Objective Exploring the influencing factors and coping strategies for Loss-Making Groups under DIP payment in public hospitals.Methods Using grounded theory,semi-structured interviews were conducted at a cardiovascular hospital in Henan Province from July to September 2023.The collected data were organized,coded,and integrated.Results Analysis of 19 interview transcripts yielded 54 initial concepts,13 initial categories,6 main categories and 3 core categories,leading to the construction of an optimization model for DIP loss-making groups in public hospitals.This model encompasses internal hospital control,incentive mechanisms,and support from health insurance policies.Conclusion It is recommended that hospitals enhance diagnostic and cost-control standards for DIP,establish a DIP-oriented performance evaluation system,and ensure reasonable reimbursement through health insurance policies.Additionally,policy measures should encourage innovation in new technologies to maximize resource efficiency and promote sustainable operations.

Objective To explore the relationship between CT quantitative left heart structure parameters and recurrence after hypertrophic cardiomyopathy(HCM)and atrial fibrillation(AF)radiofrequency ablation(RFCA).Methods A total of 120 patients with HCM and AF admitted to our hospital from April 2021 to June 2023 were selected.Patients were divided into the relapse group and the non-recurrence group according to whether RFCA recurred 6 months after operation.All patients underwent CT examination,and left ventricular ejection fraction(LVEF),left atrial ejection fraction(LAEF),left atrial volume index(LAVI)and left atrial auricular volume of the two groups were analyzed.The clinical data of patients were collected.Logistic regression model was used to analyze the influencing factors of postoperative recurrence of RFCA in HCM patients with AF.Receiver operating characteristic curve(ROC)curve was used to analyze the predictive efficacy of left heart structure parameters for postoperative recurrence of RFCA in HCM patients with AF.Results The volume levels of LAVI and left auricle were higher in the relapsed group than those in the non-relapsed group,and the level of LAEF was lower than those in the non-relapsed group(P＜0.05).Logistic regression analysis showed that persistent atrial fibrillation,LAVI and high left atrial appendage volume were independent risk factors for postoperative recurrence in HCM patients with AF(P＜0.05),and high LAEF was protective factor(P＜0.05).The results of ROC curve analysis showed that the AUC value of LAVI,LAEF and left atrial appendage volume in predicting recurrence after RFCA in patients with HCM and AF was 0.902,which was higher than that of 0.789,0.755 and 0.675 of each individual test.The combined prediction efficiency of the three tests was higher than that of each single test(Z=2.177,2.555 and 3.628,P＜0.05).Conclusion High level of LAVI and left atrial appendage volume and low level of LAEF are risk factors for postoperative recurrence of RFCA.The combined detection of the three methods has high predictive value for postoperative recurrence of RFCA in HCM patients with AF.

Objective To explore the relationship between CT quantitative left heart structure parameters and recurrence after hypertrophic cardiomyopathy(HCM)and atrial fibrillation(AF)radiofrequency ablation(RFCA).Methods A total of 120 patients with HCM and AF admitted to our hospital from April 2021 to June 2023 were selected.Patients were divided into the relapse group and the non-recurrence group according to whether RFCA recurred 6 months after operation.All patients underwent CT examination,and left ventricular ejection fraction(LVEF),left atrial ejection fraction(LAEF),left atrial volume index(LAVI)and left atrial auricular volume of the two groups were analyzed.The clinical data of patients were collected.Logistic regression model was used to analyze the influencing factors of postoperative recurrence of RFCA in HCM patients with AF.Receiver operating characteristic curve(ROC)curve was used to analyze the predictive efficacy of left heart structure parameters for postoperative recurrence of RFCA in HCM patients with AF.Results The volume levels of LAVI and left auricle were higher in the relapsed group than those in the non-relapsed group,and the level of LAEF was lower than those in the non-relapsed group(P＜0.05).Logistic regression analysis showed that persistent atrial fibrillation,LAVI and high left atrial appendage volume were independent risk factors for postoperative recurrence in HCM patients with AF(P＜0.05),and high LAEF was protective factor(P＜0.05).The results of ROC curve analysis showed that the AUC value of LAVI,LAEF and left atrial appendage volume in predicting recurrence after RFCA in patients with HCM and AF was 0.902,which was higher than that of 0.789,0.755 and 0.675 of each individual test.The combined prediction efficiency of the three tests was higher than that of each single test(Z=2.177,2.555 and 3.628,P＜0.05).Conclusion High level of LAVI and left atrial appendage volume and low level of LAEF are risk factors for postoperative recurrence of RFCA.The combined detection of the three methods has high predictive value for postoperative recurrence of RFCA in HCM patients with AF.

