的预测价值较低。近年来，电化学发光法（ECL）作为一种无放射性污染的新方法，能够区分高亲和力和低亲和力的IAbs，显著提高了疾病特异度。多项研究表明，ECL法在预测T1DM风险方面优于RBA法，特别是在单抗体阳性的情况下。本文综述了IAbs检测方法的进展及其在T1DM预测和诊断中的应用，强调了ECL法在提高疾病特异度方面的优势。
Type 1 diabetes mellitus（T1DM）is an autoimmune disease characterized by the immune-mediated destruction of pancreatic β-cells，with a rising global incidence．Islet autoantibodies（IAbs）are the most reliable biomarkers for early prediction and diagnosis of T1DM．However，the traditional radio-binding assay（RBA），despite its high experimental specificity，has limitations in disease specificity，particularly in the predictive value of single autoantibody positivity．Recently，the electrochemiluminescence（ECL）method，a non-radioactive approach，has been developed to distinguish high-affinity from low-affinity IAbs，significantly improving disease specificity．Multiple studies have shown that the ECL method outperforms RBA in predicting T1DM risk，especially in cases of single autoantibody positivity．This review discusses the advancements in IAbs detection methods and their applications in T1DM prediction and diagnosis，highlighting the advantages of the ECL method in enhancing disease specificity．
本文系统探讨了人工智能（AI）技术在模拟医学培训中的应用现状、优势与挑战。AI通过虚拟患者系统、手术模拟评估、医学影像诊断培训及结构化报告优化四大核心场景,显著提升培训的智能化与个性化水平。研究表明,AI驱动的实时反馈机制（如手术技能评估系统）在随机对照试验中表现优于传统专家指导, 并具备大规模推广潜力, 可降低人力成本。然而,技术仍面临算法透明性、数据隐私伦理及临床转化效果验证等挑战。未来需深化跨学科合作, 结合增强现实（AR）等技术创新, 构建全球资源共享的智能认证体系, 推动医学教育范式转型。
This review summarizes and discusses the application status, advantages,and challenges of artificial intelligence（AI）technology in simulated medical training．AI significantly enhances the intelligence and personalization of training through four core scenarios：virtual patient systems, surgical simulation assessment, medical imaging diagnosis training, and structured reporting optimization．Researches demonstrates that AI-driven real-time feedback mechanisms（e.g., surgical skill assessment systems）outperform traditional expert guidance in randomized controlled trials（P<0.001）and exhibit potential for large-scale implementation to reduce labor costs．However, challenges remain regarding algorithmic transparency, data privacy ethics, and clinical translation validation．Future efforts require deepened interdisciplinary collaboration, integration with innovations like augmented reality, and the establishment of a globally shared intelligent certification system to advance the transformation of medical education paradigms．
目的 了解《医疗保障基金使用监督管理条例》（以下简称《条例》）在广东省实施的情况,分析其存在的问题与挑战, 提出改进建议。方法 依据《条例》设计调查问卷,采用便利抽样方法 , 针对广东省医保基金相关监管人员和医院工作人员展开问卷调查, 并进一步围绕相关主题展开深度访谈, 以便更全面地了解《条例》的实施情况。结果 回收有效问卷1 473份, 数据分析显示《条例》的实施有效遏制了违规行为、提高了监管效率、落实了信用管理制度、促进了服务规范性与费用合理化, 但同时也存在着部分违规行为仍难以监管、政策培训效果欠佳、技术支撑能力薄弱等问题。结论 在持续推进现有各项监管举措的基础上, 需进一步细化《条例》的具体内容, 加大政策培训与宣传力度, 持续完善技术支撑手段, 以提升基金监管效能。
Objective To understand the specific implementation of the “Regulation on the Supervision and Administration of the Use of Healthcare Security Funds”（hereinafter referred to as the “Regulations”）in Guangdong Province, analyze its existing problems and challenges, and propose improvement suggestions．Methods A questionnaire was designed based on the “Regulations”, and a convenience survey method was adopted to conduct questionnaire surveys among regulatory personnel related to medical insurance funds and hospital staff．