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Investigate the association between injury severity and sports-related analgesic use, and explore the types and reasons for analgesic use in Danish youth elite athletes. 4-week prospective cohort study. 713 youth elite athletes (44 % female) aged 15–20 years provided information on demographics, sports specific questions, and injury severity. We categorized injury severity based on the amount of impact on sports participation: 1) no injury (reference), 2) injury not affecting sports participation, 3) injury causing modifications in sports participation, and 4) injury causing complete absence from sport. Participants were asked weekly over 4 weeks about the number of days with sports-related analgesic use, types, and reasons for use. Mixed-effects regression models were used to assess the association between injury severity and prevalence (yes/no) and frequency (days/week) of analgesic use. Analgesic use at least once during the four weeks was reported by 224 athletes (31 %), with a mean weekly prevalence of 13 %. The odds of analgesic use increased with injury severity compared with the reference group; injury not affecting sports participation: OR 2.6 (95 % CI 1.6–4.2), injury causing modifications in sports participation: OR 3.2 (95 % CI 2.0–5.2), injury causing complete absence from sport: OR 3.6 (95 % CI 1.5-8.7) (test for trend; p = < 0.001). The rate (frequency) of analgesic use also increased with injury severity (test for trend; p = 0.003). Athletes most commonly used analgesics to treat pain/injury after sports participation (62 %), and paracetamol was most frequently used (84 %). Injury severity was associated with increased odds and rate of analgesic use. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) has become the standard-of-care treatment for a majority of patients with severe, symptomatic aortic stenosis. The postprocedural antithrombotic therapeutic management is still a topic of debate and could affect the incidence of HALT, a phenomenon which can be assessed by 4-dimensional computed tomography (4DCT). The NOTION-4 trial is a randomized controlled trial comprising TAVR patients with no indication for oral anticoagulant (OAC) therapy, comparing lifelong single antiplatelet therapy (standard arm) versus early 3-month direct oral anticoagulant (DOAC) therapy followed by single antiplateletet therapy (experimental arm). The incidence of HALT and clinical endpoints will be evaluated in both groups at 3 months, 1 year and 5 years after randomization. The primary endpoint is the number of patients with at least 1 bioprosthetic aortic valve leaflet with HALT as assessed by cardiac 4DCT imaging at 1 year. The trial is powered for superiority testing and started enrollment in 2021. In total, 324 patients will be included. The last patient is expected to be enrolled by the end of 2024 and the primary endpoint is to be presented in 2026. The NOTION-4 trial aims to study whether an early 3-month DOAC therapy after TAVR can result in a sustained lower incidence of HALT in transcatheter aortic valves. This trial holds the potential to give valuable insights into whether early OAC therapy should be integrated in future guidelines for post-TAVR antithrombotic therapeutic management. NOTION-4, ClinicalTrials.gov ID NCT06449469, https://clinicaltrials.gov/study/NCT06449469 [ABSTRACT FROM AUTHOR]

Accelerometer-measured physical activity is an increasingly used endpoint in heart failure (HF) trials. We investigated the determinants of accelerometer-measured physical activity and the relationship with patient-reported health status. Post-hoc analysis of the Empire HF trial, including outpatients with HF with reduced ejection fraction (HFrEF). Physical activity was quantified as average accelerometer counts per minute (CPM) with higher values representing higher activity. We investigated associations between activity level and clinical variables, including age, sex, and body mass index, as well as patient-reported health status assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ). Complete data were available in 180 (95%) patients (86% male, mean age 65 year). Baseline median physical activity level was 1,318 CPM (Q1-Q3 1,111-1,585). Age and anemia were independently associated with activity level (β-coefficients: −10 CPM per year age increase [95% CI −16 to −5.1], P =.00015, and −126 CPM for anemia [95% CI −9.1 to −244], P =.035). Significant independent associations were observed between activity level and all KCCQ summary scores (β-coefficient point estimates of 3.7, 4.6, and 4.9 CPM, all P <.02). For 12-week changes in KCCQ-summary scores, only the KCCQ-CSS was associated with activity level; mean increase of 17.5 CPM [95% CI 1.5 to 34.0], P = 0.032, per 5-point increase in KCCQ-CSS. Associations were not modified by treatment allocation (interaction P -values >.05). In patients with HFrEF, older age and anemia were independently associated with lower activity. Moreover, physical activity only weakly increased with better health status, suggesting that changes in physical activity reflect improvements in patients' health status to a limited degree. This highlights the need to better understand the endpoint with regards to all other health parameters to ease interpretation in future HF trials. [Display omitted] [ABSTRACT FROM AUTHOR]

Coronary computed tomography angiography (CCTA) enables detailed quantification and characterization of coronary atherosclerotic plaques, offering diagnostic and prognostic value. Interscan reproducibility studies on plaque volume measurements are limited. This study aims to assess the interscan reproducibility of coronary plaque quantification and the implications of clinical and technical characteristics on interscan reproducibility. CCTA was performed twice in 101 patients with known coronary artery disease at a 1-h interval. The scans were conducted using identical CCTA acquisition protocols. Coronary plaque volumes were quantified using a semi-automated software and performed on a per-lesion, per-vessel, and per-patient level. Median plaque volumes were comparable between the first and second CCTA scan. Interscan correlation was high for total plaque (TP), non-calcified plaque (NCP), and calcified plaque (CP) across all analyses (Pearson's coefficient 0.93–0.99), but lower for low-density non-calcified plaque (LD-NCP) volume measurements (Pearson's coefficient 0.74–0.77). Bland-Altman analyses demonstrated higher interscan agreement on a per-patient level compared to on per-vessel and per-lesion level. Interscan reproducibility on CP volumes was affected by CT image quality with narrower LoA in scans with the highest image quality score (p ​= ​0.003), or lowest image reconstructive iteration level (p ​< ​0.001). Limits of agreement were significantly narrower for TP, NCP, and CP volumes in LAD-lesions and vessels compared to non-LAD lesions and vessels (p ​≤ ​0.001). Overall reproducibility of repeated CCTA derived plaque measurements by a semi-automated software was modest, and was influenced by image quality, image reconstruction settings, and lesion location. [ABSTRACT FROM AUTHOR]

Pre-eclampsia is a pregnancy related disorder associated with hypertension and vascular inflammation, factors that are also involved in the pathological pathway of aortic dilatation and aneurysm development. It is, however, unknown if younger women with previous pre-eclampsia have increased aortic dimensions. We tested the hypothesis that previous pre-eclampsia is associated with increased aortic dimensions in younger women. The study was a cross-sectional cohort study of women with previous pre-eclampsia, aged 40–55, from the PRECIOUS population matched by age and parity with women from the general population. Using contrast-enhanced CT, aortic diameters were measured in the aortic root, ascending aorta, descending aorta, at the level of the diaphragm, suprarenal aorta, and infrarenal aorta. 1355 women (684 with previous pre-eclampsia and 671 from the general population), with a mean (standard deviation) age of 46.9 (4.4) were included. The pre-eclampsia group had larger mean (standard deviation) aortic diameters (mm) in all measured segments from the ascending to the infrarenal aorta (ascending: 33.4 (4.0) vs. 31.4 (3.7), descending: 23.9 (2.1) vs. 23.3 (2.0), diaphragm: 20.8 (1.8) vs. 20.4 (1.8), suprarenal: 22.9 (1.9) vs. 22.0 (2.0), infrarenal: 19.3 (1.6) vs. 18.6 (1.7), p ​< ​0.001 for all, also after adjustment for age, height, parity, menopause, dyslipidemia, smoking and chronic hypertension. Guideline-defined ascending aortic aneurysms were found in 8 vs 2 women (p ​= ​0.12). Women with previous pre-eclampsia have larger aortic dimensions compared with women from the general population. Pre-eclampsia was found to be an independent risk factor associated with a larger aortic diameter. Women with previous pre-eclampsia have increased aortic dimensions compared to the general population. The found difference is not only carried by conventional risk factors, including chronic hypertension, indicating that unknown factors related to pre-eclampsia are present. It is unknown if this difference will translate into a higher frequency of severe aortic disease manifestations later in life. Future studies should clarify if these early findings are associated with an accelerated aortic growth rate leading to a higher prevalence of aortic aneurysms. Secondly, studies are warranted to test if screening should be implemented in follow-up programs for women with previous pre-eclampsia. [ABSTRACT FROM AUTHOR]

