Declining incidence of intracerebral hemorrhage over two decades in a population-based study.

BACKGROUND AND PURPOSE: The incidence and case-fatality rate (CFR) of primary intracerebral hemorrhage (PICH) over two decades were assessed in a prospective population-based study. METHODS: Cases of incident first-ever PICH were recorded over a 2-year period (2011-2012) from multiple sources in the district of L'Aquila, central Italy. Included patients were followed up to 1 year after the event to ascertain CFRs. Current data were compared with those previously collected from 1994 through 1998. RESULTS: In all, 115 patients (52 men; 45.2%) with a first-ever PICH were included. Mean age ± SD was 77.4 ± 11.8 years. The hemorrhage was lobar in 43 (37.4%) patients, deep in 56 (48.7%), in the posterior fossa in 11 (9.6%) and intraventricular or multiple localized in five (4.3%). Crude annual incidence rate was 19.3 per 100 000 and 14.8 per 100 000 when standardized to the 2011 European population, indicating a 48% reduction comparing data of 2011-2012 to those of 1994-1998 (incidence rate ratio 0.52; 95% confidence interval 0.43-0.64; P < 0.001). In 2011-2012, the 7-day CFR was 27.8%, the 30-day CFR was 42.6% and the 1-year CFR was 52.2%; the 1-year standardized mortality ratio was 0.81 (95% confidence interval 0.63-1.04) compared with 1994-1998. CONCLUSIONS: The annual incidence rate of PICH was lower than that found two decades before and close to the rates recently found in other western countries. Data also indicated a non-significant trend towards a decrease in mortality, which nonetheless remained high, pointing to the need for more appropriate treatments in order to reduce PICH severity and mortality.

Migraine and risk of ischaemic heart disease: a systematic review and meta-analysis of observational studies.

BACKGROUND AND PURPOSE: Several studies have assessed the risk of ischaemic heart diseases in migraineurs, drawing different conclusions. To define and update the issue, a systematic review and meta-analysis of the available observational studies was performed. METHODS: PubMed and EMBASE were systematically searched up to April 2014 for observational studies dealing with the risk of any form of ischaemic heart disease in migraineurs. Studies assessing migraine as exposure and several types of ischaemic heart disease as outcomes were included in the analysis. A random effects model was used to pool the effect sizes. RESULTS: Out of 3348 records, 15 studies (one case-control, one cross-sectional and 13 cohort studies) were identified and were included in the meta-analysis. The pooled analysis indicated an increased risk of myocardial infarction (pooled adjusted effect estimate 1.33, 95% confidence interval 1.08-1.64; P = 0.007) and of angina (pooled adjusted effect estimate 1.29, 95% confidence interval 1.17-1.43; P < 0.0001) in migraineurs compared to non-migraineurs. CONCLUSIONS: Based on our data indicating an association of migraine with myocardial infarction and angina and on previous data showing an association of migraine, and particularly migraine with aura, with an increased risk for stroke, migraine can be appropriately considered an overall risk factor for cardiovascular diseases.

A polymer-based drug delivery system for the antineoplastic agent bis(maltolato)oxovanadium in mice.

Using vanadyl sulphate, sodium orthovanadate or bis(maltolato)oxovanadium (BMOV), Cruz TF, Morgan A, Min W (1995, Mol Cell Biochem 153: 161-166) have recently demonstrated the antineoplastic effects of vanadium in mice. In this study, the antineoplastic effects of BMOV against human tumour cell lines was confirmed, and this effect was shown to depend on the prolonged exposure of the cells to the drug. We have investigated a polymeric drug delivery system for the sustained delivery of BMOV as an antineoplastic agent in mice. The objective was to design and evaluate an injectable polymer-BMOV paste that would act as a drug implant for the slow but sustained release of BMOV in the mice. In vitro studies showed that the biodegradable polymer poly (Ghlr epsilon epsilon-caprolactone) (PCL) released BMOV in a sustained manner with rates of drug release increasing with increased loading of the drug in the polymer. In vivo studies showed that PCL-BMOV paste implants produced a concentration-dependent inhibition of MDAY-D2 tumour growth via systemic drug delivery. Further in vivo studies showed that 5% BMOV-loaded PCL (containing 20% methoxypolyethylene glycol) was effective in preventing tumour regrowth of resected RIF tumour masses in mice when the PCL-BMOV paste was applied to the resected site for localized drug delivery. The results confirm the potential of vanadium as an antineoplastic agent and show that the injectable PCL-BMOV formulation releases a chemotherapeutic dose of vanadium for the systemic treatment of whole tumours as well as the localized treatment of resected RIF tumours.