Cerebral infarction is a polygenic disease caused by genetic factors and environmental factors.The first discovery in the Icelanders is that the ALOX5AP and PDE4D gene polymorphism may be associated with cerebral infarction.So far,many conclusions of foreign studies are still controversial.This article will summarize the research status and the progress of these two genes.

Objective To explore the preventive role of low molecular weight heparin in progressive ischemic stroke.Methods 203 patients with cerebral infarction within 72 hours of the onset were randomly divided into low molecular weight heparin(LMWH) group and routine treatment group.LMWH group was administered subcutaneously twice daily for 5~10 days with 0.4 mL LMWH on the basis of routine treatment. The activities of plasminogen and coagulation factor Ⅹ and the indexes of hemorrheology were measured before and after the treatment, the neurologic function deficits of patients with progressive ischemic stroke were evaluated.Results 11 cases for progressive ischemic stroke were occurred in LMWH group, 23 cases in routine treatment group for progressive ischemic stroke, there was remarkable difference between the two groups( P

Objective: To investigate the effects of carotid arteriosclerosis on cognitive functions and current prognosis in patients with cerebral infarction. Methods: Extracranial carotid arteries were assessed using dopple ultrasongraphy in 112 patients with cerebral infarction. Cognitive functions were evaluated with the Mini-Mental state Examination (MMSE) and five neuropsychological tests assessing memory, attention, calculation psychomotor rapidity and visuospatial perception. Deficits in neurological functions were assessed on admission and 3 to 4 weeks. Results:All neuropsychological measures were found to be poorer in patients with carotid arteriosclerosis than those with no carotid arteriosclerosis, especially in cases with severe carotid arteriosclerosis and severe carotid stenosis. There was a positive relationship between severity of carotid arteriosclerosis and change in cognitive functions. The scores of SSS were higher on admission in cerebral infarction patients with carotid arteriosclerosis. Recent prognosis was also poorer in patients with carotid arteriosclerosis.Conclusions: Significant effect of carotid arteriosclerosis was shown on cognitive functions of patients with cerebral infarction. As cerebral ischemic injury is severe, prognosis in cerebral infarction patients with carotid arteriosclerosis is poor.

Objective To study the clinical significance of carotid atherosclerosis and the relationship between carotid atherosclerosis and cerebral infarction recurrence.Methods Carotid atherosclerosis was assessed using doppler ultrasongraphy in 312 patients with cerebral infarction, the duration of following up was 12 to 18 months,and the characteristics of carotid atherosclersis was compared to patients with or without recurrence cerebral infarction.Results Of the 312 patients with cerebral infarction, 61 patients suffered from new cerebral infarction during following up period, the recurrence rate in patients with atherothrombotic brain infarction was higher than those with lacunar infarction, and the cerebral infarction recurrence usually occurred in the same side of initial stroke of the 57 patients with severe carotid atherosclerosis, 26 patients had a sufference of new infarction, of the 48 patients with high grade stenosis, 25 had a sufference of new cerebral infarction, of the 42 patients with ulcerated plaque, 23 had sufference of new cerebral infarction,showing a recurrence rate significantly higher than those patients with non carotid atherosclerosis or those with mild carotid atherosclerosis. The logistic regression analysis showed that the levels of carotid atheroslerosis , stenosis and ulcerated plaque were positively related to the cerebral infarction recurrence.Conclusions There is a positively relationship between carotid atherosclerosis and cerebral infarction recuurrence, and the level of carotid atherosclerosis is a risk factor of cerebral infarction recurrence.It serves as a risk marker of cerebral infarction recurrence.

