bluuebunny/crossref_metadata_2025 huggingface dataset:
70571 - Evaluating the 10% tracer signal cutoff for defining a lymph node being an additional sentinel lymph node in breast cancer surgery
Authors: AbuOddos Nizar , Christenhusz Anke , Alice Lejla , Mirzaei Nushin , Karakatsanis Andreas , Eriksson Staffan , Bagge Roger Olofsson , Wärnberg Fredrik
Published: August 2024

Introduction

Superparamagnetic iron oxide nanoparticles (SPIO) is an effective tracer for sentinel lymph node (SLN) identification. A common definition of an additional SLN is a node with ≥10% of the signal produced by the highest signaling SLN. This study aimed to investigate the risk of additional SLNs being metastatic based on percentage of the maximum magnetic signal.

Method

Individual SLN data from five Swedish and three Dutch studies (n=908) using SPIO in breast cancer patients were extracted from patients with SLN metastases. Additional SLNs were grouped based on the percentage of their magnetic signal compared to the highest signaling SLN (SLN1=100%). The risk of additional SLNs being metastatic by signal percentage was calculated. Chi-square-test was used to compare proportions.

Result

Of 156 patients with SLN metastases, 78 had only one SLN. Among 78 patients with ≥2 SLNs, a total of 204 SLNs were retrieved, 115 with metastases and 89 without. The risk of metastasis in SLN1 was 75.6% (59/78 nodes), in SLNs with 99-80% of SLN1 signal risk was 65.4% (17/26), 79-60%; 36.8% (7/19), 59-40%; 41.7% (10/24), 39-20%; 43.2% (16/37), and 19-10%; 37.5% (6/16)(p=0.25).

Removal of only the highest signaling SLN, would correctly stage 59/78 (75.6%) patients; the two highest signaling SLNs correctly staged 74/78 (94.9%); the three highest, 78/78(100%), respectively. The difference between 1 vs. 2 SLNs removed was 19% (p<0.001) and 2 vs. 3 SLNs: 5%(n.s.).

Discussion

In this exploratory analysis, removal of >3 SLNs following the 10% cutoff or adjustment of the cutoff did not result in a meaningful clinical benefit.
71514 - Phyllodes Tumours: Interdisciplinary Management Recommendations from the Stockholm Region
Authors: Lindqvist Ebba , Fahlén Mia , Fredholm Hanna , Hartman Johan , Karlsson Fredrik , Papakonstantinou Andri , Sackey Helena , Zouzos Athanasios
Published: August 2024

Introduction

Phyllodes tumours (PT) are fibroepithelial breast tumours divided into benign, borderline, and malignant PT.

Method

We here present the first Swedish practice guidelines for the clinical management of PT, from an interdisciplinary working group in the Stockholm region.

Result

PT should be suspected in patients over ≥ 30 years of age presenting with a fast-growing lump and/or a lump of ≥ 5 cm size. There are diagnostic challenges specific to PT, which are difficult to separate from fibroadenoma and other lesions on radiology. The preoperative work-up of breast lumps of ≥ 2 cm should involve a core needle biopsy, however, the sensitivity for PT is low with core needle biopsy and fine needle aspiration alike.

Suspected borderline and malignant PT should be managed at a sarcoma centre, in collaboration between sarcoma surgeons and breast surgeons. All suspected PT should be discussed preoperatively at a multidisciplinary team meeting. For recommended excisional margins, see Table 1. Positive margins can be accepted for benign PT, which have a low risk of recurrence and no metastatic potential.

Sentinel node biopsy is not indicated in surgery for PT. Immediate breast reconstruction is not advisable in cases of malignant PT, but may otherwise be offered. Post-operative follow-up is tailored to the subtype of PT, and for borderline and malignant PT involves both clinical and radiological surveillance. For malignant PT, adjuvant radiotherapy can sometimes be indicated and may prevent recurrence.

Discussion

We believe that these guidelines will be of clinical use in the work-up, management and follow-up of PT.
71691 - Long-term overall survival after isolated liver perfusion with melphalan in patients with isolated liver metastases of uveal melanoma (SCANDIUM trial)
Authors: Nelson Axel , Shafazand Amir , All-Ericsson Charlotta , Cahlin Christian , Elander Nils , Helgadottir Hildur , Kiilgaard Jens Folke , Kinhult Sara , Ljuslinder Ingrid , Rizell Magnus , Eilard Malin Sternby , Ullenhag Gustav , Nilsson Jonas A , Ny Lars , Lindnér Per , Bagge Roger Olofsson
Published: August 2024

Introduction

Uveal melanoma, a rare subtype of melanoma, often spreads to the liver, resulting in poor prognosis with limited treatment options. The SCANDIUM trial investigated the efficacy of isolated hepatic perfusion (IHP) with high-dose melphalan compared to investigators choice of treatment for patients with liver metastases from uveal melanoma. We have previously reported superior response rates and progression-free survival with IHP, although overall survival (OS) at 24 months did not reach statistical significance. Here we present extended OS follow-up data.

Method

In this phase III trial, treatment-naïve nordic patients with isolated liver metastases from uveal melanoma were randomized between 2013 and 2021 to receive either IHP or best alternative care in a 1:1 ratio, with no crossover allowed. All IHP treatments were performed at Sahlgrenska University hospital.

