Minor stroke is a common subtype of acute ischemic stroke， primarily defined by a National Institutes of Health Stroke Scale score ≤3 or ≤5. Despite mild clinical symptoms， it carries a risk of early deterioration， and its intravenous thrombolysis strategy has long been controversial. This article systematically summarizes the results of key randomized controlled trials in recent years， which found that although non-inferiority has been confirmed among thrombolytic agents such as alteplase， tenecteplase， and prourokinase， none of these have shown superior functional improvement in the treatment of minor stroke compared with dual antiplatelet therapy or aspirin monotherapy， and they carry safety risks such as symptomatic intracranial hemorrhage. Subgroup analyses suggested potential benefits for patients with a National Institutes of Health Stroke Scale score>3， disabling symptoms， or the large artery atherosclerosis subtype， but the evidence is inconsistent. The limited net benefit of thrombolysis is primarily attributed to heterogeneous definitions， a generally favorable natural prognosis， and the offsetting effect of bleeding risks. Future studies should focus on unifying definitions， leveraging multimodal imaging for precise patient selection， optimizing drug regimens， and ultimately achieving precise stratification and individualized thrombolytic interventions for minor stroke.

ObjectiveTo analyze the epidemiological and etiological characteristics of a cluster of human metapneumovirus (HMPV) infection in a kindergarten in Gongshu District of Hangzhou City in May 2024, and to provide reference for the prevention and control of similar outbreaks. MethodsAn on-site investigation was conducted using an epidemiological case investigation form. Throat swab specimens collected from cases were screened for 13 respiratory pathogens using real-time fluorescent polymerase chain reaction (PCR). For HMPV nucleic acid positive specimens, the F gene of HMPV was used as the target gene for amplification and sequencing. The sequencing results were then compared with sequences in GenBank database to determine the virus subtypes and perform phylogenetic analyses. ResultsThe outbreak occurred in a kindergarter junior class with a total of 28 preschoolers and 3 teachers and childcare workers. A total of 11 cases (10 preschoolers and 1 teacher) were identified, including 8 male cases and 3 female cases. Clinical manifestations included fever in all 11 cases (100.00%), cough in 8 cases (72.72%), catarrhal symptoms in 4 cases (36.36%), and headache in 3 cases (27.27%). All symptoms were mild, and no severe cases were observed. A total of 11 throat swab samples were collected. Real-time fluorescent PCR test results showed that 3 samples were positive for HMPV nucleic acid, 2 samples were positive for both HMPV and Streptococcus pneumoniae, and 1 sample was positive for both HMPV and rhinovirus. The sequences of the 6 HMPV nucleic acid positive specimens were amplified and analyzed using specific primers, and all were determined to be HMPV subtype A2b. The F gene fragment sequence showed the highest similarity to PV081665.1/Brazil/2024 (99.65%), and also exhibited high similarity to PP683455.1/Indonesia/2021 (99.48%), PV016275.1/Beijing/2024 (99.31%), and PV052230.1/USA/2024 (99.13%). ConclusionThis cluster of acute respiratory tract infection was caused by HMPV subtype A2b, with co-infection of rhinovirus and Streptococcus pneumoniae. The F gene fragment sequences of the HMPV in this outbreak were highly homologous to those of the A2b strains isolated from Brazil, Beijing, Indonesia, and the the United States.

OBJECTIVE To provide standardized guidance for the homogenization construction and management of pharmaceutical care in urban medical groups. METHODS This consensus was jointly initiated by the Therapeutic Drug Monitoring Professional Committee of the Chinese Pharmacological Society and the Expert Committee on Precision Clinical Medication of the Guangdong Pharmaceutical Association. Led by Guangzhou Red Cross Hospital， a drafting group of 7 members and an expert group of 36 members were organized. The outline of the Expert Consensus on Homogeneous Construction and Management of Pharmaceutical Care in Urban Medical Groups （hereinafter referred to as the “Consensus”） was discussed and finalized using the nominal group technique， and a preliminary draft was formed. The Delphi method was used for online c orrespondence review， and 12 external experts were invited for evaluation. After analyzing and revising expert opinions， the final Consensus was formed. RESULTS &CONCLUSIONS This Consensus defines the position setting and appointment procedures for the chief pharmacist， and establishes a three-tier professional guidance network of “chief pharmacist-regional/specialist pharmacist-pharmaceutical liaison of member institutions”. It formulates unified management standards for the drug supply catalog， establishes a full-process homogenization mechanism for prescription review， prescription commentation and comprehensive pharmaceutical care， and specifies the core functions and performance requirements of the prescription review system. It also supports by long-term mechanisms including cost allocation and performance assessment. This consensus can serve as a systematic reference for the homogeneous construction and management of pharmaceutical care systems in urban medical groups.

