Independent Risk Factor For Cerebral Infarction Research Articles

Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction.

This study investigated the relationship between ATP-binding cassette sub-family B member 1 (ABCB1) and OLIG2 single nucleotide polymorphism (SNP) and neurological injury severity and outcome in cerebral infarction (CI). The neurological injury severity of 298 CI patients was evaluated by the National Institutes of Health Stroke Scale. The prognosis of CI patients at 30 days after admission was evaluated by the modified Rankin Scale. And 322 healthy people were selected as the control group. The SNPs of the ABCB1 gene (rs1045642) and OLIG2 gene (rs1059004 and rs9653711) were detected by TaqMan probe PCR, and the distribution of SNPs genotype was analyzed. SNP rs9653711 was correlated with CI. Recessive models of rs1045642 and rs9653711 were correlated with CI. The genotypes of rs1045642 and rs9653711 and genetic models were associated with CI severity. rs1045642 had no correlation with CI prognosis, while rs9653711 had less correlation. The genotype distribution and recessive model were associated with CI prognosis. SNP rs1059004 was not associated with CI severity and prognosis. Alcohol consumption, hypertension, diabetes, hyperlipidemia, and high levels of homocysteine (HCY) were independent risk factors for CI, while hypertension, hyperlipidemia, and HCY were associated with poor prognosis of CI. ABCB1 rs1045642 and OLOG2 rs9653711 are associated with CI severity.

Apolipoprotein E Gene Polymorphism Effects on Lipid Metabolism and Risk of Cerebral Infarction in Northwest Han Chinese Population.

The apolipoprotein E (ApoE) genetic variation may contribute to the development of Cerebral Infarction (CI). Serum lipid levels are known risk factors for CI, but the effect of the ApoE gene polymorphism on lipid metabolism remains unclear. This retrospective cohort study was designed to determine the role of ApoE genotypes in CI risk and the relationships between ApoE gene polymorphism and serum lipid levels among the population of northwest China. 517 CI patients and 517 non-CI controls were enrolled in the study. Polymerase chain reaction and hybridization were utilized to determine the ApoE gene polymorphisms. The ε3/ε4 genotype and ε4 allele frequency were significantly higher in CI patients than in controls. When stratified by age and sex, statistically significant differences in the distribution and frequency of the ε3/ε4 genotype and ε4 allele were found between patients and controls. Compared to ε2 carriers, ε4 carriers had significantly lower ApoE levels and higher low-density lipoprotein cholesterol (LDL-C), ApoB and ApoB/ApoA-I levels in both two groups. Additionally, control participants with ε4 carriers had significantly higher levels of lipoprotein and total cholesterol (TC) levels than ε2 carriers, while CI patients with ε4 carriers had a significantly lower level of ApoA-I. After adjusting for other established risk factors, drinking, hypertension, lipoprotein, triglycerides (TG) and ε4 allele were significant independent risk factors for CI, which was shown to be associated with a nearly two-fold CI risk. This study demonstrated that ε4 allele is independent risk factors for CI among patients in Northwest China. ApoE polymorphism was associated with CI, which was partly mediated through blood lipids and may also be mediated through non-lipid pathways. These data might be of great clinical significance in individualized preventive and therapeutic strategies.

Associations of MTHFR gene polymorphism with lipid metabolism and risk of cerebral infarction in the Northwest Han Chinese population.

Genetic variation in the methylenetetrahydrofolate reductase (MTHFR) gene may contribute to the development of cerebral infarction (CI); however, results have been inconsistent across studies with different populations, including studies of the Chinese population. The aim of this study was to analyze the effect of MTHFR gene polymorphism on serum lipid and homocysteine levels among patients with CI in the Northwest Chinese Han population. A total of 521 CI patients and 524 non-CI controls were enrolled in the study. Polymerase chain reaction and hybridization were utilized to identify MTHFR gene polymorphisms. Multivariate logistic regression analysis was used to assess the associations of MTHFR gene polymorphism with risk of CI. Frequencies of the TT genotype and the T allele were markedly higher among CI patients than among controls. After stratifying our data by sex and age, we determined that these differences in frequency of the TT genotype and the T allele were statistically significant among participants of two different age brackets and among men, but not among women (i.e., there were no statistically significant differences between female patients and female controls). CI patients and control participants with the CT or TT genotype had significantly higher homocysteine (Hcy) levels than those with the CC genotype. Among CI patients, CT/TT carriers showed significantly lower high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (ApoA-I) levels as compared with CC carriers, but there was no significant difference for control participants. Multivariable logistic regression analysis showed that drinking; smoking; diabetes mellitus; levels of Hcy, direct bilirubin (DB), indirect bilirubin (IB), ApoA-I, and total protein (TP); and TT genotype were significant independent risk factors for CI. The results suggested that the TT genotype of the MTHFR C677T gene polymorphism, which is associated with hyperhomocysteinemia (HHcy), might be of great clinical significance in the identification of new biomarkers for CI and in the development of individualized preventive and therapeutic strategies.

