BackgroundWith the rapid development of the networking technologies， internet addiction has increasingly become a serious mental health issue. Previous studies have revealed the link between childhood trauma and internet addiction， while the mediating role of perceived stress in this link is not yet clear. ObjectiveTo investigate the role of medical students' perceived stress in the relationship between childhood trauma and internet addiction， so as to provide references for the intervention of internet addiction. MethodsFrom February to March 2023， a random sampling technique was used to select 1 232 undergraduate students from the School of Clinical Medical Sciences of Southwest Medical University as research subjects. The Childhood Trauma Questionnaire-Short Form （CTQ-SF）， Perceived Stress Scale （PSS）， Internet Gaming Disorder Scale （IGDS）， and Bergen Social Media Addiction Scale （BSMAS） were used for assessment. Pearson's correlation coefficients were calculated. The mediation effect of perceived stress in the relationship between childhood trauma and internet addiction was tested using Model 4 in the SPSS Process 4.1， and Bootstrapping procedure involving 5 000 replicates was employed to confirm the statistical significance. ResultsA total of 1 016 （82.47%） valid completed questionnaires were gathered. The CTQ-SF scores of medical students were positively correlated with PSS scores， IGD scores， and BSMAS scores （r=0.583， 0.474， 0.465， P<0.01）. PSS scores were positively correlated with IGD scores and BSMAS scores （r=0.369， 0.479， P<0.01）. Childhood trauma in medical students was found to positively predict perceived stress （β=0.191， P<0.01）， social media addiction （β=0.160， P<0.01）， and internet gaming disorder （β=0.106， P<0.01）. Perceived stress played a significant mediating role in the relationship between childhood trauma and internet gaming disorder， indirect effect value was 0.018 （95% CI： 0.009~0.027）， accounting for 16.98%. Perceived stress also exhibited a significant mediating role in the relationship between childhood trauma and social media addiction， indirect effect value was 0.063 （95% CI： 0.048~0.079）， accounting for 39.38%. ConclusionChildhood trauma in medical students may affect internet gaming disorder and social media addiction through perceived stress. ［Funded by 2022 Annual Research Project of Sichuan Applied Psychology Research Center，（number，CSXL-22102）］

With the rapid advancement of artificial intelligence technology, chatbots have shown great potential in the healthcare sector. From personalized health advice to chronic disease management and psychological support, chatbots have demonstrated significant advantages in improving the efficiency and quality of healthcare services. As the scope of their applications expands, the relationship between technological complexity and practical application scenarios has become increasingly intertwined, necessitating a more comprehensive evaluation of both aspects. This paper, from the perspective of he althcare applications, systematically reviews the technological pathways and development of chatbots in the medical field, providing an in-depth analysis of their performance across various medical scenarios. It thoroughly examines the advantages and limitations of chatbots, aiming to offer theoretical support for future research and propose feasible recommendations for the broader adoption of chatbot technologies in healthcare.

