SUN-LB137 Endocannabinoids Induce Endoplasmic Reticulum Stress in Hepatocytes and Human Coronary Artery Endothelial Cells

Obesity and diabetes are important risk factors for the development of coronary heart disease and stroke. Plasma endocannabinoid (EC) levels are inappropriately elevated in obesity and diabetes, and are hypothesized to play a causal role in central regulation of weight gain. Importantly, it was recently demonstrated that cannabinoid receptor 1 (CNR1) triggers cell stress and induces apoptosis in kidney tubule cells exposed to palmitic acid and high-glucose (HG). HepG2 and human coronary artery endothelial cells (HCAEC) were treated with tunicamycin (TM), thapsigargin (TG), high-glucose (HG), anandamide (AN), and 2-arachondonyl glycerol (2-AG), and endoplasmic reticulum (ER) stress was measured. In cells treated with TM, AM, and 2-AG and the UPR inhibitors 4-phenylbutyrate (4-PB) and taurodeoxycholic acid (TUDCA), both 4-PB and TUDCA prevented AN and 2-AG from promoting ER stress. ER stress in cells treated with AN and 2-AG, but not TM, was inhibited by the CNR1 antagonist rimonabant. Similar results were obtained with HCAEC. Furthermore, treatment with AN and 2-AG induced inositol requiring enzyme 1α and protein kinase R-like endoplasmic reticulum kinase phosphorylation but had no effect on their expression, while activating transcription factor 6 and binding immunoglobulin protein expression were also induced by AN and 2-AG in both HepG2 and HCAEC. Finally, AN and 2-AG treatment induced CNR1 expression in both cell lines. These results strongly suggest that EC’s promote ER stress and potentially induce liver and endothelial cell dysfunction.

Partial Time-Reversal Invariance Violation in a Flat, Superconducting Microwave Cavity with the Shape of a Chaotic Africa Billiard

We report on the experimental realization of a flat, superconducting microwave resonator, a microwave billiard, with partially violated time-reversal (T) invariance, induced by inserting a ferrite into the cavity and magnetizing it with an external magnetic field perpendicular to the resonator plane. In order to prevent its expulsion caused by the Meissner-Ochsenfeld effect, we used a cavity of which the top and bottom plate were made from niobium, a superconductor of type II, and cooled it down to liquid-helium temperature T_{LHe}≃4  K. The cavity had the shape of a chaotic Africa billiard. Superconductivity rendered possible the accurate determination of complete sequences of the resonance frequencies and of the widths and strengths of the resonances, an indispensable prerequisite for the unambiguous detection of T invariance violation, especially when it is only partially violated. This allows for the first time the precise specification of the size of T invariance violation from the fluctuation properties of the resonance frequencies and from the strength distribution, which actually depends sensitively on it and thus provides a most suitable measure. For this purpose we derived an analytical expression for the latter which is valid for isolated resonances in the range from no T invariance violation to complete violation.

The United Kingdom Primary Immune Deficiency (UKPID) registry 2012 to 2017

This is the second report of the United Kingdom Primary Immunodeficiency (UKPID) registry. The registry will be a decade old in 2018 and, as of August 2017, had recruited 4758 patients encompassing 97% of immunology centres within the United Kingdom. This represents a doubling of recruitment into the registry since we reported on 2229 patients included in our first report of 2013. Minimum PID prevalence in the United Kingdom is currently 5·90/100 000 and an average incidence of PID between 1980 and 2000 of 7·6 cases per 100 000 UK live births. Data are presented on the frequency of diseases recorded, disease prevalence, diagnostic delay and treatment modality, including haematopoietic stem cell transplantation (HSCT) and gene therapy. The registry provides valuable information to clinicians, researchers, service commissioners and industry alike on PID within the United Kingdom, which may not otherwise be available without the existence of a well-established registry.

Confocal Raman microscopy in life sciences

Microscopy techniques are widely used in life sciences to study cells and tissues. Fluorescence microscopy, for example, is a very common method in many laboratories. While reliable and strong fluorescence signals are a clear advantage of this method, the labelling procedure with fluorescent dyes, the availability of required antibodies or the potentially necessary genetic modifications of the studied organism all introduce potential complications. By contrast, confocal Raman microscopy is a label-free and non-destructive imaging technique. In contrast to infrared microscopy, it is easily applicable in aqueous environments. Different microscope setups and combinations allow for the examination of various solid and liquid samples, even in their typical environments. The article demonstrates the analyzing capability of confocal Raman microscopy and correlative techniques through application examples of eukaryotic and prokaryotic cells, and cancerous and normal tissues and shows how confocal Raman microscopy provides valuable information for a more comprehensive understanding of the investigated sample.

