Ryhov Hospital Jönköping

The turnover of type I collagen plays an important role in atherogenesis and atherothrombosis. The pro-α1(I) chain of type I collagen (COL1α1) has emerged as a novel circulating biomarker associated with coronary artery disease (CAD) events. This study aimed to investigate the association between circulating COL1α1 and coronary atherosclerosis in a middle-aged general population. Participants (n = 1 078) were randomly recruited from the Linköping branch of the Swedish Cardiopulmonary Bioimage Study (SCAPIS) comprising an equal number of men and women 50–64 years old. Coronary artery calcium scores were calculated from non-contrast computed tomography (CT) while coronary stenosis, presence of plaques and segmental involvement scores were derived from coronary CT angiography. COL1α1, interleukin-6 and matrix metalloproteinase-9 were quantified in plasma. Binary logistic regression models were used. Participants with low COL1α1 levels exhibited a more unfavorable cardiovascular risk profile. There was an inverse association between COL1α1 and all measures of coronary atherosclerosis before adjustment (ORrange=0.50–0.73, p < 0.05 for all). In two multivariable models adjusting for potential confounders and CAD risk factors, an association with coronary stenosis ≥ 50% (OR = 0.61 and 0.59, respectively) and non-calcified atherosclerotic plaques (OR = 0.62 for both) remained (p < 0.05 for all). The findings shed further light on COL1α1 as a potential CAD biomarker.

Immunoglobulin G subclass deficiencies (IgGSD) are associated with recurrent respiratory tract infections. Tools to identify patients with IgGSD who benefit from immunoglobulin G replacement therapy (IgGRT) are lacking. This crossover study evaluated the number of antibiotic-demanding infections on and after up to 18 mo off IgGRT in 28 patients with IgGSD. Pneumococcal antibodies against 21 serotypes were assessed using a multiplex assay. After 12 mo on IgGRT, the frequency of infections was reduced during the following 6 mo compared with the last 6 mo without IgGRT, indicating a delayed therapeutic effect. Low levels of pneumococcal serotype-specific antibodies and lower IgG2 levels were associated with the need to restart IgGRT. In conclusion, IgGRT effectively reduces bacterial infections in IgGSD, but the benefits may take at least a year to manifest. Pneumococcal antibody profiling and IgG2 levels may help identify patients needing long-term IgGRT.

Sleep disruption is common among patients with cancer, negatively impacting treatment outcomes, survival, and quality of life. However, it is often overlooked in cancer care. This study aimed to explore shared characteristics of sleep disruption in patients with cancer to facilitate simple and accurate identification in routine clinical practice. A secondary aim was to identify potential biomarkers in urine, serum, or leukocytes associated with sleep disruption before and/or after oncological therapy. Ninety cancer patients scheduled for either adjuvant or palliative oncological therapy at Ryhov County Hospital, Jönköping, Sweden, were consecutively enrolled. Of these, 72 completed all questionnaires and provided urine and blood samples at both baseline and three-month follow-up. Data were collected using the 12-item Medical Outcomes Study Sleep Scale (MOS-SS) and the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Biomarker analysis was conducted on urine and blood samples, and data were analyzed using ordinal factor and Rasch modeling. Two distinct factors-Sleep Quality (SQ) and Daytime Sleepiness (DTS)-emerged from the MOS-SS, effectively capturing key aspects of sleep disruption. Both SQ and DTS were strongly associated with sleep-related impairments identified via the EORTC QLQ-C30 and clinical history, but showed no correlation with urinary melatonin or cortisol, serum inflammatory cytokines, or Bmal1 and Per2 gene expression in blood leukocytes. Neither SQ nor DTS was significantly influenced by patient age, body mass index (BMI), or oncological therapy. However, women reported significantly lower DTS compared to men (P ​< ​0.05), while SQ remained unaffected by sex. A simplified scoring tool for SQ and DTS was developed for practical use in clinical oncology settings. This study identifies SQ and DTS as robust measures of sleep quality and daytime sleepiness in cancer patients. These new factors derived from the MOS-SS can support the early detection and management of sleep disruption in routine oncological care.

