Clopidogrel is an antiplatelet drug widely used in clinical practice now.It has been used as the secondary prevention medication for myocardial infarction,ischemic stroke,and peripheral vascular disease.However,the anti-platelet aggregation effect of clopidogrel has significant individual differences.A large part of patients have clopidogrel resistance phenomenon.The mechanism of clopidogrel resistance is not fully understood.The genetic polymorphism is an important cause of clopidogrel resistance,including ABCB1,CYP2C19,CYP3A4,CYP3A5,P2Y12,and ITGB3.

In recent years,stem cell transplantation for the treatment of ischemic stroke has become a hot topic.However,since embryonic stem cells (ESCs) transplantation is limited by the ethics and law,stem cell research was once in trouble.Induced pluripotent stem cells (iPSCs) are a class of cells by introducing the specific transcription factors into somatic cells,which have the similar characteristics with ESCs,and also avoid the ethical issues and immunological rejection,making them become the most ideal replacer of ESCs.Although the current research on iPSCs has made some progress,their induction efficiency and safety issues remain to be resolved.This article reviews the status quo,mechanisms,and problems faced in clinical practice for iPSCs transplantation in the treatment of ischemic stroke.

MicroRNAs (miRNAs) are endogenous non-coding RNAs composed of 18-25 nucleotides,and they may play a role in gene regulation through completely or partially binding to target gene mRNA complementary sequences and make it degrade or prevent its translation.miRNAs play important roles in the onset and pathophysiological processes of ischemic stroke.This article reviews the roles of miRNAs in the etiology of ischemic stroke and pathophysiological mechanisms after stroke,and the potential application of miRNAs is prospected.

Objective To investigate the dynamic change of serum high sensitive C-reactive protein (hsCRP) after carotid artery stenting (CAS) and its correlation with in-stent restenosis.Methods The serum hsCRP levels were determined before procedure,at 12 hours,7 days,3 and 6 months after procedure in patients who underwent CAS in the Department of Neurology,Jinling Hospital,Nanjing Their cerebral angiography was reexamined and whether there was in-stent restenosis after 6 months was observed.Results Eighty-four patients treated with CAS were included in the study.Fifteen (24％) had in-stent restenosis after CAS.The stenosis in 3 of them was ＞ 50％,and the stenosis m 12 of them was 30％ to 50％.The serum hs-CRP levels in all patients after procedure were significantly higher than those before treatment (all P ＜ 0.01 ),and they were significantly lower at 6 months after procedure than before treatment (all P ＜0.01).Univariate analysis showed that the proportion of diabetes in the restenosis group was significantly higher than that in the non-restenosis group (P＜0.01).At 7 days (8.83 ± 1.94 mg/L vs.6.77 ± 1.63 mg/L,t =14.398,P=0.044),3 months after procedure (8.26 ± 1.32 mg/L vs.4.58 ± 1.45 mg/L,t =17.569,P =0.008) and 6 months after procedure (7.04 ± i.07 mg/L vs.3.12 ± 1.28 mg/L,t =21.867,P =0.003),the serum hs-CRP levels in the restenosis group were significantly higher than those in the non-restenosis group,and the difference of the serum hs-CRP level (△ hs-CRP) before procedure and at 6 month after procedure was significantly lower than that in the nonrestenosis group (0.85 ± 0.13 mg/L vs.4.89 ± 0.94 mg/L,t =16.987,P =0.000).Multivariate logistic regression analysis showed that /hs-CRP (odds ratio [ OR] 2.392,95％ confidence interval [ CI] 1.538 -3.513; P =0.009) and diabetes (OR 1.840,95％ CI 1.372 -2.241; P =0.023) were the risk factors for instent restenosis.Conclusions The serum hs-CRP level increased significantly at 12 hours after CAS procedure,and then decreased continuously.At 6 months after procedure,the more decrease of the serum hs-CRP level,the lower risk of occurring in-stent restenosis was.

Objective To assess true vocal fold (TVF) length and cricothyroid distance(CTD) with ultrasonography in male-to-female (MtF)transsexual voice surgery.Methods Five MtF transsexuals were divided into two groups according to their voice change surgery methods.High-frequency ultrasonography was used to measure the length of true vocal folds and cricothyroid distance.Measurements were compared pre-and post-surgery, and correlations with fundamental frequency (F0) were analyzed.Results The ultrasonography measurements clearly showed the laryngeal structure and TVF measurement marks.After vocal fold shortening and retrodisplacement of anterior commissure(VFSRAC) surgery, the ultrasonographic measurements showed that the shortening length of TVF were 0.37 cm(21%),0.69 cm(37%) and 0.40 cm(25%), respectively.The CTD in ultrasonographicimages were 1.0 cm pre-surgery of cricothyroid approximation (CTA) and-0.33 post-surgery of CTA.The displacement of cricoid cartilage was 1.33 cm, which was consistent with the laryngeal CT image.Conclusion Both TVF length and CTD can be shown by high-frequency ultrasonography, which can be used to quantitatively assessment and follow-up MtF transsexual voice surgery.

