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  • 信息论安全的可信验证算法

    分类: 计算机科学 >> 信息安全 提交时间: 2025-07-17

    摘要: 密码是可信计算的基石。当前,经典密码体制受到了量子计算的严重挑战,后量子密码(Post-QuantumCryptography,PQC)能够抵抗已知量子攻击,然而随着量子计算的不断发展和完善,新的量子攻击方法的出现将难以避免,PQC算法的安全性是否能够长期有效是一个未知数。基于此,本文提出了信息论安全的可信验证算法,该算法基于模运算设计,其安全性为基于数学原理的直接推论,不依赖于任何困难问题假设,具有完备的抗量子计算攻击的能力。

  • Effects of a combination of biochar and cow manure on soil nutrients and cotton yield in salinized fields

    分类: 农、林、牧、渔 >> 农业基础学科 提交时间: 2025-07-17 合作期刊: 《干旱区科学》

    摘要: Biochar and animal manure application can improve crop yields in salt-affected soil. Previous studies have primarily applied biochar and animal manure either alone or at fixed ratios, while their combined effects with varying combination proportions are still unclear. To address this knowledge gap, we performed a 2-a experiment (2023–2024) in a salinized cotton field in Wensu County of Xinjiang Uygur Autonomous Region of China with the following 6 treatments: control; application of biochar (10 t/hm2) alone (BC100%); application of cow manure (10 t/hm2) alone (CM100%); application of 70% biochar (7 t/hm2) combined with 30% cow manure (3 t/hm2) (BC70%+CM30%); application of 50% biochar (5 t/hm2) combined with 50% cow manure (5 t/hm2) (BC50%+CM50%); and application of 30% biochar (3 t/hm2) combined with 70% cow manure (7 t/hm2) (BC30%+CM70%). By measuring soil pH, electrical conductivity, soil organic matter, available phosphorus, available potassium, and available nitrogen at 0–20 and 20–40 cm depths, as well as yield components and cotton yield in 2023 and 2024, this study revealed that soil nutrients in the 0–20 cm depth were more sensitive to the treatment. Among all the treatments, BC50%+CM50% treatment had the highest value of soil pH (9.63±0.07) but the lowest values of electrical conductivity (161.9±31.8 μS/cm), soil organic matter (1.88±0.27 g/kg), and available potassium (42.72±8.25 mg/kg) in 2024. Moreover, the highest cotton yield (5336.63±467.72 kg/hm2) was also observed under BC50%+CM50% treatment in 2024, which was 1.9 times greater than that under the control treatment. In addition, cotton yield in 2023 was jointly determined by yield components (density and number of cotton bolls) and soil nutrients (available phosphorus and available potassium), but in 2024, cotton yield was only positively related to yield components (density, number of cotton bolls, and single boll weight). Overall, this study highlighted that in salt-affected soil, the combination of biochar and cow manure at a 1:1 ratio is recommended for increasing cotton yield and reducing soil salinity stress.

  • Effects of climate change and human activities on grassland productivity: A case study of the Qinghai Lake Basin, China

    分类: 生物学 >> 生态学 提交时间: 2025-07-17 合作期刊: 《干旱区科学》

    摘要: Grassland is a key component of the ecosystem in the Qinghai Lake Basin, China. Understanding the effects of climate change and human activities on grassland productivity significantly improves ecological conservation and promotes sustainable vegetation growth in this area. Based on the net primary productivity (NPP) products of MOD17A3HGF (a moderate-resolution imaging spectroradiometer (MODIS) product that provides annual NPP at 500 m resolution) and meteorological data, we analyzed the spatial and temporal evolution of grassland NPP and its interaction with climate factors in the Qinghai Lake Basin from 2001 to 2022 via partial correlation and trend analysis methods. We also used the deflecting trend residual method and scenario analysis method to quantitatively assess the relative contributions of climatic factors and human activities to grassland NPP. The results revealed that: (1) during the past 22 a, grassland NPP increased considerably, with a gradient change from the northwest to the southeast of the study area; (2) sunshine duration, precipitation, and temperature positively influenced grassland NPP, with sunshine duration exerting a stronger effect on grassland NPP than precipitation and temperature; and (3) 98.47% of the grassland in the study area was restored, with an average contribution of 65.00% from human activities and 35.00% from climatic alterations. Compared with climate change, human-induced factors had a greater effect on grassland NPP in this area. The results of the study not only provide important scientific support for ecological restoration and sustainable development of the basin but also offer new ideas for research on similar ecologically fragile areas.

