Influence of CYP2C19 gene polymorphisms on the efficacy of clopidogrel treatment for the prevention of ischemic stroke following coronary stent implantation / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To assess the association of CYP2C19 gene polymorphisms with the incidence of ischemic stroke among patients receiving clopidogrel therapy following coronary stenting for coronary artery disease.</p><p><b>METHODS</b>Clinical data of patients receiving clopidogrel therapy after coronary stenting were retrospectively studied. For a case-control study, 137 patients with acute cerebral infarction and 122 non-stroke patients were selected. Based on the variants of the CYP2C19 gene detected by a DNA microarray assay, the patients were further divided into the wild-type group(CYP2C19*1/*1) and mutant group(defined by the presence of at least one loss-of-function allele, including CYP2C19*1/*2, CYP2C19*1/*3, CYP2C19*2/*2, CYP2C19*2/*3 and CYP2C19*3/*3). The incidences of ischemic stroke in the two groups were compared through a chi-square analysis. The influence of CYP2C19 gene polymorphisms and clopidogrel therapy on the incidence of ischemic stroke was analyzed through multivariable logistic regression.</p><p><b>RESULTS</b>A total of 259 patients were enrolled. The case and control groups showed no difference in terms of gender and age. There were 123 cases (47.5%) in the CYP2C19 wild-type group and 136 cases (52.5%) in the mutant group. The incidence of ischemic stroke of mutant group was significantly higher than that of wild-type group (59.9% vs. 44.3%, X2=6.398, P=0.042). Multivariate analysis revealed that loss-of-function polymorphisms of the CYP2C19 gene carried a 1.13 times greater risk for ischemic stroke compared to wild-type genotype (OR=2.13, 95%CI: 1.23-3.71).</p><p><b>CONCLUSION</b>The efficacy of clopidogrel for the prevention of ischemic stroke in post-coronary stent patients may be reduced by the insufficiency of the CYP2C19 gene. The dosage of clopidogrel therapy should be adjusted based on its polymorphisms.</p>

Therapeutic Observation of Bee-sting Therapy for Chronic Colitis / 上海针灸杂志

ObjectiveTo observe the clinical efficacy of bee-sting therapy in treating chronic colitis.MethodTotally 101 patients with chronic colitis were randomized into two groups, 39 cases in the control group and 62 cases in the treatment group.The treatment group was intervened by bee-sting therapy, while the control group was by medication. During the intervention, patients in the two groups were asked to keep bland diet and take more food rich in fiber instead of spicy and stimulating food. Abdominal pain, defecation pattern and frequency were observed during the study, and the clinical efficacies were compared a month later.Result The markedly effective rate was 82.3% in the treatment group versus 61.5% in the control group, and the therapeutic efficacyof the treatment group was significantly higher than that of the control group (P<0.05), and the improvements of pain relief and defecation occurred earlier in the treatment group than in the control group.ConclusionBee-sting therapy has advantages of faster pain relief and long-standing therapeutic efficacy.

Detection of bladder cancer by narrow band imaging cystoscopy: a meta-analysis / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the value of narrow band imaging (NBI) cystoscopy in detection of bladder cancer.</p><p><b>METHODS</b>Literatures on narrow-band imaging cystoscopy in diagnosis of bladder cancer, controlled clinical research was searched in PubMed, Cochrane Library,EMbase, and the Chinese Biomedical Literature Database. The literatures were selected according to the inclusion and exclusion criteria. The Meta-DiSc 1.4 software was used to review management and analysis.</p><p><b>RESULTS</b>The 8 studies met the inclusion criteria. On a per-people analysis, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR) of NBI cystoscopy and white light imaging (WLI) cystoscopy were respectively 0.943 (95%CI: 0.914-0.964) and 0.848 (95%CI: 0.803- 0.885), 0.847 (95%CI: 0.812-0.878) and 0.870 (95%CI: 0.831-0.903), 7.038 (95%CI: 3.357-14.754) and 6.938 (95%CI: 2.052-23.465), 0.054 (95%CI: 0.012-0.237) and 0.181 (95%CI: 0.091-0.361), 185.32 (95%CI: 45.714-751.260) and 42.931 (95%CI: 8.088-227.880). The areas under the curve (AUC) and Q* of NBI cystoscopy and WLI cystoscopy were 0.978 and 0.894, 0.934 and 0.825 respectively.</p><p><b>CONCLUSION</b>NBI cystoscopy is accurate with high diagnostic precision for diagnosis of bladder cancer. NBI cystoscopy is prior to WLI cystoscopy, but it needs more clinical evidence for further affirmance.</p>

Correlation between paraoxonase 1 Q192R polymorphism and ischemic stroke in Chinese Han population / 国际脑血管病杂志