Lingual nerve injury (LNI) is a rare, serious complication and previous studies include limited numbers of cases. The aim of this retrospective study was to report the neurosensory outcomes for a large patient cohort with permanent LNI and correlate the mechanism of injury (surgical vs non-surgical) to neurosensory characteristics. Demographics, procedural parameters, mandibular third molar (M3) position, surgeon type, neurosensory test results, and symptoms were recorded for 228 patients and analysed. The majority were female (67.1%). Overall, 59.6% of LNIs were caused by M3 removal and 36.4% by local anaesthesia. Complete loss occurred more frequently in surgical LNIs (P = 0.013). The presence of pain did not differ significantly, however the burning type of pain was significantly more frequent in non-surgical LNIs (P = 0.008) along with altered gustation (P = 0.025). The most common M3 position related to LNI was distoangular (40.4%), class III (63.2%), level A (58.1%) (Winter/Pell and Gregory classifications). The majority of patients undergoing M3 removal were >24 years. A total of 71.7% showed no sign of recovery and 5.5% reported further impairment in their condition. Overall, nine patients underwent microsurgical repair. This study presents neurosensory characteristics potentially decisive for timely referral of operable LNIs. [ABSTRACT FROM AUTHOR]

Left atrial appendage occlusion (LAAO) is rapidly growing as valid stroke prevention therapy in atrial fibrillation. Cardiac imaging plays an instrumental role in preprocedural planning, procedural execution, and postprocedural follow-up. Recently, cardiac computed tomography (CCT) has made significant advancements, resulting in increasing use both preprocedurally and in outpatient follow-up. It provides a noninvasive, high-resolution alternative to the current standard, transesophageal echocardiography, and may display advantages in both the detection and characterization of device-specific complications, such as peridevice leak and device-related thrombosis. The implementation of CCT in the follow-up after LAAO has identified new findings such as hypoattenuated thickening on the atrial device surface and left atrial appendage contrast patency, which are not readily assessable on transesophageal echocardiography. Currently, there is a lack of standardization for acquisition and interpretation of images and consensus on definitions of essential findings on CCT in the postprocedural phase. This paper intends to provide a practical and standardized approach to both acquisition and interpretation of CCT after LAAO based on a comprehensive review of the literature and expert consensus among European and North American interventional and imaging specialists. [Display omitted] • CCT is increasingly used as follow-up imaging after LAAO. • CCT has identified new findings such as HAT on the atrial device surface and LAA contrast patency. • CCT features an unparalleled ability to detect and characterize PDL, HAT, and overt device thrombosis. • CCT may provide a rich source of data, elevating our understanding of several fundamental issues in LAAO. [ABSTRACT FROM AUTHOR]

To examine the pain relief effects of comparators (placebos and untreated control groups) in hand osteoarthritis trials and the impact of contextual factors. We systematically searched PubMed, EMBASE and CENTRAL from inception to December 26, 2021. We included randomised controlled trials of people with hand osteoarthritis with a placebo or an untreated control group. We assessed the Risk of Bias with Cochrane Risk-of-Bias tool version 2. Each comparator was contrasted with a null-arm, imputed as having a zero change from baseline with the same standard deviation as the comparator. We combined the standardised mean differences with a random effects meta-analysis. The contextual factors' effect was explored in meta-regression and stratified models with pain as the dependent variable. 84 trials (7262 participants) were eligible for quantitative synthesis, of which 76 (6462 participants) were eligible for the stratified analyses. Placebos were superior to their matched null-arms in relieving pain with an effect size of −0.51 (95% confidence interval −0.61 to −0.42), while untreated control groups were not. When analysing all comparators, blinded trial designs and low risk of bias were associated with higher pain relief compared to an open-label trial design and some concern or high risk of bias. The placebo response on pain for people with hand osteoarthritis was increased by appropriate blinding and a lower risk of bias assessment. Placebos were superior to a null-arm, while untreated control groups were not. Results emphasise the importance of using appropriate comparators in clinical trials. CRD42022298984 [ABSTRACT FROM AUTHOR]

Coronary CT angiography (CCTA) is well-established for diagnosis and stratification of coronary artery disease (CAD). Its usefulness in guiding percutaneous coronary interventions (PCI) and stent sizing is unknown. This is a sub-analysis of the Precise Percutaneous Coronary Intervention Plan (P3) study (NCT03782688). We analyzed 65 vessels with matched CCTA and pre-PCI optical coherence tomography (OCT) assessment. The CCTA-guided stent size was defined by the mean distal reference lumen diameter rounded up to the nearest stent diameter. The OCT lumen-guided stent size was the mean distal reference lumen diameter rounded to the closest stent diameter. The agreement on stent diameters was determined with Kappa statistics, Passing–Bablok regression analysis, and the Bland-Altman method. The distal reference lumen diameter by CCTA and OCT were 2.75 ​± ​0.53 ​mm and 2.72 ​± ​0.55 ​mm (mean difference 0.06, limits of agreement −0.7 to 0.82). There were no proportional or systematic differences (coefficient A 1.06, 95% CI 0.84 to 1.3 and coefficient B −0.22, 95% CI -0.83 to 0.36) between methods. The agreement between the CCTA and OCT stent size was substantial (Cohen's weighted Kappa 0.74, 95% CI 0.64 to 0.85). Compared to OCT stent diameter, CCTA stent size was concordant in 52.3% of the cases; CCTA overestimated stent size in 20.0% and underestimated in 27.7%. CCTA accurately assessed the reference vessel diameter used for stent sizing. CCTA-based stent sizing showed a substantial agreement with OCT. CCTA allows for PCI planning and may aid in selecting stent diameter. [Display omitted] [ABSTRACT FROM AUTHOR]

Hip fracture is a serious affliction that requires fast care and an X-ray examination, which are provided by an ambulance and a visit to the radiology department, respectively. If a well-functioning mobile X-ray service could be developed, by examining the patient in their own home, both the work strain of hospital workers and patient suffering could be reduced. The purpose of this study was to determine if the mobile X-ray service could be a supplement to the fast-track process that is utilised by the ambulance service. The study also examines other department's opinion of this implementation. A mixed method was used where data from a Swedish hospital's local RIS/PACS was collected from 706 patients for quantitative analysis, and six personnel working at the hospital were interviewed to obtain qualitative data. The quantitative data demonstrates that the actual mobile X-ray service cannot act in such an acute manner as an ambulance service due to the staffing problems that the hospital is faced with, but with optimal staffing, radiographs with mobile X-ray service could be performed within an acute timeframe. The qualitative data shows that there is a strong wish for the mobile X-ray service to expand and be more active, but this requires a better staffing situation in the radiology department and better communication possibilities between other departments. The mobile X-ray service is desirable in the investigated region, and it could benefit both the emergency ward and the ambulance service, and it could function as infection control for geriatric patients, but more radiographers on staff is required if the service should be functional as a complement to the hip-"fast track". More studies on the subject are required. A wide generalisation of the results is not applicable in this study, as mobile X-ray and the "hip fast track" is not a widespread service throughout Sweden. This means that this study only suggests trends, which needs to be studied further. [ABSTRACT FROM AUTHOR]

