Thrombolytic therapy for ischemic stroke has received wide attention. Now the thrombolytic therapy mainly includes intervenous thrombolysis, intra-arterial thrombolysis, combination of intravenous and intra-arterial thrombolysis, and mechanical thrombolysis. The review mainly presents the recent progress in this field.

Recently,increasing evidence suggests that gingivitis and periodontitis may be one of the etiological factors for some adverse pregnancy outcomes such as preterm birth,preeclampsia,fetal growth restriction and lateral miscarriage.Although there are some conflicting findings and potential problems regarding uncontrolled underlying risk factors,most of the clinical studies indicate a positive correlation of gingivitis and periodontitis with those complications.This review discusses the relationship and its possible pathological mechanism in order to better prevent the development of adverse pregnancy outcomes.

Objective To study the adsorption capability of chitosan(CTS)for Ni~(2+)in water.Methods The effects of different adsorption time(0-360 min),different temperature(25-60℃)and different initial pH value of the solution(4-8)on the adsorption were investigated.The adsorption kinetics and thermodynamics of CTS for Ni~(2+)in water were also studied and the IR of CTS and CTS-Ni~(2+)were determined.Results The maximal adsorption quantity could reach to 42.15 mg/g in the optimum condition that the temperature is 25℃,pH value was 7.0 and the adsorption time was 4 h.The adsorption kinetics showed that the pseudo-second-order equation was suitable for describing the adsorption of CTS for Ni~(2+)and the related correlation coefficients were more than 0.99.The calculated value of equilibrium adsorption quantity of Ni~(2+)was 45.05 mg/g.Study of adsorption thermodynamics showed that the linear regression equation of lnk and 1/T was lnk=-0.827 7/T+3.416 2,and the correlation coefficient was 0.998 9.The enthalpy change(△H~0)was 6.88 kJ/mol and the entropy change(△S~0)was 28.40 J/(mol?K).The IR showed that the coordination reaction occurred between-NH_2,-OH of CTS and Ni~(2+).Conclusion CTS can effectively remove Ni~(2+) in water.The adsorption of CTS for Ni~(2+)is spontaneous and endothermic.High temperature which is beneficial to the adsorption does not influence the adsorption quantity obviously.

Objective To study the mechanism of protective effects of total rhizoma panacis japonica saponins(tRPJS)on the cerebral ischemia injury.Methods The middle cerebral artery occlusion model (MCAO)in rats and cerebral ischemia-reperfusion models in mice were used to investigate the influence of tRPJS on the nitric oxide synthase(NOS)and inducible nitric oxide synthase(iNOS)activity in hippocampus region.Results tRPJS significantly decreased the contents of NOS and iNOS in hippocampus region of MCAO rat and cerebral ischemia reinfusion mouse.Conclusion tRPJS has significantly protective effects by decreasing NOS and iNOS.

Objective To investigate the efficacy and safety of intraarterial or intravenous recombinant tissue plasminogen activator(rtPA) for patients with acute cerebral infarction.Methods 60 patients consistent with the inclusion criteria were divided into intra-arterial thrombolysis group, intravenous thrombolysis group and control group. rtPA of 10～20 mg was infused over the course of 30 minutes in intra-arterial thrombolysis group. rtPA was administered in a dose of 0.7～0.8 mg/kg(maximum dose 50 mg),with 100% as a constant infusion over a period of 90 minutes in intravenous thrombolysis group.24 hours late, both groups were followed by subcutaneous injection of low molecular weight heparin(0.4 ml,twice daily) for 7 days. The control group received only routine treatment. European Stroke Scale(ESS) and Barthel Index(BI) were used to evaluate the recovery of neurological functions.Results The efficacy in both thrombolysis groups was significantly higher than that in the control group(all P 0.05).But in intraarterial group, the stenosis of intracranial arteries or extracranial arteries could be found, and new thrombosis could be prevented by transluminal stent-assistant angioplasty. One case of intracerebral hemorrhage and one case of asymptomatic hemorrhage occurred in intraarterial thrombolysis group. One case of asymptomatic hemorrhage was found in intravenous thrombolysis group and control group respectively. No dead case was found in the three groups.Conclusion Thrombolytic therapy of intra-arterial and intravenous rtPA can be performed safely and efficaciously in patients with acute cerebral infarction within 6 hours from the onset.

In order to explore the effect of internet of things on the management of cardiac rehabilitation /secondary prevention in patients with myocardial infarction .This article first introduces briefly about the impact and the development of cardiac rehabilita -tion/secondary prevention;then discusss in detail about its current status and limitation between at home and abroad ;meanwhile intro-duces the necessity and prospect of internet of things applied in cardiac rehabilitation /secondary prevention .

