Serum urate has been implicated in hypertension and cardiovascular disease, but it is not known whether it is exerting a causal effect. To investigate this, we performed Mendelian randomization analysis using data from UK Biobank, Million Veterans Program and genome-wide association study consortia, and meta-analysis of randomized controlled trials. The main Mendelian randomization analyses showed that every 1-SD increase in genetically predicted serum urate was associated with an increased risk of coronary heart disease (odds ratio, 1.19 [95% CI, 1.10–1.30]; P =4×10 −5 ), peripheral artery disease (1.12 [95% CI, 1.03–1.21]; P =9×10 −3 ), and stroke (1.11 [95% CI, 1.05–1.18]; P =2×10 −4 ). In Mendelian randomization mediation analyses, elevated blood pressure was estimated to mediate approximately one-third of the effect of urate on cardiovascular disease risk. Systematic review and meta-analysis of randomized controlled trials showed a favorable effect of urate-lowering treatment on systolic blood pressure (mean difference, −2.55 mm Hg [95% CI, −4.06 to −1.05]; P =1×10 −3 ) and major adverse cardiovascular events in those with previous cardiovascular disease (odds ratio, 0.40 [95% CI, 0.22–0.73]; P =3×10 −3 ) but no significant effect on major adverse cardiovascular events in all individuals (odds ratio, 0.67 [95% CI, 0.44–1.03]; P =0.07). In summary, these Mendelian randomization and clinical trial data support an effect of higher serum urate on increasing blood pressure, which may mediate a consequent effect on cardiovascular disease risk. High-quality trials are necessary to provide definitive evidence on the specific clinical contexts where urate lowering may be of cardiovascular benefit.

Objective:To identify clinical, ECG and blood-based biomarkers associated with atrial fibrillation (AF) detection after ischaemic stroke or transient ischaemic attack (TIA) that could help inform patient selection for cardiac monitoring.Methods:We performed a systematic review and meta-analysis and searched electronic databases for cohort studies from 15/01/2000-15/01/2020. The outcome was AF ≥30 seconds within one year after ischaemic stroke/TIA. We used random effects models to create summary estimates of risk. Risk of bias was assessed using the Quality in Prognostic Studies tool. PROSPERO registration: CRD42020168307.Results:We identified 8503 studies, selected 34 studies and assessed 69 variables (42 clinical, 20 ECG and seven blood-based biomarkers). The studies included 11569 participants and AF was detected in 1478 people (12.8%). Overall, risk of bias was moderate. Variables associated with increased likelihood of AF detection are older age (OR 3.26, 95%CI 2.35-4.54), female sex (OR 1.47, 95%CI 1.23-1.77), a history of heart failure (OR 2.56, 95%CI 1.87-3.49), hypertension (OR 1.42, 95%CI 1.15-1.75) or ischaemic heart disease (OR 1.80, 95%CI 1.34-2.42), higher modified Rankin Scale (OR 6.13, 95%CI 2.93-12.84) or National Institutes of Health Stroke Scale score (OR 2.50, 95%CI 1.64-3.81), no significant carotid/intracranial artery stenosis (OR 3.23, 95%CI 1.14-9.11), no tobacco use (OR 1.93, 95%CI 1.48-2.51), statin therapy (OR 2.07, 95%CI 1.14-3.73), stroke as index diagnosis (OR 1.59, 95%CI 1.17-2.18), systolic blood pressure (OR 1.61, 95%CI 1.16-2.22), intravenous thrombolysis treatment (OR 2.40, 95%CI 1.83-3.16), atrioventricular block (OR 2.12, 95%CI 1.08-4.17), left ventricular hypertrophy (OR 2.21, 95%CI 1.03-4.74), premature atrial contraction (OR 3.90, 95%CI 1.74-8.74), maximum P-wave duration (OR 3.19, 95%CI 1.40-7.25), PR interval (OR 2.32, 95%CI 1.11-4.83), P-wave dispersion (OR 7.79, 95%CI 4.16-14.61), P-wave index (OR 3.44, 95%CI 1.87-6.32), QTc interval (OR 3.68, 95%CI 1.63-8.28), brain natriuretic peptide (OR 13.73, 95%CI 3.31-57.07) and HDL-cholesterol (OR 1.49, 95%CI 1.17-1.88) concentrations. Variables associated with reduced likelihood are minimum P-wave duration (OR 0.53, 95%CI 0.29-0.98), LDL-cholesterol (OR 0.73, 95%CI 0.57-0.93) and triglyceride (OR 0.51, 95%CI 0.41-0.64) concentrations.Discussion:We have identified multi-modal biomarkers that could help guide patient selection for cardiac monitoring after ischaemic stroke/TIA. Their prognostic utility should be prospectively assessed with AF detection and recurrent stroke as outcomes.

The knowledge of stroke etiology and functional outcome of family members of individuals undergoing rehabilitation after stroke shows significant limitations. Participants' ability to predict functional outcome on discharge was worse than their knowledge of current functional status. Participant predictions of length of stay and discharge disposition were areas of relative strength. Further efforts are needed to enhance the knowledge level of family members of patients undergoing rehabilitation after stroke.

Recent SOFC research has shown that impregnating fine catalyst structures into porous scaffolds to be an extremely promising route for electrode development. It is clear that in optimising the advantages offered by this technique there will be an obvious link between the morphology of the porous scaffold and the infiltrated catalyst. There are significant potential benefits to using aqueous systems for the manufacture of the scaffold. They include the potential for a far larger range of pore formers which may be employed to create specific pore morphologies and also reduced environmental burdens, such as exhaust handling, worker exposure and disposal. Recent and ongoing activities to develop such systems at University of St Andrews will be described. Areas of discussion will be effects of ceramic particle size, the size ratio of pore former to ceramic particle, pore former type and loading and how these interact with other tape constituents both on the behaviour during processing and on the final fired morphology. Better understanding of these complex relationships will help in designing optimised porous structures in the future.

MI with non-obstructive coronary arteries (MINOCA) is caused by a heterogeneous group of vascular or myocardial disorders. MINOCA occurs in 5–15% of patients presenting with acute ST-segment elevation MI or non-ST segment elevation MI and prognosis is impaired. The diagnosis of MINOCA is made during coronary angiography following acute MI, where there is no stenosis ≥50% present in an infarct-related epicardial artery and no overt systemic aetiology for the presentation. Accurate diagnosis and subsequent management require the appropriate utilisation of intravascular imaging, coronary function testing and subsequent imaging to assess for myocardial disorders without coronary involvement. Although plaque-related MINOCA is currently managed with empirical secondary prevention strategies, there remains an unmet therapeutic need for targeted and evidence-based therapy for MINOCA patients and increased awareness of the recommended diagnostic pathway.

Peripheral vein cannulation remains the most common method to facilitate LA. Practice trends indicate a move towards AV fistula creation; the favoured approach receiving support from the expert body in this area. AV fistula failure rate is high and of great concern, therefore we suggest the implementation of upper limb ultrasound vascular mapping in all patients who meet treatment eligibility criteria. We encourage close ties between apheresis units and specialist surgical centres to facilitate patient counselling and monitoring. Further prospective data regarding fistula failure is needed in this expanding treatment field.

Knowledge of stroke and its treatment was limited, and expectations for recovery tended to exceed actual accomplishments. There are significant areas of opportunity for enhanced educational efforts for stroke patients undergoing inpatient rehabilitation.

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