  • Applying joint species distribution modelling to assess the relative influence of ecological filters on community assembly in the El Bayadh steppe, Algeria

    分类: 生物学 >> 生态学 提交时间: 2025-07-17 合作期刊: 《干旱区科学》

    摘要: Understanding plant community assembly is crucial for effective ecosystem conservation and restoration. The ecological filter framework describes community assembly as a process shaped by dispersal, environmental, and biotic filters. Additionally, functional traits and phylogenetic relationships are increasingly recognized as important factors influencing species coexistence and community structure. However, both the ecological filter framework and the roles of functional traits and phylogeny in community assembly remain underexplored in the Algerian steppes—particularly in the El Bayadh region, where ongoing vegetation degradation threatens ecosystem stability. This study applied Hierarchical Modeling of Species Communities (HMSC) as an integrative approach to assess how ecological filters influence plant community assembly in the El Bayadh steppe and to evaluate the roles of functional traits and phylogenetic relationships in this process. Environmental data—including soil properties, topography, precipitation, and land use types (grazing and exclosure)—were collected across 50 plots in April and October, 2023, along with functional traits from 24 species. These traits include root length, leaf area, specific leaf area, clonality, life history, and seed mass. HMSC results revealed that soil properties and precipitation were the primary drivers of community structure, while sand height and elevation had a moderate influence. In contrast, competition and grazing played relatively minor roles. Species responses to environmental covariates were heterogeneous: soil fertility and texture had mixed effects, benefiting some species while limiting others; sand encroachment and precipitation variability generally had negative impacts, whereas grazing exclusion favored many species. A weak phylogenetic signal was recorded, indicating that community assembly was driven more by environmental filtering than by shared evolutionary history. Functional trait responses to environmental variation reflected plant strategies that balanced resource acquisition and conservation. Specifically, seed mass, leaf area, and root length increased under higher soil moisture and nutrient availability but declined in response to salinity, precipitation variability, and sand height. Clonality and perennial life history traits enhanced the survival of plant species under harsh conditions. Overall, this study provides a holistic understanding of community assembly processes in the El Bayadh steppe and offers valuable insights for ecosystem management and restoration in arid and degraded ecosystem environments.

  • Spatiotemporal dynamic and drivers of ecological environmental quality on the Chinese Loess Plateau: Insights from kRSEI model and climate-human interaction analysis

    分类: 地球科学 >> 地理学 提交时间: 2025-07-17 合作期刊: 《干旱区科学》

    摘要: The Loess Plateau (LP), one of the most ecologically fragile regions in China, is affected by severe soil erosion and environmental degradation. Despite large-scale ecological restoration efforts made by Chinese government in recent years, the region continues to face significant ecological challenges due to the combined impact of climate change and human activities. In this context, we developed a kernal Remote Sensing Ecological Index (kRSEI) using Moderate Resolution Imaging Spectroradiometer (MODIS) products on the Google Earth Engine (GEE) platform to analyze the spatiotemporal patterns and trends in ecological environmental quality (EEQ) across the LP from 2000 to 2022 and project future trajectories. Then, we applied partial correlation analysis and multivariate regression residual analysis to further quantify the relative contributions of climate change and human activities to EEQ. During the study period, the kRSEI values exhibited significant spatial heterogeneity, with a stepwise degradation pattern in the southeast to northwest across the LP. The maximum (0.51) and minimum (0.46) values of the kRSEI were observed in 2007 and 2021, respectively. Trend analyses revealed a decline in EEQ across the LP. Hurst exponent analysis predicted a trend of weak anti-persistent development in most of the plateau areas in the future. A positive correlation was identified between kRSEI and precipitation, particularly in the central and western regions; although, improvements were limited by a precipitation threshold of 837.66 mm/a. A moderate increase in temperature was shown to potentially benefit the ecological environment within a certain range; however, temperature of –1.00°C–7.95°C often had a negative impact on the ecosystem. Climate change and human activities jointly influenced 65.78% of LP area on EEQ, primarily having a negative impact. In terms of contribution, human activities played a dominant role in driving changes in EEQ across the plateau. These findings provide crucial insights for accurately assessing the ecological state of the LP and suggest the design of future restoration strategies.

  • Health risk assessment of heavy metals in coal mine soils of Northwest China

    分类: 农、林、牧、渔 >> 土壤学 提交时间: 2025-07-17 合作期刊: 《干旱区科学》

    摘要: Coal mining predisposes soils to heavy metal (HM) accumulation, which adversely affects the ecological environment and human health, particularly in extremely arid and vulnerable areas. In this study, soil samples were gathered from the Black Mountain Open Pit Coal Mine in Turpan City, Northwest China to determine the health risk of heavy metals (HMs). Results showed that positive matrix factorization model divided the sources of soil HMs into four categories, i.e., natural and animal husbandry (43.46%), industrial transportation (22.87%), fossil fuel combustion (10.64%), and atmospheric deposition and domestic pollution (23.03%). All kinds of pollution evaluation indices showed that Cd (cadmium) and Pb (plumbum) pollution was evident. The Monte Carlo simulated health risk assessment results showed that 4.00% non-carcinogenic risk and 12.00% carcinogenic risk were posed to children, and the positive matrix factorization-based health risk assessment showed that fossil fuel combustion had the highest contribution to the health risks to adults and children, while industrial transportation was the lowest. In this study, the risks of HMs in the soil of mining area were analyzed using source analysis, which not only provides reliable data support for the prevention and control of HM pollution in the soil of this arid mining area, but also provides a theoretical basis for subsequent regional research.

