Stroke is the commonest cause of disability, the second most frequent cause of dementia and the third most common cause of death in the western world. A new stroke occurs every 3.5 minutes. Our clinical interest in stroke is to test whether current guidelines for its management stand up to scrutiny. As a major cause of death following stroke is actually due to heart disease, we are also currently using statistical techniques to determine whether we can more accurately predict the likely occurrence of a heart attack following a stroke.
Evidence from animal work and human epidemiology (including adoption, migration and twin) studies suggests a likely genetic basis for common human stroke. Our understanding of stroke genetics has advanced considerably in recent years with the identification of monogenic stroke conditions and genes that have been associated with sporadic stroke. However, much of this work has been carried out in Caucasian populations. The World Health Organisation has estimated that around 80 per cent of the world’s burden of stroke will be placed in China and India by 2050. With this in mind, members of the Institute are creating one of the world’s largest highly phenotyped DNA repositories spanning the UK, India and Qatar. The repository is globally called the Bio-Repository of DNA in Stroke (BRAINS).
Cardiac muscle research
Ventricular and atrial arrhythmias significantly increase patient mortality and morbidity, either directly or indirectly through conditions such as stroke. Action potential conduction failure is an important cause of arrhythmias and we are interested in its cellular and tissue basis. In particular, we measure, using biophysical techniques, changes to the electrical properties of intercellular myocardial gap junctions using tissue from normal, hypertrophied and hypertrophy-regressed hearts. In addition we are exploring the intracellular signalling pathways that determine gap junction properties.
The enhanced recovery programme
Enhanced recovery programmes are gaining widespread acceptance as part of the peri-operative management regime to improve post-operative mortality and morbidity, as well as shorten length of stay in hospital. The programme incorporates a range of simple peri-operative techniques that includes optimisation of cardiovascular function before surgery with appropriate fluid management. We have used the programme with a number of major surgical interventions and measured not only patient post-operative recovery variables but also the stress response during and after surgery. We are expanding the range of surgical interventions for which the programme might be tailored.
See a selection of our publications.
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