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.

Objective:To investigate the computed tomography (CT) imaging features of patients with chronic hydrocephalus after intracerebral hemorrhage surgery and the difference between endoscopic third ventriculostomy (ETV) and ventricular peritoneal shunt (VPS).Methods:A total of 158 patients with intracerebral hemorrhage who received surgical treatment in the Department of Neurosurgery of the People′s Hospital of Jinan from January 2021 to June 2023 were retrospectively selected as the study objects, including 78 patients with chronic hydrocephalus after surgery as the hydrocephalus group, and 80 patients with no hydrocephalus after surgery as the non-hydrocephalus group, and the CT imaging data of the patients were statistically analyzed. Hydrocephalus group was divided into ETV group (42 cases) and VPS group (36 cases) according to different treatment methods. The efficacy and quality of life of the two groups were compared, and the incidence of complications in the two groups were counted.Results:There was no significant difference between hydrocephalus group and non-hydrocephalus group in the site of cerebral hemorrhage, hematoma morphology and the proportion of patients with mixed signs, lobular signs and black hole signs (all P>0.05). The proportion of patients with ventricular dilation and hematoma enlargement in hydrocephalus group was significantly higher than that in non-hydrocephalus group (all P<0.05). The National Institute of Health Stroke Scale (NIHSS) scores of hydrocephalus patients in the two groups were measured continuously at different time points, and there was no significant difference in NIHSS scores between the ETV group and the VPS group before treatment, at 2 weeks and 4 weeks of treatment (all P>0.05). There was no significant difference between the ETV group and the VPS group ( P>0.05). The recurrence rate of the ETV group was lower than that of the VPS group ( P<0.05). The quality of life scores of patients in ETV group were higher than those in the VPS group at 3 months and 6 months after surgery ( P<0.05). Conclusions:CT examination of patients with chronic hydrocephalus after intracerebral hemorrhage will show obvious characteristics of hematoma enlargement and ventricle enlargement. The efficacy of ETV and VPS in the treatment of chronic hydrocephalus after intracerebral hemorrhage surgery is similar, but the former has a lower recurrence rate and a higher postoperative quality of life.

Objective:It aimed to analyze the influencing factors of open sharing of healthcare data in public hospitals and identify the relationship between the factors,so as to provide references for realizing the value of data reuse.Methods:Through the review of healthcare data policies and related literature analysis,the key factors affecting the openly sharing of data were pre-summarized with the help of the technology-organization-environment analysis framework.The expert consultation method,the decision-making trial and evaluation laboratory method were further used to screen those key affecting factors and clarify the interaction between the factors.Results:A total of 8 cause factors and 6 result factors were selected.Among them,data sharing technical specifications,data security technology and data sharing support platform were the top 3 cause reasons.The quality of health data,ownership of health data and decentralization of healthcare data were the top three in the outcome factors.Conclusion:It was suggested to establish and improve data sharing technical specifications and multi-level data sharing support platform,and improve data security and quality of medical and health data.At the same time,it needed to clarify the ownership of medical data rights and responsibilities,and gradually realize the integration and open sharing of healthcare data.

Objective To analyze the correlation between the Patellotrochlear index at different knee flexion angles and recurrent patellar dislocation,and to find the optimal knee flexion angle and the best diagnostic cut-off value for predicting recurrent patellar dislocation.Methods A total of 35 patients clinically diagnosed with recurrent patellar dislocation(study group)were selected.The lengths of the central sagittal plane of the patellar cartilage and the corresponding femoral trochlear cartilage were measured at knee flexion angles ranging from 0° to 70°,in 10° increments.The Patellotrochlear index was calculated and compared with the MRI data from 55 healthy volunteers(control group).Results The Patellotrochlear index in the study group and the control group showed a positive correlation with the knee flexion angle(r=0.935 and 0.909,P＜0.001).Statistically significant differences were found between the two groups at knee flexion angles of 0°,10°,20°,30°,and 40°(t=7.480,5.742,5.200,3.558,4.271,P＜0.05).The predictive efficacy of the Patellotrochlear index for recurrent patellar dislocation varied at different knee flexion angles,with the area under the curve(AUC)and the best diagnostic cut-off values of 0.891,0.834,0.778,0.710,0.741 and 0.195,0.323,0.486,0.606,0.712,respectively.Conclusion There are significant differences in the Patellotrochlear index at different knee flexion angles.A knee flexion angle of 0° is the optimal knee flexion angle for the Patellotrochlear index to predict recurrent patellar dislocation,with a recommended best diagnostic cut-off value of 0.195.

