Västerås Municipality

Cenobamate was approved in 2020 by the EMA for the adjunctive treatment of focal-onset seizures in adults. Based on data from clinical trials and early experience in adult patients, we used cenobamate in children whose seizures were not controlled with available options. We prospectively collected clinical data in patients who started treatment with cenobamate and report dosage, efficacy, retention rate, and adverse effects. Overall, 50 patients (median age 12.2 years, range 3.1-18.5, 19 patients below age 10 years; 44% female, median concomitant antiseizure medications 2) were treated with cenobamate for a median duration of 16 months (range 3-28). After gradually increasing cenobamate to clinical effect at a reduced dosage schedule, 60% (29/48) of children were responders (≥50% reduction) and 12% were free of major motor seizures. Patients were treated with an average daily dose of 3.7mg/kg. During cenobamate treatment, 8 (16%) patients were able to discontinue at least one concomitant antiseizure medication. The retention rate at 12 months was 82%. The most common adverse events were somnolence (42%), nausea/vomiting (4%), and ataxia (4%). The findings of this single-center real-world study are in line with prior controlled studies and real-world experience in adult patients, as well as with the limited published experience in children. The efficacy and lack of serious side effects found in this study supports the use of cenobamate as a treatment for epilepsy also in children and infants.

We investigate the behavior of invertible and Fredholm operators on interpolation scales constructed via a family of interpolation functors { F θ } θ ∈ ( 0 , 1 ) . This family includes both complex and real interpolation functors. Our results demonstrate, in particular, that kernels and cokernels of operators are stable on intervals of parameters θ where the operators are Fredholm. Additionally, we introduce the notion of Fredholm operators in the category of Banach couples, establishing its relevance for the obtained results.

Risk factors for dementia include cardiovascular disease, smoking, and diabetes, which also are linked to compromised oral health and periodontal disease. Tooth loss, the hallmark of compromised oral health, is of interest for its systemic effects, including potential impacts on cognitive function. To evaluate tooth loss as a prognostic indicator in dementia, we conducted a register-based cohort study to assess associations of compromised oral health, defined by tooth loss, with mortality risk and progression of cognitive decline. The study population, obtained from linked Swedish nationwide health and quality assurance registries, comprised 3,361 individuals diagnosed with dementia from 2010 to 2013, with follow-up until 2018. Participants were categorized by tooth count: severe tooth loss (<10 remaining teeth), moderate tooth loss (10 to 19 remaining teeth), and a reference group with ≥20 remaining teeth. Mortality rate was analysed by Cox and Poisson regression models, and cognitive decline was assessed by longitudinal analyses of Mini Mental State Examination scores. Analyses were adjusted for demographic and health variables. Tooth loss at the time of dementia diagnosis was not independently associated with increased mortality after covariate adjustment (hazard ratio, 1.12 [95% CI, 0.97 to 1.28] for severe tooth loss vs reference). Annual Mini Mental State Examination scores declined across all groups, with no statistically significant differences among groups. After robust covariate control, no association was observed between tooth loss and increased mortality or cognitive decline in individuals newly diagnosed with dementia. Further studies are needed to determine whether tooth loss is an independent risk factor or a contributing marker in dementia prognosis.

Swelling force is a critical factor impacting battery capacity and safety degradation. Battery designers utilize battery pads to mitigate the effects of swelling force within the module by absorbing stress and preventing thermal runaway. Battery pad mechanical properties are essential for accurately predicting swelling forces, as certain models incorporate these characteristics. However, no prior research has explored the evolution of the mechanical properties of pads subjected to cyclic loading from the charging and discharging processes of the battery. This study investigates the evolution of mechanical properties in circular silicone foam battery pads subjected to cyclic compression, simulating charging-discharging cycles, at 20°C and 60°C. Samples were cyclically compressed, and strain energy density and tangent modulus were evaluated. Two-way ANOVA analysis of the test results demonstrates that increasing the number of cycles significantly decreases both strain energy density ( p &lt; 0.05) and tangent modulus ( p &lt; 0.05). The strain energy density decreased exponentially with cycle count, while temperature primarily influenced the tangent modulus only in the elastic region ( p &lt; 0.05). Moreover, there is no interaction between the cyclic loading and temperature factors. These findings provide a basis for enhancing swelling force prediction models by incorporating the evolution of pad mechanical properties with cycling and temperature, leading to more robust battery module designs and improved lifespan predictions.

Background and ImportanceThe role of inflammation in the pathophysiology of migraine seems to be supported by evidence of an increase in pro-inflammatory cytokines, and by a reduction of regulatory lymphocyte subsets and prevalence of Th1 lymphocytes in the peripheral blood of patients. During acute severe migraine attacks, the calcitonin gene-related peptide is elevated in the cranial circulation and stimulates the release of inflammatory cytokines.Aim and ObjectivesVerifying and confirming the monoclonal antibody anti CGRP activity in the reduction of inflammation induced by migraine. How the use of monoclonal antibody reduces the release of pro-inflammatory cytokines.Material and MethodsWe investigated the levels of Th1 and Th2 cytokines, chemokines and adiponectin in the serum of the migraine patients: at each day hospital visit, blood samples were taken before the antibody was administered; 1 month after the infusion, the patient was made to return for visit to assess the cytokine level. Determination of serum levels of the cytokines was performed using commercial ELISA Kits. A Shapiro-Wilk’s test was performed to evaluate each variable’s departure from distribution. The quantitative variables were summarised as median and interquartile range. Midas questionnaire was used to assess change in degree of disability before and after 1 month of antibody treatment.ResultsThe number of patients who underwent sampling was 13. Results showed that Th1/Th2 and TNF/IL-10 profiles are modulated by anti-CGRP treatment with a shift towards a Th2 immune response with concomitant improvement of symptoms in migraineurs (MIDAS scale score). Serum concentration of adiponectin, according to its anti-inflammatory activity, showed a significant increase after anti-CGRP treatment, suggesting a potential connection of a reduction of adiponectin to the pathophysiology of migraine.Conclusion and RelevanceThis preliminary study highlights that anti-CGRP treatment led to a shift towards a For Peer Review Th2 Immune response with concomitant improvement of symptoms in migraineurs, confirming the correlation between migraine and immune system dysfunctions. In conclusion, monoclonal antibody anti-CGRP demonstrate efficacy in the resolution of this pathology.References and/or AcknowledgementsGlobal, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England) 2018.Conflict of InterestNo conflict of interest

