Ischemic cerebrovascular disease is one of the major reasons of mortality and disability in adult populations.Ultra-early recanalization is by far the most positive treatment.Relative to intravenous thrombolysis,various endovascular treatment modalities can extend therapeutic time window and increase the recanalization rate.Furthermore,interventional therapy can also improve the clinical outcomes of patients by increasing the perfusion of colhteral circulation.This article reviews various endovascular treatment modalities and their application validated in previous clinical studies in China.

Most compounds in blood are blocked from flowing into brain by blood-brain barrier(BBB) to keep central nerve system normal, but this barrier will be open in different diseases with different mechanisms. As these mechanisms are understood more and more clearly, it will do help to protect blood-brain barrier and treat diseases which are correlative to blood-brain barrier. At the same time, it may also be helpful to let drugs entering central nerve system through BBB.

Objective To study the association between early functional outcome and serum thyroid hormone level in elderly acute ischemic stroke (AIS) patients.Methods Two hundred and twenty-four AIS patients admitted to our hospital from May to December 2016 were divided into good functional outcome group (n=166) and poor functional outcome group (n=58) according to their mRS score.The serum levels of FT3,FT4,TSH were measured.The patients were further divided into FT3≤4.05 pmol/L,FT3 4.06-4.46 pmol/L,and FT3＞4.46 pmol/L.The association between early functional outcome and serum levels of FT3,FT4,TSH in elderly AIS patients were analyzed by univariate and multivariate logistic analysis.Results The AIS was severer,the BMI and incidence of AF were higher,the number of WBC was greater,the serum FT3 and CRP levels were higher in poor functional outcome group than in good functional outcome group (P＜0.05,P＜0.01).The rate of poor functional outcome was significantly higher in FT3≤4.05 pmol/L than in FT3 4.06-4.46 pmol/L and FT3 ＞4.46 pmol/L (39.5％ vs 22.2％,39.5％ vs 15.8％,P=0.003).Univariate logistic regression analysis and multivariate logistic regression analysis showed that FT3 was an independent risk factor for early poor functional outcome in AIS patients.Concision The lower the serum FT3 level on admission is,the poorer the early functional outcome is in AIS patients.

Objective To study whether intranasally administered transforming growth factor beta1(TGF-?1)can reach central nervous system(CNS)through the trigeminal nerve pathway.Methods Nineteen healthy male SD rats were randomly assigned into control group(n=6)and administration(IN)0.5h group(n=3),1h group(n=4),2h group(n=3)and 6h group(n=3).Rats in IN groups were given 50?l(20?g)recombinant human TGF-?1(rhTGF-?1)intranasally and were sacrificed at 0.5,1,2 or 6h after IN following blood sample collection.The cerebellum,midbrain,pon,medulla and trigeminal nerve were separated quickly and the concentration of TGF-?1 was analyzed by ELISA.Results Compared with the control group(15.01?1.50pg/mg),TGF-?1 was significantly elevated in the trigeminal nerve in all the IN groups(P0.05).TGF-?1 concentrations in plasma and other caudal CNS regions,such as cerebellum,midbrain and cervical spinal cord,were not significantly changed compared with that in control group.Conclusion TGF-?1 is likely to be absorbed by the trigeminal nerve following intranasal administration,and is subsequently delivered to some brain regions through the trigeminal nerve pathway,which may provide a potential treatment strategy for trigeminal nerve and CNS disorders.

Tumor necrosis factor ?(TNF ?) is a potent proinflammatory cytokine. In human, TNF ? gene is located within the highly polymorphic major histocompatibility complex(MHC) region on chromosome 6p21.3. TNF gene cluster contains many polymorphisms including microsatellites and single nucleotide polymorphisms(SNPs).Many of these polymorphisms were found to be in linkage disequilibrium with HLA class Ⅰand Ⅱ alleles. Some of the TNF ? gene polymorphisms were found to influence TNF ? production in vitro , for example the 308SNP. Many studies have shown that this SNP and others within the TNF ? gene associate with different inflammatory conditions. Whether this phenomenon is due to the direct influence if the SNP in question and/or due to linkage disequilibrium with other polymorphisms within the TNF ? gene or the HLA system is still controversial.

At present,intranasal delivery has entered clinical trial stage.In recent years,how to imroving the efficiency of intranasal delivery has been extensively investigated.This article briefly reviews some factors that impact the targeting of intranasal delivery and the drug concentration in the central nervous system.

Objective To explore the related factors and diagnostic criteria of perioperative myocardial infarction (PMI) after on-pump coronary artery bypass grafting(CABG).Methods 258 CABG patients were selected.The cardiac troponin-I in immediately,6,12,24,and 48 hours after surgery were measured.95 percentile (P95) was used as the boundary,any measured value greater than P95 was identified PMI,as group I(13 cases),the rest as group II(245 cases).The age,sex,cardiopulmonary bypass time,aortic corss-clamp time,LV ejection fraction,left ventricular end diastolic diameter,grafted vessels,left anterior descending coronary artery occlusion,recent myocardial infarction (<3 months),severe complex coronary artery disease and other risk factors that may lead to PMI were analyzed.The data were analyzed using Student's test for continuous variables and the χ2 test for discontinuous variables.Results P95 value was 3.47,the cardiopulmonary bypass time(t=3.268,P<0.05),aortic corss-clamp time(t=2.047,P<0.05),severe complex coronary artery disease between the two groups had statistically significant difference (χ2=19.846,P<0.05).Conclusion cTnI>P95 (3.47) indicates that the myocardium injury is serious,cardiopulmonary bypass time,aortic corss-clamp time and severe complex coronary artery disease are associated with PMI in patients undergoing CABG.

