University Hospital of Umeå

Healthcare systems face challenges in optimizing resources while maintaining high-quality care. Breast cancer surgery represents a substantial share of elective surgery and provides an opportunity to evaluate different organizational models. This study presents a health economic analysis comparing two models for breast cancer surgery at the same hospital. A bottom-up micro-costing approach was employed to evaluate potential cost-savings of breast cancer surgeries performed at a general surgical department (GS) versus a cardiothoracic surgery department (CT). We analyzed 543 consecutive patients undergoing elective breast cancer surgery between January 2014 and September 2016. Resource use was identified through direct observation, hospital administrative systems, and operating room logs. Personnel, disposables, medications, and facility costs were quantified based on observed resource use within the study dataset; no external benchmarking was performed. CT was less expensive, with an average saving of 3,547 Swedish krona (SEK) per operation (95% CI: -674 to 7,510 SEK). Bootstrap analysis with 1,000 iterations showed CT was less costly in 96.2% of samples. Procedures were shorter at CT (170.8 vs. 221.3 min), enabling more operations per day (3.2 vs. 2.4). In our deterministic simulation, removing CT capacity increased waiting times by 15%, from 39 to 45.1 days, conditional on steady inflow and constant OR availability. Annual savings at the observed annual volume (~ 192 patients) were 681,104 SEK and could reach ~ 1.77 million SEK if volumes increased to 500 patients/year. The CT organizational model was more likely to be less costly while maintaining shorter waiting times. These findings suggest that CT capacity may be prioritized, particularly at higher patient volumes, to support both economic efficiency and patient access.

Background and objectivesMaximal safe resection is the cornerstone of diffuse low-grade glioma (dLGG) management, although epidemiological data are limited. We aim to explore surgical selection, techniques, and outcomes in a population-based cohort.Materials and methodsThis study utilized a multi-center case series (9 out of 10 neurosurgical departments in Norway and Sweden) of all adults (≥18 years) with histopathologically verified supratentorial dLGG, WHO grade 2, undergoing primary surgery from 2012-2017. Complications within 30 days and neurological outcomes at 3 months were assessed. Pre- and postoperative MRIs were reviewed centrally, blinded to patient outcome and center.ResultsOf 517 included patients, 217 (41.7%) were female, and the mean (SD) age was 44.5 (15.0) years. Biopsy only was performed in 119 (23.0%) patients (13.8-38.9% across centers), and 398 (77.0%) underwent resection (61.1-86.2%). Intraoperative neurophysiological monitoring (IONM) was used in 142 (35.7%, 0-58.7%) resections. The biopsy-only patients were older (52.7 years vs. 42.1 years, P<.001), had larger tumors (56.6 ml vs. 31.9 ml, P<.001), and these tumors were more often eloquently located (86.6% vs. 56.5%, P<.001). The median (IQR) extent of resection (EOR) was 82.9% (63.3-97.7%), 69.7-100.0% across centers. The median (IQR) residual tumor was 4.6 ml (0.5-19.9 ml), 0.0-14.1 ml across centers. Age and histopathology were the most important predictors of EOR. New/worsened neurological deficits occurred in 165 patients (41.5%), 23.1-66.7% across centers, and persisted in 19 (4.8%, 0-22.7%) at 3 months after surgery. A complication was observed in 87 patients (21.4%, 0-31.7%), with 12 patients (3.1%, 0-9.8%) having grade III-IV complications.ConclusionsWe found that surgical selection was associated with age, tumor size, and location. The median EOR in a population-based cohort was 83%, with age and tumor biology being significant predictors. EOR did not correlate with higher risks or worse neurological outcomes. We provide an epidemiological perspective demonstrating a variation in surgical selection and techniques reflecting persistent controversy in dLGG management.

Raman spectroscopy is a highly informative technique that is routinely used to analyze the chemical bonds in molecules, such as peptides. However, while Raman spectra of aqueous single amino acids are well-characterized, proteins and peptides are usually found only in solutions in the presence of ions for stability or further analysis. The impact of ions on the Raman spectra of amino acids and subsequently on peptides and proteins has not been systematically studied. In this work, the impact of different metal ions on the Raman spectra of four significant amino acids (glutamate, tyrosine, cysteine, and serine) and N-methylacetamide (a model of a peptide bond) in aqueous solution was studied using density functional theory simulations and Raman spectroscopy experimental validation. The research focused on analyzing band shifts and variations in peak intensity when different cations commonly used in experiments (Li+, Na+, K+, Ag+, Au+, Cu+, and Cu2+) were present. Experimental evidence on Raman spectra variation of Glutamate in the presence of different concentrations of Cu2+ is also provided. Our results show that the ions stay close to the oxygen atoms in the amino acids tested. With regard to Raman spectra, we show Cu2+ promotes Raman resonance. We have characterized and tabulated the shifts in the characteristic Raman peaks of the amino acids in response to metal ions with the aim of providing a reference for interpreting Raman spectra of proteins and other biological materials.

