The incidence of early neurological deterioration of acute ischemic stroke is higher and the clinical prognosis is poor.There are no effective prevention and treatment measures yet.The prognosis may be improved if early predicts by serum biomarkers and actively manages.This article reviews the serum biomarkers of early neurological deterioration in ischemic stroke.

In 1990,the concept of microembolic signal (MES) was put forward by Spencer et al for the first time.In 1995,the expert consensus of diagnostic criteria for MES was published in Stroke.Since then,microemboli detection had been widely used as the intraoperative monitoring indicators in cerebral angiography,intravascular stenting,and carotid endarterectomy for the prevention of thrombotic events in patients with carotid artery stenosis.In recent years,microemboli detection has become an evaluation means for carotid stenosis surgery,interventional treatment and drug antithrombotic therapy.

Current anti-hepatoma agents in clinical aplication have not been proved to be satisfactory. The major obstacles are low efficacy, toxicity, and drug resistance. Identifying new drug targets and discovering new agents accordin gly with high efficacies and low toxicities have become the key part of the solu tion. Recent studies have shown that hyper-methylation of tumor suppressor gene s, interaction between hepatocyte growth factor and its receptor, vascular endothelial growth factor and its receptor, as well as cyclooxygenase-2 might be potential targets for hepatomachemotherapy. Indeed, agents acting on these targets have shown to be effective. In addition, other agents such as As 2O 3 have also shown th eir activities against hepatoma.

The epidermal growth factor receptor (EGFR) family of receptor tyrosine kinases have close connection with the initiation, progression and progn osis of various malignancies. Recently, several approaches such as monoclonal an tibodies, bispecific antibodies, low molecular weight tyrosine kinase inhibitors and gene therapy targeting the EGFR family of receptors for anti-tumor therapy have been developed, some of which are currently undergoing clinical trials. Th ey are generally well tolerated, and have shown encouraging clinical efficacy in a variety of tumor types.

Asymmetric dimethylarginine(ADMA)is a nitric oxide synthase(NOS)inhibitor.ADMA is formed by methylation of L-arginine residues.It innbits the formation of vasoactive substances(nitric oxide),resulting in endothelial dysfunction and vaseular diseases.A number of studies have suggested that ADMA may be a risk factor for stroke.The expression of ADMA increases significantly in patients with hyperhomocysteinemia,carotid stenosis and cardiovascular disease.

The mechanisms underlying early neurological deterioration (END) after ischemic stroke are not clear.There are no reliable predictive factors and effective preventive measures for END.The glutamatemediated excitotoxicity plays a very important role in the cascade reaction of ischemic events.High level of glutamate in plasma is one of the important predictors for END.Studies have shown that the polymorphism in the promoter of the excitatory amino acid transporter-2 gene is a potential cause for individual susceptibility to END.Some therapeutic strategies of interrupting the glutamatergic pathways may be as the strategies of intervention END.

Intracranial atherosclerotic stenosis mostly occurs in Asians,blacks and Hispanicsis,which is the most important reason for the occurrence and recurrence of ischemic stroke.The current studies mainly concentrate on the aspect of the relationship between the intracranial atherosclerotic stenosis and the traditional risk factors.With the development of genetic technology,the relationship between the genetic factors and intracranial atherosclerotic stenosis has also received increasing attention.This article reviews the advances in research on the traditional risk factors for intraeranial atherosclerotic stenosis and genetic research.

Local intra-arterial thrombolysis has better efficacy in treating acute ischemic stroke, including cardiogenic embolism, and the safety of combined intravenous and intra-arterial thrombolysis is higher. Recent studies have suggested that the combination of angioplasty and local intra-arterial thrombolysis plays an important role in the treatment of acute ischemic stroke during an acute emergency.

With the development of medical sciences, the concept of prevention and treatment of ischemic stroke is being updated continuously. However, there are still some gaps between the available evidence and clinical practice in its strategies of prevention and treatment. The article performs evidence-based analysis for the available evidence in the prevention and treatment of ischemic stroke in accordance with the scientific levels of evidence classification so as to narrow the gaps between the evidence in this field and clinical practice.

Objective: To explore the operating procedure for designing the randomized scheme of multi-center clinical trial. Methods: SAS randomized program was written in accordance with the randomized parameters and stipulated randomized rules of centers, cases and blocks. The design of the SAS randomized program adopts the same seed in multi-hierarchical factors, and the principles of succession and repeatability of the randomized code. Results: This program can produce randomized numbers and complete the design and permutation of randomized codes in a standard and convenient way.