Background High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset. Methods We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UKbased ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053.
Similarities between anorexia nervosa and obsessive-compulsive disorder have been described by a number of authors but few empirical investigations have been reported. In the current study, 15 female anorexics were compared with 14 age-matched female obsessives on a variety of psychometric tests, psychiatrist's ratings and self-rating scales. Obsessives and anorexics obtained similarly high obsessive symptom and trait scores on the Leyton Obsessional Inventory LOI). Both groups were rated by the psychiatrist as similarly obsessive, and there were no significant group differences in self-ratings of obsessive symptoms. Both groups were characterized by high levels of neuroticism and anxiety and low levels of extraversion. In the anorexic group the 6 abstainers had higher resistance scores on the LOI and higher extraversion scores on th MPI than the 9 bulimics. Findings are discussed with reference to the "sorcerer's apprentice" syndrome which appears to characterize both the obsessive and the anorexic.
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