ObjectiveTo study the effect of angiotensin Ⅱ type 1 receptor antagonist (ARB) losartan on reducing the incidence of stroke in patients which suffer from hypertension and atrial fibrillation(AF).MethodsProspective randomized analysis was used to divide one hundred and eighty hypertemion patients with atrial fibrillation into two groups.ARB treatment group was treated with losartan (n =90) and beta-blockers treatment group was treated with metoprolol ( n =90),all patients were treated for three years and followed up.Blood pressure,pulse pressure,incidence of stroke and myocardial infarction and mortality of cardiovascular events were evaluated.ResultsAfter antihypertensive treatment,blood pressure was reduced in two groups,the pulse pressure in losartan group was reduced obviously( all P ＜0.01 ).The incidence of stroke and myocardial infarction and mortality of cardiovascular events in losartan group were 22.2％,10.0％ and 13.3％,respectively,lower than that in metoprolol group 70.0％,40.0％ and 44.4％ ( all P ＜0.01 ).ConclusionLosartan reduced the incidence of stroke in the hypertension patients with AF.

Objective To investigate the incidence of the aspirin resistance in secondary prevention of cerebral infarction, and the relationship between the aspirin resistance and the cerebral infarction recurrence or other vascular events during the follow-up periods.Methods Aspirin were taken from the first day of admission in 600 patients with cerebral infarction.The platelet aggregation rate was measured after 7-10 days to screen the patients with aspirin resistance or aspirin sensitivity.All patients were followed up for 6 to 24 months and the cerebral infarction recurrence and other vascular events were recorded.Logistic regression model was used to estimate the risk factors of aspirin resistance, vascular events and prognosis.Results Of 600 patients, 150 (25.0% ) patients were resistant to aspirin and 450 (75.0% ) patients were sensitive to aspirin.The proportion of female and diabetes patients, and the level of low density lipoproteins (LDL) in the aspirin resistance group were higher than those in the aspirin sensitivity group.Diabetes (OR = 2.58, 95% CI 1.37-4.85, P=0.003) and high LDL level (OR = 1.89, 95% CI 1.21-2.93, P = 0.005 ) were independent risk factors of aspirin resistance.The incidence of cerebral infarction recurrence and myocardial infarction and all-cause mortality in the aspirin resistance group were all higher than those in the aspirin sensitivity group.Diabetes ( OR = 2.47, 95% CI 1.36-4.65, P = 0.003 ) , atherothrombosis cerebral infarction (OR = 2.13, 95% CI 1.24-3.95, P = 0.023) and aspirin resistance (OR = 3.86,95% CI 1.79-5.87, P = 0.002) were independent risk factors of vascular events during the following-up period.In the patients with aspirin resistance, the risk of the recurrence of vascular events increased 3.86 times.Conclusions The incidence of aspirin resistance is high in secondary prevention of cerebral infarction.Aspirin resistance is closely correlated with cerebral infarction recurrence and other vascular events.

Objective To investigate 4 variants single nucleotide polymorphisms (SNPs) of 5-lipoxygenase-activating protein(ALOX5AP) in lipoxygenase pathway and in cytochrome P450 pathway as susceptibility genes for stroke in a southeastern Chinese population,and evaluate the associations between susceptibility genes and cerebral infarction,to find whether gene-gene interactions increase the risk of cerebral infarction.Methods By case-control study,two hundred and ninety-two patients with cerebral infarction and 259 healthy control subjects were included.Eight variants in 5 candidate genes were examined for stroke risk,including the SG13S32 (rs9551963),SG13S42 (rs4769060),SG13S89 (rs4769874),and SG13Sl14 (rs10507391) variants of the ALOX5AP gene,the G860A (rs751141) variant of the soluble epoxide hydrolase (EPHX2) gene,the A1075C (rs1057910) variant of the CYP2C9 *2 gene,the C430T (rs1799853) variant of the CYP2C9* 3 gene,and the A6986G (rs776746) variant of the CYP3A5 gene.Gene-gene interactions were explored using generalized multifactor dimensionality reduction (GMDR)methods.Results There were no statistically significant differences in the frequencies of the genotypes of the 8 candidate genes.The GMDR analysis showed a significant gene-gene interaction between SG13S114 and A6986G,with scores of 10 for cross-validation consistency and 9 for the sign test (P =0.011).These genegene interactions predicted a significantly higher risk of cerebral infarction (adjusted for age,hypertension,and diabetes mellitus;OR =1.804,95％ CI 1.180-2.759,P =0.006).Conclusions A two-loci gene interaction confers significantly higher risk for cerebral infarction.The combinational analysis used in this study may be helpful in the elucidation of genetic risk factors for common and complex diseases.