Result

Patients were randomized to IHP (n=43) or control (n=44). In the IHP group, 89% underwent the procedure. The control group received chemotherapy (49%), immunotherapy (39%) or localized treatment interventions (9%). The overall response rate in the IHP group was 40%, with a median response duration of 13.7 months. At a minimum 36-month follow-up, the 3-year OS rate was 18.6% in the IHP group compared to 9.1% in the control group (p=0.23). The 5-year OS rate was 16.3% versus 6.8%, respectively. Median OS was 21.4 months in the IHP group and 17.3 months in the control group (p=0.11, log-rank test).

Discussion

Extended analysis of the SCANDIUM trial confirms the long-term efficacy of one-time IHP treatment compared to best alternative care for isolated liver metastases from uveal melanoma.
71793 - Infectious complications after immediate versus delayed implant-based reconstruction in women with breast cancer – a retrospective cohort study
Authors: Franzén Sofie , Lothigius Karin , Landerholm Kalle
Published: August 2024

Introduction

Immediate breast reconstruction (IBR) has come to increase in Sweden. In Jönköping, an implant is used for all reconstructions. The study aimed to investigate postoperative infections and compare implant-based IBR with implant-based delayed breast reconstruction (DBR).

Method

This retrospective study included all women who had undergone IBR or DBR between 2016 and 2022 in Region Jönköpings län. Data was collected from medical charts. The main endpoint was surgical site infection within three months. The secondary endpoint was time to oncological treatment.

Result

130 breasts were included, 96 in the group IBR and 34 in the group DBR, distribution per year is shown in Figure 1. Malignancy was the most common indication (78%) and 38% of the included breasts were previously operated with breast conserving surgery. Infection within three months occurred in 15 breasts, 14 of these among IBR (p=0,11), none of them had received radiation therapy. Implant removal within three months occurred in three of the 11 reoperated breasts, only one of them due to infection. Implant volume was associated with infection in IBR (p=0,014). Time to oncological treatment was 39 days among IBR and 38 among DBR (p=0,44). No patient was excluded from adjuvant treatment because of infection.

Discussion

Infection was found almost exclusively among IBR. Few patients had a known risk factor, unexpectedly none of them were affected by infection. The chance of receiving timely adjuvant therapy did not differ between the groups.
72197 - Evaluating MRI artefacts and skin discoloration using an intradermal ultra-low dose of superparamagnetic iron oxide for sentinel lymph node detection
Authors: Mirzaei Nushin , Wärnberg Fredrik , Zaar Pontus , Diniz Micael Oliveira , Karakatsanis Andreas , Leonhard Henrik , Bagge Roger Olofsson
Published: August 2024

Introduction

Superparamagnetic iron oxide (SPIO) nanoparticles is non-inferior as a tracer for sentinel lymph node detection in patients with breast cancer compared to the standard radioactive tracer with or without blue dye. Sentinel lymph node biopsy has been successful using an ultra-low dose of 0.1 mL SPIO injected intradermally in patients with breast cancer, and this study aims to assess the potential reduction of SPIO-related skin discoloration and breast magnetic resonance imaging (MRI) artefacts at 6 and 12 months after breast conserving surgery using an ultra-low dose of SPIO.

Method

Skin discoloration and MRI artefact were pre-planned endpoints in the prospective MAGSNOW feasibility study. MRI follow-ups were scheduled 6 and 12 months after surgery, and MRI artefacts were classified in six grades. SPIO-induced skin discoloration was assessed at baseline, 1, 6 and 12 months by photography.

Result

Thirty-seven out of fifty patients underwent 6 and 12 months MRI follow-ups, revealing no MRI artefacts impairing breast assessment. At 12 months, twenty-seven (73.0%) patients had minimal MRI artefacts, primarily in the subcutaneous tissue, or less than 5 mm in the fibroglandular tissue. Additionaly, at 12 months, twenty-seven out of fifty (54%) patients had a skin discoloration with a median area of 0.79 cm2 (IQR 0.14-1.41).

Discussion

An ultra-low dose of SPIO may offer a solution to the concerns of MRI artefacts and skin discoloration associated with the present recommended dose of 1-2 mL of SPIO. However, these findings have to be confirmed in a larger trial.
70926 - Early discharge from Paediatric day surgery unit
Authors: Heina Elisabet
Published: August 2024

Introduction

Day surgery units are characterized by a rapid patient flow. In the pediatric setting there is often a delay in discharge due to micturition problem for the child postoperatively.

This might lead to a long day, waiting for the child to pee after minor surgery. Some children have difficulties urinating due to anaesthetic causes, others for surgical reasons. Furthermore, the environment at a hospital can be stressful for children and have a negative impact on the ability to urinate.

The aim for this study was to see if it’s safe for children to be discharged without having peed after day surgery procedures.

Method

A routine was developed for early discharge, which meant children were discharged prior to micturition if the child’s general condition was good. Excluded procedures were bilateral undescended testis, Fowler Stephens 2 and hypospadias. Thorough oral and written information was given regarding when/where to seek healthcare if the child didn´t urinate the same evening. Written consent was obtained by caregivers.

Result

Out of 1000 children where 122* patients selected for early discharge, 119 of these were eligible for inclusion according to protocol. 2 out of 119 patients had to attend healthcare. 1 patient urinated upon arrival at the ward, 1 needed enema to urinate.

*The 3 excluded patients had hypospadia operation, all 3 needed to attend healthcare to urinate.

