Objective This study aims to construct a prediction model for large artery atherosclerotic(LA A)ischemic stroke based on NOD-like receptor thermal protein domain associated protein 3(NLRP3)gene polymorphism and support vector machine(SVM)mod-el.Methods 84 LAA patients and 84healthy controls were selected to detect polymorphisms at rs10159239,rs10754558,rs12143966 and rs3806265 of NLRP3 gene,construct the SVM model,and the model performance was evaluated by receiver operating characteristic(ROC)curve.Results The genotype and allele frequency of NLRP3gene polymorphism sites were compared between the case group and the control group,and the difference was statistically significant(P＜0.05).The area under curve(AUC)of the ROC in the training and test sets is 0.900(95％CI:0.850-0.950)and 0.903(95％CI:0.807-0.999),respectively,with high prediction efficacy and no over-fit.The results of SHAP value analysis showed that:NLRP3 rs10159239genotype AG,rs10754558genotype CG and GG,rs12143966genotype GG and rs3806265genotype CT are the risk factors for disease development.Conclusions NLRP3gene polymor-phism is closely related to the risk of LA ischemic stroke.SVM model based on NLRP3 gene polymorphism can be used to predict the risk factors of LAA ischemic stroke,providing a new idea for early clinical diagnosis and precise prevention.

Objective:To explore the degree of change in anteversion angle and related risk factors after intramedullary nail fixation of intertrochanteric femur fracture in the elderly.Methods:The data of 256 elderly patients who underwent intramedullary nail fixation for intertrochanteric fractures of the femur at Tianjin Hospital of Tianjin University from March 2020 to March 2023 were selected, including 114 males and 142 females, with an age of 75.40±10.69 years (range, 65-94 years). The degree of change in the anteversion angle of the affected hip before and after the surgery was measured by CT scan of the hip, the Receiver Operating Characteristic Curve (ROC) was plotted, the area under the ROC curve was analyzed, and the optimal degree of grouping was determined by calculating the Youden Index, then all the patients were divided into two groups. The correlation between various risk factors (age, sex, type of internal fixation, fracture AO type, quality of reduction, fracture medial cortical defect or not, cusp distance) and the change of anterior tilt angle was screened by univariate and multivariate logistic regression analyses.Results:All 256 patients were followed up for 20.7±2.1 months (range, 18-23 months). Anteversion on the healthy side was 12.68°±5.10° (range, 5°-28°); postoperative anteversion on the affected side was 15.04°±7.67° (range, 9°-36°). By comparing the difference in the anterior tilt angle between the affected side and the healthy side, it was found that the anterior tilt angle of 67 patients was completely restored to the healthy side level after the operation. The anteversion angle was enlarged in 131 cases, of which the mildly increased angle (1°-9°) was found in 106 cases, moderately increased (10°-15°) was found in 17 cases, and significantly increased (>15°) was found in 8 cases; 58 patients showed anteversion angle reduction, of which 45 cases were mildly reduced (1°-9°), 13 cases were moderately reduced (10°-14°). The area under the ROC curve for the patient's anteversion angle and its 95% CI were 0.714(0.559, 0.867), and the maximum value of its Youden Index was 0.221, which corresponded to the optimal critical angle of 4°. There was no statistically significant difference in age, gender, reduction quality or fracture AO classification between the group with an anteversion angle>4° and the group with an anteversion angle≤4° ( P>0.05). The types of internal fixation, medial cortical defect and insufficient tip apex distance (TAD) were included in the binary variable logistic regression analysis. The results showed that single-nail internal fixation [ OR=0.412, 95% CI(0.244, 0.695), P=0.007], medial cortical defect [ OR=0.471, 95% CI(0.279, 0.793), P=0.009] and TAD>25 mm [ OR=0.367, 95% CI(0.207, 0.651), P=0.003] are independent risk factors for changes in anteversion angle after intramedullary nail fixation of intertrochanteric femur fractures in elderly. Conclusion:Single-nail internal fixation, medial cortical defect and TAD >25 mm are independent risk factors for the change of anteversion angle after intramedullary nail internal fixation of intertrochanteric fractures in the elderly.

Objective:To analyze the hospitalization cost of 116 860 patients under DRG implementation,and explore the effect of charging structure on the profit and loss of cases,so as to provide suggestion for improving the medical insurance"item+disease group".Methods:Descriptive analysis,K-means clustering,and the Hedonic model.Results:(1)The average profit and loss of the cases was 83.12±883.175 yuan.The surplus group was 71 148 cases,accounting for 60.88%,while the loss group was 45 712 cases,accounting for 39.12%.(2)There are seven types of charging structures,and cases are mainly distributed in medium service low goods and low service low goods.The average surplus of low service low goods is the most.The cases of high service high goods had the largest average loss.(3)The Hedonic model shows that the key influencing factors of case profit and loss include the"service-commodity"fee structure,the number of days of hospitalization,whether the operation is performed or not,and the level of the hospital.Conclusion:(1)Systematically evaluate the risk effect of structural adjustment on the micro-allocation mechanism of medical insurance budget;(2)strengthen the monitoring of typical disease expenses/costs and the regular mining of collection and payment data;(3)promote the convergence of the"project+disease group/disease"collection and payment system and promote the reform of doctors'salaries;(4)expand the application scenarios of big data decision support in the regional medical and medical insurance economy.

