Objective To explore the dose-effect,time-effect and safety of alteplase in the treatment of acute cerebral infarction.Methods One hundred and ten patients with acute cerebral infarction were selected,among whom 50 patients whose time window ≤3.0 h were divided into group A and group B by random digits table method with 25 cases each,and 60 patients whose time window 3.1-4.5 h were divided into group C and group D by random digits table method with 30 cases each.The patients in group A and group C received alteplase 0.6 mg/kg (maximum dose 60 mg) intravenous thrombolysis;the patients in group B and group D received alteplase 0.9 mg/kg (maximum dose 90 mg) intravenous thrombolysis.The national institutes of health stroke scale (NIHSS) scores before treatment and 1 h,24 h,7 d,30 d and 90 d after treatment were observed in the 4 groups.The therapeutic effect,complication incidence and fatality rate were compared.The prognosis was estimated by modified Rankin scale (mRS) score 90 d after treatment.Results The NIHSS scores 1 h,24 h,7 d,30 d and 90 d after treatment were significantly lower than those before treatment in the 4 groups,and there were statistical differences (P ＜ 0.05).The NIHSS score decreased significantly with time.There were no statistical differences in NIHSS score between group A and group B,group C and group D.There were no statistical differences in complication incidence and fatality rate 90 d aftcr treatment in group A and group D compared with group B and group C (P＞ 0.05).The rate of eusemia in group A was 76.00％ (19/25),in group B was 64.00％ (16/25),in group C was 43.33％ (13/30),and in group D was 53.33％ (16/30).And there were no statistical differences between group A and group B (x2 =0.620,P ＞0.05),and between group C and group D (x2 =0.069,P＞ 0.05).Conclusions The low dose alteplase is also effective and safe to acute cerebral infarction patients at time window ≤ 3 h.It is also effective and safe to acute cerebral infarction patients at time window 3.0-4.5 h at standard dose.

Primary hyperparathyroidism (PHPT) is a disorder of calcium metabolism, which is characterized by elevated blood calcium and PTH urine calcium, which is easy to involve multiple systems. The disease is mainly caused by a benign adenoma of parathyroid tissue, a few of which are parathyroid hyperplasia or parathyroid adenocarcinoma. As awareness of physical examination increased, the proportion of asymptomatic PHPT patients gradually increased. The disease can be cured by surgical resection of the parathyroid gland, most of which is a real good prognosis, but a few of them are complex and difficult to diagnose and treat. At present, there continue to be many controversies about the diagnosis and treatment of PHPT.This article is a review of the progress in the diagnosis and treatment of PHPT.

Objective To study the clinical effect of total parathyroidectomy on the patient with secondary hyperparathyroidism related to chronic renal failure. Methods The clinical data of 12 cases of total parathyroidectomy were retrospectively analyzed. All changes between preoperation and postoperation were compared, that included the clinical presentations, serum calcium and phosphate, plasma alkaline phosphatase (AKP), parathyroid hormone (iPTH), blood haematocrit (HCT), blood-lipid(TG) and complications. Results The clinical symptoms and signs were markedly improved in all cases. A postoperative decrease in the laboratory indexes of serum calcium and phosphate, AKP, iPTH, HCT was also observed(P<0.05). But the difference of TG did not reach statistical significance(P>0.05). Hypocalcaemia occurred in all patierts in different degrees. Plasma iPTH maintained at high level in 1 case and recurrence happened in 1 case after operation. Conclusions Total parathyroidectomy is an effective treatment for severe uremic secondary hyperparathyroidism and can improve the patient's life quality.

ObjectiveTo investigate the association between PPARγ gene rs3856806 polymorphism and nonalcoholic fatty liver disease (NAFLD). MethodsThe blood samples of 189 patients who were diagnosed with NAFLD by B-ultrasound and 184 healthy normal subjects were collected to determine the genotypes of PPARγ gene rs3856806 by improved multiple ligase detection reaction. Comparison of categorical data between the two groups was made by Pearson chi-square test, and comparison of continuous data was made by t test. And the logistic regression analysis was used for calculating odds ratio (OR) and 95% confidence interval (95%CI). ResultsThe NAFLD group had significantly higher body weight, waist circumference, hip circumference, and levels of alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, glucose, triglyceride, total cholesterol, and low-density lipoprotein than the control group (P＜0.05). However, the NAFLD group had a significantly lower level of high-density lipoprotein than the control group (P＜0.01). There were no significant differences in the allele and genotype frequencies of rs3856806 between the two groups (P＞0.05). The patients with rs3856806 T allele showed higher risk of developing NAFLD than those with C allele (OR=1.068, 95%CI: 0.748-1.525, P＞005). The unconditional logistic regression analysis showed that the patients with TT/TC genotypes had higher risk of developing NAFLD than those with CC genotype (OR=1.077, 95%CI: 0.706-1.643, P＞0.05). ConclusionPPARγ gene rs3856806 polymorphism is not significantly associated with NAFLD.

