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 explore the nutritional efficacy of compound protein powder formulations from different sources. Methods Three groups of compound protein powder formulations were obtained through scientific blending using soy protein, whey protein and yeast protein as raw materials. The effects of the compound protein powders on nitrogen metabolism, serum biochemical indicators, and pathological changes of liver tissue and epididymal fat in rats were evaluated. Results Compared with the control (casein), the net protein utilization, biological evaluation, and protein efficacy ratio of the compound protein powders in rats were significantly improved, and the changes in these indicators in the formula with the highest whey protein content were most significant among all three formulas. The compound protein powders effectively increased the levels of albumin and globulin, while decreased the content of total cholesterol, indicating beneficial effects on improving immunity and controlling lipid metabolism, with the formula group 2 being the most effective among all three groups. The pathological examination showed that the three groups of protein powder did not have adverse effects on liver tissue and epididymal fat. Conclusion The present study demonstrates that the compound protein powder formulation has nutritional value, which suggests a potential of the application of the compound protein powder formulation in the elderly, and people with special nutritional needs, such as sports people.

Objective    To investigate the prognosis and risk factors of mild to moderate or moderate atrioventricular valve regurgitation (AVVR) after Fontan operation. Methods    A total of 34 patients with mild to moderate or moderate AVVR who accepted Fontan operation and atrioventricular valve (AVV) repair between 2004 and 2018 in our center were selected as an AVV repair group. The patients in the same period were matched as a control group by the ratio of 1 : 1-2. Finally 99 patients were included into this study, including 64 males and 35 females, with an average age of 63.4±36.3 months and weight of 17.3±6.7 kg. Grades of AVVR decreased more than 1 was defined as significant improvement. Endpoints of the study were death, Fontan takedown, AVV replacement. Risk factors including Fontan procedures, AVV repair procedures, cardiac anatomy were analyzed. Results    Patients were followed up for 1.5 (0.3-4.0) years. Overall mortality was 15.2%. Most (82.4%) of AVV repair group accepted single AVV repair procedure while partial annuloplasty was the most common (52.9%). With the extension of follow-up, the degree of AVVR in the whole group showed a gradually increasing trend (r=0.352, P=0.000). Mild to moderate AVVR improved spontaneously after Fontan operation, while moderate AVVR did not. AVV repair could improve the degree of AVVR after moderate regurgitation, without increasing the surgical mortality, and regurgitation significantly decreased in 8.8% patients. AVV repair was not effective for mild to moderate AVVR and would increase surgical mortality. Conclusion    AVV function shows a gradual downward trend after Fontan operation. AVV repair is effective for moderate AVVR, does not increase mortality, but the degree of improvement is limited. AVV repair is not effective for mild to moderate AVVR and increases surgical mortality.

We report a case of chromoblastomycosis caused by , which was successfully treated by long-pulsed 1064 nm Nd: YAG laser combined with terbinafine. A 60-year-old man was admitted for the presence of a 30 mm×40 mm erythematous plaque on the dorsum of his right hand for about 10 months without any subjective symptoms. Both microscopic examination and tissue biopsy of the lesion showed characteristic sclerotic bodies of chromoblastomycosis. Lesion tissue culture on SDA at 26 ℃ for 2 weeks resulted in a black colony, and slide culture identified the isolate as Fonsecaea species. ITS sequence analysis of the isolate showed a 99% homology with strain KX078407. The susceptibility of the isolate to 9 antifungal agents was determined using the microdilution method according to the guidelines of CLSI M38-A2 protocol, and terbinafine showed the lowest MIC (0.125 μg/ml). We subsequently established a Wistar rat model of chromoblastomycosis using the clinical isolate and treated the rats with long-pulsed 1064 nm Nd: YAG laser (pulse width of 3.0 ms, fluence of 24 J/cm, spot size of 3 mm, frequency of 4 Hz, repeated 3 times at an interval of 30 s) twice a week for a total of 8 sessions. Although the laser treatment alone was not able to eliminate the fungi, histopathological examination showed the aggregation of numerous lymphocytes in the local affected tissue, indicating an immune response that consequently facilitate the regression of the lesion. The patient was successfully treated by long-pulsed 1064 nm Nd: YAG laser once a week combined with terbinafine (0.25 /bid) for 8 weeks, and follow-up for 20 months did not reveal any signs of recurrence.
Animals ; Chromoblastomycosis ; Humans ; Laser Therapy ; Lasers, Solid-State ; Male ; Middle Aged ; Rats ; Rats, Wistar ; Terbinafine ; Treatment Outcome

Objective Based on structure of animal trabecular bone, implants with porous structure were designed to describe mechanical properties of trabecular structure and explain significance of bionic trabecular porous implants in clinical treatment. Methods Based on anisotropic mechanical properties of animal trabecular bone, a porous structure was designed using the topology optimization method. The principles of partition and block reconstruction were first proposed according to bone function theory. The trabecular structure was then reconstructed based on micro-CT images. The boundary constraint and external load were applied on this model according to the respective-volume-element (RVE) method. Taking the solved mechanical properties as objective functions of optimization, the porous structure design and optimization were conducted using the variable density method and the homogenization method. Results The trabecular bone possessed the anisotropic mechanical properties. It was found that the volume fraction showed an increasing trend from the edge to the middle across the same section of trabecular bone. But there was no obvious regular pattern in Poisson’s ratio, which was evenly distributed in the range between 0.17 and 0.30. As to the values of elastic modulus and shear modulus, they were both significantly higher in the main pressure position compared with those in the other positions. After topography optimization based on these mechanical properties, the Poisson’s ratio of the optimized model was in the same range as the animal trabecular bone. The elastic modulus error was less than 14%， with the minimum being only 3%. In addition, the shear modulus error was below 8%， which ultimately complied with criteria of the original goal. Conclusions The designed porous structure based on topology optimization had the same anisotropic characteristics as animal trabecular bone, while reducing the stress concentration phenomenon, which could achieve the specific design for porous structure, thus providing a reasonable and effective method for clinical porous implants.

