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CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial) reported a higher periprocedural risk for any stroke, death, or myocardial infarction for women randomized to carotid artery stenting (CAS) compared with women randomized to carotid endarterectomy (CEA). No difference in risk by treatment was detected for women relative to men in the 4-year primary outcome. We aimed to conduct a pooled analysis among symptomatic patients in large randomized trials to provide more precise estimates of sex differences in the CAS-to-CEA risk for any stroke or death during the 120-day periprocedural period and ipsilateral stroke thereafter.

Data from the Carotid Stenosis Trialists' Collaboration included outcomes from symptomatic patients in EVA-3S (Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis), SPACE (Stent-Protected Angioplasty Versus Carotid Endarterectomy in Symptomatic Patients), ICSS (International Carotid Stenting Study), and CREST. The primary outcome was aative risk), indicating pooling data from these trials to estimate sex differences might not be valid. Whether sex is acting as an effect modifier of the CAS-to-CEA treatment effect in symptomatic patients remains uncertain. Registration URL https//www.clinicaltrials.gov; Unique identifier NCT00190398 (EVA-3S) and NCT00004732 (CREST). URL https//www.isrctn.com; Unique identifier ISRCTN57874028 (SPACE) and ISRCTN25337470 (ICSS).

There were significant differences between trials in the magnitude of sex differences in treatment effect (CAS-to-CEA relative risk), indicating pooling data from these trials to estimate sex differences might not be valid. Whether sex is acting as an effect modifier of the CAS-to-CEA treatment effect in symptomatic patients remains uncertain. Registration URL https//www.clinicaltrials.gov; Unique identifier NCT00190398 (EVA-3S) and NCT00004732 (CREST). URL https//www.isrctn.com; Unique identifier ISRCTN57874028 (SPACE) and ISRCTN25337470 (ICSS).

Fewer women than men tend to be enrolled in clinical trials of intracerebral hemorrhage. It is unclear whether this reflects lower prevalence of intracerebral hemorrhage in women, selection bias, or poor recruitment efforts. We undertook this study to examine differences between men and women in the reasons for exclusion from the iDEF trial (Intracerebral Hemorrhage Deferoxamine).

The screen failure log included 29 different reasons for exclusion. Chi-square statistics were used to evaluate the differences in reasons for exclusion between men and women.

A total of 38.2% of participants in iDEF were women. Three thousand nine hundred eighty-two women (45.7%) and 4736 men (54.3%) were screen failures (

<0.0001). Similar proportions of women (1.28%) and men (1.73%) were excluded due to inability to obtain consent (

=0.1). Patients or families declined participation in 1.26% of women versus 1.31% of men (

=0.9). More women than men failed screening because of age>80 (22.40% versus 12.61%; adjusted

=0.0007) and preexisting do-not-resuscitate/do-not-intubate (3.69% versus 2.83%; adjusted

=0.067).

Lower rates of women enrollment in the iDEF trial may be attributed to older age. Inability to obtain consent or declining participation was similar between women and men, arguing against selection bias. Our findings should be confirmed in other intracerebral hemorrhage trials to determine best strategies to improve women's representation in future trials.