Noninvasive techniques are gold standard to redress Severe Neuromuscular Foot Deformity (SNFD). However, simple talectomy may be considered to obtain a stable, plantigrade, pain-free foot. We present a 10-year follow-up accessing radiological correction rates, functional outcomes, complications, and patient satisfaction. This retrospective case series evaluated talectomies in 2012 to 2022. Simple talectomy was combined with Steinman pin fixation of calcaneus to tibia for approximately 6 weeks. Diagnoses primarily included arthrogryposis multiplex congenita and cerebral palsy. Indications were pain, wounds/pressure marks, severe rigidity, and residual/recurrent deformity. The primary outcome was radiological correction. Tibiotalar angle (TiTa) and tibiocalcaneal angle (TiCa) were measured on mediolateral projections. Secondary outcomes were functional scores of pain/deformity graded as good, fair or poor. Furthermore, validated patient-reported outcome measures, that is, EQ-5D-5L and the Scoliosis Research Society-30 Questionnaire (2 items) assessed health-related quality of life and patient satisfaction. Nineteen talectomies in 11 patients were analyzed. Mean follow-up was 62 months (range 9-112 months). Mean TiTa was 137° (95%CI 128;146). TiCa improved significantly: Mean difference -24° (95%CI -44;-5, p =.02). All feet became plantigrade and pain-free with no skin issues. Functional outcomes were graded as 9/19 good, 10/19 fair and 0/19 poor. Parents/primary caregivers were mainly satisfied. Perceived health was 54 (95%CI 34;75) out of 100 on a visual analogue scale, emphasizing complex medical conditions. In conclusion, simple talectomy is a suitable salvage procedure for SNFD. [ABSTRACT FROM AUTHOR]

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have previously demonstrated cardioprotective properties in patients with type 2 diabetes, suggesting a preventive effect on heart failure (HF). The Empire Prevent trial program investigates the therapeutic potential for HF prevention by evaluating the cardiac, metabolic, and renal effects of the SGLT2 inhibitor empagliflozin in patients with increased risk of developing HF, but without diabetes or established HF. The Empire Prevent trial program is an investigator-initiated, double-blind, randomized clinical trial program including elderly and obese patients (60-84 years, body mass index >28 kg/m2) with at least one manifestation of hypertension, cardiovascular or chronic kidney disease, but no history of diabetes or HF. The aims are to investigate the effects of empagliflozin on 1) physical capacity and left ventricular and atrial structural changes with peak oxygen consumption and left ventricular mass as primary endpoints (Empire Prevent Cardiac), and 2) cardiac-adipose tissue interaction and volume homeostasis with primary endpoints of changes in epicardial adipose tissue and estimated extracellular volume (Empire Prevent Metabolic). At present, 138 of 204 patients have been randomized in the Empire Prevent trial program. Patients are randomized 1:1 to 180 days treatment with empagliflozin 10 mg daily or placebo, while undergoing a comprehensive examination program at baseline and follow-up. The Empire Prevent trial program will mark the first step towards elucidating the potential of SGLT2 inhibition for HF prevention in an outpatient setting in elderly and obese patients with increased risk of developing HF, but with no history of diabetes or established HF. Furthermore, the Empire Prevent trial program will supplement the larger event-driven trials by providing mechanistic insights to the beneficial effects of SGLT2 inhibition. Both parts of the trial program have been registered on September 13th 2021 (Clinical Trial Registration numbers: NCT05084235 and NCT05042973) before enrollment of the first patient. All patients will provide oral and written informed consent. The trial is approved by The Regional Committee on Health Research Ethics and the Danish Medicines Agency. Data will be disseminated through scientific meetings and peer-reviewed journals irrespective of outcome. [ABSTRACT FROM AUTHOR]

The association between coronary computed tomography angiography (CTA) derived fractional flow reserve (FFR CT) and risk of recurrent angina in patients with new onset stable angina pectoris (SAP) and stenosis by CTA is uncertain. Multicenter 3-year follow-up study of patients presenting with symptoms suggestive of new onset SAP who underwent first-line CTA evaluation and subsequent standard-of-care treatment. All patients had at least one ≥30 ​% coronary stenosis. A per-patient lowest FFR CT -value ≤0.80 represented an abnormal test result. Patients with FFR CT ≤0.80 who underwent revascularization were categorized according to completeness of revascularization: 1) Completely revascularized (CR-FFR CT), all vessels with FFR CT ≤0.80 revascularized; or 2) incompletely revascularized (IR-FFR CT) ≥1 vessels with FFR CT ≤0.80 non-revascularized. Recurrent angina was evaluated using the Seattle Angina Questionnaire. Amongst 769 patients (619 [80 ​%] stenosis ≥50 ​%, 510 [66 ​%] FFR CT ≤0.80), 174 (23 ​%) reported recurrent angina at follow-up. An FFR CT ≤0.80 vs ​> ​0.80 associated to increased risk of recurrent angina, relative risk (RR): 1.82; 95 ​% CI: 1.31–2.52, p ​< ​0.001. Risk of recurrent angina in CR-FFR CT (n ​= ​135) was similar to patients with FFR CT >0.80, 13 ​% vs 15 ​%, RR: 0.93; 95 ​% CI: 0.62–1.40, p ​= ​0.72, while IR-FFR CT (n ​= ​90) and non-revascularized patients with FFR CT ≤0.80 (n ​= ​285) had increased risk, 37 ​% vs 15 ​% RR: 2.50; 95 ​% CI: 1.68–3.73, p ​< ​0.001 and 30 ​% vs 15 ​%, RR: 2.03; 95 ​% CI: 1.44–2.87, p ​< ​0.001, respectively. Use of antianginal medication was similar across study groups. In patients with SAP and coronary stenosis by CTA undergoing standard-of-care guided treatment, FFR CT provides information regarding risk of recurrent angina. [ABSTRACT FROM AUTHOR]

The N at I onal D anish endocarditis st U die S (NIDUS) registry aims to investigate the mechanisms contributing to the increasing incidence of infective endocarditis (IE) and to discover risk factors associated to the course, treatment and clinical outcomes of the disease. The NIDUS registry was created to investigate a nationwide unselected group of patients hospitalized for IE. The National Danish healthcare registries have been queried for validated IE diagnosis codes (International Classification of Disease, 10th edition [ICD-10]: DI33, DI38, and DI398). Subsequently, a team of 28 healthcare professionals, including experts in endocarditis, will systematically review and evaluate all identified patient records using the modified Duke Criteria and the 2015 European Society of Cardiology modified diagnostic criteria. The registry will contain all cases with definite or possible IE found in primary data sources in Denmark between January 1, 2016, and December 31, 2021. We will gather individual patient data, such as clinical, microbiological, and echocardiographic characteristics, treatment regimens, and clinical outcomes. A digital data collection form will be used to the gathering of data. A sample of approximately 4,300 individual patients will be evaluated using primary data sources. The NIDUS registry will be the first comprehensive nationwide IE registry, contributing critical knowledge about the course, treatment, and clinical outcomes of the disease. Additionally, it will significantly aid in identifying areas in which future research is needed. [ABSTRACT FROM AUTHOR]

