Objective To evaluate the effectiveness and safety of sonolysis using a low intensity 2 MHz pulsed wave ultrasound beam during carotid endarterectomy. Design Multicentre, phase 3, double blind, randomised controlled trial. Setting 16 European centres. Participants 1004 patients (mean age 68 years; 312 (31%) female) were enrolled in the study between 20 August 2015 and 14 October 2020 until the interim analysis was performed. Interventions Sonolysis (n=507) versus sham procedure (n=497). Main outcome measures The primary endpoint was the composite incidence of ischaemic stroke, transient ischaemic attack, and death within 30 days. The incidence of new ischaemic lesions on follow-up brain magnetic resonance imaging was the main substudy endpoint, and incidence of intracranial bleeding was the main safety endpoint. Results The results favoured the sonolysis group for the primary endpoint (11 (2.2%) v 38 (7.6%); risk difference −5.5%, 95% confidence interval (CI) −8.3% to −2.8%; P<0.001),

Objective To evaluate the association between contemporary hormonal contraceptive use and the risk of incident ischaemic stroke and myocardial infarction. Design Real-world, nationwide, prospective cohort study. Setting Denmark, by use of national registries. Participants All women aged 15-49 years residing in Denmark between 1996 and 2021, with no history of arterial or venous thrombosis, antipsychotics use, cancer, thrombophilia, liver disease, kidney disease, polycystic ovary syndrome, endometriosis, infertility treatment, hormone therapy use, oophorectomy, and hysterectomy. Main outcome measures First time diagnosis of ischaemic stroke or myocardial infarction at discharge. Results Among 2 025 691 women followed up for 22 209 697 person years, 4730 ischaemic strokes and 2072 myocardial infarctions occurred. Standardised ischaemic stroke rate per 100 000 person years were 18 (95% confidence interval 18 to 19) for no use, 39 (36 to 42) for combined oral contraception, 33 (25 to 44) f

The fast food giant used a GP to support appeals against planning decisions in some deprived areas with the worst rates of food related ill health in England. Then it threatened councils with bills for legal costs. Sophie Borland reports McDonald’s is overturning councils’ attempts to prevent new fast food outlets by claiming they will encourage healthier lifestyles, The BMJ can reveal. The firm has used a playbook of arguments to win planning appeals against local authorities in some of England’s most deprived areas with the poorest public health outcomes. Its tactics include arguing that customers can order salad from its drive-through branches, that they could cycle or walk there, and that its sponsorship of local football teams promotes health and wellbeing. McDonald’s has also deployed a specialist GP who claims that obesity is caused by “over 100” factors other than fast food and that its menu contains nutritious and low calorie options. In some cases McDonald’s threatened to for

The fast food giant used a GP to support appeals against planning decisions in some deprived areas with the worst rates of food related ill health in England. Then it threatened councils with bills for legal costs. Sophie Borland reports McDonald’s is overturning councils’ attempts to prevent new fast food outlets by claiming they will encourage healthier lifestyles, The BMJ can reveal. The firm has used a playbook of arguments to win planning appeals against local authorities in some of England’s most deprived areas with the poorest public health outcomes. Its tactics include arguing that customers can order salad from its drive-through branches, that they could cycle or walk there, and that its sponsorship of local football teams promotes health and wellbeing. McDonald’s has also deployed a specialist GP who claims that obesity is caused by “over 100” factors other than fast food and that its menu contains nutritious and low calorie options. In some cases McDonald’s threatened to for