Measurement of deformation heterogeneities in additive manufactured lattice materials by Digital Image Correlation: Strain maps analysis and reliability assessment

The mechanical behaviour of porous lattice materials for potential orthopaedic applications was investigated at a fine scale by means of digital image correlation (DIC). Specimens with cubic, body cubic-centered reinforced (BCCZ), and diamond mesostructures were tested in quasi-static compression up to failure. Images were continuously recorded by an imaging setup and processed by a custom DIC program, OpenDIC. The resulting strain maps were analyzed in both spatial and temporal scales, displaying the onset and evolution of strain heterogeneities. The three geometries show different failure modes, i.e. collective buckling of an entire row for cubic, diagonal shearing band for BCCZ, and generalized crushing for diamond. The strain maps correlate well with these patterns. Most importantly, they show early strain localization below the macroscopic elastic limit. After failure, a phenomenon of strain release was witnessed and evaluated in the parts of the specimen that do not fracture. In the cubic geometry, the vertical struts sustain most of the deformation. Further analysis shows that the rows of vertical struts have similar, yet scattered, evolutions until failure. Interestingly, the row that leads to specimen failure is not necessarily the first one to deform. In addition to these experimental results, the uncertainties of the method were thoroughly assessed by means of calibration procedures.

Enhancing antibiotic stewardship by tackling "spurious" penicillin allergy

Approximately 90-99% of patients with a label of penicillin allergy (PenA) are not allergic when comprehensively investigated. An inaccurate label of PenA has major public health implications-longer hospital stay, more frequent hospital admissions, greater use of fluoroquinolones, glycopeptides, cephalosporins and other expensive antibiotics resulting in significantly higher costs to the health service and predisposing to Clostridium difficile, methicillin-resistant Staphylococcus aureus infections and vancomycin-resistant enterococcus. We describe lessons learnt from recent studies regarding possible reasons contributing to an inaccurate label of PenA as well as propose a concerted multidisciplinary approach to address this important public health problem. Given the unmet need for allergy services in the UK and several other countries and knowledge gaps regarding PenA amongst healthcare professionals, we describe the potential role for a computerized clinical decision support system to enable non-specialists rapidly identify and de-label "low-risk" hospitalized patients with a label of PenA thereby obviating the need for allergy tests. This approach however needs rigorous evaluation for feasibility, safety, patient and physician acceptability, cost-effectiveness and its compatibility with information technology systems currently employed in the health service.

Residue concentration of cefquinome after intramammary dry cow therapy and short dry periods

Short dry periods and their effects on milk production, reproductive performance, as well as cow and udder health have been widely studied. A dearth of information is available about the consequences of short dry periods on the residue concentrations of dry cow antibiotics in milk after calving. The objective of our study was to determine the residue concentration of a dry cow antibiotic in milk after short dry periods during the colostrum period and early lactation. Quarters of 19 dry cows were treated with an intramammary (IMM) dry cow antibiotic containing 150 mg of cefquinome on d 21, 14, and 7 before calculated calving date. One quarter of each cow did not receive treatment and served as negative control. After calving, quarter foremilk samples were collected twice daily until 21 d and once daily until 36 d after IMM dry cow treatment (i.e., end of withdrawal period). A total of 588 foremilk samples from odd milking numbers were chosen for the determination of the residue concentration of cefquinome using HPLC-tandem mass spectrometry until the residue concentration fell below the limit of quantification (1 ng/g), which occurred at the latest in milking number 37. The dry period length of the treated quarters was categorized in 3 dry period groups ranging from 1 to 7 d (4.8 ± 2.4), 8 to 14 d (11.5 ± 2.3), and 15 to 26 d (19.5 ± 3.3; ±SEM), in dry period group 1, 2, and 3, respectively. In dry period group 1, the cefquinome concentration increased after calving until the third milking and decreased considerably until the fifth milking. In dry period group 2, the cefquinome concentration peaked at the second milking and decreased considerably until the fifth milking as well. There was no increase in cefquinome after calving in dry period group 3. Up to the 37th milking, the cefquinome concentration was higher in dry period group 1 than in dry period group 2 and 3. On average, 31.3 ± 1.2, 19.0 ± 1.1, and 6.7 ± 0.8 milkings and 19.4 ± 0.4, 20.6 ± 0.5, and 24.1 ± 0.7 d after treatment were necessary for the concentration of cefquinome to fall below the maximum residue limit (MRL) in dry period group 1, 2, and 3, respectively. These results indicate that shorter dry periods lead initially to higher cefquinome residues in milk. The residue concentration after experimental short dry periods still falls below the MRL within the recommended withdrawal period for milk of 36 d after IMM dry cow treatment. For the sake of food safety and economics, these short dry periods should not be used in the dry cow management, as they lead up to a maximum of 31.3 ± 1.2 milkings and 19.4 ± 0.4 d after treatment with cefquinome residues above the MRL. Therefore, a considerable number of milkings have to be discarded due to long withdrawal periods after calving.