Objective To investigate the immunomodulatory effects of Aedes albopictus salivary protein rAlb-34kDa-1 on macrophages (Raw264.7) and its impact on dengue virus type 2 (DENV-2) replication in Raw264.7 cells. Methods The prokaryotic expression plasmid pET32a(+)-rAlb-34kDa-1 was transfected into Escherichia coli (E.coli) BL21 (DE3), and salivary proteins were obtained according to the expression purification conditions established in the pre-laboratory stage and identified by SDS-PAGE and Western blot (WB). The toxic effects of rAlb-34kDa-1 protein in Raw264.7 cells were assessed by CCK8 assay. Raw264.7 cells were treated with rAlb-34kDa-1 at concentrations of 0.02, 0.2, and 2 μg/mL for 6, 12, and 24 h. The expression of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), chemokine ligand 2 (CCL2), interferon-β (IFN-β), and interferon-stimulated gene 15 (ISG15) within the cells was detected using real-time quantitative reverse transcription PCR (qRT-PCR). Enzyme-linked immunosorbent assay (ELISA) was used to measure IL-6 and TNF-α secretion in the cell culture supernatants. Immunofluorescence staining was used to observe the translocation of p65 into the nucleus of Raw264.7 cells following rAlb-34kDa-1 treatment, to analyze whether rAlb-34kDa-1 modulates the immune response in Raw264.7 cells through NF-κB signaling pathway. Cells were collected 6, 12, and 24 hours post-treatment under different experimental conditions (DENV-2 treatment group, salivary protein +DENV-2 co-incubation group) was measured using qRT-PCR, and the fluorescence intensity of J2 (dsRNA) in the cells was detected by flow cytometry (FCM) after 24 hours under different treatment factors. Results The results of SDS-PAGE and WB confirmed the successful acquisition of rAlb-34kDa-1 protein, and CCK8 analysis showed no cytotoxicity of this protein toward Raw264.7 cells. Both 0.2 μg/mL and 2 μg/mL rAlb-34kDa-1 induced the expression of IL-1β, IL-6, TNF-α, CCL2, IFN-β, and ISG15 in Raw264.7 cells. One hour after rAlb-34kDa-1 treatment, the fluorescence intensity of p65 in the nucleus of Raw264.7 cells was significantly enhanced. In Raw264.7 cells co-incubated with rAlb-34kDa-1 and DENV-2 for 12 hours, rAlb-34kDA-1 at a concentration of 2 μg/mL significantly increased the mRNA expression of DENV-2. After 24 hours of treatment, rAlb-34kDA-1 at concentrations of 0.02 μg/mL, 0.2 μg/mL, and 2 μg/mL all enhanced the mRNA expression of DENV-2 in Raw264.7 cells, and 2 μg/mL of rAlb-34kDa-1 co-incubated with DENV-2 significantly increased the J2 fluorescence signal in cells. Conclusion The rAlb-34kDa-1 protein can regulate the immune response in murine Raw264.7 cells and promote the replication of DENV-2 in these cells.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objective:Based on multi-subject coordination perspective,it aimed to define the stakeholders in the active health management model,analyze the functional positioning and interests of each party,and put forward relevant governance strategies,so as to provide the participating subjects with governance ideas for the subsequent exploration of the implementation path of active health.Methods:Stakeholders are identified,categorized and managed using Delphi expert consultation and Mitchell scoring method.Results:After two rounds of expert consultation,a total of 17 stakeholders were identified and categorized into three types:deterministic,anticipatory,and marginal stakeholders.In addition,taking into account the opinions from the expert interviews,the functional positioning and interests of each party were further identified,and corresponding management strategies were proposed.Conclusion:Active health management should adopt the strategy of"holistic coordination and categorization",adopting different governance strategies according to the priority of the demands of each type of stakeholder,and at the same time establishing a sound mechanism for sharing responsibilities and preventing conflicts of interest,so as to coordinate and balance the interests of all parties.

Objective Explore the impact of payment by DRG on rehabilitation cases,evaluate the effect of DRG policy reform for rehabilitation cases and make relevant recommendations.Methods Rehabilitation cases admitted to designated medical institutions in Sichuan Province in 2020-2021 were extracted,and regression analyses were per-formed after Propensity Score Matching using the Difference in Differences method to evaluate the impact of DRG payment on the inpatient costs and the hospitalization days of rehabilitation cases,then analyze the net effect of the policy.Results After the implementation of DRG payment,the total hospitalization cost,drug cost,treatment cost,and examination cost of rehabilitation cases decreased to different degrees,and only the bed cost increased,in which the total hospitalization cost decreased by 21.8％(P＜0.05),and the cost structure of the cases changed to a certain extent compared with that before the implementation of DRG payment.In addition,the number of hospi-talization days for rehabilitation cases has not been effectively reduced under the DRG policy,but rather increased by 13.4％(P＜0.05).Conclusion DRG payment can effectively reduce the financial burden of rehabilitation cases,but it does not optimize the operational efficiency of hospitals.Whether payment by DRG is applicable to rehabilita-tion cases is open to further discussion,the health insurance department and hospitals should be in close contact to actively explore new modes of health insurance payment for rehabilitation cases.

