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

The determination of phosphates in sea water

The concentration of phosphates in sea water varies from 0.000 to about 2.00 microgram atoms (µg. atoms) phosphate-phosphorus per liter at 20° C. Occasionally a maximum of 3.00 µg. atoms may be found in some deep arms of the sea

The determination of nitrates in sea water

The concentrations of nitrite-nitrogen in sea water varies from 0.000 to 2.00 microgram atoms (µg. atoms) per liter of sea water at 20° C. In the open ocean nitrites are seldom found in depths below 100 meters, and even at these depths the water may be completely devoid of nitrites. When occurring in waters near the surface, the concentration is generally less than 0.10 µg. atom of nitrite-nitrogen per liter. The higher values are obtained at times in the waters on the continental shelf and in sounds, straits, fjords and estuaries

The determination of silicate in sea water

The normal range of silicate in sea water is from 0.0 to about 200 µg. atoms Si per liter at 20° C. It has not been fully demonstrated whether the silicate determined by the method described below is in the colloidal or ionic form or both

Notes on the determination of dissolved oxygen in sea water

The oxygen dissolved in sea water is usually determined by the classical method of Winkler. Probably because of the large number of investigators who have used this method, there have developed various modifications in the method of collecting samples, in the standardization of the sodium thiosulfate solution, and in the titration of the samples. It is the purpose of this paper to discuss these various methods, the sources of possible error, and to present the best procedure for standardization of the sodium thiosulfate solution

An isolated proximal tibiofibular joint dislocation in a young male playing soccer: a case report

Isolated dislocation of the proximal tibiofibular joint is a rare injury. We present a 23-year-old caucasian man who sustained a traumatic anterolateral dislocation of the proximal tibiofibular joint. There is no consenus on definitive management, and we review the different published treatment and rehabilitation regimens for this injury. Our patient was successfully treated by open reduction and temporary Kirschner-wire fixation. The authors recommend their structured rehabilitation process involved using cast brace immobilization as allows for excellent soft tissue healing

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

HST Imaging Polarimetry of the Gravitational Lens FSC10214+4724

We present imaging polarimetry of the extremely luminous, redshift 2.3 IRAS source FSC10214+4724. The observations were obtained with HST's Faint Object Camera in the F437M filter, which is free of strong emission lines. The 0.7 arcsec long arc is unresolved to 0.04 arcsec FWHM in the transverse direction, and has an integrated polarization of 28 +/- 3 percent, in good agreement with ground-based observations. The polarization position angle varies along the arc by up to 35 deg. The overall position angle is 62 +/- 3 deg east of north. No counterimage is detected to B = 27.5 mag ($3\sigma$), giving an observed arc to counterimage flux ratio greater than 250, considerably greater than the flux ratio of 100 measured previously in the I-band. This implies that the configuration of the object in the source plane at the B-band is different from that at I-band, and/or that the lensing galaxy is dusty.Comment: 17 pages, 3 figures. Accepted for publication in Astronomical Journal, February 199

A survey of opinion: When to start oral anticoagulants in patients with acute ischaemic stroke and atrial fibrillation?

Background: There is uncertainty regarding the optimal timing for initiation of oral anticoagulant treatment (OAC) in patients with recent ischaemic stroke and atrial fibrillation (AF). We surveyed the current UK practice and assessed clinician’s opinions of when to use OAC in recent stroke patients with AF. Methods: An online survey was sent to stroke physicians within the United Kingdom via their national societies. Results: One hundred and twenty-one clinicians responded to the survey. Ninety-five percent of responders agreed there was uncertainty regarding timing of OAC initiation after AF-related ischaemic stroke. Thirty-six percent of responders followed the ‘1-3-6-12’ European Society of Cardiology (ESC) guidelines recommendation. Uncertainty was greater in cases of moderate stroke than in cases of TIA, mild or severe stroke. Eighty-eight percent of responders would be willing to participate in a clinical trial of early vs. later initiation of OAC after stroke. Direct-acting oral anticoagulant (DOAC) were the preferred OAC of choice. Conclusion: There is a lack of consensus amongst stroke physicians for when to initiate OAC to prevent recurrence in stroke patients with AF. There is little uncertainty regarding TIA. A clinical trial assessing use of early vs. later initiation of DOAC in patients with recent ischaemic stroke and AF would be beneficial