ObjectiveTo investigate the association between glucokinase regulatory protein (GCKR) gene rs780094 (C＞T) polymorphism and non-alcoholic fatty liver disease (NAFLD) in the Han population in Qingdao, China. MethodsA case-control study was conducted in 180 patients with NAFLD and 172 healthy controls. Blood samples were collected from all the subjects and were genotyped for rs780094 by polymerase chain reaction and DNA sequencing method. Genotype and allele frequencies were compared between the control and case groups. ResultsNo significant differences between the two groups were observed in both genotype and allele frequencies (both P＞0.05). The variant GCKR rs780094 T allele did not significantly increase the risk of NAFLD (OR=1.068, 95% CI: 0.748-1.525, P=0.719) compared with the C allele. Logistic regression model analysis adjusted for confounding factors exhibited that the TT + CT genotype of GCKR rs780094 did not significantly increase the risk of NAFLD relative to the CC genotype (P＞0.05). ConclusionGCKR rs780094 T allele may be not associated with the increased risk of NAFLD in the Han population in Qingdao.

Objective To investigate the suppression of mrp1 and MRP1 induced by small interfering RNA and the restoration of sensitivity to chemotherapeutic drugs in the multidrug-resistant hepatocellular carcinoma cell lines HepG2/mrp1. Methods mrp1-targeted small interfering RNA duplexes were designed and composed and introduced into multidrug-resistant hepatocellular carcinoma cell lines HepG2/mrp1. The suppression of mrp1 mRNA and its gene product MRP1 was examined by RT-PCR and flow cytometry (FCM), respectively. MTT assay was performed to measure the reverse effect of small interfering RNA based on the results of ICs0. Results The overexpression of mrp1 mRNA and MRP1 was effectively suppressed by small interfering RNAs. The level of mrp1 mRNA in the transfected HepG2/mrp1 cells was reduced to (86.36±2.76)% and MRP1 to (89.38±3.76)%compared with those of the controls. The resistance to ADR was reversed five-fold, which indicated the restoration of sensitivity to drugs. Conclusion Small interfering RNA can inhibit mrp1 expression effectively and reverse the multidrug resistance mediated by MRP1.

Objective To observe the effect and adverse reactions of ultrasound guided continuous femoral nerve block in postoperative analgesia after total knee arthroplasty(TKA) and to conduct the comparative study with traditional patient-controlled intravenous analgesia. Methods Forty patients undergoing elective unilateral knee replacement in this hospital from August 2015 to March 2016 were selected and divided into the group A and B, 20 cases in each group. The group A adopted ultrasound guided continuous femoral nerve block analgesia, while the group B adopted patient-controlled intravenous analgesia(PCA). The VAS score on postoperative 4,8,12,24,48 h were compared between the two groups, the VAS score of continuous passive motion on postoperative 24,48,72 h were compared between the two groups, the muscle strength grade and knee joint maximum passive flexion and extension on postoperative 2-6 d were compared between the two groups. Postoperative adverse reactions were observed. The levels of C-reactive protein(CRP) and interleukin- 6 (IL-6) were tested. The ultrasound monitoring of lower extremity deep vein thrombosis occurrence was performed and the changes of serum D -dimer was observed. Results The rest state VAS score at each time point in the group A was significantly lower that in the group B (P<0.05). The VAS score of continuous passive function exercise at postoperative 24,48,72 h in the group A was significantly lower than that in the group B (P<0.05). The passive flexion and extension mobility on postoperative 2,3,4 d in the group A was significantly higher than that in the group B(P<0.05). There was no signifi cant difference in muscle strength at each time point between the two groups (P>0.05). The number of PCA pressing times in the group A was less than that in the group B (P<0.05). The CRP level at postoperative 6 h in the group the A was lower than that in the group B (P<0.05). The IL-6 level after operation in the two group was higher than that before operation, but the intergroup had no significant difference (P>0.05). The lower extremity deep venous thrombosis formation detected by ultrasound had no significant difference between the two groups. The D-dimer level during perioperative period in the group A was lower than that in the group B (P<0.05). Conclusion Ultrasound guided continuous femoral nerve block used in postoperative analgesia in the patients undergoing knee arthroplasty has definite analgesic effect, can alleviate postoperative stress damage and incidence of postoperative complications, and is conducive to consolidate the operative curative effect.

