ObjectiveTo investigate the association of physical activity and balance ability with disability, and to further examine the mediating role of balance ability in the relationship between physical activity and disability. MethodsBased on data from 2021 to 2023 National Health and Nutrition Examination Survey (NHANES) cycle, a multivariable Logistic regression model was constructed to evaluate the independent association of physical activity and balance ability with disability, with covariates adjusted in four steps. An interaction model was further developed to assess the multiplicative interaction between physical activity and balance ability. Mediation analysis was performed using the Baron and Kenny three-step approach to examine the mediating role of balance ability, and the proportion of the mediation effect was calculated. The significance of the mediation effect was assessed using the Delta method, and robustness was verified through the Bootstrap method with a fixed random seed. Multiple sensitivity analyses were conducted to ensure the stability of the results. ResultsA total of 3 902 participants were included, with a prevalence of disability of 17.7%. Multivariable regression analysis showed that, after adjusting for all covariates, both light-intensity physical activity (LIPA) (OR = 0.489, 95%CI 0.380 to 0.629, P < 0.001) and high-intensity physical activity (HIPA) (OR = 0.493, 95%CI 0.371 to 0.656, P < 0.001) were significantly associated with a reduced risk of disability, whereas impaired balance ability was significantly associated with an increased risk (OR = 1.579, 95%CI 1.266 to 1.970, P < 0.001). The interaction effect analysis showed that the interaction between physical activity and balance ability were not significant (P > 0.05), however, the main effect of LIPA remained robust (β = -0.597, SE = 0.221, OR = 0.550, P = 0.007), while impaired balance ability was significantly associated with an increased risk of disability (β = 0.577, SE = 0.231, OR = 1.780, P = 0.012). The mediation analysis further indicated that balance ability played a robust mediating role in the association between LIPA and disability, with a mediation proportion of 21.1%. The indirect effect (a × b) was statistically significant (P < 0.001), and the 95% confidence intervals derived from the bootstrap method did not include zero. ConclusionPhysical activity and balance ability are significantly associated with disability, and balance ability may mediate the relationship between physical activity and disability, highlighting its potential value in disability risk assessment and intervention strategies.

Objective To identify and analyze the obstacles to public participation in the supervision of medical insurance funds,distill their commonalities,and propose strategies to break them down.Methods The preliminary obstacles were obtained through literature research and interviews with 22 public,modified and perfected through consultation with 12 experts and the fuzzy Delphi method,and the dimensions of each obstacle were determined through 200 questionnaires and factor analysis.Results Public participation in medical insurance funds supervision is hindered by 18 factors,including"medical insurance knowledge is too specialized,unable to participate","lack of understanding of policies related to medical insurance funds supervision",and"inability to identify fraudulent insurance behaviors".They can be categorized into four dimensions:costs and consequences of participation,subjective factors of participation,knowledge of medical insurance funds supervision,and external environment factors,with a cumulative contribution rate of 68.034%.Conclusion The four dimensions constitute the main obstacles to public participation in the supervision of medical insurance funds.Efforts should be made from the aspects of reducing the cost of participation,safeguarding the consequences,enhancing the awareness,improving the knowledge,and creating a social atmosphere,to form a coordinated system of supervision of medical insurance funds.

Cerebral small vessel disease （CSVD） has a high incidence rate， an insidious onset， a heterogeneous etiology， and serious damage. At present， there are still various critical issues in the clinical diagnosis and treatment of CSVD， including the difficulty in early warning， difficult etiological typing， and limited treatment methods. This article summarizes the clinical studies on the diagnosis and treatment of CSVD in recent years， in order to provide a reference for solving problems in diagnosis and treatment.
Biomarkers