Objective:To construct an analytical framework of the elements determining the value of technical labor of invited parties for telemedicine services,and to provide a theoretical basis for scientifically assessing the quantitative model of the value of technical labor in telemedicine services.Methods:A combination of semi-structured interviews and documentary research methods were used to collect data,which were coded step-by-step using procedural grounded theory,and finally the data were tested for theoretical saturation.Results:Open coding was applied to extract 38 initial concepts and merge into 14 initial categories.Principal axis coding summarized 6 main categories;and selective coding distilled 4 core determinants.Conclusion:The value of technical labor of invited parties for telemedicine services is affected by four core elements,including technical characteristics of service items,human cost input,behavioral quality,and subjective experience of experts.It is recommended to pay attention to technical risks and knowledge and skill costs,service quality and experts' professional experience in policy formulation and performance evaluation,to optimize telemedicine resource allocation and value embodiment.

Objective:To explore the key influencing factors of the technical and labor value of remote consultation doctors,and to provide references for improving the service pricing and salary mechanism.Methods:The expert consultation method and the Decision-Making Trial and Evaluation Laboratory(DEMATEL)were adopted to identify the key influencing factors of the technical and labor value of remote consultation doctors and the relationships among them.Results:A total of 6 causal factors and 8 outcome factors were screened out.Among them,the subjective feelings of the invited experts were the core causal factor,and work ability was the core outcome factor.Conclusion:Enhancing the subjective sense of acquisition and subjective sense of identity of experts on the invited side of teleconsultation guides doctors to set up correct values and improves doctors' medical knowledge,clinical experience,communication ability and other working abilities to effectively promote the sustainable development of teleconsultation.

Objective To compare the application value of direct arteriovenous fistula(AVF),after ultrasound-guided percutaneous transluminal angioplasty(PTA)dilation of radial artery AVF formation and reverse"J"arteriovenous graft(AVG)in hemodialysis patients with small diameter vessels.Methods Totally 96 end-stage renal disease patients with distal radial artery＜1.5 mm and cephalic vein≥2.0 mm who planning to receive hemodialysis were retrospectively enrolled.The patients were divided into AVF group(n=30),PTA+AVF group(n=34)and AVG group(n=32)according to fistulization methods.The technical success rate,clinical success rate,primary patency rate and secondary patency rate were compared among groups.Results The technical success rate of AVF group,PTA+AVF group and AVG group was 80.00%,94.12%and 100%,respectively,and the clinical success rate was 30.00%,82.35%and 93.75%,respectively,with significant differences among 3 groups(both P＜0.05).The primary patency rate 1,3,6,9 and 12 months after fistulization in AVF group was 80.00%,30.00%,27.59%,27.59%and 24.14%,respectively,in PTA+AVF group was 94.12%,82.35%,78.79%,68.75%and 62.50%,respectively,while in AVG group was 100%,93.33%,83.33%,76.67%and 66.67%,respectively,all being significant different among 3 groups(all P＜0.05).The secondary patency rate 1,3,6,9 and 12 months after fistulization in AVF group was 83.33%,75.00%,75.00%,70.83%and 58.33%,respectively,in PTA+AVF group was 93.33%,93.33%,83.33%,83.33%and 80.00%,respectively,while in AVG group was 100%,100%,93.33%,90.00%and 80.00%,respectively,also being significant different among 3 groups(all P＜0.05).Conclusion Compared with direct and after ultrasound-guided PTA dilation of radial artery AVF formation,AVG formation was more valuable for hemodialysis patients with small diameter vessels.