During the teenage years, many adolescents start drinking alcohol, and binge drinking is prevalent. We investigated the relationship between alcohol intake and academic performance. We conducted a longitudinal cohort study by combining data from the Danish National Youth Study on 65,233 high school students aged 15–20 years, with information on dropout and grade point average. We assessed associations between alcohol intake and academic performance using multilevel Poisson regression and linear regression, accounting for dependency between students from the same school and class. The average alcohol intake was 10 drinks per week, and 43.6% engaged in binge drinking 3+ times per month. During follow-up, 9.8% of the boys and 6.7% of the girls dropped out. The incidence rate ratio was higher in never drinkers, frequent binge drinkers, and those with a high weekly alcohol intake as compared to those with a low intake. For example, the incidence rate ratio was 1.47 (95% confidence level: 1.24, 1.76) in girls who drank 21–27 drinks per week and 1.29 (95% confidence level: 1.13, 1.48) in girls who never drank as compared to those who drank <7 drinks per week. Alcohol associated with a lower grade point average over the entire span of intake in a dose-dependent manner, and similarly so in boys and girls. Findings were consistent in strata of socioeconomy and individual academic ambition. Alcohol intake has implications for academic performance and poses a threat for the prospects of the individual as well as society. Policies and interventions aimed at lowering the intake among high school students are warranted. [ABSTRACT FROM AUTHOR]

We aimed to describe characteristics and outcomes in a nationwide population of patients with acute type A and type B aortic dissection. All patients in Denmark with a first-time diagnosis of acute aortic dissection between 2006 and 2015 were identified by national registries. The main outcomes were in-hospital mortality and long-term survival in hospital survivors. The study population comprised 1157 (68%) patients with type A aortic dissection and 556 (32%) patients with type B aortic dissection, median age of 66 (57-74) years and 70 (61-79) years, respectively. Men accounted for 64%. Median follow-up was 8.9 (6.8-11.5) years. Of patients with type A aortic dissection, 74% were managed surgically, whereas 22% of the patients with type B aortic dissection were managed with surgery or endovascular technique. In-hospital mortality was 27% for type A aortic dissection overall (surgery, 18%; no surgery, 52%) and 16% for type B aortic dissection (surgery or endovascular treatment, 13%; conservative treatment, 17%; P <.001, type A vs type B). Of patients discharged alive, survival was persistently better for type A aortic dissection than for type B aortic dissection (P <.001). Unadjusted 1- and 3-year survival of patients with type A aortic dissection discharged alive was 96% and 91%, respectively, for surgically managed and 88% and 78% without surgery. For type B aortic dissection, the numbers were 89% and 83% for endovascular/surgically managed and 89% and 77% for conservatively managed. We found higher in-hospital mortality for type A and type B aortic dissection than is reported from referral center registries. Type A aortic dissection had the highest mortality rate during the acute phase, whereas for patients who were discharged alive, the mortality rate was higher for patients with type B aortic dissection. [ABSTRACT FROM AUTHOR]

To better comprehend the initial injury experience and care requirements of knee-injured individuals, as well as healthcare professionals' interactions with early care. Qualitative interviews. Public healthcare in Denmark. Ten individuals (6 women) with major knee injuries (6 anterior cruciate ligament (ACL) and meniscal tears, 2 isolated ACL tears, 1 isolated meniscal tear, 1 patella dislocation), aged 16–33 years (median 19 years), 1–26 months post-injury (median 3 months). Thirteen HCPs (5 physiotherapists, 5 orthopedic surgeons, 3 general practitioners). Semi-structured individual and focus group interviews, transcribed verbatim and with latent thematic analysis. The three main themes were: 1) Emotional struggles in solitude – knee-injured individuals dealing with emotions alone due to limited HCP resources for emotional support. 2) Blurry beginning – knee-injured individuals finding initial care frustrating, a sentiment shared by HCPs. 3) A journey with no map – knee-injured individuals holding varied outcome expectations, while HCPs hesitate to discuss long-term knee health. Early care for knee-injured individuals is filled with worries and unmet emotional and information support needs. HCPs need more support and training to deliver timely and appropriate care. • Knee-injured individuals go through a lonely emotional struggle. • A lack of early care hinders timely information and support following knee injuries. • Some general practitioners and surgeons avoid talking about future knee health with knee-injured individuals. [ABSTRACT FROM AUTHOR]

The interplay between coronary hemodynamics and plaque characteristics remains poorly understood. The aim of this study was to compare atherosclerotic plaque phenotypes between focal and diffuse coronary artery disease (CAD) defined by coronary hemodynamics. This multicenter, prospective, single-arm study was conducted in 5 countries. Patients with functionally significant lesions based on an invasive fractional flow reserve ≤0.80 were included. Plaque analysis was performed by using coronary computed tomography angiography and optical coherence tomography. CAD patterns were assessed using motorized fractional flow reserve pullbacks and quantified by pullback pressure gradient (PPG). Focal and diffuse CAD was defined according to the median PPG value. A total of 117 patients (120 vessels) were included. The median PPG was 0.66 (IQR: 0.54-0.75). According to coronary computed tomography angiography analysis, plaque burden was higher in patients with focal CAD (87% ± 8% focal vs 82% ± 10% diffuse; P = 0.003). Calcifications were significantly more prevalent in patients with diffuse CAD (Agatston score per vessel: 51 [IQR: 11-204] focal vs 158 [IQR: 52-341] diffuse; P = 0.024). According to optical coherence tomography analysis, patients with focal CAD had a significantly higher prevalence of circumferential lipid-rich plaque (37% focal vs 4% diffuse; P = 0.001) and thin-cap fibroatheroma (TCFA) (47% focal vs 10% diffuse; P = 0.002). Focal disease defined by PPG predicted the presence of TCFA with an area under the curve of 0.73 (95% CI: 0.58-0.87). Atherosclerotic plaque phenotypes associate with intracoronary hemodynamics. Focal CAD had a higher plaque burden and was predominantly lipid-rich with a high prevalence of TCFA, whereas calcifications were more prevalent in diffuse CAD. (Precise Percutaneous Coronary Intervention Plan [P3]; NCT03782688) [Display omitted] [ABSTRACT FROM AUTHOR]

To assess the association between analgesic use and willingness to compete hurt (WCH) in Danish youth elite athletes, and to explore factors associated with such willingness. 4-week prospective cohort study. 592 Danish youth elite athletes (15–20 years) completed a baseline questionnaire assessing demographic information, sport history, and WCH, and provided weekly reports on analgesic use for 4 weeks via text messages. Analgesic use was categorized as no use (0 weeks) or use across 1, 2, 3, or 4 weeks, and as the total number of days with analgesic use. Multinomial logistic regression and zero-inflated negative binomial regression analyses estimated the association between analgesic use and WCH. Linear backward stepwise regression analysis was used to identify factors associated with WCH. Overall, risk of analgesic use increased significantly with increasing WCH scores (relative risk ratios ranging from 1.06 (95% CI 1.0 to 1.12%) to 1.34% (95% CI 1.15 to 1.57)). The incidence rate of analgesic use increased significantly with increasing WCH scores (incidence rate ratio 1.09 (95% CI 1.04 to 1.14)). Associations between the investigated possible antecedent factors and WCH were weak and not considered practically important (R2 = 0.05 or lower). Higher WCH scores were associated with increasing risk of analgesic use, irrespective of the underlying reason for the use, in Danish youth elite athletes, suggesting that analgesics may be an ingrained part of a sport-specific culture of risk acceptance. Future studies should include measures of culture, norms, and social interaction to better explain the variance in WCH. [ABSTRACT FROM AUTHOR]