  • Quantitative analysis of factors driving the variations in snow cover fraction in the Qilian Mountains, China

    分类: 地球科学 >> 地理学 提交时间: 2025-07-17 合作期刊: 《干旱区科学》

    摘要: Understanding the impact of meteorological and topographical factors on snow cover fraction (SCF) is crucial for water resource management in the Qilian Mountains (QLM), China. However, there is still a lack of adequate quantitative analysis of the impact of these factors. This study investigated the spatiotemporal characteristics and trends of SCF in the QLM based on the cloud-removed Moderate Resolution Imaging Spectroradiometer (MODIS) SCF dataset during 2000–2021 and conducted a quantitative analysis of the drivers using a histogram-based gradient boosting regression tree (HGBRT) model. The results indicated that the monthly distribution of SCF exhibited a bimodal pattern. The SCF showed a pattern of higher values in the western regions and lower values in the eastern regions. Overall, the SCF showed a decreasing trend during 2000–2021. The decrease in SCF occurred at higher elevations, while an increase was observed at lower elevations. At the annual scale, the SCF showed a downward trend in the western regions affected by westerly (52.84% of the QLM). However, the opposite trend was observed in the eastern regions affected by monsoon (45.73% of the QLM). The SCF displayed broadly similar spatial patterns in autumn and winter, with a significant decrease in the western regions and a slight increase in the central and eastern regions. The effect of spring SCF on spring surface runoff was more pronounced than that of winter SCF. Furthermore, compared with meteorological factors, a variation of 46.53% in spring surface runoff can be attributed to changes in spring SCF. At the annual scale, temperature and relative humidity were the most important drivers of SCF change. An increase in temperature exceeding 0.04°C/a was observed to result in a decline in SCF, with a maximum decrease of 0.22%/a. An increase in relative humidity of more than 0.02%/a stabilized the rise in SCF (about 0.06%/a). The impacts of slope and aspect were found to be minimal. At the seasonal scale, the primary factors impacting SCF change varied. In spring, precipitation and wind speed emerged as the primary drivers. In autumn, precipitation and temperature were identified as the primary drivers. In winter, relative humidity and precipitation were the most important drivers. In contrast to the other seasons, slope exerted the strongest influence on SCF change in summer. This study facilitates a detailed quantitative description of SCF change in the QLM, enhancing the effectiveness of watershed water resource management and ecological conservation efforts in this region.

  • Occurrence of flash drought in reservoirs in the semi-arid area of the Ceará State, Brazil

    分类: 地球科学 >> 大气科学 提交时间: 2025-07-17 合作期刊: 《干旱区科学》

    摘要: Precipitation is scarce in semi-arid areas, which results in serious drought. Occurrence of flash drought is quite often in these areas, and flash drought may also cause significant disasters. However, monitoring flash drought is still weak and remains a challenge. This study aims to identify, evaluate, and monitor flash drought events that occurred from 1961 to 2020 in reservoirs of the Ceará State, Brazil. The Christian's method, standardized precipitation index (SPI), standardized precipitation evapotranspiration index (SPEI), and evaporative demand drought index (EDDI) were used to assess the severity and persistence of flash drought. Moreover, analyses conducted in 2001, 2008, 2011, 2012, 2016, and 2020 revealed the complexity and interaction of flash drought with environmental and meteorological factors. The results indicated that in dry years such as 2001, 2012, and 2016, drought indices pointed to the intensification of drought conditions, with impacts on major reservoirs in the area, such as Banabuiú, Castanhão, and Orós. Low precipitation, associated with high evaporative demand, intensified water stress, reducing water availability for the population and local ecosystems. In wet years such as 2008, 2011, and 2020, SPEI and EDDI indicated higher moisture levels and drought relief, favoring the recovery of reservoirs. It was also observed that most flash drought episodes evolved into conventional droughts, highlighting their persistence and potential long-term impact. Moreover, the months of May and November presented a higher frequency of flash drought during the wet and dry periods, respectively, negatively impacting most of the studied reservoirs. These findings underscore the need for effective drought monitoring and mitigation strategies to reduce its impacts on agriculture and water resources in the semi-arid area. Early detection and analysis of flash drought are important for improving water resource management and for continuous adaptation to changing drought conditions.

  • 脑梗死后预后相关生物标志物的研究新进展:机制与临床应用

    分类: 医学、药学 >> 预防医学与公共卫生学 提交时间: 2025-07-17 合作期刊: 《中国全科医学》

    摘要: 缺血性卒中(缺血性脑卒中)作为导致全球残疾和死亡的主要原因之一,近年来,其预后生物标志物的研究取得了显著进展。本研究综述了包括血细胞分析指标(如红细胞体积分布宽度)、ω-3多不饱和脂肪酸、细胞因子(如白介素6、肿瘤坏死因子α)、微小核糖核酸(miRNA,如miR-21、miR-155、miR-126)和外泌体在内的多种生物标志物在缺血性脑卒中中的作用机制及其作为预后评估的研究进展。研究结果显示,血细胞分析相关指标、ω-3多不饱和脂肪酸、白介素6、肿瘤坏死因子α的浓度与缺血性脑卒中的严重程度和预后密切相关。其中,较高基线红细胞体积分布宽度与复发性缺血性脑卒中的风险增加相关,并且与缺血性脑卒中的复发时间呈负相关。特定miRNA如miR-21通过抑制细胞凋亡和促进神经元存活,改善神经功能恢复;而miR-155通过调控炎症反应加剧脑损伤,其表达水平可预测缺血性脑卒中的复发;此外,miR-126在血管生成和神经保护中发挥关键作用。外泌体则通过携带抗炎因子、神经营养因子、抗氧化酶和热休克蛋白等,显著减轻缺血再灌注引起的炎症和损伤,从而影响缺血性脑卒中的预后。尽管这些生物标志物在缺血性脑卒中预后评估中显示出巨大潜力,但其临床应用仍面临诸多挑战,包括个体间差异、长期效应和安全性研究不足以及技术标准化问题。未来研究应进一步探讨这些标志物的作用机制,开发标准化的检测方法,并进行大规模临床验证,以期将其应用于临床,改善缺血性脑卒中患者的预后和生活质量。

