SummaryBackgroundCerebral microbleeds are a potential neuroimaging biomarker of cerebral small vessel diseases that are prone to intracranial bleeding. We aimed to determine whether presence of cerebral microbleeds can identify patients at high risk of symptomatic intracranial haemorrhage when anticoagulated for atrial fibrillation after recent ischaemic stroke or transient ischaemic attack.MethodsOur observational, multicentre, prospective inception cohort study recruited adults aged 18 years or older from 79 hospitals in the UK and one in the Netherlands with atrial fibrillation and recent acute ischaemic stroke or transient ischaemic attack, treated with a vitamin K antagonist or direct oral anticoagulant, and followed up for 24 months using general practitioner and patient postal questionnaires, telephone interviews, hospital visits, and National Health Service digital data on hospital admissions or death. We excluded patients if they could not undergo MRI, had a definite contraindication to anticoagulation, or had previously received therapeutic anticoagulation. The primary outcome was symptomatic intracranial haemorrhage occurring at any time before the final follow-up at 24 months. The log-rank test was used to compare rates of intracranial haemorrhage between those with and without cerebral microbleeds. We developed two prediction models using Cox regression: first, including all predictors associated with intracranial haemorrhage at the 20% level in univariable analysis; and second, including cerebral microbleed presence and HAS-BLED score. We then compared these with the HAS-BLED score alone. This study is registered with ClinicalTrials.gov, number NCT02513316.FindingsBetween Aug 4, 2011, and July 31, 2015, we recruited 1490 participants of whom follow-up data were available for 1447 (97%), over a mean period of 850 days (SD 373; 3366 patient-years). The symptomatic intracranial haemorrhage rate in patients with cerebral microbleeds was 9·8 per 1000 patient-years (95% CI 4·0–20·3) compared with 2·6 per 1000 patient-years (95% CI 1·1–5·4) in those without cerebral microbleeds (adjusted hazard ratio 3·67, 95% CI 1·27–10·60). Compared with the HAS-BLED score alone (C-index 0·41, 95% CI 0·29–0·53), models including cerebral microbleeds and HAS-BLED (0·66, 0·53–0·80) and cerebral microbleeds, diabetes, anticoagulant type, and HAS-BLED (0·74, 0·60–0·88) predicted symptomatic intracranial haemorrhage significantly better (difference in C-index 0·25, 95% CI 0·07–0·43, p=0·0065; and 0·33, 0·14–0·51, p=0·00059, respectively).InterpretationIn patients with atrial fibrillation anticoagulated after recent ischaemic stroke or transient ischaemic attack, cerebral microbleed presence is independently associated with symptomatic intracranial haemorrhage risk and could be used to inform anticoagulation decisions. Large-scale collaborative observational cohort analyses are needed to refine and validate intracranial haemorrhage risk scores incorporating cerebral microbleeds to identify patients at risk of net harm from ora...

The effects of chest physical therapy in acute severe asthma in children have been studied in 38 children aged 6 to 13 years in a randomized placebo controlled trial. The study began between 6 and 24 hours after admission to hospital; 19 children received chest physical therapy (PT) and 19 children received placebo visits. Each child had 4 treatments over 2 days which were preceded by nebulized salbutamol. Lung volumes and flow rates were measured in a body plethysmograph before salbutamol and before and after either PT or placebo on the first and fourth treatments. Throughout the study standard asthma drug therapy was given. In both groups characteristics such as sex, race, age, height, weight, severity, and baseline lung function were similar. Taking into account the baseline, lung function at the end of the study was similar in both groups. Three 12 year old children in the PT group showed improvements in flows above those seen in any children in the placebo group. We conclude that chest PT, when combined with asthma drug therapy, does not improve lung function in most children in this age group with acute severe asthma.

Polynesian (Maori and Pacific Island) children account for approximately one quarter of the children in New Zealand, but good data for lung function in this group are not available. In this review, we report lung volume measurements in 571 healthy children 5 to 13 yr of age: 270 Polynesians (139 boys and 131 girls) and 301 Europeans (177 boys and 124 girls). All measurements were made in a body plethysmograph. Polynesian boys had significantly larger VC, FVC, FRC, TLC, and expiratory reserve volume than did Polynesian girls. Polynesian and European children generally showed different slope and intercept relationships for the prediction of lung volume from height. Racial differences are not adequately explained by differences in body proportions or social factors including parental smoking. Possible explanations include racial differences in lung growth and maturation.

Omphalocele is one of the most common fetal abdominal wall defects with an estimated incidence of 1 in 6000 live births 1,2. They are classified as either small, giant or ruptured 3. A giant omphalocele is defined as a large central covered defect measuring ≥6 cm, containing small bowel, large bowel, liver and possibly other organs. Poor prognostic factors are large size, rupture, cardiac abnormalities, respiratory distress at birth, pulmonary hypoplasia and co-morbid