Discussion

With appropriate information and instructions, discharge prior to urination is safe and can be offered to children after daycare surgery if the caregiver and patient prefer early discharge.
71821 - Comparisons of serum and urine concentrations of leucine-rich alpha-2 glycoprotein 1 (LRG1) in children with and without appendicitis
Authors: Gudjonsdottir Johanna , Roth Bodil , Ohlsson Bodil , Hagander Lars , Salö Martin
Published: August 2024

Introduction

Leucine rich alpha-2 glycoprotein 1 (LRG1) has emerged as a promising biomarker for appendicitis, especially in pediatric patients. However, the currently available data are sparse. We aimed to compare serum and urine leucine rich alpha-2 glycoprotein 1 (LRG1) concentrations in children with no appendicitis (NA), uncomplicated appendicitis (UA) and complicated appendicitis (CA).

Method

A prospective study including children <15 years with suspected appendicitis (pain in the right lower quadrant). Blood and urine samples were collected during clinical evaluation at the Pediatric ED and analyzed for LRG1 concentrations. Group comparisons were made using Kruskal-Wallis test with post hoc Dunn-Bonferroni tests for pairwise comparisons. Appendicitis diagnosis and severity were determined through histopathological examination. The study was approved by the regional ethics committee (Regionala Etikprövningsmyndigheten, Lund, Sweden, DNR 2013/614).

Result

173 children were included. 133 (77%) had appendicitis and 57 (43%) of these had complicated appendicitis. The median age was 10 (IQR 8-12) years and 99 (57%) were boys. The groups differed in distribution of sex, age and symptom duration. Median serum LRG1 for patients with NA, UA, and CA were 27.6 (19.7-36.6) μg/mL, 24.8 (18.7-30.1) μg/mL, and 23.5 (18.9-31.5) μg/mL, respectively (p=0.16). Median urine LRG1 were 0.33 (0.10-0.72) μg/mL, 0.1 (0.02-0.29) μg/mL, and 0.3 (0.12-1.07) μg/mL, respectively (p<0.001, significant when comparing NA with UA, and UA with CA).

Discussion

There were no differences in serum LRG1 in our groups. Children with UA had lower urine LRG1 compared to children with NA and CA. These analyses, however, do not take into consideration potential confounding.
72322 - Centralization of the surgical care of patients born with anorectal malformations does not reduce short-term complications
Authors: Petersens Malin af , Stenström Pernilla , Borg Helena , Danielson Johan , Gunnarsdottir Anna , Oddsberg Jenny , Gustafson Elisabet , Graneli Christina , Hagelsteen Kristine , Tofft Louise , Wester Tomas
Published: August 2024

Introduction

The Swedish National Board of Health and Welfare centralized the surgical care of patients with anorectal malformations from four to two centers in 2018. The aim of this study was to compare short term complications after anorectal reconstruction before and after centralization.

Method

This was a retrospective review of hospital records, including all children in Sweden who underwent reconstruction of an anorectal malformation 1st of July 2013 to 30th of June 2023, divided into two 5-year periods, before and after centralization. The main outcomes were unplanned readmissions and procedures requiring general anesthesia up to 90 days after the reconstruction, as well as complications classified according to Clavien-Madadi up to 30 days after the procedure.

Result

Before centralization 173 children underwent anorectal reconstruction compared with 176 children after centralization. Patient groups were comparable with respect to associated malformations and type of anorectal malformation. Eighty (46%) children had a stoma before the anorectal reconstruction prior to centralization and 89 (51%) after (p=0.454). The anorectal reconstruction was performed at median age 61 and 47 days of age, respectively. Unplanned readmissions after anorectal reconstruction were needed in 12 (6%) children before centralization compared with 24 (14%) after (p=0.0520). Unplanned procedures under general anesthesia were required in 21 (12%) children before centralization compared with 24 (14%) after (p=0.294). There were 16 (9%) complications (Clavien-Madadi III-V) within 30 days after anorectal reconstruction before centralization and 12 (7%) after (p=0.856).

Discussion

Centralization of the surgical care of patients with anorectal malformations in Sweden does not seem to reduce short-term complications.
71223 - Risk factors for severe complications and mortality in elderly undergoing colon surgery – a retrospective cohort study from the ERAS-registry
Authors: Bjerregaard Felix , Baloch Naseer , Asklid Daniel , Ljungqvist Olle , Pekkari Klas , Elliot Anders H , Gustafsson Ulf O
Published: August 2024

Introduction

The rising global population of older adults is expected to lead to more elderly individuals needing surgery for colon cancer. It's crucial to study risk factors for mortality and complications following colon surgery in this demographic.

Method

The Swedish part of the ERAS-database (EIAS) from 2009 and 2022 was used. Patients aged ≥ 75 years undergoing colon surgery were compared with younger patients regarding basic characteristics and type of surgery. Possible risk factors for mortality and complications in the elderly group were analyzed using multivariate regression.

Result

11 767 patients were included. After adjusting for available confounders, male gender, OR: 1.62; 95% CI: (1.23-2.14), ASA ≥ 3, OR: 1.59; 95% CI: (1.19-2.12), severe pulmonary disease, OR: 1.74; 95% CI: (1.03-2.95), recent immunosuppressive treatment, OR: 3.23; 95% CI: (1.61-6.47), diverticular disease as indication for surgery, OR: 2.78; 95% CI: (1.53-5.07) and open surgery, OR: 1.40; 95% CI (1.05-1.85) were significantly associated with severe complications in patients ≥ 75 years. Likewise, smoking, OR: 2.59; 95% CI (1.04-6.50), ASA ≥ 3, OR: 2.38; 95% CI (1.15-4.92), severe pulmonary disease, OR: 2.98; 95% CI (1.21-7.33), and open surgery, OR: 2.07; 95% CI (1.09-3.91) were significantly associated with mortality within 30 days in the elderly group.