Objective:To analyze the causal relationship between intestinal flora and vitiligo by two-sample Mendelian randomization (MR) analysis based on "co-diseases of skin and gut" in TCM.Methods:Genome-wide association study (GWAS) data of intestinal flora samples and vitiligo samples were obtained from the databases of MiBioGen and IEU OpenGWAS Project, respectively. Intestinal flora was used as exposure factor, vitiligo as outcome, and single nucleotide polymorphism (SNP) associated with various intestinal floras was used as instrumental variable. After screening qualified instrumental variable in this study, inverse variance weighting (IVW) was used for MR analysis to investigate the potential causal relationship between intestinal flora and vitiligo, MR-Egger regression, weighted median estimator (WME), weighted mode (WM), and simple mode (SM) were used as supplementary methods for IVW. The Cochran's Q test, MR-Egger intercept test, MR-PRESSO and leave one-out analysis were used for sensitivity analysis.Results:Euryarchaeota (IVW method: OR<1, P<0.05) were the protective factors for the occurrence of vitiligo, and Clostridialesvadin-BB60group (IVW method: OR>1, P<0.05) and Subdoligranulum (IVW method: OR>1, P<0.05) were the risk factors for the occurrence of vitiligo. No heterogeneity effect was found by the Cochran's Q test ( P>0.05), no horizontal pleiotropy was found by the MR-Egger intercept test ( P>0.05), no outliers were found in the MR-PRESSO analysis ( P>0.05), and the results of leave-one-out analysis indicated that the causal effects of the 3 identified intestinal floras on vitiligo were not driven by any single SNP. Conclusions:There are causal effects between some intestinal floras and vitiligo, but the specific mechanisms still need to be further studied. The gut microbiota affects the onset and treatment of vitiligo. Using TCM to regulate the gut microbiota may have a good therapeutic effect on treating vitiligo, providing a direction for clinical diagnosis and treatment of vitiligo.

This study explored the pathogenesis and treatment of postoperative pulmonary nodules from the perspective of deficient qi resulting into retention of pathogens,thus to expand the approach to its diagnosis and treatment.It is believed that deficient qi resulting into retention of pathogens contributes to the key pathogenesis of pulmonary nodules.As the root cause of the disease,deficient qi usually involves the deficiency of the lung and spleen.And as the incidental manifestations,retention of pathogens refers to the accumulation of pathological products such as stagnated qi,phlegm-stasis,and turbid toxins in the lung collaterals.The pathogenesis of postoperative pulmonary nodules is characterized by the collapse of pectoral qi,aggravated deficient qi,and the lingering presence of the relieved qi stagnation,phlegm-stasis,and turbid toxins.Based on the pathogenesis of deficient qi resulting into retention of pathogens,the treatment principles for postoperative pulmonary nodules should focus on tonifying deficiency and lifting collapse,and relieving qi stagnation and unblocking obstruction.Tonifying deficiency needs to prioritize strengthening the spleen and nourishing the lung to go first,lifting collapse aims at elevating the pectoral qi,relieving qi stagnation focuses on regulating qi and harmonizing the liver,and unblocking obstruction mainly involves resolving phlegm-stasis and eliminating turbid toxins.The pathogenesis of deficient qi resulting into retention of pathogens aligns with the pathological features and syndrome evolution of postoperative pulmonary nodules,and will provide dynamic and systematic guidance for its clinical diagnosis and treatment.

Objective:To explore the diagnostic value of fractional flow reserve (FFR) based on optical coherence tomography (OCT) for coronary functional ischemia, and to investigate the feasibility of synchronously obtaining Doppler blood flow velocity information with the help of OCT technology.Methods:This study was a single-center, prospective, self-controlled clinical study on coronary heart disease patients who underwent OCT and FFR assessment at Department of Cardiology, the Second Hospital of Jilin University from January 2024 to February 2025. Linear regression analysis was used to evaluate the correlation and consistency between OCT-FFR and FFR. With FFR≤0.80 as the gold standard for judging whether the target vessel was ischemic, the diagnostic performance of OCT-FFR was evaluated, and the diagnostic value of OCT-FFR for significant coronary artery ischemia was assessed using subject operating characteristic curves. Blood flow OCT data were analyzed by Doppler processing algorithm to obtain information on coronary blood flow velocity.Results:A total of 31 vessels from 28 patients were analyzed, the correlation coefficient r between OCT-FFR and FFR of the 31 vessels was 0.84 ( P<0.001). With FFR as the gold standard to determine whether a coronary artery is ischemic, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for OCT-FFR was 93.55%, 75.00%, 100.00%, 1.00, 0.92. In clinical practice, Doppler OCT was used for the first time to obtain information on coronary blood flow velocity. Conclusion:OCT-FFR had an excellent correlation and consistency with FFR in judging whether there is coronary artery ischemia. The feasibility of the simultaneous acquisition of OCT-FFR and Doppler flow velocity information in coronary stenosis was preliminarily verified.