Objective:Based on multi-subject coordination perspective,it aimed to define the stakeholders in the active health management model,analyze the functional positioning and interests of each party,and put forward relevant governance strategies,so as to provide the participating subjects with governance ideas for the subsequent exploration of the implementation path of active health.Methods:Stakeholders are identified,categorized and managed using Delphi expert consultation and Mitchell scoring method.Results:After two rounds of expert consultation,a total of 17 stakeholders were identified and categorized into three types:deterministic,anticipatory,and marginal stakeholders.In addition,taking into account the opinions from the expert interviews,the functional positioning and interests of each party were further identified,and corresponding management strategies were proposed.Conclusion:Active health management should adopt the strategy of"holistic coordination and categorization",adopting different governance strategies according to the priority of the demands of each type of stakeholder,and at the same time establishing a sound mechanism for sharing responsibilities and preventing conflicts of interest,so as to coordinate and balance the interests of all parties.

Objective Explore the impact of payment by DRG on rehabilitation cases,evaluate the effect of DRG policy reform for rehabilitation cases and make relevant recommendations.Methods Rehabilitation cases admitted to designated medical institutions in Sichuan Province in 2020-2021 were extracted,and regression analyses were per-formed after Propensity Score Matching using the Difference in Differences method to evaluate the impact of DRG payment on the inpatient costs and the hospitalization days of rehabilitation cases,then analyze the net effect of the policy.Results After the implementation of DRG payment,the total hospitalization cost,drug cost,treatment cost,and examination cost of rehabilitation cases decreased to different degrees,and only the bed cost increased,in which the total hospitalization cost decreased by 21.8％(P＜0.05),and the cost structure of the cases changed to a certain extent compared with that before the implementation of DRG payment.In addition,the number of hospi-talization days for rehabilitation cases has not been effectively reduced under the DRG policy,but rather increased by 13.4％(P＜0.05).Conclusion DRG payment can effectively reduce the financial burden of rehabilitation cases,but it does not optimize the operational efficiency of hospitals.Whether payment by DRG is applicable to rehabilita-tion cases is open to further discussion,the health insurance department and hospitals should be in close contact to actively explore new modes of health insurance payment for rehabilitation cases.

Objective:Based on multi-subject coordination perspective,it aimed to define the stakeholders in the active health management model,analyze the functional positioning and interests of each party,and put forward relevant governance strategies,so as to provide the participating subjects with governance ideas for the subsequent exploration of the implementation path of active health.Methods:Stakeholders are identified,categorized and managed using Delphi expert consultation and Mitchell scoring method.Results:After two rounds of expert consultation,a total of 17 stakeholders were identified and categorized into three types:deterministic,anticipatory,and marginal stakeholders.In addition,taking into account the opinions from the expert interviews,the functional positioning and interests of each party were further identified,and corresponding management strategies were proposed.Conclusion:Active health management should adopt the strategy of"holistic coordination and categorization",adopting different governance strategies according to the priority of the demands of each type of stakeholder,and at the same time establishing a sound mechanism for sharing responsibilities and preventing conflicts of interest,so as to coordinate and balance the interests of all parties.

Objective Explore the impact of payment by DRG on rehabilitation cases,evaluate the effect of DRG policy reform for rehabilitation cases and make relevant recommendations.Methods Rehabilitation cases admitted to designated medical institutions in Sichuan Province in 2020-2021 were extracted,and regression analyses were per-formed after Propensity Score Matching using the Difference in Differences method to evaluate the impact of DRG payment on the inpatient costs and the hospitalization days of rehabilitation cases,then analyze the net effect of the policy.Results After the implementation of DRG payment,the total hospitalization cost,drug cost,treatment cost,and examination cost of rehabilitation cases decreased to different degrees,and only the bed cost increased,in which the total hospitalization cost decreased by 21.8％(P＜0.05),and the cost structure of the cases changed to a certain extent compared with that before the implementation of DRG payment.In addition,the number of hospi-talization days for rehabilitation cases has not been effectively reduced under the DRG policy,but rather increased by 13.4％(P＜0.05).Conclusion DRG payment can effectively reduce the financial burden of rehabilitation cases,but it does not optimize the operational efficiency of hospitals.Whether payment by DRG is applicable to rehabilita-tion cases is open to further discussion,the health insurance department and hospitals should be in close contact to actively explore new modes of health insurance payment for rehabilitation cases.