Anthracycline-based chemotherapy has improved the prognosis of various malignancies, but increases the long-term risk of heart failure (HF). Identification of patients at risk prior to treatment initiation is warranted. Therefore, the aim of this study was to evaluate if a familial predisposition to HF increases the risk of anthracycline related HF. Using nationwide Danish registries, all patients treated with anthracycline from 2004 to 16 were identified. The primary outcome was long-term HF risk. First-degree relatives were identified in the Danish Family Registry and exposure was defined as a first-degree biological relative with prior HF. Risk of HF was evaluated in a cumulative incidence function and the association in a multivariable Cox regression model. A total of 11,651 patients (median age 49.1 years (IQR: 43.6-53.7), 12.2% male) were included after exclusion of 46 with preanthracycline HF. Median follow-up was 3.8 years (IQR 1.9-6.4). In the group with a first-degree relative with HF (n = 1,608) 35 patients (2.2%) were diagnosed with HF vs 133 (1.3%) in the group without a first-degree relative with HF (n = 10,043), corresponding to incidence rates per 1,000 patient-years of 5.2 (CI:3.8-7.3) vs 3.0 (CI:2.5-3.5). The cumulative incidence of HF after 10 years was higher in the first-degree relative group (3.2% vs 2.0%, P =.004); adjusted hazard ratio 1.53 (CI:1.05-2.23, P =.03). In this nationwide register-based study having a first-degree relative with HF was associated with increased risk of anthracycline related HF, suggesting that attention towards family predisposition may be warranted when estimating the risk of anthracycline related cardiotoxicity. [ABSTRACT FROM AUTHOR]

Temporomandibular joint arthroscopy and arthrocentesis are generally considered safe and minimally invasive surgical procedures. For an inexperienced surgeon, the complex anatomy of the surgical field and the limited visibility represent a significant challenge, and many surgical training programmes are considered limited in providing the adequate training. Technological advancements, involving surgical navigation, facilitate planning, execution, and evaluation of various complex surgical treatments and represent a very promising addition to the surgical training toolkit. This article presents the use of surgical navigation as an additional training tool in teaching level I and II arthroscopy to resident surgeons. Surgical navigation is used to aid the trainee by controlling the starting point and angulation, inspect anatomical landmarks and discus consequences of errors in angulation. While the trainee performs the puncture, the instructor oversees both the surgical field and the anatomy on the surgical navigation screen. It is demonstrated that real-time guidance provided by a surgical navigation system can be used as a training tool for surgeons with limited previous experience in arthroscopic procedures. This application could help improve the safety for the patient and provide a deeper educational level in training surgeons. Still, clinical and tactile feedback perioperatively should remain a primary guideline. Factors such as financial investments, challenges in implementation and a steep learning curve regarding the navigation system must be considered. [ABSTRACT FROM AUTHOR]

Current recommendations regarding the use of surgical left atrial appendage (LAA) closure to prevent thromboembolisms lack high-level evidence. Patients undergoing open-heart surgery often have several cardiovascular risk factors and a high occurrence of postoperative atrial fibrillation (AF)—with a high recurrence rate—and are thus at a high risk of stroke. Therefore, we hypothesized that concomitant LAA closure during open-heart surgery will reduce mid-term risk of stroke independently of preoperative AF status and CHA 2 DS 2 -VASc score. This protocol describes a randomized multicenter trial. Consecutive participants ≥18 years scheduled for first-time planned open-heart surgery from cardiac surgery centers in Denmark, Spain, and Sweden are included. Both patients with a previous diagnosis of paroxysmal or chronic AF, as well as those without AF, are eligible to participate, irrespective of their CHA 2 DS 2 -VASc score. Patients already planned for ablation or LAA closure during surgery, with current endocarditis, or where follow-up is not possible are considered noneligible. Patients are stratified by site, surgery type, and preoperative or planned oral anticoagulation treatment. Subsequently, patients are randomized 1:1 to either concomitant LAA closure or standard care (ie, open LAA). The primary outcome is stroke, including transient ischemic attack, as assigned by 2 independent neurologists blinded to the treatment allocation. To recognize a 60% relative risk reduction of the primary outcome with LAA closure, 1,500 patients are randomized and followed for 2 years (significance level of 0.05 and power of 90%). The LAACS-2 trial is likely to impact the LAA closure approach in most patients undergoing open-heart surgery. Trial registration: NCT03724318. [Display omitted] [ABSTRACT FROM AUTHOR]

The administration of sublingual Nitroglycerin (NTG) prior to CT coronary angiography (CCTA) can be perfomed using pump spray or tablets. Choice of method seems to be based on local preference, rather than published guidelines. This retrospective analysis tested whether proximal coronary diameters differed dependent on the sublingual administration of 0.5 mg Nitroglycerin (NTG) tablets or 0.8 mg NTG spray. 287 ECG-gated CCTA studies with optimal image quality and Agatston scores<400 were included in this retrospective analysis. 143 of the patients were dosed with NTG tablets at a dose of 0.5 mg prior to CCTA. 144 patients received 2 puffs of 0.4 mg NTG spray for a total dose of 8 mg. All were scanned on a second-generation Dual Source CT. Diameters of proximal segments of Left Main (LM), Right (RCA), Left Anterior (LAD) and circumflex (CX) coronary arteries were measured using semi-automatic electronic callipers by two blinded readers. Results were summarised as the mean of maximum and minimum diameters. Sex-specific analysis of diameters was carried out using repeated-measures ANOVA for each vessel. Agreement between readers was examined with Bland-Altman analysis and intra-class-correlation coefficient (ICC). No significant differences in coronary diameters were found except in the RCA for women and LM for men. In both cases, diameters were smaller in the spray group (11 and 9%, respectively). Reader agreement was excellent, with ICC>0.96 for all vessels, and no significant bias, except in CX (0.03 mm). We found no evidence for the systematic superiority of either administration method in proximal coronary vessels. Choosing between tablet or spray NTG prior to CCTA can be guided by practical, economical and hygienic considerations alone. [ABSTRACT FROM AUTHOR]

Mammography screening programs have been implemented in European countries as prevention tools aimed at reducing breast cancer mortality through early detection in asymptomatic women. Nordic countries (Denmark, Finland, Iceland, Norway, Sweden, the Faroe Islands, and Greenland) demonstrated high participation rates; however, breast cancer mortality could be limited by further optimizing screening. This review aimed to explore factors that affect women's participation in mammography screening in Nordic countries. A systematic review of segregated mixed research synthesis using a deductive approach was conducted. The following databases and platforms were searched to identify relevant studies: CINAHL with Full Text (EBSCOHost), MEDLINE (EBSCOHost), PsycInfo (ProQuest), Scopus (Elsevier) and Web of Science Core Collection (SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, and ESCI). The Critical Appraisal Skills Program was used for quality assessment. The Health Promotion Model was applied to integrate findings from qualitative and qualitative research. All methodological steps followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The final selection (16 articles) included studies from three Nordic countries: Denmark (four quantitative studies), Norway (one qualitative and four quantitative studies), and Sweden (three qualitative and seven quantitative studies). Sixty-three factors were identified as barriers, facilitators, or factors with no influence. A substantial number of obtained factors, spread across a wide spectrum, describe (non-)participation in mammography screening as a versatile phenomenon. Implications for practic e: The findings of this review could benefit the mammography staff and providers regarding possible interventions aimed at improving screening participation rates. [ABSTRACT FROM AUTHOR]

