Glanrhyd Hospital

Hypofibrinolysis is prevalent in obesity and type 2 diabetes mellitus (T2D) and may be involved in their pathophysiology. Metabolic bariatric surgery (MBS) markedly improves both obesity and T2D, but whether these improvements are related to fibrinolysis is not known. In this study, biomarkers of fibrinolysis were assessed before and after MBS in patients with and without T2D. A single center prospective cohort study with 2-year follow-up. The participants were adults with obesity with (n = 28) or without T2D (n = 33) undergoing MBS preceded by 2 weeks of a low-calorie diet (LCD). The plasma concentrations of plasminogen activator inhibitor 1 activity (PAI-1act), tissue plasminogen activator activity (tPAact) and antigen (tPAag), plasmin-antiplasmin complexes (PAP) and fibrinogen were determined at baseline, after LCD and at 6 weeks, 1 and 2 years after MBS. After LCD and prior to MBS, PAI-1act decreased and PAP increased significantly. Two years after MBS, PAI-1act decreased from baseline 29.8 (63) to 3.8 (121) while tPAact increased (0.08 (390) to 0.23 (150) IU), and PAP increased (544 (54) to 814 (60) ng/mL). tPAag and fibrinogen decreased (16.4 (29) to 9.7 (51) ng/mL and 4.15 (23) to 3.82 (20) g/L, respectively); p < 0.001 for all; (geometric means, except tPAact which is arithmetic mean, coefficient of variation (%CV)). There were no differences in fibrinolysis between groups at baseline or after surgery. Multivariate analysis showed that reduction in body weight and fat mass had the most important influence on fibrinolysis. Fibrinolysis is significantly improved two years after MBS, as also indicated earlier after the two-week LCD. The lack of differences between patients with vs. without T2D suggests that fat mass reduction rather than improvement of glucose control is most important for improved fibrinolysis after MBS. In summary, our results support hypofibrinolysis as a mechanism in the pathophysiology in obesity.

Short stems in total hip arthroplasty (THA) have the potential to improve periprosthetic bone preservation compared to conventional stems due to a more anatomical distribution of biomechanical force. This study is a follow-up study of a randomised controlled trial using ultra-short and conventional stems in THA with the aim to investigate the long-term changes in periprosthetic bone mineral density (BMD) at 6 and 10 years post-THA. A cohort of 51 patients with hip osteoarthritis were randomized to either an ultra-short stem (n = 26) or a conventional stem (n = 25) group. Periprosthetic BMD was measured at 6- and 10-years post-surgery. Primary endpoint was BMD changes in Gruen zones 1 and 7. Lumbar spine, L1-4, BMD was used as an indicator of overall bone loss. Clinical outcome scores and BMD changes in Gruen zone 1-7 were used as secondary endpoints. 37 hips, 17 ultra-short stems and 20 conventional stems, were followed up until 10 years. At 6- and 10-years post-THA, the ultra-short stem group had less periprosthetic BMD reduction compared to the conventional stem group in Gruen zone 1; mean differences (%) were -17.6 (CI, -23.4--10.6) and -18.3 (CI, -28.0--9.0), respectively (p < 0.001). There was similar BMD loss in Gruen zone 7 and zones 1-7 between groups. Compared to overall bone loss, the ultra-short stem group lost less BMD than the conventional group. Adverse events and clinical outcomes did not differ between groups. Over a 10-year follow-up, THA using an ultra-short stem exhibited significantly reduced periprosthetic BMD loss in Gruen zone 1 compared to the conventional stem but this did not result in better clinical results. The observed preservation of bone density suggests potential long-term advantages of the ultra-short stem in minimising stress shielding and maintaining periprosthetic bone quality. ClinicalTrials.gov registration (number NCT01319227).

