Länssjukhuset i Kalmar

To investigate the clinical use of analyzing circulating tumor DNA in a clinical setting we present a pilot study comprising 93 patients from individuals with suspected lung cancer. The study aimed to evaluate the capability of analyzing circulating tumor DNA at the initial medical visit in order to detect genetic changes and mutations associated with lung cancer in plasma samples. Tumor DNA from plasma was extracted and analyzed with Next Generation Sequencing (NGS) and the result was compared with a matched tumor tissue collected in close connection from the same individual. Cancer-associated genetic mutations could be confirmed in about 60 percent of the plasma samples, and we observed a higher degree of conformance in patients with a more advanced disease. The results from the study provide valuable insights for an early clinical use of analyzing circulating tumor DNA in cases of suspected lung cancer, which could contribute to improving early diagnosis and treatment strategies for patients with lung cancer.

ABSTRACTBackgroundExertional breathlessness is a key symptom in cardiorespiratory disease and can be quantified using incremental exercise testing (IET), but its prognostic significance is unknown.Research questionWe evaluated the ability of abnormally high breathlessness intensity during IET to predict all-cause, respiratory, and cardiac mortality.Study Design and MethodsLongitudinal cohort study of adults referred for cycle IET followed prospectively for mortality assessed using the Swedish National Causes of Death Registry. Abnormally high exertional breathlessness was defined as a breathlessness intensity response (Borg 0-10 scale) > the upper limit of normal (ULN) using published reference equations. Mortality was analyzed using multivariable Cox regression, unadjusted and adjusted for age, sex, and body mass index.ResultsOf the 13,506 people included (46% female, age 59±15 years), 2,867 (21%) had abnormally high breathlessness during IET. Over a median follow up of 8.0 years, 1,687 (12%) people died. No participant was lost to follow-up. Compared to those within normal predicted ranges, people with abnormally high exertional breathlessness had higher mortality from all causes (adjusted hazard ratio [aHR] 2.3, [95% confidence interval] 2.1-2.6), respiratory causes (aHR 5.2 [3.4-8.0]) and cardiac causes (aHR 3.0 [2.5-3.6]). Even among people with normal exercise capacity (defined as peak Watt ≥75% of predicted exercise capacity, n=10,284) those with abnormally high exertional breathlessness were at greater risk of all-cause mortality than people with exertional breathlessness within the normal predicted range (aHR 1.5 [1.2-1.8]).InterpretationAmong people referred for cycle IET, abnormally high exertional breathlessness, quantified using healthy reference values, independently predicted all-cause, respiratory and cardiac mortality.

Kroppslig kontakt ar ett vardagligt inslag i forskoleverksamhet. Fysisk beroring kan ske i situationer som blojbyten, halsnings- och avskedssituationer, for att avstyra brak, for att forebygga olyc ...

Polluting substances when released into environment become one of the main factors ofenvironmental pollution since they cause changes to the chemical composition of water,bottom sediments and soil; they also disturb the biological balance and self-cleaningprocesses of the ecosystem that may lead to unpredictable alterations within the ecosystem.Together with the chemical and physical techniques the methods of bioindication andbiotesting are employed in the current research on environmental pollution and its impact onthe ecological integrity of ecosystems,The aim of this paper was to determine the sensitivity of a test-organism L sativum to thetoxic impact of different types of samples (liquid or solid: surface water, industrialwastewater, industrial storm water, landfill leachate, lake bottom sediments and sludge fromindustrial storm water sedimentation tank) from urban environment and chemical substancesand to demonstrate the possibilities of application of this plant in both the toxicologicalinvestigation and environmental pollution assessment.The results of conducted investigation have proved that L. sativum is a sufficiently universal,cheap and sensitive biotest for determination of toxicity of different types of samples (stormwater, bottom sediments, soil, wastewater from industrial sites, landfill leachate) and includedchemical substances. Therefore, it can be successfully applied in the environmental pollutionassessment.

A water balance for a landfill in the South-West of Sweden has been performed. The waterbalance is based on measured values of leachate and calculated values of potentialevaporation using Penman's equation. The calculations include a period of 6 years (1995-200 I). During this period, the yearly precipitation was 6 I 0-1180 mm in the Halmstad area. Itwas concluded that the total storage of leachate in the landfill and in the ponds increased withtime. If increasing tendency will proceed then the amount of leachate generated might behigher during the next years and similar to results found in the literature. There is a need forthe more physical based model, the Hydrologic Evaluation of Landfill Performance (HELP)model, for calculation in order to take into account the top cover soils and vegetationinfluence.

The purpose of this article was to study the intraocular pressure (IOP)-lowering effect of adding brimonidine as the fourth antiglaucoma medication to a preexisting therapy of 3 topical drugs. This was a retrospective, register-based, cohort study of medical records and computerized medical information comprising 1 county in Sweden. The main outcome measure was change in IOP after brimonidine addition. Short-term and long-term effects were evaluated. Of 4910 patients on antiglaucoma medication, 69 (1.4%) initiated a treatment with brimonidine as the fourth drug during 2014. Fifty-three patients were eligible for analysis. Forty-six patients tolerated the treatment. Among them, short-term IOP decreased by 17% (confidence interval, 10%-25%; P<0.001) after a mean of 46 days (SD, 50 d). Twenty-eight patients, that is, 53% of the eligible, remained on unchanged therapy after a mean follow-up time of 368 days (SD, 61 d). The long-term mean IOP decrease in this group was 20% (confidence interval, 11%-29%; P<0.0001). An IOP reduction of at least 20% was reached by 28 and 14 patients, in the short-term and long-term follow-ups, respectively. Brimonidine has the potential to reduce the IOP significantly even when used as the fourth drug. In the short-term, half of the patients reached the target IOP reduction (≥20%). After 1 year, a quarter of the eligible patients had had a sustained, uneventful effect. Thus, brimonidine as the fourth adjunctive antiglaucoma drop seems a valuable option for a minority of patients.

One of the most common causes for revision surgery following total hip arthroplasty (THA) is dislocation.Dislocation is associated with a considerable amount of suffering and risks for the patient, and extra costs for the health care system.Compared with degenerative arthritis, the dislocation rate is doubled for avascular necrosis and multiplied by three times for congenital dislocation, four for fracture, five for nonunion, malunion or a failed hip arthroplasty, and eleven times after surgery for prosthetic instability.In analysing instability the cause may be assessed as 1) locally caused within the hip with explanatory radiographic findings, 2) locally caused without explanatory radiographic findings or 3) non-locally caused, i.e. non-compliant patient, neuromuscular or cognitive disorders.Revision strategies for instability are typically directed to correct the underlying aetiology, but also to strive for an upsizing of the head and liner.Cite this article: Ullmark G. The unstable total hip arthroplasty. EFORT Open Rev 2016;1:83-88. DOI: 10.1302/2058-5241.1.000022.

Departments of *Anesthesia and Intensive Care and †Clinical Physiology, Lanssjukhuset, Kalmar; Department of Medicine and Health Sciences, University Hospital Linköping, Linköping; and ‡Section for Anesthesiology and Intensive Care Medicine, Karolinska, Institutet, Stockholm, Sweden.

In Table 3, the column detailing gender was missing. Please view the corrected Table 3 here: