Objective To analyze the -ness of clinical indications of the cesarean section in evidence-based medicine,and to search for the countermeasure that dropped the higher cesarean section rates.Methods Between March 2003 and February 2006,1596 cases pregnant women with cesarean sections were analyzed retrospectively. Results In the latest 3 years,average cesarean section rate was 41%,which was higher than the proposed goals of the World Health Organization(

Objective To assess the relationship between diffusion-weighted imaging-perfusionweighted imaging (DWI-PWI) mismatch and the prognosis of patients with acute anterior circulation ischemic stroke receiving intravenous thrombolysis.Methods Patients with acute anterior circulation ischemic stroke who finished multimode MRI (T1 WI,T2 WI,DWI,PWI) within 4.5 hours after disease onset were recruited in this study.They were divided into DWI-PWI mismatched and matched groups.All patients received intravenous thrombolysis using recombinant tissue type plasminogen activator (rt-PA).Head CT was performed 24 hours later to exclude cerebral hemorrhage,and the patients were followed up for 3 months.The improvement of neurological function,the rate of death and symptomatic intracranial hemorrhage (sICH) were recorded.Results A total of 63 patients were recruited in this study,of which 41 patients presented DWI-PWI mismatch while 22 patients presented DWI-PWI match.Three months later,the rate of the improvement of neurological function in the DWI-PWI mismatched group was significantly higher than that in the DWI-PWI matched group (70.7％ vs 40.9％,x2 =5.32,P =0.021).Of note,no significant difference in the rate of death and sICH was found between DWI-PWI mismatched and matched groups (9.8％ vs 13.6％,x2 =0.22,P =0.640).Conclusions Compared with DWI-PWI matched group,the DWI-PWI mismatched group has better prognosis after receiving intravenous tbrombolysis.The results provide more direct evidence supporting the application of intravenous thrombolysis under the guidance of multimode MRI in acute anterior circulation ischemic stroke.

BACKGROUND: Bone morphogenetic protein-2(BMP-2) production of targeted cells is promoted by transfection of adenoviral vectors containing gene, but there are some immune responses. Transfection with plasmid as vector holds promise.OBJECTIVE: To explore the feasibility to construct human bone morphogenetic protein-2 eukaryotic expression vector labeled with green fluorescent protein (GFP).DESIGN: Single sample observation.SETTING: Tianjin Hospital.MATERIALS: The experiment was performed at the Key Laboratory of Hormone and Development, Ministry of Health, Tianjin Medical University from March 2006 to March 2007. pcDNA3.1/CT-hBMP2 plasmid containing full-length hBMP2 gene fragment was provided by Dr. Li; bicistronic eukaryotic expression vector pSELECT-GFPzeo-MCS and Zeo was provided by Invivogen; pTA2(R)-T Easy by Dingguo, China; restriction enzymes BamHI and NheI, T4 DNA ligase by Jingmei Biotech; PCR upstream and downstream primer synthesis and sequencing by Augct, Beijing.METHODS: With pcDNA3.1/CT-hBMP2 as template, hBMP2 target fragment was subcloned by PCR binding with designed specific primers. The fragment was bound with pTA2-T-easy and pSELECT-GFPzeo-MCS, separately, and transfected into DH5 α cells. pSELECT-GFPzeo-hBMP2 containing GFP was obtained after screening.MAIN OUTCOME MEASURES: hBMP2 sequence was identified by PCR; whether hBMP2 was cloned into pTA2-hBMP2 and pSELECT-GFPzeo-MCS was identified by digestion and sequencing.RESULTS: A target fragment of 1 216 bp was obtained by PCR amplification, and cloned into pTA2-T-easy and pSELECT-GFPZeo-MCS. The screening and sequencing results showed that the target fragment was 100% matched with BMP2cDNA sequence (NM-001200) from GenBank.CONCLUSION: hBMP2 eukaryotic expression vector labeled with green fluorescent protein is successfully constructed.

Objective To construct green fluorescent protein (GFP)-labeled pSELECT-GFP zeohBMP2 eukaryotic expression vector. Methods The encoding fragment of hBMP2 gene was obtained from a recombinant plasmid pcDNA3.1/CT-hBMP2 by using polymerase chain reaction (PCR). hBMP2 gene was inserted into pTA2-T-easy and pSELECT-GFPzeo-MCS eukaryotic expression vector, and then transferred into competence DHSα cells. After screening, pSELEC-GFPzeo-hBMP2 was obtained and identified by sequence analysis. The recombinant vector pSELECT-GFP zeo-rhBMP2 was transfected into CHO cells. The successful trasfection was verified by fluorescence microscope in 48-72 hours. The RT-PCR and immunofluorescence was used to confirm the hBMP2 expression. Western Blotting was used to detect the secretion of hBMP2.Results A 1216 bp fragment was obtained by PCR, the same as expectant fragment. The recombined pSE-LECT-GFPzeo-hBMP2 eukaryotic expression vector was identified by restriction mapping and sequence analysis. The results were identical with that of reported hBMP2 sequence (Genebank NM-001200). The successful transfection was verified by fluorescence microscope in 48-72 hours. The stable expression in eukaryotic cells was confirmed by immunofluorescence and RT-PCR which showed an obvious band between 1000-2000 bp. Western Blotting identified the immunogenicity of recombinant human BMP2 with the molecular weight of about 17×103. Conclusion The pSELECT-GFPzeo-hBMP2 eukaryotic expression vector was constructed successfully.

Objective: To investigate the effect of the time from onset to recanalization on the outcomes after endovascular treatment (EVT) in patients with acute stroke due to posterior circulation large vessel occlusion. Methods: From May 2015 to May 2019, patients with acute ischemic stroke due to posterior circulation large vessel occlusion receiving EVT in the Department of Neurology, Nanjing First Hospital, Nanjing Medical University were enrolled retrospectively. According to the modified Rankin Scale (mRS) score at 90 d after procedure, they were divided into good outcome group (≤2) and poor outcome group (>2). Demographic and clinical data were compared between the two groups. Multivariate logistic regression analysis was used to determine the independent correlation between the time from onset to recanalization and the outcomes. Results: A total of 64 patients with acute ischemic stroke due to posterior circulation large vessel occlusion treated by EVT were enrolled in this study. There were 50 males (78.0%) and 14 females (22.0%). The age was 67.52±10.30 years. The National Institutes of Health Stroke Scale (NIHSS) score was 22.04±4.17, and the time from onset to recanalization was 370.53±78.59 min. Thirty-one patients (48.0%) were in the good outcome group and 33 (52.0%) were in the poor outcome group. There were significant differences in baseline NIHSS score, systolic blood pressure, time from onset to revascularization, and the proportions of patients with tandem lesion and symptomatic intracranial hemorrhage between the two groups (all P<0.05). Multivariate logistic regression analysis showed that the longer time from onset to recanalization (odds ratio [OR] 1.317, 95% confidence interval [CI] 1.001-3.034; P=0.041) and symptomatic intracranial hemorrhage (OR 4.207, 95% CI 1.931-10.761; P=0.004) were the independent predictors of poor outcomes, while the lower baseline NIHSS score (OR 0.302, 95% CI 0.056-0.743; P=0.047) was the independent protective factor of poor outcomes. Conclusions The longer time from onset to recanalization is an independent risk factor for poor outcomes after EVT in patients with acute ischemic stroke caused by posterior circulation large vessel occlusion.

Objective: To compare the effects of modified Thrombolysis in Cerebral Infarction score (mTICI) 2b and mTICI 3 reperfusion on lesions′ changes and prognosis in patients who underwent endovascular therapy within six hours after onset. Methods: A retrospective analysis was conducted on 94 patients with acute large intracranial artery occlusion of the anterior circulation who achieved reperfusion sucesssfully by endovascular therapy within 6 hours after onset in the Department of Neurology, Nanjing First Hospital from October 2016 to March 2019. The effects of mTICI 2b and mTICI 3 reperfusion on lesions′ changes and prognosis of patients were compared. The primary endpoint was the modified Rankin Scale (mRS) score at 90 days; the secondary endpoints were the early neurological deficit score, the mortality at 90 days, the volume of infarction at 24 hours, the changes in infarct volume for 24 hours and the rate of symptomatic intracerebral hemorrhage (sICH) , reocclusion and hemorrhagic transformation. Results: In all patients, 35 cases received mTICI 2b reperfusion and 59 cases received mTICI 3 reperfusion. Compared with mTICI 2b group (10.00 (3.00, 16.00)), the early neurological deficit score at seven days of mTICI 3 group (6.00 (1.00,11.50)) was lower (Z=-2.004, P=0.045) . However, there were no statistically significant differences in mRS score at 90 days, early neurological deficit score at 24 hours and 3 days, mortality at 90 days, volume of infarction at 24 hours, the changes in infarct volume for 24 hours, and the rate of sICH, reocclusion, and hemorrhagic transformation between the two groups. Conclusion For patients with large intracranial artery occlusion of the anterior circulation within six hours after onset, achieving mTICI 3 reperfusion after endovascular therapy can improve the early neurological function more effectively, but the effects on 90-day functional outcome are similar to that of mTICI 2b reperfusion.

Objective:To investigate the safety of the use of the intermediate catheter in the endovascular treatment (EVT) of patients with acute anterior circulation large vessel occlusive stroke and its impact on the outcomes.Methods:From May 2015 to September 2018, patients with anterior circulation large vessel occlusive stroke received EVT in Nanjing First Hospital, Nanjing Medical University were enrolled retrospectively. According to whether intermediate catheter was used during the procedure, they were divided into intermediate catheter group and non-intermediate catheter group. The demographics, clinical data and procedure related information were collected. The outcome evaluation indicators included secondary embolization, symptomatic intracranial hemorrhage, clinical outcome and death at 90 d after onset. A good outcome was defined as the modified Rankin Scale score of 0-2. Multivariate logistic regression analysis was used to determine the independent predictor of clinical outcome. Results:A total of 195 patients with anterior circulation large artery occlusive stroke received EVT were enrolled, including 161 in the intermediate catheter group and 34 in the non-intermediate catheter group. There were no significant differences in demographics and clinical characteristics between the intermediate catheter group and the non-intermediate catheter group. In terms of procedure related information, the number of mechanical thrombectomy passes in the intermediate catheter group was significantly decreased (2 [1-3] times vs. 2.5 [1.75-4] times; Z=2.218, P=0.017), the recanalization rate of one-pass thrombectomy was significantly higher (38.5% vs. 20.6%; χ2=3.943, P=0.047), and the rate of thrombus escape and secondary embolism was significantly lower (19.3% vs. 35.3%; χ2=4.202, P=0.041). In terms of clinical outcome, there were no significant differences in the incidence of symptomatic intracranial hemorrhage, mortality and good outcome at 90 d between the intermediate catheter group and the non-intermediate catheter group. Multivariate logistic regression analysis showed that the use of intermediate catheter was an independent predictor of good outcome at 90 d (odds ratio 0.430, 95% confidence interval 0.196-0.947; P=0.036). Conclusion:In EVT of patients with acute anterior circulation large vessel occlusive stroke, the use of intermediate catheter can reduce the number of mechanical thrombectomy passes, improve recanalization rate of one-pass thrombectomy, reduce the rate of thrombus escape and second embolization, and then improve the outcome of patients.

Objective To investigate the efficacy and safety of mechanical thrombectomy for cardioembolic stroke (CES) due to atrial fibrillation.Methods Patients with CES admitted to Nanjing First Hospital from January 2015 to September 2017 were enrolled retrospectively.They were divided into the thrombectomy group and the intravenous thrombolysis alone group.The baseline data,the National Institutes of Health Stroke Scale (NIHSS) score at 24 h after treatment,rates of good outcome (defined as the modified Rankin Scale score 0-2) at 90 d after onset,hemorrhagic transformation and death between the two groups were compared.Multivariate logistic regression analysis was used to determine the independent factors for the outcomes in patients with CES.Results A total of 117 patients with CES were enrolket,inchding 65 (55.6％) in the thrombectomy group and 52 (44.4％) in the intravenous thrombolysis alone group.Sixty-two patients (53.0％) had good outcome and 55 (47.0％) had poor outcome.The proportion of patients whose NIHSS score decreased ＞ 4 within 24 h after treatment (58.4％ vs.26.9％;x2 =6.254,P =0.007),rates of good recanalization (78.5％ vs.57.7％;x2 =5.850,P =0.016),and good outcome at 90 d (63.1％vs.40.4％;x2 =5.972,P=0.015) in the thrombectomy group were significantly higher than those in the intravenous thrombolysis alone group,while there were no significant differences in the incidences of hemorrhagic transformation,symptomatic intracerebral hemorrhage and gastrointestinal bleeding,as well as mortality at 90 d.Multivariate logistic regression analysis showed that good recanalization (odds ratio [OR] 0.371,95％ confidence interval [CI]0.157-0.876;P =0.024) and thrombectomy (OR 0.398,95％ CI 0.179-0.883;P =0.024) were the independent factors for good outcome,while diabetes (OR 6.572,95％ CI 1.684-25.641;P =0.007) was the independent factor for poor outcome.Conclusion The efficacy of mechanical thrombectomy for patients with CES due to atrial fibrillation is superior to intravenous thrombolysis alone,and it dose not increase the mortality and complications.Good recanalization and mechanical thrombectomy are the independent factors for good outcome,while diabetes is an independent factor for poor outcome in patients with CES due to atrial fibrillation.

Objective To compare the safety and efficacy of directly thrombectomy and bridging therapy in patients with acute large vessel occlusion stroke within 4.5 h of onset.Methods From April 2014 to September 2017, patients with acute large vessel occlusion stroke treated with emergency mechanical thrombectomy in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School were collected. The patients who were eligible for intravenous thrombolysis and whose onset time was ≤4.5 h were selected. The propensity score matching analysis and McNemar test were used to compare the safety and efficacy of direct mechanical thrombectomy and bridging therapy. Results A total of 41 patients with acute large vessel occlusion stroke were enrolled.The final propensity score matching was 12 pairs.In the direct thrombectomy group, the time from door to femoral artery sheath placement was significantly reduced (P=0.03), but there was no significant difference in the good functional outcome rate, mortality rate, and incidence of symptomatic intracranial hemorrhage between the two groups of patients at 90 d(P>0.05).Conclusion It is safe and effective to start direct mechanical thrombectomy within 4.5 h of onset in patients with acute large vessel occlusion stroke and can significantly shorten the time of vascular recanalization.

Objective To investigate the effect and safety of intravenous thrombolytic therapy in the endovascular treatment of acute anterior circulation vascular occlusive stroke.Methods The clinical data of 226 patients with acute anterior circulation vascular occlusive stroke who underwent endovascular treatment in Nanjing First Hospital,Nanjing Medical University from May 2015 to May 2018 were retrospectively collected.According to whether or not intravenous thrombolysis was performed,the patients were classified into simple thrombectomy group (n=112) and bridging treatment group (n=114).The modified Thrombolysis in Cerebral Infarction Score (mTICI) was used to evaluate the vascular opening effect,and the blood vessel recanalization time,mTICI,the symptomatic intracranial hemorrhage rate,and the modified Rankin Scale (mRS) score at 90 days after surgery were evaluated.Results There were no statistically significant differences in gender,age,past history and National Institute of Health Stroke Scale score between the two groups (P＞0.05).There was no statistically significant difference in door-to-recanalization time between the two groups (P＞0.05).Excluding the patients with post-wake stroke and unexplained onset time,the simple thrombectomy group (n=63) and the bridging treatment group (n=1 11) showed statistically significant differences in onset-to-door time ((235.04± 182.64) min vs (102.48±60.51) min,t=7.01,P＜0.01)and onset-to-recanalization time ((405.31 ± 148.89) min vs (337.31 ± 117.65) min,t=3.32,P=0.01).The difference in number of thrombectomy between the simple thrombolysis group (2.55± 1.52) and the bridging treatment group (2.11± 1.48) was statistically significant (t=2.246,P=0.026).The total reperfusion (mTICI 2b/3) rate was 89.8％ (203/226),88.4％ (99/112) in the simple thrombectomy group and 91.2％ (104/114) in the bridging treatment group,with no statistically significant difference between the two groups (P＞0.05).The differences in symptomatic intracranial hemorrhage rate (8.93％ (10/112) vs 11.4％ (13/114)),mortality rate (12.5％ (12/112) vs 16.7％ (19/114)) and 90-day good functional outcome (mRS score 0-2;54.5％ (61/112) vs 55.8％ (63/114)) between the two groups were not statistically significant (P＞0.05).Conclusions In patients with acute anterior circulation vascular occlusive stroke undergoing endovascular treatment,intravenous thrombolysis can reduce the number of thrombectomy,not increase the door-to-recanalization time,the risk of symptomatic intracranial hemorrhage and mortality,and has similar good functional outcome as the simple thrombeetomy group.Therefore,intravenous thrombolysis is safe and effective for endovascular treatment of acute anterior circulation large vessel occlusive stroke.