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5,154 results on '"Svensson, A"'

1. Bioprosthetic valves and atrial fibrillation: Direct anticoagulants or warfarin

Author: Lars G. Svensson and Samir R. Kapadia
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Warfarin, Atrial fibrillation, medicine.disease, Coagulation cascade, Internal medicine, Stroke prevention, Antithrombotic, medicine, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, business, medicine.drug
Published: 2023

2. International Core Outcome Set for Acute Simple Appendicitis in Children

Author: Max Knaapen, Ernst W E Van Heurn, Martin Offringa, Shireen Anne Nah, Dayang Anita Abdul Aziz, Ramon R. Gorter, Nigel J. Hall, Roel Bakx, Sherif Emil, Johanna H. van der Lee, Erik D. Skarsgard, Shawn D. St. Peter, Jan F. Svensson, Janne S. Suominen, Darcy Moulin, Augusto Zani, Peter C. Minneci, Susan Adams, Nancy J. Butcher, Rambha Rai, Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Pediatric surgery, Amsterdam Reproduction & Development (AR&D), Other Research, Paediatric Surgery, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ARD - Amsterdam Reproduction and Development, General Paediatrics, APH - Methodology, and APH - Quality of Care
Subjects: medicine.medical_specialty, appendicitis, appendicitis research, Consensus, Adolescent, Delphi Technique, MEDLINE, Delphi method, core outcome set, 03 medical and health sciences, 0302 clinical medicine, nonoperative treatment, Outcome Assessment, Health Care, medicine, Humans, simple appendicitis, Child, Adverse effect, business.industry, medicine.disease, Focus group, Appendicitis, Bowel obstruction, Clinical trial, Treatment Outcome, Systematic review, Research Design, 030220 oncology & carcinogenesis, Family medicine, Acute Disease, 030211 gastroenterology & hepatology, Surgery, business
Abstract: Objective: : To develop an international Core Outcome Set (COS), a minimal collection of outcomes that should be measured and reported in all future clinical trials evaluating treatments of acute simple appendicitis in children.Summary Background Data: A previous systematic review identified 115 outcomes in 60 trials and systematic reviews evaluating treatments for children with appendicitis, suggesting the need for a COS.Methods: The development process consisted of four phases: (1) an updated systematic review identifying all previously reported outcomes, (2) a two-stage international Delphi study in which parents with their children and surgeons rated these outcomes for inclusion in the COS, (3) focus groups with young people to identify missing outcomes, and (4) international expert meetings to ratify the final COS.Results: The systematic review identified 129 outcomes which were mapped to 43 unique outcome terms for the Delphi survey. The first-round included 137 parents (eight countries) and 245 surgeons (10 countries), the second-round response rates were 61% and 85% respectively, with ten outcomes emerging with consensus. After two young peoples’ focus groups, two additional outcomes were added to the final COS (12): mortality, bowel obstruction, intra-abdominal abscess, recurrent appendicitis, complicated appendicitis, return to baseline health, readmission, reoperation, unplanned appendectomy, adverse events related to treatment, major and minor complications.Conclusion: An evidence-informed COS based on international consensus, including patients and parents has been developed. This COS is recommended for all future studies evaluating treatment of simple appendicitis in children, to reduce heterogeneity between studies and facilitate data synthesis and evidence-based decision-making.
Published: 2022

3. Failure to Rescue After Cardiac Surgery at Minority-Serving Hospitals: Room for Improvement

Author: A. Marc Gillinov, Siran M. Koroukian, Eric E. Roselli, Douglas R. Johnston, Guangjin Zhou, Krish C. Dewan, Edward G. Soltesz, Faisal G. Bakaeen, and Lars G. Svensson
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Failure to rescue, business.industry, Hospital mortality, medicine.disease, Hospitals, Cardiac surgery, Postoperative Complications, Failure to Rescue, Health Care, Quartile, Elective Surgical Procedures, Cardiothoracic surgery, Lung disease, Emergency medicine, Coagulopathy, medicine, Humans, Surgery, Hospital Mortality, Cardiac Surgical Procedures, Quality of care, Cardiology and Cardiovascular Medicine, business, Retrospective Studies
Abstract: Despite living closer to high-performing centers, minority patients reportedly receive care at lower-quality hospitals. Investigating opportunities for improvement at minority-serving hospitals may help attenuate disparities in care among cardiothoracic surgery patients. We sought to investigate the relationship between hospital quality and failure to rescue (FTR).Over 451,000 cardiac surgery patients from 2000 to 2011 at minority-serving hospitals (MSHs) were identified from the Nationwide Inpatient Sample. After stratifying patients by hospital mortality quartile, outcomes at poorly performing MSHs were compared with those at high-performing MSHs. Propensity score matching was used for comparisons.Though patients at poorly performing centers were more likely Black, there were no significant differences in admission status (urgent vs elective), income, insurance, or risk before matching. There were no differences in comorbidities between low-performing and high-performing MSHs including chronic lung disease, coagulopathy, hypertension, and renal failure. While complications remained similar across mortality quartiles (29%, 32%, 31%, and 36%, respectively; P.0001), FTR increased in a stepwise manner (5.4%, 8.7%, 11.2%, and 15.5%, respectively; P.0001). The same was true after propensity score matching-FTR nearly tripled in the highest-mortality centers (14.4% vs 5.3%; P.0001), while complications only increased 1.2-fold from 31.1% to 36.7% (P = .0058). This finding persisted even when stratified by procedure type and by complication.Improving timely management of complications after cardiac surgery may serve as a promising opportunity for increasing quality of care at MSHs. When considering centralization of care in cardiac surgery, equal emphasis should be placed on collaboration between tertiary care centers and low-quality MSHs to mitigate disparities in care.
Published: 2022

4. Valve-in-valve transcatheter aortic valve implantation versus repeat surgical aortic valve replacement in patients with a failed aortic bioprosthesis

Author: Rishi Puri, Grant W Reed, Samir R. Kapadia, Monil Majmundar, Anmar Kanaa'N, Joseph A. Lahorra, Rajkumar Doshi, Ashish Kumar, Amar Krishnaswamy, Lars G. Svensson, James Brockett, Ankur Kalra, and Douglas R. Johnston
Subjects: medicine.medical_specialty, Transcatheter aortic, business.industry, Hazard ratio, Retrospective cohort study, Odds ratio, medicine.disease, Confidence interval, Aortic valve replacement, Clinical Research, Internal medicine, Cardiology, medicine, Cardiology and Cardiovascular Medicine, business, Stroke, Mace
Abstract: Background Limited data are available regarding clinical outcomes of valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) following the United States Food and Drug Administration approval of ViV TAVI in 2015. Aims The aim of this study was to evaluate in-hospital, 30-day, and 6-month outcomes of ViV TAVI versus repeat surgical aortic valve replacement (SAVR) in patients with a failed aortic bioprosthetic valve. Methods This retrospective cohort study identified patients who underwent ViV TAVI or repeat SAVR utilising the Nationwide Readmission Database from 2016 to 2018. Primary outcomes were all-cause readmission (at 30 days and 6 months) and in-hospital death. Secondary outcomes were in-hospital stroke, pacemaker implantation, 30-day/6-month major adverse cardiac events (MACE), and mortality during readmission. Propensity score-matching (inverse probability of treatment weighting) analyses were implemented. Results Out of 6,769 procedures performed, 3,724 (55%) patients underwent ViV TAVI, and 3,045 (45%) underwent repeat SAVR. ViV TAVI was associated with lower in-hospital all-cause mortality (odds ratio [OR] 0.42, 95% confidence interval [CI]: 0.20-0.90, p=0.026) and a higher rate of 30-day (hazard ratio [HR] 1.46, 95% CI: 1.13-1.90, p=0.004) and 6-month all-cause readmission (HR 1.54, 95% CI: 1.14-2.10, p=0.006) compared with repeat SAVR. All secondary outcomes were comparable between the two groups. Conclusions ViV TAVI was associated with lower in-hospital mortality but higher 30-day and 6-month all-cause readmission. However, there was no difference in risk of in-hospital stroke, post-procedure pacemaker implantation, MACE, and mortality during 30-day and 6-month readmission compared with repeat SAVR, suggesting that ViV TAVI can be performed safely in carefully selected patients.
Published: 2022

5. Wellbeing, emotional response and stress among lay responders dispatched to suspected out-of-hospital cardiac arrests

Author: Leif Svensson, Mattias Ringh, Peter Lundgren, Martin Jonsson, Ellinor Berglund, Erik Olsson, Per Nordberg, Jacob Hollenberg, Åsa Högstedt, and Andreas Claesson
Subjects: Emergency Medical Services, medicine.medical_specialty, Resuscitation, Anestesi och intensivvård, Automated external defibrillator, medicine.medical_treatment, Emotions, Emergency Nursing, Stress, Affect (psychology), behavioral disciplines and activities, Lay responders, External defibrillators, Humans, Medicine, Cardiac and Cardiovascular Systems, Cardiopulmonary resuscitation, Out of hospital, Kardiologi, Anesthesiology and Intensive Care, Wellbeing, business.industry, Cardiopulmonary Resuscitation, Alertness, Posttraumatic stress, Volunteer responders, Smartphone application, Emergency Medicine, Physical therapy, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest, psychological phenomena and processes, Defibrillators
Abstract: Background: Systems for smartphone dispatch of lay responders to perform cardio-pulmonary resuscitation (CPR) and bring automated external defibrillators to out-of-hospital cardiac arrests (OHCAs) are advocated by recent international guidelines and emerging worldwide. Objectives: This study aimed to investigate the emotional responses, posttraumatic stress reactions and levels of wellbeing among smartphonealerted lay responders dispatched to suspected OHCAs. Methods: Lay responders were stratified by level of exposure: unexposed (Exp-0), tried to reach (Exp-1), and reached the suspected OHCA (Exp2). Participants rated their emotional responses online, at 90 minutes and at 4-6 weeks after an incident. Level of emotional response was measured in two dimensions of core affect: "alertness" - from deactivation to activation, and "pleasantness" - from unpleasant to pleasant. At 4-6 weeks, WHO wellbeing index and level of posttraumatic stress (PTSD) were also rated. Results: Altogether, 915 (28%) unexposed and 1471 (64%) exposed responders completed the survey. Alertness was elevated in the exposed groups: Exp-0: 6.7 vs. Exp-1: 7.3 and Exp-2: 7.5, (p < 0.001) and pleasantness was highest in the unexposed group: 6.5, vs. Exp-1: 6.3, and Exp-2: 6.1, (p < 0.001). Mean scores for PTSD at follow-up was below clinical cut-off, Exp-0: 9.9, Exp-1: 8.9 and Exp-2: 8.8 (p = 0.065). Wellbeing index showed no differences, Exp-0: 78.0, Exp-1: 78.5 and Exp-2: 79.9 (p = 0.596). Conclusion: Smartphone dispatched lay responders rated the experience as high-energy and mainly positive. No harm to the lay responders was seen. The exposed groups had low posttraumatic stress scores and high-level general wellbeing at follow-up.
Published: 2022

6. Kidney failure prediction models

Author: Ramspek, Chava L, Evans, Marie, Wanner, Christoph, Drechsler, Christiane, Chesnaye, Nicholas C, Szymczak, Maciej, Krajewska, Magdalena, Torino, Claudia, Porto, Gaetana, Hayward, Samantha, Caskey, Fergus, Dekker, Friedo W, Jager, Kitty J, van Diepen, Merel, EQUAL Study Investigators: Adamasco Cupisti, Adelia Sagliocca, Alberto Ferraro, Aleksandra Musiała, Alessandra Mele, Alessandro Naticchia, Alex Còsaro, Alistair Woodman, Andrea Ranghino, Andrea Stucchi, Andreas Jonsson, Andreas Schneider, Angelo Pignataro, Anita Schrander, Anke Torp, Anna McKeever, Anna Szymczak, Anna-Lena Blom, Antonella De Blasio, Antonello Pani, Aris Tsalouichos, Asad Ullah, Barbara McLaren, Bastiaan van Dam, Beate Iwig, Bellasi Antonio, Biagio Raffaele Di Iorio, Björn Rogland, Boris Perras, Butti Alessandra, Camille Harron, Carin Wallquist, Carl Siegert, Carla Barrett, Carlo Gaillard, Carlo Garofalo, Cataldo Abaterusso, Charles Beerenhout, Charlotte O'Toole, Chiara Somma, Christian Marx, Christina Summersgill, Christof Blaser, Claudia D'alessandro, Claudia Emde, Claudia Zullo, Claudio Pozzi, Colin Geddes, Cornelis Verburgh, Daniela Bergamo, Daniele Ciurlino, Daria Motta, Deborah Glowski, Deborah McGlynn, Denes Vargas, Detlef Krieter, Domenico Russo, Dunja Fuchs, Dympna Sands, Ellen Hoogeveen, Ellen Irmler, Emöke Dimény, Enrico Favaro, Eva Platen, Ewelina Olczyk, Ewout Hoorn, Federica Vigotti, Ferruccio Ansali, Ferruccio Conte, Francesca Cianciotta, Francesca Giacchino, Francesco Cappellaio, Francesco Pizzarelli, Fredrik Sundelin, Fredrik Uhlin, Gaetano Greco, Geena Roy, Gaetana Porto, Giada Bigatti, Giancarlo Marinangeli, Gianfranca Cabiddu, Gillian Hirst, Giordano Fumagalli, Giorgia Caloro, Giorgina Piccoli, Giovanbattista Capasso, Giovanni Gambaro, Giuliana Tognarelli, Giuseppe Bonforte, Giuseppe Conte, Giuseppe Toscano, Goffredo Del Rosso, Gunilla Welander, Hanna Augustyniak-Bartosik, Hans Boots, Hans Schmidt-Gürtler, Hayley King, Helen McNally, Hendrik Schlee, Henk Boom, Holger Naujoks, Houda Masri-Senghor, Hugh Murtagh, Hugh Rayner, Ilona Miśkowiec-Wiśniewska, Ines Schlee, Irene Capizzi, Isabel Bascaran Hernandez, Ivano Baragetti, Jacek Manitius, Jane Turner, Jan-Willem Eijgenraam, Jeroen Kooman, Joachim Beige, Joanna Pondel, Joanne Wilcox, Jocelyn Berdeprado, Jochen Röthele, Jonathan Wong, Joris Rotmans, Joyce Banda, Justyna Mazur, Kai Hahn, Kamila Jędrzejak, Katarzyna Nowańska, Katja Blouin, Katrin Neumeier, Kirsteen Jones, Kirsten Anding-Rost, Knut-Christian Gröntoft, Lamberto Oldrizzi, Lesley Haydock, Liffert Vogt, Lily Wilkinson, Loreto Gesualdo, Lothar Schramm, Luigi Biancone, Łukasz Nowak, Maarten Raasveld, Magdalena Durlik, Manuela Magnano, Marc Vervloet, Marco Ricardi, Margaret Carmody, Maria Di Bari, Maria Laudato, Maria Luisa Sirico, Maria Stendahl, Maria Svensson, Maria Weetman, Marjolijn van Buren, Martin Joinson, Martina Ferraresi, Mary Dutton, Merel van Diepen, Michael Matthews, Michele Provenzano, Monika Hopf, Moreno Malaguti, Nadja Wuttke, Neal Morgan, Nicola Palmieri, Nikolaus Frischmuth, Nina Bleakley, Paola Murrone, Paul Cockwell, Paul Leurs, Paul Roderick, Pauline Voskamp, Pavlos Kashioulis, Pawlos Ichtiaris, Peter Blankestijn, Petra Kirste, Petra Schulz, Phil Mason, Philip Kalra, Pietro Cirillo, Pietro Dattolo, Pina Acampora, Rincy Sajith, Rita Nigro, Roberto Boero, Roberto Scarpioni, Rosa Sicoli, Rosella Malandra, Sabine Aign, Sabine Cäsar, Sadie van Esch, Sally Chapman, Sandra Biribauer, Santee Navjee, Sarah Crosbie, Sharon Brown, Sheila Tickle, Sherin Manan, Silke Röser, Silvana Savoldi, Silvio Bertoli, Silvio Borrelli, Siska Boorsma, Stefan Heidenreich, Stefan Melander, Stefania Maxia, Stefano Maffei, Stefano Mangano, Stephanie Palm, Stijn Konings, Suresh Mathavakkannan, Susanne Schwedler, Sylke Delrieux, Sylvia Renker, Sylvia Schättel, Szyszkowska Dorota, Teresa Cicchetti, Teresa Nieszporek, Theresa Stephan, Thomas Schmiedeke, Thomas Weinreich, Til Leimbach, Tiziana Rappa, Tora Almquist, Torsten Stövesand, Udo Bahner, Ulrika Jensen, Valentina Palazzo, Walter De Simone, Wolfgang Seeger, Ying Kuan, Zbigniew Heleniak, Zeynep Aydin, Internal Medicine, Chava L, Ramspek, Marie, Evan, Christoph, Wanner, Christiane, Drechsler, Nicholas C, Chesnaye, Maciej, Szymczak, Magdalena, Krajewska, Claudia, Torino, Gaetana, Porto, Samantha, Hayward, Fergus, Caskey, Friedo W, Dekker, Kitty J, Jager, Merel, van Diepen, Study Investigators: Adamasco Cupisti, Equal, Sagliocca, Adelia, Ferraro, Alberto, Musiała, Aleksandra, Mele, Alessandra, Naticchia, Alessandro, Còsaro, Alex, Woodman, Alistair, Ranghino, Andrea, Stucchi, Andrea, Jonsson, Andrea, Schneider, Andrea, Pignataro, Angelo, Schrander, Anita, Torp, Anke, Mckeever, Anna, Szymczak, Anna, Blom, Anna-Lena, De Blasio, Antonella, Pani, Antonello, Tsalouichos, Ari, Ullah, Asad, Mclaren, Barbara, van Dam, Bastiaan, Iwig, Beate, Antonio, Bellasi, Raffaele Di Iorio, Biagio, Rogland, Björn, Perras, Bori, Alessandra, Butti, Harron, Camille, Wallquist, Carin, Siegert, Carl, Barrett, Carla, Gaillard, Carlo, Garofalo, Carlo, Abaterusso, Cataldo, Beerenhout, Charle, O'Toole, Charlotte, Somma, Chiara, Marx, Christian, Summersgill, Christina, Blaser, Christof, D'Alessandro, Claudia, Emde, Claudia, Zullo, Claudia, Pozzi, Claudio, Geddes, Colin, Verburgh, Corneli, Bergamo, Daniela, Ciurlino, Daniele, Motta, Daria, Glowski, Deborah, Mcglynn, Deborah, Vargas, Dene, Krieter, Detlef, Russo, Domenico, Fuchs, Dunja, Sands, Dympna, Hoogeveen, Ellen, Irmler, Ellen, Dimény, Emöke, Favaro, Enrico, Platen, Eva, Olczyk, Ewelina, Hoorn, Ewout, Vigotti, Federica, Ansali, Ferruccio, Conte, Ferruccio, Cianciotta, Francesca, Giacchino, Francesca, Cappellaio, Francesco, Pizzarelli, Francesco, Sundelin, Fredrik, Uhlin, Fredrik, Greco, Gaetano, Roy, Geena, Porto, Gaetana, Bigatti, Giada, Marinangeli, Giancarlo, Cabiddu, Gianfranca, Hirst, Gillian, Fumagalli, Giordano, Caloro, Giorgia, Piccoli, Giorgina, Capasso, Giovanbattista, Gambaro, Giovanni, Tognarelli, Giuliana, Bonforte, Giuseppe, Conte, Giuseppe, Toscano, Giuseppe, Del Rosso, Goffredo, Welander, Gunilla, Augustyniak-Bartosik, Hanna, Boots, Han, Schmidt-Gürtler, Han, King, Hayley, Mcnally, Helen, Schlee, Hendrik, Boom, Henk, Naujoks, Holger, Masri-Senghor, Houda, Murtagh, Hugh, Rayner, Hugh, Miśkowiec-Wiśniewska, Ilona, Schlee, Ine, Capizzi, Irene, Bascaran Hernandez, Isabel, Baragetti, Ivano, Manitius, Jacek, Turner, Jane, Eijgenraam, Jan-Willem, Kooman, Jeroen, Beige, Joachim, Pondel, Joanna, Wilcox, Joanne, Berdeprado, Jocelyn, Röthele, Jochen, Wong, Jonathan, Rotmans, Jori, Banda, Joyce, Mazur, Justyna, Hahn, Kai, Jędrzejak, Kamila, Nowańska, Katarzyna, Blouin, Katja, Neumeier, Katrin, Jones, Kirsteen, Anding-Rost, Kirsten, Gröntoft, Knut-Christian, Oldrizzi, Lamberto, Haydock, Lesley, Vogt, Liffert, Wilkinson, Lily, Gesualdo, Loreto, Schramm, Lothar, Biancone, Luigi, Nowak, Łukasz, Raasveld, Maarten, Durlik, Magdalena, Magnano, Manuela, Vervloet, Marc, Ricardi, Marco, Carmody, Margaret, Di Bari, Maria, Laudato, Maria, Luisa Sirico, Maria, Stendahl, Maria, Svensson, Maria, Weetman, Maria, van Buren, Marjolijn, Joinson, Martin, Ferraresi, Martina, Dutton, Mary, van Diepen, Merel, Matthews, Michael, Provenzano, Michele, Hopf, Monika, Malaguti, Moreno, Wuttke, Nadja, Morgan, Neal, Palmieri, Nicola, Frischmuth, Nikolau, Bleakley, Nina, Murrone, Paola, Cockwell, Paul, Leurs, Paul, Roderick, Paul, Voskamp, Pauline, Kashioulis, Pavlo, Ichtiaris, Pawlo, Blankestijn, Peter, Kirste, Petra, Schulz, Petra, Mason, Phil, Kalra, Philip, Cirillo, Pietro, Dattolo, Pietro, Acampora, Pina, Sajith, Rincy, Nigro, Rita, Boero, Roberto, Scarpioni, Roberto, Sicoli, Rosa, Malandra, Rosella, Aign, Sabine, Cäsar, Sabine, van Esch, Sadie, Chapman, Sally, Biribauer, Sandra, Navjee, Santee, Crosbie, Sarah, Brown, Sharon, Tickle, Sheila, Manan, Sherin, Röser, Silke, Savoldi, Silvana, Bertoli, Silvio, Borrelli, Silvio, Boorsma, Siska, Heidenreich, Stefan, Melander, Stefan, Maxia, Stefania, Maffei, Stefano, Mangano, Stefano, Palm, Stephanie, Konings, Stijn, Mathavakkannan, Suresh, Schwedler, Susanne, Delrieux, Sylke, Renker, Sylvia, Schättel, Sylvia, Dorota, Szyszkowska, Cicchetti, Teresa, Nieszporek, Teresa, Stephan, Theresa, Schmiedeke, Thoma, Weinreich, Thoma, Leimbach, Til, Rappa, Tiziana, Almquist, Tora, Stövesand, Torsten, Bahner, Udo, Jensen, Ulrika, Palazzo, Valentina, De Simone, Walter, Seeger, Wolfgang, Kuan, Ying, Heleniak, Zbigniew, Aydin, Zeynep, Medical Informatics, ACS - Pulmonary hypertension & thrombosis, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, APH - Methodology, APH - Quality of Care, and APH - Global Health
Subjects: Male, progression of chronic renal failure, medicine.medical_specialty, Time Factors, epidemiology and outcome, 030232 urology & nephrology, Risk Assessment, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Older patients, external validation, Predictive Value of Tests, medicine, Humans, Failure risk, Clinical Epidemiology, In patient, comprehensive external validation, 030212 general & internal medicine, Statistic, Aged, Aged, 80 and over, Kidney, Models, Statistical, business.industry, External validation, General Medicine, prediction, kidney failure, Europe, prediction model, medicine.anatomical_structure, chronic kidney disease, epidemiology and outcomes, prognosis, Nephrology, Emergency medicine, Disease Progression, Kidney Failure, Chronic, Female, business, prognostic, Predictive modelling, prognosi, Cohort study
Abstract: Background Various prediction models have been developed to predict the risk of kidney failure in patients with CKD. However, guideline-recommended models have yet to be compared head to head, their validation in patients with advanced CKD is lacking, and most do not account for competing risks. Methods To externally validate 11 existing models of kidney failure, taking the competing risk of death into account, we included patients with advanced CKD from two large cohorts: the European Quality Study (EQUAL), an ongoing European prospective, multicenter cohort study of older patients with advanced CKD, and the Swedish Renal Registry (SRR), an ongoing registry of nephrology-referred patients with CKD in Sweden. The outcome of the models was kidney failure (defined as RRT-treated ESKD). We assessed model performance with discrimination and calibration. Results The study included 1580 patients from EQUAL and 13,489 patients from SRR. The average c statistic over the 11 validated models was 0.74 in EQUAL and 0.80 in SRR, compared with 0.89 in previous validations. Most models with longer prediction horizons overestimated the risk of kidney failure considerably. The 5-year Kidney Failure Risk Equation (KFRE) overpredicted risk by 10%-\18%. The four- and eight-variable 2-year KFRE and the 4-year Grams model showed excellent calibration and good discrimination in both cohorts. Conclusions Some existing models can accurately predict kidney failure in patients with advanced CKD. KFRE performed well for a shorter time frame (2 years), despite not accounting for competing events. Models predicting over a longer time frame (5 years) overestimated risk because of the competing risk of death. The Grams model, which accounts for the latter, is suitable for longer-term predictions (4 years).
Published: 2021

