Digital medical insurance governance， as an important component of digital transformation， improves the efficiency of medical insurance services while facing complex ethical challenges. Taking stakeholder theory as the analytical framework， this paper explored the generative mechanisms， manifestations， and countermeasures of ethical issues in digital medical insurance governance. This study uncovered that accelerated technological iteration and lagging ethical and legal norms， as well as interest conflicts among multiple participants in governance， constituted the major causes of ethical issues. These issues specifically manifested as data privacy leakage， unfair algorithmic decision-making， widening digital divide， ambiguous accountability， and other aspects. To address these issues， this paper put forward systematic countermeasures， such as establishing a dynamic ethical and legal regulatory system， balancing the demands of stakeholders， strengthening technological ethical governance， narrowing the digital divide， and enhancing accountability mechanisms. Through the implementation of multi-dimensional governance strategies， it aimed to balance technological innovation and ethical constraints， advance the inclusiveness， fairness， and sustainable development of digital medical insurance， and provide theoretical reference and practical references for improving China’s digital medical insurance governance system.

Objective:To investigate the relationship between sarcopenia and the maximum diaphragm excursion(Dmax)observed on ultrasound in the elderly.Methods:Elderly volunteers(age≥60 years)were recruited from family members of patients at Guangdong Provincial People's Hospital.Their Dmax during forced inhalation was measured via ultrasound.The parameters for the diagnosis of sarcopenia included the appendicular skeletal muscle mass index(ASMI), handgrip strength and usual gait speed.We compared the differences in physical characteristics, pulmonary ventilation, physical performance and Dmax between patients with and without sarcopenia, and evaluated the relationship between sarcopenia and DEmax in the elderly via linear regression.Results:A total of 145 elderly volunteers[age(69.47±5.15)years]were included, and 28(19.31%)were diagnosed with sarcopenia.Body weight, ASMI, maximum inspiratory pressure(Pinmax), maximal power output(Wmax)and Dmax of patients with sarcopenia were significantly lower than those of patients without sarcopenia(all P<0.05).Dmax in the elderly was correlated with sex, height, ASMI, handgrip strength, usual gait speed, Pinmax and Wmax( r=0.181, 0.130, 0.322, 0.373, 0.401, 0.134, and 0.388, P=0.012, 0.037, 0.009, 0.002, 0.022, 0.009, and 0.002, respectively).After adjusting for sex, age, height and forced vital capacity(FVC), there was still a negative correlation between sarcopenia and Dmax in the elderly( β=-0.310, P=0.021). Conclusions:Dmax is related to Pinmax and physical performance in the elderly, and sarcopenia increases the risk of decline in the maximum diaphragm excursion in the elderly as observed on ultrasound.

Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.

Objective To observe the effectiveness of routine nursing plus foot exercise on the peripheral neuropathy and plantar pressure in patients with diabetic foot.Methods Toally 100 patients with diabetic foot were randomly divided into 2 groups.On the basis of routine nursing care,50 patients in the observation group were given foot exercises for 12 weeks,50 patients in the control group were given routine nursing only.Before and after intervention,the Toronto clinical scoring system (TCSS),left and right foot peak pressure variation were observed.Results Before intervention,there was no statistical difference between the two groups' TCSS sore and the peak pressure of left and right foot (P ＞0.05).After intervention,the observation group's average total score of TCSS was lower,there was significantly different between two groups (P＜ 0.001).The peak pressure of left and right foot is lower in the observation group,the difference was statistically significant (P ＜ 0.05).Conclusion Foot exercises is worthy of clinical promotion,because it can improve the peripheral neuropathy of patients with diabetic foot,so as to reduce the plantar pressure,reduce the pain of patients and improve their life quality.

