Serum magnesium and calcium levels in relation to ischemic stroke : Mendelian randomization study

ObjectiveTo determine whether serum magnesium and calcium concentrations are causally associated with ischemic stroke or any of its subtypes using the mendelian randomization approach.MethodsAnalyses were conducted using summary statistics data for 13 single-nucleotide polymorphisms robustly associated with serum magnesium (n = 6) or serum calcium (n = 7) concentrations. The corresponding data for ischemic stroke were obtained from the MEGASTROKE consortium (34,217 cases and 404,630 noncases).ResultsIn standard mendelian randomization analysis, the odds ratios for each 0.1 mmol/L (about 1 SD) increase in genetically predicted serum magnesium concentrations were 0.78 (95% confidence interval [CI] 0.69-0.89; p = 1.3 7 10-4) for all ischemic stroke, 0.63 (95% CI 0.50-0.80; p = 1.6 7 10-4) for cardioembolic stroke, and 0.60 (95% CI 0.44-0.82; p = 0.001) for large artery stroke; there was no association with small vessel stroke (odds ratio 0.90, 95% CI 0.67-1.20; p = 0.46). Only the association with cardioembolic stroke was robust in sensitivity analyses. There was no association of genetically predicted serum calcium concentrations with all ischemic stroke (per 0.5 mg/dL [about 1 SD] increase in serum calcium: odds ratio 1.03, 95% CI 0.88-1.21) or with any subtype.ConclusionsThis study found that genetically higher serum magnesium concentrations are associated with a reduced risk of cardioembolic stroke but found no significant association of genetically higher serum calcium concentrations with any ischemic stroke subtype

[The effectiveness of disease management in diabetes: a meta-analysis]

Item does not contain fulltextOBJECTIVE: Systematic evaluation of the effectiveness of innovative care concepts for diabetes, taking into account heterogeneity of study results. DESIGN: Systematic review, meta-analysis and meta-regression analysis. METHOD: Medline, CINAHL and PsycINFO were searched for reviews and empirical studies into adult patients with diabetes in whom interventions were used that consisted of a minimum of 2 components from the Chronic Care Model. In the meta-analysis, a random-effects model was used to pool results on HbA1c and systolic blood pressure. Meta-regression analysis was used to examine the extent to which 3 differences in study design - (a) methodological quality, (b) length of follow-up, and (c) number of intervention components - could explain the heterogeneity in effect measures. RESULTS: The reviews (n = 15) generally reported modest improvements in glycaemic control. The empirical studies (n = 56) differed greatly in the direction and magnitude of measured effects on HbA1c (mean: -5 mmol/mol; 95% CI: -7- -3.5) and systolic blood pressure (mean: -2.8 mmHg; 95% CI: -4.7- -0.95). Variation in methodological quality between the studies could not explain this. Short-term studies (/= 1 year), but this difference was not significant. The variation in the number of intervention components explained 8-12% of the heterogeneity in effects of diabetes care innovations. CONCLUSION: Diabetes care interventions that include more than 2 components have the most positive effects on clinical outcomes. Considering the connection between length of follow-up and results as well as the fact that the targets of these innovations focus primarily on the future, the impact of such interventions should be measured in the long term

Adjuvant chemotherapy and relative survival of patients with stage II colon cancer - A EURECCA international comparison between the Netherlands, Denmark, Sweden, England, Ireland, Belgium, and Lithuania

Surgical oncolog

Laboratory astrochemistry of the gas phase: general discussion.

International audienc

Reader response: Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion

Neuro Imaging Researc

A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke

Alteplase with EVT versus EVT Alone for Stroke Trials involving Asian patients with acute stroke have suggested that endovascular treatment alone is not inferior to the usual practice of thrombolysis before endovascular treatment. This trial involving European patients did not show noninferiority or superiority of endovascular treatment alone.Background The value of administering intravenous alteplase before endovascular treatment (EVT) for acute ischemic stroke has not been studied extensively, particularly in non-Asian populations. Methods We performed an open-label, multicenter, randomized trial in Europe involving patients with stroke who presented directly to a hospital that was capable of providing EVT and who were eligible for intravenous alteplase and EVT. Patients were randomly assigned in a 1:1 ratio to receive EVT alone or intravenous alteplase followed by EVT (the standard of care). The primary end point was functional outcome on the modified Rankin scale (range, 0 [no disability] to 6 [death]) at 90 days. We assessed the superiority of EVT alone over alteplase plus EVT, as well as noninferiority by a margin of 0.8 for the lower boundary of the 95% confidence interval for the odds ratio of the two trial groups. Death from any cause and symptomatic intracerebral hemorrhage were the main safety end points. Results The analysis included 539 patients. The median score on the modified Rankin scale at 90 days was 3 (interquartile range, 2 to 5) with EVT alone and 2 (interquartile range, 2 to 5) with alteplase plus EVT. The adjusted common odds ratio was 0.84 (95% confidence interval [CI], 0.62 to 1.15; P=0.28), which showed neither superiority nor noninferiority of EVT alone. Mortality was 20.5% with EVT alone and 15.8% with alteplase plus EVT (adjusted odds ratio, 1.39; 95% CI, 0.84 to 2.30). Symptomatic intracerebral hemorrhage occurred in 5.9% and 5.3% of the patients in the respective groups (adjusted odds ratio, 1.30; 95% CI, 0.60 to 2.81). Conclusions In a randomized trial involving European patients, EVT alone was neither superior nor noninferior to intravenous alteplase followed by EVT with regard to disability outcome at 90 days after stroke. The incidence of symptomatic intracerebral hemorrhage was similar in the two groups. (Funded by the Collaboration for New Treatments of Acute Stroke consortium and others; MR CLEAN-NO IV ISRCTN number, .