In a randomized trial, 4811 patients with atrial fibrillation were assigned to undergo or not undergo left atrial appendage occlusion during cardiac surgery for another indication. At 3 years, 77% of ...the patients continued to receive oral anticoagulation. At 3.8 years, the risk of ischemic stroke or systemic embolism was significantly lower with occlusion than without it.
Biometric analysis for identity verification is becoming a widespread reality. Such implementations necessitate large-scale capture and storage of biometric data, which raises serious issues in terms ...of data privacy and (if such data is compromised) identity theft. These problems stem from the essential permanence of biometric data, which (unlike secret passwords or physical tokens) cannot be refreshed or reissued if compromised. Our previously presented biometric-hash framework prescribes the integration of external (password or token-derived) randomness with user-specific biometrics, resulting in bitstring outputs with security characteristics (i.e., noninvertibility) comparable to cryptographic ciphers or hashes. The resultant BioHashes are hence cancellable, i.e., straightforwardly revoked and reissued (via refreshed password or reissued token) if compromised. BioHashing furthermore enhances recognition effectiveness, which is explained in this paper as arising from the random multispace quantization (RMQ) of biometric and external random inputs
We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the ...effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality, myocardial infarction, neurological events, new onset atrial fibrillation, transfusion requirements, postoperative bleeding, duration of ventilation, intensive care unit (ICU) stay, hospital stay, wound complications, gastrointestinal complications, and infectious complications. We included 44 trials randomizing 3205 patients. Steroids reduced new onset atrial fibrillation relative risk (RR) 0.71, 95% confidence interval (CI) 0.59 to 0.87, postoperative bleeding weighted mean difference (WMD) −99.6 mL, 95% CI −149.8 to −49.3, and duration of ICU stay (WMD −0.23 days, 95% CI −0.40 to −0.07). Length of hospital stay was also reduced (WMD −0.59 days, 95% CI −1.17 to −0.02), but this result was less robust. A trend towards reduction in mortality was observed (RR 0.73, 95% CI 0.45 to 1.18). Randomized trials suggest that perioperative steroids have significant clinical benefit in CPB patients by decreasing the risk of new onset atrial fibrillation, while results are encouraging for reducing bleeding, length of stay, and mortality. These data do not raise major safety concerns, however, a sufficiently powered trial is warranted to confirm or refute these findings.
Background
Stillbirth is a global health problem. The World Health Organization (WHO) application of the International Classification of Diseases for perinatal mortality (ICD‐PM) aims to improve data ...on stillbirth to enable prevention.
Objectives
To identify globally reported causes of stillbirth, classification systems, and alignment with the ICD‐PM.
Search strategy
We searched CINAHL, EMBASE, Medline, Global Health, and Pubmed from 2009 to 2016.
Selection criteria
Reports of stillbirth causes in unselective cohorts.
Data collection and analysis
Pooled estimates of causes were derived for country representative reports. Systems and causes were assessed for alignment with the ICD‐PM. Data are presented by income setting (low, middle, and high income countries; LIC, MIC, HIC).
Main results
Eighty‐five reports from 50 countries (489 089 stillbirths) were included. The most frequent categories were Unexplained, Antepartum haemorrhage, and Other (all settings); Infection and Hypoxic peripartum (LIC), and Placental (MIC, HIC). Overall report quality was low. Only one classification system fully aligned with ICD‐PM. All stillbirth causes mapped to ICD‐PM. In a subset from HIC, mapping obscured major causes.
Conclusions
There is a paucity of quality information on causes of stillbirth globally. Improving investigation of stillbirths and standardisation of audit and classification is urgently needed and should be achievable in all well‐resourced settings. Implementation of the WHO Perinatal Mortality Audit and Review guide is needed, particularly across high burden settings.
Funding
HR, SH, SHL, and AW were supported by an NHMRC‐CRE grant (APP1116640). VF was funded by an NHMRC‐CDF (APP1123611).
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Urgent need to improve data on causes of stillbirths across all settings to meet global targets.
Plain Language Summary
Background and methods
Nearly three million babies are stillborn every year. These deaths have deep and long‐lasting effects on parents, healthcare providers, and the society. One of the major challenges to preventing stillbirths is the lack of information about why they happen. In this study, we collected reports on the causes of stillbirth from high‐, middle‐, and low‐income countries to: (1) Understand the causes of stillbirth, and (2) Understand how to improve reporting of stillbirths.
