Background
Single intrauterine fetal death affects approximately 6% of twin pregnancies and can have serious sequelae for the surviving co‐twin.
Objectives
Determine the prognosis of the surviving ...co‐twin following spontaneous single intrauterine fetal death to aid counselling patients and highlight future research areas.
Search strategy
Medline, Embase, Web of Science, and Cochrane Library, from 1980 to June 2017.
Selection criteria
Studies of five or more cases of spontaneous single intrauterine fetal death after 14 weeks gestation, in diamniotic twin pregnancies.
Data collection and analysis
Summary event rates were calculated and stratified by chorionicity. Monochorionic and dichorionic twins, and sub‐groups, were compared by odds ratios.
Main results
In monochorionic twins, when single intrauterine fetal death occurred at less than 28 weeks’ gestation, this significantly increased the rate of co‐twin intrauterine fetal death odds ratio (OR) 2.31, 95% confidence interval (CI) 1.02–5.25, I2 = 0.0%, 12 studies, 184 pregnancies and neonatal death (OR 2.84, 95% CI 1.18–6.77, I2 = 0.0%, 10 studies, 117 pregnancies) compared with when the single intrauterine fetal death occurred at more than 28 weeks’ gestation. Neonatal death in monochorionic twins was significantly higher if the pregnancy was complicated by fetal growth restriction (OR 4.83, 95% CI 1.14–20.47, I2 = 0.0%, six studies, 60 pregnancies) or preterm birth (OR 4.95, 95% CI 1.71–14.30, I2 = 0.0%, 11 studies, 124 pregnancies). Abnormal antenatal brain imaging was reported in 20.0% (95% CI 12.8–31.1, I2 = 21.9%, six studies, 116 pregnancies) of surviving monochorionic co‐twins. The studies included in the meta‐analysis demonstrated small study effects and possible selection bias.
Conclusions
Preterm birth was the commonest adverse outcome affecting 58.5 and 53.7% of monochorionic and dichorionic twin pregnancies. Outcomes regarding brain imaging and neurodevelopmental comorbidity are an important area for future research, but meta‐analysis may be limited due to different methods of assessment.
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Preterm birth is the highest risk in single co‐twin death. Abnormal antenatal brain imaging was found in 1/5 surviving MC twins.
Tweetable
Preterm birth is the highest risk in single co‐twin death. Abnormal antenatal brain imaging was found in 1/5 surviving MC twins .
A podcast to accompany this paper is available at https://soundcloud.com/bjog/author-interview-kilby
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This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death ...determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential. This Guideline is endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists’ Society, the Canadian Neurological Sciences Federation (representing the Canadian Neurological Society, Canadian Neurosurgical Society, Canadian Society of Clinical Neurophysiologists, Canadian Association of Child Neurology, Canadian Society of Neuroradiology, and Canadian Stroke Consortium), Canadian Blood Services, the Canadian Donation and Transplantation Research Program, the Canadian Association of Emergency Physicians, the Nurse Practitioners Association of Canada, and the Canadian Cardiovascular Critical Care Society.
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In this revised esition, Thomas Attig tells tales of survival to illustrate the poignant suffering that the loss of a loved one entails. Dr. Attig shows how through grieving we meet daunting ...challenges, make choices, and reshape our lives forever. In so doing, he redefines grief as an active, coping process rather than a stage to be endured, or a problem to be overcome. The book's many valuable lessons inform and instruct a wide audience of clinicians, caregivers, friends and family members of bereaved persons, and those who seek a general, non-clinical perspective on their own experience of grief.This version includes updated references and a new introduction.