BackgroundTAP block is a recommended intervention for postoperative pain relief in colorectal surgery. Although ultrasound TAP (ULTAP) is the most studied approach, a laparoscopic technique (LAPTAP) has been described with heterogeneous results. The objective of this study is to compare laparoscopic-guided transversus abdominis plane (TAP) block versus ultrasound-guided TAP block in minimally invasive colorectal surgery.MethodsBetween May 1, 2021, and July 31, 2023, patients undergoing minimally invasive colorectal surgery were invited to participate in a randomized observer-blind controlled trial at Danderyd Hospital, Sweden. Postoperative pain and analgesia use, along with the time required for the TAP procedure, duration of anesthesia, and surgery were studied. The analysis was conducted on an intention-to-treat basis with subgroup analysis based on participants Body Mass Index (BMI).ResultsA total of 175 participants (88 LAPTAP and 87 ULTAP) underwent randomization. LAPTAP was associated with a shorter anesthesia duration (238 min) than ULTAP (265 min) with a median difference of 27 min (95% CI -49 to -5), and the procedure itself was faster, with a median time of 2 min versus 8 min for ULTAP (median difference -6 min, 95% CI -8 to -4). Pain measured using VAS was similar. There was no significant difference in the mean dosage of postoperative pain medication although more participants in the LAPTAP group than in the ULTAP group received opioids in the postoperative care unit.ConclusionLAPTAP is a feasible approach for postoperative pain relief in minimally invasive colorectal surgery, with comparable postoperative pain relief to ULTAP and a significantly shorter time under anesthesia.

ABSTRACTBackgroundFor children with speech sound disorder (SSD), speech intervention often involves a considerable amount of home‐training, to achieve high‐enough training frequency to promote speech change. A digital speech‐training app has been developed that could serve as a cost‐effective means of providing accessible intervention to children with SSD.AimsTo evaluate whether self‐supervised home‐training with the app Pop2TalkNordic can expedite more target‐like speech for children with SSD and to explore children's experiences of using the app.Methods and ProceduresFour 4–6‐year‐old Swedish children with SSD participated in a single‐case experimental design study, with a multiple‐baseline across‐subjects design. The children's production of target error patterns was monitored during baseline and intervention phases, for trained and untrained stimulus words. Three weeks of self‐supervised training with the app, with an aspired frequency of 5 days a week, in 15‐min training sessions, served as the intervention. The children's app usage was tracked, and their production of target word stimuli was recorded via the app.Outcomes and ResultsNone of the children reached more target‐like production of targeted consonants as a result of the intervention. For two participants, slight improvement was observed on trained, but not untrained, word stimuli. In terms of user experiences, the children varied from liking the game a lot and finding it easy, to not liking the game much at all and finding it difficult.Conclusions and ImplicationsIn its current form, and when delivered as a self‐supervised training‐activity over three weeks, training with Pop2TalkNordic is not sufficient to expedite more target‐like speech in children with SSD. More parental engagement in the children's training with the app, and changes in game design (e.g., highlighting phonological contrast and allowing playback of multiple exemplars of target word items), are suggested routes to achieve better outcomes.WHAT THIS PAPER ADDSWhat is already known on this subjectTo achieve high‐enough intervention dose, home‐training is often an important part of intervention for speech sound disorder (SSD). This is not always easy for families to attain, however, and digital speech training games may offer an attractive alternative or complement.What this paper adds to existing knowledgeBy tracking four children's usage and speech production over three weeks of playing a speech training game at home, the paper shows that the current version of the game and the implemented intervention delivery are not sufficient to promote more accurate production of targeted speech sounds.What are the potential or actual clinical implications of this work?Before recommending the speech training game for children with SSD, changes are recommended both with regard to the design of the game itself (e.g., refining the feedback provided in the game) and to the intervention delivery (e.g., increasing parental involvement).

