“I Dread the Heart Surgery but it Keeps My Child Alive”—Experiences of Parents of Children with Right Ventricular Outflow Tract Anomalies during the Assessment for Cardiac Reoperation

Background:Parents of children with complex right ventricular outflow tract(RVOT)anomalies are confronted with their child’s need for heart surgery early in life and repeated reoperations later on.Preoperative assessment needs to be performed whenever an indication for reoperation is suspected.The aim was to illuminate the experiences of parents of children diagnosed with RVOT anomalies,in particular,how they experience their child’s heart disease and everyday life during the assessment and after the decision on whether to perform a reoperation.Method:Individual interviews(n=27)were conducted with nine parents on three occasions between 2014 and 2016 and analyzed using reflexive thematic analysis.Results:The analysis resulted in the following five main coexisting themes:The heart surgery keeps my child alive illuminates parents’experiences during and after the assessment and emphasizes that heart surgery,although dreaded,is central for their child’s survival;Everyday struggles illuminates the different struggles parents had to face to ensure that their child would be in the best possible condition;the remaining three themes,Unconditional love,Trust in life,and Togetherness,illuminate the ways in which the parents gained inner strength and confidence in their everyday lives.Conclusion:Although the parents were grateful for the assessment and had learned to navigate among the fears it aroused,they experienced several distressing situations during the assessment process that should be addressed.By inviting both the parents and their child to participate in the child’s care,individualized support can take into account the needs of both parents and child.

Persistent elevation of fibrosis biomarker cartilage oligomeric matrix protein following hepatitis C virus eradication

Serum levels of cartilage oligomeric matrix protein(COMP) has been presented as a biomarker of liver fibrosis in several cross-sectional studies. COMP is also an essential mediator in carcinoma development and has also been associated with hepatocellular carcinoma. We present a prospective analysis of this biomarker in38 patients with chronic hepatitis C who were subject to eradication therapy with direct acting antivirals. We confirm previous studies associating COMP elevation with liver cirrhosis. We also show how viral levels are correlated with COMP at baseline. In our prospective analysis, we report that successful eradication of hepatitis C results in improvement in liver stiffness and laboratory liver function tests at 1 year follow-up. In contrast, median COMP-levels remain unchanged during the study period. We conclude that the biomarker potential of COMP in the prospective evaluation of liver diseases, remains to be elucidated.

Hyponatremia in the Emergency Department: Could Biomarkers Help in Diagnosis and Treatment?

Objective: Hyponatremia is the most common electrolyte imbalance. The initial treatment decision is based on clinical evaluation of patient volume status but an accurate assessment is difficult, particularly differentiating mild hypovolemia from euvolemia. The aim of this study is to examine if biomarkers are valuable in the early determination of volume status and SIADH diagnosis. Methods: Blood samples were collected from an unselected patient population at entry to the Emergency Department. If the plasma sodium level (P-Na) was ≤125 mmol/L, the sample was frozen for further analysis. Mid-regional pro-atrial natriuretic peptide (MR-proANP), proadrenomedullin (MR-proADM), C-terminal prepro-vasopressin (copeptin), pro-endothelin-1 (proET-1) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were analysed. A comprehensive assessment of volume status and underlying causes was made after discharge blinded for biomarker results. Results: A total of 81 patients were included. A well substa ntiated volemic state (hypo/eu/hypervolemia) was established in 72 patients (mean age 76 years, 65% women, median P-Na 119 mmol/L). A significant association was observed between MR-proANP levels and volemic state (p = 0.0001). Data was specifically analysed with respect to distinguishing hypo- from euvolemia (n = 59) using logistic regression. In a crude analysis, MR-proANP was significantly related to euvolemia (OR: 2.54 per SD of MR-proANP, 95% CI 1.32 - 4.86, p = 0.005) and remained so after the multivariate backward elimination model (OR: 2.45 per SD of MRproANP, 95% CI 1.22 - 4.91, p = 0.012.), whereas the other studied biomarkers were not. Copeptin levels were not associated with a diagnosis of SIADH. Conclusions: MR-proANP may be of value in early determination of volume status in hyponatremic patients.