Cerebral Infarction in Childhood-Onset Craniopharyngioma Patients - Results of KRANIOPHARYNGEOM 2007

Purpose: Cerebral infarction (CI) represents a vascular complication following treatment of suprasellar tumors. Risk factors for CI, incidence rate, and long-term prognosis are unknown for patients with childhood-onset craniopharyngioma (CP). Methods: MRI of 242 CP patients, recruited 2007-2019 in KRANIOPHARYNGEOM 2007, were reviewed for CI. Risk factors for CI and outcome after CI were analyzed. Results: Twenty-eight of 242 patients (11%) presented with CI based on reference assessment of MRI. One CI occurred before initial surgery and one case of CI after release of pressure via intracystic catheter. 26 of 28 CI were detected after CP resecting surgical procedures at a median postoperative interval of one day (range: 0.5-53 days). Surgical intraoperative vascular lesions were documented in 7 cases with CI. There was a trend (p=0.069) towards higher initial presurgical tumor volume in CI patients (21.7 cm3, range: 0.01-187.6 cm3) compared with non-CI patients (15.5 cm3, range: 0.01-286.3 cm3). The CI rate was lower in cases operated via transsphenoidal approach (4%) when compared with transcranial approach (13%). CP patient load of neurosurgical centers as a potential measure of surgical expertise was not associated with CI. In 12 irradiated patients, CI occurred before irradiation in all cases. Multivariate analyses showed that hydrocephalus and gross-total resection (GTR) at the time of primary diagnosis/surgery were independent risk factors for CI. Two-years progression-free survival rate was lower (p=0.023) after CI (0.310±0.095) when compared with the subgroup of patients without CI (0.604±0.034). After CI, quality of life (PEDQOL) and functional capacity (FMH) were impaired when compared with patients without CI. Conclusions: CI occurs in about 11% of CP cases mainly after surgery. Degree of resection and increased intracranial pressure are risk factors, which should be considered in the planning of surgical procedures for prevention of CI.

Would intravitreal bevacizumab injection increase risk of cerebral infarction?

Although studies have evaluated the relationship between intravitreal bevacizumab (IVB) injection and cerebral infarction (CI), the effects of IVB on CI are still not clear. The aim of this study was to investigate the effects of IVB injection on patients with CI with age-related macular degeneration (AMD). We retrospectively reviewed patients with AMD who received IVB injections for 1year and determined the incidence of CI within 60days after IVB injection to analyze the possible association between IVB and CI. A total of 263 patients were enrolled over a 12-month period. Six patients (2.28%) were diagnosed with CI within 2months after receiving an IVB injection. The incidence of CI in patients of 75-84years of age was 6.38%. These results showed a higher incidence for patients with IVB injections than the results of previous epidemiological studies (0.13% for all age groups, 1.68% for patients of 75-84years of age). All CIs occurred 21-53days after the IVB injection (mean: 39.33±14.65days). Logistic regression analyses showed that age and CI history were factors associated with CI. Treatment with IVB might be an independent risk factor for CI. These results are useful for planning treatment strategies for patients with AMD and for prevention of CI.

Cerebral infarction in advanced non-small cell lung cancer: a case control study.

BackgroundAdvanced non-small cell lung cancer (NSCLC) patients often develop thromboembolic events, including cerebral infarction (CI). However, the relationship between advanced NSCLC and CI has not been thoroughly investigated. We examined the association between advanced NSCLC and CI and risk factors for CI in advanced or post-operative recurrent NSCLC patients.MethodsWe retrospectively investigated 515 patients diagnosed with advanced or post-operative recurrent NSCLC at Juntendo University Hospital between April 2009 and March 2014.ResultsAmong the 515 patients evaluated, 15 patients (2.9 %) developed CI after diagnosis of advanced or post-operative recurrent NSCLC. Univariate and multivariate analyses were conducted, and brain metastasis was the only significant independent risk factor for CI (odds ratio 5.24, 95 % confidence interval 1.72–16.10, p = 0.004). The incidence was 6.3 % in these patients. The median survival time was 36 days, and 1-year survival rate was 6.7 % after development of CI. Overall survival from diagnosis of advanced NSCLC or post-operative recurrence was significantly shorter in patients with CI than in patients without CI (223 days versus 895 days; HR, 3.46; 95 % confidence interval, 2.04–6.02; p = 0.001).ConclusionsThe incidence of CI is high in advanced or post-operative recurrent NSCLC, and is especially higher in patients with brain metastasis than in those without brain metastasis. Moreover, CI may affect patient’s prognosis. Careful monitoring for the development of CI in patients with advanced or post-operative recurrent NSCLC is needed, especially for patients with brain metastasis.

