Karlstad Central Hospital

To compare oncological outcomes after extended pelvic lymph node dissection (PLND) versus limited in patients with high-risk prostate cancer (PCa) undergoing curative external beam radiation therapy (EBRT). From 3627 men with PCa at a single centre between 2000 and 2013, 167 with high-risk, age ≤75, Gleason score 6-10, clinical stage T1-T3, PSA < 100 ng/ml, no distant metastases (M1) and node-negative at the obturator fossa, underwent PLND before curative EBRT. Of these, 90 received limited, and 77 underwent extended PLND. Mean follow-up (SD) was 14.9 yr (5.8) for the limited and 12.3 yr (3.3) for the extended PLND. Primary endpoint was biochemical recurrence (BCR), secondary M1, cancer-specific mortality (CSM), overall mortality (OM). HR, KM and Cox regression models adjusted for age and Cambridge prognostic group (CPG) score. RR, RD at 11 yr. Extended PLND was associated with a significantly lower risk for BCR (HR: 0.51, 95% CI: 0.31-0.86, p =0.01) (RR: 0.43, 95% CI: 0.26-0.69, p = 0.001), lower risk of M1 (HR: 0.22, 95% CI: 0.08-02.65, p = 0.006) (RR: 0.26, 95% CI: 0.09-0.73, p = 0.004) and lower CSM compared with limited PLND (HR: 0.31, 95% CI: 0.08-0.65 p= 0.035) (RR 0.27, 95% CI: 0.08-0.91, p= 0.028). OM did not differ significantly. Extended PLND prior to curative ERBT shows reductions in BCR, M1 and CSM long-term outcomes following extended versus limited PLND. Extended PLND can be considered in cases with high-risk PCa prior to curative EBRT.

Rapid correction of profound hyponatremia (serum sodium <125 mmol/L) has been associated with osmotic demyelination syndrome (ODS) but this has been challenged. Potential associations with other neurological and psychiatric diseases have not been studied. The basis of this study was the Stockholm Sodium Cohort, a laboratory data repository covering inhabitants of the Stockholm Region who had a sodium concentration analyzed (2005-2018, n = 1632,249). Patients admitted with profound hyponatremia for the first time during the study period where sodium correction rates during the first 24 h could be calculated were included. Sodium correction ≤8 and >8 mmol/L/24 h was compared. Hospitalization with profound hyponatremia occurred in 7623 individuals, 3199 (42.0 %) were males, and the median age was 70 years (IQR 59-80 years). Alcohol misuse was present in 18.3 %, a neurological and/or psychiatric disease in 52.4 % and hypokalemia in 27.9 %. The recommended correction rate ≤8 mmol/L/24 h was adhered to in 3985 (52.3 %) patients. Seven patients (0.09 %) were diagnosed with ODS, six had a correction rate >8 mmol/L/24 h (compared to 1 patient with a correction rate ≤8 mmol/L, P = 0.0441). The risk of new neurological or psychiatric diseases did not differ significantly between those with a correction rate ≤8 mmol/L/24 h and those above in the fully adjusted model (adjusted hazard ratio 1.02 95 %CI 0.89-1.17)) nor in the subgroups. ODS was rare, however, mainly associated with rapid correction. Consequently, slow correction may be preferable.