Background:The relative effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for kidney protection, both individually and in combination, is incompletely understood. We sought to compare associations of GLP-1 receptor agonists, SGLT2 inhibitors, and both medications in combination with incident kidney failure among individuals with type 2 diabetes.Methods:We conducted a target trial emulation study with new user, active comparator design using de-identified electronic health records data from Optum Labs Data Warehouse. We included adults with type 2 diabetes who were prescribed a GLP-1 receptor agonist, SGLT2 inhibitor, or both between January 1, 2015, and June 29, 2024. We estimated the association of medication class with incident kidney failure using inverse probability of treatment weighted Cox proportional hazards regression models in both intention-to-treat and as-treated methodologies.Results:There were 504,151 individuals with 2,965 kidney failure events during a median 2.35 (interquartile range 1.09-4.32) years of follow-up. Average prescription duration was 0.69 years for GLP-1 receptor agonists, 0.62 years for SGLT2 inhibitors, and 0.44 years for combination therapy. In the intention-to-treat analysis, compared to GLP-1 receptor agonists, the risk of kidney failure was significantly lower with SGLT2 inhibitors (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.73 to 0.91) but no different with combination therapy (HR, 0.72; 95% CI, 0.45 to 1.15). Results were similar in the as-treated model. Among individuals with chronic kidney disease (CKD) or heart failure, the risk of kidney failure was significantly lower with combination therapy compared to GLP-1 receptor agonists (HR, 0.54; 95% CI, 0.30 to 0.97).Conclusions:SGLT2 inhibitors were associated with a lower risk of kidney failure compared to GLP-1 receptor agonists. Among high-risk patients with type 2 diabetes and CKD or heart failure, combination therapy may further reduce the risk of kidney failure.

Abstract Background Participation in comprehensive cardiac rehabilitation (CR) in general, and exercise-based CR (EBCR) in particular, is strongly advocated for patients with myocardial infarction (MI) and for those with heart failure (HF). Despite well-documented benefits, attendance remains low due to barriers at multiple levels. Purpose We aimed to describe determinants of attendance in comprehensive CR and EBCR for patients with MI and i) no history of HF and normal (≥50%) left ventricular ejection fraction (LVEF) post-MI, ii) no history of HF and new LVEF reduction (&amp;lt;50%) post-MI and iii) history of HF (irrespective of LVEF pre/post-MI). Methods In this retrospective observational study, patients &amp;lt;80 years of age registered in the Swedish cardiac registry SWEDEHEART with a MI diagnosis 2010-2019 were included. Patient- and system-level determinants of attendance in CR and EBCR were assessed using adjusted Cox proportional hazards and binary logistic regression models, respectively. Results Out of the 72,977 included patients (median age 64 [IQR 57-69] years, 74% men), 59.3% (n=43,289) had no history of HF and normal LVEF at discharge, 34.3% (n=25,032) had no history HF but developed reduced LVEF post-MI, and 6.4% (n=4676) had a history of HF. Proportion of patients attending CR was highest in patients with no HF history and normal LVEF (82.7%) and lowest in patients with a history of HF (61.8%, Figure 1). Of all MI patients with a history of HF, 19.6% attended EBCR. Compared to patients with no history of HF and normal LVEF, those with new LVEF reduction and those with a history of HF were less likely to attend CR (hazards ratio [95% confidence interval]: 0.97 [0.95-0.99] and 0.82 [0.78-0.85]) and EBCR (0.90 [0.87-0.94] and 0.75 [0.67-0.83]). Patients with lower income, younger patients, women, those born outside of Sweden, prior and current smokers, patients with comorbidities and those living far from the CR centre were less likely to attend CR (Figure 2, Panel A). Among those attending CR, low income and educational level, having no partner, being an active smoker, having comorbidities and living far from the CR centre were associated with lower EBCR attendance (Figure 2, Panel B). Belonging to a small hospital or university hospital predicted higher attendance in both comprehensive CR and EBCR across all groups. No major differences in determinants of attendance were observed between the three strata based on HF and LVEF (data not shown). Conclusion Compared to patients with no history of HF and normal LVEF, CR and EBCR attendance was lower in those with new-onset impairment of LVEF as well as in patients with a history of HF. Additionally, socioeconomically disadvantaged patients and those with comorbidities had the lowest attendance across all groups. Efforts to increase attendance in CR and EBCR in these vulnerable groups should be a priority.Attendance in CR and EBCR Determinants of attendance in CR, EBCR

