EPOS trial: the effect of air filtration through a plasma chamber on the incidence of surgical site infection in orthopaedic surgery: a study protocol of a randomised, double-blind, placebo-controlled trial.

Introduction: There is controversy regarding the importance of air-transmitted infections for surgical site infections (SSIs) after orthopaedic surgery. Research has been hindered by both the inability in blinding the exposure, and by the need for recruiting large enough cohorts. The aim of this study is to investigate whether using a new form of air purifier using plasma air purification (PAP) in operating rooms (ORs) lowers the SSI rate or not.

[Pharmacological treatment reduces mortality in COPD].

Approximately 500 000 individuals in Sweden have chronic obstructive pulmonary disease (COPD). Co-morbid, especially cardiovascular, conditions are common in COPD and globally COPD is the third most common cause of mortality. Mortality in COPD is driven by dyspnea, exacerbations and comorbidities and is reduced by smoking cessation and lung rehabilitation.

2021 Updated European Association of Urology Guidelines on the Use of Adjuvant Pembrolizumab for Renal Cell Carcinoma.

Adjuvant treatment of nonmetastatic high-risk renal cell carcinoma is an unmet medical need. In the past, several tyrosine kinase inhibitor trials have failed to demonstrate an improvement of disease-free survival (DFS) in this setting. Only one trial (S-TRAC) provided evidence for improved DFS with sunitinib but without an overall survival (OS) signal.

Artificial disc replacement and adjacent-segment pathology: 10-year outcomes of a randomized trial.

Objective: Artificial disc replacement (ADR) is designed to preserve motion and thus protect against adjacent-segment pathology (ASP) and act as an alternative treatment to fusion surgery. The question remains, how well do ADR devices perform after 10 years of follow-up compared with fusion surgery in terms of patient satisfaction, sustainability, and protection against ASP?

Methods: This was the 10-year follow-up study of 153 participants who underwent ADR or fusion surgery after anterior decompression due to cervical degenerative radiculopathy (ISRCTN registration no. 44347115).

Bivalirudin Versus Heparin Monotherapy in ST-Segment-Elevation Myocardial Infarction.

Background: Bivalirudin was not superior to unfractionated heparin in patients with myocardial infarction (MI) treated with percutaneous coronary intervention and no planned use of GPI (glycoprotein IIb/IIIa inhibitors) in contemporary clinical practice of radial access and potent P2Y-inhibitors in the VALIDATE-SWEDEHEART randomized clinical trial (Bivalirudin Versus Heparin in STEMI and NSTEMI Patients on Modern Antiplatelet Therapy-Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry).

Methods: In this prespecified separately powered subgroup analysis, we included patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with the primary composite end point of all-cause death, MI, or major bleeding event within 180 days.

Results: Among the 6006 patients enrolled in the trial, 3005 patients with ST-segment-elevation MI were randomized to receive bivalirudin or heparin.

[What surgeons can learn from athletes and fighter pilots - mental training in surgery].

Performing surgery requires the execution of fine-tuned motor skills, as well as cognitive decision-making processes, much like the demands elite athletes or fighter pilots are facing. Mental training is used successfully in those fields, and according to research it can also be highly effective in surgical training, both for enhancing cognitive abilities and acquisition of technical skills. Therefore, mental training could be a valuable complement in surgical training, both for novices and more experienced surgeons.

Incidence, detection and outcome of differentiated thyroid cancer in Western Sweden.

Background: It is unclear whether the increasing incidence of thyroid cancer (TC) due to increased diagnosis of small and indolent tumours might mask a real increase of clinically significant cancers. The aim of this study was to correlate surgery, pathology and outcome data of individual patients to the mode of primary detection (palpation, by imaging or incidental) to assess if TC incidence has increased.

Methods: The Swedish Cancer Registry identified all patients with TC in Västra Götaland County representing approximately 1.

Imaging of the left atrium: pathophysiology insights and clinical utility.

Left atrial imaging and detailed knowledge of its pathophysiology, especially in the context of heart failure, have become an increasingly important clinical and research focus. This development has been accelerated by the growth of non-invasive imaging modalities, advanced image processing techniques, such as strain imaging, and the parallel emergence of catheter-based left atrial interventions like pulmonary vein ablation, left atrial appendage occlusion, and others. In this review, we focus on novel imaging methods for the left atrium, their pathophysiological background, and their clinical relevance for various cardiac conditions and diseases.

[SCORE2 - an updated model for cardiovascular risk prediction].

