ObjectiveTo develop a novel precision rehabilitation service model for structural problems in rural rehabilitation services for persons with disabilities in China, such as shortages of professional resources, imprecise assessment and lack of service continuity, guided by International Classification of Functioning, Disability and Health (ICF) and supported by digital technologies. MethodsUsing ICF as an analytical tool and rural disability rehabilitation services as the application scenario, this study adopted a problem-oriented approach focused on current service challenges. Through literature review, situation analysis and strategy exploration, elements of body functions and structures, activities and participation, environmental factors, and digital technologies were organically integrated to form systematic solutions. ResultsA precision rehabilitation service model developed for rural persons with disabilities was constructed based on ICF and integrated with digital technologies such as the Internet of Things, big data and telerehabilitation. The model encompassed three dimensions: precise assessment of body functions, precise matching of intervention modalities and precise adjustment of environmental factors. An implementation pathway for digital technology-empowered precision rehabilitation in rural areas was proposed. ConclusionThe digitally empowered precision rehabilitation service model based on ICF is helpful for addressing the challenges of equity and precision in rural rehabilitation services in China, promoting access fairer, more accessible and systematically continuous rehabilitation services.

The repair of bone defects is heavily influenced by the dynamic osteogenic microenvironment. Static scaffolds constructed by traditional 3D printing technology cannot simulate the dynamic nature of the microenvironment during bone defect repair due to the fixed structure, uncontrollable release of active factors, and difficult regeneration of blood vessels, among other factors. Breaking through the limitations of these static scaffolds and realizing the intelligent and dynamic regulation of the osteogenic microenvironment is a key scientific issue in the field of bone tissue engineering. 4D printing technology combines the dynamic responsiveness of bone restoration materials with the concept of intelligent design to regulate the micro and macro structure of scaffolds. This technology provides a new method for bone tissue engineering by responding to endogenous and exogenous stimuli and creating a better osteogenic microenvironment through functionalized design, including drug delivery and antibacterial function. However, this technology currently suffers from challenges related to dynamic response material design, insufficient precision of printing technology, and mismatches between multi-stimulus response systems, metabolic rhythms of bone tissue, and functionalized composite scaffolds. Future research should focus on the development of smart response materials with excellent dynamic responses and bioactivity, the creation of new printing technologies, and the design of personalized and precise bone repair solutions. The aim of this paper is to review the current research status of 4D printing for bone tissue engineering in terms of material types, response mechanisms, and applications to provide a theoretical basis for the development and clinical application of functional bone repair materials in the future.

There are practical and cost-effective opportunities for the prevention and early intervention of periodontal disease, a common oral condition. Depression and anxiety represent major global mental health challenges, and they are characterized by high prevalence rates and an elevated suicide risk. Their clinical management is complicated by extended treatment timelines and substantial healthcare costs. Accumulating evidence demonstrates a statistically significant bidirectional association between periodontal disease and depression/anxiety disorders. However, established clinical pathways integrating these conditions remain lacking. This review presents a comprehensive analysis of current research examining the relationship between periodontal disease and mood disorders, specifically depression and anxiety. This study explored the bidirectional mechanisms within the microbiota-oral-brain axis, which includes both periodontal disease inducing neuroinflammation through pro-inflammatory factors, such as interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) activating the TLR-4/NF-κB signaling pathway, and depression and anxiety leading to “glucocorticoid resistance” through hypothalamic-pituitary-adrenal (HPA) axis dysregulation, thus causing dual immune dysfunction that exacerbates periodontal tissue destruction, as well as the mechanisms by which biological, psychological, and social factors contribute to the bidirectional association between periodontal disease and depression/anxiety. We propose implementing bidirectional referral protocols between dental and psychiatric services in clinical practice, incorporating mental health screening tools, such as Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7(GAD-7), for patients with moderate-to-severe periodontal disease, and incorporating periodontal examination into routine assessment during psychiatric services. This multidisciplinary approach aims to break the vicious circle between these conditions and provide clinicians with pragmatic intervention strategies.