Decitabine demonstrates antileukemic activity in B cell precursor acute lymphoblastic leukemia with MLL rearrangements

Background

Promotor hypermethylation of CpG islands is common in B cell precursor acute lymphoblastic leukemia (BCP-ALL) with mixed lineage leukemia (MLL) gene rearrangements. Hypomethylating agents (HMA) such as azacitidine (AZA) and decitabine (DEC) reduce DNA hypermethylation by incorporation into DNA and were successfully introduced into the clinic for the treatment of myeloid neoplasias.

Methods

Here, we investigated whether HMA induce comparable biological effects in MLL-positive BCP-ALL. Further, efficacy of HMA and concomitant application of cytostatic drugs (cytarabine and doxorubicin) were evaluated on established SEM and RS4;11 cell lines. In addition, promising approaches were studied on BCP-ALL cell line- and patient-derived xenograft models.

Results

In general, DEC effects were stronger compared to AZA on MLL-positive BCP-ALL cells. DEC significantly reduced proliferation by induction of cell cycle arrest in G0/G1 phase and apoptosis. Most sensitive to HMA were SEM cells which are characterized by a fast cell doubling time. The combination of low-dose HMA and conventional cytostatic agents revealed a heterogeneous response pattern. The strongest antiproliferative effects were observed when ALL cells were simultaneously exposed to HMA and cytostatic drugs. Most potent synergistic effects of HMA were induced with cytarabine. Finally, the therapeutic potential of DEC was evaluated on BCP-ALL xenograft models. DEC significantly delayed leukemic proliferation in xenograft models as demonstrated longitudinally by non-invasive bioluminescence as well as ¹⁸F-FDG-PET/CT imaging. Unexpectedly, in vivo concomitant application of DEC and cytarabine did not enhance the antiproliferative effect compared to DEC monotherapy.

Conclusions

Our data reveal that DEC is active in MLL-positive BCP-ALL and warrant clinical evaluation.

Electronic supplementary material

The online version of this article (10.1186/s13045-018-0607-3) contains supplementary material, which is available to authorized users.

Diacetylene polymerization on a bulk insulator surface

Molecular electronics has great potential to surpass known limitations in conventional silicon-based technologies. The development of molecular electronics devices requires reliable strategies for connecting functional molecules by wire-like structures. To this end, diacetylene polymerization has been discussed as a very promising approach for contacting single molecules with a conductive polymer chain. A major challenge for future device fabrication is transferring this method to bulk insulator surfaces, which are mandatory to decouple the electronic structure of the functional molecules from the support surface. Here, we provide experimental evidence for diacetylene polymerization of 3,3'-(1,3-butadiyne-1,4-diyl)bisbenzoic acid precursors on the (10.4) surface of calcite, a bulk insulator with a band gap of around 6 eV. When deposited on the surface held at room temperature, ordered islands with a (1 × 3) superstructure are observed using dynamic atomic force microscopy. A distinct change is revealed upon heating the substrate to 485 K. After heating, molecular stripes with a characteristic inner structure are formed that excellently match the expected diacetylene polymer chains in appearance and repeat distance. The corresponding density functional theory computations reveal molecular-level bonding patterns of both the (1 × 3) superstructure and the formed striped structure, confirming the assignment of on-surface diacetylene polymerization. Transferring the concept of using diacetylene polymerization for creating conductive connections to bulk insulator surfaces paves the way towards application-relevant systems for future molecular electronic devices.