AimTo investigate left atrial (LA) function assessed by peak atrial longitudinal strain (PALS) in an elderly population with silent paroxysmal atrial fibrillation (PAF) compared to age‐matched control group.MethodsFrom the STROKESTOP2‐study, patients with newly diagnosed silent PAF were enrolled together in a randomly selected age‐matched control group. All patients had NT‐proBNP levels between 125 and 900 ng/L. Echocardiographic examinations were performed and analyzed offline using dedicated software. In addition to conventional echocardiographic variables, PALS was measured using a two‐dimensional speckle tracking (2D‐ST) biplane.ResultsThe study population (mean age 76 ± 0.3) demonstrated significantly reduced PALS in patients with PAF (N = 69) compared to controls (N = 94) (23.9% ± 6.5% vs 30.7% ± 7.6%, p < 0.001). In the PAF group, 29 (42%) patients had normal LA volume index (LAVI) defined as ≤34 mL/m2. When subgroups with normal LAVI were compared, PALS was reduced in PAF compared to controls (25.1 ± 8.0 vs 31.1 ± 7.8, p = 0.001). NT‐proBNP levels did not differ between the PAF group (median 228 ng/L) and the control group (median: 217 ng/L) (p = 0.16). In multiple linear regression analysis, left ventricular global longitudinal strain, stroke volume index and LAVI were independent predictors of PALS. Receiver operating characteristic curve identified PALS threshold <22% for predicting risk of silent PAF.ConclusionPALS was significantly reduced in PAF patients even in the absence of significant LA remodeling. PALS <22% predicts risk for silent PAF in general elderly population. In high‐risk patients PALS could be used for AF screening enrichment.

The present comparative research study was carried out with the purpose of proposing the “Utility Model for Social Improvement with Strategic Social Responsibility” in the discipline of Social Work is a constant challenge, to raise interventions related to the social area with the use of systemic processes or models, standardized and regulated in the daily practice of their professional discipline, in topics that help to clarify the intervention, In this sense, the present MODEL is designed with the main purpose of systematizing the compliance of actions that are carried out in Mexico with the character of Mexican Official Standards (NOM) with obligation mandate, but as through the comparative analysis of these mandatory “duties”, it opens the possibility of complying with “shoulds” suggested by international instances (ISO, UN) in all types of organizations, whether public, private or social. The NOMs that initially start from their obligatory nature, it is possible to focus on a more holistic vision to become tools, already established for the implementation of actions of a Human Rights nature. The Utility Model with an integrating inclusive not excluding vision, allows the use and analysis of various comparative tables between the governance (5 types) that make up the model to be applied in actions of Social Responsibility and Strategic Planning of the ISO 26000 “Social Responsibility Guide” (7 governance) and the relationship with elements that serve for Strategic Planning such as ISO 31000 “Risk Management” (Principles, Framework and Process), in addition to its relationship with the fulfillment of the UN Sustainable Development Goals (17 goals), while seeking community solutions to each problem, always operating in its professional field giving priority to the social before the individual. El presente estudio de investigación documental y comparativa propone una herramienta sistémica inicial: el Modelo de Utilidad para la Mejora Social con Responsabilidad Social Estratégica, desde una perspectiva profesional del Trabajo Social. En los entornos organizacionales contemporáneos, las y los trabajadores sociales enfrentan el reto de diseñar intervenciones respaldadas por marcos normativos, estándares internacionales y modelos con enfoque sistémico e inclusivo. El modelo facilita la intervención profesional ante problemáticas relacionadas con el desarrollo social organizacional, articulando el cumplimiento de la legislación nacional —como las Normas Oficiales Mexicanas— con marcos internacionales emitidos por la Organización Internacional del Trabajo, la guía Organización Internacional de Normalización (ISO) 26000 sobre responsabilidad social, la Organización Internacional de Normalización (ISO) 31000 sobre gestión del riesgo y los 17 Objetivos de Desarrollo Sostenible de la ONU. Mediante el uso de análisis normativo y tablas comparativas, se demuestra la posibilidad de integrar obligaciones legales con recomendaciones internacionales, contribuyendo a una cultura organizacional ética, inclusiva y transformadora. El modelo, además, destaca el papel del Trabajo Social como eje articulador de decisiones estratégicas centradas en los derechos humanos laborales, el bienestar colectivo y el valor social organizacional. La propuesta se dirige a organizaciones públicas, privadas y sociales, brindando una herramienta adaptable a diferentes contextos y tipos de derecho humano a intervenir. Así, se fortalece la legitimidad y la “licencia social” para operar con responsabilidad y compromiso.