Further in-depth interviews were conducted around relevant themes to gain a more comprehensive understanding of the implementation of the “Regulations．” Results The implementation of the “Regulations” has effectively curbed violations, improved regulatory efficiency, implemented a credit management system, and promoted service standardization and cost rationalization．However, challenges remain,such as difficulties in regulating certain violations, suboptimal policy training outcomes, and weak technical support capabilities．Conclusions On the basis of continuously advancing existing regulatory measures, it is necessary to further refine the specific content of the “Regulations” strengthen policy training and publicity efforts, and continuously improve information technology support methods to better enhance the effectiveness of fund supervision．
目的 分析广东省卒中中心建设现状及存在的问题,提出切实可行的改善建议。方法 基于广泛的文献调研, 通过问卷对广东省护士协会卒中中心建设与管理分会相关单位开展问卷调查, 统计分析其在医院管理制度、医护人员卒中救治水平及健康宣教等方面的现状与问题。结果 广东省卒中中心建设与管理委员会相关单位在卒中救治中基本实现跨学科合作, 院前评估制度基本满足卒中判断需求, 在提高卒中救治效率方面已基本形成共识, 卒中健康宣教基本满足患者需求, 但方式有待改进, 卒中随访制度和个案管理制度基本符合要求; 存在的问题包括卒中中心一线救治人员外出交流学习机会较少; 院前评估数据采集的便利性有待提高; 卒中康复需求仍难以满足; 健康宣教工作仍需加强。结论 广东省卒中中心建设与管理委员会相关单位在卒中院前评估、院内救治、出院随访和健康宣教方面能够满足患者需求, 但仍存在不足。建议相关单位为一线工作人员提供更多外出交流学习机会, 充分应用互联网和物联网技术提高院前卒中数据采集共享便利性; 加强多种形式的科普宣教, 继续完善拓展卒中康复治疗和护理服务并完善相关制度。
Objective To understand the current situation of construction and existing problems of Stroke Center in Guangdong Province．Put forward feasible suggestions for improvement．Methods Based on extensive literature research, a questionnaire was designed to investigate the relevant organizations of Stroke Center Construction and Management Branch of Guangdong Nurses Association．The status quo and existing problems in hospital management system, stroke treatment level of medical staff, health education and other aspects were statistically analyzed．Results The relevant organizations of the Guangdong Stroke Center Construction and Management Committee could basically achieve interdisciplinary cooperation in stroke treatment, the pre-hospital assessment system basically met the needs of stroke judgment, and a consensus was basically reached on how to improve the efficiency of stroke treatment．Stroke health education basically met the needs of patients but the methods need to be improved．The stroke follow-up system and case management system basically met the requirements,but there were not many opportunities for first-line treatment personnel in stroke centers to exchange and study abroad．The convenience of data collection for pre-hospital assessment needed to be improved．Stroke rehabilitation needs were still difficult to meet．Health education still needs to be strengthened．Conclusions The relevant units of Guangdong Stroke Center Construction and Management Committee can meet the needs of patients in the aspects of pre-hospital assessment, in-hospital treatment,discharge follow-up and health education, but there are still shortcomings．It is suggested that relevant organizations provide more opportunities for front-line staff to exchange and study abroad, make full use of Internet and Internet of Things technology to improve the convenience of pre-hospital stroke data collection and sharing．Strengthen various forms of science popularization and education, and continue to improve and expand stroke rehabilitation treatment and nursing services, improve relevant systems．