  • 绝经后女性内脏脂肪指数与心血管疾病的关联性分析:前瞻性队列研究

    分类: 医学、药学 >> 预防医学与公共卫生学 提交时间: 2025-07-17 合作期刊: 《中国全科医学》

    摘要: 背景 心血管疾病是威胁女性健康的主要疾病之一,而绝经后女性是心血管疾病的高危人群。绝经后雌激素水平的下降可能促进内脏脂肪的积累,而内脏脂肪的增加与胰岛素抵抗、慢性炎症反应以及脂质代谢紊乱紧密相关,这可能会提高心血管疾病的风险。然而,目前关于内脏脂肪指数与绝经后女性心血管疾病之间联系的研究相对较少。目的 探索绝经后女性内脏脂肪指数(CVAI)与心血管疾病之间的关系,为绝经后女性心血管疾病的预防提供借鉴。方法 基于中国健康与养老追踪调查(CHARLS)2015—2020年数据,纳入2015年基线无心血管疾病年龄≥45岁绝经后女性4743人,将参与对象基线CVAI作为暴露因素,将2018年、2020年发生心血管疾病作为结局事件,采用Cox比例风险回归模型分析CVAI与心血管疾病的关系,采用限制性立方样条(RCS)分析评估剂量反应关系。结果 随访至2020年,4743名绝经后女性心血管疾病、心脏病、卒中的发病率分别为20.2%(958/4743)、13.6%(645/4743)、8.3%(393/4743)。研究对象基线CVAI的四分位数Q1、Q2、Q3、Q4分别为≤84.78、(84.78~108.49]、(108.49~132.01]、>132.01。调整混杂因素后,Cox比例风险回归模型结果显示,以CVAIQ1组为参照,Q3、Q4组绝经后女性心血管疾病的发生风险分别增加69%(HR=1.69,95%CI=1.29~2.21)、82%(HR=1.82,95%CI=1.38~2.14);卒中的发生风险分别增加76%(HR=1.76,95%CI=1.10~2.82)、95%(HR=1.95,95%CI=1.21~3.14);心脏病的发生风险分别增加57%(HR=1.57,95%CI=1.14~2.15)、68%(HR=1.68,95%CI=1.21~2.33)。RCS分析发现CVAI与心血管疾病、心脏病、卒中发生风险之间均存在剂量-反应关系(P<0.05)。亚组分析结果表明,CVAI与CVD心血管疾病发生风险的关联性在年龄<65岁、≥65岁、BMI<24.35kg/m2、农村绝经后女性中均显著(P<0.05)。结论 CVAI升高显著增加绝经后女性心血管疾病的发病风险,尤其BMI较低及农村人群中,应针对这些亚群加强内脏肥胖的监测与管理,以降低心血管疾病发生风险。

  • 《痔中西医结合诊疗指南》临床问题与结局指标的收集与确定

    分类: 医学、药学 >> 预防医学与公共卫生学 提交时间: 2025-07-17 合作期刊: 《中国全科医学》

    摘要: 背景 痔病是肛肠科最常见的疾病,患者群体庞大,临床中西医结合诊疗优势明显,目前缺乏相关高质量指南或推荐标准,规范痔的中西医结合诊疗意义重大。目的 筛选并界定《痔中西医结合诊疗指南》的核心临床问题与结局指标,为后续循证证据整合及指南撰写提供支撑。方法 通过文献分析、专家访谈及临床调研形成初稿问题清单,采用德尔菲法开展两轮专家咨询。运用 SPSS 26.0 和 Excel 2021 进行数据分析,计算积极系数、均值、满分率、变异系数及 Cronbach's α 系数,纳入标准:临床问题均分≥ 3 分、结局指标均分≥ 7 分、满分率≥ 50%、变异系数 0.7、Cronbach's α 系数≥ 0.7 作为德尔菲法问卷质量控制标准。结果 经过初步调研,拟定了 27 个临床问题(9 个基础问题和 18 个 PICO 化临床问题)与 9 个结局指标。对 34 位相关领域专家进行两轮德尔菲法调查后,形成 28 个临床问题(9 个基础问题和 19 个 PICO 化临床问题)与 9个关键结局指标。两轮问卷专家的积极系数分别为 85% 和 97%,肯德尔和谐系数分别为 0.837、0.826,临床问题和结局指标各条目的 Cronbach's α 系数分别为 0.929、0.866 和 0.923、0.803,表明专家对本研究的关注度高,分歧小,协调程度高,问卷信度良好,结果可靠性高。最终,经研究组内专家讨论后确定 28 个临床问题(9 个基础问题和19个PICO 化临床问题)纳入指南。临床问题涵盖痔病中医特征、术前评估、中西医诊疗方式、围术期管理等。结论 基于多维度调研与德尔菲法建立的临床问题及结局指标体系,为指南编制提供了科学框架,凸显多学科共识在整合医学指南制定中的重要性。