Objective To explore the expression of nutrition information based on consumer cognitive psychology,and improve the applicability of pre-packaged food nutrition labels.Method Taking the "nutrition label" of a biscuit as an example:First,the energy (kilojoules) of the biscuit is converted into "food exchange serving";Then,the energy supply ratio of three major calorigenic nutrients of various foods in the biscuit is calculated according to the "China Food Composition Table",and the energy supply ratio of three major calorigenic nutrient in different food combinations is also calculated.Finally,we determined whether energy supply ratio of the three major calorigenic nutrients of the biscuit is similar to a mix of certain energy ratios of certain types of food.Thus,the new nutritional information expression of'nutrition labels' was determined.The applicability and operability of balanced food practice was compared between the existing and improved nutrition information expression by the'desktop deduction'method.Results The biscuit contains 1 823 k] of energy per 100 g,which is about 5 "food exchange servings".The average energy supply ratio of protein,fat,and carbohydrate of all kinds of food are as follows:The cereals were 15％,5％ and 80％ respectively;the meats were 55％,39％ and 10％ respectively;the vegetables were 27％,9％ and 58％ respectively;and the fruits were 5％,3％ and 91％,respectively.If different types of food are mixed according to their energy ratio,then the energy supply ratio of the three energy producing nutrients is different.The energy ratio of the three energy producing nutrients of the prepackaged food will always be similar to that of the mixture of some kinds of food.The biscuit is similar to 1:4 energy mixed with oil foods and cereals,which translates to about 10 g of oils and 100 g of grains,based on the'food exchange serving'.Hence,if you eat 100 g of these cookies,subtract about 10 g of fat and 100 g of cereal from your three meals per day.Conclusion The nutritional ingredient list of'prepackaged food nutrition label'should increase the expression of 'food exchange'and food category and energy proportion,so as to facilitate the practice of balanced diet by consumers.

Objective To evaluate the effects of isoflurane postconditioning on angiogenesis during cerebral ischemia-reperfusion ( I∕R) in rats and the role of Shh signaling pathway. Methods Thirty-two clean-grade healthy male Sprague-Dawley rats, aged 6-8 weeks, weighing 220-280 g, were divided into 4 groups ( n=8 each) by a random number table method:sham operation group ( Sham group) , I∕R group, isoflurane postconditioning group ( ISO group) , and isoflurane postconditioning plus Shh signaling pathway specific inhibitor cyclopamine group ( ISO+CYC group) . Cerebral ischemia was produced by inserting a 3-0 nylon thread with a rounded tip into the internal jugular vein. The nylon thread was threaded cranially until resistance was met. Occlusion was maintained for 1. 5 h followed by 24 h reperfusion. Neurological deficit was scored at 24 h of reperfusion. Rats were then sacrificed, and brains were removed for determination of cerebral infarct volume ( by TTC) and expression of glioma-associated oncogene homolog 1 ( Gli1) , vascu-lar endothelial growth factor ( VEGF) and transmembrane phosphoglycoprotein protein ( CD34) in cerebral cortex (by Western blot) and for examination of the pathological changes (by Nissl staining). Results Compared with Sham group, the neurological deficit score and cerebral infarct volume were significantly in-creased, and the expression of Gli1, VEGF and CD34 in the cerebral cortex was up-regulated in I∕R and ISO groups ( P <0. 05) . Compared with I∕R group, the neurological deficit score and cerebral infarct vol-ume were significantly decreased, and the expression of Gli1, VEGF and CD34 in the cerebral cortex was up-regulated ( P<0. 05) , and the pathological changes of brain tissues were significantly attenuated in ISO group, and no significant change was found in the parameters mentioned above in ISO + CYC group ( P>0. 05) . Compared with ISO group, the neurological deficit score and cerebral infarct volume were signifi-cantly increased, and the expression of Gli1, VEGF and CD34 in the cerebral cortex was down-regulated in ISO+CYC group ( P<0. 05) . Conclusion The mechanism by which isoflurane post-conditioning attenuates cerebral I∕R injury is related to activating Shh signaling pathway and promoting angiogenesis in rats.

Objective To investigate the feasibility of transient blocking of both pulmonary artery and veins for surgical treat- ment of central lung cancer with stage Ⅲ to preserve the normal pulmonary.Methods Firstly,the relation of the pulmonary artery, the lung neoplasm and the enlarged mediastinal lymph nodes was investigated.If the hilum of lung remained frozen,the pericardium was opened and the pulmonary artery,the upper and lower lobe pulmonary veins were dissected.Then those three vessels were blocked.When the pulmonary cireulation was stopped,bloodless lobectomy and pulmonary artery angioplasty and/or anastomosis were performed.Then the blockers were released,and pulmonary circulation was restored.The time of blocking was(35?15)minutes (16～66 minutes).Results All 20 patients suffer from stage Ⅲ central lung cancer,which' s the hila of lung remained frozen,re- ceived complete resection of the tumor.The normal functioning pulmonary tissue in the 20 patients was preserved instead of pneumone- ctomy.The average amount of bleeding was 256 ml(180～420 ml)during operation.All 20 patients recovered well.Conclusion Transient blocking of both pttlmonary artery and veins for surgical treatment of stage Ⅲ central lung cancer is and innovation in surgical technique,which makes the operation safe and easy.This technique may provide a chance to patients,with poor cardio-pulmonary function.In addition,this technique widens the surgical indications for patients suffering from lung cancer.