Objective Exploring the influencing factors and coping strategies for Loss-Making Groups under DIP payment in public hospitals.Methods Using grounded theory,semi-structured interviews were conducted at a cardiovascular hospital in Henan Province from July to September 2023.The collected data were organized,coded,and integrated.Results Analysis of 19 interview transcripts yielded 54 initial concepts,13 initial categories,6 main categories and 3 core categories,leading to the construction of an optimization model for DIP loss-making groups in public hospitals.This model encompasses internal hospital control,incentive mechanisms,and support from health insurance policies.Conclusion It is recommended that hospitals enhance diagnostic and cost-control standards for DIP,establish a DIP-oriented performance evaluation system,and ensure reasonable reimbursement through health insurance policies.Additionally,policy measures should encourage innovation in new technologies to maximize resource efficiency and promote sustainable operations.

With the increasing aging process, the number of elderly people with cognitive frailty is gradually increasing, which has a profound impact on the clinical outcomes of the elderly. Early identification and precise intervention of cognitive frailty can delay the occurrence of adverse outcomes. This paper reviews the development and research status of cognitive frailty risk prediction models for the elderly in the community, summarizes and compares the characteristics and basic situation of each prediction model, in order to provide references for improving the early identification and intervention of cognitive frailty among the elderly population in the community.

Objective To measure and comprehensively analyze the operation efficiency of coronary heart disease Center of National Regional Medical Center for Cardiovascular Disease from the dimensions of department service in-come,department service quality,department service efficiency and department service benefit,and put forward targeted operation management optimization strategies based on the analysis results.Methods The operation effective-ness evaluation index of CHD centers in sample hospitals from 2020 to 2022 was measured by the empirical re-search method from the overall level of the center and the level of clinical departments,and the scores were com-pared and analyzed.Results From 2020 to 2022,the operation effectiveness evaluation index of CHD centers in sam-ple hospitals showed a good trend,increasing from 80.57 points to 82.86 points.The 3-year average score was 81.74;Among them,the score rate of department service benefit dimension is higher,the average is 96.64％;The score rate of department service efficiency was lower,with an average of 68.53％.The departments with the lowest operational efficiency scores from 2020 to 2022 are all A2 departments,with 74.39,72.41 and 75.89 scores respec-tively,mainly due to the relatively low scores of A2 departments in the dimensions of department service revenue and department service efficiency.Conclusion The results of clinical department operation effectiveness evaluation can provide the evidence-based basis for hospital operation management,and hospitals can establish benchmarking management departments according to the evaluation results and take targeted measures to improve the comprehen-sive operation efficiency of departments.

Objective:To evaluate the clinical efficacy of ultrasound-guided radiofrequency ablation therapy for patients with papillary thyroid microcarcinoma (PTMC).Methods:A retrospective analysis was conducted on the clinical data of 80 PTMC patients admitted to Zhongshan Hospital of Traditional Chinese Medicine(Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine) from January 2018 to September 2020. All cases were divided into two groups according to different treatment methods, with 40 cases in each group. The control group received PTMC radical surgery, while the observation group received ultrasound guided radiofrequency ablation. The situation of new tumors and cervical lymph node metastasis in both groups was observed through follow-up, the relative indexes of operation and safety of the two groups were compared.Results:There was no significant difference in the incidence of situation of new tumors and cervical lymph node metastasis between the two groups ( P>0.05). The operation time, intraoperative blood loss and hospital stay in the observation group were less than those in the control group: (20.23 ± 5.07) min vs. (54.51 ± 12.13) min, (1.68 ± 0.28) ml vs.(13.68 ± 2.31) ml, (1.82 ± 0.32) d vs. (5.43 ± 0.57) d, there were statistical differences ( P<0.05). The incidence of complications in the observation group was lower than that in the control group: 5.00%(2/40) vs. 25.00%(10/40), there was statistical difference ( P<0.05). Conclusions:Ultrasound guided radiofrequency ablation for the treatment of PTMC is safe and effective, minimally invasive in beauty, and can effectively reduce the incidence of complications.

