Interleukin-6, C-reactive protein, fibrinogen, and risk of recurrence after ischaemic stroke: Systematic review and meta-analysis.

BACKGROUND: Recent randomised trials showed benefit for anti-inflammatory therapies in coronary disease but excluded stroke. The prognostic value of blood inflammatory markers after stroke is uncertain and guidelines do not recommend their routine measurement for risk stratification. METHODS: We performed a systematic review and meta-analysis of studies investigating the association of C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen and risk of recurrent stroke or major vascular events (MVEs). We searched EMBASE and Ovid Medline until 10/1/19. Random-effects meta-analysis was performed for studies reporting comparable effect measures. RESULTS: Of 2,515 reports identified, 39 met eligibility criteria (IL-6, n = 10; CRP, n = 33; fibrinogen, n = 16). An association with recurrent stroke was reported in 12/26 studies (CRP), 2/11 (fibrinogen) and 3/6 (IL-6). On random-effects meta-analysis of comparable studies, CRP was associated with an increased risk of recurrent stroke [pooled hazard ratio (HR) per 1 standard-deviation (SD) increase in loge-CRP (1.14, 95% CI 1.06-1.22, p < 0.01)] and MVEs (pooled HR 1.21, CI 1.10-1.34, p < 0.01). Fibrinogen was also associated with recurrent stroke (HR 1.26, CI 1.07-1.47, p < 0.01) and MVEs (HR 1.31, 95% CI 1.15-1.49, p < 0.01). Trends were identified for IL-6 for recurrent stroke (HR per 1-SD increase 1.17, CI 0.97-1.41, p = 0.10) and MVEs (HR 1.22, CI 0.96-1.55, p = 0.10). CONCLUSION: Despite evidence suggesting an association between inflammatory markers and post-stroke vascular recurrence, substantial methodological heterogeneity was apparent between studies. Individual-patient pooled analysis and standardisation of methods are needed to determine the prognostic role of blood inflammatory markers and to improve patient selection for randomised trials of inflammatory therapies.

Emergency service nursing staff: a survey of knowledge, attitudes, and concerns.

A survey of the nursing staff in an emergency service was completed by anonymous questionnaire. The results of the survey indicate satisfaction and confidence in the triaging group, a wish for more staff and specific inservice course content, good perception of emergency situations, misperception about restraint policy and the life-threatening nature of opiate withdrawal, and the need to focus on a clearer definition of those patients who do not require acute care.

The role of the nurse in the care of sexual assault victims.

In this article, a unique and comprehensive role has been described for the nurse who functions within the context of a rape counseling team. Nurses can assume a variety of nontraditional roles in facilitating the recovery of sexual assault victims. They can function as crisis intervention counselors, victim advocates with regard to law enforcement and medical personnel, as well as educators in relation to both the victim's significant other and to legal, medical, mental health personnel with whom the victim may interact. The nurse who responds to the victim in a holistic manner, fulfilling a number of nontraditional roles, can promote the victim's smooth navigation of systems involved with her care. In so doing, the nurse provides continuity of care and facilitates the victim's recovery from the trauma of sexual assault by simplifying the process of treatment.

Polymer suppliers and medical plastics: problems and opportunities.

Strong supplier-customer relationships are essential to the development of polymer materials that are suitable for manufacture. This is especially true in the medical device field. Issues such as understanding the customer's material specification, simple medical compatibility assessments, communicating polymer developments and changes and a co-development business strategy are addressed in this article. The subject is dealt with from the viewpoint of a medium-to-large-volume injection moulder of plastic components for the medical device industry.

Mychonastes desiccatus Brown sp. nova (Chlorococcales, Chlorophyta)--an intertidal alga forming achlorophyllous desiccation-resistant cysts.

An intertidal Chlorella-like alga Mychonastes desiccatus Brown sp. nova, capable of forming achlorophyllous desiccation-resistant cysts, has been grown in unialgal culture. This small alga was first isolated from a dried sample of a well-studied microbial mat. The mat, located at North Pond, Laguna Figueroa, San Quintin, Baja California, Mexico, is a vertically-stratified microbial community which forms laminated sediments. Morphology, pigment composition and G+C content are within the range typical for the genus Chlorella s. 1. Unlike other chlorellae, however, upon desiccation M. desiccatus forms an achlorophyllous, lipid-filled cyst (thick-walled resting stage) in which no plastid is evident. Rewetting leads to chloroplast differentiation, excystment and recovery of the fully green alga. During desiccation, sporopollenin is deposited within a thickening cell wall. Encystment cannot be induced by growth in the dark. The formation of desiccation-induced cysts allows the alga to survive frequent and intermittent periods of dryness. These chlorellae tolerate wide ranges of acidity and temperature; they both grow and form cysts in media in which sodium ions are replaced with potassium. Although the cysts tolerate crystalline salts, the cell grow optimally in concentrations corresponding from three-quarters to full-strength seawater.