Objective:To explore the degree of change in anteversion angle and related risk factors after intramedullary nail fixation of intertrochanteric femur fracture in the elderly.Methods:The data of 256 elderly patients who underwent intramedullary nail fixation for intertrochanteric fractures of the femur at Tianjin Hospital of Tianjin University from March 2020 to March 2023 were selected, including 114 males and 142 females, with an age of 75.40±10.69 years (range, 65-94 years). The degree of change in the anteversion angle of the affected hip before and after the surgery was measured by CT scan of the hip, the Receiver Operating Characteristic Curve (ROC) was plotted, the area under the ROC curve was analyzed, and the optimal degree of grouping was determined by calculating the Youden Index, then all the patients were divided into two groups. The correlation between various risk factors (age, sex, type of internal fixation, fracture AO type, quality of reduction, fracture medial cortical defect or not, cusp distance) and the change of anterior tilt angle was screened by univariate and multivariate logistic regression analyses.Results:All 256 patients were followed up for 20.7±2.1 months (range, 18-23 months). Anteversion on the healthy side was 12.68°±5.10° (range, 5°-28°); postoperative anteversion on the affected side was 15.04°±7.67° (range, 9°-36°). By comparing the difference in the anterior tilt angle between the affected side and the healthy side, it was found that the anterior tilt angle of 67 patients was completely restored to the healthy side level after the operation. The anteversion angle was enlarged in 131 cases, of which the mildly increased angle (1°-9°) was found in 106 cases, moderately increased (10°-15°) was found in 17 cases, and significantly increased (>15°) was found in 8 cases; 58 patients showed anteversion angle reduction, of which 45 cases were mildly reduced (1°-9°), 13 cases were moderately reduced (10°-14°). The area under the ROC curve for the patient's anteversion angle and its 95% CI were 0.714(0.559, 0.867), and the maximum value of its Youden Index was 0.221, which corresponded to the optimal critical angle of 4°. There was no statistically significant difference in age, gender, reduction quality or fracture AO classification between the group with an anteversion angle>4° and the group with an anteversion angle≤4° ( P>0.05). The types of internal fixation, medial cortical defect and insufficient tip apex distance (TAD) were included in the binary variable logistic regression analysis. The results showed that single-nail internal fixation [ OR=0.412, 95% CI(0.244, 0.695), P=0.007], medial cortical defect [ OR=0.471, 95% CI(0.279, 0.793), P=0.009] and TAD>25 mm [ OR=0.367, 95% CI(0.207, 0.651), P=0.003] are independent risk factors for changes in anteversion angle after intramedullary nail fixation of intertrochanteric femur fractures in elderly. Conclusion:Single-nail internal fixation, medial cortical defect and TAD >25 mm are independent risk factors for the change of anteversion angle after intramedullary nail internal fixation of intertrochanteric fractures in the elderly.

Objective:To analyze the hospitalization cost of 116 860 patients under DRG implementation,and explore the effect of charging structure on the profit and loss of cases,so as to provide suggestion for improving the medical insurance"item+disease group".Methods:Descriptive analysis,K-means clustering,and the Hedonic model.Results:(1)The average profit and loss of the cases was 83.12±883.175 yuan.The surplus group was 71 148 cases,accounting for 60.88%,while the loss group was 45 712 cases,accounting for 39.12%.(2)There are seven types of charging structures,and cases are mainly distributed in medium service low goods and low service low goods.The average surplus of low service low goods is the most.The cases of high service high goods had the largest average loss.(3)The Hedonic model shows that the key influencing factors of case profit and loss include the"service-commodity"fee structure,the number of days of hospitalization,whether the operation is performed or not,and the level of the hospital.Conclusion:(1)Systematically evaluate the risk effect of structural adjustment on the micro-allocation mechanism of medical insurance budget;(2)strengthen the monitoring of typical disease expenses/costs and the regular mining of collection and payment data;(3)promote the convergence of the"project+disease group/disease"collection and payment system and promote the reform of doctors'salaries;(4)expand the application scenarios of big data decision support in the regional medical and medical insurance economy.