Structure of the myenteric plexus in normal and diseased human ileum analyzed by X-ray virtual histology slices

BACKGROUND The enteric nervous system(ENS)is situated along the entire gastrointestinal tract and is divided into myenteric and submucosal plexuses in the small and large intestines.The ENS consists of neurons,glial cells,and nerves assembled into ganglia,surrounded by telocytes,interstitial cells of Cajal,and connective tissue.Owing to the complex spatial organization of several interconnections with nerve fascicles,the ENS is difficult to examine in conventional histological sections of 3-5μm.AIM To examine human ileum full-thickness biopsies using X-ray phase-contrast nanotomography without prior staining to visualize the ENS.METHODS Six patients were diagnosed with gastrointestinal dysmotility and neuropathy based on routine clinical and histopathological examinations.As controls,fullthickness biopsies were collected from healthy resection ileal regions after hemicolectomy for right colon malignancy.From the paraffin blocks,4-μm thick sections were prepared and stained with hematoxylin and eosin for localization of the myenteric ganglia under a light microscope.A 1-mm punch biopsy(up to 1 cm in length)centered on the myenteric plexus was taken and placed into a Kapton®tube for mounting in the subsequent investigation.X-ray phase-contrast tomography was performed using two custom-designed laboratory setups with micrometer resolution for overview scanning.Subsequently,selected regions of interest were scanned at a synchrotron-based end-station,and high-resolution slices were reported.In total,more than 6000 virtual slices were analyzed from nine samples.RESULTS In the overview scans,the general architecture and quality of the samples were studied,and the myenteric plexus was localized.High-resolution scans revealed details,including the ganglia,interganglional nerve fascicles,and surrounding tissue.The ganglia were irregular in shape and contained neurons and glial cells.Spindle-shaped cells with very thin cellular projections could be observed on the surface of the ganglia,which appeared to build a network.In the patients,there were no alterations in the general architecture of the myenteric ganglia.Nevertheless,several pathological changes were observed,including vacuolar degeneration,autophagic activity,the appearance of sequestosomes,chromatolysis,and apoptosis.Furthermore,possible expulsion of pyknotic neurons and defects in the covering cellular network could be observed in serial slices.These changes partly corresponded to previous light microscopy findings.CONCLUSION The analysis of serial virtual slices could provide new information that cannot be obtained by classical light microscopy.The advantages,disadvantages,and future possibilities of this method are also discussed.

Bioreactance and Apelin in the Management of Severe Hyponatremia

Hyponatremia is a severe electrolyte disturbance associated with substantial morbidity and mortality. It often poses a diagnostic and therapeutic challenge. Accurate assessment of patient fluid-volume status is central to effective management. This pilot study aimed to evaluate the usefulness of the Cheetah NICOM bioreactance system and apelin in early differentiation between hypo- and euvolemia in patients with severe hyponatremia. Methods: Patients > 50 years of age with a serum sodium ≤ 125 mmol/L were eligible for inclusion after written informed consent. Blood- and urine analyses of cardiovascular load (NT-proBNP), osmotic stress (copeptin, apelin, osmolality, sodium), mineralocorticoid status (aldosterone, renin) and sympathetic activity (methoxycathecholamines) were analysed at baseline and after isotonic sodium chloride infusion. Bedside bioreactance examination was used to visualise parameters, including stroke volume before and after passive leg raise test. Classification of volume status was made retrospectively blinded for biomarker and bioreactance results. Results: 8 patients (4 hypovolemic and 4 euvolemic), 79 years old, median plasma sodium 120 mmol/L were included. At the Emergency Department volume status was misclassified in all hypo- and in 2 of 4 euvolemic patients. Apelin was significantly higher in hypovolemic patients ((299 vs. 175 ng/ml), p = 0.021). All hypovolemic, but none of the euvolemic, patients had a level above 250 ng/ml. Copeptin did not differ between groups. All patients in the hypovolemic group increased their stroke volume after passive leg raise. Conclusions: Apelin seems to be a promising future biomarker in the early management of severe hyponatremia. Bioreactance measurements may offer a supplement to bedside evaluation of volume status.