Significant correlation between cystatin C, cerebral infarction, and potential biomarker for increased risk of stroke.

This study investigated the correlation of serum cystatin C levels with cerebral infarction (CI) and different subtypes of CI, the severity of CI and the risk of recurrent CI. Totally 1017 patients with CI and 534 healthy controls were included, with clinical and biochemical characteristics documented and analyzed. The results showed serum cystatin C were 0.93 ± 0.21 mg/l and 1.19 ± 0.5 mg/l in control and CI, respectively (p < 0.001). The significant risk factors for CI were age (p < 0.001, OR = 1.048), presence of diabetes (p = 0.007, OR = 2.397), cystatin C (p = 0.001, OR = 1.021), uric acid (p = 0.017, OR = 4.226), and systolic blood pressure (p = 0.021, OR = 1.003). The risk of CI increased with cystatin C levels. Also, cystatin C levels were associated with different subtypes of CI, with large-artery atherosclerosis (LAA) subtype having the highest level of cystatin C. Moreover, cystatin C levels were significantly and positively correlated with Essen Stroke Risk Score (ESRS). The higher level of cystatin C the higher risk of recurrent stroke. In contrast, correlation between cystatin C levels and National Institute of Health stroke scale (NIHSS) score was not significant. In conclusion, cystatin C was an independent risk factor for CI. LAA subtype of CI was more closely related to increased cystatin C level. Furthermore, cystatin C levels predict risk of recurrent CI but not the severity of CI.

Elevated Factor VIII: C Level Is a Risk Factor for Cerebral Infarction.

To explore the association between the risk of cerebral infarction (CI) and markers of coagulation and fibrinolytic systems. A prospective case-control study was carried out in PUMCH, in which 124 unselected patients with CI as well as 91 control patients were studied. Blood samples in acute phase of CI were obtained within 10 days from onset, and the convalescent smples were obtained at least 6 months after onset. Factor VII, FVIII:C, FX, vWF, AT-III, PC, PS, FPS,protein Z( PZ), D-dimer and TAT levels were measured. Associtions were assessed by multiple logistic regression analyses. Compared with control group, levels of FVIII:C, vWF, FVII, DD, TAT in patients with acute CI were marked elevated (FVIII:C194.6±48.6% vs 91.1±26.9%, p=0.000; vWF 123.2±28.8% vs 90.0±20.5%, p=0.003; FVII 98.7±25.2% vs 82.3±25.3%, p=0.002; DD 0.41±0.61 mg/l vs 0.12±0.10 mg/l, p=0.008; TAT 40.9±73.3 ng/ml vs 12.3±11.5 ng/ml, p=0.028, whereas level of FX was not changed significantly. Levels of anticoagulation proteins were decreased. Levels of PZ was 0.41μg/ml lower than cortrol (1.32±0.83μg/ml vs 1.73 ±0.55μg/ml, p=0.004) The result of logistic regression analysis showed levels of FVIII:C and vWF in acute phase were related with CI, with OR 1.143, 95%CI 1.099~1.189, P<0.01 and OR 1.040, 95%CI 1.003~1.082, P<0.05 for FVIII:C and vWF respectively. Compared with acute phase, levels of FVIII:C, DD and TAT in convalescent phase were reduced (FVIII:C 144.3±37.2% vs 193.5±46.2%, P=0.000; DD 0.21±0.20 mg/l vs 0.41±0.78 mg/l,p=0.025; TAT 15.2±10.3 ng/ml vs 42.9±72.6 ng/ml, p=0.030). However, the levels of FVIII:C, vWF and FVII were still higer than that of control(FVIII: C 144.3±47.2%, vs 91.1±26.9%, vWF 110.7±23.2% vs 90.0±20.5%, FVII 93.6±25.5% vs 82.3±25.3%, P<0.05). Level of PZ was elevated by 0.33μg/ml. The result of multiple logistic regression analyses indicated FVIII:C, vWF were the independent risk factors for CI