Discussion

Several risk factors for severe complications and mortality within 30 days of colon surgery in the elderly population were identified. Among these, severe pulmonary disease, an ASA score of ≥ 3, and undergoing open surgery were all significantly associated with both severe complications and mortality.
71274 - Earnings and work loss after colon and rectal cancer: A Swedish nationwide matched cohort study
Authors: Nilsson Per J , Boman Sol Erika , Hed-Myrberg Ida , Bruze Gustaf , Martling Anna , Nordenvall Caroline
Published: August 2024

Introduction

Colorectal cancer is common and prognosis improving. Thus, survivorship including financial consequences after treatment is important. The aim of this study was to assess financial toxicity in working-age patients with colon and rectal cancer relative to matched comparators.

Method

The study utilised data from the Swedish national research database CRCBaSe that is generated from the Swedish ColoRectal Cancer Register and links several national registers. A retrospective population-based nation-wide cohort study on financial toxicity (i.e., earnings, disposable income, work loss) in survivors of stage I-III colorectal cancer treatment was undertaken. Median regression analyses were used to compare incomes and logistic regression for probability of work loss.

Result

A cohort of 8 863 colorectal cancer survivors (all diagnosed prior to 2017) with 52 138 matched comparators could be analysed. Although a clear reduction in earnings was observed the year of diagnosis, disposable income was unaltered. Earnings never fully recovered during the 5-year follow-up. The probability of work loss increased the year of diagnosis and never fully recovered. Probability of work loss appeared similar between colon and rectal cancer survivors, but the risk was most pronounced among patients with rectal cancer who had received neoadjuvant therapy.

Discussion

This study shows that despite a developed well-fare system providing maintained disposable income for colorectal cancer survivors, financial toxicity, particularly risk of work loss, occurs among survivors of colorectal cancer.
71795 - Income is associated with survival after diagnosis of metastatic colorectal cancer
Authors: Ljunggren Malin , Dietrich Caroline E , Merk Cecilia , Palmer Gabriella , Martling Anna , Nordenvall Caroline
Published: August 2024

Introduction

Treatment for metastatic colorectal cancer (mCRC) has evolved rapidly over the last few decades. We hypothesised that this had led to increasing differences in survival based on patient income. The aim was to investigate whether income was associated with survival after mCRC and whether a potential association persisted over the years.

Method

All Swedish adult patients diagnosed with colorectal cancer in 2009-2021 and metastases including 2022 were included. The CRCBaSe linkage was used to identify patients and retrieve data. The association between income quartile at metastasis diagnosis and overall survival was investigated using Cox regression. Diagnosis year was investigated as an effect modifier. Models were adjusted for sex, age, education level, marital status, and birth country.

Result

There were 33,800 patients with mCRC included. Median survival was 13 months for patients in the lowest income quartile and 19 months for patients in the highest income quartile. Median survival improved during the study period from 14 months in 2007-2011 to 19 months in 2017-2022. The adjusted model showed that patients in the highest income quartile had a superior survival (HR Q4 vs Q1: 0.86, 95% confidence interval: 0.83-0.90). Diagnosis year only marginally modified the effect income had on survival.

Discussion

Income is an important factor affecting survival after mCRC. Survival improved significantly during the time period. However, diagnosis year neither strengthened nor weakened the association between income and survival.
72315 - Point Of Care Ultrasound (POCUS) in screening for Abdominal Aortic Aneurysm: a comparative, cohort study
Authors: Starck Joachim , Brunkwall Silke , Mosonyi Andrea , Holst Jan
Published: August 2024

Introduction

Screening for abdominal aortic aneurysm (AAA) performed with ultrasound (US) in men reduces AAA-related mortality. Ambulatory screening and surveillance procedures could improve adherence to screening programs. Point Of Care Ultrasound (POCUS) could facilitate ambulatory screening for AAA. The aim of this study was to assess whether the infrarenal aortic diameter (IAD) in a screening setting could be measured interchangeably with POCUS compared to standard ultrasound equipment.

Method

A comparative cohort study was conducted of men screened for AAA at the age of 65 with IAD measured to ≥25-29 mm. The cohort was invited to re-examination 5-12 years after screening. Three measurements of IAD each were conducted with a standard US (LOGIQTM, GE) device and POCUS (LumifyTM, Philips) device. Limits of agreement between the devices and repeatability for each device were calculated.

Result

At screening, 500 men had IAD of ≥25–29 mm. With 102 men deceased at follow-up (FU), 230 men attended the examination. Median FU was 9.9 years (interquartile range [IQR]: 8.0-11.0). Median IAD was 27.1 mm, (IQR: 23.7-32.8). POCUS underestimated IAD by 0.23 mm compared to the standard ultrasound machine, 95% limits of agreement were -3.1 mm to 2.6 mm between the devices. The repeatability was ± 2.5 mm for standard equipment and ± 3.2 mm for handheld device.