Objectives: Dietary recommendations for individuals with diabetes are easy to provide, but adherence is difficult to monitor. The objective of this study was to investigate whether there was a difference in grocery purchases between households with and without diabetes.Study Design: Cohort study.Methods: Consumer purchase data in 2019 was collected from 6662 households donating their supermarket receipts via a receipt collecting service. Of these households, 718 included at least one individual with diabetes. The monetary percentages spent on specific food groups were used to characterize households using all purchases in 2019. A probability index model was used to compare households with diabetes to households without diabetes.Results: We included 405,264 shopping trips in 2019 attributed to 6662 households. Both households with and without diabetes spent the highest monetary percentage on sweets (with diabetes: 9.3%, without diabetes: 8.8%), with no statistically significant difference detected. However, compared to households without diabetes, households with diabetes had a significantly higher probability of spending a higher monetary percentage on butter, oil and dressings; non-sugary drinks; processed red meat and ready meals as well as a significantly lower probability of spending a higher monetary percentage on accessory compounds; alcoholic beverages; eggs; grains; rice and pasta, and raw vegetables.Conclusions: Households with diabetes spent a relatively higher monetary value on several unhealthy foods and less on several healthy groceries compared to households without diabetes. There is a need for more diabetes self-management education focused on including more healthy dietary choices in their household grocery purchases. [ABSTRACT FROM AUTHOR]

Normative data are important in the clinical setting of Speech and Language Pathology. The purpose of this study was to develop a normative reference dataset of voice range profiles from young females. Descriptive study including a prospective collection of voice range profile data. Voice range profile recordings from 39 females with healthy voices aged 18 to 28 years were conducted. Seven voice range profile variables were analyzed: minimum and maximum fundamental frequency and intensity, semitone and intensity ranges, and voice range profile area. Descriptive statistical methods were applied. An age-specific voice range profile normative dataset was established. The mean values and standard deviations were as follows: semitone range 34.7 ± 3.9 ST, minimum fundamental frequency 143.6 ± 21.7 hertz, maximum fundamental frequency 1063.5 ± 160 hertz, intensity range 65.6 ± 5.0 dB, minimum intensity 43.2 ± 2.5 dB SPL, maximum SPL 108.9 ± 5.1 dB SPL, and voice range profile area 1346 ± 222 cells. A normative dataset usable for optimization of future voice assessments has been established. It may especially benefit evaluation and treatment planning for younger females suffering from vocal fold nodules. [ABSTRACT FROM AUTHOR]

• Cognitive deficits are seen in all Idiopathic Generalized Epilepsies. • Cognitive deficits include executive dysfunction and reduced psychomotor speed. • Cognitive deficits are not associated with drug treatment outcome. The endophenotype of Idiopathic Generalized Epilepsies (IGE) comprises distinct neuropsychological deficits compared to normal controls. It is unknown if the severity of features of the endophenotype correlates with resistance to anti-seizure medication. Therefore, we here studied the association of neuropsychological profiles with treatment response. We evaluated 106 Danish patients aged ≥18 and diagnosed with IGE using a neuropsychological test battery comprising tests for executive dysfunction, visual attention, episodic memory, and verbal comprehension. Tests were complemented by the Purdue Pegboard test. Patients with suspected ongoing psychogenic non-epileptic seizures were excluded. At testing, 72 patients were seizure free, and 34 patients had recent seizures despite anti-seizure medication. As compared to age corrected Danish normative values, IGE patients showed significant impairments in semantic fluency and performed significantly worse in the Purdue Pegboard test. The vocabulary subtest of the WAIS-IV suggested lower verbal comprehension in IGE patients. We found no signs of memory impairment. Comparisons between results of the test battery, drug resistance, and the different IGE subsyndromes revealed consistent null-associations in various predefined and exploratory univariate and multivariate analyses. We here found and confirmed the distinct neuropsychological profile comprising impaired executive functions, reduced psychomotor speed, and normal memory previously described in juvenile myoclonic epilepsy. This profile was, however, not restricted to juvenile myoclonic epilepsy but equally affected all IGE patients. The neuropsychological deficits were not significantly associated with drug treatment outcome. [ABSTRACT FROM AUTHOR]

To assess the longer-term effect of the Good Life with osteoarthritis in Denmark (GLAD) exercise and education program relative to open-label placebo (OLP) on changes from baseline in core outcomes in individuals with knee osteoarthritis (OA). In this 1-year follow-up of an open-label, randomized trial, patients with symptomatic and radiographically confirmed knee OA were monitored after being randomized to either the 8-week GLAD program or OLP given as 4 intra-articular saline injections over 8 weeks. The primary outcome was the change from baseline in the Knee injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain subscale after 1 year in the intention-to-treat population. Key secondary outcomes were the KOOS function and quality of life subscales, and Patients' Global Assessment of disease impact. 206 adults were randomly assigned: 102 to GLAD and 104 to OLP, of which only 137 (63/74 GLAD/OLP) provided data at 1 year. At one year the mean changes in KOOS pain were 8.4 for GLAD and 7.0 for OLP (Difference: 1.5 points; 95% CI −2.6 to 5.5). There were no between-group differences in any of the secondary outcomes. In this 1-year follow-up of individuals with knee OA, the 8-week GLAD program and OLP both provided minor longer-term benefits with no group difference. These results require confirmation given the significant loss to follow-up. NCT03843931. [ABSTRACT FROM AUTHOR]

The TACSI trial (ClinicalTrials.gov Identifier: NCT03560310) tests the hypothesis that 1-year treatment with dual antiplatelet therapy with acetylsalicylic acid (ASA) and ticagrelor is superior to only ASA after isolated coronary artery bypass grafting (CABG) in patients with acute coronary syndrome. The TACSI trial is an investigator-initiated pragmatic, prospective, multinational, multicenter, open-label, registry-based randomized trial with 1:1 randomization to dual antiplatelet therapy with ASA and ticagrelor or ASA only, in patients undergoing first isolated CABG, with a planned enrollment of 2200 patients at Nordic cardiac surgery centers. The primary efficacy end point is a composite of time to all-cause death, myocardial infarction, stroke, or new coronary revascularization within 12 months after randomization. The primary safety end point is time to hospitalization due to major bleeding. Secondary efficacy end points include time to the individual components of the primary end point, cardiovascular death, and rehospitalization due to cardiovascular causes. High-quality health care registries are used to assess primary and secondary end points. The patients will be followed for 10 years. The TACSI trial will give important information useful for guiding the antiplatelet strategy in acute coronary syndrome patients treated with CABG. [Display omitted] [ABSTRACT FROM AUTHOR]

