Objective:To analyze the influencing factors of China′s DRG payment system reform(DRG reform) and its hierarchical relationship, for references for the in-depth promotion of China′s medical insurance payment reform.Methods:Relevant literature on DRG reform in China from databases such as CNKI, Wanfang Database, Pubmed, etc, were obtained. Content analysis method was used to extract the influencing factors of DRG reform. The correlation between each influencing factor was determined through expert discussion. An interpretive structural model(ISM) was constructed to analyze the hierarchical relationship of factors influencing DRG reform.Results:After analysis, the influencing factors(12) of DRG reform in China were included such as medical level, hospital management, and medical staff′s cognition and behavior. Among them, the local situation was the deep-level factor affecting DRG reform, 9 factors such as data quality assurance and policy design/implementation were the middle-level factors, and patients′ interests/needs and disease grouping were the surface-level factors.Conclusions:There were many influencing factors on the reform of China′s DRG payment system. It was suggested that relevant management departments in various regions should focus on the actual situation of the locality, take data quality and policy design and implementation as the key points of reform, formulate a scientific and reasonable DRG grouping scheme, safeguard the interests of patients, so as to promote the deepening of DRG reform.

Hepatitis B virus（HBV）infection poses a significant global health burden，with chronic infection driving progression to cirrhosis，hepatic failure，and hepatocellular carcinoma（HCC）. Mounting evidence implicates immune dysfunction and microbiota dysbiosis as core drivers of disease progression across all HBV infection stages. Gut and tissue-specific microbiota alterations disrupt innate/adaptive immunity，fueling inflammation，immunosuppression，and tumor immune evasion in chronic and end-stage disease. This review synthesizes mechanisms of immune-microbiota interplay in HBV pathogenesis and explores their translational potential for diagnostics and targeted interventions，including microbiota modulation and microbial biomarker applications.

Objective:To analyze the influencing factors of China′s DRG payment system reform(DRG reform) and its hierarchical relationship, for references for the in-depth promotion of China′s medical insurance payment reform.Methods:Relevant literature on DRG reform in China from databases such as CNKI, Wanfang Database, Pubmed, etc, were obtained. Content analysis method was used to extract the influencing factors of DRG reform. The correlation between each influencing factor was determined through expert discussion. An interpretive structural model(ISM) was constructed to analyze the hierarchical relationship of factors influencing DRG reform.Results:After analysis, the influencing factors(12) of DRG reform in China were included such as medical level, hospital management, and medical staff′s cognition and behavior. Among them, the local situation was the deep-level factor affecting DRG reform, 9 factors such as data quality assurance and policy design/implementation were the middle-level factors, and patients′ interests/needs and disease grouping were the surface-level factors.Conclusions:There were many influencing factors on the reform of China′s DRG payment system. It was suggested that relevant management departments in various regions should focus on the actual situation of the locality, take data quality and policy design and implementation as the key points of reform, formulate a scientific and reasonable DRG grouping scheme, safeguard the interests of patients, so as to promote the deepening of DRG reform.

Hepatitis B virus（HBV）infection poses a significant global health burden，with chronic infection driving progression to cirrhosis，hepatic failure，and hepatocellular carcinoma（HCC）. Mounting evidence implicates immune dysfunction and microbiota dysbiosis as core drivers of disease progression across all HBV infection stages. Gut and tissue-specific microbiota alterations disrupt innate/adaptive immunity，fueling inflammation，immunosuppression，and tumor immune evasion in chronic and end-stage disease. This review synthesizes mechanisms of immune-microbiota interplay in HBV pathogenesis and explores their translational potential for diagnostics and targeted interventions，including microbiota modulation and microbial biomarker applications.