7. Glycemic Control and Risk of Sepsis and Subsequent Mortality in Type 2 Diabetes

Author: Anders Oldner, Mikael Andersson Franko, Johan Mårtensson, Björn Eliasson, Maria Cronhjort, Anca Balintescu, Marcus Lind, and Ann-Marie Svensson
Subjects: Blood Glucose, Glycated Hemoglobin, Advanced and Specialized Nursing, Research design, medicine.medical_specialty, Proportional hazards model, business.industry, Endocrinology, Diabetes and Metabolism, Hazard ratio, Glycemic Control, Type 2 diabetes, medicine.disease, Sepsis, Diabetes Mellitus, Type 2, Risk Factors, Diabetes mellitus, Internal medicine, Cohort, Internal Medicine, medicine, Humans, business, Glycemic
Abstract: OBJECTIVE To investigate the nature of the relationship between HbA1c and sepsis among individuals with type 2 diabetes, and to assess the association between sepsis and all-cause mortality in such patients. RESEARCH DESIGN AND METHODS We included 502,871 individuals with type 2 diabetes recorded in the Swedish National Diabetes Register and used multivariable Cox regression and restricted cubic spline analyses to assess the association between time-updated HbA1c values and sepsis occurrence between 1 January 2005 and 31 December 2015. The association between sepsis and death was examined using multivariable Cox regression analysis. RESULTS Overall, 14,534 (2.9%) patients developed sepsis during the study period. On multivariable Cox regression analysis, compared with an HbA1c of 48–52 mmol/mol (6.5–6.9%), the adjusted hazard ratio for sepsis was 1.15 (95% CI 1.07–1.24) for HbA1c 82 mmol/mol (9.7%). In the cubic spline model, a reduction of the adjusted risk was observed within the lower HbA1c range until 53 mmol/mol (7.0%), with a hazard ratio of 0.78 (0.73–0.82) per SD; it increased thereafter (P for nonlinearity CONCLUSIONS In a nationwide cohort of individuals with type 2 diabetes, we found a U-shaped association between HbA1c and sepsis and a fourfold increased risk of death among those developing sepsis.
Published: 2021

8. Safety and Efficacy of Mevidalen in Lewy Body Dementia: A Phase 2, Randomized, Placebo‐Controlled Trial

Author: Paul A. Ardayfio, Kjell A. Svensson, Leanne Munsie, Kevin Biglan, Miroslaw Brys, Melissa Pugh, and John R. Sims
Subjects: Lewy Body Disease, medicine.medical_specialty, Movement disorders, Lewy body, business.industry, Placebo-controlled study, medicine.disease, Placebo, Cognition, Neuroprotective Agents, Blood pressure, Double-Blind Method, Neurology, Alzheimer Disease, Rating scale, Internal medicine, medicine, Humans, Dementia, Neurology (clinical), medicine.symptom, business, Adverse effect
Abstract: BACKGROUND Mevidalen is a selective positive allosteric modulator (PAM) of the dopamine D1 receptor subtype. OBJECTIVE To assess the safety and efficacy of mevidalen for treatment of cognition in patients with Lewy body dementia (LBD). METHODS PRESENCE was a phase 2, 12-week study in participants with LBD (N = 344) randomly assigned (1:1:1:1) to daily doses of mevidalen (10, 30, or 75 mg) or placebo. The primary outcome measure was change from baseline on Cognitive Drug Research Continuity of Attention (CoA) composite score. Secondary outcomes included Alzheimer's Disease Assessment Scale-Cognitive Subscale 13 (ADAS-cog13 ), Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC). Numerous safety measures were collected. RESULTS Mevidalen failed to meet primary or secondary cognition endpoints. Mevidalen resulted in significant, dose-dependent improvements of MDS-UPDRS total score (sum of Parts I-III, 10 mg P
Published: 2021

9. Experiences of Swedish Parents Seeking Social Services Support for Their Adult Children With Drug Addiction

Author: Torkel Richert, Björn Johnson, and Bengt Svensson
Subjects: Drug, medicine.medical_specialty, Sociology and Political Science, Addiction, media_common.quotation_subject, Face (sociological concept), Professional support, Social Welfare, Help-seeking, medicine, Psychology, Psychiatry, Social Sciences (miscellaneous), media_common
Abstract: Objective: Family members of a person with drug addiction often experience negative impacts on their lives and face barriers to seeking professional support. More knowledge is needed about ...
Published: 2021

10. Evolution of Alternative-access Transcatheter Aortic Valve Replacement

Author: Samir R. Kapadia, Eugene H. Blackstone, James Yun, Kevin Hodges, Bogdan A. Kindzelski, Tamer Attia, Ashley M. Lowry, Zoran B. Popović, Shinya Unai, Stephanie Mick, Shirin Siddiqi, Lars G. Svensson, and Amar Krishnaswamy
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Transcatheter aortic, business.industry, medicine.medical_treatment, Preoperative risk, MEDLINE, Surgery, Text mining, Valve replacement, medicine, Cardiology and Cardiovascular Medicine, business, Transaxillary approach
Abstract: Background Transfemoral access is the most common approach for transcatheter aortic valve replacement (TAVR). However, a subset of patients require alternative access. This study describes the evolution and outcomes of alternative-access TAVR at Cleveland Clinic. Methods From January 2006 to January 2019, 2446 patients underwent TAVR, 414 (17%) through alternative access (247 transapical, 95 transaortic, 56 transaxillary, 2 transcarotid, 10 transiliac, 4 transcaval). Patients undergoing alternative-access TAVR had high preoperative risk. Propensity-matched comparisons were targeted at comparing transfemoral versus transaxillary approaches since 2012. Results Over time, the favored alternative-access approach shifted from transapical and transaortic to transaxillary. Pacemaker requirement was similar for alternative-access and transfemoral approaches. Compared with transfemoral access, major vascular injuries were higher in the alternative-access group (12 [2.9%] vs 27 [1.3%], P = .02), but minor vascular injuries were lower (13 [3.1%] vs 198 [9.8%], P Conclusions The transaxillary approach has emerged as our preferred alternative-access strategy for TAVR. It is associated with superior operative outcomes compared with transthoracic approaches, and results are comparable with those of the transfemoral approach.
Published: 2021

11. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes

Author: Michelena, H.I., Corte, A. della, Evangelista, A., Maleszewski, J.J., Edwards, W.D., Roman, M.J., Devereux, R.B., Fernandez, B., Asch, F.M., Barker, A.J., Sierra-Galan, L.M., Kerchove, L. de, Fernandes, S.M., Fedak, P.W.M., Girdauskas, E., Delgado, V., Abbara, S., Lansac, E., Prakash, S.K., Bissell, M.M., Popescu, B.A., Hope, M.D., Sitges, M., Thourani, V.H., Pibarot, P., Chandrasekaran, K., Lancellotti, P., Borger, M.A., Forrest, J.K., Webb, J., Milewicz, D.M., Makkar, R., Leon, M.B., Sanders, S.P., Markl, M., Ferrari, V.A., Roberts, W.C., Song, J.K., Blanke, P., White, C.S., Siu, S., Svensson, L.G., Braverman, A.C., Bavaria, J., Sundt, T.M., Khoury, G. el, Paulis, R. de, Enriquez-Sarano, M., Bax, J.J., Otto, C.M., Schafers, H.J., Endorsed Heart Valve Soc HVS, European Assoc Cardiovasc Imaging, Soc Thoracic Surg STS, Amer Assoc Thoracic Surg AATS, Soc Cardiovasc Magnetic Resonance, Soc Cardiovasc Computed Tomography, North Amer Soc Cardiovasc Imaging, Int Bicuspid Aortic Valve Consorti, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, Michelena, H. I., Della Corte, A., Evangelista, A., Maleszewski, J. J., Edwards, W. D., Roman, M. J., Devereux, R. B., Fernandez, B., Asch, F. M., Barker, A. J., Sierra-Galan, L. M., De Kerchove, L., Fernandes, S. M., Fedak, P. W. M., Girdauskas, E., Delgado, V., Abbara, S., Lansac, E., Prakash, S. K., Bissell, M. M., Popescu, B. A., Hope, M. D., Sitges, M., Thourani, V. H., Pibarot, P., Chandrasekaran, K., Lancellotti, P., Borger, M. A., Forrest, J. K., Webb, J., Milewicz, D. M., Makkar, R., Leon, M. B., Sanders, S. P., Markl, M., Ferrari, V. A., Roberts, W. C., Song, J. -K., Blanke, P., White, C. S., Siu, S., Svensson, L. G., Braverman, A. C., Bavaria, J., Sundt, T. M., El Khoury, G., De Paulis, R., Enriquez-Sarano, M., Bax, J. J., Otto, C. M., Schafers, H. -J., Michelena, Hector I, Corte, Alessandro Della, Evangelista, Arturo, Maleszewski, Joseph J, Edwards, William D, Roman, Mary J, Devereux, Richard B, Fernández, Borja, Asch, Federico M, Barker, Alex J, Sierra-Galan, Lilia M, De Kerchove, Laurent, Fernandes, Susan M, Fedak, Paul W M, Girdauskas, Evalda, Delgado, Victoria, Abbara, Suhny, Lansac, Emmanuel, Prakash, Siddharth K, Bissell, Malenka M, Popescu, Bogdan A, Hope, Michael D, Sitges, Marta, Thourani, Vinod H, Pibarot, Phillippe, Chandrasekaran, Krishnaswamy, Lancellotti, Patrizio, Borger, Michael A, Forrest, John K, Webb, John, Milewicz, Dianna M, Makkaar, Raj, Leon, Martin B, Sanders, Stephen P, Markl, Michael, Ferrari, Victor A, Roberts, William C, Song, Jae-Kwan, Blanke, Philipp, White, Charles S, Siu, Samuel, Svensson, Lars G, Braverman, Alan C, Bavaria, Joseph, Sundt, Thoralf M, El Khoury, Gebrine, De Paulis, Ruggero, Enriquez-Sarano, Maurice, Bax, Jeroen J, Otto, Catherine M, and Schäfers, Hans-Joachim
Subjects: Statement (logic), Predictive Value of Test, Computed tomography, 030204 cardiovascular system & hematology, Congenital Aortic Valve Insufficiency, 0302 clinical medicine, Bicuspid aortic valve, Bicuspid Aortic Valve Disease, 030212 general & internal medicine, Nomenclature, Aorta, medicine.diagnostic_test, General Medicine, Anatomy, Prognosis, Classification, Phenotype, Aortic Valve, cardiovascular system, Cardiology and Cardiovascular Medicine, Key Words, Human, Pulmonary and Respiratory Medicine, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Consensus, Prognosi, education, Aortic Diseases, Consensu, Aortography, 03 medical and health sciences, Bicuspid valve, Predictive Value of Tests, Terminology as Topic, Aortopathy, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Special Report, Cardiac Imaging Technique, business.industry, General surgery, Systematized Nomenclature of Medicine, Forme fruste, nomencla-ture, Aortic Valve Stenosis, Aortic Disease, medicine.disease, Aortic Valve Stenosi, Cardiac Imaging Techniques, Cusp (anatomy), Surgery, business
Abstract: This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes. © 2021 Jointly between the RSNA, the European Association for Cardio-Thoracic Surgery, The Society of Thoracic Surgeons, and the American Association for Thoracic Surgery. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. All rights reserved. Keywords: Bicuspid Aortic Valve, Aortopathy, Nomenclature, Classification.
Published: 2021

12. Commentary: Time to reassess valve reimplantation for root aneurysms in Marfan syndrome?

Author: Lars G. Svensson
Subjects: Pulmonary and Respiratory Medicine, Marfan syndrome, medicine.medical_specialty, business.industry, medicine, Surgery, Cardiology and Cardiovascular Medicine, medicine.disease, business
Published: 2023

13. Center differences in diabetes treatment outcomes among children with type 1 diabetes: A nationwide study of 3866 Danish children