Obtaining detailed insights into people's unique hand hygiene behaviour could play an important role in developing the most effective long-term hand hygiene compliance (HHC) interventions. To investigate the effect of two feedback interventions provided by an electronic hand hygiene monitoring system (EHHMS) on sustained HHC improvement, individual responsiveness, and prevention of hospital-acquired bloodstream infections (HABSIs) and urinary tract infections (HAUTIs). The study included two 2-year cohorts (exposed and unexposed to EHHMS) observed over 4 years in an internal medicine department with 142 caregivers and 39 doctors. Healthcare workers (HCWs) were stratified into four groups based on their baseline performance to assess predicted responsiveness to the interventions. All HCWs increased their HHC independently from their performance at baseline, except for a few in the low-performance groups with constantly low HHC. The two low-performance groups at baseline were most responsive to group feedback (weekly change in HHC of 4.4% and 3.1%) compared with individual feedback (weekly change in HHC of 1.0% and 2.2%). The number of cases of HABSI reduced significantly during the intervention period (P =0.01), with the greatest effect on Staphylococcus aureus. No significant change in HAUTIs was observed. The EHHMS interventions sustained the HHC improvements successfully and reduced the number of cases of HABSI. Nearly all HCWs responded to the interventions. The two low-performance groups at baseline never reached the same HHC levels as those in the high-performance groups, indicating the potential for further improvement and the need for intensified individualized interventions. [ABSTRACT FROM AUTHOR]

Absolute measures of myocardial blood flow (MBF) obtained with dynamic myocardial CT perfusion (DM-CTP) are underestimated when compared with reference standards. This is to some extent explained by incomplete extraction of iodinated contrast agent (iCA) to the myocardial tissue. We aimed to establish an extraction function for iCA, use the function to calculate MBF CT and to compare this with MBF measured with 82Rb positron emission tomography (PET). Healthy individuals without coronary artery disease (CAD) were examined with 82Rb PET and DM-CTP. The factors a and β of the generalized Renkin-Crone model were estimated using a non-linear least squares model. The factors providing the best fit for the data were subsequently used to calculate MBF CT. Of consecutive 91 individuals examined, 79 were eligible for analysis. The factors a and β providing the best fit of the nonlinear least-squares model to the data were a ​= ​0.614 and β ​= ​0.218 (R-squared ​= ​0.81). Conversion of the CT inflow parameter (K1) values using the derived extraction function resulted in a significant correlation between MBF measured during stress using CT and PET (P ​= ​0.039). In healthy individuals, flow estimates obtained with dynamic myocardial CT perfusion during stress were, after conversion to MBF using the extraction of iodinated CT contrast agent, correlated with absolute MBF quantified with 82Rb PET. TOC summary : Myocardial blood flow (MBF) obtained with dynamic myocardial CT perfusion is underestimated when compared with reference standards. This is partially explained by incomplete extraction of iodinated contrast to the myocardial tissue. We aimed to establish an extraction function for iodinated contrast in healthy individuals without coronary artery disease, use the function to calculate MBF and to compare this with MBF measured with 82Rb positron emission tomography. We found that flow estimates obtained with dynamic myocardial CT perfusion during stress were, after conversion to MBF using the extraction of iodinated contrast, correlated with absolute MBF quantified with 82Rb positron emission tomography. [ABSTRACT FROM AUTHOR]

We aimed to identify specific anaerobic bacteria causing bacteraemia and a subsequent diagnosis of colorectal cancer. A nationwide population-based cohort study, which included all episodes of defined specific anaerobic bacteraemia from 2010 (5,534,738 inhabitants) through 2020 (5,822,763 inhabitants) and all cases of colorectal cancer diagnosed from 2010 through 2021 in Denmark. We calculated the incidence and risk of colorectal cancer after bacteraemia with specific anaerobic bacteria using Escherichia coli bacteraemia as reference. Nationwide data on colorectal cancer and specific anaerobic bacteraemia (100% complete, representing 11,124 episodes). The frequencies of colorectal cancer within one year following anaerobic bacteraemia were higher for species, which almost exclusively reside in the colon, such as Phocaeicola vulgatus/dorei (5.5%), Clostridium septicum (24.2%), and Ruminococcus gnavus (4.6%) compared to 0.6% in 50,650 E. coli bacteraemia episodes. Bacteroides spp. had a subhazard ratio for colorectal cancer of 3.9 (95% confidence interval [CI], 3.0 to 5.1) and for Clostridium spp. it was 8.9 (95% CI, 6.7 to 11.8, with C. septicum 50.0 [95% CI, 36.0 to 69.5]) compared to E. coli (reference). This nationwide study identified specific colorectal cancer-associated anaerobic bacteria, which almost exclusively reside in the colon. Bacteraemia with these bacteria could be an indicator of colorectal cancer. • Gut microbiota anaerobic bacteria have been associated with colorectal cancer. • Nationwide data on colorectal cancer and anaerobic bacteraemia were collected. • Several specific anaerobic bacteria were associated with colorectal cancer. • Bacteraemia with specific anaerobic bacteria could indicate colorectal cancer. [ABSTRACT FROM AUTHOR]

Objective: Investigate change in physical activity following an 8-week education and exercise therapy program for patients with knee/hip osteoarthritis, focusing on those with low physical activity level. Furthermore, to evaluate associations between changes in pain intensity and physical activity.Method: Data from the Good Life with osteoArthritis in Denmark (GLA:D®) registry, at baseline, immediately after completion, and 12 months after entering the program was used. Measures of interest were UCLA activity scale (1-10) and Visual Analog Scale for pain intensity (0-100 mm). Changes in physical activity levels (low 1-4, moderate 5-6, and high 7-10) over three time points were investigated. Asymmetric fixed effects regression models were used to evaluate the association between clinically relevant change in pain (≥15 mm) and change in physical activity level from baseline to 12 months.Results: 37% with low activity level at baseline (n = 4,836) and 69% of all patients (n = 17,454) reached or maintained at least a moderate physical activity level at follow-ups. Surprisingly, both an improvement (β = 1.44, P < 0.001) and a worsening (β = 1.18, P < 0.001) in pain intensity was associated with increased physical activity in low activity patients. For all patients a similar trend was observed (β = 0.51, P < 0.001 and β = 0.11, P = 0.215, respectively).Conclusion: In low active knee or hip OA patients, a third of patients participating in an education and exercise therapy program reached and maintained at least a moderate physical activity level for 1 year. The improvement in physical activity was not dependent on pain reduction. [ABSTRACT FROM AUTHOR]

• Measurements for 20 months in 8 inhabited rooms with different internal insulation. • Mold risk behind insulation depend on the material sensitivity. • Long-term simulations show enhanced risk. • Material properties of old bricks in the same building vary a lot. • Robustness of sensors is crucial for the assessment. Thermal retrofitting of historic buildings is essential to reducing heat loss in all buildings. Although exterior insulation often is hygrothermally a better solution, internal insulation is the only option in facades worthy of preservation (e.g., solid masonry external walls). However, mold growth has frequently been discovered in buildings with internal insulation at the interface between the insulation and the original wall, while simulations and lab tests show minimum risk, and vice versa. Therefore, real-life testing is required so that the building owners are more likely to accept these measures. This paper presents a case study of an 1837-built typical historic building. The study focuses on the building's top floor, a residential area (commune). Eight different rooms have four different types of internal insulation installed. The performance of the insulation systems was determined by monitoring the interior and exterior climate and the temperature and relative humidity at the intersection of the insulation and the existing wall for 20 months. The risk of mold growth was estimated based on the measurements. In the wall interfaces, the Mold Index indicated that the risk for mold growth is not severe. Hygrothermal simulations for the measured period and ten years were also performed. To increase simulation accuracy, the original exterior masonry bricks underwent laboratory testing to determine their precise material properties. The main outcome from the simulations was that the three vapor-open systems were more susceptible to indoor moisture load changes and had an elevated risk of mold growth, whereas the vapor-tight system was more robust to variation in insulation thickness and internal moisture level changes, and in this case, demonstrated the best performance in respect to moisture safety. [ABSTRACT FROM AUTHOR]