In National Comprehensive Cancer Network guideline, patients with the clinical stages of Ⅰ B-ⅢA esophageal neoplasms should be given radical PF regimen (cisplatin + 5-fluorouracil) concurrent chemoradiotherapy.The majorization PF and radiation dosage are studied by some scholars in China and abroad, and the local control rate and survival rate are improved, adverse reaction is within a controllable range.In recent years, some new drugs such as capecitabine, paclitaxel, docetaxel, pemetrexed and carboplatin also show their advantages in radical concurrent chemoradiotherapy.

Objective The aim of the study was to investigate the related factor of postoperative provisional paraly?sis of parasagittal meningioma in the eloquent area. Methods A retrospective review was conducted on ninety-six pa?tients with parasagittal meningioma in the eloquent area treated by surgery from May 2005 to December 2015. Accord?ing to the diagnostic criteria for postoperative provisional paralysis, patients were divided into postoperative provisional paralysis group(n=31)and non- postoperative provisional paralysis group(n=65). Univariate and multivariate logistic regression methods were used to analyze the data including age, size of tumor,preoperative epilepsy, preoperative periph?eral edema, complete the occlusion of superior sagittal sinus(SSS) by tumor, incision of SSS during surgery, drainage vein damage during surgery. Results Univariate analysis showed that there were significant differences(P<0.05)between these two groups in age(χ2=14.943,P=0.000), preoperative peripheral edema(χ2=4.435,P=0.049), the complete occlu?sion of SSS by tumor(χ2=5.248,P=0.028), incision of SSS during surgery(χ2=5.773,P=0.026), drainage vein damage during surgery(χ2=11.441,P=0.002). Multivariate analysis showed that the factors related to postoperative provisional paralysis were age(OR=8.709,P=0.028), drainage vein damage during surgery(OR=16.242,P=0.012)and complete oc?clusion of SSS by tumor(OR=0.053,P=0.025). Conclusion Age and the drainage vein damage during surgery are the risk factors of postoperative provisional paralysis and complete occlusion of SSS by tumor is the protective factor for the oc? currence of postoperative provisional paralysis.

Objective To identify the therapeutic effect and safety of anterograde flexibleureteroscopy on the treatment of upper -middle ureteral calculi.Methods The clinical data of 47 patients who underwent anterograde flexible ureteroscopy for the treatment of upper -middle ureteral calculi in our center were retrospectively reviewed. During the 47 patients,28 cases were men,19 cases were women.Age ranged from 20 to 68 years.The diameter of calculi ranged from 8 to 22mm(mean =14 mm).Results The flexible ureteroscopic lithotripsy procedure were successful in all the cases.The mean operative time was (65.3 ±8.5)min.The mean hospital stay was 8 days.The average blood loss was less than 50mL.The initial stone -free rate was 93.62%(44 /47).No severe complications occurred intraoperative and postoperative.Conclusion Anterograde flexible ureteroscope has good therapeutic effect in treating upper -middle ureteral calculi.It is safe and effective procedure,with less complication and a high calculus removing rate.The surgical methods is worthy of clinical application.

Objective To select a simple, stable and reliable mouse model of alcoholic liver disease. Methods The mouse models of alcoholic liver disease were induced by oral gavage ethanol or Lierber?DeCarli ethanol liquid diet for 8 weeks. The food intake and body weight were recorded. Pathological changes were examined using HE staining. Liver injury was assessed by the activities of serum ALT, AST, AKP and γ?GT, and serum and hepatic TC and TG. Results After modeling, both models showed significantly increased activities of serum ALT, AST, AKP, and contents of serum and hepatic TG (P<0?05), indicating the successful development of alcoholic steatohepatitis. However, oral ethanol gavage led to body weight loss and weak mental state. Ethanol liquid diet less affected the body weight and mental state. Ethanol liquid diet enhanced liver to?body weight ratio and serum TC, but oral gavage of ethanol did not. The changes of serum ALT, AST, serum and hepatic TG, and hepatic steatosis in the ethanol liquid diet models were more severe than those in the oral gavage ethanol models, suggesting that Lierber?DeCarli ethanol liquid diet led to more serious liver injury than oral gavage ethanol. Conclusions Lierber?DeCarli ethanol liquid diet model is better than oral gavage ethanol model, and is more suitable for studies on mechanisms and evaluation of hepato?protective drugs for alcoholic liver disease.

We report a case of cutaneous and subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei after renal transplantation in Guangdong. A 66-year-old man who had a renal transplantation 6 years ago was admitted in October 2011 for the presence of 16 nodules (0.5-1.5 cm) found on his right middle finger, wrist and forearm for 5 months. Microscopic examination of the purulent exudate showed segmented and branched brown mycelium, and tissue biopsy and PAS staining showed fungal hyphae. The isolate was processed for morphological identification and molecular sequence analysis. A black colony was found after culture of the isolate on SDA at 26 degrees Celsius;, and small culture identified the isolate as Exophiala jeanselmei. ITS sequence analysis of the isolate showed a 100% homology with Exophiala jeanselmei. E-test strip was used in drug sensitivity test, and the isolate was sensitive to amphotericin B, voriconazole, itraconazole and fluconazole, but resistant to 5-flucytosine and caspofungin. Good response was obtained with surgical intervention, local injection and systemic antifungal treatment.
Aged ; Exophiala ; pathogenicity ; Humans ; Kidney Transplantation ; adverse effects ; Male ; Phaeohyphomycosis ; etiology ; Postoperative Complications