The mutation rate used in the previous analyses of pig evolution and demographics was cursory and hence invited potential bias in inferring evolutionary history.Herein,we estimated the de novo mutation rate of pigs as 3.6×10-9 per base per generation using high-quality whole-genome sequencing data from nine individuals in a three-generation pedigree through stringent filtering and validation.Using this mutation rate,we re-investigated the evolutionary history of pigs.The esti-mated divergence time of～10 kiloyears ago(KYA)between European wild and domesticated pigs was consistent with the domestication time of European pigs based on archaeological evidence.However,other divergence events inferred here were not as ancient as previously described.Our estimates suggest that Sus speciation occurred～1.36 million years ago(MYA);European wild pigs split from Asian wild pigs only～219 KYA;and south and north Chinese wild pigs split～25 KYA.Meanwhile,our results showed that the most recent divergence event between Chinese wild and domesticated pigs occurred in the Hetao Plain,northern China,approximately 20 KYA,supporting the possibly independent domestication in northern China along the middle Yellow River.We also found that the maximum effective population size of pigs was～6 times larger than estimated before.An archaic migration from other Sus species originating～2 MYA to European pigs was detected during western colonization of pigs,which may affect the accuracy of previous demo-graphic inference.Our de novo mutation rate estimation and its consequences for demographic his-tory inference reasonably provide a new vision regarding the evolutionary history of pigs.

Objective To detect molecular subtypes of medulloblastoma, and its correlation with prognosis. Methods Surgically treated 32 cases of primary medulloblastoma from 2010-2013 were collected, the molecular subtypes were determined by immunohistochemical detection of GAB1 and YAP1 protein in the sample. Clinical characteristics, imaging features and survival condition of different molecular subtypes were analyzed. Results Molecular typing of the 32 cases (21 males and 11 females) shows 4 (12.5%) cases of SHH, 7 (21.9%) cases of WNT and 21 (65.6%) cases of non-SHH. There was no significant correlation of molecular subtypes with age, gender and pathological classification. Three-year progression free survival rate in SHH, WNT and non-SHH/WNT subtypes were 75%, 57.1% and 38.1%, respectively. Three-year progression free survival rate was significantly higher in patients under 3 years old group than that in patients over 3 years old group in non SHH/WNT (P=0.047). Conclusions The prognosis of SHH was better than WNT, WNT was better than non-SHH/WNT type, prognosis in patients under 3 years old group of non-SHH/WNT was better than that in patients over 3 years old group.

Objective To compare the value of fractional anisotropy(FA)of MR diffusion tensor imaging(DTI) and Glasgow coma scale(GCS) at admission for judging the injury severity and prognosis of diffuse axonal injury (DAI). Methods Thirty-four patients with DAI adopted the GCS score to evaluate the conscious disturbance levels at admission and conducted the DTI examination within 2 weeks. Twenty-three individuals undergoing healthy physical examination conducted the DTI examination. The FA values of visuality lesion area in various sites,healthy side symmetric site and cerebral midline site were measured. The reduction degree of mean FA value at midline site and visuality lesions were measured. The correlation between GCS score,mean FA value reduction degree in visuality lesions and mean FA value at cerebral midline site with consciousness disorder time and recovery degree in half a year after injury was analyzed. Results The reduction degree of mean FA value at cerebral midline site was significantly correlated with consciousness disorder time and recovery degree in half a year after injury(r= 0. 519,P=0. 002; r= 0. 669, P=0. 000) ;the mean FA value reduction degree in visuality lesions and GCS score had low or weak correlation with consciousness dis order time and recovery degree in half a year after injury(r=0. 285,P=0. 103;r=0. 487,P=0. 003;r= -0. 241,P=0. 169;r=-0. 229,P=0. 192). The correlation between mean FA reduction degree in cerebral midline site and mean FA value reduction degree in visuality lesions with the recovery degree in a half years after injury was higher than that in GCS score. Conclusion DTI is a sensitive sequence for diagnosing DAI and has much more value for judging the injury degree and prognosis than the GCS score generally adopted by clinic.