Association of reversed Robin Hood syndrome with risk of stroke recurrence.

BACKGROUND: Reversed Robin Hood syndrome (RRHS) has recently been identified as one of the mechanisms of early neurologic deterioration in acute ischemic stroke (AIS) patients related to arterial blood flow steal from ischemic to nonaffected brain. We sought to investigate the association of RRHS with risk of stroke recurrence in a single-center cohort study. METHODS: Consecutive patients with AIS or TIA affecting the anterior circulation were prospectively evaluated with serial NIH Stroke Scale assessments and bilateral transcranial Doppler monitoring with breath-holding test. RRHS was defined according to previously validated criteria. RESULTS: A total of 360 patients (51% women, mean age 62 ± 15 years) had an ischemic stroke (81%) or TIA (19%) in the anterior circulation, and 30 (8%) of them had RRHS. During a mean follow-up period of 6 months (range 1-24), a total of 16 (4%) recurrent strokes (15 ischemic and 1 hemorrhagic) were documented. The cumulative recurrence rate was higher in patients with RRHS (19%; 95% confidence interval [CI] 1-37) compared to the rest (15%; 95% CI 0-30; p = 0.022 by log-rank test). All recurrent strokes in patients with RRHS were cerebral infarcts that occurred in the ipsilateral to the index event anterior circulation vascular territory. After adjusting for demographic characteristics, vascular risk factors, and secondary prevention therapies, RRHS was independently associated with a higher stroke recurrence risk (hazard ratio 7.31; 95% CI 2.12-25.22; p = 0.002). CONCLUSIONS: Patients with AIS and RRHS appear to have a higher risk of recurrent strokes that are of ischemic origin and occur in the same arterial territory distribution to the index event. Further independent validation of this association is required in a multicenter setting.

Linkage analysis of variations in CD4:CD8 T cell subsets between C57BL/6 and DBA/2.

The ratio of CD4 T cells to CD8 T cells (CD4:CD8 ratio) varies over two-fold between C57BL/6 and DBA/2 mice for both T cell precursors in the thymus and mature T cells in the periphery. Correlation analysis of the CD4:CD8 ratio in thymic precursors vs peripheral T cells in F2 and backcross mice found that thymic precursor ratios are inherited independently from those in the periphery, indicating that the CD4:CD8 ratios in these populations are affected by distinct genetic mechanisms. A genome scan of progeny in the phenotypic extremes identified three quantitative trait loci (QTLs). Trmq1 (for T cell ratio modifier QTL 1) was detected in the telomeric end of c6 (peak marker D6Mit15 at 74 cM) and had a maximum LOD score of 4.6. Trmq2, in the telomeric half of c2, peaked at D2MIT483 and had a maximum LOD score of 3.41. Both of these QTLs impacted the CD4:CD8 ratios in peripheral T cells and had no impact on variation in this ratio among thymic precursors. However, heterozygosity for the H2 complex was suggestively associated (LOD score of 2.43) with increases in CD4 T cells among T cell precursors in the thymus. All of these QTLs were affected by epistatic interactions, indicating that additional modifiers in the B6 and DBA/2 genomes modulate this phenotype.

Disease outcome subsequent to primary and secondary urogenital infection with murine or human biovars of Chlamydia trachomatis.

A susceptible strain of mice infected intravaginally with the mouse pneumonitis biovar of Chlamydia trachomatis became infertile and sustained high rates of hydrosalpinx formation regardless of prior infection with a human serovar. Conversely, susceptible mice infected with human serovars remained fertile unless challenged with a homologous human serovar.

Prior genital tract infection with a murine or human biovar of Chlamydia trachomatis protects mice against heterotypic challenge infection.