OBJECTIVE: To explore the role of antibiotic-eluting absorbable calcium sulfate in treating periprosthetic infection after one-stage revision of knee arthroplasty. METHODS: A retrospective analysis was performed on 36 patients(36 knees)who underwent phaseⅠrevision for periprosthesis infection after total knee arthroplasty from January 2018 to March 2022. All patients were underwent knee cavity puncture before operation and had positive results of aseptic body fluid culture, 21 patients received revision combined with antibiotic loaded calcium sulfate at stageⅠ(calcium sulfate group) during operation, and 15 patients underwent renovation at stageⅠ(revision group). There were 9 males and 12 females in calcium sulfate group, aged from 54 to 76 years old with an average of(67.6±6.2) years old. There were 15 patients in revision group, including 4 males and 11 females, aged from 60 to 75 years old with average of (69.6±4.1) years old. The levels of serum C-reactive protein (CRP), interleukin-6 (IL-6) at 7, 14, 30 and 90 days after operation were compared between two groups, and the rate of end-infection control at follow-up were compared. The systemic antibiotic application time, hospital stay and postoperative complications were observed between two groups. RESULTS: Calcium sulfate group were followed up for 12 to 29 months with an average of(18.9±4.2) months, and the infection control rate was 90.5%;while revision group were followed up 18 to 29 months with average of (21.6±3.7) months, and the infection control rate was 86.7% (13/15). There were no significant differences in follow-up time and infection control rate between two groups(P>0.05). Postoperative levels of CRP and IL-6 at 7, 14 and 30 days in calcium sulfate group were (32.79±11.48), (15.50±6.52), (9.36±3.32) mg·L^-1 and (17.31±6.15) pg·ml^-1, respectively;which were lower than those in revision group (40.65±11.32), (30.15±10.57), (18.97±5.86) mg·L^-1 and (25.54±6.73) pg·ml^-1, had statistical differences(P<0.05). There were no significant differences in IL-6 levels at 7 and 14 days after operation and CRP levels at 90 days after operation between two groups (P>0.05). The hospitalization time and systemic antibiotic application time in calcium sulfate group were (18.4±2.2) and (63.5±21.4) d, respectively;which were better than those in revision group (20.5±2.4) and (82.7±16.9) d, and had statistical differences(P<0.05). No significant wound complications and hypercalcemia were observed in calcium sulfate group. CONCLUSION Antibiotic eluted absorbable calcium sulfate could be used to treat periprosthetic knee infection, significantly reducing CRP levels in the early postoperative period, shortening hospital stay and systemic antibiotic application time, but it does not significantly improve the control rate of revision infection at stageⅠ.
Humans ; Male ; Female ; Aged ; Prosthesis-Related Infections/surgery* ; Middle Aged ; Calcium Sulfate/administration & dosage* ; Arthroplasty, Replacement, Knee/adverse effects* ; Retrospective Studies ; Anti-Bacterial Agents/therapeutic use* ; Interleukin-6/blood* ; C-Reactive Protein/metabolism* ; Reoperation ; Knee Prosthesis/adverse effects*

Polymer magnetic microspheres are a new type of composite functional materials,which have the advantages of stable structure,diverse modification methods,and magnetic response.These characteristics make polymer magnetic microspheres have the advantages of high sensitivity,high-specificity and fast response when detecting logo carriers or modified materials,and shows great application prospects in the fields of biomedicine and medical diagnosis.In this review,the basic properties of polymer magnetic microspheres were summarized,the research progresses of magnetic microspheres in the fields of biomedicine and medical diagnosis were emphatically introduced,and the improvement of preparation methods and development trends in the future were prospected.

