Quality of life and economic burdens of malocclusion in U.S. patients enrolled in Medicaid

BackgroundPatients enrolled in Medicaid have limited access to orthodontic services in the United States. No studies are available, to the authors' knowledge, regarding the clinical and psychosocial burdens of malocclusion on these patients from an economic perspective.MethodsThe authors conducted a systematic review of the relevant economic literature. They identified issues from the perspectives of the various stakeholders (dentists, patients and parents, Medicaid programs) and developed a conceptual model for studying decision making focused on the strategy of providing early interceptive and preventive treatment rather than, or in addition to, comprehensive care in the patient's permanent dentition.ResultsMedicaid coverage and reimbursement amounts vary nationwide, and decision making associated with obtaining care can be complex. The perspectives of all relevant stakeholders deserve assessment. A conceptual framework of the cost-effectiveness of interceptive orthodontic treatment compared with comprehensive treatment illustrates the issues to be considered when evaluating these strategies.ConclusionsPolicymakers and the dental community should identify creative solutions to addressing low-income families' limited access to orthodontic services and compare them from various perspectives with regard to their relative cost-effectiveness.Clinical ImplicationsDentists should be aware of the multiple problems faced by low-income families in obtaining orthodontic services and the impact of stakeholder issues on access to care; they also should be proactive in helping low-income patients obtain needed orthodontic services.     

Changes in Dental Health and Dental Health Habits from 3 to 5 Years of Age

Objectives : This study sought to determine how dental health and dental health habits change from 3 to 5 years of age and to consider whether preventive dental health care helped in preventing or halting caries in children. Methods : The study included 67 maternity health care clinics, 72 well-baby clinics, and 69 dental health care clinics. Of the 1,292 newborn children, 1,003 (90.8%) were included in this study. Results : Preventive dental health care contributed to dental caries being halted in only 13.2 percent of those children who had enamel caries at 3 years of age. The dmft index did not increase in 22.6 percent of those children who had dentinal caries at 3 years of age. For all others, the disease became more severe. Toothbrushing habits of 3-year-old children were very consistent over the two years studied. Children were at a risk for caries when their mothers had nine years of basic education, when they already had plaque and caries at 3 years of age, and when the frequency of eating sweets increased the most during the two-year study period. Conclusion : Among 3-year-old children, plaque is an indicator of caries risk and therefore should be a key element in health education. Those children who already have evidence of caries at 3 years of age should be the target of preventive dental services because of their increased risk.     

The cost of endodontic procedures in a French university hospital

Clinical costs have become an important consideration in dental schools, and have been the subject of several recent studies. In order to determine the actual costs of endodontic procedures, we have attempted to identify the various components of root canal therapy. The present study is based on findings in a university hospital functioning within the context of the French health care system. A questionnaire was used to survey the major factors entering into the achievement of the clinical procedure. The endodontic treatments were performed on 100 1st or 2nd molars, by undergraduate students. The survey involves fixed, variable, direct and indirect costs, and takes into consideration the reimbursements made by the French health care system. Findings indicate that all procedures show an appreciable deficit with a significant difference between initial treatment and retreatment. The analysis of the survey questionnaire findings enables us to offer some recommendations in the area of undergraduate education, as well.     

UHPLC-MS/MS同时测定黄芩清热除痹胶囊中6种活性成分

目的 建立超高效液相色谱-串联质谱同时测定黄芩清热除痹胶囊中6种成分（黄芩苷、栀子苷、木犀草素、齐墩果酸、薏苡素、苦杏仁苷）含量的方法。方法 采用Phenomenex Luna Omega C18色谱柱（100 mm×2.1 mm,1.6 μm）,以含10 mmol/L甲酸铵的0.1%甲酸水溶液（A）-0.1%甲酸的乙腈（B）为流动相,进行梯度洗脱,柱温为30 ℃,流速为0.25 mL/min,进样量5 μL,分析时间10 min。采用电喷雾离子源,以多反应监测模式在负离子条件下进行检测。结果 所测6种活性成分在测定浓度范围内线性关系良好（r≥0.999 0）,精密度、稳定性和重复性良好,平均加样回收率为98.62%~103.7%,RSD≤2.70%。结论 该方法准确度高、分析速度快、检测限低、重复性高,适用于黄芩清热除痹胶囊质量控制。     