Objective:To define the concept of public value on digital supervision of medical insurance funds and to interpret its basic characteristics.Methods:Based on defining the concept of"public value"using the atomic atlas method,the formal logic definition method is used to define the"public value on digital supervision of medical insurance funds".Results:Among 47 concepts related to"public value",public,citizen,collective,and preference are the core elements;negotiation,utility,and expectation are the quasi-core elements;government,outcome,and common are the important elements;and integration,construction,and appeal are the non-important elements.The"public value on digital supervision of medical insurance fund"can be defined as"in the practice of digital supervision of the health insurance fund,citizens' value demands and expectations,and the degree of satisfaction of these demands and expectations,based on their knowledge and basic value judgments of the health insurance system and digital technology,and formed through a wide range of value-constructing mechanisms,such as social communication and political consultation."Conclusion:The public value on digital supervision of medical insurance funds has the characteristics of people-centeredness,the construction of multi-subject negotiation,and the integration of multiple value dimensions.These features together constitute the rich connotation of the public value of digital supervision of medical insurance funds,which provides a certain reference for promoting the modernization and governance of healthcare insurance and the construction of digital government.

Objective:To explore the latent class characteristics of demoralization in severely disabled stroke patients, and analyze the differences and influencing factors of each class by latent class analysis.Methods:Convenience sampling was used to select 335 patients in the Neurointensive Care Unit of three Class Ⅲ Grade A hospitals in Anhui Province from October 2023 to March 2024, and were confirmed to be with post-stroke disability through follow-up as research subjects. General Information Questionnaire and Demoralization Scale-Ⅱ were used for a survey. Latent class analysis was used to identify latent classes of demoralization, and multiple logistic regression was used to analyze the influencing factors of different latent classes.Results:A total of 335 questionnaires were distributed, and 321 valid questionnaires were retrieved. The effective recovery rate of the questionnaires was 95.8%. Demoralization of severe stroke patients with disability was classified into four categories of low demoralization (40.2%, 129/321), moderate demoralization with coping loss (12.1%, 39/321), moderate demoralization with goal loss (21.2%, 68/321), and high disability (26.5%, 85/321). Multiple Logistic regression analysis showed that age, gender, per capita monthly income of the family, whether was the economic pillar of the family, long-term residence, and relationship with cohabitants were the influencing factors of demoralization in severe stroke patients with disability (all P<0.05) . Conclusions:There are four latent classes of demoralization in stroke patients with disability, and age, gender, per capita monthly income of the family, whether they are the economic pillar of the family, long-term residence, and relationship with cohabitants are the influencing factors of demoralization in severe stroke patients with disability.

Objective:To translate the Clinical Leadership Needs Analysis Instrument (CLeeNA) into Chinese and to test its reliability and validity.Methods:The source scale was translated based on the Beaton translation model, and cultural debugging was completed through expert consultation and pre-surveys to form the Chinese version of CLeeNA. Convenience sampling was used to select 536 nurses from three Class Ⅲ Grade A hospitals in Anhui Province from August to December 2023 to conduct the survey and to verify the reliability and validity of the scale. A total of 536 questionnaires were distributed and 495 valid questionnaires were recovered, with an effective recovery rate of 92.351% (495/536) .Results:The Chinese version of CLeeNA contained 43 entries in 7 dimensions of self and team development, staff and care delivery, technology and care initiatives, financial and service management, leadership and clinical practice, patient safety and risk management, and standards of care. The content validity index at the item level ranged from 0.800 to 1.000, and the content validity index at the scale level was 0.953. Exploratory factor analysis extracted 7 common factors with a cumulative variance contribution rate of 82.098%. Confirmatory factor analysis showed that the model fit was acceptable. The total Cronbach's ɑ coefficient for the scale was 0.958, the folding coefficient was 0.898, and the retest reliability coefficient was 0.928.Conclusions:The Chinese version of CLeeNA has good reliability and validity, and can be used for measuring the clinical leadership needs of nurses.

Objective:To define the concept of public value on digital supervision of medical insurance funds and to interpret its basic characteristics.Methods:Based on defining the concept of"public value"using the atomic atlas method,the formal logic definition method is used to define the"public value on digital supervision of medical insurance funds".Results:Among 47 concepts related to"public value",public,citizen,collective,and preference are the core elements;negotiation,utility,and expectation are the quasi-core elements;government,outcome,and common are the important elements;and integration,construction,and appeal are the non-important elements.The"public value on digital supervision of medical insurance fund"can be defined as"in the practice of digital supervision of the health insurance fund,citizens' value demands and expectations,and the degree of satisfaction of these demands and expectations,based on their knowledge and basic value judgments of the health insurance system and digital technology,and formed through a wide range of value-constructing mechanisms,such as social communication and political consultation."Conclusion:The public value on digital supervision of medical insurance funds has the characteristics of people-centeredness,the construction of multi-subject negotiation,and the integration of multiple value dimensions.These features together constitute the rich connotation of the public value of digital supervision of medical insurance funds,which provides a certain reference for promoting the modernization and governance of healthcare insurance and the construction of digital government.