The appendix is a small, worm-like diverticulum of the caecum, potentially having a role in regulating intestinal microbiota and immunology. Inflammation of the appendix, acute appendicitis, is one of the most common reasons for acute abdominal pain in children and adults and surgical emergency visits worldwide. The pathophysiology of appendicitis is still poorly understood. During the past decade, evidence has overturned the long-lasting dogma that all appendicitis cases have a clinical course inevitably progressing to perforation and life-threatening peritonitis unless operated upon in a timely manner. Instead, this natural course occurs only in a smaller proportion of patients, for whom emergency appendectomy remains mandatory. Advances in diagnostic accuracy following utilization of clinical scoring systems and imaging has enabled more accurate pre-interventional assessment of appendicitis disease severity. While some patients still require urgent surgery, the majority can be treated successfully with antibiotics, and in some the disease has even been shown to resolve spontaneously. This has confirmed the notion of at least two different forms of appendicitis: non-perforating and perforating, often referred to as uncomplicated and complicated appendicitis. Unified definitions of these forms are still undergoing rigorous research and debate, hampering both comparison of different studies and the establishment of unified treatment guidelines. The current knowledge on the safe and effective outcomes of non-operative treatment alternatives has further underlined the need for standardized uniform definitions of appendicitis severity and assessment of the success of two fundamentally different treatment options.

ABSTRACTOptimising pain management during subcutaneous venous port (SVP) implantation is essential for patient‐centred cancer care. However, evidence‐based approaches to minimise intraoperative pain remain underexplored. This trial evaluated the clinical effectiveness and safety of the propofol‐alfentanil patient‐controlled sedation (PCS) technique as an adjunct to local anaesthesia (LA) for pain reduction during SVP implantation. Adult cancer patients at two Swedish anaesthesia departments received either LA + PCS or LA alone for SVP implantation. The primary outcome was the maximum intraoperative pain score on an 11‐point numeric rating scale (NRS). Safety outcomes included respiratory, haemodynamic and insertion‐related complications. Secondary outcomes assessed patient satisfaction and procedural measurements. A total of 340 patients (median age 70 [interquartile range, [IQR] 61–76], 51.8% male) were recruited between January 2023 and November 2024. Median intraoperative NRS pain scores were similar between groups (2 [0–3] vs. 2 [0–3], p = 0.292), with pain scores ≥ 4 reported in 22.9% (LA + PCS) and 22.2% (LA) (OR 0.96; 95% CI 0.57–1.60; p = 0.872). Hypoxia or obstructed airway occurred in 2/166 (1.2%) patients in the LA + PCS group and none in the LA group. Patient satisfaction was high in both groups (10 [10–10], p = 0.102). Optimal procedural conditions were reported more frequently with LA + PCS (96.4% vs. 82.0%; OR 5.84; 95% CI 2.36–14.44; p < 0.001), without affecting perioperative workflow. Propofol‐alfentanil PCS does not significantly reduce intraoperative pain in patients during SVP implantation. Its routine use for pain reduction cannot be recommended. However, PCS may reasonably be offered to patients who prefer procedural sedation.Editorial CommentThis randomised clinical trial found that adding patient‐controlled sedation with propofol‐alfentanil to standard local anaesthesia for subcutaneous venous port implantation does not have an impact on pain scores or patient satisfaction. Additional studies focusing on patients experiences and safety are recommended before implementing propofol‐alfentanil patient‐controlled sedation.Trial Registration: EudraCT number: 2021‐003821‐31; ClinicalTrials.gov identifier: NCT 05688384.