Social Aspects of the Quality of Life of Persons Suffering from Schizophrenia

Background: Several studies have shown that persons with schizophrenia (PWS) suffer from severely reduced quality of life (QoL). Impaired social functioning is a defining characteristic of schizophrenia (SZ) and social cognition deficits affect interpersonal relations and outcomes such as independent living, vocational functioning and employment status. Some studies have demonstrated important socio-cultural aspects of SZ, for instance by examining experiences of SZ in different developing countries and among minority groups in the Western world. The socio-cultural context is central to understanding patients’ experiences in any society, however. Using an anthropological approach, we use qualitative research methods to examine patient perspectives on SZ. Sampling and Methods: In-depth qualitative interviews are carried out with SZ patients in France, the UK and the USA representing diversity in Western mental health systems. Results: To the participants, the most important QoL aspects are close relations and support from loved ones, a safe home and comfort zone, and meaningful daily activities. Normalisation and independence act as central themes to patients’ QoL and hopes for social integration. The participants need a buffer zone consisting of social relations, a home and daily occupation that is flexible and may balance issues of equality/inequality, abnormality/normality, and dependence/independence. Conclusion: By using participatory methods, PWS may be involved in shaping their own treatment and recovery plans based on what is subjectively meaningful and beneficial to their mental health. QoL and functioning are closely linked to the socio-cultural context in which health care structures go hand in hand with health care cultures that shape patients’ expectations and preferences.

Pilot Study of Problem Gambling in Specialized Substance Use Disorder Treatment—High Lifetime Prevalence of Problem Gambling in Opioid Maintenance Treatment Patients

Problem gambling is over-represented in patients treated for substance use disorders, but substance-specific prevalence of problem gambling is rarely reported. In specialized addiction treatment facilities for opioid maintenance treatment and for alcohol and prescription drug dependence, respectively, 129 patients were screened for problem gambling using the NODS-CLiP. The lifetime prevalence of problem gambling was markedly higher in opioid maintenance treatment (61 percent) than in alcohol and prescription drug dependence treatment (11 percent, p < 0.001). When controlling for gender and age, problem gambling remained significantly associated with opioid maintenance treatment. The present study demonstrated a very high prevalence of lifetime problem gambling in opioid maintenance treatment patients. This calls for active screening for problem gambling in substance use disorder patients, and mainly in treatment for opioid dependence.

Causes of Surgical Delay and Demographic Characteristics in Patients with Hip Fracture

Background: Several studies analyze how surgical delay affects patients with hip fracture. The aim of this study was to identify the causes of surgical delay and demographic characteristics in patients with hip fracture who had delays longer than 24 hours from admission to hospital. Methods: Quantitative retrospective register study of 484 patients was consecutively included during the period November 1, 2010 and October 31, 2011 in the University Hospital in Lund (Sweden). Results: A frequency of 29.4% had a surgical delay longer than 24 hours. The main reasons for delays to surgery were lack of theatre facilities (54%), medical unstable patient (16%) and anticoagulant treatment (10%). Of all patients, 69% (n = 332) were women and 31% (n = 151) were men. The mean age for women were 83.6 (CI 83-85) vs. 79 (CI 77-81) for men, respectively. The most common type of hip fracture was displaced cervical hip fracture (39%, n = 188) with a majority of fractures in male patients. In total, women suffered hip fractures to a greater extent than men (69% vs. 31%, p = 0.016), but no relationship was found with respect to the fracture type and age (p = 0.358). Conclusion: The main result demonstrated that delays longer than 24 hours were due to lack of theatre facilities. Further researches have to be done in order to investigate whether lack of theatre facilities depends on improper operation planning and/or on lack of medical staff.

