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 investigate the infection episode and related risk factors in continuous hemodialysis patients. METHODS The relationship among infection and etiologies of infection,nutritional status,pathogens and causes of chronic renal failure(CRF) were retrospectively analyzed in 180 continuous hemodialysis patients. RESULTS Totally 113 times infections were observed among the 86 inpatients under continuous hemodialysis.The main infectious site in hemodialysis patients was lungs.Thirty eight times were positive in 50 times of etiologic detection,Gram-negative germ was the most common(60.3%).Hemoglobin and serum albumin decreased obviously in infectious patients.Diabetes and systemic lupus erythematosus patients were more susceptible to infection.The hepatitis virus infections rate in hemodialysis patients was relatively high. CONCLUSIONS There is higher infections rate in continuous hemodialysis patients.Diabetes and systemic lupus erythematosus patients are more susceptible to infection.Anemia,lower serum albumin,old age and bad compliance are the susceptible factors.

OBJECTIVE:Percutaneous sacroiliac screw internal fixation has become the main surgical procedure for the treatment of posterior pelvic ring fractures;however,the unassisted closure operation requires high operator experience and repeated fluoroscopy increases the radiation hazard for patients and medical personnel.This article compares the clinical efficacy of robot-assisted versus unassisted percutaneous sacroiliac screw placement for posterior pelvic ring fractures by meta-analysis. METHODS:Computer searches of CNKI,WanFang,VIP,CBM,PubMed,Embase,Cochrane Library and ClinicalTrials.gov were conducted from the time of database inception to December 2022.The literature on the clinical efficacy of robot-assisted versus freehand percutaneous sacroiliac screw placement in the treatment of posterior pelvic ring fractures was collected in and outside China.The data were independently screened and extracted by two investigators according to the inclusion and exclusion criteria,respectively.The quality of randomized controlled trials was evaluated using Cochrane risk assessment criteria.The quality of included cohort studies was assessed using the Newcastle-Ottawa Scale.Meta-analysis was performed using RevMan 5.4 software for inclusion metrics.Outcome metrics included operative time,intraoperative bleeding,fluoroscopy time,fluoroscopy frequency,number of holes drilled,Majeed postoperative function score,the excellent and good rates of Matta fracture reduction,the excellent and good rates of Gras screw position,fracture healing time and complications. RESULTS:(1)A total of 13 publications were included,2 were randomized controlled trials both referring to randomized methods,11 non-randomized controlled studies were evaluated for quality of literature according to the Newcastle-Ottawa Scale,1 scored 8,9 scored 7;and 1 scored 6;the quality of literature was good.A total of 748 patients were included,including 430 in the robot-assisted group and 318 in the freehand group.(2)The results of the meta-analysis showed that the operative time(MD=-28.30,95%CI:-40.20 to-16.40),intraoperative bleeding(MD=-6.36,95%CI:-10.06 to-2.66),intraoperative fluoroscopy time(MD=-12.13,95%CI:-19.54 to-4.72),intraoperative fluoroscopy frequency(MD=-17.39,95%CI:-29.00 to-5.78),number of intraoperative needle drillings(SMD=-9.50,95%CI:-14.27 to-4.73)and the excellent and good rates of Gras screw position(OR=8.65,95%Cl:3.26-22.92)in the robot-assisted group were significantly better than those in the freehand group(P<0.05).(3)In the robot-assisted group,the overall postoperative complication rate was significantly reduced(OR=0.10,95%Cl:0.02-0.48,P<0.05).(4)No significant difference was detected in fracture healing time(MD=-0.08,95%CI:-0.21,0.06),the excellent and good rates of Matta fracture repositioning rate(OR=2.06,95%Cl:0.97-4.39),and Majeed functional score(MD=0.91,95%CI:-0.31-2.13)between both groups(P>0.05). CONCLUSION:Compared with freehand sacroiliac joint nailing,robotic assistance shortens the operative time,reduces intraoperative bleeding,decreases radiation damage to patients and medical staff,improves the excellent and good rate of screw position,and reduces the overall incidence of postoperative complications in patients,but there was no significant improvement in fracture reduction quality,fracture healing time,and postoperative function.In the future,more large-sample,multicenter,and high-quality randomized controlled trials are still needed to verify.

Objective To explore the influences of the teaching mode based on working process systematization on teaching results of geriatric nursing. Methods A totally of 209 students of 2013 higher vocational nursing major in four classes were selected and divided into the experimental group and the control group by simple random methods, among which the experimental group contains 103 students who were taught in teaching mode based on working process systematization while the control group contains 106 students who were taught in the traditional teaching mode. The new teaching mode′s design and development linked closely to working situations and tasks; adopt the teaching mode combining teaching, learning and practicing together aimed at the position requirements of old-age nursing service system at the core of the true clinic old-age nursing work-post-skills, which were based on nurse practice qualification. Students′ performance achievement between two groups after teaching were compared. The thinking ability of students was evaluated by judging thought scale, and the students′ evaluation of the new teaching method in the experimental group was accessed by a self-designed questionnaire based on working process systematization.Results After the implementation of teaching, there were significant differences between students in two groups in their performance in theory examination and practice examination based on statistics tests ( P<0. 05 ); after the intervention, there were statistically significance in the differences in students′critical thinking ability between two groups by comparison in term of each aspect such as reasoning, agree on the assumptions, explanation, deduction, discoursing ( t=7. 452, 6. 964,10.220,4.771,4.765;P<0.05);the students in the experimental group made a positive evaluation on the teaching method based on working process systematization.Conclusions The teaching method based on working process systematization is available for the teaching of geriatric nursing in higher vocational institutions, and is helpful for students to master professional skills, cultivate their spirit of innovation, strengthen their team spirit, communication skills, critical thinking ability and other qualities. This new method is worth learning in the teaching of geriatric nursing course in higher vocational colleges.

Objective:To analyze the research hotspots and development directions of medical device information management,and to provide reference for the research of medical device information management.Methods:A total of 5434 articles related to information management in the field of medical devices were retrieved from the China National Knowledge Infrastructure(CNKI)database from January 1,2000 to December 31,2023.After screening,1618 valid articles were finally included in the study.Bibliometric methods were used to analyze the publication volume,keywords,journals,and author affiliations,and CiteSpace software was used to visualize the results.Results:The number of literature in the field of medical device information management showed a linear increase from 2000 to 2023,with an average of 70.34 publications per year.The keywords of"medical equipment,""medical consumables,""medical devices,""information systems,"and"management"have the highest centrality.The most representative keywords in cluster analysis are"medical equipment","medical consumables","quality control","management",and"Internet of Things".Conclusion:The research on medical device information management has gone through the initial stage,development stage,integration and integration stage,and the keyword"Internet of Things"has quickly become a research hotspot since its first appearance,and medical device information management has become the main development direction.The medical device management system has effectively improved the service quality and management level of medical institutions with the integration application of various information technologies and management tools and met the growing demand for statistical analysis.