Objective To investigate the correlation between large artery atherosclerotic stroke and paraoxonase 1 (PON1) Q192R polymorphism.Methods Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect the PON1 Q192R polymorphism of 120 patients with large artery atherosclerotic stroke (case group) and 117 healthy subjects (control group).Results There was significant difference in the genotype distribution of PON1 Q192R (x2 =18.727,P＜0.001) and the allele frequency distribution (x2 =16.427,P ＜0.001) between the case group and the control group.Multivariate logistic regression analysis showed that RR genotype was an independent risk factor for large artery atherosclerotic stroke (odds ratio 1.377,95％ confidence interval 1.032-2.185; P =0.026).Conclusions The allelic gene mutation rate of PON1 Q192R in patients with large artery atherosclerotic stroke was significantly higher than that in the healthy population.RR genotype is an independent risk factor for large artery atherosclerotic stroke.

Relation between NEW-TOAST classification and glucose level in patients with acute ischemic stroke / 中华神经科杂志

ObjectiveTo investigate the relation between each subtype of cerebral ischemic stroke classified by NEW-TOAST criteria and the levels of blood sugar. MethodsA retrospective study in 624 patients hospitalized with acute cerebral ischemic stroke. All the patients were classified using NEW-TOAST classification standard. Blood glucose in patients with different stroke subtypes was recorded, and analyzed for the incidence of abnormal glucose metabolism in each subtype. The correlation of glucose to blood sugar,blood pressure and blood fat was analyzed using odd ratio (OR) and 95％ confidence intervals (CI).Results(1) Among 624 patients, the most common stroke subtype by NEW-TOAST classificationis atherothrombosis (AT), followed by small arterial occlusion (SAO). One hundred and nineteen patients (19. 1％ ) had diabetes history; another 40 patients(7.5％ ) were newly diagnosed with diabetes in this study; and 71 patients ( 11.4％ ) were found to have glycoregulation abnormality. The incidence of abnormal glycometabolism was high in patients with AT ( 40. 4％ ) and SAO ( 39. 7％ ). ( 2 ) Association analysis between stroke subtypes and blood sugar: x2 =14. 83,P =0. 020, r =0. 152; in SAO patients, OR was 1. 925 (95％ CI 1. 392-2. 664) ; in the patients with AT, there was no correlation to blood sugar levels.Association analysis of high blood pressure in stroke subtypes: in AT patients, OR was 2. 874 (95％ CI 1. 957-4. 222) ; in SAO, OR was 1. 609 (95％ CI 1. 100-1. 235). Association analysis of high LDL-C in each subtype: OR in SAO was 1.419 (95％ CI 1.026-1. 962) ;No significant correlation of LDL-C in AT patients, P =0. 929 ; (3) There is significant difference of frequency of abnormal glycometabolism between stroke subtypes: x2 =17. 79 ,P =0. 000; between AT and SAO patients, x2 =0. 024,P =0. 877; between AT or SAO patients to other three subtypes, P ＜ 0. 05. ConclusionsAmong the subtypes of cerebral ischemic stroke by NEW-TOAST classification, AT and SAO are the most common subtypes.All the subtypes have correlation to the high level of blood sugar, and SAO has the highest correlation to blood sugar levels. High blood pressure may affect both large vessels and small vessels, while high LDL-C may mainly affect small vessels.

Abnormal glucose metabolism of patients with stroke in hospital in Foshan / 中华神经科杂志

Objective To investigate abnormal glucose metablism of patients with stroke in hospital in Foshan in order to design more reasonable diagnostic and treatment plans.Methods Our study was conducted in 557 patients with stroke who were in hospital in Neurology Department of the First Hospital of Foshan from June 2007 to April 2008 (all were consistent with diagnostic criteria of stroke).Sex,age,history of diabetes mellitus and smoking,height,weight,blood pressure,waist circumference,random blood glucose,fasting blood glucose and oral glucose tolerance test of all were recorded when they were in hospital Results All 368 individuals (66.1%) had abnormal blood glucose,including 185 cases (33.2%) of diabetes,183 cases (32.9%) of impaired glucose tolerance and 189 cases (33.9%) of normal sugar tolerance.Furthermore,about 89.1% (189/368) cases with impaired glucose regulation and 14.1% (26/185) cases of diabetes were misdiagnosed if they did not undergo oral glucose tolerance test.Conclusions Most of patients with stroke in Foshan have impaired glucose regulation,who have been diagnosed by oral glucose tolerance test,in favour of us to better design more reasonable diagnostic and treatment plans.