Primary aldosteronism (PA) is prevalent among hypertensive patients, and associated with worsened cardiovascular outcomes compared to essential hypertension (HT). Screening and diagnostics for PA are currently complicated and invasive, why new methods are needed. Unilateral PA (uPA) is best treated surgically, and bilateral PA (bPA) - medically. No validated proteomic diagnostic test has been found yet. Our aim was to explore proteomic markers in peripheral serum to discriminate between HT, PA, uPA and bPA. Eighty-eight hypertensive individuals were evaluated for PA, and diagnosed with HT (n = 30); bPA (n = 29); and uPA (n = 29). Serum samples from these study groups were analyzed by Olink® Explore 384 Cardiometabolic Panel. A machine learning model based on ridge logistic regression with a stratified 5-fold cross-validation was used to identify HT, PA, bPA and uPA. In the study groups, 56 circulating proteins were significantly different, and some of them specifically: 4 between PA vs. HT; 3 between bPA vs. uPA; 1 between bPA vs. HT; 9 between uPA vs. HT; 1 between HT vs. bPA vs. uPA. Three proteins with strongest differentiation (Coagulation factor IX for PA vs. HT; dipeptidyl peptidase 4 for uPA vs. HT and bPA; heat shock protein B1 for bPA vs. uPA) were validated by enzyme-linked immunosorbent assay. Our machine learning model could successfully identify 95% of HT, bPA, and uPA samples. Serum protein biomarkers may serve as a tool for discriminating HT, PA, uPA and bPA. Further studies are needed to support our results.

Cerebral small vessel disease (CSVD) is a chronic, progressive disorder that affects small blood vessels in the brain's white matter. This white matter damage appears on brain imaging as white matter hyperintensities (WMH). Although CSVD is often asymptomatic, it causes one fifth of strokes and nearly half of all vascular dementia cases, highlighting its clinical importance. Statins, widely used to lower lipid levels, are effective for reducing cardiovascular mortality in high-risk groups and are recommended for patients with myocardial infarction and ischemic stroke. This systematic review and meta-analysis of randomized controlled trials aimed to evaluate the impact of statin therapy on CSVD. A literature search was performed in PubMed, Embase, the Cochrane Library and Epistemonikos resulting in the full-text review of 86 articles, of which two were used for the meta-analysis. A non-significant trend towards lower WMH volume in milliliters was observed in the statin group compared to controls, mean difference (MD) = -4.44 (95 % CI -10.19-1.31). There is limited evidence available for the use of stain-treatment for CSVD, and further research is needed as well as studies on the clinical and person-centered benefits of statins on cognition and functional level in persons with CSVD.

To explore the symptom cluster management process from the perspective of patients with lung cancer within the oncological care context. We used a constructivist grounded theory methodology to collect and analyze rich data from 15 patients with lung cancer via individual interviews and a two-dimensional symptom assessment scale. A situational theoretical model describes the symptom cluster management process through the main category 'To get through to survive', with the category 'Handling symptom clusters' together with six sub-categories concerning the patients' management strategies and the category 'Living with symptom clusters,' together with two sub-categories describing the outcome in their daily life. Impacting conditions are incorporated in the model. Patients often feel left to their own devices to deal with symptom clusters and may not understand or foresee problematic circumstances as they manage their situations on a day-to-day basis. When symptoms are normalized and accepted, patients do not ask for support, or support is not being offered to them. Healthcare professionals should consider the peril of normalizing symptoms and the patients' altered time perspective that stems from their approach of living one day at a time, in further development of nursing interventions and person-centered care for this population.

Validation of biobanks and large cancer cohorts is essential in ensuring high-quality research results. We examined the coverage, generalisability and validity of the lymphoma collection of the Uppsala-Umeå Comprehensive Cancer Consortium (U-CAN) biobank in Sweden, one of the largest cancer biobanks in Europe. Up until 2022, 889 lymphoma patients in U-CAN Uppsala had available samples, and 329 in U-CAN Umeå. Patients diagnosed in the U-CAN Uppsala area 2011-2021 (n = 843) were linked to the nationwide Swedish Lymphoma Register, and a subset diagnosed before 2019 (n = 727) to population-based registers. The coverage was 39% of all lymphoma patients between 2011 and 2019 diagnosed in the U-CAN Uppsala area, with a pandemic decline to 10% during 2020-2021. The patients included had superior overall survival (hazard ratio = 0.70 [95% confidence interval, CI: 0.60-0.82]) than all lymphoma patients in Sweden. They had better performance status, were younger (odds ratio [OR] = 0.21 [95% CI: 0.13-0.34]) and had less comorbidities (OR = 0.66 [95% CI: 0.56-0.78]). However, cause-specific survival and stage distribution were similar. The questionnaire data captured less comorbidities compared to the national registers. Evaluations of biobanks are important, as even population-based biobanks such as U-CAN select younger patients with higher socioeconomical status and better performance status. However, the similar cause-specific survival as in the registries suggests U-CANs usefulness for prognostic biomarker studies.

