Short-term outcomes from the 'Watch and Wait' (WoW) study: prospective cohort study.

Background: Despite absence of level 1 evidence on the long-term oncological safety of non-operative management for rectal cancer (watch and wait), increased implementation has occurred globally over the past decades. In Sweden, a pan-national prospective non-randomized study was initiated in 2017 to assess its implementation.

Method: Patients with biopsy-proven rectal cancer receiving neoadjuvant therapy according to national guidelines in whom a clinical complete response was detected at reassessment were eligible for inclusion following informed consent.

Associations of infection burden with Kawasaki disease in a population-based setting during 30 years.

Objectives: The objective of this study was to investigate the role of infections in the pathogenesis of Kawasaki disease.

Methods: The investigation was a nationwide epidemiological case-control study, comprising all cases of Kawasaki disease diagnosed in Sweden 1987-2018. Controls were randomly sampled from the general population, matched on sex, age, and area of residency.

Challenges and opportunities in organ donation after circulatory death.

In recent years, there has been resurgence in donation after circulatory death (DCD). Despite that, the number of organs transplanted from these donors remains low due to concerns about their function and a lack of an objective assessment at the time of donation. This overview examines the current DCD practices and the classification modifications to accommodate regional perspectives.

[Preparing for patient work founded on evidence in medical school - a questionnaire study on final-year medical students].

Several of the requirements for obtaining a medical degree according to the Swedish Higher Education Ordinance illustrate the scientific basis of the profession, and systematic reviews as well as health technology assessments (HTA) constitute cornerstones in evidence-based medicine. In this study, medical students' experience of scientific education related to the profession was explored, and their knowledge achieved was sampled by five multiple-choice questions (MCQ). A total of 433 out of 641 students attending the final semester in six medical schools in Sweden participated (response rate: 68%).

[Management of patients in cardiac arrest in the emergency department].

Cardiac arrest is the most time-sensitive condition that personnel face in the emergency department. Optimal management consists of good quality cardiopulmonary resuscitation, the simultaneous performance of focused investigations to identify potential reversible causes, and the delivery of cause-specific treatments. In order to manage patients with cardiac arrest in an efficient manner, team members need to have clearly defined roles and ready access to required equipment.

[New Alzheimer's treatments - a need for national preparations and coordination].

Approximately 100,000 persons live with Alzheimer's disease in Sweden. As the population ages, the need for diagnostics and disease-modifying treatment grows. Previously available treatments provide moderate symptom relief but do not affect disease progression.

How to make cardiology clinical trials more inclusive.

Cardiovascular clinical trials continue to under-represent children, older adults, females and people from ethnic minority groups relative to population disease distribution. Here we describe strategies to foster trial representativeness, with proposed actions at the levels of trial funding, design, conduct and dissemination. In particular, trial representativeness may be increased through broad recruitment strategies and site selection criteria that reflect the diversity of patients in the catchment area, as well as limiting unjustified exclusion criteria and using pragmatic designs that minimize research burden on patients (including embedded and decentralized trials).

An atlas of small non-coding RNAs in human preimplantation development.

Understanding the molecular circuitries that govern early embryogenesis is important, yet our knowledge of these in human preimplantation development remains limited. Small non-coding RNAs (sncRNAs) can regulate gene expression and thus impact blastocyst formation, however, the expression of specific biotypes and their dynamics during preimplantation development remains unknown. Here we identify the abundance of and kinetics of piRNA, rRNA, snoRNA, tRNA, and miRNA from embryonic day (E)3-7 and isolate specific miRNAs and snoRNAs of particular importance in blastocyst formation and pluripotency.

Blood biomarkers of neuronal injury and astrocytic reactivity in electroconvulsive therapy.

Despite electroconvulsive therapy (ECT) being recognized as an effective treatment for major depressive episodes (MDE), its application is subject to controversy due to concerns over cognitive side effects. The pathophysiology of these side effects is not well understood. Here, we examined the effects of ECT on blood-based biomarkers of neuronal injury and astrocytic reactivity.

[The first Swedish national care program for pediatric chronic pain].

Pediatric chronic pain is common and frequently results in reduced wellbeing and functioning. Limited knowledge among health care professionals has motivated a national care program for pediatric chronic pain to increase the standard of care for this group. Emphasizing a biopsychosocial approach, treatment should focus on self-management of pain and distress to increase resilience, functioning and wellbeing.