Objective: Antibiotic prophylaxis reduces infection risk following transrectal prostate biopsy. Studies in countries with high antibiotic resistance show that fosfomycin, given an hour or more before biopsy, has equal or better outcomes than ciprofloxacin. This study aimed to evaluate if fosfomycin, administered immediately before biopsy, is as effective as ciprofloxacin in Sweden, where antibiotic resistance is low. Material and Methods: A randomised, non-inferiority study of different antibiotic prophylactic regimes, including men undergoing transrectal prostate biopsy, was conducted. A total of 3448 patients were planned to be included. Primary outcome was hospitalisation due to urinary tract infection (UTI) within 14 days. Men without risk factors for infection received either fosfomycin or ciprofloxacin immediately before biopsy. Patients with risk factors received additional doses post-biopsy. Results: The study was stopped by the safety board after enrolment of 42 men. Four of 20 men (25%) in the fosfomycin group were hospitalised due to UTI, including two with positive blood cultures for Pseudomonas , whereas no hospitalisations (0%) occurred in the ciprofloxacin group. The main limitation was the small sample size. Conclusion: Fosfomycin administered immediately before biopsy was not supported by this study. The results may be skewed by the high incidence of Pseudomonas infections. Level of evidence: 2

This study investigated the associations of muscular strength measures with anthropometry, chronological age, biological maturation, and training experience in trained prepubertal and pubertal males. Another aim was to investigate if handgrip strength can predict general or overall muscle strength in the same population. Forty-one (n = 41) trained male children and adolescents aged 10-16 participated in the study. The 10-repetition maximum (RM) leg press and bench press were used to assess upper- and lower-body muscular strength, handgrip strength was used as an overall strength assessment, and a countermovement jump with arm swing (CMJa) was used to estimate extensor muscle power of the lower extremity. The maturity status was determined using the Tanner scale. Anthropometric factors included height, body mass, two skinfolds, limb length, and lean leg volume. Multivariable linear regressions were performed on absolute strength values to explore predictors of muscular strength and power. Body mass explained 81% of the variance in leg press strength (p < 0.001), whereas bench press was associated with body mass and chronological age, explaining 83% of the variance (p < 0.001). The countermovement jump (CMJa) height was positively associated with lean leg volume, which explained 52% of the variance (p < 0.001). Chronological age and fat-free mass explained 87% of the variance in handgrip strength (p < 0.001). Biological maturity (Tanner) did not contribute to the final models. Handgrip strength was strongly associated with total muscle strength (r = 0.89-0.91, p < 0.001). The results indicate that anthropometrical factors, rather than biological maturity, are associated with muscular strength in trained male children and adolescents. Our findings suggest that handgrip strength may be a quick and effective screening tool for assessing total muscle strength in youth.

<strong class="journal-contentHeaderColor">Abstract.</strong> The chemical signature of surface waters is influenced by the interactions with soil particles and old groundwater. In permafrost landscapes ground ice restricts the flow of water in soils, and this implies a limited influence of, e.g., weathering on the chemical signature of the runoff. The aim of this study was to test to what extent freeze-thaw processes, hydrology and water-age play for shaping the chemical and isotopic signature of surface water and shallow groundwater in a catchment in West Greenland. Measuring runoff in remote catchments is challenging, and we therefore use a validated hydrological model to estimate the daily runoff over multiple years. We have also used a particle tracking simulation to determine the age of groundwater, and isotopic and chemical data from various water types (surface water, groundwater, lake water and precipitation) collected during different hydrological situations. Together this shows that even though the age of the groundwater rarely exceeds 4 years, runoff is dominated by subsurface flow, and overland flow is restricted to the early snowmelt period and heavy rain events. Our monitoring of the active layer indicates a rapid thaw, especially in connection with running water, and melting of ground ice quickly becomes an important fraction of the runoff. Taken together our data indicate that, similar to in other climatic settings and despite the lack of truly old groundwater and a shallow active layer, there is a profound influence from soil processes on the chemical and isotopic signature of the runoff.

Abstract Purpose Factors associated with early re-collapse after posterior fixation of thoracolumbar burst fractures have been sparsely examined in previous studies. We investigated the factors associated with re-collapse within the first 3 months after posterior fixation of thoracolumbar burst fractures.Methods This retrospective study used data from the Swedish Fracture Register (2015–2019), encompassing patients aged 18 to 66 who sustained a single-level thoracolumbar burst fracture between T11 and L3 and underwent posterior fixation. The fractures were classified by a modified AO classification and the load sharing classification (LSC). Hounsfield unit (HU) values were used to evaluate bone quality. Vertebral collapse assessment included measurements of the kyphosis angle, wedge angle, and anterior/posterior height. Moreover, pull-out of pedicle screws was assessed. Multiple logistic regression analysis assessed the factors associated with re-collapse within 3 months after surgeryResults This study comprised 100 participants, of whom 58 were male and 42 were female. Some 16 patients had radiographic vertebral re-collapse and 15 had pedicle screw pull-out. A statistically significant association was observed between HU values and re-collapse (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.94–0.99). Preoperative LSC also tended to be associated with re-collapse (OR: 2.35, 95% CI: 1.07–6.82). However, no association with screw insertion depth or the number of fixated vertebrae was seen in this study.Conclusion Three months post-surgery, a statistically significant association was noted between HU values and early re-collapse after posterior spinal fixation in patients with thoracolumbar burst fractures.