The debate over whether brain death is death has focused on whether individuals who have sustained total brain failure have satisfied the biological definition of death as “the irreversible loss of ...the integration of the organism as a whole.” In this paper, I argue that what it means for an organism to be integrated “as a whole” is undefined and vague in the views of those who attempt to define death as the irreversible loss of the integration of the organism as a whole. I show how what it means for a living thing to be integrated as a whole depends on the sortal (kind) concept by which it is identified. Since interests, values, and ontological considerations besides strictly biological ones affect the concepts by which we individuate and identify living things, those non-biological considerations have a bearing on what it means for a particular kind of living thing to exist as a whole and thus what it means for one of us to die. Even if our bodies may remain organically integrated in some sense despite total brain failure, this fact should not lead us to reject brain death as death. Artificially sustained brain-dead human bodies are not human beings, but the remains of them. While such bodies may be alive in some sense, they are not human beings or human persons. They are not one of us.
Periods of transition are often symbolically associated with death, making the latter the paradigm of liminality. Yet, many volumes on death in the social sciences and humanities do not specifically ...address liminality. This book investigates these "ultimate ambiguities, " assuming they can pose a threat to social relationships because of the disintegrating forces of death, but they are also crucial periods of creativity, change, and emergent aspects of social and religious life. Contributors explore death and liminality from an interdisciplinary perspective and present a global range of historical and contemporary case studies outlining emotional, cognitive, artistic, social, and political implications.
Programmed Cell Death 1 (PD-1) receptor and its ligands (PD-Ls) are essential to maintain peripheral immune tolerance and to avoid tissue damage. Consequently, altered gene or protein expression of ...this system of co-inhibitory molecules has been involved in the development of cancer and autoimmunity. Substantial progress has been achieved in the study of the PD-1/PD-Ls system in terms of regulatory mechanisms and therapy. However, the role of the PD-1/PD-Ls pathway in neuroinflammation has been less explored despite being a potential target of treatment for neurodegenerative diseases. Multiple Sclerosis (MS) is the most prevalent, chronic, inflammatory, and autoimmune disease of the central nervous system that leads to demyelination and axonal damage in young adults. Recent studies have highlighted the key role of the PD-1/PD-Ls pathway in inducing a neuroprotective response and restraining T cell activation and neurodegeneration in MS. In this review, we outline the molecular and cellular mechanisms regulating gene expression, protein synthesis and traffic of PD-1/PD-Ls as well as relevant processes that control PD-1/PD-Ls engagement in the immunological synapse between antigen-presenting cells and T cells. Also, we highlight the most recent findings regarding the role of the PD-1/PD-Ls pathway in MS and its murine model, experimental autoimmune encephalomyelitis (EAE), including the contribution of PD-1 expressing follicular helper T (TFH) cells in the pathogenesis of these diseases. In addition, we compare and contrast results found in MS and EAE with evidence reported in other autoimmune diseases and their experimental models, and review PD-1/PD-Ls-targeting therapeutic approaches.
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•The PD-1/PD-Ls system plays a key role in regulating immune tolerance and homeostasis.•Dysregulation of the PD-1/PD-Ls pathway contributes to the pathogenesis of MS and other autoimmune diseases.•New molecular and cellular mechanisms regulating PD-1/PD-Ls pathway have been described.•Targeting the PD-1/PD-Ls axis provides opportunities for novel therapies in autoimmunity.
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In his doctoral dissertation, Christoph Seelinger provides an overview of strategies for legitimizing and functionalizing documentary death scenes in narrative cinema. Seelinger's chronological arc ...begins with the earliest animal deaths on camera, such as the filmed execution of the female elephant Topsy in »Electrocuting an Elephant – Thomas A. Edison« (1903), and it continues to the glossy snuff videos of the Islamic State's media department in the 2010s. Between these two poles, the author – with the same academic scrutiny – looks at established arthouse films, but all also at countless representations of station cinema that have been dismissed as trash and exploitation and have so far eluded academic research. The result is a foray through the more ostracized regions of cinema history and, in the process, nothing less than the first detailed history of the intrusion of real depictions of death into the fiction of the feature film.