The leukotriene receptor antagonist montelukast as a potential therapeutic adjuvant in multiple sclerosis - a review.

Multiple Sclerosis (MS) is a multifactorial autoimmune disease of the central nervous system (CNS). It is characterized by a heightened activation of the immune system with ensuing inflammation, demyelination and neurodegeneration with consequences such as motor, sensory, cognitive, as well as autonomic dysfunctions. While a range of immune-modulatory drugs have shown certain efficacy in alleviating pathology and symptoms, none of the currently available therapeutics regenerates the damaged CNS to restore function.

Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma.

Background: Major hepatectomy in perihilar cholangiocarcinoma (pCCA) patients with a small future liver remnant (FLR) risks posthepatectomy liver failure (PHLF). This study examines combined portal and hepatic vein embolisation (PVE/HVE) to increase preoperative FLR volume and potentially decrease PHLF rates.

Methods: In this retrospective, multicentre, observational study, data was collected from centres affiliated with the DRAGON Trials Collaborative and the EuroLVD registry.

[Health-related quality of life for patients with inflammatory bowel disease requires more than anti-inflammatory treatment].

The care of IBD patients aims to achieve the best possible health. The treatment goals in IBD should therefore, in addition to stable control of intestinal inflammation, also consider health-related quality of life (HRQL) and extraintestinal complications. Fatigue is an underrecognized array of symptoms that need more attention and, if possible, treatment.

Inhibition of endothelial-to-mesenchymal transition in a large animal preclinical arteriovenous fistula model leads to improved remodelling and reduced stenosis.

Aims: Vein grafts are used for many indications, including bypass graft surgery and arteriovenous fistula (AVF) formation. However, patency following vein grafting or AVF formation is suboptimal for various reasons, including thrombosis, neointimal hyperplasia, and adverse remodelling. Recently, endothelial-to-mesenchymal transition (EndMT) was found to contribute to neointimal hyperplasia in mouse vein grafts.

Patient-reported outcomes in chronic hepatitis delta: An exploratory analysis of the phase III MYR301 trial of bulevirtide.

Background & Aims: Once-daily treatment of chronic hepatitis delta (CHD) with bulevirtide is well tolerated and associated with significant reductions in HDV RNA in the blood and in biochemical liver disease activity. This study explored the effects of 48-week bulevirtide treatment on health-related quality of life (HRQoL) in patients with CHD.

Methods: In an open-label, randomised, phase III trial, 150 patients with CHD and compensated liver disease were stratified by cirrhosis status and randomised 1:1:1 to no treatment (control), bulevirtide 2 mg/day, or bulevirtide 10 mg/day for 48 weeks.

Bowel function, urinary tract function, and health-related quality of life in males with anorectal malformations.

Purpose: There is a knowledge gap regarding long-term outcomes for males undergoing surgery for an anorectal malformation (ARM). The purpose of this study was to investigate bowel function, bladder function, and health-related quality of life (HRQoL) in male patients with an anorectal malformation.

Methods: This cross-sectional questionnaire-based study included males treated for ARM at our institution between 1994 and 2017.

[Is ambulatory endocrine neck surgery safe?].

This retrospective observational study aimed to identify complications and re-admissions after unilateral exploration of the parathyroid, hemithyroidectomy or resection of the thyroid isthmus in patients that underwent ambulatory surgery at Karolinska University Hospital 2018-2019. The medical records of 280 patients were scrutinized by searching for re-admissions within 10 days or frequent contact with the healthcare provider within 30 days. 256 out of 280 patients underwent ambulatory surgery.

[Risk factors among children born at the limit of viability 22+0 - 23+6 weeks].

Despite improved survival of extremely preterm infants born at <28 weeks gestational age (GA) since the 1990s, only few reports on long-term outcomes have been published. The aim of our study was to determine risk factors among mothers and outcomes for their children born at the limit of viability (GA 22 + 0 - 23 + 6 weeks) at the Karolinska university hospital in 2009-19, before and after the introduction of new national interventionist guidelines in 2016. We hypothesized that infant survival, morbidity and cognitive functions at 2 years' corrected age had improved after the new clinical practice.