Dynamik der Elektrolytkonzentrationen im Blutplasma von Rindern mit operativ beendeter Torsio uteri intra partum

Gegenstand und Ziel: Es sollte überprüft werden, inwieweit beim Rind die Elektrolyte im Blutplasma durch eine Torsio uteri intra partum einschließlich operativer Behandlung (Gruppe 1) im Vergleich zu mit Sectio caesarea beendeten Dystokien ohne Torsio uteri (Gruppe 2) bzw. Normalgeburten (Gruppe 3) während der ersten 10 Tage post operationem/partum beeinflusst werden. Material und Methoden: In die Studie gingen 45 schwarzbunte Rinder mit chirurgisch therapierter Torsio uteri intra partum ein. Im Abstand von 24 Stunden, beginnend unmittelbar präoperativ, bis 10 Tage post operationem (p. o.) wurden Blutproben aus der Vena jugularis externa entnommen und Gesamtkalzium, anorganisches Phosphat, Mg2+, Na+, und K+ bestimmt. Die Vergleichsgruppen umfassten jeweils 11 Tiere. Ergebnisse: Die Veränderungen der Plasmaspiegel von Gesamtkalzium, anorganischem Phosphat, Na+ und K+ waren bei den 33 überlebenden Rindern mit Torsio uteri und den Tieren der Gruppen 2 und 3 gering. Der Magnesiumplasmaspiegel fiel postoperativ besonders bei Gruppe 1, aber auch bei Gruppe 2 im Vergleich zu Gruppe 3 signifikant ab und verblieb bis zum Ende der Beobachtungszeit unterhalb des Referenzbereichs. Bei den 12 verendeten Patienten mit Torsio uteri traten im Vergleich zu den überlebenden Rindern mit Gebärmutterdrehung eine deutlichere, am vierten postoperativen Tag signifikante Hypomagnesiämie und ein signifikant erniedrigter Plasmakaliumspiegel auf. Schlussfolgerung: Nach geburtshilflich-chirurgischen Eingriffen sollten bei Rindern die Elektrolytplasmaspiegel insbesondere von Magnesium und Kalium überprüft und die Elektrolyte gegebenenfalls substituiert werden. Klinische Relevanz: Ein postoperativ niedriger Plasmakaliumspiegel in Verbindung mit einer Hypomagnesiämie ist bei Rindern, die wegen einer Torsio uteri operiert wurden, ein Hinweis auf eine schlechte Prognose quoad vitam.

Untersuchungen zur Eignung des ultrasonographisch ermittelten Uterusgewichtes und der uterinen Echotextur zur Prognose der Fertilität beim weiblichen Schwein

Gegenstand und Ziel: Es wurde untersucht, ob sich ultrasonographisch ermitteltes Uterusgewicht (UG) und uterine Echotextur (ET) zur Prognose der Fertilität beim weiblichen Schwein eignen. Gleichzeitig sollte eruiert werden, ob ein optimales UG, das für Jung- (JS) und Altsauen (AS) 400-600 bzw. 500-700 g betragen soll, existiert. Material und Methoden: Insgesamt 67 abgesetzte AS (Betrieb A = B-A) sowie 44 JS und 64 AS mit unterschiedlichen Reproduktionsstörungen (Betrieb B = B-B) wurden einen Tag nach dem Absetzen (B-A) oder am Ende einer 15-tägigen Altrenogest- Applikation (B-B) transkutan sonographisch untersucht. Das UG wurde mithilfe der sonographisch ermittelten Querschnittsfläche der Uterushörner (QF) errechnet (UG = 357,6 × QF0,801; beide B), die ET in die Grade 1-4 eingeteilt (homogen bis hochgradig heterogen; nur B-B) und Uteri mit ET-Grad 1 als physiologisch betrachtet. Tiere wurden nur dann berücksichtigt, wenn sie zum Zeitpunkt der Erfassung von UG und ET sonographisch Follikel mit einer Größe von 2-4 mm aufwiesen und im darauf folgenden Östrus zeitgerecht ovuliert hatten. Eine Sau galt als fertil, wenn sie tragend wurde. Ergebnisse: Die UG betrugen 306-1789 g. Tragende und nicht tragende AS (B-A) bzw. JS und AS (B-B) wiesen jeweils ein ähnliches mittleres UG und zu ähnlichen Anteilen UG von < 400 / > 600 g (JS) oder < 500 / > 700 g (AS) auf. Sauen mit ET-Grad 4 wurden seltener (p ≤ 0,05) bzw. tendenziell seltener (p ≤ 0,1) tragend als Tiere mit den ET-Graden 1 und 2 (57,1% vs. 87,0% bzw. 82,2%). Uteri mit dem ET-Grad 4 waren schwerer als die mit den ET-Graden 1-3 (p ≤ 0,05). Schlussfolgerungen: JS und AS werden unabhängig davon tragend, ob die Uteri leicht oder schwer sind. Weisen Sauen kleine Follikel, aber hochgradig heterogen texturierte Uteri auf, sind die Uteri häufig funktionsgestört und überwiegend schwer. Derartige Sauen haben verringerte Trächtigkeitschancen. Klinische Relevanz: Die sonographisch beurteilte ET eignet sich zur Prognose der Fertilität beim weiblichen Schwein, das UG nicht. Optimale UG sind zu bezweifeln.