To investigate differences in personality traits in female and male soccer players with or without primary anterior cruciate ligament reconstruction (ACLR) and between female and male players with ACLR. Cross-sectional. 188 female and 58 male players two years after ACLR and 119 female and 107 male knee-healthy players. The Swedish universities Scales of Personality and the Sport Multidimensional Perfectionism Scale questionnaires. Females with ACLR did not differ from females without ACLR in any personality trait. Males with ACLR scored slightly higher than males without ACLR for stress susceptibility (50.9±9.0 vs 47.8±8.0) and lack of assertiveness (50.3±8.9 vs 46.6±9.4), and slightly lower in adventure seeking (51.9±8.3 vs 55.1±8.0), personal standards (3.3±0.9 vs 3.7±0.7), concern over mistakes (2.6±0.9 vs 2.9±0.8), and perceived coach pressure (2.0±0.9 vs 2.4±0.9) (p<0.05, small‒medium effect sizes). Females with ACLR scored higher than males with ACLR for psychic anxiety and social desirability and lower for detachment, physical trait aggression and perceived parental and coach pressure (p<0.05, small‒medium effect sizes). Personality traits do not differ between females and small differences in males with or without ACLR. Sex differences exist in personality in soccer players, but the clinical importance is unclear.

OBJECTIVEAutoantibodies have long been recognized as biomarkers of islet autoimmunity in type 1 diabetes, but their role in the pathogenesis is not fully understood. The aim of this study was to analyze clinical and hereditary characteristics of children presenting with and without autoantibodies at type 1 diabetes diagnosis.RESEARCH DESIGN AND METHODSData were collected from children (<18 years) at the time of diabetes diagnosis as part of Sweden's national Better Diabetes Diagnosis study. Participants were categorized based on the presence or absence of autoantibodies. Variables compared were age at diagnosis, sex, HbA1c, diabetic ketoacidosis (DKA), parental heredity of type 1 and type 2 diabetes, level of C-peptide, BMI SD score (SDS), and HLA genotype. We used t tests, χ2 tests, and logistic regression for comparisons.RESULTSOf the 2,753, children, 169 (6.1%) were autoantibody-negative at type 1 diabetes diagnosis. Of those, 66% were boys compared with 56% of children with autoantibodies (P = 0.009). Also, children without autoantibodies had higher HbA1c at diagnosis (11.3 vs. 10.8% [100 vs. 94 mmol/mol], P = 0.003), were less likely to present with DKA (9 vs. 15%, P = 0.039), and more likely to have parental history of type 2 diabetes (8 vs. 2%, P < 0.001) compared with children with autoantibodies. We did not observe differences for age at diagnosis, C-peptide levels, BMI-SDS, or HLA genotype between the children with and without autoantibodies.CONCLUSIONSWe identified differences in clinical characteristics when comparing children with and without autoantibodies at type 1 diabetes diagnosis, highlighting potential heterogeneity in the disease's pathogenesis across subgroups.

PurposeTo compare football players who have undergone one anterior cruciate ligament (ACL) reconstruction (ACLR) with those who have undergone a subsequent ACLR (revision or contralateral) regarding (1) demographics, (2) football‐related factors and (3) injury‐specific data.MethodsPlayers who voluntarily completed a football‐specific questionnaire available at the Swedish National Knee Ligament Registry website between April 2017 and September 2020 at the time of their primary ACL injury were included in the study. The questionnaire covered demographics, football‐related activities and injury‐specific factors. Subsequent ACLR registrations within 4 years of the primary ACLR were identified in December 2023. Data on game participation post‐primary ACLR were retrieved from the Swedish Football Association's administrative system in September 2022.ResultsA total of 992 football players (66% men) were included, of whom 99 (10%) were registered for subsequent ACLRs. Univariable analysis showed that the following factors significantly increased the odds of a subsequent ACLR: female sex, younger age, a lower weight and body mass index, fewer years played, use of knee control exercises during warm‐up, more likely to plan a return to football, more game participation registered following the primary ACLR, and shorter time between injury and ACLR. Multivariable logistic regression analysis indicated that the odds of undergoing subsequent ACLR decreased significantly with each additional year of age (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.83‒0.92, p < 0.01). Players using knee control exercises during warm‐up (OR, 1.71; 95% CI, 1.08‒2.72, p = 0.02), planning to return to football (OR, 2.74; 95% CI, 1.27‒5.91, p = 0.01), and participating in games after primary ACLR (OR, 1.81; 95% CI, 1.13‒2.91, p = 0.01) increased the odds of undergoing a subsequent ACLR.ConclusionsYounger age and returning to play after an ACLR significantly increase the likelihood of undergoing a subsequent ACLR in football players.Level of EvidenceLevel IV.