BACKGROUND: miRNA plays a critical regulatory role in the development and plasticity of spinal cord, and pathological changes after spinal cord injury. OBJECTIVE: To study the effect of miR-136-5p on the A20 expression in mouse astrocytes stimulated by interleukin-17 (IL-17). METHODS: C57BL/6 mouse astrocytes were cultured in vitro, identified by immunofluorescence staining, and then stimulated by 100 μg/L IL-17 for 0, 3, 6, 12 and 24 hours, respectively. The relative mRNA expression levels of IL-6 and tumor necrosis factor-α were detected by RT-PCR to determine the optimal stimulation time of IL-17. The mouse astrocytes were respectively stimulated by 10, 20, 50, 100 and 200 μg/L IL-7 for 6 hours, and similarly, the relative mRNA expression levels of IL-6 and tumor necrosis factor-α were detected to determine the optimal concentration of IL-17. At 6 hours after IL-17 (50 μg/L) stimulation, the mRNA expression levels of miR-136-5p and A20 in mouse astrocytes were detected by RT- PCR, and the protein expression level of A20 was detected by western blot assay. In addition, the lentiviral expression vector (miR-136-5p-inhibition) was constructed and transfected into the mouse astrocytes that were also stimulated by IL-7 to detect the expression levels of miR-136-5p, A20 mRNA and A20 protein. RESULTS AND CONCLUSION: Compared with the blank control group, the expression level of miR-136-5p in the miR-136-5p-inhibition group was significantly decreased after 6-hour IL-17 stimulation (P < 0.05). The expression levels of A20 mRNA and protein in each group were significantly decreased after 6-hour IL-17 (50 μg/L) stimulation (P < 0.05). The expression levels of A20 mRNA and protein in the miR-136-5p-inhibition group were significantly higher than those in the blank control group (P < 0.05), while there were no significant differences in the expression level of A20 protein between blank control and negative groups (P > 0.05). To conclude, miR-136-5p makes certain effect on the expression of A20 protein in astrocytes after IL-17 stimulation.

Vegetable oil is one of the most potential alternatives of petroleum and has become a hot issue in recent years. This review focuses on the influence of vegetable oil structure on platform compounds and polymers properties, and further systematically introduces their developments and the latest progress. Meanwhile, we also summarized the main confronting problems and the future development directions in the research of oil-based platform compounds and polymers. The review provides useful information for readers to fully understand biochemical engineering of vegetable oils and their prospects.

OBJECTIVETo observe the effect difference betweendecoction combined with acupuncture at back-points and simpledecoction for chronic fatigue syndrome.

METHODSSixty patients were randomly assigned into an herbal group and a combination group, 30 cases in each one. Simpledecoction was used in the herbal group for continuous one month, one decoction a day. Based on that in the herbal group, 30 min acupuncture was used in the combination group at bilateral Xinshu (BL 15), Feishu (BL 13), Pishu (BL 20), Ganshu (BL 18) and Shenshu (BL 23), with acupoints according to syndrome differentiation. Acupuncture was given for 3 courses, 10 times as a course with 3 days between two courses, once a day. Fatigue status was evaluated before and after treatment by fatigue scale 14 (FS-14) and self-rating anxiety scale (SAS).

RESULTSThe FS-14 scores, including body fatigue scores, mental fatigue scores and total scores, and SAS scores after treatment were lower than those before treatment in the two groups (all<0.01), with better improvements in the combination group (all<0.01).

CONCLUSION decoction combined with acupuncture at back-points can improve chronic fatigue syndrome, which are better than simpledecoction.

Ambulatory Care Facilities ; HIV Seropositivity ; Humans ; Incidence ; Male

Objective To discuss the impact of different markers on the estimation of MSM using the capture-recapture method.Methods From March to July 2013,MSM were captured from the their related network to estimate the site of this population,under the capture-recapture method.Two different markers were set in the process of first ‘capture'.Results The estimated numbers of MSM in Beijing were 239 258 (95％CI:48 932-429 584) and 115 731 (95％CI:78 153-153 309) when using the two markers under capture-recapture method.Conclusion The estimated size of MSM population varied greatly under different markers which called for the right selection on markers when using the capture-recapture method to estimate the size of specific population.

Objective To investigate the therapeutic effects of electromyography biofeedback (EMGBF) on motor and psychological function in patients with spinal cord injury (SCI).Methods Seventy SCI patients were randomly divided into research and control groups with 35 patients in each.In addition to conventional rehabilitation,the patients in the research group received EMGBF training while those in the control group were treated with medium frequency electrotherapy.To evaluate the patients' self confidence and motor function of their paralyzed limbs,Rosenberg's self-esteem scale (RSES) and American Spinal Injury Association (ASIA) locomotor function scoring were performed before and six weeks after the interventions in both groups of patients.The changes of EMG of the quadriceps,hamstring and anterior tibial muscles of both groups in maximum contraction were also observed before and six weeks after the interventions.Results There were no significant differences in the RSES scores or ASIA locomotor function results between the groups before the interventions.ASIA locomotor function evaluation scores increased significantly in both groups after the interventions,with significantly better results in the research group.The RSES scores in the research group also improved significantly after the interventions,and RSES scoring and ASIA scoring were positively correlated in those patients.But no significant improvement in average RSES scores was found in the control group.The muscle contraction EMG amplitudes also increased significantly in patients of the research group after the interventions.Conclusions EMGBF training can enhance patients' self-confidence,which helps patients with SCI improve their motor functions.