Subarachnoid haemorrhage (SAH) accounts for 5-10% of strokes and its prognosis may be influenced by different complications, including delayed cerebral ischaemia (DCI). The pathophysiology of DCI is complex and still unknown. Many different mechanisms may contribute to the occurrence of DCI. Arterial stiffness (AS), a well-known risk factor for cardiovascular events, also associated with the development and rupture of cerebral aneurysms, may represent a novel contributing risk factor. The aim of our study was to investigate a possible link between AS and DCI after SAH.

Fifty-nine (59) patients with SAH (age [mean±standard deviation], 62±12 years) underwent neuroimaging examination, and 24-hour heart rate and blood pressure monitoring, including AS index (ASI) measurement.

Of 59 patients, DCI occurred in 12. ASI was significantly higher in patients with DCI than in patients without it (0.70±0.1 vs 0.62±0.1; p=0.03). ASI was a significant predictor for DCI (odds ratio [for an increase of 0.20 points in ASI], 5.99; 95% confidence interval, 1.23-29.22; p=0.03).

Arterial stiffness index is a simple and inexpensive tool that is able to predict the risk of DCI in patients with SAH. This marker can impact on intensive care unit monitoring, early recognition, and treatment, contributing to optimal acute management of patients with SAH.

Arterial stiffness index is a simple and inexpensive tool that is able to predict the risk of DCI in patients with SAH. This marker can impact on intensive care unit monitoring, early recognition, and treatment, contributing to optimal acute management of patients with SAH.

Spontaneous coronary artery dissection (SCAD) is an important but under-recognised cause of acute coronary syndrome (ACS), particularly in younger women. We assessed trends in the detection, management and outcomes of all patients with SCAD over 6 consecutive years.

All patients with first diagnosis of SCAD at Christchurch Public Hospital, New Zealand, between January 2014 and January 2020 were included. Monastrol solubility dmso Patient management and outcomes were determined by retrospective review of medical records. SCAD presentations were compared to total ACS presentations, obtained from a national ACS (ANZACS-QI) database.

We identified 113 patients with angiographic diagnosis of SCAD. Median age was 54 years (88% female). The detection of SCAD increased over the period, both as a total number (Kendall’s τ 0.87, p=0.015) and as a proportion of all ACS (p value for trend <0.0001). In 2019, SCAD represented 2.4% of all ACS and 18% of ACS in females aged less than 60 years. The most common presentation was non-ST elevation myocardial infarction (NSTEMI) in 72%; and, there was an increase in NSTEMI compared with STEMI over the period (p=0.023). Initial strategy of percutaneous coronary intervention (PCI) was undertaken in 12% of patients, with a significant trend towards a more conservative approach over the study period (p=0.019). The rate of 30-day major adverse cardiovascular events (MACE) was 8.8% overall, and significantly reduced over the study period to 3% in 2019 (p value for trend, 0.006).

The detection of SCAD has increased and is a particularly important cause of ACS in younger women. This increase has been largely driven by an increasing number of NSTEMI patients diagnosed with SCAD, associated with a significant improvement in 30-day MACE.

The detection of SCAD has increased and is a particularly important cause of ACS in younger women. This increase has been largely driven by an increasing number of NSTEMI patients diagnosed with SCAD, associated with a significant improvement in 30-day MACE.

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure performed to remove bile duct stones. Intraoperative cholangiography (IOC) is often performed at the time of cholecystectomy to determine the presence of intraductal stones. However, many of the ERCP procedures performed for this indication fail to find any intraductal stones. Given that ERCP carries significant patient morbidity, we investigated whether there are features on IOC that can guide ERCP patient selection.

A retrospective analysis of 152 patients who had an IOC filing defect and a subsequent ERCP was performed.

Small single stones greater than or equal to 4.5 mm on IOC can be used to predict the presence of stones on a subsequent ERCP. Furthermore, ERCPs performed for single filling defects smaller than 4.5 mm are more likely to be negative if performed later rather than earlier, suggesting that small stones can pass over time. We show that 80% of these stones will pass by 11 days after the IOC.

Single small stones on IOC should be given adequate time to pass into the intestine. Imaging should be performed to determine if the stone has passed into the intestine after day 11 prior to performing a therapeutic ERCP.

Single small stones on IOC should be given adequate time to pass into the intestine. Imaging should be performed to determine if the stone has passed into the intestine after day 11 prior to performing a therapeutic ERCP.

As countermeasures against the COVID-19 outbreak, sports and entertainment events were canceled (VEC) in Japan for two weeks from 26 February through 13 March. Moreover, most schools were closed (SC).

For this study, we estimated the basic reproduction number (R

) and SC and VEC effects.

After constructing a susceptible-infected-recovered model with three age classes, we used data of symptomatic patients in Japan for 14 January through 24 March. The SC and VEC effects were incorporated into the model through changes in contact patterns and contact frequencies among age classes.

Results suggest R

as 2.56, with 95% CI of [2.51, 2.96] before SC and VEC. The respective effects of SC and VEC were estimated as 0.4 (95% CI [0.3, 0.5]) and 0.5 (95% CI [0.3, 0.7]).

The estimated R

is similar to those found from other studies of China and Japan. Significant reduction of contact frequency has been achieved by SC and VEC. Nevertheless, its magnitude was insufficient to contain the outbreak.

The estimated R0 is similar to those found from other studies of China and Japan. Significant reduction of contact frequency has been achieved by SC and VEC. Nevertheless, its magnitude was insufficient to contain the outbreak.