Impact of Field Strength and Respiratory Motion Control on Diffusion-Weighted MR Imaging of the Liver

Purpose: To evaluate the impact of field strength and respiratory motion control on diffusion-weighted MR imaging (DWI) of the liver at 1.5 and 3 T. Material and Methods: Three DWI sequences using seven b-values from 20 - 400 s/mm2 were designed with identical parameters but with different handling of respiratory motion [respiratory triggered (RT), free breathing (FB), breath hold (BH)] on 3 T and 1.5 T. Thirteen volunteers were examined at a 3 T and six of them also at a 1.5 T magnet. DW images were analyzed quantitatively and qualitatively. Regions of interest were placed in cranial, middle and caudal parts of the right liver lobe (RLL) and ADC and SNR were calculated. Results: ADC in RLL tended to be lower at 3 T MRI. Least inter-subject ADC variability was found with RT in the middle RLL at 3 T. Highest ADCs were found caudally in the RLL. Significant differences in ADC between middle and caudal RLL were calculated in FB and RT at 3 T and FB and BH at 1.5 T, respectively. No significant difference in SNR was found between 3 T and 1.5 T. There were significantly more artifacts in the left liver lobe (LLL) compared to the RLL in all sequences and in the LLL at 3 T compared to 1.5 T. Conclusion: Our study suggests that longitudinal hepatic ADC measurements should be performed using equivalent field strength, b-values, and acquisition technique, given influence of these factors on ADC measurements.

Insulin resistance with impaired fasting glucose increases the risk of NAFLD

Background: Our aim was to investigate the frequency of elevated liver enzymes and NAFLD in patients with known insulin resistance during 15 years of follow-up. Methods: Subjects with insulin resistance were identified from a population-based prospective cohort study in Sweden, Malm? Diet and Cancer Study, conducted in 1991-1996. Inall, 285 non-diabetic subjects with insulin resistance established by HOMA-IR (homeostasis model assessment) were invited to do the liver function testing and if elevated, they should be further assessed by radiological examination of the liver, anthropometric measures and blood testing. Results: 165 subjects (57.9%) agreed to do the liver function testing. Of these, 25 subjects (15%) had elevated liver enzymes. After exclusion of other diseases, 5 of the remaining 21 subjects (23.8%) had radiological signs of steatosis. Liver steatosis significantly correlated with ALT (alanine aminotransferase) (p = 0.04), HOMA-IR (p = 0.00) and the metabolic syndrome (p = 0.03). 80% of the subjects with NAFLD had either developed type 2 diabetes mellitus or had impaired fasting glucose and 80% fulfilled the WHO-criteria for the metabolic syndrome, which were of significant differences to the group without NAFLD. Conclusion: The risk of developing elevated liver enzymes and NAFLD at long-term follow-up in insulin resistant subjects is not insignificant, but mainly associated with the simultaneous development of impaired fasting glucose, established diabetes mellitus and/ or the metabolic syndrome.

Co-delivery of rhBMP-2 and zoledronic acid using calcium sulfate/hydroxyapatite carrier as a bioactive bone substitute to enhance and accelerate spinal fusion

Recombinant human bone morphogenetic protein-2(rhBMP-2)has been FDA-approved for lumbar fusion,but supraphysiologic initial burst release due to suboptimal carrier and late excess bone resorption caused by osteoclast activation have limited its clinical usage.One strategy to mitigate the pro-osteoclast side effect of rhBMP-2 is to give systemic bisphosphonates,but it presents challenges with systemic side effects and low local bioavailability.The aim of this in vivo study was to analyze if posterolateral spinal fusion(PLF)could be improved by utilizing a calcium sulfate/hydroxyapatite(CaS/HA)carrier co-delivering rhBMP-2 and zoledronic acid(ZA).Six groups were allocated(CaS/HA,CaS/HA+BMP-2,CaS/HA+systemic ZA,CaS/HA+local ZA,CaS/HA+BMP-2+systemic ZA,and CaS/HA+BMP-2+local ZA).10-week-old male Wistar rats,were randomly assigned to undergo L4-L5 PLF with implantation of group-dependent scaffolds.At 3 and 6 weeks,the animals were euthanized for radiography,μCT,histological staining,or biomechanical testing to evaluate spinal fusion.The results demonstrated that the CaS/HA biomaterial alone or in combination with local or systemic ZA didn’t support PLF.However,the delivery of rhBMP-2 significantly promoted PLF.Combining systemic ZA with rhBMP-2 didn’t enhance spinal fusion.Notably,the co-delivery of rhBMP-2 and ZA using the CaS/HA carrier significantly enhanced and accelerated PLF,without inhibiting systemic bone turnover,and potentially reduced the dose of rhBMP-2.Together,the treatment regimen of CaS/HA biomaterial co-delivering rhBMP-2 and ZA could potentially be a safe and cost-effective off-the-shelf bioactive bone substitute to enhance spinal fusion.