Discussion

The handheld device showed no systematic bias of clinical importance in measuring IAD in a screening setting although with a slightly wider repeatability interval compared to standard US equipment implying the possibility to consider POCUS devices for AAA-screening purposes.
71312 - Ambulatory True-Close Thoracic Vent, an outpatient management of Pneumothorax – results of 24 years' experience
Authors: Leo Jonas , Shahrivar Mehrnoosh
Published: August 2024

Introduction

Traditional guidelines for the primary treatment of pneumothorax differ and include simple aspiration, small-bore catheter or chest tube drainage. Treatment via conventional chest tube drainage connected to a suction system is usually associated with hospitalization for approximately 6 days, immobilization, and discomfort. However, reliable patients who do not want to be hospitalized can safely be treated as outpatients with a small-bore catheter attached to a Heimlich valve, True-Close Thoracic Vent (TV).

We started using TV at Capio S:t Görans hospital (CStG) in 1999 in cooperation with dr Leif Dernevik, Department of Thoracic Surgery, Sahlgrenska University Hospital.

Method

TV is a minimally invasive, immediate salvage device for the treatment of pneumothorax. Indications are primary & secondary spontaneous and iatrogenic pneumothorax.

The exclusion criteria: hydro/hemopneumothorax, patient refusal, dementia or psychologically unstable, and underlying pulmonary disease requiring supplemental oxygen.

Patients are identified and operated on in the ward or postop area.

Operation technique: 2nd intercostal-space (IC2) in the midclavicular line (MCL), local anesthetics together with light iv sedation, mini thoracotomy (no-bore safe ATLS-technique), aspiration of air and fixation of TV.

Post drain x-ray is conducted and most of the patients are sent home the next day with a 5+2-day ambulatory treatment plan.

Result

2016-2023:

Cases n 445

Male/female 75/25%

Success rate 93%

AVLOS 2,3 days

Mortality 0%

Morbidity grade 3b, one patient (erroneous placement in IC1 MCL).

Discussion

TV is a safe, cost-effective ambulatory method for treatment of pneumothorax. By using this technique, CStG has saved approximately 2800 beds since 1999 compared to non-ambulatory pneumothorax care.
71533 - Epidemiology of the Trauma Population and Trauma-related Mortality at the Karolinska University Hospital over a 5-year period (2018-2022)
Authors: Kashash Sara , Akram Shahzad
Published: August 2024

Introduction

Trauma is the leading cause of mortality in adults under 45 years old. Trauma demographics change over time therefore requiring constant re-evaluation of the presenting trauma population to decrease morbidity and mortality. The study aimed to describe the trauma population at the Karolinska University Hospital, causes of death and examine the proportion of potentially preventable and preventable deaths.

Method

Using the trauma registry SweTrau, variables for all trauma patients >15 years (6483 patients) were extracted during the period 2018 to 2022 with regards to age, gender, type of injury, injury mechanism, injury intention etc. Descriptive statistics were used to describe the general trauma population and compare survivors and non-survivors. Logistic regression was used to evaluate factors associated with 30-day mortality.

Result

Stockholm’s trauma demographics consist of predominantly male patients. Blunt, unintentional, injuries were the most common presenting trauma. The most common injury mechanism was falls. Most patients presented with mild to moderate injuries and were healthy prior to presentation. The main cause of death was traumatic brain injury. The percentage of potentially preventable and preventable deaths was 7% and 0.5%. The most common trauma care error was delay in time to surgery/treatment.

Discussion

The study shows a change in trauma mortality, with increasing mortality in the elderly population. There is a decrease in the number of preventable deaths which suggests that trauma care is improving. Future studies on specific subgroups of the trauma population, such as fall injuries in females and gunshot wound patients in males, can lead to further improvements.
72122 - Mesh removal due to foreign body reaction and mesh infection in Groin hernia surgery: A long-term nationwide population-based register study
Authors: Melkemichel Maria , Nordenson Mårten , De la Croix Hanna , Nordin Pär
Published: August 2024

Introduction

Groin hernia repairs (GHRs) with mesh is today gold standard procedure in western countries. Yet, foreign body reaction and mesh infection are feared complications. This study aimed to investigate the incidence and risk factors for mesh removal due to foreign body reaction and mesh infection following GHR.

Method

This is an observational nationwide populations-based register-study with the use of prospectively collected data from the Swedish Hernia Register (SHR). All patients ≥ 15 years old with a GHR registered in SHR between 1992 and 2022 were eligible. Primary outcome was the prevalence of re-surgery with mesh removal. Secondary outcome was risk factors for re-surgery with mesh removal.

Result

Out of 363 664 GHRs during this 30-years long study-period, 211 (0.058%) had a re-surgery with mesh removal. The share of female GHRs was higher in the mesh removal group (15.2 %) compared to the non-mesh removal group (7.9 %). Adjusted multivariate Cox regression analysis for the risk of re-surgery with mesh removal, demonstrated significantly increased hazard ratios for women (2.80, CI 1.70-4.63), emergency GHR (3.43, CI 1.94-6.03), open anterior GHR (2.76, CI 1.61-4.72), combined anterior/posterior GHR (3.98, CI 1.84-8.57) and for patients below the total median of 63 years old (2.61, CI 1.78-3.81). Combined anterior/posterior GHR consisted domintely of mesh plug repairs.