Christoph Seelinger liefert in seiner Promotionsschrift einen Überblick über Legitimations- und Funktionalisierungsstrategien dokumentarischer Toten- und Todesszenen im Erzählkino. Seelingers chronologischer Bogen beginnt bei den frühesten animalischen Toden vor laufender Kamera wie beispielsweise der filmisch festgehaltenen Hinrichtung des Elefantenweibchens Topsy in »Electrocuting an Elephant – Thomas A. Edison« (1903) und er führt bis zu den Hochglanz-Snuff-Videos der Medienabteilung des Islamischen Staates in den 2010er Jahren. Zwischen diesen beiden Polen betrachtet der Autor mit derselben medienwissenschaftlichen Hinwendung arrivierte Arthouse-Filme, vor allem aber auch zahllose als Trash und Exploitation abqualifizierte Vertreter des Bahnhofskinos, die einem akademischen Zugriff bislang entzogen waren. Das Ergebnis ist ein Streifzug durch die verfemteren Regionen der Kinogeschichte und dabei nichts weniger als die erste auführliche Geschichte des Einbruchs realer Todesdarstellungen in die Fiktion des Spielfilms.
Are you alive? Most people believe that some law defines our status as living (or not) for all purposes. But Foley shows that "not being dead" isn't necessarily the same as being alive, in the eyes ...of the law. The need for more organ transplants and conservation of health care resources is exerting pressure to expand the legal definition of death.
Abstract
Aims
The aim of this study was to examine the effect of dapagliflozin on the incidence of ventricular arrhythmias and sudden death in patients with heart failure and reduced ejection ...fraction (HFrEF).
Methods and results
In a post hoc analysis of DAPA-HF, we examined serious adverse event reports related to ventricular arrhythmias or cardiac arrest, in addition to adjudicated sudden death. The effect of dapagliflozin, compared with placebo, on the composite of the first occurrence of any serious ventricular arrhythmia, resuscitated cardiac arrest, or sudden death was examined using Cox proportional hazards models. A serious ventricular arrhythmia was reported in 115 (2.4%) of the 4744 patients in DAPA-HF (ventricular fibrillation in 15 patients, ventricular tachycardia in 86, ‘other’ ventricular arrhythmia/tachyarrhythmia in 12, and torsade de pointes in 2 patients). A total of 206 (41%) of the 500 cardiovascular deaths occurred suddenly. Eight patients survived resuscitation from cardiac arrest. Independent predictors of the composite outcome (first occurrence of any serious ventricular arrhythmia, resuscitated cardiac arrest or sudden death), ranked by chi-square value, were log-transformed N-terminal pro-B-type natriuretic peptide, history of ventricular arrhythmia, left ventricular ejection fraction, systolic blood pressure, history of myocardial infarction, male sex, body mass index, serum sodium concentration, non-white race, treatment with dapagliflozin, and cardiac resynchronization therapy. Of participants assigned to dapagliflozin, 140/2373 patients (5.9%) experienced the composite outcome compared with 175/2371 patients (7.4%) in the placebo group hazard ratio 0.79 (95% confidence interval 0.63–0.99), P = 0.037, and the effect was consistent across each of the components of the composite outcome.
Conclusions
Dapagliflozin reduced the risk of any serious ventricular arrhythmia, cardiac arrest, or sudden death when added to conventional therapy in patients with HFrEF.
Clinical trial registration
ClinicalTrials.gov unique identifier: NCT03036124 (DAPA-HF).
Graphical Abstract
DAPA-HF: trial design and main findings. BMI, body mass index; BP, blood pressure; CI, confidence interval; HF, heart failure; HFrEF, heart failure and reduced ejection fraction; HR, hazard ratio; LVEF, left ventricular ejection fraction; MI, myocardial infarction; NT-proBNP, N-terminal pro-B-type natriuretic peptide.
Dealing with confusion over death “counts” Spagat, Michael; Jewell, Britta; Jewell, Nicholas
Significance (Oxford, England),
December 2018, 2018-12-01, 20181201, Volume:
15, Issue:
6
Journal Article
Open access
President Trump is not alone in mistaking death “estimates” for death “counts”, write Michael Spagat, Britta Jewell and Nicholas Jewell
President Trump is not alone in mistaking death “estimates” for ...death “counts”, write Michael Spagat, Britta Jewell and Nicholas Jewell.
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