Patients undergoing breast surgery are at risk of severe postoperative pain. Several opioid-sparing strategies exist to alleviate this condition. Regional anesthesia has long been a part of perioperative pain management for these patients. This randomized study examined the benefits of interpectoral and pectoserratus plane block (IPP/PSP), also known as pectoralis nerve plain block, compared with advanced local anesthetic infiltration. We analyzed 57 patients undergoing partial mastectomy with sentinel node dissection. They received either an ultrasound-guided IPP/PSP block performed preoperatively by an anesthetist or local anesthetic infiltration performed by the surgeon before and during the surgery. Pain measured with the numerical rating scale (NRS) indicated no statistically significant difference between the groups (IPP/PSP 1.67 vs. infiltration 1.97; p value 0.578). Intraoperative use of fentanyl was significantly lower in the IPP/PSP group (0.18 mg vs 0.21 mg; p value 0.041). There was no statistically significant difference in the length of stay in the PACU (166 min vs 175 min; p value 0.51). There were no differences in reported postoperative nausea and vomiting (PONV) between the groups. The difference in postoperative use of oxycodone in the PACU (p value 0.7) and the use of oxycodone within 24 hours postoperatively (p value 0.87) was not statistically significant. Our study showed decreased intraoperative opioid use in the IPP/PSP group and no difference in postoperative pain scores up to 24 hours. Both groups reported low postoperative pain scores. This trial is registered with NCT04824599.

BackgroundThe Otsu method and the Chan–Vese model are two methods proven to perform well in determining volumes of different organs and specific tissue fractions. This study aimed to compare the performance of the two methods regarding segmentation of active thyroid gland volumes, reflecting different clinical settings by varying the parameters: gland size, gland activity concentration, background activity concentration and gland activity concentration heterogeneity.MethodsA computed tomography was performed on three playdough thyroid phantoms with volumes 20, 35 and 50 ml. The image data were separated into playdough and water based on Hounsfield values. Sixty single photon emission computed tomography (SPECT) projections were simulated by Monte Carlo method with isotope Technetium-99 m (^{text {99m}}Tc). Linear combinations of SPECT images were made, generating 12 different combinations of volume and background: each with both homogeneous thyroid activity concentration and three hotspots of different relative activity concentrations (48 SPECT images in total). The relative background levels chosen were 5 %, 10 %, 15 % and 20 % of the phantom activity concentration and the hotspot activities were 100 % (homogeneous case) 150 %, 200 % and 250 %. Poisson noise, (coefficient of variation of 0.8 at a 20 % background level, scattering excluded), was added before reconstruction was done with the Monte Carlo-based SPECT reconstruction algorithm Sahlgrenska Academy reconstruction code (SARec). Two different segmentation algorithms were applied: Otsu’s threshold selection method and an adaptation of the Chan–Vese model for active contours without edges; the results were evaluated concerning relative volume, mean absolute error and standard deviation per thyroid volume, as well as dice similarity coefficient.ResultsBoth methods segment the images well and deviate similarly from the true volumes. They seem to slightly overestimate small volumes and underestimate large ones. Different background levels affect the two methods similarly as well. However, the Chan–Vese model deviates less and paired t-testing showed significant difference between distributions of dice similarity coefficients (p-value <0.01).ConclusionsThe investigations indicate that the Chan–Vese model performs better and is slightly more robust, while being more challenging to implement and use clinically. There is a trade-off between performance and user-friendliness.