Author: Charlotte Søndergaard, Niels Skipper, Jannet Svensson, Amanda Gaulke, Peter R Thingholm, Tine Louise Mundbjerg Eriksen, and Luise Borch
Subjects: Blood Glucose, Male, Insulin pump, Research design, Pediatrics, medicine.medical_specialty, endocrine system diseases, Denmark, Endocrinology, Diabetes and Metabolism, Diabetes treatment, Danish, Risk Factors, Internal Medicine, medicine, Humans, Child, Socioeconomic status, Quality of Health Care, Glycated Hemoglobin, Blood glucose monitoring, Type 1 diabetes, medicine.diagnostic_test, business.industry, Infant, nutritional and metabolic diseases, medicine.disease, language.human_language, Diabetes Mellitus, Type 1, Treatment Outcome, Child, Preschool, Pediatrics, Perinatology and Child Health, language, Universal health care, Female, Health Facilities, business
Abstract: Objective: Mean differences in HbA1c across centers are well established, but less well understood. The aim was to assess whether differences in patient case-mix can explain the variation in mean HbA1c between pediatric diabetes centers in Denmark. The association between HbA1c, frequency of blood glucose monitoring (BGM), treatment modality, and center visits was investigated. Research Design and Methods: This longitudinal nationwide study included 3866 Danish children with type 1 diabetes from 2013 to 2017 (n = 12,708 child-year observations) from 16 different pediatric diabetes centers. Mean HbA1c, proportion of children reaching HbA1c treatment target (HbA1c ≤ 58 mmol/mol [7.5%]) were compared across centers using linear regression models. This was done with and without adjustment for socioeconomic characteristics (patient case-mix). Results: The mean difference in HbA1c during follow-up was 11.6 mmol/mol (95% CI 7.9, 15.3) (1.1% [95% CI 0.7, 1.4]) when comparing the centers with the lowest versus highest mean HbA1c. The difference was attenuated and remained significant after adjustment for the patient case-mix (difference: 10.5 mmol/mol [95% CI 6.8, 14.2] (1.0% [95% CI 0.6, 1.3])). Overall, 6.8% of the differences in mean HbA1c across centers were explained by differences in the patient case-mix. Across centers, more frequent BGM was associated with lower HbA1c. The proportion of insulin pump users and number of visits was not associated with HbA1c. Conclusion: In a setting of universal health care, large differences in HbA1c across centers were found, and could not be explained by patient background, number of visits or use of technology. Only BGM was associated with center HbA1c.
Published: 2021

14. Association of Bariatric Surgery With Cancer Incidence in Patients With Obesity and Diabetes: Long-term Results From the Swedish Obese Subjects Study

Author: Felipe M. Kristensson, Lena M. S. Carlsson, Per-Arne Svensson, Markku Peltonen, Peter Jacobson, Johanna C. Andersson-Assarsson, Magdalena Taube, and Kajsa Sjöholm
Subjects: Research design, Cardiovascular and Metabolic Risk, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Bariatric Surgery, Type 2 diabetes, Interquartile range, Neoplasms, Diabetes mellitus, Internal Medicine, medicine, Humans, Obesity, Prospective Studies, Sweden, Advanced and Specialized Nursing, business.industry, Incidence, Incidence (epidemiology), Hazard ratio, Cancer, medicine.disease, Surgery, Diabetes Mellitus, Type 2, Female, business
Abstract: OBJECTIVE Obesity and type 2 diabetes are associated with serious adverse health effects, including cancer. Although bariatric surgery has been shown to reduce cancer risk in patients with obesity, the effect of bariatric surgery on cancer risk in patients with obesity and diabetes is less studied. We therefore examined the long-term incidence of cancer after bariatric surgery and usual care in patients with obesity and diabetes in the matched prospective Swedish Obese Subjects (SOS) study. RESEARCH DESIGN AND METHODS The SOS study examines long-term outcomes following bariatric surgery or usual care. The current analysis includes 701 patients with obesity and type 2 diabetes at baseline, 393 of whom underwent bariatric surgery and 308 who received conventional obesity treatment. Information on cancer events was obtained from the Swedish National Cancer Register. Median follow-up time was 21.3 years (interquartile range 17.6–24.8 years, maximum 30.7 years). RESULTS During follow-up, the incidence rate for first-time cancer was 9.1 per 1,000 person-years (95% CI 7.2–11.5) in patients with obesity and diabetes treated with bariatric surgery and 14.1 per 1,000 person-years (95% CI 11.2–17.7) in patients treated with usual obesity care (adjusted hazard ratio 0.63 [95% CI 0.44–0.89], P = 0.008). Moreover, surgery was associated with reduced cancer incidence in women (0.58 [0.38–0.90], P = 0.016), although the sex-treatment interaction was nonsignificant (P = 0.630). In addition, diabetes remission at the 10-year follow-up was associated with reduced cancer incidence (0.40 [0.22–0.74], P = 0.003). CONCLUSIONS These results suggest that bariatric surgery prevents cancer in patients with obesity and diabetes and that durable diabetes remission is associated with reduced cancer risk.
Published: 2021

15. Total opioid‐free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management: A systematic review and meta‐analysis

Author: Sven-Egron Thörn, Carl Johan Svensson, Axel Wolf, Paulin Andréll, Pether Jildenstål, and Alexander Olausson
Subjects: Pain, Postoperative, medicine.medical_specialty, Nausea, business.industry, Breast surgery, medicine.medical_treatment, General Medicine, Anesthesia, General, Cochrane Library, Surgery, Analgesics, Opioid, Anesthesiology and Pain Medicine, Opioid, medicine, Vomiting, Humans, General anaesthesia, Patient Safety, medicine.symptom, Adverse effect, business, Postoperative nausea and vomiting, medicine.drug
Abstract: BACKGROUND Opioid-based treatment is used to manage stress responses during surgery and postoperative pain. However, opioids have both acute and long-term side effects, calling for opioid-free anaesthetic strategies. This meta-analysis compares adverse events, postoperative recovery, discharge time from post-anaesthesia care unit, and postoperative pain, nausea, vomiting, and opioid consumption between strict opioid-free and opioid-based general anaesthesia. METHODS We conducted a systematic review and meta-analysis. We searched PubMed, Embase, Cinahl, Cochrane Library, selected reference lists, and Google Scholar. We included randomised controlled trials (RCTs) published between January 2000 and February 2021 with at least one opioid-free study arm, i.e. no opioids administered preoperatively, during anaesthesia induction, before skin closure, or before emergence from anaesthesia. RESULTS The study comprised 1934 patients from 26 RCTs. Common interventions included laparoscopic gynaecological surgery, upper gastrointestinal surgery, and breast surgery. There is firm evidence that opioid-free anaesthesia significantly reduced adverse postoperative events (OR 0.32, 95% CI 0.22 to 0.46, I2 = 56%, p
Published: 2021

16. Different training responses in elderly men and women following a prolonged muscle resistance training intervention

Author: Mads Bloch-Ibenfeldt, Anne Theil Gates, Ellen Garde, Michael Kjaer, Rene B. Svensson, Kenneth Mertz, and Maria Baekgaard
Subjects: medicine.medical_specialty, business.industry, Intervention (counseling), Training (meteorology), Physical therapy, Resistance training, Medicine, business
Abstract: Resistance training is an effective strategy to counteract the age-related loss of muscle mass and strength in elderly, but whether the benefits of training differ between sexes is unclear. A total of 297 elderly men and women were randomized to 1 year of heavy resistance training (HRT) or control (CON). Changes in muscle function and body composition were compared between sexes and groups. Improvements in muscle strength, body fat, muscle mass and size were observed, but the absolute improvements in muscle strength (23 Nm ± 2.3 vs 11 Nm ± 2.2, P < .01) and visceral fat content (−215 g ± 50 vs −60 g ± 21, P < .01) were greater in men. Also, the relative decrease in body fat % (−6.8% ± 1.1 vs −2.7% ± 0.7, P < .05) and fat mass (−7.9% ± 1.4 vs −2.7% ± 1.0, P < .05) was more pronounced in men. Heavy resistance training improved more than CON in most muscular and body composition parameters with greater increase in muscle strength and decrease in body fat in men. Consequently, resistance training is recommendable to counteract age-related losses of muscle mass and strength and to reduce body fat in elderly, however, with a small advantage for men in parameters that predict metabolic risk factors.
Published: 2021

17. Intermediate-term outcomes of aortic valve replacement using a bioprosthesis with a novel tissue

Author: Agata Bilewskai, Bartley P. Griffith, Craig R. Smith, Shuab Omer, Percy Boateng, Jerzy Sadowski, Lars G. Svensson, William R. Ryan, Tomasz A. Timek, Joseph E. Bavaria, Vaughn A. Starnes, Douglas R. Johnston, Todd K. Rosengart, Hiroo Takayama, Eugene H. Blackstone, Michael E. Halkos, John D. Puskas, Jacek Różański, Mubashir Mumtaz, Leonard N. Girardi, Krzysztof Bartus, Charles T. Klodell, David Heimansohn, and James S. Gammie
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, Heart Valve Diseases, Hemodynamics, Investigational device exemption, 030204 cardiovascular system & hematology, Prosthesis Design, New york heart association, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Aortic valve replacement, medicine, Risk of mortality, Animals, Humans, Prospective Studies, Aged, Aged, 80 and over, Bioprosthesis, Heart Valve Prosthesis Implantation, business.industry, Recovery of Function, Middle Aged, medicine.disease, Thrombosis, United States, Confidence interval, Surgery, Functional Status, Treatment Outcome, 030228 respiratory system, Aortic Valve, Heart Valve Prosthesis, Heterografts, Tears, Cattle, Female, Poland, Cardiology and Cardiovascular Medicine, business, Pericardium
Abstract: Objectives The COMMENCE trial was conducted to evaluate the safety and effectiveness of an aortic bioprosthesis with novel RESILIA tissue (Edwards Lifesciences, Irvine, Calif). Reports of early noncalcific valve failure resulting from thrombosis or leaflet tears in other valves warrant careful evaluation of early valve performance. Methods Patients underwent clinically indicated surgical aortic valve replacement with the Edwards Pericardial Aortic Bioprosthesis, Model 11000A (Edwards Lifesciences) in a prospective, multinational, multicenter (n = 27), single-arm, Food and Drug Administration Investigational Device Exemption trial. Events were adjudicated by an independent clinical events committee; echocardiograms were analyzed by an independent core laboratory. Results Between January 2013 and March 2016, 689 patients received the study valve. Mean age was 67.0 ± 11.6 years. Mean Society of Thoracic Surgeons predicted risk of mortality was 2.0% ± 1.8%. Follow-up duration was 3.7 ± 1.2 years, with a total of 2533 patient years of follow-up and a median follow-up of 4 years. Early all-cause mortality was 1.2%, thromboembolism 2.3%, all bleeding 1.0%, and major paravalvular leak 0.1%. One- and 4-year actuarial freedom from all-cause mortality was 97.7% (95% confidence interval, 96.5%-98.8%) and 91.9% (95% confidence interval, 89.7%-94.1%), respectively. At 4 years, New York Heart Association functional class improved compared with baseline in 63.0%, effective orifice area was 1.5 ± 0.5 cm2, and mean gradient was 11.0 ± 5.6 mm Hg. Freedom from moderate or greater transvalvular insufficiency was 99.7%. There were no events of structural valve deterioration. Conclusions Safety and hemodynamic performance of this aortic bioprosthesis with RESILIA tissue at 4 years are favorable. This novel tissue does not appear to result in unexpected early thrombosis events or noncalcific structural valve deterioration.
Published: 2021

18. Quantification of normetanephrine in canine urine using ELISA: evaluation of factors affecting results

Author: S. Ringmark, Hanna Palmqvist, Katja Höglund, and Anna Svensson
Subjects: dogs, medicine.medical_specialty, Enzyme-Linked Immunosorbent Assay, Urine, Normetanephrine, Specimen Handling, acidification, chemistry.chemical_compound, sample storage, metanephrines, Internal medicine, medicine, Animals, Full Scientific Reports, Metanephrine, metanephrine, Hematologic Tests, General Veterinary, Metanephrines, Pathobiology, Endocrinology, chemistry, catecholamine, Catecholamine, medicine.drug
Abstract: Catecholamine release increases in dogs with pheochromocytomas and in situations of stress. Although plasma catecholamines degrade rapidly, their metabolites, normetanephrine (NME) and metanephrine (ME), are stable in acidified urine. Our aim was to verify a human urine ELISA kit for the quantification of NME and ME in canine urine and to determine the effects on metabolite stability of sampling time (morning or midday) and day (ordinary or day spent in a clinic). We analyzed 179 urine samples from 17 healthy dogs. For NME, the mean intra-assay CV was 6.0% for all samples and 4.3% for the canine control; inter-assay CVs were 3.3, 3.8, and 12% for high and low concentration human urine positive controls supplied in the ELISA kit and a positive canine control, respectively; spike-recovery was 90–101%. For ME, mean intra-assay CV was 6.5% for samples and 9.0% for the canine control; inter-assay CVs were 12.7, 7.2, and 22.5% for high and low concentration human urine positive controls supplied in the ELISA kit and a positive canine control, respectively; spike-recovery was 85–89%. Dilution recovery was unsatisfactory for both metabolites. Based on our verification results, NME was selected for remaining analyses. We found no effect on NME concentrations of acidification or room temperature storage for up to 24 h. The NME:creatinine ratio was higher after the first of 3 clinic days compared to the same morning (111.2 ± 5.5 vs. 82.9 ± 5.3; p
Published: 2021

19. Safety, Tolerability, and Pharmacokinetics of Mevidalen (LY3154207), a Centrally Acting Dopamine D1 Receptor–Positive Allosteric Modulator, in Patients With Parkinson Disease

Author: Paul A. Ardayfio, Max Tsai, Kevin Biglan, Melissa Pugh, Kjell A. Svensson, Darren Wilbraham, and William Kielbasa
Subjects: medicine.medical_specialty, business.industry, Receptors, Dopamine D1, Pharmaceutical Science, Parkinson Disease, Isoquinolines, Placebo, medicine.disease, Gastroenterology, Neuroprotective Agents, Dopamine receptor D1, Pharmacokinetics, Tolerability, Dopamine, Internal medicine, Cohort, medicine, Humans, Dementia, Pharmacology (medical), Adverse effect, business, medicine.drug
Abstract: Mevidalen (LY3154207) is a positive allosteric modulator of the dopamine D1 receptor that enhances the affinity of dopamine for the D1 receptor. The safety, tolerability, motor effects, and pharmacokinetics of mevidalen were studied in patients with Parkinson disease. Mevidalen or placebo was given once daily for 14 days to 2 cohorts of patients (cohort 1, 75 mg; cohort 2, titration from 15 to 75 mg). For both cohorts, the median time to maximum concentration for mevidalen plasma concentration was about 2 hours, the apparent steady-state clearance was 20-25 L/h, and mevidalen plasma concentrations were similar between the 1st and 14th administration in cohort 1, indicating minimal accumulation upon repeated dosing. Mevidalen was well tolerated, and most treatment-emergent adverse events were mild. Blood pressure and pulse rate increased when taking mevidalen, but there was considerable overlap with patients taking placebo, and vital signs normalized with repeated dosing. In the Movement Disorder Society-United Parkinson's Disease Rating Scale, all patients taking mevidalen showed a better motor examination sub-score on day 6 compared to only some patients in the placebo group. These data support examining mevidalen for symptomatic treatment of patients with Parkinson disease and Lewy body dementia.
Published: 2021

20. Induction of labour at 41 weeks of gestation versus expectant management and induction of labour at 42 weeks of gestation: A cost‐effectiveness analysis

Author: Mårten Alkmark, Verena Sengpiel, U-B Wennerholm, M Svensson, Henrik Hagberg, Lars Ladfors, Ylva Carlsson, Helena Fadl, Jan Wesström, Helen Elden, Christina Bergh, Maria Jonsson, and Sissel Saltvedt
Subjects: medicine.medical_specialty, induction of labour, Cost effectiveness, Total cost, Cost-Benefit Analysis, Population, Superiority Trial, Pregnancy, Humans, Medicine, Labor, Induced, Watchful Waiting, education, health care economics and organizations, education.field_of_study, Labor, Obstetric, Cesarean Section, business.industry, Obstetrics, Absolute risk reduction, Obstetrics and Gynecology, Public Health, Global Health, Social Medicine and Epidemiology, Cost-effectiveness analysis, Confidence interval, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, prolonged pregnancy, Gestation, Female, Cost-effectiveness, business
Abstract: Objective To assess the cost-effectiveness of induction of labour (IOL) at 41 weeks of gestation compared with expectant management until 42 weeks of gestation. Design A cost-effectiveness analysis alongside the Swedish Post-term Induction Study (SWEPIS), a multicentre, randomised controlled superiority trial. Setting Fourteen Swedish hospitals during 2016-2018. Population Women with an uncomplicated singleton pregnancy with a fetus in cephalic position were randomised at 41 weeks of gestation to IOL or to expectant management and induction at 42 weeks of gestation. Methods Health benefits were measured in life years and quality-adjusted life years (QALYs) for mother and child. Total cost per birth was calculated, including healthcare costs from randomisation to discharge after delivery, for mother and child. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in mean cost between the trial arms by the difference in life years and QALYs, respectively. Sampling uncertainty was evaluated using non-parametric bootstrapping. Main outcome measures The cost per gained life year and per gained QALY. Results The differences in life years and QALYs gained were driven by the difference in perinatal mortality alone. The absolute risk reduction in mortality was 0.004 (from 6/1373 to 0/1373). Based on Swedish life tables, this gives a mean gain in discounted life years and QALYs of 0.14 and 0.12 per birth, respectively. The mean cost per birth was euro4108 in the IOL group (n = 1373) and euro4037 in the expectant management group (n = 1373), with a mean difference of euro71 (95% CI -euro232 to euro379). The ICER for IOL compared with expectant management was euro545 per life year gained and euro623 per QALY gained. Confidence intervals were relatively wide and included the possibility that IOL had both lower costs and better health outcomes. Conclusions Induction of labour at 41 weeks of gestation results in a better health outcome and no significant difference in costs. IOL is cost-effective compared with expectant management until 42 weeks of gestation using standard threshold values for acceptable cost per life year/QALY. Tweetable abstract Induction of labour at 41 weeks of gestation is cost-effective compared with expectant management until 42 weeks of gestation.
Published: 2021

21. Success rate of external cephalic version in relation to the woman’s body mass index and other factors—a population‐based cohort study

