Angiotensin-converting enzyme gene polymorphism and middle cerebral artery stenosis in a Chinese Han population

The angiotensin-converting enzyme gene is a candidate gene of stroke. The present study involved 62 healthy volunteers and 148 patients with middle cerebral artery stenosis as confirmed by brain color ultrasound from a Han population in North China, and determined the peripheral blood angiotensin-converting enzyme genotype using PCR-restriction fragment length polymorphism analysis. The results showed that the frequencies of the DD genotype and D allele were increased in patients with middle cerebral artery stenosis, but the difference was not statistically significant compared with healthy controls. The findings of this study on the relationship between stroke genes and middle cerebral artery stenosis indicate no significant correlation between the frequencies of the DO genotype and D allele of angiotensin-converting enzyme and middle cerebral artery stenosis in this Han population from North China. In the future, studies will be carried out to investigate correlations between multiple stroke candidate gene synergy and middle cerebral artery stenosis to provide a foundation for the development of gene therapy.

Increased globulin and its association with hemorrhagic transformation in patients receiving intra-arterial thrombolysis therapy

Previous studies have identified a diverse set of predisposing factors for the occurrence of hemorrhagic transformation （HT）, but the independent clinical predictors of HT after intra- arterial thrombolysis have not been determined. In this retrospective study, we investigated the characteristics of patients with or without HT who had received intra-arterial thrombolysis therapy, using biochemical analysis, renal function test, routine blood test, blood lipid test, coagulation blood test, liver function test, random blood glucose test, time- window for intra-arterial thrombolysis, recanalization, National Institutes of Health Stroke Scale （NIHSS） score and systolic blood pressure before intra-artedal thrombolysis. The mortality rates were similar in the HT and non-HT groups （P = 0.944）. In the single- factor analysis, patients with a higher globulin level （P 〈0.002）, prothrombin time activity percentage （PTA; P = 0.026）, and NIHSS score （P = 0.002）, had a significantly increased risk of developing HT. In the multifactor logistic regression model involving globulin level, PTA, white blood cell count, and NIHSS score, the globulin level （P 〈0.001; OR, 1.185; 95% confidence interval [CI], 1.090-1.288）, PTA （P = 0.018; OR, 1.016; 95% CI, 1.003-1.029）, white blood cell count （P = 0.025; OR, 1.097; 95% CI, 1.012-1.190） and NIHSS score （P = 0.003; OR, 1.097; 95% CI, 1.031-1.166） were significantly increased in the HT group. The increase in globulin level is an independent risk factor for HT in patients receiving intra-arterial thrombolysis. The possible mechanisms may involve inflammatory cytokines, matrix metalloproteinase 9, and positive acute-phase reactants synthesized by the liver.

Compromised cerebrovascular modulation in chronic anxiety:evidence from cerebral blood flow velocity measured by transcranial Doppler sonography

Objective Cerebral autoregulation （CA） is the mechanism by which constant cerebral blood flow is maintained despite changes in cerebral perfusion pressure. CA can be evaluated by dynamic monitoring of cerebral blood flow velocity （CBFV） with transcranial Doppler sonography （TCD）. The present study aimed to explore CA in chronic anxiety. Methods Subjects with Hamilton anxiety scale scores 〉14 were enrolled and the dynamic changes of CBFV in response to an orthostatic challenge were investigated using TCD. Results In both the anxious and the healthy subjects, the mean CBFV was significantly lower in the upright position than when supine. However, the CBFV changes from supine to upright differed between the anxious and the healthy groups. Anxious subjects showed more pronounced decreases in CBFV with abrupt standing. Conclusion Our results indicate that cerebrovascular modulation is compromised in chronic anxiety; anxious subjects have some insufficiency in maintaining cerebral perfusion after postural change. Given the fact that anxiety and impaired CA are associated with cardiovascular disease, early ascertainment of compromised cerebrovascular modulation using TCD might suggest interventional therapies in the anxious population, and improve the primary prevention of cardiovascular disease.

Effect of haemodynamics on the risk of ischaemic stroke in patients with severe vertebral artery stenosis

Objectives Endovascular treatment strategies to optimise individualised care for patients with vertebral artery(VA)stenosis need to be revisited.This study aimed to investigate the relationship between net VA flow volume(NVAFV)and the risk of posterior circulation infarction(PCI)in a high-risk patient population.Methods We screened 1239 patients with extracranial VA stenosis,of whom 321 patients with severe VA V1 segment stenosis(≥70%)were enrolled in our study.We restratified the patients based on NVAFV and contralateral VA stenosis grades to analyse the proportion of each PCI mechanism-large artery atherosclerosis and branch artery occlusive disease.Furthermore,we estimated the incidence of recurrent ischaemic stroke between groups with different NVAFV over a follow-up period of 2 years.Results NVAFV was lower in the PCI group.Multiple logistic regression analysis showed that NVAFV is an independent risk factor for PCI and that the OR for PCI for the lowest NVAFV(<112.8 mL/min)was 4.19(1.76 to 9.95,p=0.001).In patients with severe carotid artery disease,the OR for the lowest NVAFV was 14.03(3.18 to 61.92,p<0.001).The lower NVAFV group had a higher incidence of recurrent ischaemic stroke events than the higher NVAFV group(HR 2.978,95%CIs 1.414 to 6.272).Conclusion Our study demonstrated that NVAFV,as estimated by colour duplex ultrasonography,was associated with the incidence of PCI and subsequent ischaemic events and that a high-risk population could be identified for further posterior circulation revascularisation.