ObjectiveTo investigate rational surgical approaches for Siewert type Ⅰ adenocarcinoma of the esophagogastric junction (AEG),and analyze the prognostic factors.MethodsThe clinical data of 103 patients with Siewert type Ⅰ AEG who were admitted to the Renji Hospital from January 2005 to December 2009 were retrospectively analyzed.All patients were divided into transthoracic approach group (61 patients) and thoracoabdominal approach group (42 patients).The incidences of numbers of lymph node dissected and postoperative complications of the 2 groups were compared using the chi-square test,Fisher exact probability or the t test.The survival curve was drawn by the Kaplan-Meier method and the survival was analyzed using the Log-rank test.Prognostic factors were analyzed using the one-way analysis of variance and Cox regression model.ResultsNo perioperative death was observed in the 2 groups.There were significant differences in the number of lymph node dissected and number of metastatic lymph node between the 2 groups (t =2.18,2.29,P ＜ 0.05 ).There was no significant difference in splenic injury between the 2 groups (P ＞ 0.05 ).There were no significant differences in postoperative bleeding,anastomotic fistula and stricture,esophagogastric reflux,pulmonary infection and esteomyelitis between the 2 groups (x2 =0.07,0.94,0.22,1.41,0.17,P＞0.05).Of the 103 patients,97(94.2％) were followed up.The mean postoperative survival time was 26 months.The median survival time was 26 months,and the 3-yearsurvival rate was 35.9％.The 3-year survival rates of transthoracic approach group and thoracoabdominal approach group were 32.8％ and 40.2％,with no significant difference between the 2 groups ( x2 =0.37,P ＞ 0.05).The results of univariate analysis showed that radical or palliative resection,TNM stage,lymph node metastasis stage,tumor diameter and metastasis rate,degree of radical resection were independent factors influencing the prognosis of patients with Siewert type Ⅰ AEG (x2 =21.07,26.04,22.42,6.26,32.20,20.80,P＜0.05).The results of multivariate analysis showed that degree of TNM stage,lymph node metastasis rate and radical resection were independent factors influencing the prognosis of patients ( Wald =12.01,8.75,10.03,P ＜ 0.05 ).Conclusions Thoracoabdominal approach is a reasonable selection for patients with Siewert type I AEG.Degree of TNM stage,lymph node metastasis rate and radical resection were independent risk factors influencing the prognosis of patients.

Objective To investigate the dynamic variation of subsets of myeloid derived suppressor cells (MDSC) and their ratio in septic mice, and to discuss their role in the development of sepsis. Methods Male C57BL/6 mice were randomly divided into sepsis model group and sham group according to random number table. Polymicrobial sepsis was induced by using cecal ligation and puncture (CLP), while mice in sham group only underwent laparotomy and laparorrhaphy without CLP. Thirty mice in each group were used to observe living condition, and the 20-day survival rate was compared between the two groups. In addition, subsets of MDSC in peripheral blood, spleen and bone marrow were analyzed with flow cytometry for other 60 mice (12 mice at each time point, as 0, 3, 7, 12 and 20 days). Spleens were harvested at 7 days for weighing, and single cell suspension of spleen tissue was prepared for splenocyte counting. Histopathologic changes in spleen tissue and liver tissue were observed under light microscope after hematoxylin and eosin (HE) stain. Results ① No mice died in sham group within 20 days after the operation. On the other hand, 10 mice in model group died within 20 days, and the difference in survival rate between the two groups was statistically significant (100.0% vs. 66.7%, χ2 = 11.861, P = 0.001). ② The spleens in model group showed obvious enlargement and significantly outweighed as compared with those in sham group (mg: 413.33±41.63 vs. 111.67±17.56, t = 11.564, P = 0.000), and the total count of splenocytes was significantly higher than that in sham group (×109/L: 21.20±2.43 vs. 1.87±0.06, t = 13.578, P = 0.005). ③ Pathological sections with HE staining showed that the liver tissue and spleen tissue remained normal in sham group. In model group, the hepatic tissue showed acute inflammatory reaction, including tissue disruption, capillary congestion, infiltration of neutrophils, marked edema of hepatocytes and focal hepatocellular necrosis. Abnormalities were also found in the spleen tissue: the red pulp and white pulp were disordered, splenic sinus was congested with numerous red cells, the splenic capsule thickened, immature myeloid cells with circular nuclei proliferated in the subcapsular region and perivascular region, splenic cord and splenic sinus were infiltrated with a large number of hematopoietic cells. ④ No significant changes in the monocytic MDSC (M-MDSC) and granulocytic MDSC (G-MDSC), and their ratio were found in peripheral blood, spleen and bone marrow at every time point in sham group. On the other hand, in model group, the ratio of M-MDSC and G-MDSC was continuously increased in peripheral blood, spleen and bone marrow, and M-MDSC only slightly decreased at 20 days. On the other hand, the ratio of M-MDSC/G-MDSC rose at first followed by a decrease. The ratio of M-MDSC/G-MDSC in peripheral blood was higher than 1 from 3 days after the operation, reaching the peak at 12 days (compared with 0 day: 4.16±0.53 vs. 0.79±0.11, P < 0.05), while the ratio of M-MDSC/G-MDSC in spleen and bone marrow after CLP were lower than 1 at all time points, reaching the peak on 7 days after the operation (compared with 0 day: 0.70±0.06 vs. 0.25±0.02 in spleen, 0.39±0.06 vs. 0.11±0.01 in bone marrow, both P < 0.05), and then gradually decreased afterwards. Conclusion Subgroups of MDSCs were continuously aggregated in the peripheral blood, spleen and bone marrow, and their ratio rose first and decreased afterwards along with the development of sepsis, and the changes may reflect the change of immune status at different stages of sepsis.