目的 探讨重性抑郁障碍（MDD）患者肠道菌群特征与选择性5-羟色胺再摄取抑制剂（SSRIs）疗效的关联性, 筛选可预测SSRIs疗效的肠道菌群生物标志物。方法 选取2024年5月—2025年5月宁夏回族自治区人民医院收治的90例MDD患者, 根据SSRIs治疗8周后疗效分为应答组56例和无应答组34例, 并选择30例健康对照, 采集基线粪便样本进行16S rRNA基因测序, 分析肠道菌群α多样性、菌属相对丰度差异,并通过相关性分析、多因素Logistic回归及ROC曲线评估菌群标志物对SSRIs疗效的预测价值。结果 MDD患者肠道菌群Chao1指数、Shannon指数低于健康对照（P<0.05）, 应答组与无应答组α多样性无差异（P>0.05）。应答组基线Blautia、双歧杆菌属、粪球菌属丰度高于无应答组（P<0.05）, 大肠杆菌-志贺菌属丰度低于无应答组（P<0.05）。基线Blautia、双歧杆菌属、粪球菌属丰度与SSRIs治疗8周HAMD-17减分率呈正相关（r分别为0.390、0.420、0.350,均P<0.05）, 三者联合预测SSRIs疗效的ROC曲线下面积（AUC）为0.910（灵敏度83.9%,特异度85.3%）。结论 MDD患者存在肠道菌群结构异常, 基线Blautia、双歧杆菌属、粪球菌属丰度可作为SSRIs疗效的潜在预测标志物,为MDD个体化治疗提供实验依据。
Objective To explore the association between gut microbiota characteristics and the efficacy of selective serotonin reuptake inhibitors（SSRIs）in patients with major depressive disorder（MDD）, and to screen gut microbiota biomarkers for predicting SSRIs efficacy．Methods A total of 90 MDD patients（divided into responders[n=56] and non-responders[n=34] based on 8-week SSRIs efficacy）and 30 healthy controls were enrolled from May 2024 to May 2025．Fecal samples were collected for 16S rRNA gene sequencing to analyze gut microbiota α diversity and genus-level relative abundance．Correlation analysis, multivariate logistic regression, and receiver operating characteristic curve were used to evaluate the predictive value of microbiota markers for SSRIs efficacy．Results The Chao1 and Shannon indices of gut microbiota in MDD patients were significantly lower than those in healthy controls（P<0.05）, with no difference between responders and non-responders（P>0.05）．Responders had higher baseline abundances of Blautia,Bifidobacterium, and Coprococcus（P<0.05）, and lower abundance of Escherichia-Shigella compared to non-responders．Baseline abundances of Blautia,Bifidobacterium（P<0.05）, and Coprococcus were positively correlated with 8-week HAMD-17 reduction rate（r=0.390, 0.420, 0.350; all P<0.05）．The combined prediction of these three genera for SSRIs efficacy showed an area under the curve of 0.910（sensitivity 83.9%, specificity 85.3%）．Conclusions MDD patients exhibit abnormal gut microbiota structure．Baseline abundances of Blautia,Bifidobacterium, and Coprococcus may serve as potential predictive biomarkers for SSRIs efficacy, providing experimental basis for personalized treatment of MDD．
目的 调查国内养老机构痴呆照护服务现状,为今后国内进一步推进养老机构痴呆照护服务的发展提供可借鉴的依据。方法 2024年1月1日至3月31日以全国养老机构为研究对象, 采取两阶段分层抽样, 随机抽取国内15个省、自治区、直辖市的养老机构, 采用网络问卷调查方法对抽取的养老机构管理人员进行问卷调查。结果 共回收线上调查问卷443份, 经过去重和排除无效问卷, 最终得到的有效问卷为412份, 有效率为93%。调查发现有313家（76%）机构有收住痴呆患者, 养老床位规模为100~299张的养老机构占比最高。小规模的养老机构中,民办民营机构收住痴呆患者的比例高于公建公营机构。有181家机构设置了痴呆照护专区。床位数在300张以上的养老机构中设立痴呆照护专区的比例高于中、小规模的养老机构。结论 本调查较客观地呈现了我国养老机构痴呆照护服务开展的现状, 大规模的养老机构提供痴呆照护服务的能力更高, 设置痴呆照护专区的机构更能满足痴呆患者多层次、多样化的照护需求。目前国内仍存在专业化的痴呆照护服务供给不足、照护人员短缺等现象, 急需国家加强顶层设计, 促进行业健康发展。