  • 中国脑卒中后认知障碍患病趋势及影响因素的Meta分析

    分类: 医学、药学 >> 预防医学与公共卫生学 提交时间: 2025-07-17 合作期刊: 《中国全科医学》

    摘要: 背景 脑卒中后认知障碍(PSCI)是脑卒中患者常见的后遗症,严重影响患者的生活质量,且易被忽视。PSCI 的高发病率、隐匿性症状和沉重的社会负担使其成为研究重点。了解 PSCI 的患病情况和相关因素,对于制定脑卒中的防治策略至关重要。目的 系统评价 2014—2024 年我国 PSCI 患病现状及发展趋势,总结归纳 PSCI 相关危险因素和保护因素。方法 系统检索 PubMed、Web of Science、Embase、中国知网(CNKI)、万方数据知识服务平台(Wanfang Data)、维普中文科技期刊数据库(VIP)和中国生物医学文献数据库(CBM),搜集关于中国 PSCI 患病率及危险因素的研究,检索时限为 2014 年 11 月—2024 年 11 月。利用 Stata 16.0 和 SPSS 26.0 软件分析 PSCI 的现状与趋势,并使用 RevMan 5.4 软件分析相关因素。结果 共纳入 59 项研究,Meta 分析结果显示,我国 PSCI 总体患病率为 51%(95%CI=48%~55%)。男性和女性的 PSCI 患病率分别为 50%(95%CI=46%~54%)和 56%(95%CI=51%~60%);6 个月)时,患病率分别为 52%(95%CI=45%~58%)、52%(95%CI=45%~58%)、40%(95%CI=35%~44%)和 56%(95%CI=43%~70%);小学及以下者患病率为 63%(95%CI=55%~71%);已婚、未婚者分别为 57%(95%CI=46%~68%)、64%(95%CI=52%~75%);有工作者、无业者分别为 64%(95%CI=44%~84%)、71%(95%CI=56%~87%);脑力劳动、体力劳动者分别为 48%(95%CI=33%~64%)、53%(95%CI=30%~76%);与家人同住、独居者分别为 62%(95%CI=43%~82%)和 71%(95%CI=62%~81%)。我国 PSCI 的患病率随着年龄增加而增高(χ2 =73.805,P<0.01);文化程度较高者 PSCI 患病率较低(χ2 趋势 =164.711,P<0.01);不同地区之间 PSCI患病率比较,差异有统计学意义(χ2 =74.701,P<0.01)。随着评估时间延长,患病率呈上升趋势(χ2 趋势 =186.504,P<0.05);各时段之间 PSCI 患病率比较,差异有统计学意义(χ2 趋势=325.964,P<0.01),但未表现出线性相关性(P=0.259)。高龄、女性、高血压、糖尿病、高脂血症、卒中史、颈动脉斑块、高同型半胱氨酸血症、C 反应蛋白水平升高、吸烟、饮酒和高 NIHSS 评分是我国脑卒中患者发生 PSCI 的危险因素,而受教育水平高和体育锻炼是保护因素。结论 我国PSCI 总体患病率较高,为 51%,不同地区、省份之间存在明显差异,且随着时间发展呈现出动态变化趋势。女性、高龄、受教育程度低等群体 PSCI 患病率较高。此外,高血压、糖尿病、高脂血症等是 PSCI 发病的危险因素,各级医疗机构应重点关注以上高危人群,加快制订并实施 PSCI 综合防治策略,以减轻我国社会照护压力和经济负担。