Objective: To explore the association role of anxiety and depressive symptoms with Internet gaming disorder (IGD) and emotional-behavioral problems among junior high school students, so as to provide references for preventing the occurrence and progression of emotional-behavioral problems in middle school students. Methods: From September to October 2024, a random cluster sampling method was adopted to select 38 069 students from 28 junior high schools in 14 counties (cities and districts) and functional areas of Jining City, Shandong Province. Surveys were conducted by Nine item Internet Gaming Disorder Scale-Short Form, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Strengths and Difficulties Questionnaire. The correlation of emotional and behavioral issues, online game addiction, anxiety and depressive symptoms among junior high school students was analyzed by Speaman correlation analysis. Mediation analysis was used to explore the role of anxiety and depressive symptoms between IGD and emotional-behavioral problems among junior high school students. Results: The detection rates of emotional-behavioral problems, anxiety symptoms, depressive symptoms, and IGD among junior high school students were 19.24 %, 9.48%, 16.69%, and 19.68%, respectively. The scores of emotional-behavioral problems, anxiety symptoms, depressive symptoms and IGD were 10.00 (6.00, 15.00), 3.00 (0.00, 7.00), and 4.00 (1.00, 8.00), 13.00 (10.00, 19.00), respectively. There were positive correlations between each pair of emotional-behavioral problem, IGD, anxiety symptoms, and depressive symptoms scores ( r =0.51-0.81, all P <0.01). Anxiety and depressive symptoms played mediating roles between IGD and emotional-behavioral problems among junior high school students, with mediating effect values of 0.16 (95% CI =0.15-0.17) and 0.12 (95% CI =0.11-0.14), respectively (both P <0.01). Conclusions Anxiety and depressive symptoms mediate the relationship between IGD and emotional-behavioral problems among junior high school students. It is necessary to identify early signs of IGD among junior high school students, strengthen intervention for anxiety and depressive symptoms, to prevent the occurrence and development of emotional and behavioral issues.

Objective To explore the value of carotid pulse wave combined with urinary transferrin(TRF)and β2-microglobulin(β2-MG)in the evaluation of renal injury in patients with hyperten-sive nephropathy.Methods A total of 30 patients with hypertensive nephropathy,30 patients with simple hypertension and 90 patients with non-hypertensive nephropathy who were admitted to our hospital between May 2021 and April 2024,and 30 healthy individuals(control group)who taking physical examination during same period were enrolled and assigned into corresponding groups,respectively.According to the severity of renal injury,the 120 patients from the hyperten-sive nephropathy group and non-hypertensive nephropathy group were divided into normal group(28 cases),mildly injured group(36 cases),moderately injured group(31 cases)and severely in-jured group(25 cases).The carotid pulse wave indicators[pulse wave velocity at beginning of the systole(PWV-BS),pulse wave velocity at ending of the systole(PWV-ES)],and urinary TRF and β2-MG levels were detected and compared in above groups.ROC curves were plotted to ana-lyze the diagnostic values of these indicators in hypertensive nephropathy.The relationship be-tween the above indicators and the severity of renal injury was analyzed with sequential multivari-ate logistics regression analysis.Results There were significant differences in PWV-BS,PWV-ES,and urinary TRF and β2-MG levels among the hypertensive nephropathy group,non-hyperten-sive nephropathy group,hypertension group and control group(P＜0.01).ROC curve analysis showed that the AUC value of the four indictors combined together in the diagnosis of hyperten-sive nephropathy was 0.907,which was statistically greater than that of single indicator alone(0.774,0.743,0.728,0.749,P＜0.01).Obvious differences were also observed in PWV-BS,PWV-ES,and urinary TRF and β2-MG levels among the severely,moderately and mildly injured groups and normal group(P＜0.01).Sequential multivariate logistics regression analysis indicated that PWV-BS(OR=1.824,95％CI:1.272-2.616,P=0.001),PWV-ES(OR=1.910,95％CI:1.268-2.877,P=0.002),and urinary TRF(OR=2.442,95％CI:1.485-4.018,P=0.001)and β2-MG levels(OR=2.807,95％CI:1.580-4.984,P=0.001)were influencing factors of renal injury severity in the renal injured patients.Conclusion Carotid pulse wave combined with urinary TRF and β2-MG can be applied in auxiliary diagnosis of hypertensive nephropathy,and they are correla-ted with the severity of renal injury.