Lower rates of women enrollment in the iDEF trial may be attributed to older age. Inability to obtain consent or declining participation was similar between women and men, arguing against selection bias. Our findings should be confirmed in other intracerebral hemorrhage trials to determine best strategies to improve women's representation in future trials.Clinically recognized atrial fibrillation (AF) is associated with higher risk of complications, including ischemic stroke, cognitive decline, heart failure, myocardial infarction, and death. It is increasingly recognized that AF frequently is undetected until complications such as stroke or heart failure occur. Hence, the public and clinicians have an intense interest in detecting AF earlier. However, the most appropriate strategies to detect undiagnosed AF (sometimes referred to as subclinical AF) and the prognostic and therapeutic implications of AF detected by screening are uncertain. Our report summarizes the National Heart, Lung, and Blood Institute's virtual workshop focused on identifying key research priorities related to AF screening. Global experts reviewed major knowledge gaps and identified critical research priorities in the following areas (1) role of opportunistic screening; (2) AF as a risk factor, risk marker, or both; (3) relationship between AF burden detected with long-term monitoring and outcomes/treatments; (4) designs of potential randomized trials of systematic AF screening with clinically relevant outcomes; and (5) role of AF screening after ischemic stroke. Our report aims to inform and catalyze AF screening research that will advance innovative, resource-efficient, and clinically relevant studies in diverse populations to improve the diagnosis, management, and prognosis of patients with undiagnosed AF.This month's highlights from the subspecialty journals cover atrial fibrillation, microvascular dysfunction, progression of atherosclerosis, a stroke quality initiative, and a subanalysis of DAPAHF (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure). Applying an artificial intelligence algorithm to sinus rhythm ECGs independently predicts atrial fibrillation in a study from Circulation Arrhythmia and Electrophysiology. In Circulation Genomic and Precision Medicine, the association of alcohol intake with atrial fibrillation was evaluated according to genetic predisposition to atrial fibrillation. In Circulation Cardiovascular Interventions, a randomized trial of ranolazine treatment for microvascular dysfunction is reported. In Circulation Cardiovascular Imaging, baseline 18F-sodium florid activity by positron emission tomography was associated with incident coronary calcification. The Target Stroke quality initiative from the American Heart Association is reported in Circulation Cardiovascular Quality and Outcomes. A substudy in Circulation Heart Failure evaluates the benefit of dapagliflozin across cohorts of duration of heart failure from DAPA-HF.Objective Telemedicine is seen as an important tool to face contemporary health challenges. The factors that help improve quality in these services must be studied. The objective of this work was to assess the quality of telehealth primary care services offered in the State of Minas Gerais -Brazil, based on the ISO 13131 standard. Methods This cross-sectional analytical study with a quantitative approach was conducted in the cities in the state of Minas Gerais that use telehealth services. A stratified sample composed of 385 cities was used. A questionnaire, based on ISO 13131 on the quality of telehealth services, was prepared, used, and verified for its consistency. Quality levels in telehealth were built from the data. To analyze the quality of care, data from the Ministry of Health's quality improvement program were used, involving 366 surveyed cities. Logistic regression was performed to verify the association between quality of telehealth and quality of care. Results The research identified that 64% of the cities had records of telehealth activities, and 51% of cities had high quality telehealth services. mTOR inhibitor There was no association between quality of telehealth and quality of care; only the dimensions of Quality and Risk Management were associated with quality of care. Conclusion The developed instrument enabled the quality of telehealth actions to be verified. The State of Minas Gerais has high-quality telehealth services.Research investigating hemp protein consumption on glycemic response is limited. The effects of hemp protein consumption on blood glucose (BG), insulin, and satiety compared to soybean protein and a carbohydrate control were examined. Two acute randomized repeated-measures crossover experiments were conducted. In both, participants consumed isocaloric treatments 40g of hemp protein (hemp40), 20g of hemp protein (hemp20), 40g of soybean protein (soy40), 20g of soybean protein (soy20), and a carbohydrate control. In experiments 1 (n=27) and 2 (n=16), appetite and BG were measured before (0-60 min, pre-pizza) and after a pizza meal (80-200 min, post-pizza). In experiment 1, food intake was measured at 60 min by ad libitum meal; in experiment 2 a fixed meal was provided (based on body weight) and insulin was measured pre-pizza and post-pizza. In both experiments, BG response was affected by treatment (p less then 0.01), time (p less then 0.001) and time-by-treatment (p less then 0.001) from 0-200 min. Protein treatments lowered 0-60 min BG overall mean, and area under the curve (AUC) compared to control (p less then 0.05) dose-dependently. In experiment 2, hemp40 and soy40 lowered (p less then 0.05) overall mean insulin concentrations compared to hemp20, soy20, and control pre-meal. Results suggest that hemp protein, like soybean, dose-dependently lowers post-prandial BG and insulin concentrations compared to a carbohydrate control. Clinical trial registry NCT02366598 (Experiment 1) and NCT02458027 (Experiment 2) Novelty bullets 1) Hemp protein concentrate dose-dependently leads to lower post-prandial BG response compare to a carbohydrate control. 2) No differences were seen between hemp and soy protein.Osteomyelitis is one of the infections of the bone, and the treatment needs to the infection problems. Here, a local therapeutic approach for efficient drug delivery systems was designed to enhance the antibiotic drug's therapeutic activity. Calcium-Alginate nanoparticle (Ca-Alg) crosslinked phosphorylated polyallylamine (PPAA) was prepared through the salting-out technique, and it achieved 82.55% encapsulation of Clindamycin drug. The physicochemical characterizations of FTIR, SEM/EDX, TEM, and XRD were investigated to confirm the materials nature and formation. Clindamycin loaded Ca-Alg/PPAA system showed sustained Clindamycin release from the carrier. Cell viability was assessed in bone-related cells by Trypan blue assay and MTT assay analysis method. Both assay results exhibited better cell viability of synthesized materials against MG63 cells. MIC value of Ca-Alg/PPAA/Clindamycin in the Methicillin-resistant Staphylococcus aureus (MRSA) pathogen was 275 µg/mL, and it was 120 µg/mL for Enterobacter cloacae pathogen. The materials promising material for Osteomyelitis affected bone regeneration without any destructive effect and speedy recovery of infected parts from these investigations.

At the 12th meeting of AORTIC (African Organization for Research and Training in Cancer) in Maputo, Mozambique, held between November 5 and November 8, 2019, a special workshop was organized to focus on the need for collaboration and coordination between governments and health systems in Africa with academic, industry, association, and other nongovernmental organizations to effect sustainable positive change for the care of patients with cancer.

Representatives from seven different projects in Africa presented implementation science and demonstration projects of their to date efforts in cancer system improvement including patient access, South-South partnerships, in-country specialized training, palliative care consortium, treatment outcomes, and focused pathology and diagnostic capacity building. Key partners of the various projects served as moderators and commentators during the session.

From across all the presentations, lessons learned and exemplary evidence of the value of partnerships were gathered and summarized.