Objective To explore the impact of urban and rural resident basic medical insurance(URRBMI)integration policy on the health and health inequality of middle-aged and elderly people,and to provide an evidence-based basis for further improving the URRBMI system.Methods Based on data from the China health and retirement longitudinal study(CHARLS)from 2013 to 2018,the impact of the URRBMI integration policy on the self-rated health,disability,and depression of middle-aged and elderly people was investigated using the staggered differences-in-differences method.The health inequality status of middle-aged and elderly people and its change trend were analyzed by the concentration index,and the index was decomposed according to different years and different integration modes to explore the impact of URRBMI on health inequality of middle-aged and elderly people.Results A study was conducted on 7589 middle-aged and elderly individuals,which found that the URRBMI integration policy had a significant positive impact on the self-rated health of this population(OR=1.309,P<0.001).Additionally,the policy had a significant negative impact on the occurrence of depression(OR=0.696,P<0.001).However,it was found to increase the disability score of middle-aged and elderly individuals(β=0.354,P<0.001)and did not improve their disability status.In addition,health disparity exists among middle-aged and elderly people in China,and middle-aged and elderly people with health problems are mainly concentrated in groups with lower socioeconomic status,and health disparity has been increasing over time.Health insurance for urban and rural residents has a certain effect on alleviating health inequality,the contribution rate of disability inequality and depression inequality decreased from 1.21%and 1.20%in 2013 to-0.58%and 0.31%in 2018,respectively,and compared with the one-tier model,the split-tier system has a greater negative impact on the health status of low-income groups.Conclusion The URRBMI integration policy improved the self-rated health and depression status of middle-aged and elderly people,but had a limited effect on improving the disability status.The policy can reduce the health inequality of middle-aged and elderly people to some extent,but the health inequality varies widely within the population.It is recommended to strengthen the top-level design of URRBMI,to shift from a strategy that emphasizes medicine over prevention to one that emphasizes prevention and combines prevention and treatment,and to shift from formal equity based on the elimination of household boundaries to substantive equity based on the elimination of reimbursement policies and other barriers.

Objective:To evaluate a novel self-designed elbow flexion-extension axis guide that is easy to operate, accurately positioned, and X-ray-free.Methods:This study collected the elbow joint CT scans from 60 normal adults [40 males and 20 females with an age of (38.1±9.3) years] at Department of Orthopedics, The Third Hospital of Xiamen between September and December 2024. The scan images were imported into 3D modeling software for systematic measurement of key anatomical parameters of the distal humerus. The structural design of a novel elbow flexion-extension axis guide was completed based on these measurements, combined with the anatomical data of the distal humerus reported in 6 relevant articles between January 2008 and December 2024 retrieved from the CNKI and PubMed databases. After physical models of the distal humerus from the 60 healthy adults were fabricated using 3D printing technology, they were divided into 2 even groups: a guide-assisted group ( n=30) where the positioning needle was inserted with the assistance of the elbow flexion-extension axis guide and a conventional group ( n=30) where the positioning needle was inserted freehand. The entry deviation, exit deviation, inter-axial angle, inter-axial distance, operation time, and fluoroscopic verifications in positioning of elbow flexion-extension axis were compared between the 2 groups. Results:The guide-assisted group demonstrated significantly smaller values than the conventional group in entry deviation [(1.52±0.70) mm versus (2.29±1.00) mm], exit deviation [(2.83±1.49) mm versus (4.95±1.63) mm], inter-axial angle (3.46°±0.93° versus 6.45°±1.21°), and operation time [(92.0±17.0) s versus (509.5±42.3) s] (all P<0.05). The conventional group required an average of (10.7±2.1) fluoroscopic verifications, while the guide-assisted group eliminated radiation exposure. No statistically significant difference was observed in the inter-axial distance between the 2 methods in positioning of elbow flexion-extension axis ( P>0.05). Conclusion:As the novel self-designed elbow flexion-extension axis guide can improve accuracy in positioning the elbow flexion-extension axis without requiring fluoroscopy, it significantly shortens intraoperative positioning time, and is handy to use.