Objective To investigate the predictive value of serum soluble lectin-like oxidized low density lipoprotein receptor-1(sLOX-1)and chitinase-3-like protein 1(CHI3L1)for in-stent restenosis(ISR)in pa-tients with coronary heart disease(CHD)and myocardial bridge after anterior descending stent implantation.Methods A total of 80 patients with CHD and myocardial bridge who underwent anterior descending stent implantation in a hospital from May 2018 to May 2023 were included as the disease group.They were followed up for one year after surgery and separated into ISR group(n=31)and non ISR group(n=49)based on whether ISR occurred on coronary angiography examination.Another 80 CHD patients who received treatment in a hospital were selected as the control group.The levels of serum sLOX-1 and CHI3L1 were detected by en-zyme-linked immunosorbent assay.Multivariate Logistic regression was used to analyze the influencing factors of ISR after anterior descending stent implantation in patients with CHD combined with myocardial bridge,and to analyze the predictive value of serum sLOX-1 and CHI3L1 for the occurrence of ISR after anterior de-scending stent implantation in patients with CHD combined with myocardial bridge.Results Compared with the control group,the levels of serum sLOX-1 and CHI3L1 in the disease group increased,and the difference was statistically significant(P<0.05).The levels of serum sLOX-1 and CHI3L1 in the ISR group were high-er than those in the non-ISR group,and the distance of the myocardial bridge proximal to the stent was lower than that in the non-ISR group,the differences were statistically significant(P<0.05).Serum sLOX-1,CHI3L1,and the distance of the myocardial bridge proximal to the stent were the influencing factors for the occurrence of ISR after anterior descending stent implantation in patients with CHD combined with myocardi-al bridge(P<0.05).The area under the curve of the combined prediction of serum sLOX-1 and CHI3L1 for the occurrence of ISR after anterior descending stent implantation in patients with CHD complicated with my-ocardial bridge was superior to their individual predictions(Zcombination-sLOX-1=2.502,Zcombination-CHI3L1=2.028,P=0.012,0.043).Conclusion The levels of serum sLOX-1 and CHI3L1 in patients with CHD combined with myocardial bridge are significantly increased.The combined detection of the two has certain predictive value for the occurrence of ISR after anterior descending stent implantation in patients with CHD combined with myocardial bridge.

Objective To investigate the efficacy of Yiqi Wenyang Sanjie Decoction in the treatment of patients with pulmonary ground glass nodules and yang-deficiency constitution,and to observe its effect on serum inflammatory factors and immune function.Methods From January 2020 to June 2024,a total of 106 patients with pulmonary ground glass nodules and yang-deficiency constitution admitted to the Department of Respiratory Medicine and Preventive Treatment of Disease Center of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine were selected.The patients were randomly divided into control group and Chinese medicine group by random number table method,with 53 cases in each group.The patients in the control group were only given follow-up without any intervention,and the patients in the Chinese medicine group were treated with Yiqi Wenyang Sanjie Decoction for 3 months.Before and after treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,maximum diameter of pulmonary ground glass nodules,serum levels of inflammatory factors of interleukin-6(IL-6),interleukin-17A(IL-17A),and tumor necrosis factor-α(TNF-α),and levels of immune function indicators of peripheral blood CD3+,CD4+cell percentage and CD4+/CD8+ratio.After treatment,the efficacy and safety of the two groups were evaluated.Results(1)During the trial,5 cases fell off from the control group and 3 cases fell off from the Chinese medicine group.A total of 98 cases were eventually included,and 48 cases were in the control group and 50 cases were in the Chinese medicine group.(2)After 3 months of treatment,the total effective rate of the Chinese medicine group was 46.00%(23/50),and that of the control group was 10.42%(5/48).The intergroup comparison(tested by chi-square test)showed that the efficacy of the Chinese medicine group was significantly superior to that of the control group(P＜0.01).(3)After treatment,the TCM syndrome score and the maximum diameter of pulmonary ground glass nodules in the Chinese medicine group were lowered(P＜0.05),while the TCM syndrome score and the maximum diameter showed no obvious changes compared with those at enrollment(P＞0.05);the intergroup comparison showed that the reduction of TCM syndrome score and the maximum diameter of pulmonary ground glass nodules in the Chinese medicine group was significantly superior to that in the control group(P＜0.05).(4)After treatment,the levels of serum inflammatory factors of IL-6,IL-17A and TNF-α in the Chinese medicine group were significantly lowered compared with those at enrollment(P＜0.05),while there was no significant change in serum IL-6,IL-17A and TNF-α levels of the control group(P＞0.05);the intergroup comparison showed that the decrease of serum IL-6,IL-17A and TNF-α levels in the Chinese medicine group was significantly superior to that in the control group(P＜0.05).(5)After treatment,the percentage of T lymphocyte subset CD4+and the ratio of CD4+/CD8+in the Chinese medicine group were significantly increased compared with those at enrollment(P＜0.05),while there was no significant change in the percentage of CD3+,CD4+cells and the ratio of CD4+/CD8+of the control group and in the percentage of CD3+cells of the Chinese medicine group(P＞0.05).The intergroup comparison showed that the increase of CD4+percentage and CD4+/CD8+ratio in the Chinese medicine group was significantly superior to that in the control group(P＜0.05).(6)There were no obvious adverse reactions occurring in the Chinese medicine group during the treatment,showing relatively high safety.Conclusion Yiqi Wenyang Sanjie Decoction exerts certain effect in the treatment of patients with pulmonary ground glass nodules and yang-deficiency constitution.It can effectively promote the reduction of nodules,relieve clinical symptoms,decrease serum levels of inflammatory factors,improve immune function,and has good safety.