Author: Sofia Nevander, Marie Nelson, Emelie Svensson, Marie Blomberg, and Daniel Axelsson
Subjects: Adult, medicine.medical_specialty, medicine.medical_treatment, Population, Gestational Age, Reproduktionsmedicin och gynekologi, Logistic regression, Body Mass Index, Cohort Studies, Young Adult, Pregnancy, Obstetrics, Gynecology and Reproductive Medicine, Humans, Medicine, Breech Presentation, Version, Fetal, education, Retrospective Studies, education.field_of_study, Cesarean Section, business.industry, Obstetrics, Confounding, Obstetrics and Gynecology, Gestational age, General Medicine, Odds ratio, medicine.disease, Obesity, Parity, body mass index, breech presentation, external cephalic version, obesity, population-based, External cephalic version, Female, business, Body mass index
Abstract: Introduction The aim of this study was to evaluate the impact of womens body mass index (BMI) on the probability of a successful external cephalic version (ECV). Material and methods A retrospective population-based observational study including all women that underwent an ECV in the southeast region of Sweden from January 2014 to December 2019. Data were collected from electronic medical records, Obstetrix, Cerner. The women were divided into BMI categories according to the World Health Organization classification. Women with a BMI below 25 kg/m(2) formed the reference group. Crude and adjusted odds ratios for unsuccessful ECV in each BMI group were calculated using binary logistic regression. Furthermore, the association between maternal characteristics and clinical and ultrasound variables at the time of the ECV and unsuccessful ECV was evaluated. Results A total of 2331 women were included. The overall success rate of ECV was 53.4%. Women with a BMI below 25 kg/m(2) had a success rate of 51.3% whereas obese women had a success rate of 58.6%. The risk of an unsuccessful ECV among obese women (BMI >= 30 kg/m(2)) had an OR of 0.74 (95% CI 0.59-0.94) compared with women with a BMI below 25 kg/m(2). After adjusting for suitable confounding factors, the association was no longer significant. Higher maternal age, multiparity, higher gestational age, posterior placenta position, polyhydramnios and higher estimated weight of the fetus at the ECV significantly decreased the risk of an unsuccessful ECV. Conclusions Maternal obesity does not seem to negatively influence the success rate of ECV. This is a finding that may encourage both caregivers and obese pregnant women to consider an ECV and so avoid a planned cesarean section for breech presentation in this group. Funding Agencies|Medical Research Council of Southeast Sweden (FORSS) [FORSS 909171]; ALF grants, Region Ostergotland
Published: 2021

22. Editor's Choice – Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial

Author: Anders Gottsäter, Hans Lindgren, Mikael Svensson, Mårten Falkenberg, Henrik Djerf, and Joakim Nordanstig
Subjects: Male, medicine.medical_specialty, Time Factors, Cost effectiveness, Cost-Benefit Analysis, medicine.medical_treatment, Peripheral Arterial Disease, Internal medicine, Humans, Medicine, health care economics and organizations, Aged, Sweden, Medical treatment, business.industry, Superficial femoral artery, Endovascular Procedures, Stent, Health Care Costs, Intermittent Claudication, Intermittent claudication, Implicit cost, Quality-adjusted life year, Femoral Artery, Treatment Outcome, Female, Stents, Surgery, Quality-Adjusted Life Years, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Incremental cost-effectiveness ratio
Abstract: Invasive treatment of intermittent claudication (IC) is commonly performed, despite limited evidence of its cost effectiveness. IC symptoms are mainly caused by atherosclerotic lesions in the superficial femoral artery (SFA), and endovascular treatment is performed frequently. The aim of this study was to investigate its cost effectiveness vs. non-invasive treatment.One hundred patients with IC due to lesions in the SFA were randomised to treatment with primary stenting, best medical treatment (BMT) and exercise advice (stent group), or to BMT and exercise advice alone (control group). Patients were recruited at seven hospitals in Sweden. For this analysis of cost effectiveness after 24 months, 84 patients with data on quality adjusted life years (QALY; based on the EuroQol Five Dimensions EQ-5D 3L™ questionnaire) were analysed. Patient registry and imputed cost data were used for accumulated costs regarding hospitalisation and outpatient visits.The mean cost per patient was €11 060 in the stent group and €4 787 in the control group, resulting in a difference of €6 273 per patient between the groups. The difference in mean QALYs between the groups was 0.26, in favour of the stent group, which resulted in an incremental cost effectiveness ratio (ICER) of € 23 785 per QALY.The costs associated with primary stenting in the SFA for the treatment of IC were higher than for exercise advice and BMT alone. With concurrent improvement in health related quality of life, primary stenting was a cost effective treatment option according to the Swedish national guidelines (ICER€50 000 - €70 000) and approaching the UK's National Institute for Health and Care Excellence threshold for willingness to pay (ICER£20 000 - £30 000). From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.
Published: 2021

23. Association between recorded medication reviews in primary care and adequate drug treatment management – a cross-sectional study

Author: Susanna M. Wallerstedt, Naldy Parodi López, and Staffan Svensson
Subjects: Male, Drug, medicine.medical_specialty, pharmacoepidemiology, Cross-sectional study, media_common.quotation_subject, prescription drugs, cross-sectional studies, Type 2 diabetes, Internal medicine, Humans, Medicine, medication review, Depression (differential diagnoses), media_common, business.industry, Procedure code, Public Health, Environmental and Occupational Health, inappropriate prescribing, Original Articles, Odds ratio, Pharmacoepidemiology, medicine.disease, Confidence interval, primary health care, aged, Diabetes Mellitus, Type 2, Pharmaceutical Preparations, Female, Public aspects of medicine, RA1-1270, business, Research Article
Abstract: To investigate the association between a recorded procedure code for a medication review and adequate drug treatment management, and to explore factors associated with this code. Cross-sectional study; two primary health care centres, in Region Västra Götaland, Sweden. A total of 302 consecutive patients (≥65 years old, 59% female; median number of drugs: six) requiring a non-urgent consultation with a physician in October–November 2017. Adequate drug treatment management (treatment that did not require any further action), determined in consensus by two specialists in family medicine blinded to the medication review code. Adequate drug treatment management was, overall, less common in those with a recorded medication review over the last year: 63% versus 73% (p = 0.047). This negative association was evident among patients aged 65–74 years: 49% versus 74% (p = 0.003), but absent in those ≥75 years old: 67% versus 70% (p = 0.77). Recommendations from consensus included the search for additional information to be able to make a decision regarding initiation or withdrawal of a drug (n = 53), withdrawal of a drug (n = 41), or ordering a laboratory test (n = 25). Factors associated with a recorded procedure code included age above the remuneration limit of 75 years (odds ratio: 9.8; 95% confidence interval 5.0–19), type 2 diabetes (3.0 (1.5–6.2)), hypertension (2.4 (1.2–4.8)), and depression (2.5 (1.02–6.0)). The presence of a recorded medication review was not positively associated with adequate drug treatment management but was associated with the age limit for remuneration, and some chronic diseases.Key pointsTo improve drug treatment in older people in primary care, a remuneration system linked to recorded medication reviews has been introduced.In this study, fewer patients with than without a recorded medication review (63% versus 73%) had adequate drug treatment management.A recorded medication review was ten times more common in those ≥75 years, that is, the age limit for remuneration.Recorded codes for medication reviews were also common in those with type 2 diabetes, hypertension, and depression. To improve drug treatment in older people in primary care, a remuneration system linked to recorded medication reviews has been introduced. In this study, fewer patients with than without a recorded medication review (63% versus 73%) had adequate drug treatment management. A recorded medication review was ten times more common in those ≥75 years, that is, the age limit for remuneration. Recorded codes for medication reviews were also common in those with type 2 diabetes, hypertension, and depression.
Published: 2021

24. Cost-Effectiveness of the FreeStyle Libre® System Versus Blood Glucose Self-Monitoring in Individuals with Type 2 Diabetes on Insulin Treatment in Sweden

Author: Mark Lamotte, Fleur Levrat-Guillen, Ann-Marie Svensson, Katarina Eeg-Olofsson, Johan Jendle, and Stefan Franzén
Subjects: medicine.medical_specialty, endocrine system diseases, business.industry, Cost effectiveness, Continuous glucose monitoring, Endocrinology, Diabetes and Metabolism, Insulin, medicine.medical_treatment, Core diabetes model, nutritional and metabolic diseases, FreeStyle Libre flash continuous glucose monitoring system, Type 2 diabetes, medicine.disease, Diabetes model, Diabetes mellitus, Blood Glucose Self-Monitoring, Internal medicine, Internal Medicine, medicine, Interstitial glucose, Cost-effectiveness, business, Original Research
Abstract: Introduction Frequent glucose monitoring is essential to obtain glucose control. This is done by periodic self-monitoring of blood glucose (SMBG) using finger-prick testing, or by using continuous glucose monitoring devices, wherein a sensor records interstitial glucose data automatically. This study assessed the cost-effectiveness of using the FreeStyle Libre Flash Continuous Glucose Monitoring System (FSL) compared to SMBG in individuals with type 2 diabetes (T2D) treated with insulin from a Swedish societal perspective. Methods Cost-effectiveness analysis was conducted using the IQVIA Core Diabetes model v9.5, with demographic and clinical inputs from a real-world study using Swedish National Diabetes Register data. Two cohorts of individuals with T2D were considered based on baseline HbA1C (HbA1c: 8–9% [64–75 mmol/mol]; HbA1c: 9–12% [75–108 mmol/mol]). HbA1c reductions with FSL were − 0.41% (− 4 mmol/mol; SD: 0.94%-10 mmol/mol) and − 1.30% (− 14 mmol/mol; SD: 1.40%-15 mmol/mol) for the two cohorts, respectively. Utilities, treatment costs and diabetes-related complication costs were obtained from published sources. Analyses were conducted over a lifetime horizon, applying annual discounting of 3% on costs and effects. Scenario analyses and probabilistic sensitivity analyses were performed. Results Individuals with T2D who had a baseline HbA1c of 8–9% (64–75 mmol/mol) and 9–12% (75–108 mmol/mol) and used FSL gained 0.50 and 0.57 quality-adjusted life-years (QALYs), respectively, at an incremental cost of SEK109,957 and SEK82,170 compared to SMBG, generating an incremental cost-utility ratio of SEK219,127 and SEK144,412 per QALY gained. Assuming a willingness-to-pay threshold of SEK300,000 per QALY gained, FSL use was considered cost-effective compared to SMBG for the majority of the individuals in both the lower and higher HbA1c cohorts. The key driver identified was the additional quality-of-life benefit that applied to FSL use. Conclusion The FreeStyle Libre Flash Continuous Glucose Monitoring System is a cost-effective glucose monitoring alternative to SMBG for individuals with T2D in Sweden who are treated with insulin but are not reaching their glycaemic goals. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-021-01172-1.
Published: 2021

25. Tyrosine kinase type A–specific signalling pathways are critical for mechanical allodynia development and bone alterations in a mouse model of rheumatoid arthritis

Author: Elisabeth Miot-Noirault, Célia Barrachina, Ludivine Boudieu, Camilla I. Svensson, Fabien Marchand, Aziz Moqrich, Emeric Dubois, Lauriane Delay, Philippe Auzeloux, Julie Barbier, Youssef Aissouni, Arnaud Briat, Denis Ardid, and Alexandra Jurczak
Subjects: medicine.medical_specialty, Arthritis, Osteoarthritis, Tropomyosin receptor kinase A, Bone resorption, Arthritis, Rheumatoid, Mice, 03 medical and health sciences, 0302 clinical medicine, Dorsal root ganglion, 030202 anesthesiology, Osteoclast, Ganglia, Spinal, Internal medicine, Nerve Growth Factor, medicine, Animals, Receptor, trkA, business.industry, Protein-Tyrosine Kinases, medicine.disease, Disease Models, Animal, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Endocrinology, Nerve growth factor, nervous system, Neurology, Hyperalgesia, Rheumatoid arthritis, Neurology (clinical), business, 030217 neurology & neurosurgery, Signal Transduction
Abstract: Rheumatoid arthritis is frequently associated with chronic pain that still remains difficult to treat. Targeting nerve growth factor (NGF) seems very effective to reduce pain in at least osteoarthritis and chronic low back pain but leads to some potential adverse events. Our aim was to better understand the involvement of the intracellular signalling pathways activated by NGF through its specific tyrosine kinase type A (TrkA) receptor in the pathophysiology of rheumatoid arthritis using the complete Freund adjuvant model in our knock-in TrkA/C mice. Our multimodal study demonstrated that knock-in TrkA/C mice exhibited a specific decrease of mechanical allodynia, weight-bearing deficit, peptidergic (CGRP+) and sympathetic (TH+) peripheral nerve sprouting in the joints, a reduction in osteoclast activity and bone resorption markers, and a decrease of CD68-positive cells in the joint with no apparent changes in joint inflammation compared with wild-type mice after arthritis. Finally, transcriptomic analysis shows several differences in dorsal root ganglion mRNA expression of putative mechanotransducers, such as acid-sensing ionic channel 3 and TWIK-related arachidonic acid activated K+ channel, as well as intracellular pathways, such as c-Jun, in the joint or dorsal root ganglia. These results suggest that TrkA-specific intracellular signalling pathways are specifically involved in mechanical hypersensitivity and bone alterations after arthritis using TrkA/C mice.
Published: 2021

26. Clinical outcomes in cancer patients with COVID-19 in Sweden

Author: Johanna Svensson, Lisa Bondeson, Lars Ny, Max Levin, Magnus Lindh, Anna Thulin, and Zhiyuan Zhao
Subjects: Male, medicine.medical_specialty, Population, Disease, Logistic regression, Neoplasms, Internal medicine, Case fatality rate, medicine, Humans, Radiology, Nuclear Medicine and imaging, education, Aged, Retrospective Studies, Sweden, education.field_of_study, SARS-CoV-2, business.industry, Incidence (epidemiology), Medical record, COVID-19, Cancer, Retrospective cohort study, Hematology, General Medicine, medicine.disease, Oncology, business
Abstract: BACKGROUND: The results of studies on the relationship between cancer and COVID-19 have been conflicting and therefore further studies are needed. We aimed to examine the incidence of COVID-19 among patients at one of the largest oncology departments in Sweden, and to evaluate and identify risk factors for poor outcomes, hospital care and death, associated with COVID-19 among cancer patients. MATERIAL AND METHODS: This retrospective study included cancer patients at a single center who tested positive for SARS-CoV-2 by PCR either in hospital, primary health care center or commercial laboratory between 1 March and 14 August 2020. Clinical and demographic data were collected from the medical records. Logistic regression analysis was used to identify variables that associated the primary outcomes of need for hospital care and death within 30 days of positive test. RESULTS: Of 10,774 patients from the Department of Oncology at Sahlgrenska University Hospital, 135 tested positive for SARS-CoV-2 (1.3%). Twenty-eight patients were excluded from further the data collection since they did not meet the inclusion criteria. Altogether, 107 cancer patients were included and the case fatality rate (CFR) was 12% (13) within 30 days of confirmed SARS-CoV-2 infection by PCR. Increasing years of age (OR 1.10; CI 95% 1.03-1.18), palliative treatment intent (OR 15.7; CI 95% 1.8-135.8), and transition to end-of-life care (OR 52.0; CI 95% 3.7-735.6) were associated with increased odds of death within 30 days. Male sex was associated with needing hospital care (OR 3.7; CI 95% 1.50-9.1). CONCLUSION: As in the general population, male sex was found to be at greater risk of needing hospital care for COVID-19, with terminal cancer disease, and older age increasing the odds of fatality. Compared to the general population, slightly more cancer patients had COVID-19. The CFR was within the lower range of others reported in cancer patients.
Published: 2021

27. Racial Differences and In-Hospital Outcomes Among Hospitalized Patients with COVID-19

Author: Aditya Sahai, Mina K. Chung, Lee Kirksey, Penelope Rampersad, Scott J. Cameron, Chete Eze-Nliam, Pulkit Chaudhury, Ankur Kalra, Neil Mehta, Islam Y. Elgendy, John R. Bartholomew, Rohan Bhandari, Douglas Joseph, Lars G. Svensson, Geoffrey Ouma, and Ayman Elbadawi
Subjects: medicine.medical_specialty, Race, Health (social science), Sociology and Political Science, Coronavirus disease 2019 (COVID-19), Hospitalized patients, medicine.medical_treatment, Outcomes, Article, law.invention, law, Internal medicine, Epidemiology, medicine, Humans, Retrospective Studies, SARS-CoV-2, business.industry, Health Policy, Public Health, Environmental and Occupational Health, COVID-19, Odds ratio, Intensive care unit, Hospitals, United States, Confidence interval, Race Factors, Anthropology, Racial differences, Hemodialysis, business
Abstract: Objective There is a paucity of data on how race affects the clinical presentation and short-term outcome among hospitalized patients with SARS-CoV-2, the 2019 coronavirus (COVID-19). Methods Hospitalized patients ≥ 18 years, testing positive for COVID-19 from March 13, 2020 to May 13, 2020 in a United States (U.S.) integrated healthcare system with multiple facilities in two states were evaluated. We documented racial differences in clinical presentation, disposition, and in-hospital outcomes for hospitalized patients with COIVD-19. Multivariable regression analysis was utilized to evaluate independent predictors of outcomes by race. Results During the study period, 3678 patients tested positive for COVID-19, among which 866 were hospitalized (55.4% self-identified as Caucasian, 29.5% as Black, 3.3% as Hispanics, and 4.7% as other racial groups). Hospitalization rates were highest for Black patients (36.6%), followed by other (28.3%), Caucasian patients (24.4%), then Hispanic patients (10.7%) (p
Published: 2021

28. Risk factors and incidence over time for lower extremity amputations in people with type 1 diabetes: an observational cohort study of 46,088 patients from the Swedish National Diabetes Registry

Author: Sara Hallström, Arndís F. Ólafsdóttir, Magnus Löndahl, Marcus Lind, Aldina Pivodic, Hans Wedel, and Ann-Marie Svensson
Subjects: Adult, Male, medicine.medical_specialty, HbA1c, Epidemiology, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Lower-extremity amputation, Amputation, Surgical, Article, Cohort Studies, Quality of life, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, Registries, Amputation, Sweden, Type 1 diabetes, business.industry, Proportional hazards model, Incidence, Incidence (epidemiology), Cardiovascular disease, medicine.disease, Diabetic Foot, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Lower Extremity, Risk factors, Quality of Life, business, Cohort study
Abstract: Aims/hypothesis The aim of this work was to study the incidence over time of lower extremity amputations and determine variables associated with increased risk of amputations in people with type 1 diabetes. Methods Individuals with type 1 diabetes registered in the Swedish National Diabetes Registry with no previous amputation from 1 January 1998 and followed to 2 October 2019 were included. Time-updated Cox regression and gradient of risk per SD were used to evaluate the impact of risk factors on the incidence of amputation. Age- and sex-adjusted incidences were estimated over time. Results Of 46,088 people with type 1 diabetes with no previous amputation (mean age 32.5 years [SD 14.5], 25,354 [55%] male sex), 1519 (3.3%) underwent amputation. Median follow-up was 12.4 years. The standardised incidence for any amputation in 1998–2001 was 2.84 (95% CI 2.32, 3.36) per 1000 person-years and decreased to 1.64 (95% CI 1.38, 1.90) per 1000 person-years in 2017–2019. The incidence for minor and major amputations showed a similar pattern. Hyperglycaemia and renal dysfunction were the strongest risk factors for amputation, followed by older age, male sex, cardiovascular comorbidities, smoking and hypertension. Glycaemic control and age- and sex-adjusted renal function improved during the corresponding time period as amputations decreased. Conclusions/interpretation The incidence of amputation and of the most prominent risk factors for amputation, including renal dysfunction and hyperglycaemia, has improved considerably during recent years for people with type 1 diabetes. This finding has important implications for quality of life, health economics and prognosis regarding CVD, indicating a trend shift in the treatment of type 1 diabetes. Graphical abstract
Published: 2021