Objective To study the effect of intranasal nerve growth factor (NGF) on the expression of amyloid-β,peptide (Aβ) in the central nervous system in rats with traumatic brain injury (TBI).Methods Eighty rats were randomly divided into sham(n =26),control(n =27) and treatment group (n =27 ).They were subjected to the modified Feeney' s weight-drop model.The treatment group was treated with NGF administered by nasal route,and the control group was given phosphate-buffered saline (PBS).Beam walking and Morris water maze test were performed in the three groups.The concentration of Aβ40 and Aβ42 in the injured ipsilateral hippocampus was elevated by ELISA measurement.Immunohistochemistry was used to detect the amyloid precursor protein (APP) positive cells near the region of injury in the hippocampus in rats after TBI.Results NGF group traversed the beam significantly quicker (s) than control group ( 19.00 + 6.99 vs 27.33 ± 7.39 respectively,F2,15 =12.87,P =0.028 ).Morris water maze performance revealed that mean time of latency in the NGF group was significant shorter than vehicle group,and significant memory retention in NGF group as evidenced by a greater percentage of the 60 s allotted time spent in the target quadrant (45.82％ ± 11.15％ vs 33.99％ ± 3.46％,F2,15 =6.814,P=0.037),as well as the number crossing of the former site of the removed platform in NGF group was significant more than control group (8.60 ±2.73 vs 3.60 ±2.06,F2,15 =5.346,P =0.04).The Aβ42 level in control group was increased significantly higher than NGF group as indicated by ELISA measurements.While the Aβ40 level did not have similar shown.Immunohistochemical staining showed that APP level had significant differences among three groups ( F2,15 =8.672,P =0.003).The APP level in NGF group did not alter with control group.Conclusion Intranasal administration of NGF can regulate Aβ42 overproduction,improve the motor and cognitive function after brain injury in rats.

Objective Neuroinflammation following traumatic brain injury (TBI) may give rise to neurodisorder.This study aimed to investigate the effect of intranasal delivery of nerve growth factor ( NGF) on neuroinflammation following TBI and its action mechanism in rats. Methods Thirty-six male adult Sprague-Dawley rats were equally divided into a sham , a TBI, and a TBI+NGF group.The rats in the TBI +NGF group were treated with NGF intranasally at 12 and 24 hours after TBI.The levels of IL-1βand TNF-αin the injured cerebral cortex were detected by ELISA , the DNA-binding activity of NF-κB evaluated by EMSA , and the expres-sion of amyloid-β( Aβ42 ) determined by Western blot . Results NGF attenuated the inflammation following TBI .Compared with the TBI group, the level of IL-1βwas obviously decreased in the TBI +NGF group at 12 hours (70.65 ±3.10 vs 37.51 ±1.92) and 24 hours (68.85 ±8.10 vs 36.23 ±2.99, P<0.05), and so was that of TNF-α(47.12 ±7.38 vs 27.63 ±5.77 and 56.15 ±11.20 vs 29.94 ±8.62, P<0.05).The DNA-binding activity of NF-κB was reduced to 111.62 ±0.49 and 131.52 ±0.88, and the expression of Aβ42 to 0.23 ±0.008 and 0.52 ±0.004 at 12 and 24 hours respectively after treatment with NGF , both with statistically significant differences from the TBI group (P<0.05). Conclusion Intranasal administration of NGF attenuates TBI-induced neuroinflamma-tion in rats, which may be associated with its regulatory effect on the Aβ42/NF-κB signaling pathway .

Objective Ischemic stroke with elevated serum immunoglobulin E ( IgE) in some young patients is regarded as cerebral vasculitis clinically though without sufficient pathological evidence .This study was to investigate the characteristics of vascular lesions in these patients by temporal artery biopsy . Methods We performed histopathologic examinations on the temporal arteries of 32 young ischemic stroke patients with unknown etiology , 16 with normal and the other 16 with elevated serum IgE .We observed inflammatory cells infiltration and mast cells by HE staining and toluidine blue stai-ning respectively and determined the expressions of matrix metalloproteinase -9 (MMP-9), monocyte chemotaxis protein -1 (MCP-1) and serum IgE by immunohistochemistry . Results Compared with the patients with normal IgE , those of the elevated IgE group showed a significantly higher rate of inflammatory cells infiltration (12.5%vs 62.5%, P<0.01), with 1 case of focal necrosis and fi-brinous exudation in the adventitia in the latter group .The average optical density ( OD) of monocyte chemotaxis protein-1 ( MCP-1) in the temporal artery was also dramatically higher in the elevated IgE group than in the normal controls ([9.25 ±5.79] ×10 -5 vs [4.41 ±2.87] ×10 -5, P<0.01).The average OD of matrix metalloproteinase 9 (MMP-9) and intima-media thickness were both increased in the elevated IgE group ([32.79 ±21.38] ×10 -4 and [0.25 ±0.06] mm) but showed no statistically significant differ-ence from those in the normal IgE group ([25.23 ±12.78] ×10 -4 and [0.22 ±0.06] mm) (both P>0.05).Nor was any signifi-cant difference observed in the number of the mast cells between the normal and elevated IgE groups (2.8 ±1.5 vs 3.6 ±2.3, P>0.05). Conclusion The infiltration and necrosis of inflammatory cells and fibrin exudation in the temporal artery of the young pa-tient with elevated serum IgE are likely to be the manifestations of vasculitis , and MCP-1 may play a role in the pathogenesis of the disease.