  • 北京市三级甲等综合医院全科医学科病房收治慢性病及不明病因症状情况研究

    分类: 医学、药学 >> 预防医学与公共卫生学 提交时间: 2025-07-17 合作期刊: 《中国全科医学》

    摘要: 背景 在政府对全科医学发展的高度重视下,三级综合医院陆续设置全科医学科,全科医学科的学科特色使其在慢性病及不明病因症状的收治与管理中具有显著优势。然而,慢性病及不明病因症状在综合医院全科医学科病房的收治及管理情况尚不清楚。目的 了解三级甲等综合医院全科医学科病房收治慢性病及不明病因症状情况,分析其中存在的问题,探索持续提升全科医学科管理质量与效率的方向。方法 以首都医科大学附属北京友谊医院院全科医学科病房为例,于2024年2月通过电子病历系统提取全科医学科病房建立以来(2019年11月—2024年1月)所有住院患者的临床资料,回顾性分析患者的一般情况、入院来源、入院诊断、住院诊治、出院诊断及转归情况。结果 共纳入2 725例次住院患者,年龄为12~95岁,平均年龄为(57.4±15.8)岁,≥ 60岁患者1 400例次(51.38%),中位住院天数为7(5,9)d,中位住院费用为9 053.71(6 551.53,12 380.82)元。由全科门诊收入1 724例次(63.27%),由急诊科或专科转入1 001例次(36.73%)。入院诊断占比最高的前3位疾病依次是急性胰腺炎(9.06%)、腹痛待查(7.41%)、肺炎(7.30%)。1 899 例次(69.69%)患者患有慢性病,1 085 例次(39.81%)患者有多病共存现象,1 016 例次(37.18%)患者存在多重用药。1 658 例次(60.84%)患者入院时诊断明确,1 067 例次(39.16%)患者以不明病因症状入院。入院诊断占比最高的前 3 位不明病因症状依次是腹痛待查(7.41%)、头晕待查(5.43%)、腹胀待查(5.03%)。出院主要诊断所在系统排序前 5 位依次为消化系统 1 166 例次(42.79%)、呼吸系统 334 例次(12.26%)、内分泌系统 317 例次(11.63%)、心血管系统 279 例次(10.24%)、血液系统 176 例次(6.46%),主要诊断病例数排在前 10 位的依次是急性胰腺炎 249 例次(9.14%)、肺炎 238 例次(8.73%)、慢性胃炎 220 例次(8.07%)、2 型糖尿病伴慢性并发症 175 例次(6.42%)、急性胆囊炎 174 例次(6.39%)、恶性肿瘤 154 例次(5.65%)、高血压109例次(4.00%)、冠状动脉粥样硬化性心脏病 73 例次(2.68%)、结直肠息肉 62 例次(2.28%)、甲状腺结节 59 例次(2.17%)。2 411 例次(88.48%)患者经全科住院诊治后好转出院,96 例次(3.52%)患者诊断明确后因需专科治疗转入相应专科。以不明病因症状入院患者的住院费用高于入院时诊断明确的患者(P0.05);患有慢性病者的住院天数和住院金额均高于未患慢性病者(P<0.05);多病共存患者的住院天数和住院费用均高于非多病共存患者(P<0.05)。结论 北京市三级甲等综合性医院全科医学科病房住院患者年龄范围广,≥60岁患者占多数,疾病谱涉及多个系统的常见病、慢性病及不明病因症状,多病共存及多重用药现象常见,医疗工作符合全科医疗的诊疗方向。全科医学科与基层医疗卫生机构及医院急诊、专科联系紧密,在慢性病及不明病因症状的分级诊疗及多学科诊治中有重要意义。慢性病、不明病因症状及多病共存患者的住院天数长、住院费用高,提示全科医生在慢性病及不明病因症状管理过程中需不断细化管理流程和服务内容,不断提升管理水平和质量。

  • 痔的注射治疗在中国的应用现状及共识:一项横断面研究

    分类: 医学、药学 >> 临床医学 提交时间: 2025-07-17 合作期刊: 《中国全科医学》

    摘要: 背景 痔疮是肛肠科常见疾病之一,注射治疗是常用的治疗方法,但目前关于注射治疗的应用深度、规范应用情况等方面的全国性数据较为缺乏,因此有必要开展此项调查研究。目的 探究当前痔注射治疗在中国开展的深度和广度、规范性应用情况、有效性和安全性和未能开展的原因。方法 于2022年7—11月对中国医药教育协会肛肠疾病专业委员会的委员发布线上问卷,自行设计问卷内容,共37个问题,其中包括人口学资料、治疗痔的方法、注射治疗应用情况、并发症等问题,应用SPSS 21.0软件进行数据统计分析。结果 共回收335份问卷,有效问卷312份(回收率为93.1%)。有293名(93.9%)医生使用硬化剂注射治疗,153名(54.2%)医生实施500例以上的注射治疗,且不同医院级别、医院性质、医院类型肛肠医生开展注射治疗的数量比较,差异均无统计学意义(P>0.05)。293名(93.9%)、263名(84.3%)医生认为注射治疗适合于治疗内痔、混合痔的内痔部分。对于Ⅰ、Ⅱ度内痔而言,硬化剂注射占比分别为55.4%(173/312)、79.2%(247/312)。对于麻醉方式的选择,以局部麻醉229例(73.4%)和腰麻145例(46.5%)为主。有280名(89.7%)应用过消痔灵注射液,占硬化剂使用首位;有201名(64.4%)选择单次治疗3个痔核,对于肛门前部的痔核,有140名(44.9%)医生认为可以予以注射,172名(55.1%)医生认为不应该予以注射硬化剂。剂量分析显示消痔灵单处注射集中于1~5 mL,占比80.7%(92名),低剂量(0~3 mL)方案占56.7%(59/104);尽管有233名(74.7%)认可单独注射的治愈性,但227名(88.8%)临床实践仍联合术式,其中痔切除术占64.7%(202/312)。单独注射的1年复发率<10%评估达90.3%(233/258),但5年评估下降至58.9%(146/248);采用注射治疗的患者并发症发生率显示:肛门疼痛134例(42.9%)、尿潴留90例(28.8%)、注射部位硬结182例(58.3%),为常见不良反应,其他严重并发症包括肛周脓肿(5.1%,16例)、败血症(1.3%,4例)及直肠穿孔(1.6%,5例)。未开展注射治疗的主要原因,15名(35.7%)认为是医院管理因素、9名(21.4%)认为是价格问题、8名(19.0%)对疗效质疑、6名(14.3%)认为药品短缺。结论 痔注射疗法在中国已获肛肠科医生广泛认可与应用,93.9%的医生开展此疗法,超54.2%的医生操作超500例,且普及度在各级各类医院中无显著差异。至少55.4%的医生能规范掌握适应证(Ⅰ~Ⅱ度内痔更倾向于采用注射治疗)。消痔灵为最常用硬化剂,一次多注射3处痔核。痔注射疗法疗效确切,90%医生报告1年复发率<10%,长期复发率数据支持其可靠性。近90%医生倾向联合其他术式,反映对单独注射信心不足,需明确器械治疗“减轻症状”的目标并加强医患沟通。痔注射疗法作为安全有效的痔病管理手段适合全国推广,但需加强操作规范化培训与并发症防控体系建设。