29. Pain in rheumatoid arthritis: a seven-year follow-up study of pain distribution and factors associated with transition from and to chronic widespread pain

Author: M. Andersson, Björn Svensson, and Stefan Bergman
Subjects: medicine.medical_specialty, business.industry, Chronic Widespread Pain, Immunology, Follow up studies, MEDLINE, General Medicine, medicine.disease, Arthritis, Rheumatoid, Rheumatology, Surveys and Questionnaires, Internal medicine, Rheumatoid arthritis, Quality of Life, medicine, Humans, Immunology and Allergy, Distribution (pharmacology), Female, In patient, Chronic Pain, business, human activities, Follow-Up Studies
Abstract: To study transitions from and to chronic widespread pain (CWP) over 7 years in patients with rheumatoid arthritis (RA).Two postal questionnaires were sent to patients included in the BARFOT (Better Anti-Rheumatic Pharmacotherapy) study, the first in 2010 and the second in 2017. The questionnaires assessed pain, number of tender and swollen joints, functional disability, health-related quality of life (HRQoL), pharmacological treatment, lifestyle factors, and patient-reported body mass index (BMI). The responders to both questionnaires were divided into three groups according to the reported pain duration and distribution: patients having no chronic pain (NCP), chronic regional pain (CRP), and CWP.In all, 953 patients answered the questionnaires at both time-points. One-third (324) of the patients reported CWP in 2010, and 140 (43%) of the patients had transition to NCP or CRP in 2017. In multivariate logistic regression models, adjusting for age, gender, and disease duration, transition from CWP was associated with normal BMI, fewer tender joints, less pain, less fatigue, fewer pain regions, less disability, better HRQoL, and biologic treatment. In 2010, 628 patients reported NCP or CRP, whereas 114 of them reported CWP in 2017. Transition to CWP was associated with female gender, obesity, more tender and swollen joints, higher pain-related variables, worse disability, and worse HRQoL.There are modifiable factors associated with transitions from and to CWP that could be identified. Paying attention to these factors could improve pain treatment in the management of RA.
Published: 2021

30. A systematic review and meta-analysis of risks and benefits with breast reduction in the public healthcare system: priorities for further research

Author: Ann Liljegren, Fredrik Wärnberg, Lennart Jivegård, Maud Eriksson, Christian Jepsen, Håkan Hallberg, Emma Hansson, Emmelie Widmark-Jensen, Mikael Svensson, Max Petzold, and Susanne Bernhardsson
Subjects: Plastic surgery, medicine.medical_specialty, Evidence-based medicine, RD1-811, Mammaplasty, medicine.medical_treatment, Prioritizing, MEDLINE, Breast hypertrophy, PsycINFO, Anxiety, Cochrane Library, Risk Assessment, Quality of life, medicine, Humans, business.industry, Research, General Medicine, Surgery, Breast reduction, Reduction mammaplasty, Meta-analysis, Family medicine, Sick leave, Quality of Life, Female, business, Delivery of Health Care
Abstract: Background There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction. Methods A systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible. Results Fifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%. Conclusion There is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified. Pre-registration The study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden.
Published: 2021

31. Exploring termination setback in a psychodynamic therapy for panic disorder

Author: Rolf Sandell, Thomas Nilsson, Sean Perrin, Martin Svensson, Fredrik Falkenström, and Håkan Johansson
Subjects: Adult, Pediatrics, medicine.medical_specialty, medicine.medical_treatment, law.invention, Randomized controlled trial, law, medicine, Humans, Agoraphobia, Applied Psychology, Control treatment, Psychodynamic psychotherapy, Cognitive Behavioral Therapy, Latent growth modeling, Panic disorder, Panic, Tillämpad psykologi, medicine.disease, Cognitive behavioral therapy, Psychiatry and Mental health, Clinical Psychology, Treatment Outcome, Panic Disorder, Female, Self Report, medicine.symptom, Psychotherapy, Psychodynamic, Psychology
Abstract: Termination in psychodynamic therapy (PDT) is a potentially conflictual and turbulent phase for patients, with a risk for increases in symptoms. However, few studies of PDT have assessed symptoms frequently enough during the treatment to determine whether such setbacks are in fact common in PDT.In a doubly randomized clinical preference trial, 217 adults, female = 163; M age = 34.8 (12.6), with panic disorder with or without agoraphobia were treated with panic-focused psychodynamic psychotherapy (PFPP) or panic control treatment (PCT), a form of cognitive behavioral therapy. Participants completed the Panic Disorder Severity Scale Self-Report (PDSS-SR) weekly during treatment (Weeks 1-12), and 6, 12, and 24 months after treatment. Using piecewise latent growth curve modeling, we tested the trajectories of change focusing on the termination phase in PFPP.Week-to-week improvement on the PDSS-SR stopped (a termination setback [TS]) in PFPP during Weeks 10-12, whereas PCT participants continued to improve. Larger symptom reductions up to Week 10 in PFPP predicted a more severe TS. Less avoidant attachment and less severe interpersonal problems also predicted more severe TS. The TSs tended to last, as evidenced by inferior outcomes, up to the 12-month follow-up.This study provides evidence of a TS in PDT. Resurgence of symptoms as termination approached was more common in PFPP than in PCT. Studies involving weekly assessment of primary and comorbid symptoms, as well as qualitative analyses of the patient experiences of the therapeutic process during termination, in different forms of PDT, are warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Published: 2021

32. Genotype-phenotype correlation in arrhythmogenic right ventricular cardiomyopathy-risk of arrhythmias and heart failure

Author: Kristina H. Haugaa, Pyotr G. Platonov, Jesper Hastrup Svendsen, Alex Hørby Christensen, Henrik Jensen, Anneli Svensson, Tanja Charlotte Frederiksen, Henning Bundgaard, Trine Madsen, Monica Chivulescu, Tiina Heliö, Øyvind H. Lie, and Pia Dahlberg
Subjects: Male, medicine.medical_specialty, IMPACT, Cardiomyopathy, 030204 cardiovascular system & hematology, Right ventricular cardiomyopathy, Ventricular Function, Left, Correlation, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Genotype, Genetics, Medicine, Arrhythmogenic Right Ventricular Dysplasia/complications, Humans, Arrhythmias, Cardiac/genetics, genetics, cardiovascular diseases, Genetics (clinical), Arrhythmogenic Right Ventricular Dysplasia, Genetic Association Studies, Heart Failure, SPECTRUM, 0303 health sciences, DSC2, Ejection fraction, Plakophilins/genetics, MUTATIONS, business.industry, 030305 genetics & heredity, Stroke Volume/genetics, COMPOUND, Arrhythmias, Cardiac, Stroke Volume, Desmosomes, medicine.disease, Heart failure, Cohort, Cardiology, cardiovascular system, Female, business, Plakophilins, cardiomyopathy
Abstract: BackgroundArrhythmogenic right ventricular cardiomyopathy (ARVC) is predominantly caused by desmosomal genetic variants, and clinical hallmarks include arrhythmias and systolic dysfunction. We aimed at studying the impact of the implicated gene(s) on the disease course.MethodsThe Nordic ARVC Registry holds data on a multinational cohort of ARVC families. The effects of genotype on electrocardiographic features, imaging findings and clinical events were analysed.ResultsWe evaluated 419 patients (55% men), with a mean follow-up of 11.2±7.4 years. A pathogenic desmosomal variant was identified in 62% of the 230 families: PKP2 in 41%, DSG2 in 13%, DSP in 7% and DSC2 in 3%. Reduced left ventricular ejection fraction (LVEF) ≤45% on cardiac MRI was more frequent among patients with DSC2/DSG2/DSP than PKP2 ARVC (27% vs 4%, pPKP2 than DSC2/DSG2/DSP carriers: HR 0.25 (0.10–0.68, pDSC2/DSG2/DSP carriers. Male sex was a risk factor for both arrhythmias and reduced LVEF across all genotype groups (pConclusionIn this large cohort of ARVC families with long-term follow-up, we found PKP2 genotype to be more arrhythmic than DSC2/DSG2/DSP or gene-negative carrier status, whereas reduced LVEF was mostly seen among DSC2/DSG2/DSP carriers. Male sex was associated with a more severe phenotype.
Published: 2022

33. Stroke prevention in patients from Latin American countries with non‐valvular atrial fibrillation: Insights from the GARFIELD‐AF registry