Objective:To understand the status quo of self-regulating fatigue (SRF) in aged patients undergoing maintenance hemodialysis (MHD) and analyze its influencing factors.Methods:This study is a cross-sectional study. From January to June 2022, 310 aged patients undergoing MHD from the blood purification centers of three ClassⅢ Grade A hospitals in Jinan, Shandong Province, were selected by convenience sampling. Various questionnaires, including the general information questionnaire, Mini-Mental State Examination (MMSE), Self-Regulatory Fatigue Scale (SRF-S), Medical Coping Modes Questionnaire (MCMQ), General Self-Efficacy Scale (GSES), and 5-Item Geriatric Depression Scale (GDS-5), were used to investigate and analyze the factors influencing self-regulation of fatigue in aged patients undergoing MHD through univariate and multiple stepwise regression analysis.Results:The SRF-S score for the aged patients undergoing MHD was (42.26±7.86). The results of the multiple factor analysis showed that family average monthly income, depression, coping style, and self-efficacy were factors influencing SRF in these patients ( P<0.05) . Conclusions:It is urgent to pay attention to the current status of self-regulation of fatigue in aged patients undergoing MHD and take effective measures to improve their self-efficacy, promote positive coping strategies, alleviate depression, and reduce their level of SRF.

Bacteria and their derivatives-mediated tumor therapy is an emerging therapeutic strategy. This strategy uses bacteria or bacterial derivatives as drug carriers to deliver drugs to tumor tissues through the targeting and motility of bacteria or bacterial derivatives and utilizes their special biological characteristics to cooperate with other therapies. In this review, the mechanism and advantages of bacteria-mediated tumor therapy were summarized, focusing on the combined application of bacterial therapy and chemotherapy, photothermal therapy, and radiotherapy, which improves the therapeutic effect through a synergistic effect. At the same time, the characteristics, structure, and composition of bacterial derivatives of bacterial outer membrane vesicles (OMVs) and minicells and their application in tumor therapy were also summarized. Although there are still some problems to be solved in the treatment of tumors mediated by bacteria and their derivatives, their potential to colonize in tumors and induce immune responses cannot be ignored. This therapy also provides new ideas for tumor therapy.

Objective: To understand and analyze the epidemiological characteristics of dental caries in children and its effects on jaw function, so as to prevent occurrence of abnormality of jaw function. Methods: In October 2020, 860 cases of children from 5 kindergartens and 3 primary schools in Beijing were selected by adopting the convenience sampling method. All of them received oral examination, and the questionnaire according to the fourth national oral health epidemiological survey standard, including demographic information, eating habits, oral hygiene habits, oral health care,etc. The epidemiological characteristics of dental caries in children and its effects on jaw function were analyzed. Results: A total of 190 children had dental caries, with a dental caries incidence rate of 22.09%. Dental caries in children s deciduous teeth or permanent teeth was related to age, residence, parents education level,whethe to eat before going to bed, whether eating sweet food, tooth brushing age, daily brushing frequency, whether parents have assisted tooth brushing, whether regular oral examination, whether parents have received oral health guidance( χ 2= 5.04 ,4.70，75.37，7.91，12.03，9.30，7.64，255.47，253.27，11.38, P <0.05). Compared with the noncaries group[(81.52±3.16， 80.54± 1.52，1.92±0.25，31.52±1.62，33.63±3.41，50.72±1.68)°], the sella nasion A point(SNA), sella nasion B point(SNB),A point nasion B point(ANB),frankfot horizontal mandibular plane angle(FH MP),skull nasion mandibular plane angle(SN MP),anteriors relationship palataplane mandibular(Ptm ANS) decreased in the dental caries group[(78.62±2.11，79.35±1.02，1.68±0.32，30.69±0.45，32.15±3.02，48.62±1.21)°](t=78.62,79.35,10.94, 30.69, 32.15, 48.62, P<0.05). Conclusion The prevalence of caries in children was high and jaw structure abnormalities and dysfunction. It is suggested that caries prevention and control work should be carried out early to strengthen the prevention and control of oral disease education work.