Immobilization of pH-sensitive CdTe Quantum Dots in a Poly(acrylate) Hydrogel for Microfluidic Applications

Microfluidic devices present the basis of modern life sciences and chemical information processing. To control the flow and to allow optical readout, a reliable sensor material that can be easily utilized for microfluidic systems is in demand. Here, we present a new optical readout system for pH sensing based on pH sensitive, photoluminescent glutathione capped cadmium telluride quantum dots that are covalently immobilized in a poly(acrylate) hydrogel. For an applicable pH sensing the generated hybrid material is integrated in a microfluidic sensor chip setup. The hybrid material not only allows in situ readout, but also possesses valve properties due to the swelling behavior of the poly(acrylate) hydrogel. In this work, the swelling property of the hybrid material is utilized in a microfluidic valve seat, where a valve opening process is demonstrated by a fluid flow change and in situ monitored by photoluminescence quenching. This discrete photoluminescence detection (ON/OFF) of the fluid flow change (OFF/ON) enables upcoming chemical information processing.

[The first biologic for rheumatoid arthritis: factors influencing the therapeutic decision]

BACKGROUND AND AIMS

Biologics (disease modifying antirheumatic drugs, bDMARD) have been in use in Germany for the treatment of rheumatoid arthritis (RA) since 2001, usually after failure of at least one conventional synthetic (cs)DMARD. We analyzed temporal changes in factors that influence the decision for either a first bDMARD or a further csDMARD.

MATERIAL AND METHODS

We analyzed data from 9513 bDMARD-naive RA patients in the German biologics register RABBIT who switched to a new therapy. For three recruitment periods (2001-2003, 2004-2006 and 2009-2015) factors influencing the therapeutic decision were analyzed by means of machine learning methods and logistic regression analysis.

RESULTS

In all recruitment periods the number of previous csDMARDs, high dosages of glucocorticoids (>7.5 mg/day) and a higher DAS28 (>5.1) were significantly associated with the decision for a first bDMARD. Over time, the chance of receiving a bDMARD increased in patients with moderate disease activity, moderate glucocorticoid dosages (5-7.5 mg/day) and those with comorbidities, such as congestive heart failure or prior malignancy. Men had a higher chance of receiving a bDMARD than women only in the first recruitment period. Private health insurance, high education and gainful employment were significantly associated with more frequent prescription of bDMARDs in all recruitment periods.

DISCUSSION

The time-dependent changes in the impact of disease activity, concomitant drugs, gender and comorbidity on the prescription of bDMARDs mirror the increasing therapeutic options and the growing experience in the application of the new substances in patients at higher risk. The influence of demographic and social factors may reflect safety concerns in patients at increased risk of adverse events but also the need to economize drug costs..

Test of the Brink-Axel Hypothesis for the Pygmy Dipole Resonance

The gamma strength function and level density of 1^{-} states in ^{96}Mo have been extracted from a high-resolution study of the (p[over →], p[over →]^{'}) reaction at 295 MeV and extreme forward angles. By comparison with compound nucleus γ decay experiments, this allows a test of the generalized Brink-Axel hypothesis in the energy region of the pygmy dipole resonance. The Brink-Axel hypothesis is commonly assumed in astrophysical reaction network calculations and states that the gamma strength function in nuclei is independent of the structure of the initial and final state. The present results validate the Brink-Axel hypothesis for ^{96}Mo and provide independent confirmation of the methods used to separate gamma strength function and level density in γ decay experiments.

