Background and Purpose Inflammatory biomarkers predict incident and recurrent cardiac events, but their relationship to stroke prognosis is uncertain. We hypothesized that high-sensitivity C-reactive protein (hsCRP) predicts recurrent ischemic stroke after recent lacunar stroke. Methods Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) was an international, multicenter, prospective ancillary biomarker study nested within Secondary Prevention of Small Subcortical Strokes (SPS3), a Phase III trial in patients with recent lacunar stroke. Patients were assigned in factorial design to aspirin versus aspirin plus clopidogrel, and higher versus lower blood pressure targets. Patients had blood samples collected at enrollment, and hsCRP measured using nephelometry at a central laboratory. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals (HR, 95%CI) for recurrence risks before and after adjusting for demographics, comorbidities, and statin use. Results Among 1244 lacunar stroke patients (mean 63.3 ± 10.8 years), median hsCRP was 2.16 mg/L. There were 83 recurrent ischemic strokes (including 45 lacunes), and 115 major vascular events (stroke, myocardial infarction, vascular death). Compared with the bottom quartile, those in the top quartile (hsCRP >4.86 mg/L) were at increased risk of recurrent ischemic stroke (unadjusted HR 2.54, 95%CI 1.30–4.96), even after adjusting for demographics and risk factors (adjusted HR 2.32, 95%CI 1.15–4.68). HsCRP predicted increased risk of major vascular events (top quartile adjusted HR 2.04, 95%CI 1.14–3.67). There was no interaction with randomized antiplatelet treatment. Conclusions Among recent lacunar stroke patients, hsCRP levels predict risk of recurrent strokes and other vascular events. HsCRP did not predict response to dual antiplatelets.

.stitiitc>, Aj,r K A 6 5 H L I . Two experiments were conducted to study the digestion of nitrogcnous constituents in the rumen, small intestine and caecum and colon of sheep given diets of grass silage or grass silage and barley. Three silages were used. One was made from first-harvest grass in the spring and the others from regrowth grass cut in either early autunin or late autumn. All were of perennial ryegrass (Lolirtm pcr-rrrne) and were preserved with formic acid.2 . Expt I involved a comparison between the spring silage given alone (644 g dry matter (DM)/d) and the spring silage supplemented with barley (151 g DM/d). The intakes (g/d) of total nitrogen for the silage diet and for the supplemented diet were 14.89 and 17.36. Corresponding values (g/d) for N passage were 15'55 and 18.53 (P < 0 . 0 1 ) at the duodenum. 6.01 and 7.09 at the ileum and 5.06 and 5'52 in the faeces. The barley supplement had no significant (P < 0.05) effect on rumen ammonia-N concentration.3. Expt z involved a comparison between the two autumn-cut silages each offered at a level of feeding of approximately 700 g DM/d. The intakes (g/d) of total N for the early-cut silage and for the late-cut silage were 21.67 and 15.62 respectively. Corresponding values (g/d) for N passage were 17.10 and 16.96 at the duodenum, 6.65 and 6.80 at the ileum and 4.5 and 5.22 in the faeces. The concentration of NHJ-N in the runicn was significantly (P < 0.001) higher with the early-cut silage than with the late-cut silage.4. In both experiments the rates of bacterial crude protein (N x 6.25) synthesis in the rumen, estimated using z.c-diaminopinielic acid as a marker, were low, 1 4 2 and 161 g crude protein/kg organic matter apparently digested in the rumen for the spring silage and the spring silage and barley diets respectively, and 68 and 103 g crude protein/kg organic matter apparently digested in the rumcn for the early-cut autumn silage and the late-cut autumn silage respectively. For all diets theie was a relatively low contribution of bacterial crude protein to the duodenal passage of crude protein and the amounts of individual amino acids ingested in the diets had a marked influence on the amino acids passing to the duodenum and as a consequence on the mixture of amino acids taken up from the small intestine.5 . The results are discussed in relation to the nutritive value of silage N for ruminants.

