SummaryBackgroundResults of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.MethodsFOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762.FindingsBetween Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months.InterpretationFluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.FundingUK Stroke Association and NIHR Health Technology Assessment Programme.

Qualitative results suggest that inter-professional learning may be a successful strategy for improving the delivery of collaborative arthritis care and supporting patient self-management.

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Abstract. Joints from 153 arthritic and 80 normal slaughter hogs were examined by culture for presence of bacteria. Although none of the normal joints yielded bacteria, 37% of the disease joints were positive for bacterial growth. Of 67 bacterial isolates obtained, 45% were Erysipelothrix rhusiopathiae. Occurrence of other bacteria in order of their frequency was Streptococcus suis (16%), Actinomyces pyogenes (10%), Mycoplasma spp. including 3 M. hyorhinis isolates (7%), staphylococci (7%), Streptococcus spp. (6%), and organisms of uncertain significance (7%).Arthritis is common in hogs sent to market and is a cause of economic concern to the farmers because of loss of portions of carcasses as well as condemnation of entire carcasses in the abattoir. Joint diseases are responsible for a significant percentage of total condemnations of swine in Canada. 10 Figures collected at Garden Province Meats, Charlottetown, Prince Edward Island, where over 80% of the island's hogs are slaughtered, indicate that on average every month 0.6% of the hogs (11 condemned and 70 demerited) had arthritis. The association of Zoonotic agents with swine arthritis and the resulting public health hazards are other major considerations.Despite the importance of arthritis in swine, there has been a paucity of documented research on this subject, particularly during the last 15 years. Because most cases of porcine arthritis are probably the result of bacterial infections, 2,3 the present study was aimed at identifying the bacteria associated with arthritis in slaughter pigs and determining antimicrobial susceptibility. Materials and methodsSpecimen collection. Two hundred thirty-three hogs slaughtered at Garden Province Meats, Charlottetown, were chosen for this study. The hogs were 6-7 mo old and were raised in confinement. The samples were collected during May-August 1990, and all the arthritic joints were sampled consecutively. Of 145 hogs sampled, 93 had >1 joint affected. Arthritic joints were selected on the basis of the following criteria: the joint was swollen, and the accompanying lymph node that drained the joint was enlarged. One hundred fiftythree joints that met these criteria were retained for culture. In the case of polyarthritis, the most severely affected joint was sampled. Of 153 joints sampled, 60% were stifle and the remainder were elbow (14%), hock (13%), and other (13%). One hundred fifteen enlarged lymph nodes directly associated with affected joints were also collected and placed on ice for transport to the laboratory. Control hogs without arthritis and the specific joints cultured were chosen randomly using a random number generator. Eighty normal joints were collected. The joints were taken to the plant's laboratory. Skin and subsequently subcutaneous tissue were flamed with a propane torch. Using sterile forceps and scalpel blade, the synovial membrane was opened and the joint fluid was aspirated with a sterile 10-ml syringe and 16-gauge needle. Bacteriologic examination. Immediately after collection, a drop of as...

1. The influence of hydrocortisone, insulin and diet on the size distribution of ribosomes in a post-mitochondrial supernatant prepared from rat skeletal muscle was studied by sedimentation analysis with a linear 15-40% (w/v) sucrose gradient. 2. Within 4hr. after the injection of 5mg. of hydrocortisone to well-nourished rats, a decrease in the yield per g. of muscle and proportion of total RNA due to polyribosomes was observed. Similar results were obtained in rats given a protein-free diet for 3 days before administration of the hormone. 3. Insulin injection increased the yield and proportion of polyribosomes within 2hr. and decreased the proportion of the lighter ribosomal aggregates. Similar results were noted in rats given a protein-free diet for 3 days before injection. A protein-free diet given for 3 days decreased the yield and proportion of polyribosomes. Insulin did not increase the yield of polyribosomes if rats were starved for 52hr. before injection, but decreased the yield and proportion of the lighter ribosome species. 4. A 52hr. period of starvation or 2,4-dinitrophenol (15mg./kg. body wt.) given 1hr. before the rats were killed resulted in a decreased yield and proportion of polyribosomes, and, within 6hr. of re-feeding the rats with protein-free diets, an increased concentration of polyribosomes was noted. 5. The effects of a protein-free diet, hydrocortisone and insulin on the sedimentation of muscle ribosomes were found to be in accord with their net effects on muscle protein synthesis.