Prognostic significance of short-term blood pressure variability in acute stroke

Background and Purpose— Blood pressure variability (BPV) may be an important prognostic factor acutely after stroke. This review investigated the existing evidence for the effect of BPV on outcome after stroke, also considering BPV measurement techniques and definitions. Methods— A literature search was performed according to a prespecified study protocol. Two reviewers independently assessed study eligibility and quality. Where appropriate, meta-analyses were performed to assess the effect of BPV on poor functional outcome. Results— Eighteen studies from 1359 identified citations were included. Seven studies were included in a meta-analysis for the effect of BPV on functional outcome (death or disability). Systolic BPV was significantly associated with poor functional outcome: pooled odds ratio per 10-mm Hg increment, 1.2; confidence interval (1.1–1.3). A descriptive review of included studies also supports these findings, and in addition, it suggests that systolic BPV may be associated with increased risk of intracranial hemorrhage in those treated with thrombolytic therapy. Conclusions— This systematic review and meta-analysis suggest that greater systolic BPV, measured early from ischemic stroke or intracerebral hemorrhage onset, is associated with poor longer-term functional outcome. Future prospective studies should investigate how best to measure and define BPV in acute stroke, as well as to determine its prognostic significance. </jats:sec

Increasing levels of the endocannabinoid 2-AG is neuroprotective in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine mouse model of Parkinson's disease

Date of Acceptance: 28/07/2015 The authors are grateful to the staff of the Medical Research Facility for their help with the animal care. This work was supported by the NHS Endowment fund 09/03 and the Wellcome Trust (WT080782MF). We thank Merck & Co. Inc., Rathway NJ, USA for the supply of DFU.Peer reviewedPublisher PD

Non cell autonomous upregulation of CDKN2 transcription linked to progression of chronic hepatitis C disease

Chronic hepatitis C virus infection (C-HC) is associated with higher mortality arising from hepatic and extrahepatic disease. This may be due to accelerated biological aging; however, studies in C-HC have thus far been based solely on telomere length as a biomarker of aging (BoA). In this study, we have evaluated CDKN2 locus transcripts as alternative BoAs in C-HC. Our results suggest that C-HC induces non-cell-autonomous senescence and accelerates biological aging. The CDKN2 locus may provide a link between C-HC and increased susceptibility to age-associated diseases and provides novel biomarkers for assessing its impact on aging processes in man

IPD—the Immuno Polymorphism Database

The Immuno Polymorphism Database (IPD) (http://www.ebi.ac.uk/ipd/) is a set of specialist databases related to the study of polymorphic genes in the immune system. IPD currently consists of four databases: IPD-KIR, contains the allelic sequences of Killer-cell Immunoglobulin-like Receptors; IPD-MHC, a database of sequences of the Major Histocompatibility Complex of different species; IPD-HPA, alloantigens expressed only on platelets; and IPD-ESTAB, which provides access to the European Searchable Tumour Cell-Line Database, a cell bank of immunologically characterized melanoma cell lines. The IPD project works with specialist groups or nomenclature committees who provide and curate individual sections before they are submitted to IPD for online publication. The IPD project stores all the data in a set of related databases. Those sections with similar data, such as IPD-KIR and IPD-MHC share the same database structure. The sharing of a common database structure makes it easier to implement common tools for data submission and retrieval. The data are currently available online from the website and ftp directory; files will also be made available in different formats to download from the website and ftp server. The data will also be included in SRS, BLAST and FASTA search engines at the European Bioinformatics Institute

Randomised controlled trial of a Calcium Channel or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker Regime to Reduce Blood Pressure Variability following Ischaemic Stroke (CAARBS): a protocol for a feasibility study

Introduction Raised blood pressure (BP) is common after stroke and is associated with a poor prognosis, yet trials of BP lowering in the immediate poststroke period have not demonstrated a benefit. One possible explanation for this may be that BP variability (BPV) rather than absolute levels predicts outcome, as BPV is increased after stroke and is associated with poor outcomes. Furthermore, there is evidence of distinct antihypertensive class effects on BPV despite similar BP-lowering effects. However, whether BPV in the immediate poststroke period is a therapeutic target has not been prospectively investigated. The objectives of this trial are to assess the feasibility and safety of recruiting patients following an acute ischaemic stroke or transient ischaemic attack (TIA) to an interventional randomised controlled trial comparing the effects of two different antihypertensive drug classes on BPV. Secondary exploratory objectives are to assess if different therapeutic strategies have diverse effects on levels of BPV and if this has an impact on outcomes. Methods 150 adult patients with first-ever ischaemic stroke or TIA who require antihypertensive therapy for secondary prevention will be recruited within 7 days of the event from stroke services across three sites. After baseline assessments they will be randomly assigned to treatment with a calcium channel blocker or ACE inhibitor/angiotensin receptor blocker-based regimen and followed up for a period of three months. Ethics and dissemination Ethical and regulatory approvals have been granted. Dissemination is planned via publication in peer-reviewed medical journals and presentation at relevant conferences. Trial registration number ISRCTN10853487

Demographics, social position, dental status and oral health-related quality of life in community-dwelling older adults

PURPOSE: To identify demographic, socioeconomic and dental clinical predictors of oral health-related quality of life (OHRQoL) in elderly people. METHODS: Cross-sectional study involving 613 elderly people aged 65–74 years in Manaus, Brazil. Interviews and oral examinations were carried out to collect demographic characteristics (age and sex) and socioeconomic data (income and education), dental clinical measures (DMFT, need of upper and lower dentures) and OHRQoL (GOHAI questionnaire). Structural equation modelling was used to estimate direct and indirect pathways between the variables. RESULTS: Being older predicted lower schooling but higher income. Higher income was linked to better dental status, which was linked to better OHRQoL. There were also indirect pathways. Age and education were linked to OHRQoL, mediated by clinical dental status. Income was associated with dental clinical status via education, and income predicted OHRQoL via education and clinical measures. CONCLUSION: Our findings elucidate the complex pathways between individual, environmental factors and clinical factors that may determine OHRQoL and support the application of public health approaches to improve oral health in older people

Holocene Sediment Records From the Continental Shelf of Mac. Robertson Land, East Antarctica

Geochemical records are presented for five sediment cores from basins on the continental shelf of Mac. Robertson Land, East Antarctica. The cores contain 2-4 m thick sequences of hemipelagic, siliceous mud and ooze (SMO) deposited under seasonally open marine conditions. The inner and middle shelf SMO sequences are massive dark olive green material, whereas the outer shelf SMO sequences are dark olive material interspersed with light olive green layers similar to1-10 cm thick. The biogenic material is dominated by marine diatoms including Fragilariopsis curta, Fragilariopsis cylindrus, and Chaetoceros spp. in the dark-colored SMO and Corethron criophilum in the light-colored layers. Radiocarbon dates suggest that the cores provide continuous accumulation records extending from \u3c 1 kyr before present (B.P.) back as far as 4-15 kyr B.P., with estimated accumulation rates of 0.07-5 mm yr(-1). The three core records from the middle and outer shelf suggest six episodes of increased accumulation of biogenic material at 5.5 kyr B.P. tall three cores), 1, 2, and 6.2 kyr B.P. (two of the three cores), and 3.8 and 10.8 kyr B.P. tone core), most of which coincide with Corethron layers. We interpret these features as the result of enhanced diatom production over the outer shelf, possibly related to climatic warm periods. The absence of such features in the inner shelf core records is thought to reflect a relatively constant level of seasonal diatom production in adjacent waters maintained by a coastal polynya