Author: Jerjes-Sanchez C., Corbalan R., Barretto A. C. P., Luciardi H. L., Allu J., Illingworth L., Pieper K. S., Kayani G., Fitzmaurice D. A., Goto S., Hacke W., Mantovani L. G., Turpie A. G. G., Gersh B. J., Gibbs H., Brodmann M., Cools F., Connolly S. J., Spyropoulos A., Eikelboom J., Hu D., Jansky P., Nielsen J. D., Ragy H., Raatikainen P., Le Heuzey J. -Y., Darius H., Keltai M., Kakkar S., Sawhney J. P. S., Agnelli G., Ambrosio G., Koretsune Y., Diaz C. J. S., ten Cate H., Atar D., Stepinska J., Panchenko E., Lim T. W., Jacobson B., Oh S., Vinolas X., Rosenqvist M., Steffel J., Angchaisuksiri P., Parkhomenko A., Al Mahmeed W., Chen K. N., Zhao Y. S., Zhang H. Q., Chen J. Z., Cao S. P., Wang D. W., Yang Y. J., Li W. H., Yin Y. H., Tao G. Z., Yang P., Chen Y. M., He S. H., Wang Y., Fu G. S., Li X., Wu T. G., Cheng X. S., Yan X. W., Zhao R. P., Chen M. S., Xiong L. G., Chen P., Jiao Y., Guo Y., Xue L., Wang F. Z., Li H., Yang Z. M., Bai C. L., Chen J., Chen J. Y., Chen X., Feng S., Fu Q. H., Gao X. J., Guo W. N., He R. H., He X. A., Hu X. S., Huang X. F., Li B., Li J., Li L., Li Y. H., Liu T. T., Liu W. L., Liu Y. Y., Lu Z. C., Luo X. L., Ma T. Y., Peng J. Q., Sheng X., Shi X. J., Sun Y. H., Tian G., Wang K., Wang L., Wu R. N., Xie Q., Xu R. Y., Yang J. S., Yang L. L., Yang Q., Ye Y., Yu H. Y., Yu J. H., Yu T., Zhai H., Zhan Q., Zhang G. S., Zhang Q., Zhang R., Zhang Y., Zheng W. Y., Zhou B., Zhou Z. H., Zhu X. Y., Jadhav P., Durgaprasad R., Ravi Shankar A. G., Rajput R. K., Bhargava K., Sarma R., Srinivas A., Roy D., Nagamalesh U. M., Chopda M., Kishore R., Kulkarni G., Chandwani P., Pothiwala R. A., Padinhare Purayil M., Shah S., Chawla K., Kothiwale V. A., Raghuraman B., Vijayaraghavan G., Vijan V. M., Bantwal G., Bisne V., Khan A., Gupta J. B., Kumar S., Jain D., Abraham S., Adak D., Barai A., Begum H., Bhattacharjee P., Dargude M., Davies D., Deshpande B., Dhakrao P., Dhyani V., Duhan S., Earath M., Ganatra A., Giradkar S., Jain V., Karthikeyan R., Kasala L., Kaur S., Krishnappa S., Lawande A., Lokesh B., Madarkar N., Meena R., More P., Naik D., Prashanth K., Rao M., Rao N. M., Sadhu N., Shah D., Sharma M., Shiva P., Singhal S., Suresh S., Vanajakshamma V., Panse S. 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H., Yoo K. M., Yoon E. J., Yun S. Y., Chawanadelert S., Mongkolwongroj P., Kanokphatcharakun K., Cheewatanakornkul S., Laksomya T., Pattanaprichakul S., Chantrarat T., Rungaramsin S., Silaruks S., Wongcharoen W., Siriwattana K., Likittanasombat K., Katekangplu P., Boonyapisit W., Cholsaringkarl D., Chatlaong B., Chattranukulchai P., Santanakorn Y., Hutayanon P., Khunrong P., Bunyapipat T., Jai-Aue S., Kaewsuwanna P., Bamungpong P., Gunaparn S., Hongsuppinyo S., Inphontan R., Khattaroek R., Khunkong K., Kitmapawanont U., Kongsin C., Naratreekoon B., Ninwaranon S., Phangyota J., Phrommintikul A., Phunpinyosak P., Pongmorakot K., Poomiphol S., Pornnimitthum N., Pumprueg S., Ratchasikaew S., Sanit K., Sawanyawisuth K., Silaruks B., Sirichai R., Sriwichian A., Suebjaksing W., Sukklad P., Suttana T., Tangsirira A., Thangpet O., Tiyanon W., Vorasettakarnkij Y., Wisaratapong T., Wongtheptien W., Wutthimanop A., Yawila S., Altun A., Ozdogru I., Ozdemir K., Yilmaz O., Aydinlar A., Yilmaz M. B., Yeter E., Ongen Z., Cayli M., Pekdemir H., Ozdemir M., Sucu M., Sayin T., Demir M., Yorgun H., Ersanli M., Okuyan E., Aras D., Abdelrahman H., Aktas O., Alpay D., Aras F., Bireciklioglu M. F., Budeyri S., Buyukpapuc M., Caliskan S., Esen M., Felekoglu M. A., Genc D., Ikitimur B., Karaayvaz E. B., Karatas S. K., Okutucu S., Ozcelik E., Quisi A., Sag H., Sahiner L., Sayin B. Y., Seker T., Alkan D. U., Yildirim E., Yildirim R., Yilmaz F., Yuksekdag V., Vensentini N., Ingaramo A. C., Sambadaro G. A., Caputi V. F., Berman S. G., Dragotto P., Kleiban A. J., Centurion N., Giacomi G., Guerrero R. A. A., Conde D., Zapata G., Di Paola L. A., Ramos J. L., Dran R. D., Egido J., Fernandez A. A., Fosco M. J., Sassone S., Sinisi V. A., Cartasegna L. R., Berli M. A., Vilamajo O. A. G., Ferroni F., Alaguibe E. D., D'Amelio A. A., Arabetti C., Arias L., Belardi J. A., Bergesio L., Berli F., Berli M., Borchowiec S., Buzzetti C., Cabrini R., Campisi V., Cappi A. L., Carrizo R., Berra F. 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K., Braga J. C. F., Negri A., Souto L., Moncada C., Precoma D. B., Roquette F., Reis G., Filho R. A. R., Figueiredo E. L., Botelho R. V., Tavares C. M. D. F., Frack C. R. C., Saad J. A., Finimundi H. C., Pisani C., Chemello D., Martins M. P., Franca C. C. B., Alban F., Rosito G. B. A., Moraes Junior J. B. M. X., Tumelero R. T., Maia L. N., de Almeida R. S., do Carmo Borges N. C., Ferreira L. G. G., Agliardi P., Gomes J. A. O., Araujo V., Nakazone M. A., Barbosa T., Barroso S., Falchetto E. B., Lopes H. B., Lemos M. A. B. T., Biazus G., Queiroz L. B., Camazzola F. E., Caporale M., Cardoso Boscato S., Chieza F., Chokr M. O., Mingireanov R. C., Goes N. C., Correa C., Costa M., Ortiz C. C., da Silva L. S., Paulitsch F. D. S., da Silveira J. A., Daros E., de Araujo G. R., Del Monaco M. I., Dias C., Dias M. A., Wainstein A. P. D., Pizzato P. E., Esteves D. C., Fabri P., Fonseca T. F. L., Fernandes E., Fonseca C., Costantini C. R. F., Ferraz R. F., Freire F., Gottardo P., Guanaes D., Guizzardi S., Magedanz E. H., Igansi F., Jannuzzi F., Junior G., Komar D., Lino E. G., Lopes D., Junior O. L. D. S., Lustosa E., Macagnan A. P., Marinho M. C., Mazzoni M., Melo G., Mortari L., Mouco O. M. C. C., Vital C. N., Ormundo C., Emmer S. O., Palmegiani E., Pavani R., Pereira L., Pereira V. L., Perreira R., Poletti S., Fortunato S. C. Q., Queirantes C., Pereira N. R., Rech R. L., Ribeiro S., Rodrigues A., Roesch H., Reichert T. R., Santos D., Santos I., Santos M., Seroqui M. V., Silva S., Soares L., Spolaor L., Stoll C., Duda N. T., Trama L., Unterkircher B., Valois M. V., Vargas T., Viana T., Vicente C., Armaganijan L. V., Homem R. V., Torres L. G. V., Vila L., Filho F. V. G., Eggers G., Gutierrez C. B., Arriagada G., Cardenas S. P., Fernandez B. A. J. S., Conejeros C., Houzvic C., Cuevas P. M., Montecinos H., Forero A., Lanas F., Gomez M. L., Vilches G. C., Rey C., Astudillo C., Aguilar J., Campisto Y., Lara C., Molina E., Oyarzon J. M., Olguin V., Vergara M., Villan C., Diaz J. I., Cantu R. L., Zavala M. G. R., Jardines R. C., Zavaleta N. E., Umana S. V., Rosas E. L., Esperon G. L., Pozas G., Munoz E. C., Hernandez N. M., Rendon A. L., Hernandez N. G., Ibarra M. L. R., Carrillo L. V., Villezca D. L., Herrera C. H., Prieto J. J. L., Rodriguez R. G., Espinosa E. V., Martinez D. F., Barcena J. V., Yong R., Briones I. R., Pons J. L. L., Lopez H. A., Ruiz R. O., de la Vega C. D., Brito C. C., Valenzuela E. C., Reyes-Sanchez R., Ruiz A. B., Flores O. N., Gonzalez M. B., Nava R. A., Cerda J. D. M., Fierro O. F., Campos P. F., Alfaro T. A. A., Bellorin S. A., Avena R., Chavarria M., Espinosa I., Silva F. F., Nava R. H. G., Godoy K., Felix E. J. G., Garcia C. L. G., Salas L. G. G., Guajardo P., Gonzalez S. H., Izquierdo T., Ortiz M. C. M., Vasquez D. M., Mendoza N., Morales J., Nikitina N., Aybar S. O., Ortiz A., Macias P. P., Perez F., Sanchez J. A. P., Toledano S. P., Gonzalez M. R., Ramos C. R., Castro V. 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Y., De Cleen D., De Coninck M., de Vos M., de Weerdt N., Delforge M., Delvigne M., Denie D., Derycker K., Deweerd E., Dormal F., Drieghe S., Everaert M., Eykerman T., Feys E., Ghekiere M., Gits F., Hellemans S., Helvasto L., Jacobs C., Lips S., Mestdagh I., Nimmegeers J., Piamonte V., Pollet P., Postolache A., Raepers M., Raymenants E., Richa J., Rombouts H., Salembier J., Scheurwegs C., Semeraro O., Simons N., Smessaert C., Smolders W., Stockman I., Tahon S., Thyssen V., Tincani G., Van Durme F., Van Lier D., Vandekerckhove H., Vandekerckhove Y., Vandenbroeck D., Vandorpe A., Vanhalst E., Vanhauwaert B., Vantomme C., Vergauwen L., Verloove H., Vydt T., Weyn T., Reichert P., Spacek R., Machova V., Zidkova E., Ludka O., Olsr J., Kotik L., Plocova K., Racz B., Ferkl R., Hubac J., Kotik I., Monhart Z., Burianova H., Jerabek O., Pisova J., Petrova I., Dedek V., Honkova M., Podrazil P., Spinar J., Vitovec J., Novak M., Lastuvka J., Durdil V., Antonova P., Bockova L., Bultas J., Chlumsky J., Dastychova L., Drasnar T., Honek J., Horejsi M., Hubacova V., Janska L., Kopeckova I., Kratochvilova R., Krcova E., Labrova R., Lindourkova A., Lipoldova J., Lubanda H., Ludkova A., Mahdalikova L., Majernikova M., Michalik D., Potuznik P., Prochazkova E., Sulc A., Sveceny J., Valtova M., Zidek M., Zika J., Nielsen H., Husted S., Hintze U., Rasmussen S., Bremmelgaard A., Markenvard J., Boerger J., Solgaard J., Simonsen P., Loekkegaard T., Bruun M., Mertz J., Dominguez H., Skagen K., Egstrup K., Ibsen H., Raymond I., Bang-Hansen T., Ellervik C., Eriksen E., Jensen L., Jensen M., Leth M., Nygaard A., Park J., Schou M., Therkelsen A., Tilma J., Vesterager K., Airaksinen J., Arola O., Koistinen J., Nappila H., Peltomaki K., Rasanen V., Vasankari T., Galinier M., Gottwalles Y., Paganelli F., Loiselet P., Muller J. -J., Koujan M. 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K., Kremis, E., Kruczyk, D., Krzesiak-Lodyga, A., Krzyzanowski, M., Kurdzielewicz, W., Kustrzycka-Kratochwil, D., Lesniewska-Krynska, D., Leszczynski, J., Lewicka, E., Lichota, E., Lip, K., Loboz-Rudnicka, M., Luka, J., Lysek-Jozefowicz, A., Machnikowska, M., Majewska, K., Mariankowski, R., Markiewicz, A., Mazur, M., Metzgier-Gumiela, A., Miedlar, E., Mielcarek, M., Neubauer-Geryk, J., Niedek, J., Niemirycz-Makurat, A., Nowak, A., Nowak, S., Opielowska-Nowak, B., Ozgowicz, M., Pawelska-Buczen, A., Pawlik-Rak, E., Piotrowicz, R., Ptaszynski, P., Raczynska, A., Rogowski, W., Romanek, J., Romaszkiewicz, R., Rostoff, P., Roszczyk, N., Rozewska-Furmanek, D., Rychta, J., Rzyczkowska, B., Sidor, A., Skalska, J., Smichura, M., Splawski, M., Staneta, P., Staniszewska, E., Starak-Marciniak, J., Stopyra-Poczatek, M., Sukiennik-Kujawa, M., Szafranski, J., Szalecki, P., Szczepanska, A., Szkrobka, W., Szuchnik, E., Szulowska, A., Szumczyk-Muszytowska, G., Szwoch, M., Traczyk, T., Troszczynska, M., Trzcinski, G., Tybura, S., Walasik, P., Wegrzynowska, M., Wesolowska, K., Wieczorek, W., Wierzbicka, A., Wilczewski, P., Wilgat-Szecowka, M., Wojewoda, P., Wojnowski, L., Wrobel, M., Zakutynska-Kowalczyk, K., Zyczynska-Szmon, M., Eltishcheva, V., Libis, R., Tereshchenko, S., Popov, S., Kamalov, G., Belenky, D., Zateyshchikova, A., Kropacheva, E., Kolesnikova, A., Nikolaev, K., Egorova, L., Khokhlov, A., Yakupov, E., Poltavskaya, M., Zateyshchikov, D., Drapkina, O., Vishnevsky, A., Barbarash, O., Miller, O., Aleksandrova, E., Chizhov, P., Sergeev, M., Shutemova, E., Mazur, E., Zrazhevskiy, K., Novikova, T., Kostenko, V., Moiseeva, Y., Polkanova, E., Sobolev, K., Rossovskaya, M., Zubeeva, G., Shapovalova, Y., Nagibovich, O., Edin, A., Agakhanyan, A., Batalov, R., Belenkova, Y., Bitakova, F., Chugunnaya, S., Dumikyan, A., Erofeeva, S., Gorbunova, E., Gorshkova, T., Gubanov, A., Gurmach, M., Ivanova, Y., Kolesova, T., Konyushenko, D., Korneeva, O., Kropova, O., Kuchuk, P., Kungurtseva, O., Kupriyanova, T., Kurylo, B., Kuvanova, M., Lebedeva, O., Lileeva, E., Machilskaya, O., Medvedeva, T., Monako, G., Motylev, I., Nagibovich, G., Novikova, E., Orlov, Y., Osmolovskaya, Y., Ovsannikova, A., Platonov, D., Rachkova, S., Sinitsina, O., Speshilova, S., Suslova, O., Ushakov, A., Volodicheva, O., Zemlianskaia, O., Zhirov, I., Zhuravleva, E., Zotova, I., Garcia, P. 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P., Prieto, I., Quintern, V., Renom, R., Diaz, L. M. R., Rios, V., Sola, L. R., Rivera, R., Robiro, X. R., Roca, M., Saumell, C. R., Rodrigo, C., Rodriguez, E., Garcia, M. R., Jimenez, S. S., Calderon, P. S., Mendez, L. S., Parra, S. S., Santolaya, C., Sanz, M. R. S., Blanco, A. S., Serralvo, E., Sierra, N., Valero, C. S., Lopez, J. S., Fontanillas, M. T., Riera, M. T., Tobajas, G., Torres, C., Marques, J. T., Pastor, M. U., Wirdby, A., Linden, J., Henriksson, K., Elmersson, M., Egilsson, A., Borjesson, U., Svard, G., Liu, B., Lindh, A., Olsson, L. -B., Gustavsson, M., Andersson, L., Benson, L., Bothin, C., Hajimirsadeghi, A., Kadir, K., Ericsson, M., Ohlsson, A., Lindvall, H., Svensson, P., Thorne, K., Handel, H., Platonov, P., Eriksson, B., Timberg, I., Romberg, K., Crisby, M., Karlsson, J. -E., Jensen, S. A., Andersson, A., Malmqvist, L., Martinsson, B., Bernsten, F., Engdahl, J., Thulin, J., Hot-Bjelac, A., Stalby, P., Aaroe, H., Ahbeck, E., Ahlmark, H., Al-Khalili, F., Bonkowski, G., Dzeletovic, S., Ekstrand, A. -B., Eriksson, G. -B., Floren, K., Grassjo, C., Hahn, S., Jaensson, P., Jansson, B., Jansson, J. -H., Kangert, R. -M., Koch, A., Kusiak, D., Lettenstrom, A., Lindberg, A., Lindholm, C. -J., Mannermyr, A., Mansson, K., Millborg, M., Nilsson, C., Ohlin, A. -M., Olofsson, A., Osberg, A., Pedersen, A., Risbecker, K., Rosenberg, K., Samuelsson, J., Shayesteh, M., Skoglund, K., Stjernberg, M., Thorsen, C., Beer, J. H., Debrunner, J., Amstutz, D., Bruegger, J., Elise, G., Grau, A., Guinand, A., Henriette, I., Saga, E., Winnik, S., Rudyk, I., Tseluyko, V., Karpenko, O., Zhurba, S., Kraiz, I., Kupnovytska, I., Serediuk, N., Mostovoy, Y., Ushakov, O., Koval, O., Kovalskyi, I., Svyshchenko, Y., Sychov, O., Stanislavchuk, M., Kraydashenko, O., Yagensky, A., Tykhonova, S., Fushtey, I., Belegai, R., Berko, G., Burdeuna, L., Chabanna, O., Daniuk, I., Ivanov, A., Kamenska, E., Kaplan, P., Khyzhnyak, O., Kizim, S., Matova, O., Medentseva, O., Mochonyi, V., Mospan, M., Nemtsova, V., Ovdiienko, T., Palamarchuk, O., Pavelko, M., Petrovskyy, R., Plevak, D., Proshak, O., Pyvovar, S., Rasputina, L., Romanenko, O., Romanova, O., Sapatyi, A., Shumakov, O., Stets, R., Todoriuk, L., Varenov, V., Chauhan, N., Goodwin, D., Saunders, P., Evans, R., Leese, J., Jhittay, P. S., Ross, A., Kainth, M. S., Pickavance, G., Mcdonnell, J., Williams, A., Gooding, T., Wagner, H., Suryani, S., Singal, A., Sircar, S., Bilas, R., Hutchinson, P., Wakeman, A., Stokes, M., Paul, N., Aziz, M., Ramesh, C., Wilson, P., Franklin, S., Fairhead, S., Thompson, J., St Joseph, V., Taylor, G., Tragen, D., Seamark, D., Paul, C., Richardson, M., Jefferies, A., Sharp, H., Jones, H., Giles, C., Page, M., Oginni, O., Aldegather, J., Wetherwell, S., Lumb, W., Evans, P., Scouller, F., Macey, N., Stipp, Y., West, R., Thurston, S., Wadeson, P., Matthews, J., Pandya, P., Gallagher, A., Railton, T., Sinha, B., Russell, D., Davies, J. A., Ainsworth, P., Jones, C. P., Weeks, P., Eden, J., Kernick, D., Murdoch, W., Lumley, L., Patel, R. P., Wong, S. W., Saigol, M., Ladha, K., Douglas, K., Cumberlidge, D. F., Bradshaw, C., Van Zon, G., Jones, K. P., Thomas, M. J., Watson, E., Sarai, B., Ahmad, N., Willcock, W., Cairns, J., Sathananthan, S., de Kare-Silver, N., Gilliland, A., Strieder, E., Howitt, A., Vishwanathan, B., Bird, N., Gray, D., Clark, M., Bisatt, J., Litchfield, J., Fisher, E., Fooks, T., Kelsall, A. R., Alborough, E., Wakeling, J., Parfitt, M., Milne, K., Rogers, S., Priyadharshan, R., Oliver, J. L., Davies, E., Abushal, S., Jacobs, M., Hutton, C., Walls, N. I., Thompson, R., Chigbo, C., Zaidi, S. M. A., Howard, M., Butter, K. C., Barrow, S., Little, H., Haq, I. U., Gibbons, L., Glencross, S., Mcleod, A. J., Poland, K., Mulholland, C., Warke, A., Conn, P., Burns, G., Smith, R. N., Lowe, S., Kamath, R., Dau, H. S., Webster, J., Hodgins, I., Vercoe, S., Roome, P. C., Pinnock, H., Patel, J. R. A., Ali, A., Hart, N., Davies, R., Stuart, E., Neden, C. A., Danielsen, M., Heath, R., Sharma, P., Galloway, S., Hawkins, C., Oliver, R., Aylward, M., Mannion, S., Braddick, M., Edwards, D., Rothwell, A. C., Sabir, A., Choudhary, F., Khalaque, S., Wilson, A., Peters, S., Coulson, W., Roberts, N., Heer, A., Coates, S., Ward, B., Jackson, D., Walton, S., Shepherd, D., Sterry, M., Wong, T., Boon, M., Bunney, R., Haria-Shah, R., Baron, R. T., Davies, S., Schatzberger, T., Hargreaves, N., Stephenson, T., Choi, H., Batson, R., Lucraft, L., Myhill, T., Estifano, S., Geatch, D., Wilkinson, J., Veale, R., Forshaw, K., Davies, T., Zaman, K., Vinson, P., Liley, C., Bandrapalli, M., Mcginty, P., Wastling, R., Mceleny, P., Beattie, A., Cooke, P., Wong, M., Gunasegaram, J., Pugsley, M., Ahmad, S., A'Court, C., Ayers, J., Bennett, J., Cartwright, S., Dobson, S., Dooldeniya, C., Flynn, A., Fox, R., Goram, J., Halpin, A., Hay, A., Jacobs, P., Jeffers, L., Lomax, L., Munro, I., Muvva, R., Nadaph, M., Powell, K., Randfield, S., Redpath, D., Reed, R., Rickenbach, M., Rogers, G., Saunders, P. B., Seamark, C., Shewring, J., Simmons, P., Simper, H., Stoddart, H., Sword, A., Thomas, N., Thomson, A., Blenkhorn, A., Singh, B., Van Gaal, W., Abhayaratna, W., Lehman, R., Roberts-Thomson, P., Kilian, J., Coulshed, D., Catanchin, A., Colquhoun, D., Kiat, H., Eccleston, D., French, J., Zimmett, L., Ayres, B., Phan, T., Blombery, P., Crimmins, D., O'Donnell, D., Choi, A., Astridge, P., Arstall, M., Jepson, N., Binnekamp, M., Lee, A., Rogers, J., Starmer, G., Carroll, P., Faunt, J., Aggarwala, A., Barry, L., Batta, C., Beveridge, R., Black, A., Bonner, M., Boys, J., Buckley, E., Campo, M., Carlton, L., Connelly, A., Conway, B., Cresp, D., Dimitri, H., Dixon, S., Dolman, M., Duroux, M., Eskandari, M., Eslick, R., Ferreira-Jardim, A., Fetahovic, T., Fitzpatrick, D., Geraghty, R., Gibbs, J., Grabek, T., Modi, M. H., Hayes, K., Hegde, M. P., Hesketh, L., Hoffmann, B., Johnson, K., Juergens, C., Kassam, I., Lawlor, V., Lehman, M., Lehman, S., Leung, D., Mackay, S., Mackenzie, M., Mccarthy, C., Mcintosh, C., Mckeon, L., Morrison, H., Mussap, C., Myers, J. -D., Nagalingam, V., Oldfield, G., O'May, V., Palmer, J., Parsons, L., Patching, K., Patching, T., Paul, V., Plotz, M., Preston, S., Rashad, H., Ratcliffe, M., Raynes, S., Rose, J., Sanders, L., Seremetkoska, M., Setio, H., Shone, S., Shrestha, P., Singh, C., Singleton, C., Stoyanov, N., Sutcliffe, S., Swaraj, K., Tarrant, J., Thompson, S., Tsay, I. M., Vorster, M., Waldman, A., Wallis, L., Wilford, E., Wong, K., Luton, R., Gupta, M., Pandey, A. S., Cheung, S., Leader, R., Beaudry, P., Ayala-Paredes, F., Berlingieri, J., Heath, J., Poirier, G., Du Preez, M., Nadeau, R., Dresser, G., Dhillon, R., Hruczkowski, T., Schweitzer, B., Coutu, B., Angaran, P., Macdonald, P., Vizel, S., Fikry, S., Parkash, R., Lavoie, A., Cha, J., Ramjattan, B., Bonet, J., Ahmad, K., Aro, L., Aves, T., Beaudry, K., Bergeron, C., Bigcanoe, J., Bignell, N., Breakwell, L., Burke, E., Carroll, L., Clarke, B., Cleveland, T., Daheb, S., Dehghani, P., Denis, I., Djaidani, Z., Dorian, P., Douglass, S., Dunnigan, J., Ewert, A., Farquhar, D., Fearon, A., Ferleyko, L., Fournier, D., Fox, B., Grenier, M. -C., Gulliver, W., Haveman, K., Hines, C., Hines, K., Jackson, A. M., Jean, C., Jethoo, G., Kahlon, R., Kelly, S., Kim, R., Korley, V., Kornder, J., Kwan, L., Largy, J., Lewis, C., Lewis, S., Mangat, I., Moor, R., Navratil, J., Neas, I., Otis, J., Otis, R., Pandey, M., Petrie, F., Pinter, A., Raines, M., Roberts, P., Robinson, M., Sas, G., Schulman, S., Snell, L., Spearson, S., Stevenson, J., Trahey, T., Wong, S., Wright, D., El-Aziz, A. A., Seif, S. K. A., El Din, M. G., El Etriby, S., Elbahry, A., El-Etreby, A., Elkhadem, M., Katta, A., Khairy, T., Mowafy, A., Nawar, M., Ohanissian, A., Reda, A., Reda, M., Salem, H., Sami, N., Samir, S., Setiha, M., Sobhy, M., Soliman, A., Taha, N., Tawfik, M., Zaatout, E., Kettles, D., Bayat, J., Siebert, H., Horak, A., Kelfkens, Y., Garda, R., Pillay, T., Guerra, M., van Zyl, L., Theron, H., Murray, A., Louw, R., Greyling, D., Mntla, P., Ueckermann, V., Loghdey, R., Ismail, S., Ahmed, F., Engelbrecht, J., Ramdass, A., Maharajh, S., Oosthuysen, W., Angel, G., Bester, C., Booysen, M., Boshoff, C., Cannon, C., Cassimjee, S., Chami, C., Conway, G., Davids, A., de Meyer, L., Du Plessis, G., Ellis, T., Henley, L., Karsten, M., Loyd, E., Marks, J., Mavhusa, L., Mostert, M., Page, A., Rikhotso, L., Salie, M., Sasto, J., Shaik, F., Skein, A., Smith, L., Tarr, G., Tau, T., van Zyl, F., Yousef, G., Agrawal, A., Nathani, M., Ibrahim, M., Esheiba, E. M., Singh, R., Naguib, A., Abu-Mahfouz, M., Al Omairi, M., Al Naeemi, A., Maruthanayagam, R., Bazargani, N., Wassef, A., Gupta, R., Khan, M., Subbaraman, B., Abdul, A., Al Mulla, A., El Bardisy, S., Haridas, P., Jadhav, S., Magdaluyo, K., Makdad, M., Maqsood, I., Mohamed, R., Sharma, N., Sharma, R., Thanzeel, M., Canosa, R., Rama, P., Blumberg, E., Garcia, J., Mullen, P., Wilson, V., Quick, A., Ferrick, K., Kutayli, W. M., Cox, M., Franco, M., Falkowski, S., Mendelson, R., Williams, M., Miller, S., Beach, S., Alfieri, A., Gutowski, T., Haque, I., Reddy, R., Ahmed, W., Delafontaine, P., Diercks, D., Theodoro, D., Remmel, K., Alberts, M., Ison, R., Noveck, H., Duffy, P., Pitta, S., Nishijima, D., Treasure, C., Asafu-Adjaye, N., Ball, K., Bartlett, M., Bentley, M., Bowers, S., Brown, A., Browne, A., Cameron-Watts, J., Canova, M., Cassidy, D., Cervellione, K., Congal, S., Depauw, J., Dickerson, A., Eley, M., Evans, L., Felpel, S., Ferdinand, K., Fielder, D., Gentry, P., Haideri, A., Hakimi, F., Harbour, T., Hartranft, E., Hawkins, B., Headlee, M., Henson, L., Herrick, C., Hicks, T., Jasinski, S., Jones, A., Jones, L., Jones, P., Karl, S., Keeling, M., Kerr, J., Knowles, P., Langdon, J., Lay, M., Lee, J. A., Lincoln, T., Malone, E., Merliss, A., Merritt, D., Minardo, J., Mooso, B., Orosco, C., Palumbo, V., Parker, M., Parrott, T., Paserchia, S., Pearl, G., Peterson, J., Pickelsimer, N., Purcell, T., Raynor, J., Raziano, S., Richard, C., Richardson, T., Robertson, C., Sage, A., Sanghera, T., Shaw, P., Shoemaker, J., Smith, K., Stephanie, B., Thatcher, A., Theobald, H., Thompson, N., Treasure, L., Tripti, T., Verdi, C., and Worthy, V.
Subjects: Registrie, Male, Latin Americans, 030204 cardiovascular system & hematology, outcomes, 0302 clinical medicine, Drug Prescription, Retrospective Studie, Risk Factors, Atrial Fibrillation, Antithrombotic, Prospective Studies, Registries, 030212 general & internal medicine, Practice Patterns, Physicians', Stroke, Anticoagulant, Atrial fibrillation, General Medicine, Middle Aged, Treatment Outcome, Stroke prevention, outcome, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, medicine.drug_class, Clinical Investigations, Hemorrhage, antithrombotic treatment, Drug Prescriptions, 03 medical and health sciences, Internal medicine, medicine, Humans, Mexico, Aged, Retrospective Studies, Fibrillation, business.industry, Risk Factor, Anticoagulants, South America, medicine.disease, Drug Utilization, Clinical trial, Prospective Studie, Latin American, antithrombotic treatment, atrial fibrillation, Latin American, outcomes, business
Abstract: Author(s): Jerjes-Sanchez, Carlos; Corbalan, Ramon; Barretto, Antonio CP; Luciardi, Hector L; Allu, Jagan; Illingworth, Laura; Pieper, Karen S; Kayani, Gloria; GARFIELD-AF Investigators | Abstract: BackgroundAtrial fibrillation (AF) is an important preventable cause of stroke. Anticoagulation (AC) therapy can reduce this risk. However, prescribing patterns and outcomes in patients with non-valvular AF (NVAF) from Latin American countries are poorly described.MethodsUsing data from the Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF), we examined the stroke prevention strategies and the 1-year outcomes in patients from four Latin American countries: Argentina, Brazil, Chile, and Mexico.ResultsA total of 4162 patients (2010-2014) were included in this analysis. At the time of AF diagnosis, 39.9% of patients were prescribed vitamin K antagonists (VKA) ± antiplatelet (AP) therapy, 21.8% non-VKA oral anticoagulant (NOAC) ± AP, 24.1% AP only and 14.1% no antithrombotic treatment. The proportion of moderate-high risk patients receiving no AC therapy at participating centers was highest in Mexico (46.4%) and lowest in Chile (14.3%). During 1-year follow-up, the rates of all-cause mortality, stroke/SE and major bleeding were: 5.77 (95% CI) (5.06-6.56), 1.58 (1.23-2.02), and 0.99 (0.72-1.36) and per 100 person-years, respectively, which are higher than the global rates across all countries in GARFIELD-AF. Unadjusted rates of all-cause mortality were highest in Argentina, 6.95 (5.43-8.90), and lowest in Chile, 4.01 (2.92-5.52).ConclusionsGARFIELD-AF results describes the marked variation in the baseline characteristics and patterns of antithrombotic treatments in patients with NVAF in four Latin American countries. Over one-third of patients with a moderate-to-high risk of stroke received no AC therapy, highlighting the need for improved management of patients according to national guideline. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
Published: 2019