Discussion

The groin tissue tolerance for implanted mesh following GHR is considered high where re-surgery for mesh removal due to foreign body reaction and mesh infection is rare. Women, younger patients, emergency repairs and surgical method of repair were associated risk factors for such re-surgery.
71523 - 25 years with the Swedish national quality register for cleft lip and palate: -Where are we now?
Authors: Becker Magnus
Published: August 2024

Introduction

Initiated in 1999 by Sweden's six Cleft Lip and Palate (CLP) centers, the national CLP registry aimed to standardize treatment and improve care through outcome comparisons. Achieving a 100% participation rate, it was designated a national quality registry in 2009, including all Swedish children and adolescents with CLP born in 2009 onwards. In 2023, the registry attained the highest certification level, leveraging registered data for care development and research.

Method

As of March 20, 2023, the registry documented 4,695 individuals born between 1999 and 2022, with 2,671 cases post-2009. The predominant diagnosis was a cleft of the hard and soft palate, among other variations.

Data Quality: The registry boasts a 100% participation and a 94.6% coverage rate, with surgical and dental assessment reporting rates impressively over 90% for various age milestones. Early speech documentation presented challenges but showed improvement in recent cohorts.

Result

For isolated cleft palate cases, findings include a notable range in surgical interventions, secondary surgeries, and speech and dental outcomes at ages 5 and 10. Parent-reported intelligibility scores reflect high satisfaction, despite significant center-to-center variations in treatment specifics.

Discussion

CLP treatment in Sweden, marked by long-term engagement and diverse outcomes influenced by cleft severity and other factors, shows consistent success rates in dental occlusion and speech. The treatment for bilateral CLP and children with additional challenges continues to evolve, aiming for personalized care improvements.
71660 - Visualization of patient flow in standardized cancer patient pathways, and performance of detecting cancer
Authors: Borg Sixten , Hörstedt Ann-Sofi , Carlsson Tobias , Nilbert Mef , Larsson Anna-Maria , Ohlsson Björn
Published: August 2024

Introduction

Standardized cancer patient pathways (CPPs) were implemented to improve investigation and diagnostics for patients with symptoms comprising well-founded suspicion of cancer.

Our primary aim was to visualize the patient population going through CPPs, in terms of investigation time and various outcomes including cancer diagnoses. A second aim was to examine the performance of cancer detection in CPPs.

Method

We used data on patients starting in any of 28 CPPs (n=19,204) and patients diagnosed with cancer (n=7,895), in 2018 in Region Skåne in Sweden. The data, deterministically linked on the individual level, covered dates, events, and outcomes of CPPs and diagnoses recorded in the Swedish Cancer Register.

A state-transition model was developed to map patients' pathways through the CPPs. The patient flow through the model was visualized. Diagnoses were used to study rates of detected and undetected cancer.

Result

The visualization shows time of investigation, time to start of treatment, and rates of detected and undetected cancer. In patients whose suspicion of cancer was rejected, 0.8% were later diagnosed with the primarily suspected cancer, 1.0% with other cancer. Among patients not meeting criteria for well-founded suspicion, less than 3% were later diagnosed with cancer, none of which with the primarily suspected cancer.

Discussion

The visualization provides a useful overview of the patient flow through CPPs and illustrates investigation time, events, and outcomes. The use of CPPs detects cancer efficiently.
72012 - Nurses experience of caring for patients in need of surgical care cared for in non-surgical beds
Authors: Palafox Lucia Ocaranza , Persson Emma
Published: August 2024

Introduction

As the number of open care places in inpatient care has decreased over time, the number of outpatients has increased. Outlying of patients involve an increased patient safety risk and affect the nurse's nursing work. Patients with a surgical need of care may have a complex need for nursing and specialist nurses are an important part of the patient's care context. The aim is to describe nurses' experiences of caring for patients with a need of surgical care and who are out located in a non-specialized surgical ward.

Method

A qualitative interview study was conducted and a total of 8 nurses were interviewed. A qualitative content analysis was used in accordance with Graneheim and Lundman.

Result

Three main categories were crystallized: Patient safety risk, Impact on the work environment and Learning and development in the role of the nurse. The nurses stated that patients in need of surgical care are an interesting group of patients and that caring for these patients provided a positive variation in their work as well as development opportunities. The nurses also stated obstacles regarding providing patients with good and safe care as well as shortcomings in the nurses' work environment.

Discussion

Increased competence and better collaboration between different specialties can lead to improved patient safety and working environment for nurses who care for patients with surgical need of care and who are being treated at non-surgical wards. To increase the patient safety, the specialist nurse could have a more central role in the care of these patients.
Snow alga Sanguina aurantia as revealed through de novo genome assembly and annotation
Authors: Raymond Breanna B , Guenzi-Tiberi Pierre , Maréchal Eric , Quarmby Lynne M
Published: August 2024

To thrive on melting alpine and polar snow, some Chlorophytes produce an abundance of astaxanthin, causing red blooms, often dominated by genus Sanguina. The red cells have not been cultured, but we recently grew a green biciliate conspecific with Sanguina aurantia from a sample of watermelon snow. This culture provided source material for Oxford Nanopore Technology and Illumina sequencing. Our assembly pipeline exemplifies the value of a hybrid long- and short-read approach for the complexities of working with a culture grown from a field sample. Using bioinformatic tools we separated assembled contigs into two genomic pools based on a difference in GC content (57.5% and 55.1%). We present the data as two assemblies of S. aurantia variants but explore other possibilities. High-throughput chromatin conformation capture analysis (Hi-C sequencing) was used to scaffold the assemblies into a 96 MB genome designated ‘A’ and a 102 MB genome designated ‘B’. Both assemblies are highly contiguous: genome A consists of 38 scaffolds with an N50 of 5.4 Mb while genome B has 50 scaffolds with an N50 of 6.4 Mb. RNA-sequencing was used to improve gene annotation.
The Impact of Multimorbidity on Labor Force Participation Among the Middle-Aged and Older Working Population in the United States
Authors: Zhang Zhang , Gong Qing , Gilleskie Donna , Moulton Jeremy G , Sylvia Sean Y
Published: August 2024