基于近红外光谱法的阿托伐他汀钙片质量一致性评价及含量快速测定

目的：建立近红外光谱法对阿托伐他汀钙片进行质量一致性评价及有效含量的快速测定。方法：采用便携式近红外光谱仪,采集23批阿托伐他汀钙片样品的漫反射近红外光谱数据,使用主成分分析（principal component analysis,PCA）建立不同批次阿托伐他汀钙片样品的质量一致性评价模型。使用不同光谱预处理方法对原始光谱进行光谱预处理,采用组合区间偏最小二乘（synergy interval partial least squares,SiPLS）算法对建模波数区间进行优化,并以高效液相色谱（high performance liquid chromatography,HPLC）法为参考方法,建立阿托伐他汀钙片的近红外定量分析模型。结果：使用不同批次阿托伐他汀钙片的光谱信息建立的PCA模型分类效果良好。对不同的光谱预处理方法进行比较,得到光程散射校正（multiplicative scattering correction,MSC）为最佳光谱预处理方法。当全光谱划分为30个区间时,选择3个子区间进行组合可得到最佳建模波数范围。校正模型的交叉验证均方根误差（root mean square error of cross-validation,RMSECV）为1.230 2,交叉验证相关系数（correlation coefficient of cross-validation,R_CV）为0.914 6,预测模型的预测均方根误差（root mean square error of prediction,RMSEP）为1.676 4,预测相关系数（correlation coefficient of the prediction,R_P）为0.964 2。结论：该研究建立的定性和定量方法准确、可靠,可以快速进行阿托伐他汀钙片的质量一致性评价及含量测定。     

基于指纹图谱、多指标定量及网络药理学的大黄质量标志物预测分析

目的 建立大黄HPLC指纹图谱及多指标定量分析方法,结合网络药理学预测大黄潜在质量标志物。方法 采用HPLC对20批掌叶大黄样品中的没食子酸、儿茶素、表儿茶素等13种指标性成分进行含量测定,采用中药色谱指纹图谱相似度评价系统进行相似度分析,以13种指标成分含量进行主成分分析、正交偏最小二乘判别分析,采用网络药理学预测大黄相关成分的作用靶点和通路,构建成分-靶点-通路网络图并对核心靶点进行器官定位分析以预测大黄的潜在质量标志物。结果 指纹图谱相似度在0.882～0.998,共确定了15个共有峰,大黄素甲醚、儿茶素、大黄素-1-O-葡萄糖苷、大黄素甲醚-8-O-葡萄糖苷、芦荟大黄素-8-O-葡萄糖苷是差异化合物,可用于鉴别和区分大黄质量。经筛选得到15个化合物,8个核心靶点,包括AKT1、TP53、JUN、HSP90AA1、CASP3、EGF、TNF、IL-6,涉及对氧化应激的反应、对脂多糖的反应、内肽酶活性,涉及脂质和动脉硬化、MAPK信号传导途径、AGE-RAGE信号通路在糖尿病并发症中的作用、非酒精性脂肪性肝病等通路,并构建成分-靶点-通路图,预测没食子酸、儿茶素、芦荟大黄素、大黄酸...     

