Background Despite promising epidemiological data, it remains unclear if increased blood pressure variability is associated with death after acute ischemic stroke. Our objective was to examine this association in a large cohort of acute ischemic stroke patients. Methods We conducted a retrospective analysis of anonymized, pooled, participant data from the Virtual International Stroke Trial Archive. We included patients with a 90-day modified Rankin Scale and blood pressure readings in the 24 h after study enrollment. The exposure was blood pressure variability during the day after study enrollment, calculated for the systolic and diastolic blood pressure using six statistical methodologies. The primary outcome was death within 90 days of stroke onset. Results Our cohort comprised 1891 patients of whom 277 (14.7%) died within 90 days. All indices of blood pressure variability were higher in patients who died, but the difference was more pronounced for systolic than diastolic blood pressure variability (systolic standard deviation for alive versus dead patients = 13.4 versus 15.9 mmHg, p < 0.001). Similar results were found in logistic regression models fit to the outcome of death, but only systolic blood pressure variability remained significant in adjusted models (Odds Ratio for death when comparing highest to lowest tercile of systolic blood pressure variability = 1.41–1.89, p < 0.03 for all). Conclusions and relevance: These results reinforce prior studies that found increased blood pressure variability is associated with worse neurologic outcome after stroke. These data should help guide research on blood pressure variability after stroke and advocate for the inclusion of death as a clinical outcome in future studies that therapeutically reduce blood pressure variability.

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Conclusion:One third of patients with fatal blunt trauma have thoracic aortic injuries. The majority of deaths occur at the scene of the injury.Summary: There have been recent paradigm shifts in the management of blunt thoracic aortic trauma, including more widespread imaging using CT scanning, aggressive blood pressure control of patients who reach the hospital alive, delayed treatment of thoracic aortic injuries and more frequent use of endovascular techniques for repair of blunt thoracic trauma. These changes appear to have resulted in a decline in mortality from 22% to 13% for patients with thoracic aortic injuries who reach the hospital alive (Demetriades D. J Trauma 2008;64:1415-8). Many patients with blunt thoracic injury, however, cannot benefit from these advnces because they die at the scene of the accident. To develop some sense of the magnitude of this problem the authors analyzed autopsy findings in a series of blunt traumatic fatalities. They reviewed autopsies for blunt trauma performed by the Los Angeles County Coroner's Office in 2005. Victims without thoracic aortic trauma were compared with those with a traumatic thoracic aortic injury with respect to patterns of associated injuries and differences in baseline characteristics. During the study time there were 881 fatal victims of blunt trauma received by the Los Angeles County Department of Coroner. Of these 304 (35%) underwent a full autopsy and were included in the analysis here. Average age was 43 Ϯ 21 years and 71% were men. The most common mechanism of injury was a motor vehicle accident (50%) and the second most common was a pedestrians struck by an auto (37%). 102 of the 304 victims (34%) had a thoracic aortic injury. The descending thoracic aorta was the site of injury in 66%. Compared to patients without thoracic aortic injuries those with thoracic aortic injuries were more likely to have a cardiac injury (44% versus 25%; P ϭ .001), hemothorax (86% versus 56%; P Ͻ .001), rib fractures (86% versus 72%; P ϭ .006), and intra-abdominal injury (74% versus 49%; P Ͻ .001). Death at the scene was more likely if you had a thoracic aortic injury (80% versus 63%; P ϭ .002).Comment: It is not surprising most patients with thoracic aortic injury die at the accident scene. Motor vehicle accidents serve as the greatest source of thoracic aortic injury. It is interesting that despite advances in automotive and safety engineering the prevalence of blunt thoracic aortic injury in motor vehicle accidents does not seem to have been impacted by engineering advances. The association of thoracic aortic injury with motor vehicle accidents appears very similar to that, identified by Parmley, et. al. fifty years ago (Parmley LF. Circulation 1958;17:1086-101). However, it is possible engineering advances may have reduced the fatality rate of blunt aortic thoracic trauma following motor vehicle trauma without affecting its prevalence.

SummaryThe relation between the bleeding time and the megakaryocyte nuclear DNA content and size was evaluated in eleven consecutive patients with normal steady state thrombopoiesis undergoing thoracotomy. A statistically significant inverse correlation was found between the bleeding time and both megakaryocyte DNA content (r = −0.71, p <0.05), megakaryocyte total size (r = ‒0.58, p <0.05), megakaryocyte cytoplasmic size (r = −0.64, p <0.05) and megakaryocyte nuclear size (r = −0.58, p <0.05). The megakaryocyte total size and the megakaryocyte cytoplasmic size were statistically significantly larger in men than women (p <0.02 and p <0.03 respectively). Changes in the megakaryocytes in the bone marrow are associated with changes in primary haemostasis in normal individuals.