Influencial Factors of Early Treatment on Patients with Acute Stroke / 中国康复理论与实践

@#ObjectiveTo investigate the factors influencing early treatment of patients with acute stroke.Methods300 patients with acute stroke were investigated with questionnaire which including 28 factors influencing patients receiving early treatment.Results41.5% of patients were admitted within 6 hours after onset. The responses after onset, the time to the special hospital after stroke, and whether being able to describe symptoms and style of stroke correctly were independent influencing factors. Other factors such as age, sex and stroke severity had not obvious influence to admission delay.ConclusionEffective public health programs and establishment of effective emergent medical service system are measures to minimize the admission delay.

The relationship between homocysteine, polymorphism of its enzymes and cerebral thrombosis / 中国康复理论与实践

@# ObjectiveTo explore the relationship between plasma homocysteine (Hcy), polymorphism in 5,10-methylenetetrahydrofolate reductase (MTHFR) and cystathionine-β-synthase (CBS), and cerebral thrombosis.Methods87 subjects with first-ever acute cerebral thrombosis and 80 controls were studied. The plasma Hcy levels were measured using high-performance liquid chromatography-fluorescence detection (HPLC-FD). The polymorphism in MTHFR was determined by a polymerase chain reaction (PCR) assay and subsequent restriction enzyme digestion and that in CBS was determined by amplification refractory mutation system (ARMS).ResultsThe fast plasma Hcy level in the patient group was (15.28±4.33)μmol/L significantly higher than that ( 11.32 ±3.86)μmol/L in the control group (P<0.001). Different genotype had different influence on the plasma Hcy levels. There were no differences in genotype frequencies or allele frequencies between the patient group and control group (P>0.05).ConclusionCommon mutations in MTHFR, CBS G919A and CBS T833C lead to hyperhomocysteinemia. Hyperhomocysteinemia, but not common mutations in MTHFR and CBS is associated with the increased incidence of cerebral thrombosis.

Relationships between the plasma homocysteine levels and the polymorphisms of itsmetabolic enzymes and the cerebral infarction / 中华神经科杂志

Objective To investigate the influences of the genetic factors on the plasma homocysteine (Hcy) level, and the relationships between the plasma homocysteine levels and the polymorphisms in 5,10-methylenetetrahydrofolate reductase (MTHFR) and cystathionine ?-synthase (CBS) and the cerebral infarction. Methods All 87 patients with acute cerebral thrombosis and 80 controls were studied. Plasma Hcy levels were measured by high-performance liquid chromatography-fluorescence detection(HPLC-FD)from using baseline 810 high-performance liquid chromatograph. The presence of the MTHFR C677T mutation was determined by polymerase chain reaction (PCR) assay and subsequent restriction enzyme digestion, and the presence of the CBS G919A or CBS T833C was determined by amplification refractory mutation system. Results Fast plasma Hcy levels were shown higher in the patient group (15.3?4.3) ?mol/L as compared with those in the control group (11.3?3.9) ?mol/L (P

A study of the relationship between plasma homocysteine level and cerebral infarction / 临床神经病学杂志

Objective To explore the relationship between plasma homocysteine(Hcy) levels and cerebral infarction.Methods 87 patients with acute cerebral infarction and 80 controls were enrolled in the study. Plasma Hcy levels were measured by high-performance liquid chromatography-fluorescence detection(HPLC-FD) technology using Baseling 810 type high-performance liquid chromatograph.Results Fast plasma Hcy levels were higher in the patient group[(15.28?4.33)?mol/L] compared with those in the control group[(11.32?3.86) ?mol/L]( P

Relationship of plasma homocysteine, polymorphism in its enzymes genes and cerebral infarction in the elderly / 临床神经病学杂志

Objective To study the relationship of plasma homocysteine (Hcy), polymorphism in 5,10-methylenetetrahydrofolate reductase (MTHFR) and cystathionine-?-synthase (CBS) genes, and cerebral infarction in the elderly. Methods 61 elderly patients with first-ever acute cerebral infarction and 57 controls were studied. The plasma Hcy levels were measured using high-performance liquid chromatography-fluorescence detection (HPLC-FD). The polymorphism in MTHFR was determined by a polymerase chain reaction (PCR) assay and subsequent restriction enzyme digestion.CBS was determined by amplification refractory mutation system (ARMS). Results The fast plasma Hcy levels were higher in the patient group compared with those in the control group [(13.07?3.96)?mol/L vs (11.51?3.90)?mol/L, P 0.05). There were no differences in the plasma Hcy levels among the different genotypes. Conclusions The MTHFR, CBS gene mutations cannot lead to hyperhomocysteinemia in the elderly patients with acute cerebral infarction. Hyperhomocysteinemia is associated with the independent risk of cerebral infarction, however, mutations only in MTHFR and CBS cannot be ascertained to be independent risk of cerebral infarction in the elderly.