Objective To explore the impact of urban and rural resident basic medical insurance(URRBMI)integration policy on the health and health inequality of middle-aged and elderly people,and to provide an evidence-based basis for further improving the URRBMI system.Methods Based on data from the China health and retirement longitudinal study(CHARLS)from 2013 to 2018,the impact of the URRBMI integration policy on the self-rated health,disability,and depression of middle-aged and elderly people was investigated using the staggered differences-in-differences method.The health inequality status of middle-aged and elderly people and its change trend were analyzed by the concentration index,and the index was decomposed according to different years and different integration modes to explore the impact of URRBMI on health inequality of middle-aged and elderly people.Results A study was conducted on 7589 middle-aged and elderly individuals,which found that the URRBMI integration policy had a significant positive impact on the self-rated health of this population(OR=1.309,P<0.001).Additionally,the policy had a significant negative impact on the occurrence of depression(OR=0.696,P<0.001).However,it was found to increase the disability score of middle-aged and elderly individuals(β=0.354,P<0.001)and did not improve their disability status.In addition,health disparity exists among middle-aged and elderly people in China,and middle-aged and elderly people with health problems are mainly concentrated in groups with lower socioeconomic status,and health disparity has been increasing over time.Health insurance for urban and rural residents has a certain effect on alleviating health inequality,the contribution rate of disability inequality and depression inequality decreased from 1.21%and 1.20%in 2013 to-0.58%and 0.31%in 2018,respectively,and compared with the one-tier model,the split-tier system has a greater negative impact on the health status of low-income groups.Conclusion The URRBMI integration policy improved the self-rated health and depression status of middle-aged and elderly people,but had a limited effect on improving the disability status.The policy can reduce the health inequality of middle-aged and elderly people to some extent,but the health inequality varies widely within the population.It is recommended to strengthen the top-level design of URRBMI,to shift from a strategy that emphasizes medicine over prevention to one that emphasizes prevention and combines prevention and treatment,and to shift from formal equity based on the elimination of household boundaries to substantive equity based on the elimination of reimbursement policies and other barriers.

Stomatological education is highly dependent on the development of practical skills. However, traditional teaching models present significant limitations in terms of standardization, cost-control, assessment objectivity, and operational safety. Virtual simulation technology offers a novel solution to these issues and with the integration of virtual simulation technology and artificial intelligence (AI) further advances the field toward more intelligent, personalized, and precise applications in the field. AI has demonstrated a key enabling role in various aspects, including creating high-fidelity virtual teaching content, enhancing clinical simulation realism, implementing intelligent assessment with personalized adaptive learning, and providing smart interaction and guidance. However, its practical application in virtual simulation teaching still faces multiple challenges related to resource investment, faculty training, technological iteration, system usability, and ethical-legal regulations. Looking forward, the continuous advancement of AI and its integration into multimodal teaching systems are expected to play a crucial role in building higher-fidelity immersive learning environments, achieving more intelligent personalized teaching, developing comprehensive clinical competencies, and promoting data-driven educational reform. This review aims to provide a comprehensive overview of the current application status, key enabling pathways, primary challenges, and future prospectives of AI in virtual simulation-based stomatologcial education.

Stomatological education is highly dependent on the development of practical skills. However, traditional teaching models present significant limitations in terms of standardization, cost-control, assessment objectivity, and operational safety. Virtual simulation technology offers a novel solution to these issues and with the integration of virtual simulation technology and artificial intelligence (AI) further advances the field toward more intelligent, personalized, and precise applications in the field. AI has demonstrated a key enabling role in various aspects, including creating high-fidelity virtual teaching content, enhancing clinical simulation realism, implementing intelligent assessment with personalized adaptive learning, and providing smart interaction and guidance. However, its practical application in virtual simulation teaching still faces multiple challenges related to resource investment, faculty training, technological iteration, system usability, and ethical-legal regulations. Looking forward, the continuous advancement of AI and its integration into multimodal teaching systems are expected to play a crucial role in building higher-fidelity immersive learning environments, achieving more intelligent personalized teaching, developing comprehensive clinical competencies, and promoting data-driven educational reform. This review aims to provide a comprehensive overview of the current application status, key enabling pathways, primary challenges, and future prospectives of AI in virtual simulation-based stomatologcial education.