Insulin plus incretin:A glucose-lowering strategy for type 2-diabetes

There are many advantages of combining incretin therapy[glucagon-like peptide-1(GLP-1)receptor agonists and dipeptidyl peptidase-4(DPP-4)inhibitors]with insulin therapy as a glucose-lowering strategy in type2 diabetes.One important advantage is the complementary mode of the mechanistic action of incretin and insulin therapy.Another advantage is the reduction in risk of hypoglycemia and weight gain when adding incretin therapy to insulin.Several clinical trials have studied the addition of GLP-1 receptor agonists[exenatide BID(twice daily),lixisenatide,albiglutide]or DPP-4inhibitors(vildagliptin,sitagliptin,saxagliptin,alogliptin,linagliptin)to ongoing insulin therapy or adding insulin to ongoing therapy with a GLP-1 receptor agonist(liraglutide).These studies show improved glycemia in the presence of limited risk for hypoglycemia and weight gain with the combination of incretin therapy with insulin.This article reviews the background and clinical studies on this combination.

Alkaline sphingomyelinase(NPP7) in hepatobiliary diseases: A field that needs to be closely studied

Alkaline sphingomyelinase cleaves phosphocholine from sphingomyelin, platelet-activating factor, lysophosphatidylcholine, and less effectively phosphatidyl-choline. The enzyme shares no structure similarities with acid or neutral sphingomyelinase but belongs to ectonucleotide pyrophosphatase/phosphodiesterase(NPP) family and therefore is also called NPP7 nowadays. The enzyme is expressed in the intestinal mucosa in many species and additionally in human liver. The enzyme in the intestinal tract has been extensively studied but not that in human liver. Studies on intestinal alkaline sphingomyelinase show that it inhibits colonic tumorigenesis and inflammation, hydrolyses dietary sphingomyelin, and stimulates cholesterol absorption. The review aims to summarize the current knowledge on liver alkaline sphingomyelinase in human and strengthen the necessity for close study on this unique human enzyme in hepatobiliary diseases.

Risk factors and outcomes for patients with pancreatic cancer undergoing surgical exploration without resection due to metastatic disease:A national cohort study

Background:Unresectable disease is sometimes diagnosed during surgery in patients with pancreatic ductal adenocarcinoma(PDAC).This study aimed to identify preoperative risk factors for metastatic disease diagnosed at surgical exploration and to investigate and compare survival in resected and nonresected patients.Methods:Patients were identified from the Swedish National Pancreatic and Periampullary Cancer Registry 2010-2018.Predictors of metastatic disease were evaluated with a multivariable logistic regression model,and survival was evaluated with Kaplan-Meier estimates and log-rank tests.Results:In total,1938 patients with PDAC were scheduled for surgery.An unresectable situation was diagnosed intraoperatively in 399 patients(20.6%),including 234(12.1%)with metastasized disease.Independent risk factors for metastasis were involuntary weight loss(OR=1.72;95%CI:1.27-2.33)and elevated carbohydrate antigen 19-9(CA19-9)(35-599 U/m L,OR=1.79,95%CI:1.11-2.89;≥600 U/m L,OR=3.24,95%CI:2.04-5.17).Overall survival was lower among patients with metastasized disease than that among patients with a resectable tumor(P<0.001).Conclusions:Involuntary weight loss and an elevation of CA19-9 are preoperative risk factors for diagnosing metastasized disease during surgical exploration.