基于Roy适应理论的健康宣教配合智慧平台在T1DM带泵治疗患儿中的应用

目的　探讨基于Roy适应理论的健康宣教配合智慧平台在1型糖尿病（T1DM）带泵治疗患儿中的应用效果。方法　纳入2020年5月至2022年5月经郑州儿童医院收治的84例T1DM带泵治疗患儿及主要监护人作前瞻性研究,按随机数字表法设为对照组（患儿42例,主要监护人42例）及观察组（患儿42例,主要监护人42例）。对照组予以常规健康宣教,观察组则于对照组基础上,基于Roy适应理论的健康宣教配合智慧平台实施干预,比较两组主要监护人健康教育知识掌握程度、照护水平及患儿血糖控制效果、治疗依从性。统计学方法采用χ²检验、t检验。结果　两组主要监护人干预前健康教育知识掌握度、照护者负担水平（ZBI）、家庭关怀度（APGAR）比较,差异均无统计学意义;两组干预后健康教育知识掌握度、APGAR均有提高,ZBI有所降低,观察组健康教育知识掌握度［（68.15±7.36）分比（54.62±10.18）分］、APGAR［（8.03±1.35）分比（6.72±1.13）分］均高于对照组,ZBI［（26.87±5.21）分比（30.24±5.48）分］低于对照组（t=6.98、4.822、2.888,均P<0.05）;两组患儿干预前HbA1c、FBG比较,差异无统计学意义。两组干预后糖化血红蛋白（HbA1c）、空腹血糖（FBG）均有降低,观察组HbA1c［（6.51±0.58）%］、FBG［（6.76±0.65）mmol/L］低于对照组［（7.44±0.86）%、（7.83±0.91）mmol/L］,差异均有统计学意义（t=5.810、6.201,均P<0.05）,且观察组干预后HbA1c、FBG合格率高于对照组（χ²=7.244、5.833,均P<0.05）;经Redit分析,两组患儿治疗依从性比较,差异有统计学意义（χ²=2.090,P<0.05）,且观察组MMAS-8评分高于对照组,差异有统计学意义（t=11.770,P<0.05）。结论　基于Roy适应理论的健康宣教配合智慧平台应用于T1DM带泵治疗患儿,可提升主要监护人健康教育知识掌握程度,提高照护水平,且患儿血糖控制效果良好,治疗依从性上升。     

指纹图谱结合多成分含量测定的猪苓配方颗粒质量评价

目的 建立猪苓配方颗粒质量评价方法,综合评价不同厂家产品质量均一性和稳定性。方法 采用HPLC以Shim-pack GIST C₁₈-AQ （4.6 mm×150 mm,3 μm）为色谱柱,乙腈-水溶液为流动相,梯度洗脱,流速1.0 mL·min^–1,检测波长为350 nm （0~3 min）和250 nm （3~35 min）,柱温30℃,构建不同厂家猪苓配方颗粒指纹图谱,指认共有峰,并进行相似度评价、聚类分析;采用相同HPLC测定4种活性成分含量,对16批样品进行质量分析和评价。结果 猪苓配方颗粒指纹图谱共标定14个共有峰,指认出其中6个成分,分别为2号峰（尿苷）、4号峰（鸟苷）、6号峰（腺苷）、12号峰（猪苓酮B）、13号峰（猪苓酮A）、14号峰（猪苓酮C）;16批样品指纹图谱相似度为0.609~0.982;聚类分析将全部样品分为2大类;鸟苷、腺苷、猪苓酮B、猪苓酮A在各自质量浓度范围内线性关系良好,r均≥0.999 7;仪器精密度、重复性、稳定性试验的RSD均<3％;平均加样回收率分别为98.22%,99.32%,99.56%,99.15%,RSD均<3%（n=6）。16批样品中,鸟苷、腺苷、猪苓酮B、猪苓酮A含量分别为6.326~28.006,13.392~44.058,10.324~30.335,9.270~26.964 μg·g^–1。结论 不同厂家样品存在较大的质量差异,本研究建立的指纹图谱结合多指标性成分含量测定方法可全面、准确评价猪苓配方颗粒内在质量,为整体提升该药品质量提供依据。