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.

Objective To detect the protective effect of sufentanil preconditioning on hepatic ischemia-reperfusion injury in rats and the role of c-Jun N-terminal kinase signal pathway in the mech-enism.Methods One hundred and sixty-two SD rats(in either gender,weighing 250-300 g)were ran-domly divided into seven groups:Sham-operated group (group S,n = 30 ),ischemia-reperfusion group (group IR,n =30),sufentanil preconditioning group (group SF1:1 μg/kg,n =30;group SF5:5 μg/kg,n =30;group SF10:10 μg/kg,n =30),SP600125 group (group SP,n =30),and dimethyl sulphoxide control group (group DMSO,n =6),different doses of sufentanil was administered 30 min before hepatic ischemia in group SF1,SF5 and SF10.Blood and liver samples were collected from each group at 0(T1 ),1 (T2 ),2 (T3 ),4 (T4 ),and 6 (T5 )hours after reperfusion.Serum alanine amin-otransferase (ALT)and aspartate aminotransferase (AST)were measured by an automatic biochemi-cal analyzer.Malondialdehyde (MDA)and superoxide dismutase (SOD)in liver tissue was measured. Liver sample was stained with HE to observe the hepatic pathological changes.Immunohistochemical method was used to determine the expression of JNK and western blotting was used to detect the ex-pression of P-JNK.Results Compared with group S,levels of AST,ALT increased significantly in group IR,SF1,SF5,SF10 at T1-T5 and in group SP,DMSO at T3 (P <0.05 ).Compared with group IR,levels of AST,ALT decreased significantly in group SF1,SF5,SF10 at T1-T5 and in group SP at T3 (P <0.05).Compared with group S,levels of MDA,SOD increased significantly in group IR,SF1, SF5,SF10 at T1-T5 and in group SP,DMSO at T3 (P < 0.05 ).Compared with group IR,levels of MDA,SOD decreased significantly in group SF1,SF5,SF10 at T1-T5 and in group SP at T3 (P <0.05).Compared with group SF1 and SF5,levels of MDA,SOD decreased significantly in SF10 at T4 . Compared with T1 ,the expression of p-JNK in group IR increased significantly at T3 (P < 0.05 ). Compared with group S,the expression of p-JNK in groups IR,SF1,SF5,SF10,SP,DMSO increased significantly at T3 (P < 0.05 ).Compared with group IR,the expression of p-JNK in groups SF1, SF5,SF10,SP decreased significantly and that in groups SF5,SF10 were less than that in group SF1 (P <0.05 ).The expression of p-JNK in group SF10 was less than that in group SF5 (P < 0.05 ). Conclusion Sufentanil preconditioning can reduce the hepatic ischemia-reperfusion injury and the dos-age of 10 μg/kg was the most effective.The protective mechanisms may inhibit JNK pathway and re-duce the expression of JNK.

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 investigate the effect of early bedside neuromuscular electrical stimulation combined with routine rehabilitation training on the prognosis of patients with acute cerebral infarction. Methods A total of 200 patients with acute cerebral infarction admitted in our hospital from January 2016 to January 2018 were randomly selected. According to the random number table method, these patients were divided into early bedside neuromuscular electrical stimulation therapy combined with routine rehabilitation training group (combined group, n=100) and the separate conventional rehabilitation training group (routine group, n=100). The NDF score, FMA score, MBI score, and clinical efficacy were compared between the two groups. Results The NDF scores after treatment were significantly lower than before treatment (P<0.05), and the FMA score and MBI score of the two groups after treatment were significantly higher than those before treatment (P<0.05). The NDF score in combined group was significantly lower than that in the routine group (P<0.05), and the FMA score and MBI score of the patients in combined group were significantly higher than that in the routine group after treatment (P<0.05). But the difference in the NDF score, FMA score and MBI score between the two groups before treatment was not significant (P>0.05). The total effective rate of treatment in the combined group was95.0％ (95/100), which was significantly higher than 81.0％ (81/100) in the routine group (P<0.05). Conclusion Early bedside neuromuscular electrical stimulation combined with conventional rehabilitation training can improve the prognosis of patients with acute cerebral infarction more effectively than conventional rehabilitation training.