  • 基于卡诺模型的功能楼宇人群家庭医生签约服务需求特征研究

    分类: 医学、药学 >> 临床医学 提交时间: 2025-07-17 合作期刊: 《中国全科医学》

    摘要: 背景 随着家庭医生签约服务制度持续深入,如何将有效的家庭医生签约服务覆盖向功能楼宇人群成为关注焦点之一,切实了解该类人群的需求特征是制订有效策略的重要手段。目的 了解功能楼宇人群的家庭医生签约服务需求,为完善和优化功能楼宇的家庭医生签约服务提供参考。方法 于2024年3—4月,采用典型抽样法在课题组所在辖区选取功能楼宇3个,采用整群随机抽样法在功能社区抽取中青年396名进行问卷调查。问卷内容包括一般人口学信息、对家庭医生签约服务需求的KANO问卷、过去6个月接受家庭医生签约服务最多的时间段及支付意愿等。对家庭医生签约服务需求的KANO问卷进行信效度分析,构建Better-Worse矩阵对19个服务条目进行KANO需求特征分析,根据不同服务时段和支付意愿进行敏感性分析。结果 共回收396份有效问卷,19个签约服务条目形成的量表Cronbach's α系数为0.991。按KANO模型对条目进行初步归类,19个条目均属于无差异属性项目,构建Better-Worse矩阵对需求属性进行进一步划分,诊疗服务中的“代配药服务”“专家坐诊服务”2个条目,健康管理服务中的“体检报告解读和健康咨询”“眼症防治”“颈椎病防治”等9个条目归属为“期望属性”项目,诊疗服务中的“延伸处方”服务归属为魅力属性项目,其余为无差异属性项目。敏感性分析显示:“长处方”服务在上班前1 h、周末时段的SR值最高,“中医体质辨识/推拿/艾灸/拔罐/刮痧/针灸”服务在午间1 h服务的SR值最高;支付意愿在0~50元/人/年和≥201元/人/年时“专家坐诊”服务的SR值最高,支付意愿在151~200元/人/年时“中医体质辨识/推拿/艾灸/拔罐/刮痧/针灸”服务的SR值最高。结论 功能楼宇人群对家庭医生签约下的专项化健康管理服务需求度较高,需求内容多元化,家庭医生提供的长处方、代配药、专家坐诊等签约诊疗服务是满足中青年人群服务需求的基石,应进一步优化和完善针对此类人群的服务内容设计。

  • 免疫介导炎症性疾病妊娠期和哺乳期生物制剂治疗:疗效、安全性和挑战

    分类: 医学、药学 >> 临床医学 提交时间: 2025-07-17 合作期刊: 《中国全科医学》

    摘要: 免疫介导的炎症性疾病(IMIDs)常影响育龄期女性,疾病性治疗药物对妊娠结局、胎儿发育和婴儿的影响使在妊娠期与哺乳期的药物治疗决策复杂。本文回顾国内外最新诊疗指南和临床研究,从免疫平衡角度分析IMIDs 疾病活动对妊娠结局的影响,从胎盘转运机制与母体生理变化解释生物制剂在妊娠期的药物暴露,综述妊娠期、哺乳期 IMIDs 患者生物制剂治疗的前沿进展和安全性,对比分析不同生物制剂在妊娠期和哺乳期应用的指南推荐意见,并提出妊娠期生物制剂停药时机和新生儿疫苗接种的最佳建议。通过多学科合作为围妊娠期 IMIDs 患者提供有效且安全的治疗方案,保障母婴健康。

  • 脂肪组织与肥胖相关高血压发病机制研究进展

    分类: 医学、药学 >> 临床医学 提交时间: 2025-07-17 合作期刊: 《中国全科医学》

    摘要: 肥胖相关高血压患病率在全球显著上升,成为当前医学界关注的焦点。肥胖增加高血压控制难度,促进心脑血管损害,加重疾病负担。脂肪组织异常扩张和重塑被认为是肥胖核心表现,其与肾素血管紧张素醛固酮系统激活、脂肪因子失衡、炎症反应、交感神经激活、胰岛素抵抗等高血压致病机制密切相关。鉴于脂肪组织的功能分类、躯体分布和内分泌效应具有极强的异质性和复杂性,故本文系统回顾了脂肪组织的最新知识,重点介绍脂肪组织的不同分类、分布、和病理机制及其与肥胖相关高血压之间的联系,并对当前的研究证据和未来方向进行了综述,为肥胖相关高血压基础和临床研究提供新见解,启发新兴的治疗靶点研究。