Findings
We found 85 reports from 50 different countries. The information available from the reports was inconsistent and often of poor quality, so it was hard to get a clear picture about what are the causes of stillbirth across the world. Many different definitions of stillbirth were used. There was also wide variation in what investigations of the mother and baby were undertaken to identify the cause of stillbirth. Stillbirths in all income settings (low‐, middle‐, and high‐income countries) were most frequently reported as Unexplained, Other, and Haemorrhage (bleeding). Unexplained and Other are not helpful in understanding why a baby was stillborn. In low‐income countries, stillbirths were often attributed to Infection and Complications during labour and birth. In middle‐ and high‐income countries, stillbirths were often reported as Placental complications.
Limitations
We may have missed some reports as searches were carried out in English only. The available reports were of poor quality.
Implications
Many countries, particularly those where the majority of stillbirths occur, do not report any information about these deaths. Where there are reports, the quality is often poor. It is important to improve the investigation and reporting of stillbirth using a standardised system so that policy makers and healthcare workers can develop effective stillbirth prevention programs. All stillbirths should be investigated and reported in line with the World Health Organization standards.
Tweetable
Urgent need to improve data on causes of stillbirths across all settings to meet global targets.
Background
Coronavirus disease 2019 (COVID‐19) is an emerging infectious disease of pandemic proportions. Healthcare workers in Singapore working in high‐risk areas were mandated to wear personal ...protective equipment (PPE) such as N95 face mask and protective eyewear while attending to patients.
Objectives
We sought to determine the risk factors associated with the development of de novo PPE‐associated headaches as well as the perceived impact of these headaches on their personal health and work performance. The impact of COVID‐19 on pre‐existing headache disorders was also investigated.
Methods
This is a cross‐sectional study among healthcare workers at our tertiary institution who were working in high‐risk hospital areas during COVID‐19. All respondents completed a self‐administered questionnaire.
Results
A total of 158 healthcare workers participated in the study. Majority 126/158 (77.8%) were aged 21‐35 years. Participants included nurses 102/158 (64.6%), doctors 51/158 (32.3%), and paramedical staff 5/158 (3.2%). Pre‐existing primary headache diagnosis was present in about a third 46/158 (29.1%) of respondents. Those based at the emergency department had higher average daily duration of combined PPE exposure compared to those working in isolation wards 7.0 (SD 2.2) vs 5.2 (SD 2.4) hours, P < .0001 or medical ICU 7.0 (SD 2.2) vs 2.2 (SD 0.41) hours, P < .0001. Out of 158 respondents, 128 (81.0%) respondents developed de novo PPE‐associated headaches. A pre‐existing primary headache diagnosis (OR = 4.20, 95% CI 1.48‐15.40; P = .030) and combined PPE usage for >4 hours per day (OR 3.91, 95% CI 1.35‐11.31; P = .012) were independently associated with de novo PPE‐associated headaches. Since COVID‐19 outbreak, 42/46 (91.3%) of respondents with pre‐existing headache diagnosis either “agreed” or “strongly agreed” that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance.
Conclusion
Most healthcare workers develop de novo PPE‐associated headaches or exacerbation of their pre‐existing headache disorders.
Aims To obtain estimates of the efficacy and safety of pre-operative aspirin in patients undergoing coronary artery bypass grafting (CABG). Methods and results Eligible studies included randomized ...controlled trials (RCTs) and observational studies of patients undergoing CABG, comparing pre-operative aspirin with no aspirin/placebo, and reporting at least one of our primary outcomes. In eight RCTs (n = 805), pre-operative aspirin increased post-operative bleeding Mean difference (MD), 104.9 mL; 95% confidence interval (CI), 19.2–190.6; P = 0.016 and reoperation odds ratio (OR), 2.52; 95% CI, 1.18–5.38; P = 0.017), but not transfusion requirements (MD, 0.62 units; 95% CI, −0.06–1.30; P = 0.072). Subgroup analysis suggested that bleeding was increased with aspirin doses ≥325 mg/day, but not with lower doses. In 14 observational studies (n = 4485), pre-operative aspirin increased post-operative bleeding (MD, 113.6 mL; 95% CI, 45.2–182.0; P = 0.001) and transfusion requirements (MD, 0.34; 95% CI, 0.12–0.56 units; P = 0.002), but not reoperation (OR, 1.12; 95% CI, 0.69–1.83; P = 0.647). Neither analysis detected a significant effect on myocardial infarction or death. Conclusion Pre-operative aspirin increases post-operative bleeding, but this may be avoided by the use of aspirin doses <325 mg/day. Most of the RCTs are old and the meta-analysis was underpowered for efficacy outcomes. A large randomized trial is necessary to determine the safety and efficacy of pre-operative aspirin in the setting of contemporary cardiac surgical practice.