Objective This study aims to construct a prediction model for large artery atherosclerotic(LA A)ischemic stroke based on NOD-like receptor thermal protein domain associated protein 3(NLRP3)gene polymorphism and support vector machine(SVM)mod-el.Methods 84 LAA patients and 84healthy controls were selected to detect polymorphisms at rs10159239,rs10754558,rs12143966 and rs3806265 of NLRP3 gene,construct the SVM model,and the model performance was evaluated by receiver operating characteristic(ROC)curve.Results The genotype and allele frequency of NLRP3gene polymorphism sites were compared between the case group and the control group,and the difference was statistically significant(P＜0.05).The area under curve(AUC)of the ROC in the training and test sets is 0.900(95％CI:0.850-0.950)and 0.903(95％CI:0.807-0.999),respectively,with high prediction efficacy and no over-fit.The results of SHAP value analysis showed that:NLRP3 rs10159239genotype AG,rs10754558genotype CG and GG,rs12143966genotype GG and rs3806265genotype CT are the risk factors for disease development.Conclusions NLRP3gene polymor-phism is closely related to the risk of LA ischemic stroke.SVM model based on NLRP3 gene polymorphism can be used to predict the risk factors of LAA ischemic stroke,providing a new idea for early clinical diagnosis and precise prevention.

Hypoalbuminemia is one of the important clinical features of decompensated cirrhosis. As the disease progresses, not only does the total albumin concentration decrease, but so does the proportion of albumin that remains structurally and functionally intact. The structural and functional integrity of albumin is essential for its normal physiological role in the body. This led to the concept of "effective albumin concentration," which may be much lower than the total albumin concentration routinely measured clinically in patients with advanced cirrhosis. Liquid chromatography-tandem mass spectrometry, and electron paramagnetic resonance (EMR) are emerging technologies for effective albumin concentration detection, showing promising clinical application prospects, but research in patients with cirrhosis is still in the preliminary stage. Therefore, this article will comprehensively summarize the latest research on the aspects of effective albumin detection methods, liquid chromatography-tandem mass spectrometry, and electron paramagnetic resonance, as well as their applications.

ObjectiveTo analyze the quantity-quality transfer of standard decoction of Ginseng Radix et Rhizoma（GRR） decoction pieces produced by fresh and traditional cutting， and to provide reference for quality control and application development of the decoction pieces produced by fresh cutting. MethodTen batches of representative GRR decoction pieces produced by fresh and traditional cutting and their standard decoctions were prepared by standard process， and high performance liquid chromatography（HPLC） fingerprint of the standard decoction was established and performed on an Agilent EC-C₁₈ column（4.6 mm×150 mm， 2.7 μm） with acetonitrile（A）-0.1% phosphoric acid aqueous solution（B） as the mobile phase for gradient elution（0-23 min， 18%-21%A； 23-35 min， 21%-28%A； 35-80 min， 28%-32%A）， and the detection wavelength was 203 nm. Then similarity evaluation， principal component analysis（PCA） and partial least squares-discriminant analysis（PLS-DA） of fingerprint of the standard decoction were performed to screen the differential components with variable importance in the projection（VIP） value>1. Quantitative analysis was carried out on the screened known differential components， and combined with the indicators of the dry extract rate and the transfer rate， to explore the differences in the quantity-quality transfer between the standard decoction of GRR decoction pieces produced by fresh and traditional cutting. ResultThe fingerprint similarity of the standard decoction of GRR decoction pieces produced by fresh and traditional cutting was more than 0.950， and 18 common peaks were identified， including 9 identified common peaks. The results of PCA and PLS-DA showed that there were some differences in the contents of index components between the two standard decoctions. The contents of ginsenoside Rg₁， Re and Ro in GRR decoction pieces produced by fresh cutting were higher than those in traditional decoction pieces， while the contents of ginsenoside Rb₁， Rc ， Rb₂ and Rd were lower than those in traditional decoction pieces. The contents of ginsenoside Rg₁， Re， Rb₁ and Ro in the standard decoction of GRR decoction pieces produced by fresh cutting were higher than those in the standard decoction of traditional decoction pieces， while the contents of ginsenoside Rc ， Rb₂ and Rd were comparable between the two standard decoctions. Compared with the standard decoction of the traditional decoction pieces， the average transfer rates of ginsenoside Rg₁， Rb₁， Rc， Rb₂ and dry extract rate of the standard decoction of GRR decoction pieces produced by fresh cutting were significantly increased（P<0.05）， and the average transfer rate of ginsenoside Re and Rd also increased， but the difference was not statistically significant. ConclusionThe dry extract rate， content and transfer rate of index components of standard decoction of GRR decoction pieces produced by fresh cutting are better than those of the standard decoction of traditional decoction pieces， which can provides data support for the subsequent clinical application of fresh cutting products.

The number of dental schools increased from 55 in 2000 to 66 in 2019 in the United States. The number of public, private, and private-state-related dental schools were 40, 22 and 4, respectively. A majority of them were located in most developed areas, such as western, eastern, and southern regions of the country. In the same period, the number of freshman enrollees rose from 4 234 to 6 231 while the average of enrollees kept under 100. On the basis of learning relevant experiences of the United States, it might be necessary for China to expand the overall scale of stomatology education in order to address the shortage of dentists, take measures to increase the number of stomatology schools and improve their distribution, and control the number of enrollees per school to enhance the quality of education.