  • 基于融合三维U-Net与Transformer的深度学习网络自动分割腹部CT图像结直肠癌:一项多中心多设备研究

    分类: 医学、药学 >> 临床医学 提交时间: 2025-07-17 合作期刊: 《中国全科医学》

    摘要: 背景 深度学习在医学图像中的应用面临数据标注耗时费力等挑战,制约了其临床转化效率。目的 探讨一种融合三维U-Net(3D U-Net)与Transformer的深度学习网络(TransUNet-Cascade)在腹部CT图像中自动分割结直肠癌(CRC)病灶的可行性与效能。方法 回顾性纳入2018年1月—2023年5月来自广东省中医院(中心1)、南方医科大学南方医院(中心2)及中山大学孙逸仙纪念医院(中心3)的2 180例CRC患者腹部CT增强图像,采用加权随机抽样法划分为训练集(n=1 159)、验证集(n=289)和外部测试集(n=732)。本研究提出一种新型深度学习网络模型——TransUNet-Cascade,通过多阶段学习策略优化分割精度。以手动标注为基准,采用Dice相似系数(DSC)、F1值、95%豪斯多夫距离(HD95)、交互比(IoU)、精确度(PRE)以及召回率(REC)评估模型性能。本研究选取三维no new U-Net(3D nnU-Net)作为对比基线模型,在统一的数据集和评估标准下,与所提出的TransUNet-Cascade网络进行系统训练与性能对比,以全面验证其在CRC分割任务中的有效性。结果 在独立的外部测试集中,两种深度学习网络基于动脉期图像的分割效能总体优于静脉期图像;TransUNet-Cascade动脉期平均DSC、F1、HD95、IoU、PRE及REC分别为0.740、0.839、34.084、0.656、0.737及0.767,总体优于3D nnU-Net(平均DSC、F1、HD95、IoU、PRE及REC分别为0.724、0.838、35.954、0.642、0.730及0.744)。模型对右半结肠癌的分割效果最佳(DSC=0.784),直肠癌分割效果相对较差(DSC=0.622)。结论 TransUNet-Cascade通过结合卷积神经网络与Transformer的优势,提升了CRC病灶的自动分割精度,具有一定的临床应用潜力。

  • 相对脂肪量与中老年人群心血管疾病之间的关联:一项基于CHARLS的横断面与纵向研究

    分类: 医学、药学 >> 临床医学 提交时间: 2025-07-16 合作期刊: 《中国全科医学》

    摘要: 背景 近年来,医学研究发现相对脂肪量(RFM)与心血管疾病(CVD)存在一定的关联。然而,目前关于中国人群RFM与CVD发病风险的全国性队列研究仍然有限。目的 利用中国健康与养老追踪调查(CHARLS)数据,分析RFM与中国中老年人群(≥45岁)CVD发病风险的关系。方法 本研究使用CHARLS 2011—2018年数据进行横断面和纵向研究,横断面研究纳入≥45岁的12 867名中老年人,将2011年横断面研究中11 171名未被诊断为CVD的中老年人纳入纵向研究,随访至2018年。采用多因素Logistic回归和限制性立方样条(RCS)分析RFM与CVD之间的横断面关联。采用Kaplan-Meier曲线、多因素Cox比例风险回归模型和RCS分析2011年不同的基线RFM水平与新发CVD风险之间的纵向关联,并采用亚组分析探讨评估不同亚组相关性的一致,采用敏感性分析验证模型的稳定性。结果 多因素Logistic回归分析结果显示,RFM升高是CVD发生的危险因素(OR=1.03,95%CI=1.02~1.04,P<0.05);与Q1组相比,Q2组(OR=1.26,95%CI=1.07~1.49)、Q3组(OR=1.78,95%CI=1.47~2.16)和Q4组(OR=1.81,95%CI=1.49~2.19)具有更高的CVD风险(P<0.05)。在随访期间,共1 655人(14.9%)首次被诊断为CVD。多因素Cox回归分析结果显示,RFM升高是CVD发生的危险因素(HR=1.03,95%CI=1.02~1.04,P<0.05);与Q1相比,Q2组(HR=1.31,95%CI=1.12~1.52)、Q3组(HR=1.34,95%CI=1.12~1.61)和Q4组(HR=1.79,95%CI=1.49~2.14)组具有更高的新发CVD风险。亚组分析显示,RFM与婚姻情况具有交互作用(P=0.022)。敏感性分析结果与以上主要研究结果趋势一致。结论 较高水平的RFM与CVD发病风险增加有关,提示RFM可能在CVD预防和治疗中具有潜在价值。

  • 女性全生命周期生殖因素与卒中发生发展的研究进展

    分类: 医学、药学 >> 临床医学 提交时间: 2025-07-16 合作期刊: 《中国全科医学》

    摘要: 卒中是全球疾病与死亡负担的主要成因之一,同时位居中国人群死因之首,已成为威胁公众健康与社会发展的重大公共卫生问题。既往研究表明,卒中在发病风险、影响因素与预后结局等方面存在显著性别差异。受性别特异生殖因素影响,女性通常面临更高的终生卒中风险与更差的卒中后功能恢复,卒中相关疾病负担在该群体中日益加剧。识别女性特异卒中发病关键影响因素,并构建科学的早期风险分层系统,是实现精准化一级预防、优化医疗资源配置的关键路径。本文对女性全生命周期生殖因素与卒中发生发展的相关研究进行全面综述,旨在总结生殖因素对女性卒中风险影响的研究现状,以推动女性卒中领域研究的深度开展与临床实践创新。