Objective To investigate the impact and underlying mechanism of curcumin(Cur)on the aberrant proliferation and migration of VSMC.Methods VSMC was treated with Ang Ⅱ to establish a cell proliferation model.The experiment included blank control group,model group,and low-,medium-and high-dose Cur treatment groups(1.5,3.0 and 4.5 pmol/L,n=11).To explore the effect of Cur on the AMPK/mTOR signaling pathway,VSMC was also assigned into blank control,Ang Ⅱ(10-6 mol/L),Cur(3.0 μmol/L)and Ang Ⅱ+Cur groups(n=3).Western blotting was employed to detect the expression of VSMC differentiation markers(α-SMA),dedif-ferentiation marker(OPN),autophagy-related proteins(P62 and Beclin-1),and proteins involved in the AMPK/mTOR pathway(AMPK,p-AMPK,mTOR,p-mTOR,p70S6K,p-p70S6K).Results Exposure to Ang Ⅱ enhanced the proliferation and migration of VSMC when compared with the blank control group(155％vs 100％,66％vs 48％,P＜0.05).When compared with the model group,the proliferative rate was significantly lower in the medium-and high-dose Cur groups,and the migratory rate was obviously decreased in the three Cur groups(P＜0.05).The α-SMA expression was increased in the medium-and high-dose Cur groups,and that of OPN was decreased in the three Cur groups when compared with the model group(P＜0.05).Enhanced Be-clin-1 and p-AMPK/AMPK and down-regulated P62,p-mTOR/mTOR,and p-p70S6K/p70S6K were observed in the Ang Ⅱ and Cur groups than the blank control group(P＜0.05).The Cur Ang Ⅱ and Cur+AngⅡ groups had notably higher Beclin-1 and p-AMPK/AMPK but lower P62,p-mTOR/mTOR,and p-p70S6K/p70S6K than the Ang Ⅱ group(P＜0.05).Conclusion Cur in-hibits the proliferation and migration of VSMC induced by Ang Ⅱ,potentially through its activa-ting the AMPK/mTOR signaling pathway and enhancing autophagy in VSMC.

Objective To investigate the level 4 surgical safety management in tertiary public hospitals in Sichuan Province.Methods A combination of questionnaires and qualitative interviews was used to investigate the basic situation of four-level surgery performed,the volume of surgery,and the management of surgery in 34 tertiary public hospitals in Sichuan Province.Results Among the 34 tertiary public hospitals surveyed,the percentage of patients discharged with level Ⅳ surgery in 2023 was 18.96％,which was lower than the level of the percentage of patients discharged with level Ⅳ surgery did not establish a leading group for level Ⅳ surgery (17.65％),a system for preoperative multidisciplinary discussion of level Ⅳ surgery(14.71％),and a system for preoperative multidisciplinary discussion of level Ⅳ surgery with various department-related expert pool(41.18％),multidisciplinary joint examination room(23.53％),and the monitoring and evaluation mechanism for the completion of preoperative multidisciplinary discussion for level 4 surgery(20.59％).Conclusion The volume of level Ⅳ surgeries in tertiary public hospitals in Sichuan Province needs to continue to be improved,and the establishment of a standardized management system for level Ⅳ surgeries is imperative.

Public hospitals have introduced third-party payment methods to improve patients'medical treatment experience,however large public hospitals face challenges in financial reconciliation due to the complexity of income types,multiple accounting units,and delayed cross-hospital reconciliation.Based on the practical experience of the First Affiliated Hospital of Zhengzhou University in financial management,it analyzes the current situation of third-party payment in hospitals and identifies key problems in financial reconciliation,such as increased risk of re-funds,prominent single-sided accounting issues,and low efficiency of manual reconciliation.It proposes strategies for optimizing the hierarchical structure of the reconciliation post,updating accounting subjects rationally,and im-proving the intelligence of the reconciliation system,to provide reference for financial reconciliation work in large pub-lic hospitals under third-party payment methods and improve the operational efficiency of public hospitals.