Objective:To evaluate a novel self-designed elbow flexion-extension axis guide that is easy to operate, accurately positioned, and X-ray-free.Methods:This study collected the elbow joint CT scans from 60 normal adults [40 males and 20 females with an age of (38.1±9.3) years] at Department of Orthopedics, The Third Hospital of Xiamen between September and December 2024. The scan images were imported into 3D modeling software for systematic measurement of key anatomical parameters of the distal humerus. The structural design of a novel elbow flexion-extension axis guide was completed based on these measurements, combined with the anatomical data of the distal humerus reported in 6 relevant articles between January 2008 and December 2024 retrieved from the CNKI and PubMed databases. After physical models of the distal humerus from the 60 healthy adults were fabricated using 3D printing technology, they were divided into 2 even groups: a guide-assisted group ( n=30) where the positioning needle was inserted with the assistance of the elbow flexion-extension axis guide and a conventional group ( n=30) where the positioning needle was inserted freehand. The entry deviation, exit deviation, inter-axial angle, inter-axial distance, operation time, and fluoroscopic verifications in positioning of elbow flexion-extension axis were compared between the 2 groups. Results:The guide-assisted group demonstrated significantly smaller values than the conventional group in entry deviation [(1.52±0.70) mm versus (2.29±1.00) mm], exit deviation [(2.83±1.49) mm versus (4.95±1.63) mm], inter-axial angle (3.46°±0.93° versus 6.45°±1.21°), and operation time [(92.0±17.0) s versus (509.5±42.3) s] (all P<0.05). The conventional group required an average of (10.7±2.1) fluoroscopic verifications, while the guide-assisted group eliminated radiation exposure. No statistically significant difference was observed in the inter-axial distance between the 2 methods in positioning of elbow flexion-extension axis ( P>0.05). Conclusion:As the novel self-designed elbow flexion-extension axis guide can improve accuracy in positioning the elbow flexion-extension axis without requiring fluoroscopy, it significantly shortens intraoperative positioning time, and is handy to use.

Objective:To study the minimally invasive fixation with virtual self-designed screws between the iliac plates for acetabular posterior column fractures and compare the differences between genders.Methods:The CT data were collected from the 80 patients with normal pelvis who had undergone pelvic CT scan due to physical examination or trauma at Department of Orthopaedics, The Third Hospital of Xiamen from June 2021 to June 2022. There were 40 males and 40 females with an age of (45.0±12.4) years. The virtual screws between the minimally invasive iliac plates were designed with design software after 3D modeling. The insertion point, screw length, screw diameter, angle between the screw and the coronal plane of the pelvis, angle between the screw and the sagittal plane of the pelvis, angle ε between the screw and the anterior edge bone crest line of the greater sciatic notch, and bone channel volume were measured. Comparisons of the above data were made between genders. Results:The insertion point of the screw between the minimally invasive iliac plates was located between the anterior superior iliac spine and the iliac tubercle nodule, going toward the area between the ischial spine and the small ischial notch. The screw length was (139.64±8.46) mm, the screw diameter (8.95±1.16) mm, and the bone channel volume (51.91±10.77) cm 3. The screw length [144.34±7.58) mm], screw diameter [9.50±0.98) mm], angle between the screw and the sagittal plane of the pelvis (31.14°±2.74°), and bone channel volume [(57.82±8.82) cm 3] for males were significantly larger than those for females [(134.95±6.48) mm, (8.40±1.07) mm, 26.72°±2.74°, and (46.01±9.22) cm 3], while the angle between the screw and the sagittal plane of the pelvis [(35.74°±3.85°) mm] and angle ε between the screw and the anterior edge bone crest line of the greater sciatic notch (11.96°±4.57°) for males were significantly smaller than those for females (36.89°±2.96° and 14.17°±5.15°) (all P < 0.05). Conclusions:Fixation with screws between the iliac plates provides a new treatment for acetabular posterior column fractures, because the screws can be placed percutaneously in a minimally invasive manner or antegradely. The screw length, screw diameter, angle between the screw and the sagittal plane of the pelvis, and bone channel volume for males are significantly larger than those for females, while the angle between the screw and the sagittal plane of the pelvis and the angle between the screw and the anterior edge bone crest line of the greater sciatic notch for males are significantly smaller than those for females. Therefore, the angles between the iliac plate screw and the sagittal and coronal planes of the pelvis should be adjusted according to gender in screw placement.