In the context of medical insurance payment reform,the sample hospital has implemented performance management optimization to effectively address the challenges posed by diagnosis-intervention packet(DIP)payment.Reform measures focused on disease quality,rational diagnosis and treatment,operational management,medical technological value,and policy orientation,and they have significantly optimized service ability and performance evaluation indexes of the hospital.Main achievements included a reduction in the cost consumption index and an increase in the clinical performance index,with the overall DIP payment rate increasing from 88.86%to 103.23%and a marked improvement in operational management.The quality control and operational efficiency of the hospital have been effectively enhanced by choosing proper DIP payment evaluation indexes and improving performance management,and provided strong support for the high-quality development of the hospital.

Objective:To compare and analyze the clinical efficacy of using a posterior "S" shape incision versus a medial small incision with suture anchors in the treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament (PCL).Methods:A retrospective study was conducted on clinical data from patients with PCL tibial avulsion fractures who met surgical criteria and were treated at Department of Joint 2, Tangshan Second Hospital from March 2021 to May 2023. Among those patients, there were 25 cases classified as Meyers-McKeever type Ⅱ and 41 cases as type Ⅲ. 32 patients who underwent surgery through the posterior "S" shape incision served as the control group; based on matched baseline characteristics, 34 patients who underwent surgery through the medial small incision were selected as the observation group. Both groups received fixation of the avulsion fracture with suture anchors. Surgical indicators, as well as Lysholm scores, International Knee Documentation Committee (IKDC) scores, visual analogue scale (VAS) scores, range of motion (ROM) of the injured knee, the difference in posterior tibial translation between both sides (calculated by measuring the posterior translation on both sides), and the incidence of postoperative complications were collected at 1, 3, and 6 months post-surgery. Comparative analyses were conducted to evaluate postoperative functional recovery. Chi-square tests were used for categorical data comparison, and t-tests were employed for normally distributed continuous data.Results:The observation group had shorter incision lengths ((5.71±1.85) cm), less intraoperative blood loss ((74.87±20.74) mL), and shorter operation times ((48.76±6.46) min) compared to the control group ((12.45±1.52) cm, (120.29±31.12) mL, (61.14±10.23) min), and the differences were statistically significant ( t values were 16.21, 7.02, 5.92, respectively; all P<0.001). At 3 and 6 months post-surgery, the Lysholm ((79.67±3.08), (91.16±2.23) points) and IKDC scores ((84.67±5.08), (93.16±3.23) points) in the observation group were significantly higher than those ((65.29±3.84), (79.52±2.98), (79.29±4.84), (85.32±3.98) points) in the control group, and the differences were statistically significant ( t values were 16.72, 18.04, 4.40, 8.81, respectively; all P<0.001). At 3 and 6 months, the VAS scores ((2.83±0.38), (2.12±0.34) points) in the control group were significantly higher than those ((2.41±0.25), (1.73±0.49) points) in the observation group ( t values were 5.34 and 3.73 respectively, both P<0.001). At 6 months post-surgery, all fractures had healed, in the observation group and control group the ROM ((130.56±5.96)° and (121.45±7.32)°) of the injured knee had increased, and the difference in posterior tibial translation ((1.17±0.61) and (1.94±0.57) mm) had decreased. However, the ROM in the observation group was significantly greater than that in the control group, and the difference in posterior tibial translation was significantly lower in the observation group, with statistically significant differences ( t values were 5.56 and 5.29 respectively; both P<0.001). Conclusions:Compared to the posterior "S" shape incision approach, the medial small incision approach with suture anchors for treating PCL tibial avulsion fractures offers advantages such as reduced trauma, shorter operation time, and less intraoperative blood loss, which is more beneficial for knee joint functional recovery.