Objective To explore the current situation of cognitive care services in nursing homes in China, and provide reference for further promoting the development of cognitive care services in nursing homes in China．Methods From January 1 to March 31, 2024, a two-stage stratified sampling was carried out to randomly select pension institutions in 15 provinces, autonomous regions and municipalities directly under the central government across the country, and a questionnaire survey was conducted on the nursing homes．Results A total of 443 online questionnaires were recovered in this survey, and 412 valid questionnaires were obtained after eliminating duplicated and invalid questionnaires, with an effective rate of 93%．In this survey, 76% of the institutions admitted the elderly with dementia, and the nursing homes with 100-299 beds accounted for the highest proportion．Among the small-scale nursing homes, the proportion of the elderly with dementia in private institutions is significantly greater than that in public institutions．There were 181 nursing homes with special cognitive care areas．The proportion of cognitive care area in nursing homes with more than 300 beds was significantly greater than that in medium and small scale nursing homes．Conclusions This survey Objectively presents the current situation of the development of cognitive care services in nursing homes in our country．Large-scale nursing homes have a higher capacity to provide cognitive care services．Nursing homes that set up special areas for cognitive care can better meet the multi-level and diversified care needs of the elderly with dementia．At present, there are still insufficient supply of professional cognitive care services and shortage of nursing personnel in China．It is urgent for the country to strengthen top-level design and promote the healthy development of the industry．
目的 探究四子散中药封包药熨在股骨骨折术后疼痛及肿胀中的临床疗效及安全性。方法 选取2024年6月—2025年5月婺源县人民医院骨科收治的60例股骨骨折术后患者, 随机分为观察组（30例,常规治疗+四子散中药封包药熨）与对照组（30例,常规治疗）。比较两组治疗前后疼痛评分（NRS-11）、肿胀程度评分、C反应蛋白（CRP）、白细胞介素-6（IL-6）水平及不良事件发生率。结果 治疗前两组患者疼痛、肿胀评分、CRP、IL-6水平比较差异无统计学意义（P>0.05）; 治疗1周后,观察组疼痛评分为（2.11±0.48）分、肿胀程度为（0.35±0.43）度、CRP为（12.23±3.12）mg/L、IL-6为（16.03±4.01）ng/L,均低于对照组的（3.54±0.56）分、（1.04±0.58）度、（24.31±4.51）mg/L、（23.19±6.75）ng/L,差异有统计学意义（P<0.001）。观察组与对照组均无发生不良事件。结论 四子散中药封包药熨可缓解股骨骨折术后疼痛及肿胀,安全性良好。
Objective To explore the clinical efficacy and safety of Sizi powder pack hot compress in the treatment of pain and swelling after femoral fracture surgery．Methods From June 2024 to May 2025, 60 patients after femoral fracture surgery were admitted to the Orthopedics Department of Wuyuan County People's Hospital and randomly divided into observation group（30 cases, conventional treatment+Sizi power pack hot compress）and control group（30 cases, conventional treatment）． The pain score（NRS-11）, swelling score, CRP,IL-6 levels and incidence of adverse events before and after treatment were compared between the two groups．Results There was no significant difference in pain and swelling scores between the two groups before treatment（P>0.05）．After 1 week of treatment, the pain score（2.11±0.48）, swelling score（0.35±0.43）, CRP（12.23±3.12 mg/L）, IL-6（16.03±4.01 ng/L）levels in the observation group were significantly lower than those in the control group（3.54±0.56, 1.04±0.58, 24.31±4.51 mg/L, 16.03+4.01 ng/L）, and the difference was statistically significant（P<0.001）．There were no adverse events in the observation group or the control group．Conclusions Sizi power pack hot compress can significantly alleviate the pain and swelling after femoral fracture surgery,and with good safety．