Aging leads to increased cellular senescence and is associated with decreased potency of tissue‐specific stem/progenitor cells. Here, we have done an extensive analysis of cardiac progenitor cells ...(CPCs) isolated from human subjects with cardiovascular disease, aged 32–86 years. In aged subjects (>70 years old), over half of CPCs are senescent (p16INK4A, SA‐β‐gal, DNA damage γH2AX, telomere length, senescence‐associated secretory phenotype SASP), unable to replicate, differentiate, regenerate or restore cardiac function following transplantation into the infarcted heart. SASP factors secreted by senescent CPCs renders otherwise healthy CPCs to senescence. Elimination of senescent CPCs using senolytics abrogates the SASP and its debilitative effect in vitro. Global elimination of senescent cells in aged mice (INK‐ATTAC or wild‐type mice treated with D + Q senolytics) in vivo activates resident CPCs and increased the number of small Ki67‐, EdU‐positive cardiomyocytes. Therapeutic approaches that eliminate senescent cells may alleviate cardiac deterioration with aging and restore the regenerative capacity of the heart.
Due to their distinctive structural features, lyotropic nonlamellar liquid crystalline nanoparticles (LCNPs), such as cubosomes and hexosomes, are considered effective drug delivery systems. ...Cubosomes have a lipid bilayer that makes a membrane lattice with two water channels that are intertwined. Hexosomes are inverse hexagonal phases made of an infinite number of hexagonal lattices that are tightly connected with water channels. These nanostructures are often stabilized by surfactants. The structure's membrane has a much larger surface area than that of other lipid nanoparticles, which makes it possible to load therapeutic molecules. In addition, the composition of mesophases can be modified by pore diameters, thus influencing drug release. Much research has been conducted in recent years to improve their preparation and characterization, as well as to control drug release and improve the efficacy of loaded bioactive chemicals. This article reviews current advances in LCNP technology that permit their application, as well as design ideas for revolutionary biomedical applications. Furthermore, we have provided a summary of the application of LCNPs based on the administration routes, including the pharmacokinetic modulation property.
Preterm birth is the primary cause of infant death worldwide. A short cervix in the second trimester of pregnancy is a risk factor for preterm birth. In specific patient cohorts, vaginal progesterone ...reduces this risk. Using 16S rRNA gene sequencing, we undertook a prospective study in women at risk of preterm birth (n = 161) to assess (1) the relationship between vaginal microbiota and cervical length in the second trimester and preterm birth risk and (2) the impact of vaginal progesterone on vaginal bacterial communities in women with a short cervix.
Lactobacillus iners dominance at 16 weeks of gestation was significantly associated with both a short cervix <25 mm (n = 15, P < 0.05) and preterm birth <34
weeks (n = 18; P < 0.01; 69% PPV). In contrast, Lactobacillus crispatus dominance was highly predictive of term birth (n = 127, 98% PPV). Cervical shortening and preterm birth were not associated with vaginal dysbiosis. A longitudinal characterization of vaginal microbiota (<18, 22, 28, and 34 weeks) was then undertaken in women receiving vaginal progesterone (400 mg/OD, n = 25) versus controls (n = 42). Progesterone did not alter vaginal bacterial community structure nor reduce L. iners-associated preterm birth (<34 weeks).
L. iners dominance of the vaginal microbiota at 16 weeks of gestation is a risk factor for preterm birth, whereas L. crispatus dominance is protective against preterm birth. Vaginal progesterone does not appear to impact the pregnancy vaginal microbiota. Patients and clinicians who may be concerned about "infection risk" associated with the use of a vaginal pessary during high-risk pregnancy can be reassured.
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