We sought to assess the degree of cross-protective immunity in a mouse model of chlamydial genital tract infection. Following resolution of genital infection with the mouse pneumonitis (MoPn) biovar of Chlamydia trachomatis, mice were challenged intravaginally with either MoPn or human serovar E or L2. The majority of animals previously infected with MoPn were solidly immune to challenge with either of the two human biovars. Surprisingly, approximately 50% of animals became reinfected when homologously challenged with MoPn, although the secondary infection yielded significantly lower numbers of the organism isolated over a shorter duration than in the primary infection. Primary infection with serovar E also protected against challenge with MoPn or serovar L2, although the degree of immune protection was lower than that resulting from primary infection with MoPn. Blast transformation and assessment of delayed-type hypersensitivity indicated that mice previously infected with either human or murine biovars produced broadly cross-reactive T cells that recognized epitopes of either murine or human biovars of C. trachomatis. Immunoblotting demonstrated that primary MoPn infection produced immunoglobulin G (IgG) antibody to antigens of MoPn as well as at least three distinct antigenic components of human serovar E, one of which was identical in molecular weight to the major outer membrane protein (MOMP). Primary infection with serovar E produced IgG antibody reactive against serovar E but not MoPn MOMP and against at least one ca. 60-kDa protein of both chlamydial strains. Our results indicate that primary genital infection of mice with murine C. trachomatis induces immunity against challenge with either of two human biovars.

Food security: what the community wants. Learning through focus groups.

We used focus groups to learn the range of issues threatening food security of low income residents in our community. Five major themes emerged from the discussions: literacy, money, time, mental health and self-esteem, suggesting several approaches that could help ensure food security: 1) education, 2) sharing of resources, 3) coalition building, and 4) advocacy. Education programs have to be practical, allowing for demonstrations and hands-on learning while emphasizing skill building and problem solving. Incorporating a social aspect into learning may compensate for the social isolation and would capitalize on the impressive mutual support we witnessed. Strategies based on self-help and peer assistance may counteract low self-esteem and overcome suspicion of health professionals. A community-wide effort is needed to address the factors contributing to food insecurity. We envision the formation of a coalition of professionals, agencies, and low income people to develop a comprehensive strategy for achieving food security.

Weight control in adolescent girls: a comparison of the effectiveness of three approaches to follow-up.

The purpose of the project was to compare the effectiveness of three different types of follow-up of a weight control program in assisting adolescent girls to achieve and maintain ideal body weight. During the initial phase of the weight control program, subjects attended two sessions of approximately one hour each for eight weeks. One session each week included theory and practice of physical exercise. The other session was devoted to behavioral control of eating and diet therapy. After eight weeks, 18 subjects were divided randomly into three groups for follow-up: Group 1--monthly measurements and reinforcement of behavioral, diet, and exercise components of the weight control program; Group 2--monthly measurements; and Group 3--annual measurements. Fifteen subjects completed the 12-month follow-up program. Mean weight loss during follow-up of Group 1 was 3.65 kg, Group 2 was 1.90 kg, while Group 3 had a mean weight gain of 3.44 kg. The results suggest that regular follow-up may be a critical element in successful weight control programs for adolescent girls.

The awareness of risk and personal relevance in alcoholics.

From the perspective of health professionals, the estimated nine million alcoholics in America are engaged in repetitive health-avoidance behavior. The purpose of this study was to asses whether alcoholics were themselves aware of the risk-taking implications of their drinking, particularly in view of the denial clinically attributed to alcoholics. Horn's Smoker's Self-Testing Kit, modified to measure respondents' attitudes toward excessive drinking and its consequences, was administered to 61 alcoholic inpatients. This instrument evaluates awareness of the health hazards of excessive drinking, awareness of the seriousness of alcoholism as a health problem, awareness of its personal relevance, and the value of stopping, concern with mastery of the drinking problem, and belief in capability for stopping. The results indicated that during sobriety these alcoholics definitely acknowledged the health hazards of excessive drinking, the seriousness of the problem, its personal relevance, and the value of stopping. However, subjects generally anticipated great difficulty in making any significant change in their self-destructive drinking patterns.