The glymphatic system is a unique network of the central nervous system that facilitates the removal of metabolic waste from the brain and maintains homeostasis.The glymphatic system is relatively active during sleep,and its physiological function is affected by many factors.The application of non-invasive imaging techniques to evaluate the function of the glymphatic system has promoted the development of clinical studies.More and more studies have demonstrated the association between the function of glymphatic system and the pathogenesis of neurodegenerative diseases,cerebrovascular diseases and other central nervous system diseases.The glymphatic system is expected to become a novel target for predicting prognosis of central nervous system diseases and clinical effects.

Maxillary sinus floor augmentation using lateral window and crestal technique is considered as predictable methods to increase the residual bone height; however, this surgery is commonly complicated by Schneiderian membrane perforation, which is closely related to anatomical factors. This article aimed to assess anatomical factors on successful augmentation procedures. After review of the current evidence on sinus augmentation techniques, anatomical factors related to the stretching potential of Schneiderian membrane were assessed and a decision tree for the rational choice of surgical approaches was proposed. Schneiderian membrane perforation might occur when local tension exceeds its stretching potential, which is closely related to anatomical variations of the maxillary sinus. Choice of a surgical approach and clinical outcomes are influenced by the stretching potential of Schneiderian membrane. In addition to the residual bone height, clinicians should also consider the stretching potential affected by the membrane health condition, the contours of the maxillary sinus, and the presence of antral septa when evaluating the choice of surgical approaches and clinical outcomes.
Sinus Floor Augmentation ; Decision Trees

Objective:To compare the efficacy and safety of ticagrelor tablets produced by Zhejiang Hisun Pharmaceutical Co., Ltd. (the generic drug) and ticagrelor tablets produced by AstraZeneca Pharmaceutical Co., Ltd. (the original drug) in antiplatelet therapy.Methods:The study design was a retrospective cohort study. The subjects were patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and postoperative antiplatelet therapy with ticagrelor tablets at First Affiliated Hospital of Dalian Medical University during January 2020 to July 2021. Through the hospital electronic medical record system, relevant clinical data of patients (age, gender, comorbidities, blood lipid level on admission, PCI indications, antiplatelet treatment regimen, efficacy and safety assessment endpoint events within 12 months of treatment, etc.) were collected. The patients were divided into the generic drug group and the original drug group. To exclude confounders, propensity score matching (PSM) method was used. The efficacy evaluation index was the incidence of the primary endpoint events (cardiogenic death, stroke, target revascularization, recurrent infarction) and secondary endpoint events (all-cause mortality, peripheral artery occlusion, stent thrombosis, angina attacks) within 12 months of treatment. The safety evaluation index was the incidence of bleeding event within 12 months of treatment.Results:A total of 1 486 patients were included in this study, including 734 in the generic drug group and 752 in the original drug group. The proportion of women and unstable angina, and the level of high-density lipoprotein cholesterol were higher than those in the original drug group (all P<0.05). The proportion of patients with hyperlipidemia and ST-segment elevation myocardial infarction were lower than those in the original drug group (both P<0.05). After PSM, 690 patients were enrolled in the generic drug group and 690 patients in the original drug group (all P>0.05). No differences in the comparison of clinical features between the 2 groups was significant (all P>0.05). No differences in the incidences of primary endpoints, secondary endpoints, and bleeding events between the 2 groups was significant before and after PSM [before PSM: 12.1%(89/734) vs. 10.9%(82/752), 10.8%(79/734) vs. 8.4%(63/752), 0.3%(2/734) vs. 0.5%(4/752); after PSM: 12.6%(87/690) vs. 12.3%(85/690), 11.0%(76/690) vs. 8.3%(57/690), 0.3%(2/690) vs. 0.4%(3/690); all P>0.05]. No death occurred in patients of both groups. Bleeding is predominantly characterized by epistaxis and subcutaneous petechiae, which did not lead to interruption of antiplatelet therapy. Conclusion:The efficacy and safety of ticagrelor tablets produced by Zhejiang Hisun Pharmaceutical Co., Ltd. for antiplatelet therapy in ACS patients after PCI surgery were basically the same as those of the original drug.