Stroke is a class of complex diseases,and it is the result of the combined action of environmental and genetic factors.With the development of molecular biology techniques,a large number of candidate genes associated with stroke and susceptibility loci have been identified.This article reviews the recent progress in research on the genetics of different subtypes of ischemic stroke.

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 ToinvestigatetherelationshipbetweenmuscleRASoncogenehomolog (MRAS)genepolymorphismandyoungpatientswithischemicstroke.Methods Atotalof243young patients with ischemic stroke from Nanjing Stroke Registry Program from December 2009 to October 2012 were enrolled retrospectively. At the same time,512 age-and sex-matched healthy controls were selected. The polymorphisms of MRAS genes rs3755751 and rs9289559 loci were analyzed by the modified multiplex PCR-ligase detection reaction assay. The genotype of each locus and the allele frequencies were analyzed and compared. Results (1)The frequencies of AA,AG and GG genotypes for rs3755751 in the stroke group (n=243)were 7. 4%(n=18),37. 0%(n=90),and 55. 6%(n=135),respectively. There were no significant differences compared with those (6. 4%[n=18],36. 9%[n=189]and 56. 6%[n=190]) in the control group (n=512)(P>0. 05). The frequencies of AA,AG and GG genotypes for rs9289559 in stroke group were 7. 0 (n=17)%,42. 0%(n=102),and 51. 0%(n=124),respectively. There were no significant differences compared with 6. 1%,(n=31)37. 9%(n=194),and 56. 1%(n=287)in the control group (P>0. 05). (2)Further construction of an effect model (AA vs. AG+GG and GG vs. AG+AA),there was no significant difference between the stroke group and the control group (P >0. 05 ). Analyzing the effects of different genotypes on plasma lipid levels showed that the high-density lipoprotein cholesterol level of the GG genotype subgroup in the young ischemic stroke group was significantly higher than that rs3755751 of the AG +AA genotype subgroup (OR,6. 80,95%CI 2.18-21.27, P=0. 001 ). Conclusions MRAS gene polymorphism may have no significant correlation with the genetic susceptibility in young patients with ischemic stroke. Polymorphism of rs3755751 may be correlated with the level of serum high-density lipoprotein cholesterol.

Objective To investigate the efficacy of endovascular stenting complicating other craniocervical artery stenosis (OCAS) in patients with atherosclerotic subclavian artery stenosis/occlusion (SASO).Methods The clinical data of receiving endovascular stenting therapy in patients with atherosclerotic SASO were analyzed retrospectively,including demographic characteristics,vascular risk factors,complicating OCAS,as well as stenting for SASO and follow-up results.Results A total of 65 patients with SASO were included in the study,47 of them were males and 18 were females (mean age of 64 ± 9 years).Forty-six patients (70.8％ ) complicated OCAS.The overall technical success rate was 95.4％,in which the patients with stenosis (n =58) were 98.1％ and those with complete occlusion (n =7) were 71.4％.The complications occurred in 4 patients.There were no intervention-related serious stroke and death.Mean follow-up was 24 ± 19 months,6 patients with restenosis and 10 with clinically relevant events were found.They mainly occurred in patients with OCAS.The first angioplasty patency rates were 94.5％,81.8％ and 81.8％,respectively at 12 and 24 months after procedure and at the end of follow-up.The survival rates of no clinically relevant events were 92.9％,74.6％ and 68.3％,respectively.Conclusions Endovascular stenting can safely and effectively treat the SASO patients complicating OCAS.Its overall clinical outcome may be affected to some extent by OCAS.

Objective To observe the therapeutic effect of Wenwei Zhitong Granules ( WZG) combined with acupoint moxibustion for spleen-stomach deficiency-cold ulcer disease. Methods A total of 120 cases of spleen-stomach deficiency-cold ulcer disease were evenly randomized into treatment group and control group. Both groups were given conventional treatment with western medicine plus oral use of WZG, and the treatment group was given acupoint moxibustion additionally. The treatment lasted for 8 weeks. The therapeutic effect on gastroscopy and on relieving stomachache, and the adverse reaction were observed. Results ( 1) The total effective rate showed by gastroscopy was 95.00% in the treatment group and was 85.00% in the control group, the difference being significant (P<0.05). (2) Total effective rate for relieving stomachache was 98.33% in the treatment group and was 88.33% in the control group, the difference being significant ( P<0.05). ( 3) During the treatment, both groups had 2 cases of adverse reaction of nausea, poor appetite and loose stool after oral use of Clarithromycin and Amoxicillin, and then the adverse reaction disappeared after two weeks. No other reverse action was found. Conclusion WZG combined with acupoint moxibustion is effective, convenient and safe for the treatment of spleen-stomach deficiency-cold ulcer disease by promoting the healing of ulcer and relieving stomachache.