Endoscopic retrograde cholangiopancreatography with rendezvous cannulation reduces pancreatic injury

AIM:To examine whether rendezvous endoscopic retrograde cholangiopancreatography(ERCP)is associated with less pancreatic damage,measured as leakage of proenzymes,than conventional ERCP.METHODS:Patients(n=122)with symptomatic gallstone disease,intact papilla and no ongoing inflammation,were prospectively enrolled in this case-controldesigned study.Eighty-one patients were subjected to laparoscopic cholecystectomy and if intraoperative cholangiography suggested common bile duct stones(CBDS),rendezvous ERCP was performed intraoperatively(n=40).Patients with a negative cholangiogram constituted the control group(n=41).Another 41 patients with CBDS,not subjected to surgery,underwent conventional ERCP.Pancreatic proenzymes,procarboxypeptidase B and trypsinogen-2 levels in plasma,were analysed at 0,4,8 and 24 h.The proenzymes were determined in-house with a double-antibody enzyme linked immunosorbent assay.Pancreatic amylase was measured by an enzymatic colourimetric modular analyser with the manufacturer’s reagents.All samples were blinded at analysis.RESULTS:Post ERCP pancreatitis(PEP)occurred in3/41(7%)of the patients cannulated with conventional ERCP and none in the rendezvous group.Increased serum levels indicating pancreatic leakage were significantly higher in the conventional ERCP group compared with the rendezvous ERCP group regarding pancreatic amylase levels in the 4-and 8-h samples(P=0.0015;P=0.03),procarboxypeptidase B in the4-and 8-h samples(P<0.0001;P<0.0001)and trypsinogen-2 in the 24-hour samples(P=0.03).No differences in these markers were observed in patients treated with rendezvous cannulation technique compared with patients that underwent cholecystectomy alone(control group).Post procedural concentrations of pancreatic amylase and procarboxypeptidase B were significantly correlated with pancreatic duct cannulation and opacification.CONCLUSION:Rendezvous ERCP reduces pancreatic enzyme leakage compared with conventional ERCP cannulation technique.Thus,laparo-endoscopic technique can be recommended with the ambition to minimise the risk for post ERCP pancreatitis.

国际糖尿病足工作组:促进糖尿病足溃疡创面愈合干预指南——《国际糖尿病足工作组:糖尿病足防治国际指南(2019)》的一部分

推荐1.考虑到疼痛或严重缺血等相对禁忌证,采用锐性清创术去除糖尿病足溃疡的腐肉、坏死组织和周围的胼胝优于其他方法。(GRADE推荐强度:强;证据质量:低)2.选择敷料主要是考虑渗出物控制、舒适性和成本。(强;低)3.不要使用含表面抗菌药物的敷料以加速溃疡的愈合。(强;低)4.针对曾用最佳标准治疗难以愈合的未感染的神经性缺血性糖尿病足溃疡,可以考虑使用蔗糖八硫酸盐敷料(脂质水胶寡糖敷料—校者注)。

Tailor-Made Electrospun Culture Scaffolds Control Human Neural Progenitor Cell Behavior—Studies on Cellular Migration and Phenotypic Differentiation