34. The Association Between Hemoglobin Upswing in the Reference Range and Sleep Apnea Syndrome

Author: Hirotaka Miyashita, Thomas Svensson, Akiko Kishi Svensson, and Masahiro Nakamura
Subjects: Pediatrics, medicine.medical_specialty, education.field_of_study, business.industry, Proportional hazards model, Incidence (epidemiology), Hazard ratio, Population, Sleep apnea, Reference range, medicine.disease, Health check, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Neurology, medicine, 030212 general & internal medicine, Neurology (clinical), Hemoglobin, business, education, 030217 neurology & neurosurgery
Abstract: Purpose Sleep apnea syndrome (SAS) is a relatively common disorder, but many patients with SAS are still undiagnosed. Using Japanese annual health check and medical claims data, we analyzed the association between hemoglobin upswing, defined as an increase in hemoglobin level within the reference range, and the incidence of SAS. Methods In this study, we used the Japan Medical Database Center (JMDC) annual health check and medical claims data of 351,930 male individuals aged 40−59 who had their hemoglobin concentration checked in 2014. We initially identified the reference range of hemoglobin level based on the mean and the standard deviation of hemoglobin concentration in this population. We examined the effect of hemoglobin upswing on the incidence of SAS using Cox proportional hazards models. Results The hemoglobin upswing was defined as a change greater than 1.19 g/dL in the reference range of 13.1 to 17.2 g/dL. During a mean follow-up period of approximately 1285 days, 1.9% of the individuals with hemoglobin upswing were diagnosed with SAS, while 1.6% of those without hemoglobin upswing were diagnosed with SAS. The hazard ratio of hemoglobin upswing to the incidence of SAS was 1.21 (95% CI; 1.01–1.44, p = 0.04). Conclusion We herein revealed the association between hemoglobin upswing and the incidence of SAS in a middle-aged male population. A statistically significant increase in hemoglobin concentration even in the reference range should be paid attention to as it may indicate the presence of SAS.
Published: 2020

35. Remote physical examination for temporomandibular disorders

Author: Dyna Mara F Costa, Peter Svensson, Cristina R Exposto, Eduardo Castrillon, Yuri Martins Costa, Fernando G Exposto, and Muhammed A Gøkhan
Subjects: myalgia, medicine.medical_specialty, Arthralgia/etiology, Physical Examination/adverse effects, Fleiss' kappa, Physical examination, Odontologi, Facial Pain/complications, Myalgia/etiology, Quality of life, medicine, Humans, Medical diagnosis, Physical Examination, Protocol (science), medicine.diagnostic_test, business.industry, Temporomandibular Joint Disorders/complications, COVID-19, Myalgia, Temporomandibular Joint Disorders, Arthralgia, Telemedicine, Confidence interval, Anesthesiology and Pain Medicine, Neurology, Dentistry, Quality of Life, Physical therapy, Neurology (clinical), medicine.symptom, business, Psychosocial
Abstract: There is a need to further develop telemedicine approaches due to the immediate and perhaps long-term consequences of the coronavirus disease 2019. Thus, a remote protocol for assessment of patients with temporomandibular disorders (TMD) was developed, and the agreement of this protocol was compared to the guidelines of the diagnostic criteria for temporomandibular disorders (DC/TMD). A total of 16 individuals were first assessed by a reference standard examination (RSE) and three other examinations applied in a random order by three examiners: standard physical examination (standard examination), physical examination keeping 2 m distance (physical distanced examination) and examination done with the aid of video communication technology (video communication examination). The primary outcomes were the diagnoses of myalgia of the masseter and temporalis muscles, and arthralgia. The diagnoses of intra-articular joint disorders were considered secondary outcomes because of less impact on psychosocial functioning and quality of life when compared with the pain-related diagnoses. The Fleiss kappa coefficient and its 95% confidence interval were computed to determine the level of agreement in diagnoses between each examination protocol and the RSE. There was substantial to almost perfect agreement between the RSE and all the examination protocols for the diagnoses of myalgia (0.86 to 1.00) and arthralgia (0.86 to 0.87) (p
Published: 2021

36. Feasibility of an inexperienced examiner using trans-cervical ultrasound in the diagnosis of peritonsillar abscesses

Author: Joacim Svensson, Mathias von Beckerath, and Fredrik Landström
Subjects: Adult, Male, medicine.medical_specialty, Students, Medical, Adolescent, Sensitivity and Specificity, Young Adult, Predictive Value of Tests, otorhinolaryngologic diseases, Humans, Medicine, Peritonsillar Abscess, Ultrasonography, business.industry, Acute Tonsillitis, Ultrasound, Gold standard, Reproducibility of Results, General Medicine, Middle Aged, Cervical ultrasound, Otorhinolaryngology, Radiological weapon, Feasibility Studies, Female, Clinical Competence, Radiology, business, Complication, Neck
Abstract: Background A peritonsillar abscess (PTA) is a common complication to acute tonsillitis. Needle aspiration (NA) is the gold standard for diagnosis of PTA. NA is usually painful and not risk-free. Ultrasound (US) is a noninvasive, portable radiological modality that could potentially be used in the diagnosis of PTA and selection of patients for NA. The reliability of US is dependent on the experience of the examiner which limits is usefulness. Aim To evaluate the reliability of US in the diagnosis of PTA by an inexperienced examiner. Methods Thirty patients with suspected PTA were included. They were first examined with trans-cervical US by a medical student then clinically examined by a physician that performed a NA if clinically motivated. They were then followed for at least two days. Results Three patients were excluded from analysis because no NA was performed. In these patients, US correctly classified them as negative for PTA. In the remaining 27 patients, the sensitivity and negative predictive value was 100%. The specificity was 64.3% and the positive-predictive value was 72.2%. Conclusion US can be very useful in the diagnosis of PTA and the selection for NA even with an inexperienced examiner. Significance The results highlight the usefulness of ultrasound in otolaryngology.
Published: 2021

37. An important cardiac surgery milestone: The first known stopped-heart operation

Author: Lars G. Svensson and Tomislav Mihaljevic
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, General surgery, medicine, Milestone (project management), Surgery, business, Congenital: Ventricular Septal Defect: Cardioplegia Historical Vignette, Cardiac surgery
Published: 2021

38. A Serosurvey of Tick-Borne Encephalitis Virus in Sweden: Different Populations and Geographical Locations

Author: Kristina E. M. Persson, Joel Svensson, and Claus B Christiansen
Subjects: 0301 basic medicine, medicine.medical_specialty, 030231 tropical medicine, Disease, Antibodies, Viral, Microbiology, Encephalitis Viruses, Tick-Borne, 03 medical and health sciences, 0302 clinical medicine, Seroepidemiologic Studies, Virology, Neutralization test, Internal medicine, Animals, Medicine, Seroprevalence, Subclinical infection, Sweden, biology, business.industry, 030108 mycology & parasitology, biology.organism_classification, medicine.disease, Vaccination, Tick-borne encephalitis virus, Infectious Diseases, biology.protein, Antibody, business, Encephalitis, Tick-Borne, Encephalitis
Abstract: Background: New risk areas for tick-borne encephalitis (TBE) are emerging and the spread of disease and vaccine coverage is unclear in Sweden. We wanted to study the prevalence and levels of TBE-virus (TBEV) antibodies in southern Sweden, and to investigate whether there were individuals with undiagnosed TBE. Materials and Methods: Two cohorts of sera were collected: One group of anonymous individuals in rural areas (AIRA) in Skane and one group of volunteers who often got tick-bites (tick-bitten individuals [TBI]). An enzyme-linked immunosorbent assay for TBEV IgM and IgG was performed, as well as a TBEV neutralization test (NT) in selected individuals. Results: In the AIRA group, there was an IgG seropositivity of 5.3%. There were individuals with high antibody levels both in areas previously considered as risk areas (Bromolla and Knislinge), as well as in another area (Tyringe). In the TBI group, 45% of the individuals were vaccinated according to the questionnaires and IgG seropositivity was 28%. A lower seroprevalence and levels of antibodies were seen in the middle-aged group (50-69 years) compared with younger or elderly study participants. A positive NT revealed several individuals with suspected undiagnosed episodes of TBE. Conclusion: Subclinical or misdiagnosed cases have probably occurred in Skane. Middle-aged individuals had lower levels of IgG, which could indicate either less tick exposure or a lower vaccine response. Less than half of the TBI were vaccinated, an indication that more information about the disease and vaccine might be needed. We conclude that the study motivates an increased awareness of TBEV in the region.
Published: 2021

39. Psychophysical evaluation of somatosensory function in oro‐facial pain: achievements and challenges

Author: Yuri Martins Costa, Peter Svensson, Paulo César Rodrigues Conti, and Leonardo Rigoldi Bonjardim
Subjects: Orofacial pain, medicine.medical_specialty, diagnosis, oro-facial pain, quantitative sensory testing, somatosensory system, Somatosensory system, Somatosensory function, Physical medicine and rehabilitation, Facial Pain, Sensory threshold, Humans, Pain Management, Medicine, General Dentistry, Pain Measurement, neuropathic pain, SISTEMA NERVOSO, business.industry, Quantitative sensory testing, sensory threshold, Chronic pain, Reproducibility of Results, medicine.disease, Treatment efficacy, classification, Neuropathic pain, qualitative sensory testing, Chronic Pain, medicine.symptom, business
Abstract: AIM: This critical review describes key methodological aspects for a successful orofacial psychophysical evaluation of the somatosensory system and highlights the diagnostic value of somatosensory assessment and management perspectives based on somatosensory profiling.METHODS: This topical review was based on a non-systematic search for studies about somatosensory evaluation in orofacial pain in PubMed and Embase.RESULTS: The recent progress regarding psychophysical evaluation of somatosensory function was largely possible due to the development and application of valid, reliable, and standardized psychophysical methods. Qualitative sensory testing may be useful as a screening tool to rule out relevant somatosensory abnormalities. Nevertheless, the patient should preferably be referred to a more comprehensive assessment with the quantitative sensory testing battery if confirmation of somatosensory abnormalities is necessary. Moreover, the identification of relevant somatosensory alterations in chronic pain disorders that do not fulfill the current criteria to be regarded as neuropathic has also increased the usefulness of somatosensory evaluation as a feasible method to better characterize the patients and perhaps elucidate some underpinnings of the so-called "nociplastic" pain disorders. Finally, an additional benefit of orofacial pain treatment based on somatosensory profiling still needs to be demonstrated and convincing evidence of somatosensory findings as predictors of treatment efficacy in chronic orofacial pain awaits further studies.CONCLUSION: Psychophysical evaluation of somatosensory function in orofacial pain is still in its infancy but with a clear potential to continue to improve the assessment, diagnosis and management of orofacial pain patients.
Published: 2021

40. Cerebrospinal Fluid Sulfatide Levels Lack Diagnostic Utility in the Subcortical Small Vessel Type of Dementia

Author: Jan-Eric Månsson, Petronella Kettunen, Maria Bjerke, Maria Blomqvist, Marcus Henricsson, Michael Jonsson, Anders Wallin, Johan Svensson, Carl Eckerström, Clinical Biology, Clinical sciences, and Neuroprotection & Neuromodulation
Subjects: Male, 0301 basic medicine, subcortical small vessel type of dementia, sulfatide species, Gastroenterology, mixed dementia, 0302 clinical medicine, Cerebrospinal fluid, Neurofilament Proteins, medicine.diagnostic_test, biology, General Neuroscience, General Medicine, white matter hyperintensities, Magnetic Resonance Imaging, White Matter, Psychiatry and Mental health, Clinical Psychology, Population study, Biomarker (medicine), Female, Alzheimer’s disease, medicine.medical_specialty, Neuroscience(all), Serum albumin, Diagnostic Techniques, Neurological, cerebrospinal fluid, Diagnosis, Differential, 03 medical and health sciences, Alzheimer Disease, Internal medicine, medicine, Humans, Dementia, Aged, Sulfoglycosphingolipids, business.industry, Dementia, Vascular, Reproducibility of Results, Magnetic resonance imaging, medicine.disease, Hyperintensity, Cross-Sectional Studies, 030104 developmental biology, sulfatides, biology.protein, Human medicine, Small vessel, Geriatrics and Gerontology, business, Procedures and Techniques Utilization, 030217 neurology & neurosurgery, Chromatography, Liquid, Demyelinating Diseases
Abstract: Background: Sulfatides (STs) in cerebrospinal fluid (CSF), as well as magnetic resonance imaging (MRI)-detected white matter hyperintensities (WMHs), may reflect demyelination. Here, we investigated the diagnostic utility of CSF ST levels in the subcortical small vessel type of dementia (SSVD), which is characterized by the presence of brain WMHs. Objective: To study the diagnostic utility of CSF ST levels in SSVD. Methods: This was a mono-center, cross-sectional study of SSVD (n = 16), Alzheimer’s disease (n = 40), mixed dementia (n = 27), and healthy controls (n = 33). Totally, 20 ST species were measured in CSF by liquid chromatography-mass spectrometry (LC-MS/MS). Results: CSF total ST levels, as well as CSF levels of hydroxylated and nonhydroxylated ST species, did not differ across the study groups. In contrast, CSF neurofilament light chain (NFL) levels separated the patient groups from the controls. CSF total ST level correlated with CSF/serum albumin ratio in the total study population (r = 0.64, p
Published: 2021

41. Complications of implantable cardioverter-defibrillator treatment in arrhythmogenic right ventricular cardiomyopathy

Author: Alex Hørby Christensen, Pyotr G. Platonov, Anneli Svensson, Jesper Hastrup Svendsen, Pia Dahlberg, Kristina H. Haugaa, Henrik Jensen, Henning Bundgaard, Tanja Charlotte Frederiksen, Trine Madsen, Christine Rootwelt-Norberg, and Tiina Heliö
Subjects: Adult, Male, medicine.medical_specialty, Complications, Cardiomyopathy, medicine.medical_treatment, Electric Countershock, 030204 cardiovascular system & hematology, Implantable cardioverter-defibrillator, Right ventricular cardiomyopathy, Sudden cardiac death, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Physiology (medical), Internal medicine, medicine, Humans, Registries, 030212 general & internal medicine, Risk factor, Arrhythmogenic Right Ventricular Dysplasia, business.industry, Atrial fibrillation, medicine.disease, Defibrillators, Implantable, Death, Sudden, Cardiac, Treatment Outcome, Cohort, Ventricular arrhythmia, Cardiology, Female, Arrhythmogenic right ventricular cardiomyopathy, Cardiology and Cardiovascular Medicine, business, Complication
Abstract: Aims Treatment with implantable cardioverter-defibrillators (ICD) is a cornerstone for prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy (ARVC). We aimed at describing the complications associated with ICD treatment in a multinational cohort with long-term follow-up. Methods and results The Nordic ARVC registry was established in 2010 and encompasses a large multinational cohort of ARVC patients, including their clinical characteristics, treatment, and events during follow-up. We included 299 patients (66% males, median age 41 years). During a median follow-up of 10.6 years, 124 (41%) patients experienced appropriate ICD shock therapy, 28 (9%) experienced inappropriate shocks, 82 (27%) had a complication requiring surgery (mainly lead-related, n = 75), and 99 (33%) patients experienced the combined endpoint of either an inappropriate shock or a surgical complication. The crude rate of first inappropriate shock was 3.4% during the first year after implantation but decreased after the first year and plateaued over time. Contrary, the risk of a complication requiring surgery was 5.5% the first year and remained high throughout the study period. The combined risk of any complication was 7.9% the first year. In multivariate cox regression, presence of atrial fibrillation/flutter was a risk factor for inappropriate shock (P 0.05). Conclusion Forty-one percent of ARVC patients treated with ICD experienced potentially life-saving ICD therapy during long-term follow-up. A third of the patients experienced a complication during follow-up with lead-related complications constituting the vast majority.
Published: 2021