Objectives

Multimorbidity, known as multiple chronic conditions (MCC), is the coexistence of two or more chronic health conditions (CHC). The near-retirement-age population with MCC is more likely to experience discontinued labor force participation (LFP). Our objective was to evaluate the impact of MCC on LFP among adults aged 50–64 and to explore heterogeneous effects between self-employed and non-self-employed workers.

Methods

We constructed our sample using the Health and Retirement Study (HRS) from 1996 to 2018. We adopted an individual fixed-effect (F.E.) model and propensity score matching (PSM) to measure the impact of MCC on the probability of being employed and changes in annual work hours.

Results

50.5% of respondents have MCC. Individuals with MCC exhibit a predicted probability of being employed that is 9.3 percentage points (p < .01, 95% confidence interval [95% CI]: −0.109, −0.078) lower than those without MCC. Compared with non-CHC, MCC significantly reduced annual working hours by 6.1% (p < .01, 95% CI: −0.091, −0.036) in the F.E. model and by 4.9% (p < .01, 95% CI: −0.064, −0.033) in PSM estimation. The effect is more pronounced for the self-employed with MCC, who have 13.0% (p < .05, 95% CI: −0.233, −0.026) fewer annual work hours than non-CHC based on the FE model and 13.4% (p < .01, 95% CI: −0.197, −0.070) in PSM estimation.

Discussion

MCC significantly reduces LFP compared with non-MCC. MCC has a heterogeneous impact across occupational types. It is important to support the near-retirement-age working population with multimorbidity through effective clinical interventions and workplace wellness policies to help manage health conditions and remain active in the labor market.
Co-creating Humanistic AI AgeTech to Support Dynamic Care Ecosystems: A Preliminary Guiding Model
Authors: Hwang Amy S , Tannou Thomas , Nanthakumar Jarshini , Cao Wendy , Chu Charlene H , Zeytinoglu Atici Ceren , Scane Kerseri , Yu Amanda , Tsang Winnie , Chan Jennifer , Lea Paul , Harris Zelda , Wang Rosalie H
Published: August 2024

As society rapidly digitizes, successful aging necessitates using technology for health and social care and social engagement. Technologies aimed to support older adults (e.g., smart homes, assistive robots, wheelchairs) are increasingly applying artificial intelligence (AI), and thereby creating ethical challenges to technology development and use. The international debate on AI ethics focuses on implications to society (e.g., bias, equity) and to individuals (e.g., privacy, consent). The relational nature of care, however, warrants a humanistic lens to examine how “AI AgeTech” will shape, and be shaped by, social networks or care ecosystems in terms of their care actors (i.e., older adults, care partners, service providers); inter-actor relations (e.g., care decision making) and relationships (e.g., social, professional); and evolving care arrangements. For instance, if an older adult’s reduced functioning leads actors to renegotiate their risk tolerances and care routines, smart homes or robots become more than tools that actors configure; they become semiautonomous actors, in themselves, with the potential to influence functioning and interpersonal relationships. As an experientially diverse, transdisciplinary working group of older adults, care partners, researchers, clinicians, and entrepreneurs, we co-constructed intersectional care experiences, to guide technology research, development, and use. Our synthesis contributes a preliminary guiding model for AI AgeTech innovation that delineates humanistic attributes, values, and design orientations, and captures the ethical, sociological, and technological nuances of dynamic care ecosystems. Our visual probes and recommended tools and techniques offer researchers, developers/innovators, and care actors concrete ways of using this model to promote successful aging in AI-enabled futures.
Characteristics of Informal Caregivers and Social Participation of People With Dementia
Authors: Palaza Abigail , Bouldin Erin D , Miyawaki Christina E , Palumbo Mary Val , Gell Nancy M
Published: August 2024

Background and Objectives

Social participation is associated with increased quality of life and well-being but declines following the onset of dementia. Informal caregivers may facilitate social participation among people with dementia. This study aims to identify characteristics of informal caregivers associated with social participation of people with dementia in valued activities.

Research Design and Methods

This cross-sectional study used data from the 2011, 2015, and 2017 National Health and Aging Trends Study (NHATS) and the National Study of Caregiving. NHATS respondents with possible or probable dementia and an informal caregiver were included (N = 1,060). Respondents were asked whether they participated in each of 5 social activities during the past month. Valued activities were considered somewhat or very important. Survey-weighted logistic regression models were computed to identify characteristics of primary informal caregivers associated with participation of people with dementia in social activities.

Results

Social participation of people with dementia was not independently associated with sociodemographic variables or relationship to the primary caregiver (spouse/partner, adult child, or other relative/nonrelative). Social participation of primary caregivers was associated with increased participation of people with dementia in the same activity for visiting friends/family (odds ratio [OR] = 1.88, p = .016), attending religious services (OR = 4.82, p < .001), and volunteering (OR = 3.25, p = .015), whereas greater caregiver external support was associated with increased participation of people with dementia in organized activities (OR = 1.37, p = .022).