In neuroscience research, cell culture systems are essential experimental platforms. It is of great interest to explore in vivo-like culture substrates. We explored how basic properties of neural cells, nuclei polarization, phenotypic differentiation and distribution/migration, were affected by the culture at poly-L-lactic acid (PLLA) fibrous scaffolds, using a multipotent mitogen-expanded human neural progenitor cell (HNPC) line. HNPCs were seeded, at four different surfaces: two different electrospun PLLA (d = 1.2 - 1.3 μm) substrates (parallel or random aligned fibers), and planar PLL- and PLLA surfaces. Nuclei analysis demonstrated a non-directed cellular migration at planar surfaces and random fibers, different from cultures at aligned fibers where HNPCs were oriented parallel with the fibers. At aligned fibers, HNPCs displayed the same capacity for phenotypic differentiation as after culture on the planar surfaces. However, at random fibers, HNPCs showed a significant lower level of phenotypic differentiation compared with cultures at the planar surfaces. A clear trend towards greater neuronal formation at aligned fibers, compared to cultures at random fibers, was noted. We demonstrated that the topography of in vivo-resembling PLLA scaffolds significantly influences HNPC behavior, proven by different migration behavior, phenotypic differentiation potential and nuclei polarization. This knowledge is useful in future exploration of in vivo-resembling neural cell system using electrospun scaffolds.

Women Who Develop Diabetes Later in Life Have Diabetes-Associated Complications during Preceding Pregnancies

Aims:?The aim of this study was to explore the outcome of previous pregnancies in women who later developed diabetes. Method: A Swedish population based cohort of 23,524 women from 1990 aged 45 - 85 yr in 2000 when they self reported health status in a questionnaire. To identify which women who delivered we matched it towards the Swedish Medical Birth Register (SMBR). We identified 14,856 women who appeared in both registers and a total of 30,559 new birth registrations. Among these women 216 had developed diabetes after their pregnancy (ies) and additional twelve women were reported to have gestational diabetes in SMBR. These 228 women and their 455 pregnancies were compared with women without diabetes. Results: Women who developed diabetes later in life were already heavier before the pregnancy (ies) (69.2 ± 13.9 vs. 63.2 ± 10.3 kg;p < 0.001) but had less weight gain during pregnancy (13.3 ± 5.4 vs. 14.1 ± 4.6 kg;p = 0.03) compared to women without diabetes. Newborns to women with diabetes diagnosed any time after pregnancy had higher birth weight (3602 vs. 3507 g;p < 0.001), were more often large for gestational age (10.5% vs. 3.1%;p < 0.001), were more often delivered by caesarean section (4.8% vs. 2.7%;p = 0.005) and had lower Apgar scores. Conclusion: Women who developed diabetes after pregnancy had hyperglycaemia-associated complications during their pregnancy (ies). We therefore postulated that women with Type 2 diabetes are mainly recruited from women with earlier GDM. A general screening for GDM should identify these women and enable life style intervention that may prevent or at least delay diabetes.

The increase of firearm-related violence in Sweden

Firearm-related violence is common in our contemporary world and causes serious harm to humans as well as to the society.One of the countries in which firearm-related violence is increasing is Sweden and its most southern region,Skane,in which Malmo,Sweden’s third largest city,is highly affected.If not contained and limited,Sweden risks becoming more and more violent.

High-resolution ex vivo analysis of the degradation and osseointegration of Mg-xGd implant screws in 3D

Biodegradable magnesium(Mg)alloys can revolutionize osteosynthesis,because they have mechanical properties similar to those of the bone,and degrade over time,avoiding the need of removal surgery.However,they are not yet routinely applied because their degradation behavior is not fully understood.In this study we have investigated and quantified the degradation and osseointegration behavior of two biodegradable Mg alloys based on gadolinium(Gd)at high resolution.Mg-5Gd and Mg-10Gd screws were inserted in rat tibia for 4,8 and 12 weeks.Afterward,the degradation rate and degradation homogeneity,as well as bone-to-implant interface,were studied with synchrotron radiation micro computed tomography and histology.Titanium(Ti)and polyether ether ketone(PEEK)were used as controls material to evaluate osseointegration.Our results showed that Mg-5Gd degraded faster and less homogeneously than Mg-10Gd.Both alloys gradually form a stable degradation layer at the interface and were surrounded by new bone tissue.The results were correlated to in vitro data obtained from the same material and shape.The average bone-to-implant contact of the Mg-xGd implants was comparable to that of Ti and higher than for PEEK.The results suggest that both Mg-xGd alloys are suitable as materials for bone implants.