This study was approved by the ethics committee of the Affiliated Drum Tower Hospital of Nanjing University. Between August 2011 and July 2012, a total of 259 patients were enrolled in this study based on the following inclusion criteria: (1) clinical diagnosis of acute atherosclerotic cerebral infarction and (2) aged 45 to 80 years. Exclusion criteria were the following: (1) exposure to thienopyridine or glycoprotein IIb/IIIa inhibitor within 1 week, (2) cerebral embolism and small vessel disease, and (3) intracranial hemorrhage after cerebral infarction.The participants were given ozagrelum injection 80 mg/d for 7 days and 75 mg clopidogrel once daily for ≥3 months after stroke onset. Whole blood (5 mL) was obtained for genotyping and adenosine diphosphate-induced platelet aggression testing. The polymorphisms of 5 gene loci within 3 genotypes, including CYP2C19 (EM, IM, PM), 5-7 CYP3A4 (894C>T), and P2Y12 (34C>T, 52G>T), were screened for mutations.The neurological function of each patient was assessed using the NIHSS and the mRS. The assessments were conducted by attending neurologists at baseline, 7 days, and at 3 and 6 months.All data were analyzed using SPASS version 16.0 (Chicago, IL) statistical analysis software. The effect of the studied genotypes on clopidogrel response was evaluated by 1-way ANOVA. The χ 2 test was used to compare changes in mRS score among the 3 CYP2C19 genotypic groups at baseline and at 3-month and 6-month follow-up.Background and Purpose-Little research regarding genotypes and clopidogrel response related to acute ischemic stroke has been published. This study was conducted to investigate whether the polymorphisms of receptors or enzymes involved in the metabolic process of clopidogrel affect clopidogrel response and prognosis related to acute stroke. Methods-A total of 259 patients with acute ischemic stroke were enrolled in this study; all received follow-up evaluations 3 and 6 months after clopidogrel treatment. CYP2C19, CYP3A4, and P2Y12 were screened. The adenosine diphosphateinduced platelet aggregation test, the National Institutes of Health Stroke Scale (NIHSS), and the modified Rankin Scale (mRS) were used, and blood vascular events were evaluated. Results-The difference before and after clopidogrel treatment on adenosine diphosphate-induced platelet aggregation was significantly smaller in patients carrying 1 or 2 CYP2C19 loss-of-function alleles (*2, *3) compared with patients carrying none. Patients with none had better outcomes than patients with CYP2C19 loss-of-function alleles, as demonstrated by NIHSS and mRS scores at 3 and 6 months after treatment. Regression analysis showed that CYP2C19 was an independent predictor of clopidogrel resistance. Conclusions-CYP2C19 genotypes had significant impact on clopidogrel response and prognosis of patients with stroke. Clinical Trial Registration Information-URL: http://www.chictr.org/. Unique

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Background/AimsThe Rome III criteria separated chronic constipation into functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C), but some researchers questioned the partitioning and treated both as distinct parts of a continuum. The study aims to explore the similarity and diversity of brain white matter between FC and IBS-C. MethodsThe voxel-wise analysis of the diffusion parameters was used to quantify the white matter changes of female brains in 18 FC patients and 20 IBS-C patients compared with a comparison group with 19 healthy controls by tract-based spatial statistics. The correlations between diffusive parameters and clinical symptoms were evaluated using a Pearson's correlation. ResultsIn comparison to healthy controls, FC patients showed a decrease of fractional anisotropy (FA) and an increase of radial diffusivity (RD) in multiple major fibers encompassing the corpus callosum (CC, P = 0.001 at peak), external capsule (P = 0.002 at peak), corona radiata (CR, P = 0.001 at peak), and superior longitudinal fasciculus (SLF, P = 0.002 at peak). In contrast, IBS-C patients showed FA and RD aberrations in the CC (P = 0.048 at peak). Moreover, the direct comparison between FC and IBS-C showed only RD differences in the CR and SLF. In addition, FA and RD in the CC were significantly associated with abdominal pain for all patients, whereas FA in CR (P = 0.016) and SLF (P = 0.040) were significantly associated with the length of time per attempt and incomplete evacuation separately for FC patients. ConclusionThese results may improve our understanding of the pathophysiological mechanisms underlying different types of constipation.

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