Objective:To compare the efficacy of robot system-assisted versus freehand screw revision for ankylosing spondylitis (AS) with lower cervical fractures.Methods:A multicenter retrospective cohort study was conducted to analyze the clinical data of 57 patients with AS combined with lower cervical fractures admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine, Henan Provincial People's Hospital, Zhengzhou Orthopedic Hospital, and Qilu Hospital of Shandong University, including 46 males and 11 females, aged 38-77 years [(65.4±9.5)years]. Injury segments involved C 3 in 7 patients, C 4 in 13, C 5 in 25, C 6 in 10, and C 7 in 2. All the patients underwent revision surgery, among whom, 22 patients were treated with robot system-assisted cervical pedicle screw placement (robot nailing group, with 190 screws), and 35 with freehand cervical pedicle screw placement (freehand nailing group, with 300 screws). The operative duration, intraoperative bleeding volume, frequency of intraoperative fluoroscopy, incision length, and length of hospital stay of the two groups were compared; the time of single nscrew insertion, the number of single nail revisions, the distance between screws and the anterior cortex, the accuracy of screw placement of grade 0 and grade 0+1 were recorded in the two groups. The visual analogue scale (VAS), Japanese Orthopedic Society (JOA) score, neck dysfunction index (NDI), American Spine Injury Association (ASIA) classification before operation, at 3 days, 3 months after operation and at the last follow-up were compared between the two groups. The complication rate was also noted. Results:All the patients were followed up for 12-16 months [(14.3±2.1)months]. The operative duration, intraoperative bleeding volume, and frequency of intraoperative fluoroscopy were (186.4±12.9)minutes, (486.1±68.6)ml, and (3.4±1.3)times in the robot nailing group, which were shorter or less than (206.7±14.4)minutes, (660.3±45.2)ml, and (13.5±3.6)times in the freehand nailing group ( P<0.01). The incision length was (9.4±2.4)cm in the robot nailing group, longer than (5.6±1.2)cm in the freehand nailing group ( P<0.01), and the length of hospital stay was (3.7±0.4)days, shorter than (4.4±1.4)days in the freehand nailing group ( P<0.01). The length of single nail insertion, the number of single nail revision, and the distance between the screws and the front cortex were (6.5±0.4)minutes, (1.1±0.1)times, and (3.5±1.3)mm in the robot nailing group, which were shorter or less than (11.6±0.2)minutes, (1.5±0.2)times, and (12.4±4.7)mm in the freehand nailing group ( P<0.01). The accuracy of the screw placement in the robot nailing group was 90.0% (171/190) and 95.8% (182/190) with level 0 and 0+1 screws, better than 80.0% (240/300) and 89.0% (267/300) in the freehand nailing group ( P<0.05). There was no significant difference in VAS, JOA score, NDI, or ASIA grading between the two groups before operation ( P>0.05). The VAS, JOA, and NDI scores at 3 days after operation were (3.1±0.6)points, (12.1±1.2)points, and (15.6±2.9)points, respectively in the robot nailing group, which were better than (5.0±1.4)points, (11.3±1.1)points and (22.5±3.7)points, respectively in the freehand nailing group ( P<0.05). No statistically significant difference was observed in the ASIA grade between the two groups at 3 days after operation ( P>0.05). There were no significant differences in VAS, JOA, NDI scores, or ASIA grading between the two groups at 3 months after operation and at the last follow-up ( P>0.05). Compared with those before operation, the VAS, JOA, NDI scores, and ASIA grading were significantly improved at 3 days, 3 months after operation and at the last follow-up in the two groups, which were further improved with the passage of time. Two patients in the robot nailing group had pneumonia, with a complication rate of 9% (2/22), while 2 patients in the freehand nailing group had dural sac rupture and cerebrospinal fluid leakage and 3 had lung infection after operation, with a complication rate of 14% (5/35) ( P<0.05). Conclusion:Compared with freehand nailing, the robot system-assisted nailing revision for AS with lower cervical fracture has more advantages in terms of the operative duration, length of hospital stay, intraoperative bleeding volume, frequency of intraoperative fluoroscopy nailing speed and accuracy, screw holding force, early pain relief, function restoration, and complication rate, despite longer surgical incision.