Previous reports have suggested that direct oral anticoagulants exert a prothrombolytic effect against intracardiac thrombi. We hypothesized that these anticoagulants may also help recanalize occluded intracranial arteries via prothrombolytic effects. In this study, we evaluated the effects of rivaroxaban, a direct oral anticoagulant, on fibrin emboli within the cerebrocortical microvessels in a mouse model of embolic stroke. Fibrin emboli prepared ex vivo were injected into the common carotid artery of male C57BL/6 mice, and embolization in the microvessels on the brain surface was observed through a cranial window. Oral administration of rivaroxaban was initiated a week before injection of the emboli. The number and sizes of the emboli were measured at two time points: immediately after and 3 h after the embolus injection in the rivaroxaban-treated mice (n =6) and untreated mice (n =7). The rates of recanalization and change in the embolus size were analyzed between the two groups. Complete recanalization was observed only in the rivaroxaban group (three mice in the rivaroxaban group compared with none in the control group). A significantly higher rate of reduction of the embolus size was observed in the rivaroxaban group than in the control group (P=0.0216). No significant differences between the two groups were observed in the serum levels of the following coagulation markers: thrombin–antithrombin III complexes, D-dimers, or plasmin–α2-plasmin inhibitor complex. Our findings indicate that rivaroxaban may promote reduction in the size of stagnated fibrin emboli in cerebrocortical microvessels in cases of embolic stroke.

This cross-sectional study investigated the associations of business type with the prevalence of metabolic syndrome (MetS) and lifestyle characteristics among workers in small- and medium-sized enterprises. In total, data from 167,736 workers (114,746 men and 52,990 women) who participated in health checkups in 2013 were analyzed using multilevel logistic regression models. The odds ratios (ORs) of having MetS, defined based on the criteria of the joint interim statement, were significantly higher in employees of transportation businesses (reference OR =1) than in other business types among men (OR: 0.67–0.85) and similar result was observed among women (OR: 0.70–0.88). The prevalence of a smoking habit was significantly higher in transportation workers than in employees of other businesses for both men and women. Furthermore, male transportation workers were more likely to skip breakfast, engage in <1 h/day of walking, walk at a slower speed, and eat dinner just before going to bed. Female transportation workers were more likely to have gained 10 kg since the age of 20 years. In conclusion, the prevalence of MetS was higher in transportation workers than in workers from other businesses; the associated risk factors may also vary by sex. To effectively promote public health, the labor environment, such as the business type, should be considered.

Dementia care currently costs the UK 21 bn pounds a year, and that doesn’t include the huge informal costs of family careers and community support networks. Developing services to meet the needs of patients with complex health problems must involve service users. Professor Robinson has addressed what resources are needed to provide a better quality of care, and how these can be successfully delivered to patients and their family. As Newcastle University’s Professor of Primary Care and Ageing, and as a working GP in a Newcastle practice, she is keen to ensure that the benefits of the University’s excellent research into ageing and the diseases of old age are translated into high quality treatment and care for older people. She leads the Primary Care Group of the Dementia and Neurodegenerative Diseases Research Network (DeNDRoN), a national network of researchers which aims to explore the whole spectrum of dementia care from diagnosis and early detection, through to advanced dementia and end of life care. Another Professor Robinson’s ambitions would be to help create a center of excellence at Newcastle University for training GPs, hospital staff, community nurses and others in all aspects of dementia care. In this lecture, Prof Robinson will talk about how her translational research had influenced UK practice over the last 10+ years and at same time bring in her career development in both clinical and academic field.

(Presented at the 1982th Meeting, June 25, 2019)

In contrast to many other countries, training of medical specialists is funded by the Department of Health. The curriculum of medical specialist training including general surgery is well structured and lasts 6 years. Specialist (trainers) and hospitals involved in surgical training have been accredited by the Dutch Association of Surgeons. Surgical training includes 4 years of general surgery followed by two years of differentiation in one of the sub-specialities. These are gastrointestinal, oncological, vascular, pediatric and trauma surgery. The training program is competency based: there are key procedures and so called EPA (entrusted professional activities) that are defined to monitor the progress of an individual. Unique in the Dutch system is the quality control and governance of surgical training that will be discussed in my lecture.

The number of positions available for surgical trainees is limited and determined by the government each year. Hence, to enter surgical training has always been very competitive and not easy for young doctors. This is one of the reasons why many students start a PhD program after medical school and to gain experience in basic or clinical research. These young and talented students usually work for 3-4 years full time and are well capable of coordinating trials. This is just one of the reasons that many clinical (randomised) studies come from the Netherlands. Besides this strong academic environment, lack of private practice, strong multidisciplinary working parties and the geographical situation in our small country facilitates multicenter studies. Some more crucial factors for success will be discussed in the lecture.

(Presented at the 1983th Meeting, July 10, 2019)