Background In oral cancers, tumour borders are typically defined by white light (WL). Narrow-band imaging (NBI) is an optical endoscopic technique commonly used for the larynx and for cancers of unknown primary. However, evidence for using NBI in oral cancers is insufficient. Aims/objectives We investigated whether NBI is a better predictor of the true mucosal tumour borders than WL in oral cancers. Additionally, we examined the agreement between NBI-based Takano intrapapillary capillary loop classifications and pathology reports. Materials and methods In this prospective study, the tumour borders were assessed by both NBI and WL at the time of surgical resection and then compared. Pathology reports of the examined areas were used as gold standard. Results Forty-nine participants were included. After exclusion of 15 patients due to missing data, 34 were included in analyses. In 26.5% of the assessments, the tumour borders defined by NBI were outside the borders defined by WL. However, 55.5% of these were false-positives. Conclusions and significance The delineation of mucosal tumour borders in oral cancers by NBI was not better than that by WL in this study. Several methodological challenges may have influenced the findings of this study, similar to the limitations reported in previous studies.

BackgroundPercutaneous coronary intervention (PCI) is frequently used for patients with chronic coronary syndrome (CCS). However, the role of PCI beyond symptom relief in CCS remains controversial. The objective of this study was to determine whether PCI is associated with better outcomes, compared with medical therapy (MT) alone.MethodsWe conducted a retrospective cohort study. Using the Swedish Coronary Angiography and Angioplasty Registry, we included all patients with CCS undergoing coronary angiography in Sweden between 2010 and 2020. Two groups were formed based on treatment strategy: PCI+MT versus MT alone. One-to-one propensity score (PS) matching was used to address confounding. Outcome was assessed using matched win ratio analysis, a statistical method that ranks the components of the composite by clinical importance. The primary outcome was net adverse clinical event (NACE) within 5 years. In the win ratio analysis, the components of NACE were ranked as follows: (1) all-cause mortality, (2) myocardial infarction (MI), (3) bleeding and (4) urgent revascularisation. Secondary outcomes were the individual components of NACE, major adverse cardiovascular events (MACE) and cardiovascular mortality.ResultsAfter PS matching, two groups of 7220 patients each were formed. The hierarchical outcome analysis of NACE and MACE showed that PCI was associated with improved outcome (matched win ratio: 1.28 (95% CI 1.20 to 1.36, p<0.001) and matched win ratio: 1.38 (95% CI 1.29 to 1.48, p<0.001), respectively). The use of PCI was associated with higher win ratio of MI (matched win ratio: 1.15, 95% CI 1.04 to 1.28, p=0.008), urgent revascularisation (matched win ratio: 1.85, 95% CI 1.69 to 2.03, p<0.001) and cardiovascular mortality (matched win ratio: 1.15, 95% CI 1.00 to 1.34, p=0.044). No difference in win ratio was observed for all-cause mortality or bleeding.ConclusionsIn this study, which sought to evaluate the outcomes of patients with CCS using a hierarchical approach, patients selected for revascularisation with PCI experienced better outcome compared with MT alone.

This study compares hearing outcomes of two prosthesis materials, bone and titanium, used in ossiculoplasty. This retrospective nationwide registry-based study uses data systematically collected by the Swedish Quality Registry for Ear Surgery (SwedEar). The data were obtained from clinics in Sweden that perform ossiculoplasty. Patients who underwent ossiculoplasty using either bone or titanium prostheses were registered in SwedEar between 2013 and 2019. Hearing outcome expressed as air-bone gap (ABG) gain. The study found no differences between bone and titanium for ABG or air conduction (AC) for either partial ossicular replacement prostheses (PORP) or total ossicular replacement prostheses (TORP). In a comparison between PORP and TORP for ABG and AC outcomes, regardless of the material used, PORP showed a small advantage, with an additional improvement of 3.3 dB (95% CI [confidence interval], 0.1-4.4) in ABG and 2.2 dB (95% CI, 1.7-4.8) in AC. In secondary surgery using TORP, titanium produced slightly better results for high-frequency pure tone average. The success rate, a postoperative ABG ≤20 dB, was achieved in 62% of the operations for the whole group. Both bone and titanium used to reconstruct the ossicular chain produce similar hearing outcomes for both PORP and TORP procedures. However, titanium may be a preferable option for secondary surgeries involving TORP. The success rate, a postoperative ABG ≤20 dB, is consistent with other studies, but there is room for improvement in patient selection criteria and surgical techniques.