Circulating insulin-like growth factor binding protein-3 predicts one-year outcome after ischemic stroke.

BACKGROUND: Insulin-like Growth Factor-1 (IGF-1) and Insulin-like Growth Factor Binding Protein-3 (IGFBP-3) have been ascribed neuroprotective effects. We sought to determine whether levels of IGF-1 and IGFBP-3 predict functional outcome after ischemic stroke. METHODS: IGF-1 and IGFBP-3 levels were measured in the first week after stroke in patients with first ischemic stroke who were enrolled in the Berlin Cream&Sugar Study. National Institutes of Health Stroke Scale (NIHSS) was collected at admission. Lesion volume was determined from acute MRI if available. Functional outcome according to the modified Rankin Scale (mRS) was assessed after one year. In multivariate analyses we identified parameters associated with unfavourable functional outcome (mRS>2). RESULTS: We included 100 patients. 21 patients had an unfavourable functional outcome. IGF-1 levels were<- 2 standard deviation score (SDS) in 7 patients, and>2 SDS in 12 patients. IGFBP-3 levels werethe 95(th) percentile. Low levels of IGFBP-3 (p=0.002), NIHSS at admission (p=0.043) and age (p=0.001) were associated with unfavourable functional outcome in the univariate analyses. In multivariate analysis including IGFBP-3, IGF-1, age, thrombolysis and NIHSS only low IGFBP-3 levels (OR 7.2, 95%CI 1.8-29.0, p=0.006) were associated with unfavourable functional outcome. If lesion volume was incuded (n=71), only IGFBP-3 levels (OR 7.2, 95%CI 1.5-35.5, p=0.015) were associated with unfavourable functional outcome. CONCLUSION: IGFBP-3 levels after ischemic stroke may independently predict functional outcome after one year.

Linking integrated water resources management and integrated coastal zone management.

Some of the world's most valuable aquatic ecosystems such as deltas, lagoons and estuaries are located in the coastal zone. However, the coastal zone and its aquatic ecosystems are in many places under environmental stress from human activities. About 50% of the human population lives within 200 km of the coastline, and the population density is increasing every day. In addition, the majority of urban centres are located in the coastal zone. It is commonly known that there are important linkages between the activities in the upstream river basins and the environment conditions in the downstream coastal zones. Changes in river flows, e.g. caused by irrigation, hydropower and water supply, have changed salinity in estuaries and lagoons. Land use changes, such as intensified agricultural activities and urban and industrial development, cause increasing loads of nutrients and a variety of chemicals resulting in considerable adverse impacts in the coastal zones. It is recognised that the solution to such problems calls for an integrated approach. Therefore, the terms Integrated Water Resources Management (IWRM) and Integrated Coastal Zone Management (ICZM) are increasingly in focus on the international agenda. Unfortunately, the concepts of IWRM and ICZM are mostly being developed independently from each other by separate management bodies using their own individual approaches and tools. The present paper describes how modelling tools can be used to link IWRM and ICZM. It draws a line from the traditional sectoral use of models for the Istanbul Master Planning and assessment of the water quality and ecological impact in the Bosphorus Strait and the Black Sea 10 years ago, to the most recent use of models in a Water Framework Directive (WFD) context for one of the selected Pilot River Basins in Denmark used for testing of the WFD Guidance Documents.