BACKGROUND Remote ischemic preconditioning (RIPC) can inhibit recurrent ischemic events effectively in patients with acute or chronic cerebral ischemia. However, it is still unclear whether RIPC can impede ischemic injury after carotid artery stenting (CAS) in patients with severe carotid artery stenosis. METHODS Subjects with severe carotid artery stenosis were recruited in this randomized controlled study, and assigned to RIPC, sham, and no intervention (control) groups. All subjects received standard medical therapy. Subjects in the RIPC and sham groups underwent RIPC and sham RIPC twice daily, respectively, for 2 weeks before CAS. Plasma neuron-specific enolase and S-100B were used to evaluate safety, hypersensitive C-reactive protein, and new ischemic diffusion-weighted imaging lesions were used to determine treatment efficacy. The primary outcomes were the presence of ≥1 newly ischemic brain lesions on diffusion-weighted imaging within 48 hours after stenting and clinical events within 6 months after stenting. RESULTS We randomly assigned 189 subjects in this study (63 subjects in each group). Both RIPC and sham RIPC procedures were well tolerated and completed with high compliance (98.41% and 95.24%, respectively). Neither plasma neuron-specific enolase levels nor S-100B levels changed significantly before and after treatment. No severe adverse event was attributed to RIPC and sham RIPC procedures. The incidence of new diffusion-weighted imaging lesions in the RIPC group (15.87%) was significantly lower than in the sham group (36.51%; relative risk, 0.44; 96% confidence interval, 0.20–0.91; P<0.01) and the control group (41.27%; relative risk, 0.39; 96% confidence interval, 0.21–0.82; P<0.01). The volumes of lesions were smaller in the RIPC group than in the control and sham groups (P<0.01 each). Ischemic events that occurred after CAS were 1 transient ischemic attack in the RIPC group, 2 strokes in the control group, and 2 strokes and 1 transient ischemic attack in the sham group, but these results were not significantly different among the 3 groups (P=0.597). CONCLUSIONS RIPC is safe in patients undergoing CAS, which may be able to decrease ischemic brain injury secondary to CAS. However, the mechanisms and effects of RIPC on clinical outcomes in this cohort of patients need further investigation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01654666

Evidence is accumulating about the association between strong family ties and the emotional and physical welfare of older adults, and researchers have identified negative consequences of being unmarried, being childless, and/or living alone. These associations have been recognized in multiple contexts, including in Asia where living with a spouse and/or grown children has been shown in some studies to improve elderly well-being. Social support, especially family support, is expected to continue to be important where populations are aging and social safety nets are weak. Using longitudinal data from the 2010 and 2012 waves of the China Family Panel Studies, we focus on the effects of marital status at times 1 and 2, changes in marital status between the two surveys, and other family-related indicators of social connectedness on ratings of depression, levels of life satisfaction, and self-reported physical health among those aged 50 and over. Our sample includes 9831 respondents who have valid data on wellbeing indicators for Wave 1 and Wave 2, as well as complete information on the other covariates controlled in our analysis. In analyses of the full sample, those who were married at both points in time reported lower depression scores than those who were never-married, divorced, or widowed at both time points, and those whose unions dissolved in the interval. Those who were married at both times also generally reported greater levels of life satisfaction than those who were never married at both time points and those who became divorced during the interval. Important underlying gender differences are observed both for life satisfaction and depression. In addition, those who were married at both time points reported being in better physical health than those who became widowed during the interval (significant primarily for women), and those who had never been married (significant primarily for men). Our study contributes to the literature on social ties and the wellbeing by highlighting the importance of marital status and changing marital status, net of child co-residence and proximity, in China.

No abstract

No abstract