42. Experiences of job demand and control: A study of first line managers in for-profit psychiatric and addiction care

Author: Sven Svensson, Erika Wall, and Linda Widar
Subjects: Sweden, medicine.medical_specialty, 030504 nursing, Job strain, First line, 05 social sciences, Rehabilitation, Control (management), Public Health, Environmental and Occupational Health, Workload, Occupational safety and health, 03 medical and health sciences, 0502 economics and business, medicine, For profit, Humans, Occupations, 0305 other medical science, Psychology, Psychiatry, 050203 business & management, Addiction care
Abstract: BACKGROUND: The complex position of a first line manager is characterized by heavy workload and contradictory demands. Little is known about how first line managers experience demand and control in their work. OBJECTIVES: The aim of this study was to explore experiences of demand and control among first line managers within psychiatric and addiction care. METHOD: In the present study, interviews with ten managers in for-profit psychiatric and addiction care in Sweden were analyzed with a phenomenographic approach. RESULTS: The managers experiences of demand and control implied varied and extensive responsibilities for a wide range of professions; regulation by organizational, economic, and political frameworks; creating balance in their work; and handling the emergence and consequences of acute crisis. These experiences of demand and control involved high and contradictory demands together with coexisting high and low levels of control. Many of their work characteristics could be described in terms of both demand and control. CONSLUSION: The first line managers experiences of demand and control are more complex than implied by the job demand control theory. Our results suggest that the organizational position and branch should be considered when identifying health hazards in the work environment of first line managers.
Published: 2021

43. Changes in rehabilitation actors’ mental health literacy and support to employers: An evaluation of the SEAM intervention

Author: Bengt Svensson, Annika Lexén, Lars Hansson, Susann Porter, Maria Emmelin, and Ulrika Bejerholm
Subjects: Occupational therapy, 030506 rehabilitation, medicine.medical_specialty, medicine.medical_treatment, Occupational safety and health, 03 medical and health sciences, Return to Work, 0302 clinical medicine, Nursing, Intervention (counseling), medicine, Humans, Longitudinal Studies, Mental health literacy, Rehabilitation, Public Health, Environmental and Occupational Health, Rehabilitation, Vocational, Mental illness, medicine.disease, Mental health, Health Literacy, 030227 psychiatry, Mental Health, 0305 other medical science, Psychology, Mental health first aid
Abstract: BACKGROUND: Lack of mental health literacy among rehabilitation professionals and employers in the return-to-work of persons with mental health problems resulted in the development of a three-day group training program, the Support to Employers from rehabilitation Actors about Mental health (SEAM) intervention. OBJECTIVE: To evaluate the impact of SEAM on rehabilitation professionals’ knowledge and beliefs, attitudes, and supporting behaviors towards people with mental health problems and employers as part of the return-to-work process. METHODS: In this longitudinal study, 94 rehabilitation professionals were included. Data were collected prior to (T1), immediately after (T2) and 6 months after SEAM training (T3) using knowledge and attitude scales and a questionnaire on supporting behaviors. SEAM includes training in Mental Health First Aid, presentations and discussions on current research on work and mental health, and strategies and communication guidelines to use when meeting service users and employers as part of the return-to-work of persons with mental health problems. SEAM also includes a homepage with targeted employer information. Data were analyzed using non-parametric statistics. RESULTS: SEAM significantly increased rehabilitation professionals’ knowledge of mental health (T1-T2: z = –2.037, p = 0.042; T2-T3: z = –5.093, p = 0.001), and improved their attitudes towards persons with mental health problems (T1-T2: z = 4.984, p = 0.001). Professionals (50–60%) also estimated that they had increased their use of supporting strategies towards service users and employers. CONCLUSIONS: The study suggests that SEAM can increase mental health literacy among rehabilitation professionals and lead to a greater focus on service users’ resources and work ability, as well as on employers’ support needs.
Published: 2021

44. Left Ventricular Longitudinal Strain in Characterization and Outcome Assessment of Mixed Aortic Valve Disease Phenotypes

Author: Yoshihito Saijo, Lars G. Svensson, Zoran B. Popović, Nicolas Isaza, Eric E. Roselli, Julijana Z. Conic, Milind Y. Desai, Richard A. Grimm, Samir R. Kapadia, Douglas R. Johnston, Brian P. Griffin, and Nancy A. Obuchowski
Subjects: Male, medicine.medical_specialty, Percentile, Longitudinal strain, Regurgitation (circulation), 030204 cardiovascular system & hematology, Ventricular Function, Left, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aortic valve replacement, Predictive Value of Tests, Internal medicine, medicine, Clinical endpoint, Humans, Radiology, Nuclear Medicine and imaging, Aged, Aged, 80 and over, business.industry, Stroke Volume, Aortic Valve Stenosis, Middle Aged, medicine.disease, Aortic Valve Disease, Stenosis, Phenotype, Concomitant, Cardiology, Cardiology and Cardiovascular Medicine, business, Cohort study
Abstract: The aims of this study were to characterize the interplay between mixed aortic valve disease (MAVD) phenotypes (defined by concomitant severities of aortic stenosis and aortic regurgitation) and left ventricular global longitudinal strain (LV-GLS), and to assess the prognostic utility of LV-GLS in MAVD.Little is known about the way LV-GLS separates MAVD phenotypes and if it is associated with their outcomes.This observational cohort study evaluated 783 consecutive adult patients with left ventricular ejection fraction ≥50% and MAVD, which was defined as coexisting with at least moderate aortic stenosis and at least moderate aortic regurgitation. We measured the conventional echocardiographic variables and average LV-GLS from apical long, 2- and 4-chamber views. The primary endpoint was all-cause mortality.Mean age of patients was 69 ± 15 years, and 58% were male. Mean LV-GLS was -14.7 ± 2.9%. In total, 458 patients (59%) underwent aortic valve replacement at a median period of 50 days (25th to 75th percentile range: 6 to 560 days). During a median follow-up period of 5.6 years (25th to 75th percentile range: 1.8 to 9.4 years), 391 patients (50%) died. When stratified patients into tertiles according to LV-GLS values, patients with worse LV-GLS had worse outcomes (p 0.001). LV-GLS was independently associated with mortality (hazard ratio: 1.09; 95% confidential intervals: 1.04 to 1.14; p 0.001), with the relationship between LV-GLS and mortality being linear.LV-GLS is associated with all-cause mortality. LV-GLS may be useful for risk stratification in patients with MAVD.
Published: 2021

45. Human adipose tissue gene expression of solute carrier family 19 member 3 ( SLC19A3 ); relation to obesity and weight‐loss

Author: Peter Jacobson, Johanna C. Andersson-Assarsson, Prasad G. Kamble, Lena M. S. Carlsson, Magdalena Taube, Per-Arne Svensson, Maria J. Pereira, and Kajsa Sjöholm
Subjects: obesity, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Adipose tissue, Endocrinology and Diabetes, thiamine transporter, Weight loss, Internal medicine, Gene expression, Thiamine transporter, Medicine, Nutrition and Dietetics, biology, business.industry, medicine.disease, RC31-1245, Obesity, adipose tissue, Solute carrier family, Endocrinology, SLC19A3, Endokrinologi och diabetes, biology.protein, weight‐loss, medicine.symptom, business, weight-loss
Abstract: Objective: Adipose tissue is a specialized endocrine organ that is involved in modulating whole-body energy homeostasis and expresses a specific subset of genes, which may play a role in adipose tissue metabolism. The aim of this study was to search for novel adipose tissue-specific genes using a tissue panel of RNAseq expression profiles. Methords: RNAseq expression profiles from 53 human tissues were downloaded from the GTex database. SLC19A3 expression was analyzed by microarray or real-time PCR in two sets of paired subcutaneous and omental adipose tissue samples, in two studies with adipose tissue from persons with high or low body mass index (BMI), in adipose tissue from patients who underwent weight loss with a very-low caloric diet and during preadipocyte-adipocyte differentiation. Results: The RNAseq-based tissue distribution expression screen identified SLC19A3 (encoding the thiamine transporter 2) as adipose tissue-specific. SLC19A3 expression was higher in subcutaneous compared with omental adipose tissue in both sample sets (p = 0.043 and p < 0.001). Preadipocyte differentiation towards adipocytes resulted in increased SLC19A3 gene expression (p = 0.018 or less at all-time points). Subcutaneous adipose tissue expression of SLC19A3 was lower in persons with high BMI in both cohorts (p = 0.008, and p < 0.001) and increased during a weight-loss intervention (p = 0.006). Conclusion: The specific adipose tissue expression pattern of SLC19A3, together with its regulation in obesity and during weight loss, indicate that it plays a key role in adipocyte metabolism.
Published: 2021

46. Outcomes of contemporary imaging-guided management of sinus of Valsalva aneurysms

Author: Wael A. Jaber, Carlos Godoy-Rivas, Venu Menon, Duygu Kocyigit, Paul Schoenhagen, L. Leonardo Rodriguez, Jorge J. Betancor, Richard H. Grimm, Brian P. Griffin, Lars G. Svensson, Bo Xu, and Scott D. Flamm
Subjects: medicine.medical_specialty, Conservative management, medicine.diagnostic_test, Cardiac computed tomography, business.industry, Retrospective cohort study, Cardiac surgery, medicine.anatomical_structure, Cardiac magnetic resonance imaging, Cohort, Original Article on Heart Valve Disease, Medicine, Radiology, Cardiology and Cardiovascular Medicine, Cardiac magnetic resonance, business, Sinus (anatomy)
Abstract: BACKGROUND: Sinus of Valsalva aneurysms (SVAs) are rare. We assessed the role of multimodality imaging in guiding the contemporary management. METHODS: A single-center retrospective cohort study over a 20-year period was performed. RESULTS: Between January 1997 and June 2017, 103 patients were diagnosed with SVAs (median age: 58 years). Eighty patients presented with non-ruptured SVAs, and 23 with ruptured SVAs. Seventy-six patients underwent surgery, and 27 were conservatively managed. The median durations of follow-up were: 48 months (surgical group) vs. 37.5 months (conservative group). There was no mortality directly attributable to SVA surgery. There were no late complications in the conservative group. Transthoracic echocardiography (TTE) was the first-line imaging investigation (100.0% in surgical group vs. 92.6% in conservative group, P=0.019). Additional imaging studies included: (I) transesophageal echocardiography (TEE): 93.4% in surgical group vs. 22.2% in conservative group, P
Published: 2021

47. The art of aortic valve repair

Author: Lars G. Svensson
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Aorta, Valve leaflet, Aortic valve repair, business.industry, medicine.artery, Internal medicine, Cardiology, medicine, Surgery, business, Cardiac surgery
Published: 2021

48. Performance and Durability of Cryopreserved Allograft Aortic Valve Replacements

Author: Wael A. Jaber, Gösta B. Pettersson, Lars G. Svensson, Penny L. Houghtaling, Eric E. Roselli, Faisal G. Bakaeen, Emily Durbak, Shinya Unai, Douglas R. Johnston, James C. Witten, and Eugene H. Blackstone
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, Aortic valve, medicine.medical_specialty, Hemodynamics, chemical and pharmacologic phenomena, 030204 cardiovascular system & hematology, Cryopreservation, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Hospital discharge, Humans, Medicine, Thoracic aorta, Aged, Retrospective Studies, Bioprosthesis, Body surface area, Endocarditis, business.industry, Middle Aged, medicine.disease, Prosthesis Failure, Surgery, surgical procedures, operative, medicine.anatomical_structure, 030228 respiratory system, Aortic Valve, Heart Valve Prosthesis, Infective endocarditis, Female, Implant, Cardiology and Cardiovascular Medicine, business
Abstract: Background The value of allografts for aortic root replacement is controversial, with recent concern about limited durability. Currently, we prefer allografts for invasive infective endocarditis. Purposes of this study were to assess allograft performance and durability in our cumulative experience with aortic allografts. Methods From January 1987 to January 2017, 2042 adults received 2110 aortic allograft root replacements at our institution: 986 (47%) for infective endocarditis (669 [68%] for prosthetic valve endocarditis) and 1124 (53%) for other indications. Mean recipient age was 54 ± 15 years, and mean allograft donor age was 35 ± 13 years. Follow-up was 85% complete and comprised 17,253 patient-years of data. Longitudinal allograft performance was extracted from 6339 available echocardiographic studies. Durability was assessed by explant for allograft structural failure. Results Allograft mean gradient at hospital discharge was 6 mm Hg and 9, 13, and 15 mm Hg at 5, 10, and 15 years post-implant, respectively. Severe aortic regurgitation was 0% at hospital discharge, but 14%, 25%, and 35% at 5, 10, and 15 years, respectively. A total of 405 allografts were explanted for structural failure, actuarially 2%, 14%, 34%, and 51% at 5, 10, 15, and 20 years, respectively. Risk factors for structural failure were younger recipient age, larger body surface area, hypertension, and thoracic aorta disease; donor factors were older age and larger allograft size. Implant for infective endocarditis was not associated with accelerated structural failure. Conclusions This study affirms allografts’ long-term acceptable hemodynamic performance and durability. Concern about structural failure should not limit allograft use. Recipient hypertension, allograft size, and donor age are modifiable risk factors.
Published: 2021

49. Coronavirus disease and the cardiovascular system: a narrative review of the mechanisms of injury and management implications

Author: Agam Bansal, Vardhmaan Jain, Maria Vega Brizneda, Richard A. Grimm, Grant W. Reed, Venu Menon, Samir R. Kapadia, Penelope Rampersad, Lars G. Svensson, Bo Xu, Paul Cremer, and Brian P. Griffin
Subjects: medicine.medical_specialty, Isolation (health care), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Disease, medicine.disease_cause, Pandemic, Health care, medicine, Anxiety, medicine.symptom, Cardiology and Cardiovascular Medicine, Intensive care medicine, business, Review Article on Heart Valve Disease, Depression (differential diagnoses), Coronavirus
Abstract: Coronavirus disease (COVID-19), first identified in Wuhan, China, in December 2019, is now a pandemic, having already spread to 188 countries, with more than 28,280,000 infections worldwide. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the responsible infectious agent, and similar to other human coronaviruses, uses membrane-bound angiotensin-converting enzyme 2 (membrane-bound ACE2) for entry into the host cells. COVID-19 has important cardiovascular implications, especially for patients with pre-existing cardiovascular co-morbidities, potentially mediated through several mechanisms, including direct myocardial injury, worsening of those pre-existing cardiovascular co-morbidities, and adverse cardiovascular effects of potential therapies for COVID-19. The disease is causing a significant burden on health systems worldwide. Elective surgeries and procedures were postponed for a considerable period of time, and many patients with known cardiovascular disease (CVD) risk factors presented late to hospitals, for fear of contracting COVID-19, with serious adverse consequences. Significant negative impact on a population level is highlighted by prolonged isolation, decreased exercise and physical activity, and higher levels of depression and anxiety, all predisposing to elevated cardiovascular risk. This article provides a timely overview of COVID-19 and its impact on the cardiovascular system, focusing on the pathogenesis, potential adverse cardiovascular events, the potential treatment options, protection for health care providers and patients, and what the cardiovascular community could do to mitigate the impact of COVID-19.
Published: 2021

50. Neurodevelopmental Disorders, Glycemic Control, and Diabetic Complications in Type 1 Diabetes: a Nationwide Cohort Study

Author: Ralf Kuja-Halkola, Soffia Gudbjörnsdottir, Eva Serlachius, Shengxin Liu, Paul Lichtenstein, Ann-Marie Svensson, Agnieszka Butwicka, Jonas F. Ludvigsson, Henrik Larsson, and Magnus Tideman
Subjects: Male, Pediatrics, type 1 diabetes, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Comorbidity, Biochemistry, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, Neurodevelopmental disorder, Diabetic Nephropathies, 030212 general & internal medicine, Longitudinal Studies, Prospective Studies, Child, education.field_of_study, neurodevelopmental disorders, Autism spectrum disorder, Child, Preschool, nephropathy, Female, AcademicSubjects/MED00250, Cohort study, medicine.medical_specialty, Adolescent, Population, 030209 endocrinology & metabolism, Glycemic Control, Diabetes Complications, 03 medical and health sciences, Internal medicine, mental disorders, retinopathy, medicine, Humans, education, Online Only Articles, Clinical Research Articles, Glycemic, Glycated Hemoglobin, Sweden, Type 1 diabetes, Diabetic Retinopathy, business.industry, Biochemistry (medical), Odds ratio, medicine.disease, Diabetes Mellitus, Type 1, chemistry, Glycated hemoglobin, business, Follow-Up Studies
Abstract: Context Neurodevelopmental disorders are more prevalent in childhood-onset type 1 diabetes than in the general population, and the symptoms may limit the individual’s ability for diabetes management. Objective This study investigated whether comorbid neurodevelopmental disorders are associated with long-term glycemic control and risk of diabetic complications. Methods This population-based cohort study used longitudinally collected data from Swedish registers. We identified 11 326 individuals born during 1973-2013, diagnosed with type 1 diabetes during 1990-2013 (median onset age: 9.6 years). Among them, 764 had a comorbid neurodevelopmental disorder, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and intellectual disability. We used multinomial logistic regression to calculate odds ratios (ORs) of having poor glycemic control (assessed by glycated hemoglobin [HbA1c]) and Cox regression to estimate hazard ratios (HRs) of nephropathy and retinopathy. Results The median follow-up was 7.5 years (interquartile range [IQR] 3.9, 11.2). Having any neurodevelopmental disorder (ORadjusted 1.51 [95% CI 1.13, 2.03]), or ADHD (ORadjusted 2.31 [95% CI 1.54, 3.45]) was associated with poor glycemic control (mean HbA1c > 8.5%). Increased risk of diabetic complications was observed in patients with comorbid neurodevelopmental disorders (HRadjusted 1.72 [95% CI 1.21, 2.44] for nephropathy, HRadjusted 1.18 [95% CI 1.00, 1.40] for retinopathy) and patients with ADHD (HRadjusted 1.90 [95% CI 1.20, 3.00] for nephropathy, HRadjusted 1.33 [95% CI 1.07, 1.66] for retinopathy). Patients with intellectual disability have a particularly higher risk of nephropathy (HRadjusted 2.64 [95% CI 1.30, 5.37]). Conclusion Comorbid neurodevelopmental disorders, primarily ADHD and intellectual disability, were associated with poor glycemic control and a higher risk of diabetic complications in childhood-onset type 1 diabetes.
Published: 2021

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