Cardiovascular disease is the most important cause of death and life-years lost in Sweden today. Cardiovascular risk prediction is a cornerstone in primary prevention; the use of antihypertensive and lipid-lowering therapy is guided by absolute cardiovascular risk. The Systematic COronary Risk Evaluation (SCORE) model has been the most widely applied model in Sweden for almost two decades.

[Microwave ablation of the spleen: An easy and gentle method for treatment of secondary splenomegaly in children. A case report].

Portal hypertension (PHT) in children may be caused by many different liver and vascular diseases and can lead to life threatening complications such as splenomegaly with thrombocytopenia. The treatment of choice for symptomatic splenomegaly is Partial Splenic Embolization (PSE) which is effective but painful, and therefore not offered to children younger than 10 years of age at the Karolinska University Hospital in Stockholm.  Percutaneous microwave ablation (MWA) is a well-established method in adults for the treatment of tumors in the liver and other organs.

[Paroxysmal dysarthria and ataxia - unusual MS manifestation].

Multiple sclerosis is a common inflammatory demyelinating disease of the central nervous system. Although many patients present permanent symptoms, a number of them suffer of deficits of paroxysmal character. One unusual manifestation of paroxysmal nature is episodes of dysarthria and ataxia known as PDA (paroxysmal dysarthria and ataxia).

[Mavacamten - the first disease-specific pharmacological treatment of hypertrophic cardiomyopathy].

Mavacamten, a selective inhibitor of cardiac myosin ATPase, which reduces hypercontractility, is the first disease-specific treatement of HCM. In phase 2 trials including persons with HCM without outflow obstruction, a significant reduction in NT-proBNP and troponin I was reported. In the EXPLORER-HCM trial participants with hypertrophic cardiomyopathy with outflow obstruction randomized to mavacamten displayed a significant recuduction in the outflow gradient, a greater exercise capacity and an improvement in quality of life as compared with those who were randomized to placebo.

[Specialized services for adults with developmental disabilities].

Adults with developmental disabilities, e.g. intellectual disability, autism, cerebral palsy or neuromuscular diseases ,have an increased risk of somatic and psychiatric disorders and of premature death.

Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial.

Background: Observational and small, randomized studies suggest that influenza vaccine may reduce future cardiovascular events in patients with cardiovascular disease.

Methods: We conducted an investigator-initiated, randomized, double-blind trial to compare inactivated influenza vaccine with saline placebo administered shortly after myocardial infarction (MI; 99.7% of patients) or high-risk stable coronary heart disease (0.

A comparison of the in vitro effects of three fibrinogen concentrates on clot strength in blood samples from cardiac surgery patients.

Background: Fibrinogen concentrate is used clinically to improve hemostasis in bleeding patients. We investigated and compared the efficacy of three commercially available fibrinogen concentrates to improve clot strength in blood samples from cardiac surgery patients.

Objectives: Postoperative blood samples were collected from 23 cardiac surgery patients.

[High correlation between the different measures suggests that mortality is relatively correctly reported in Sweden].

Infection fatality ratio (IFR) in covid-19 is highly debated in international and Swedish press. In Sweden, three different estimates have been used to estimate mortality, based on statistics either from the Swedish National Board of Health and Welfare, and the Public Health Agency of Sweden, whereas excess mortality calculated by EuroMOMO. Mortality is based on death certificates, which can be accurate or erroneous, but previous analyses have suggested that over- and underdiagnosis usually even out.

Surgical procedures for children in the public healthcare sector: a nationwide, facility-based study in Uganda.

Objective: This study investigated the surgical services for children at the highest levels of the public healthcare sector in Uganda. The aim was to determine volumes and types of procedure performed and the patients and the human resource involved.

Design: The study was a facility-based, record review.

[20-25 procent of patients with rectal cancer may be saved from a rectal resection].

Besides clinical evaluation, all patients with rectal cancer must be examined with CT of the chest and abdomen to assess the presence of metastases, pelvic MRI to stage the tumour locally, and if possible, colonoscopy to detect synchronous lesions. The recommended treatment is then discussed at an MDT conference and neoadjuvant radio- or chemoradiotherapy given according to national guidelines. A new digital rectal examination (DRE) and proctoscopy, CT and pelvic MRI should be performed around six weeks after treatment.

Uninterpretable cerebrospinal fluid absorbance scans caused by antibiotic therapy.

Background: The revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage (UK) provide an objective means of assessing cerebrospinal fluid samples to determine the risk of subarachnoid haemorrhage. The guidelines are intended for general use, but samples rendered uninterpretable due to the presence of the antibiotic doxycycline have been described. Here, further cases of antibiotic-based interference, and their implications, are presented.