BACKGROUND:Based on the principle of vertical tooth movement,a personalized orthodontic appliance is created through digital design combined with 3D printing,so that the personalized orthodontic appliance forms a support system with the individual incisors.With the help of the absolute support of the micro-implant,the single tooth is precisely controlled in a three-dimensional direction.OBJECTIVE:To design personalized orthodontic appliances with 11,12,21,and 22 intrusion and extrusion based on biomechanical principles,and analyze the safety of the personalized orthodontic appliances in terms of their movement effect on the teeth by means of the three-dimensional finite element method.METHODS:Three-dimensional finite element models of alveolar bone-periodontium-maxillary incisors-personalized cantilever micro-implant-connecting plates-personalized brackets in the maxillary anterior region(teeth numbers 11,12,21,and 22)were established using Mimics,Geomagic Wrap,SolidWorks,and Ansys Workbench software,respectively.Personalized orthodontic appliances with low pressure movement and extended movement were set up at each tooth position.The stress level of each component of the personalized orthodontic appliances was analyzed,and the tooth displacement and periodontal stress distribution were calculated under loading of 300 g tensile or thrust force.RESULTS AND CONCLUSION:(1)The maximum equivalent force on the personalized intrusion mobile orthodontic appliance was 162.90 MPa,and the maximum equivalent force on the personalized extrusion mobile orthodontic appliance was 239.57 MPa.The maximum equivalent stress on both devices was located in the vertical portion of the personalized bracket loading attachment.The equivalent stresses on each part of the personalized orthodontic appliance were all within the yield strength,and they had good safety.(2)The initial displacement of the teeth under the action of the personalized orthodontic appliances showed a tendency towards overall intrusion or extrusion,with the displacement in the vertical direction far exceeding that in the horizontal and sagittal directions.The equivalent stress peak appeared at the root tip or neck of the periodontal membrane,and the equivalent stress concentration area appeared in the periodontal membrane of the root apical region.(3)The results show that the personalized orthodontic appliance allows 11,12,21,and 22 to approximate either intrusion movement or extrusion movement,initially confirming the effectiveness of the personalized vertical movement orthodontic appliance.

Objective The Hybrid Education Competence Instrument(HybridEduCom)was sinicized,and its reliability and validity were tested.Methods The translation,cultural adjustment and pre-investigation of HybridEduCom were followed by the Brislin translation model.The reliability and validity of the HybridEduCom was tested by surveying 553 educators in medical and nursing related fields by convenience sampling from March to April 2024.Results The Chinese version of HybridEduCom consisted of 46 items in 5 dimensions:planning and resourcing competence,technology competence,interaction competence,digital pedagogy competence,and ethical competence in the hybrid education.The confirmatory factor analysis resulted in the second-order five-factor model,with the chi-square and degree of freedom ratio being 1.274,approximate root mean square error being 0.022,goodness of fit index being 0.913,and standard fit index(NFI)being 0.934,and Tucker-Lewis and comparative fit index being 0.985.All main evaluation indexes were within the acceptable range of the judgment criteria.The item-content validity index was 0.833-1.000,and the scale-content validity index was 0.968.The Cronbach's α for the whole scale was 0.982,while varied from 0.892 to 0.936 for each dimension.The test-retest reliability of the scale was 0.978.Conclusion The reliability and validity of the Chinese version of HybridEduCom were satisfactory,and it can serve as a valid assessment instrument for the implementation of hybrid education competence of Chinese higher medical and nursing educators.

Objective To explore the value of carotid pulse wave combined with urinary transferrin(TRF)and β2-microglobulin(β2-MG)in the evaluation of renal injury in patients with hyperten-sive nephropathy.Methods A total of 30 patients with hypertensive nephropathy,30 patients with simple hypertension and 90 patients with non-hypertensive nephropathy who were admitted to our hospital between May 2021 and April 2024,and 30 healthy individuals(control group)who taking physical examination during same period were enrolled and assigned into corresponding groups,respectively.According to the severity of renal injury,the 120 patients from the hyperten-sive nephropathy group and non-hypertensive nephropathy group were divided into normal group(28 cases),mildly injured group(36 cases),moderately injured group(31 cases)and severely in-jured group(25 cases).The carotid pulse wave indicators[pulse wave velocity at beginning of the systole(PWV-BS),pulse wave velocity at ending of the systole(PWV-ES)],and urinary TRF and β2-MG levels were detected and compared in above groups.ROC curves were plotted to ana-lyze the diagnostic values of these indicators in hypertensive nephropathy.The relationship be-tween the above indicators and the severity of renal injury was analyzed with sequential multivari-ate logistics regression analysis.Results There were significant differences in PWV-BS,PWV-ES,and urinary TRF and β2-MG levels among the hypertensive nephropathy group,non-hyperten-sive nephropathy group,hypertension group and control group(P＜0.01).ROC curve analysis showed that the AUC value of the four indictors combined together in the diagnosis of hyperten-sive nephropathy was 0.907,which was statistically greater than that of single indicator alone(0.774,0.743,0.728,0.749,P＜0.01).Obvious differences were also observed in PWV-BS,PWV-ES,and urinary TRF and β2-MG levels among the severely,moderately and mildly injured groups and normal group(P＜0.01).Sequential multivariate logistics regression analysis indicated that PWV-BS(OR=1.824,95％CI:1.272-2.616,P=0.001),PWV-ES(OR=1.910,95％CI:1.268-2.877,P=0.002),and urinary TRF(OR=2.442,95％CI:1.485-4.018,P=0.001)and β2-MG levels(OR=2.807,95％CI:1.580-4.984,P=0.001)were influencing factors of renal injury severity in the renal injured patients.Conclusion Carotid pulse wave combined with urinary TRF and β2-MG can be applied in auxiliary diagnosis of hypertensive nephropathy,and they are correla-ted with the severity of renal injury.