Objective:To investigate the effect of lncRNA AC132217.4 on the proliferation and invasion of liver cancer MHCC97-H cells and its molecular mechanism.Methods:The TCGA database was used to analyze the differential expression of AC132217.4 in liver cancer tissue and adjacent tissue, and to analyze the relationship between the expression level of AC132217.4 and the overall survival of liver cancer patients. Transfection of pcDNA-AC132217.4 plasmid into MHCC97-H cells was defined as AC132217.4 group, transfection of pcDNA plasmid into MHCC97-H cells was defined as negative control (NC) group, respectively. The proliferation and invasion ability of MHCC97-H cells were detected by MTT method and Matrigel invasion assay. The binding site between AC132217.4 and miR-18a-5p was analyzed by starBase v2.0 software and dual luciferase reporter gene assay. Real-time quantitative PCR (RT-qPCR) detected the differential expression of miR-18a-5p in the two groups of MHCC97-H cells. The expression of epithelial-mesenchymal transition protein was detected by Western-blotting. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for comparison between the two groups. Results:Compared with adjacent tissues, the expression of AC132217.4 was down-regulated in liver cancer tissues ( P<0.01). Compared with liver cancer patients with low expression of AC132217.4, the overall survival of liver cancer patients with high AC132217.4 expression was longer ( P<0.05). The pcDNA-AC132217.4 plasmid significantly inhibited the proliferation of MHCC97-H cells ( P<0.05). The number of invasive cells in the NC group and AC132217.4 group were (131.30±12.55) and (37.45±7.77), respectively. The pcDNA-AC132217.4 plasmid significantly inhibited the invasive ability of MHCC97-H cells ( t=6.36, P<0.01). AC132217.4 directly complemented miR-18a-5p ( P<0.01). The expression of miR-18a-5p in MHCC97-H cells in AC132217.4 group (1.04±0.30) was significantly lower than that in NC group (6.13±0.75) ( t=6.27, P<0.01). Compared with the NC group, the expressions of epithelial phenotype proteins Cytokeratin and Claudin-1 in MHCC97-H cells in AC132217.4 group were up-regulated, while the expressions of mesenchymal phenotype proteins Vimentin, Slug and Snail were down-regulated. Conclusions:The expression of AC132217.4 is low in liver cancer tissue, and it is related to the overall survival of liver cancer patients. AC132217.4 might inhibit the proliferation and invasion of liver cancer MHCC97-H cells by sponge miR-18a-5p.

【Objective】 To explore the feasibility and efficacy of laparoscopic bladder muscle flap ureteroplasty in the treatment of long-segment injury in the middle and lower ureter and to summarize the clinical experience. 【Methods】 The clinical data of 6 patients treated in our hospital during Oct.2018 and Aug.2021 were retrospectively analyzed. Four of them had long-segment ureteral mucosal cuff-like avulsion during ureteroscopic lithotripsy and could not undergo end-to-end ureteral anastomosis or reimplantation, and then laparoscopic bladder muscle flap ureteroplasty plus lumbaris major fixation of the bladder was performed immediately. The other 2 patients had to undergo this procedure due to stricture. 【Results】 All operations were successful. The median ureteral avulsion or ureteral stricture length was 14.5(6, 16) cm, muscle flap length 16.5(8,18) cm, operation time 190 (160, 240) min, blood loss 175 (100, 250) mL, postoperative hospital stay 8 (7, 12) days, and postoperative creatinine (89.38±21.74) μmoI/L. No major complications occurred. One patient developed urinary leakage, which returned to normal after active glycemic control and nutritional therapy; one patient developed postoperative absorption fever, which recovered after physical cooling. During the follow-up of 6 to 45 months, CT showed mild hydronephrosis in some patients, but no ureteral stenosis, impaired renal function or other complications, and patients complained no subjective discomfort. 【Conclusion】 Laparoscopic bladder muscle flap ureteroplasty is safe and effective for patients with long-segment injury in the middle and lower ureter. It has the advantages of small trauma, few long-term complications, and rapid recovery and improvement of renal function. If necessary, it can be combined with lumbaris major fixation of the bladder to shorten the distance from the muscle flap to the broken end of the ureter and to reduce the tension of the anastomosis.

【Objective】 To compare the efficacy, safety and survival of partial nephrectomy (PN) and radical nephrectomy (RN) in the treatment of clinical T1b and T2a renal cell carcinoma (RCC). 【Methods】 A total of 115 patients with stage T1b and T2a RCC treated during Apr.2014 and Jul.2017 were retrospectively analyzed. According to the different surgical methods, the patients were divided into PN group (n=55) and RN group (n=60). The clinical data and prognosis of the two groups were compared. 【Results】 There were no significant differences in the general clinical data and perioperative related factors between the two groups (P>0.05). The incidence of complications was significantly higher in PN group than in RN group (P=0.024), but there was no significant difference in serious complications (Clavien grade ≥3) (P>0.05). In terms of renal function recovery, there was no significant difference in serum creatinine between the two groups before operation (P>0.05), but the serum creatinine was significantly lower in PN group than in RN group on the 1st day, 3rd, 6th and 12th months after operation (P<0.05). After more than 5 years of follow-up, there was no significant difference in 5-year survival rate, overall survival rate, recurrence and metastasis rate, and cancer specific survival rate between the two groups (P>0.05). 【Conclusion】 Both PN and RN are safe and effective in the treatment of stage T1b and T2a RCC, and can achieve good oncological control effects. Compared with RN, PN can fully and effectively protect the postoperative renal function, but it causes more surgical complications. However, there is no significant difference in severe complications (Clavien grade ≥3).