1. Two calorimetric experiments were conducted to study the utilization of energy in sheep given diets of grass silage or grass silage and barley. Three silages were investigated. One was made from first-harvest grass in the spring (S) and the others from regrowth cut either early or late in the autumn (E and L respectively). All were of perennial ryegrass (Lolium perenne) and preserved with formic acid. Each silage was given at two levels of feeding, the lower providing approximately a maintenance energy intake. The S and L silages were also given supplemented with barley.2. The digestibilities of organic matter, cellulose and energy in the silages were high. Measured at maintenance, digestible energy (DE) contents (MJ/kg dry matter (DM)) were 11.83, 14.67 and 12.90 for S, E and L respectively. The DE contents of the S and E silages were depressed at the higher level of feeding but the effect was offset by changes in the energy losses as methane and urine. Metabolizable energy (ME) contents (MJ/kg DM) for the three silages, S, E and L were respectively 9.88,12.54 and 10.73 at the low level of feeding and 9.91, 11.99 and I 1.08 at the high level of feeding. The mean ME content of barley calculated by difference was 13.76 MJ/kg OM.3. The mean efficiencies of utilization of ME for maintenance (k,) for the S, E and L silages were o.@.0.71 and 0.68 respectively. Corresponding values for fattening (k,) were 0.21, 0.57 and 0.59. Excepting the k, for the S silage which was low, observed efficiencies were in broad agreement with those predicted by the equations of the Agricultural Research Council (1965). Similar agreement was obtained with all diets consisting of silage and barley.Although grass silage is used throughout the United Kingdom for the winter feeding of cattle and sheep, the factors influencing its nutritive value are poorly understood (see Wilkins, 1974). This led to the work reported here which was designed to provide calorimetric information about energy metabolism in sheep receiving diets of silage alone or silage and barley. Three perennial ryegrass (Lolium perenne) silages were studied. One was made from first-harvest grass in the spring and the others from regrowth either early or late in autumn.A preliminary report of some of the results has been given elsewhere (Thomas, Kelly, Chamberlain & Macdonald, 1976). E X P E R I M E N T A L Animals and managementA total of ten Finnish Landrace x Dorset Horn wether sheep were used. They were 2 or 3 years old and weighed 50-55 kg. The four animals used in Expt I were rumen-cannulated.The animals were held in metabolism cages in a small animal house during experimental periods except during the determination of respiratory exchange. Food was given in four equal meals each day at 07.00, 12.00, 17.00 and 22.00 hours. Water and mineralized salt blocks were freely available. Foods The three silages used were prepared from swards of perennial ryegrass, of the SZ8 and SZ4varieties. The grass used in Expt I was cut in mid-May, 1974, allowed to wilt overnight and har...

These relatively high rates of lacunar stroke and stroke of unknown cause are similar to those from other recent surveys and may reflect an important shift in the pathophysiologic mechanisms that underlie ischemic stroke.

I .Two experiments were conducted to study the digestion of organic matter, gross energy and carbohydrate constituents in the rumen, small intestine and caecum and colon of sheep given grass silage diets. Three silages made from perennial ryegrass (Lolium perenne) with formic acid as an additive were used. One was made from first-harvest grass in the spring and the others from regrowth grass cut from a single sward in either early autumn or late autumn. Expt I involved a comparison between the spring silage given alone or supplemented with barley (silage: barley, 4: i dry matter (DM) basis). Expt 2 involved a comparison between the early-cut and late-cut autumn silages.2. In Expt I , supplementation of the silage with barley resulted in a non-significant (P > 0.05) reduction in the proportion of digestible energy (DE) and digestible organic matter digested in the rumen and an increase in the proportions digested in the small intestine. There were also pronounced effects of barley on ruminal cellulolysis and the proportion of digestible cellulose broken down in the rumen was reduced (P < 0 . 0 5 ) from 0.90 to 0.77. There was an increased passage of a-linked glucose polymers to the duodenum but even with the supplemented diet 0.91 of the dietary polymers were digested in the rumen. The molar proportion of propionic acid in the rumen tended to be reduced and there were increases in the proportions of butyric acid (P < 0.01) and acetic acid.3. In Expt 2 , the digestibility of organic matter, gross energy and cellulose in the early-cut silage was higher (P < 0.01) than in the late-cut silage but there were no significant (P < 0.05) differences between silages in the sites of digestion of these constituents. However, the molar proportion of acetic acid in the rumen was higher (P < 0.01) and the molar proportion of propionic acid was lower (P < 0.01) with the late-cut silage than with the early-cut silage.4. The results are discussed in relation to the voluntary intake and utilization of high-digestibility silages.In calorimetric studies of energy metabolism in sheep Kelly & Thomas (1978) examined the utilization of the energy of three perennial ryegrass (Lolium perenne) silages prepared using formic acid as an additive. One silage was made from first harvest grass in the spring and the others were from regrowth cut either early or late in the autumn. Each silage was given as a sole food and the spring and late-cut autumn silages were also given supplemented with barley. The experiments reported here were to study the sites of digestion of organic matter, gross energy and carbohydrates in sheep given silage diets similar to some of those used by Kelly and Thomas (1978). The object was to provide a fuller understanding of the effects of barley supplementation and of the maturity of the grass ensiled on the digestion processes, and to investigate whether differences between silages in the efficiency of utilization of metabolizable energy for fattening (kf), observed in the earlier experiments, could be related to the pa...