Objective To investigate the correlation between two single nucleotide polymorphisms of the leukotriene A4 hydrolase (LTA4H) gene (rs2660845 and rs2540493) and risk of ischemic stroke in population of southern Zhejiang Province.Methods A total of 300 ischemic stroke patients and 300 healthy controls,recruited from the Department of Neurology,Third Affiliated Hospital of Wenzhou Medical University between September 2010 and June 2013,were enrolled in this study.Two single nucleotide polymorphisms of the LTA4H gene (rs2660845 and rs2540493) were analyzed by polymerase chain reaction and matrix-assisted laser desorption/ionization time of flight,respectively.Sixty-seven patients and thirty controls were randomly selected (complete randomization) and detected the serum leukotriene B4 (LTB4)concentration by ELISA method.Results There was no evidence of association between the two variants of LTA4H gene and the risk of ischemic stroke or its TOAST (Trial of Org 10 172 in acute stroke treatment)subtypes (P ＞ 0.05).Analysis of LTB4 levels revealed that there was no statistically significant difference in serum LTB4 concentration between patients (n =67) and controls (n =30; 0.991 ± 0.305 vs 1.035 ± 0.498 ; P =0.692),and no statistically significant difference in LTB4 concentration was found among the three genotypes of rs2660845 as well (AG genotype vs AA genotype vs GG genotype:0.938 ± 0.269 vs 1.038 ± 0.268 vs 1.043 ± 0.383 ; P =0.401).Conclusion The present study suggests that there is no association between the two polymorphisms in the LTA4H gene and risk of ischemic stroke in population of southern Zhejiang Province.

Objective To explore the clinical value of endovascular embolization treatment with Guglielmi detachable coil (GDC) for the patients with ruptured intracranial aneurysm. Methods 15 cases of patients with ruptured intracranial aneurysm were undengone endovascular embolization with GDC. According to Hunt Hess classification, 8 belonged to grade Ⅰ, 6 for grade Ⅱ, and 1 in grade Ⅳ. All the patients were diagnosed with cerebral DSA and CT scan. Results 13 cases of the 15 patients (86.7%) were succeeded in embolization with GDC. Other 2 cases were failed with embolization, died of hemorrhage on the fourth day and in fourth month respectively. There were no complications and hemorrhage in the 13 cases in the follow up 3 to 25 months. Other follow up methods all showed normal appaerance and position including skull X ray films of 13 patients and carotid artery DSA of 2 patients at an interval of 6 months. Conclusion Endovascular embolization treatment with GDC is an effective method for ruptured intracranial aneurysm to avoid hemorrhage.

Objective To investigate the correlation between prostacyclin synthase (prostaglandin I2 synthase, PGIS) gene rs5602 single nucleotide polymorphism and ischemia stroke in Chinese Han population. Methods The patients with ischemia stroke and healthy controls in Chinese Han population were enroled. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF MS) was used to detect the rs5602 polymorphism. Results A total of 297 patients with ischemic stroke (male 177 and female 120) and 291 healthy controls (male 165, female 126) over the same period were enroled. The frequencies of TT genotype (31. 1% vs. 43. 6% ; χ2 = 5. 773, P = 0. 016) and T alele (56. 8% vs. 65. 8% ; χ2 = 5. 793, P = 0. 016) in the male patients with ischemic stroke were significantly lower than those in the male healthy controls. Multivariate logistic regression analysis showed that the rs5602 TT genotype was a protective factor for ischemic stroke in male (odds ratio 0. 260, 95% confidence interval 0. 118-0. 570; P = 0. 001). Conclusions PGIS gene rs5602 polymorphism is associated with ischemic stroke in male in Chinese Han population.