This paper highlights the specific nursing experiences in an early inflammatory bowel obstruction of a patient after the surgery for abdominal cocoon syndrome.Immediately after the surgery,the nursing care focused on prevention of postoperative metabolic disorders,including dynamic monitoring and correction of refeeding syndrome and goal-oriented sequential nutritional support management.Over the period of postoperative recovery,the nursing care shifted to prevention and treatment of early postoperative inflammatory bowel obstruction,including dynamic monitoring and identification of an early postoperative inflammatory bowel obstruction,goal-oriented early postoperative inflammatory small bowel obstruction(EPISBO)fluid therapy together with the traditional Chinese medicine to promote bowel movement and control inflammation,the auricle copper-blade Gua Sha combined with auricular point sticker compression to regulate qi and reduce bowel flatulence,as well as a goal-oriented early mobilisation to prevent a re-obstruction of bowel.The patient discharged at 28 days after surgery without an event.At the 6 months of postoperative follow-up,the patient was found in continuous improvement of relevant indicators and increase of body weight.

BACKGROUND:Based on the principle of vertical tooth movement,a personalized orthodontic appliance is created through digital design combined with 3D printing,so that the personalized orthodontic appliance forms a support system with the individual incisors.With the help of the absolute support of the micro-implant,the single tooth is precisely controlled in a three-dimensional direction.OBJECTIVE:To design personalized orthodontic appliances with 11,12,21,and 22 intrusion and extrusion based on biomechanical principles,and analyze the safety of the personalized orthodontic appliances in terms of their movement effect on the teeth by means of the three-dimensional finite element method.METHODS:Three-dimensional finite element models of alveolar bone-periodontium-maxillary incisors-personalized cantilever micro-implant-connecting plates-personalized brackets in the maxillary anterior region(teeth numbers 11,12,21,and 22)were established using Mimics,Geomagic Wrap,SolidWorks,and Ansys Workbench software,respectively.Personalized orthodontic appliances with low pressure movement and extended movement were set up at each tooth position.The stress level of each component of the personalized orthodontic appliances was analyzed,and the tooth displacement and periodontal stress distribution were calculated under loading of 300 g tensile or thrust force.RESULTS AND CONCLUSION:(1)The maximum equivalent force on the personalized intrusion mobile orthodontic appliance was 162.90 MPa,and the maximum equivalent force on the personalized extrusion mobile orthodontic appliance was 239.57 MPa.The maximum equivalent stress on both devices was located in the vertical portion of the personalized bracket loading attachment.The equivalent stresses on each part of the personalized orthodontic appliance were all within the yield strength,and they had good safety.(2)The initial displacement of the teeth under the action of the personalized orthodontic appliances showed a tendency towards overall intrusion or extrusion,with the displacement in the vertical direction far exceeding that in the horizontal and sagittal directions.The equivalent stress peak appeared at the root tip or neck of the periodontal membrane,and the equivalent stress concentration area appeared in the periodontal membrane of the root apical region.(3)The results show that the personalized orthodontic appliance allows 11,12,21,and 22 to approximate either intrusion movement or extrusion movement,initially confirming the effectiveness of the personalized vertical movement orthodontic appliance.