ObjectivesThe aim of this study was to investigate whether any feature of carotid artery calcification (CAC) detected on panoramic radiographs (PRs) is associated with more severe signs of cardiovascular disease (CVD), as assessed by carotid ultrasound (CUS) including multi-view assessment of carotid intima media thickness (cIMT).MethodsThe present investigation was a retrospective sub-study of the randomized controlled trial visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA), which included 60-, 50-, and 40-year-old inhabitants of Västerbotten County, each of whom underwent CUS. The present sub-study included 135 participants who had undergone PR for odontological indications within 18 months before or after CUS examination. Findings of CAC on PR were compared with CUS findings of cIMT and carotid plaque. CAC features were categorized into 4 types: single, scattered, vessel width-defining, or vessel-outlining.ResultsCompared to participants without CAC on PR, those with any CAC type on PR exhibited significantly more carotid plaque (80.9% vs 43.2%, P < .001) and a higher average cIMT score (0.83 vs 0.77 mm, P = .013) on CUS. The vessel-outlining CAC group exhibited the most pronounced cIMT and carotid plaque occurrence (P = .011).ConclusionsAll CAC types detected on PR were associated with CVD on CUS, and vessel-outlining CAC indicated more severe CVD. By detecting CAC on PR, especially vessel-outlining CACs, dentists could contribute to the early identification of patients with asymptomatic CVD, and recommend that these patients seek medical attention for preventive treatment.Advances in knowledgeAll types of CAC detected on PR—particularly the vessel-outlining type—are associated with carotid ultrasound findings, including carotid intima media thickness, indicating CVD and increased risk of stroke and myocardial infarction. Thus, dentists can identify patients at increased risk of cardiovascular events by detecting CAC on PR, with higher diagnostic reliability in cases with vessel-outlining calcification.

Prostate cancer (PCa) screening using prostate-specific antigen (PSA) thresholding and systematic biopsies reduces advanced disease presentations and cancer-specific mortality, but also leads to overdiagnosis. Magnetic resonance imaging (MRI) integration may maintain screening benefits, while reducing overdiagnosis and unnecessary biopsies. This review analyses the benefit-harm balance when MRI is integrated as first-line and second-stage (after PSA >3ng/ml) test in PCa screening. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed a PROSPERO-registered systematic review (CRD420251006926). Literature searches identified five first-line and four second-stage MRI screening studies. We assessed MRI strategies (first-line/second-stage and risk thresholds), biopsy avoidance, and biopsy methods (targeted/systematic) for histological outcomes (grade group [GG] ≥2/GG 1 cancer detection and benign biopsies). Benefit-to-harm ratios of >1 suggest a positive net benefit. First-line MRI screening detects twice as many men with GG ≥2 cancer as second-stage MRI screening but has more MRI-negative men (range, 66-89% vs 56-61%). Second-stage MRI significantly reduced biopsy rates (range, 42-79%) compared with systematic biopsy rates in all PSA-positive men. Subsequently, GG ≥2/GG 1 cancer detection ratios increased in MRI-positive men undergoing targeted and systematic biopsies (range, 1.9-6.2) and targeted biopsies alone (range, 1.8-7.0), compared with systematic biopsies alone (range, 0.8-1.4). First-line and second-stage MRI screening allowed biopsy avoidance in three to 55 and two to 15 men, respectively, for each benign diagnosis. All benefit-to-harm ratios showed positive net benefits (>1). Heterogeneity in the study protocols limits generalisability. Targeted biopsies in second-stage MRI screening optimise clinically significant PCa detection, while reducing the number of biopsies. First-line MRI screening requires further assessments of its feasibility. PCa screening quality assurance requires standardised MRI interpretations and biopsy protocols.