Discussion and Implications

Assets of informal primary caregivers found to promote social participation of people with dementia include traveling to the person with dementia’s home, being socially active themselves, and utilizing support services.
Dynamic evolution of West Gondwana inferred from crustal anisotropy of the South American platform
Authors: Feng Mei , An Meijian , Zang Hulin , Assumpção Marcelo S , Bianchi Marcelo B , França George S , Rocha Marcelo P , Bettucci Leda S , Chaves Carlos A
Published: August 2024

The amalgamation and breakup of the West Gondwana shaped the South American platform. The dynamics during the processes can be reflected by crust anisotropy of the platform, but there are no specialized crustal anisotropic measurements yet. Splitting analysis of Moho-converted shear waves in P-wave receiver functions (Pms) can reveal crustal-scale anisotropy, which is important for understanding the dynamic evolution of the crust and for the interpretation of mantle anisotropy from splitting analysis of core–mantle refracted shear waves (XKS phases). This study measured crustal anisotropy for the old and stable South American platform by Pms splitting analysis. The splitting times vary mainly in the range of 0–0.5 s, with a regional mean of 0.2 s, slightly lower than that observed in tectonically active regions. The detected crustal anisotropy shows distinct characteristics and spatial zoning, providing insights into tectonic processes. (1) Fast polarization directions at stations close to the Transbrasiliano Lineament (TBL) are oriented NNE–SSW, generally consistent with the strike of the TBL but inconsistent with the maximum horizontal compressive stress, implying that they might be formed by dynamic metamorphism during the formation of the TBL. (2) Crustal anisotropy along the passive continental margin in the east and northeast is weak. Still, the fast polarization directions tend to be oriented along the margin, implying the existence of fossil extensional crustal fabrics formed during the continental rifting of West Gondwana. (3) The Paraná Basin, one of the world's largest Large Igneous Provinces (LIP) covered by continental flood basalts, shows distinctively strong anisotropy, with fast polarization directions highly aligned with mantle anisotropy, implying that synchronous crust–mantle deformation occurred in these regions as a result of magmatism during the breakup of West Gondwana.
Comparing geophysical inversion and petrophysical measurements for northern Victoria Land, Antarctica
Authors: Lowe Maximilian , Jordan Tom , Ebbing Jörg , Koglin Nikola , Ruppel Antonia , Moorkamp Max , Läufer Andreas , Green Chris , Liebsch Jonas , Ginga Mikhail , Larter Robert
Published: August 2024

Bedrock geology from Antarctica remains largely unknown since it is hidden beneath thick ice sheets. Geophysical methods such as gravity and magnetic inverse modelling provide a framework to infer crustal rock properties indirectly in Antarctica. However, due to limited availability of rock samples, validation against direct geological information is challenging. We present a new rock property catalogue containing density and susceptibility measurements on 320 rock samples from northern Victoria Land. This catalogue is used to assess the reliability of local and regional scale inverse results, including a new local high resolution magnetic inversion in the Mesa Range region and a previously published regional scale joint inversion of gravity and magnetic data in northern Victoria Land and the Wilkes Subglacial Basin. We compare our density and susceptibility measurements to global and local measurements from the literature to access the correlation to rock types and geological units. Furthermore, the measured values are compared against inverted values. The close correspondence between inverted and measured rock properties allows us to predict locations of rock types where currently such information is missing. The utility of measured susceptibility and density relationships for interpreting inversion output provides a strong incentive to incorporate local rock samples into geophysical studies of subglacial geology across Antarctica.
Hurricane Irma Linked to Coral Skeletal Density Shifts on the Florida Keys Reef Tract
Authors: Aliyah Griffith , Jose Sanchez Gomez , Karl Castillo
Published: August 2024

Synopsis

Coral reefs are at risk due to various global and local anthropogenic stressors that impact the health of reef ecosystems worldwide. The most recent climate models predict that climate change will increase the frequency and intensity of tropical storms. This increased storm occurrence and strength will likely compromise coral reef structures and habitats for reef-dwelling organisms, including across the Florida Keys Reef Tract (FKRT), the most extensive tropical reef system along the US coast. While several recent studies reveal the chronic impacts of tropical storms on corals, relatively little is known about the effects of major storm events on coral growth and how these effects vary over spatiotemporal scales. Here, I characterize the skeletal growth of two common Caribbean reef-building coral species, Siderastrea siderea and Pseudodiploria strigosa, before and after Hurricane Irma to investigate the storm’s impact on coral skeletal growth on inner and outer reefs of the FKRT. Coral cores were extracted from both species at four inner and four outer reef sites in May 2015, before Hurricane Irma struck the Florida Keys in September 2017. Subsequently, 33 micro-cores were collected in May 2019, two years after the storm traversed our previously cored coral colonies. A three-way ANOVA model with storm, species, and reef location as the three factors was used to assess the impact of the storm on each of three growth parameters: skeletal density, linear extension, and calcification rates. Results reveal no difference in the coral annual skeletal growth parameters pre- and post-Hurricane Irma, although previously quantified differences in these growth parameters across species and location were observed. However, analysis of the “yearly” change in annual skeletal growth parameters showed significant differences in skeletal density across groups before and after Hurricane Irma, but not for linear extension and calcification rates. Our findings improve an understanding of the impacts of tropical storms on coral skeletal growth and offer new insights into how we can employ corals’ innate growth capacities to help conserve coral reefs under climate change.