Generic nature of long-range repulsion mechanism on a bulk insulator?

Dynamic atomic force microscopy measurements are reported that provide evidence for the presence of long-range repulsion in molecular self-assembly on a bulk insulator surface. We present the structures formed from four different benzoic acid derivatives on the (10.4) cleavage plane of calcite kept in ultra-high vacuum. These molecules have in common that they self-assemble into molecular stripes when deposited onto the surface held at room temperature. For all molecules tested, a detailed analysis of the stripe-to-stripe distance distribution reveals a clear deviation from what would be expected for randomly placed, non-interacting stripes (i.e., geometric distribution). When excluding kinetic effects during growth, this result gives evidence for a long-range repulsion mechanism acting during the assembly of these stripes. The fact that this finding is robust against changes in the molecular structure indicates a generic nature of the observed mechanism, implying a ubiquitous origin such as electrostatic repulsion. Finally, we discuss parameters that might affect the unambiguous observation of this generic repulsion under specific experimental conditions.

Comprehensive assessment of food and nutrient intake of children and adolescents in Germany: EsKiMo II - the eating study as a KiGGS module

Background

As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), food and nutrient intake of children and adolescents aged 6–17 years living in Germany is assessed in EsKiMo II – the Eating Study as a KiGGS Module.

Methods

EsKiMo II is a cross-sectional study, conducted from June 2015 until September 2017. The study population comprises 6 to 17-year-old study participants from the cross-sectional sample of KiGGS Wave 2 in 167 KiGGS sample points, which are revisited by trained nutritionists. Dietary intake is assessed by weighted food records during three consecutive days plus one randomly selected day within the following 3 months for children aged 6–11 years. Dietary intake for adolescents aged 12–17 years is assessed by computer-assisted dietary history interviews, reflecting the past four weeks, using the software DISHES. Further information, for example, about specific diets and dietary supplement intake, is reported during a standardised computer assisted interview for all participants. Food items are coded by the German Food Code and Nutrient Database (BLS 3.02).

Discussion

EsKiMo II provides actual data on the dietary behaviour of children and adolescents living in Germany and their determinants. Results of EsKiMo II will be relevant for decision-making, measures, and evaluations within nutrition, consumer and health policy.

Serious adverse events and the risk of stroke in patients with rheumatoid arthritis: results from the German RABBIT cohort

OBJECTIVE

In the general population, the incidence of stroke is increased following other serious events and hospitalisation. We investigated the impact of serious adverse events on the risk of stroke in patients with rheumatoid arthritis (RA), taking risk factors and treatment into account.

METHODS

Using data of the German biologics register RABBIT (Rheumatoid Arthritis: Observation of Biologic Therapy) with 12354 patients with RA, incidence rates (IRs) and risk factors for stroke were investigated using multi-state and Cox proportional hazard models. In addition, in a nested case-control study, all patients with stroke were matched 1:2 to patients with identical baseline risk profile and analysed using a shared frailty model.

RESULTS

During follow-up, 166 strokes were reported. The overall IR was 3.2/1000 patient-years (PY) (95% CI 2.7 to 3.7). It was higher after a serious adverse event (IR: 9.0 (7.3 to 11.0)), particularly within 30 days after the event (IR: 94.9 (72.6 to 121.9)). The adjusted Cox model showed increased risks of age per 5 years (HR: 1.4 (1.3 to 1.5)), hyperlipoproteinaemia (HR: 1.6 (1.0 to 2.5)) and smoking (HR: 1.9 (1.3 to 2.6)). The risk decreased with better physical function (HR: 0.9 (0.8 to 0.96)). In the case-control study, 163 patients were matched to 326 controls. Major risk factors for stroke were untreated cardiovascular disease (HR: 3.3 (1.5 to 7.2)) and serious infections (HR:4.4 (1.6 to 12.5)) or other serious adverse events (HR: 2.6 (1.4 to 4.8)).

CONCLUSIONS

Incident adverse events, in particular serious infections, and insufficient treatment of cardiovascular diseases are independent drivers of the risk of stroke. Physicians should be aware that patients who experience a serious event are at increased risk of subsequent stroke.