• Measurements for 20 months in 8 inhabited rooms with different internal insulation. • Mold risk behind insulation depend on the material sensitivity. • Long-term simulations show enhanced risk. • Material properties of old bricks in the same building vary a lot. • Robustness of sensors is crucial for the assessment. Thermal retrofitting of historic buildings is essential to reducing heat loss in all buildings. Although exterior insulation often is hygrothermally a better solution, internal insulation is the only option in facades worthy of preservation (e.g., solid masonry external walls). However, mold growth has frequently been discovered in buildings with internal insulation at the interface between the insulation and the original wall, while simulations and lab tests show minimum risk, and vice versa. Therefore, real-life testing is required so that the building owners are more likely to accept these measures. This paper presents a case study of an 1837-built typical historic building. The study focuses on the building's top floor, a residential area (commune). Eight different rooms have four different types of internal insulation installed. The performance of the insulation systems was determined by monitoring the interior and exterior climate and the temperature and relative humidity at the intersection of the insulation and the existing wall for 20 months. The risk of mold growth was estimated based on the measurements. In the wall interfaces, the Mold Index indicated that the risk for mold growth is not severe. Hygrothermal simulations for the measured period and ten years were also performed. To increase simulation accuracy, the original exterior masonry bricks underwent laboratory testing to determine their precise material properties. The main outcome from the simulations was that the three vapor-open systems were more susceptible to indoor moisture load changes and had an elevated risk of mold growth, whereas the vapor-tight system was more robust to variation in insulation thickness and internal moisture level changes, and in this case, demonstrated the best performance in respect to moisture safety. [ABSTRACT FROM AUTHOR]

Improved diagnosis and awareness of transthyretin amyloid cardiomyopathy (ATTR-CM) have resulted in global increases in its estimated incidence and prevalence. However, current US epidemiology data are lacking. To estimate temporal trends in incidence and prevalence of ATTR-CM in different populations in the USA. This study assessed data from three US claims databases, covering inpatient and outpatient data: MerativeTM MarketScan® Medicare and Commercial databases (study period: 2010-2021) and IQVIA PharMetrics Plus (2016-2023) all analyses were performed separately in each database. An algorithm using ICD-9/10 codes and RxNorm codes for clinical drugs was used to identify patients with ATTR-CM among individuals ≥ 18 years old at index date and with ≥ 1 year of continuous enrollment in the database pre-index; index date was defined as January 1 in every year in the study periods. Included patients required a code for amyloidosis and for a cardiac manifestation (heart failure, atrial fibrillation, or cardiomyopathy), and no code indicating light chain amyloidosis. Incidence rates and prevalence proportions were estimated annually in cross-sectional cohorts, overall and stratified by age and sex. Age and sex among individuals with newly diagnosed ATTR-CM were also assessed annually. The incidence and prevalence of ATTR-CM increased over time in all three databases (Figure). Compared with the other databases, the incidence and prevalence were highest and increased most over the study period in Medicare, which includes individuals aged ≥ 65 years (incidence per 100,000 person-years, 2010: 10.1; 2020: 38.9; prevalence per 100,000 individuals, 2010: 15.8; 2021: 85.6) (Figure). Overall, incidence and prevalence were higher and increased more among older age groups relative to younger age groups, and in men relative to women. The total number of incident cases of ATTR-CM over the study periods was 3504 for Medicare; 2185 for Commercial; and 3305 for PharMetrics Plus. Across databases, the mean age in the year of diagnosis remained stable or increased over time (study period start to end; Medicare: ​79 years to 80 years; Commercial: 55 years at both time points; PharMetrics Plus: 67 years to 70 years). The proportion of men among newly diagnosed individuals also remained stable or increased (study period start to end; Medicare: 61% at both time points; Commercial: 55% to 62%; PharMetrics Plus: 58% to 61%). The incidence and prevalence of ATTR-CM diagnoses in the USA increased between 2010 and 2023 across all three claims databases. Over time, people with newly diagnosed ATTR-CM tended to be older. There were more new diagnoses in men than in women, and this also became more pronounced over time. [ABSTRACT FROM AUTHOR]

Ribulose-1,5-biphosphate-carboxylase/oxygenase (RuBisCO) from alfalfa is a promising source of alternative food protein, but it is challenging to purify. Ultrafiltration shows potential for concentrating and fractionating RuBisCO from low molecular weight compounds present in the extracted juice, but there is limited information on their partitioning depending on the membrane pore size. Therefore, the objective of this study was to evaluate the partitioning of various compounds from the juice depending on membrane pore size. It was hypothesized that both membrane pore sizes will retain RuBisCO but might partition low molecular weight compounds within the matrix differently. RuBisCO was fully retained by both the 300 and 100 kDa polyethersulfone (PES) membranes, while ash (29.7%–35.4% dry matter (DM)), non-protein nitrogen (2.38%–2.53% DM), and free N-terminals (10.13–10.34 mg glutamic equivalent/100 mg DM) were transmitted through both membranes. The retentates showed a distinct yellow color when filtering with 100 kDa membranes, but not when using 300 kDa membranes. Although no significant differences in total polyphenol permeation were observed through a spectrophotometric assay, a metabolomics screening analysis showed that the 100 kDa membranes had less transmission of the flavonoids apigenin, chrysoeriol, tricin, and tricin glycosides, which might contribute to the yellow color. These results reiterate the importance of measuring individual polyphenols using hyphenated techniques as opposed to spectrophotometric total reducing capacity. Sixteen saponins were identified and their permeation was lower in the 100 than the 300 kDa membranes, indicating a better potential for higher degree of protein refinement for the latter. This study demonstrates for the first time the difference in partitioning of the small molecular weight components, using PES membranes of similar chemistry but different size, during ultrafiltration of alfalfa juice. • RuBisCO was retained by both 300 and 100 kDa membranes. • Ash, non-protein nitrogen, and free N-terminals transmitted freely both membranes. • Yellow color associated with flavonoids were concentrated by 100 but not 300 kDa. • Saponin transmission was higher in 300 kDa than 100 kDa membranes. • Extensive proteolysis occurred during membrane processing and needs to be minimized. [ABSTRACT FROM AUTHOR]

To identify instruments for assessing family functioning in adults patients with cancer and summarize their psychometric properties. Psychometric systematic literature review was conducted to June 2023 using four databases: PubMed, CINAHL, Psych INFO, and Web of Science. The psychometric properties of the instruments and the methodological quality of the studies were evaluated using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the best available evidence. Forty-four studies reporting 13 instruments were included. The instruments measured varied attributes of family functioning and the dimensions were heterogeneous. The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF) was rated the highest in terms of both methodological rigor and instrument quality. However, the Family Adaptability and Cohesion Evaluation Scale (FACES) and the Ice-Expressive Family Functioning Questionnaire (ICE-EFFQ) offer a more comprehensive measure of family functioning, since they assess multiple dimensions of family functioning and demonstrate high-quality measurement properties. Instruments to assess family functioning were heterogeneous and exhibited limited reliability and validity. The FACES and the ICE-EFFQ seem to be the most suitable measures for adult cancer patients and their families. Future research should aim to refine the content of existing instruments and rigorously assess their psychometric properties. Given the profound impact of cancer on family functioning, the initial step in crafting effective interventions is providing valid and reliable instruments to measure the impact of these interventions. This paper could assist nursing professionals in making informed decisions regarding the most suitable instrument for assessing family functioning in adults patients living with life-threatening illness as is the case with cancer. [ABSTRACT FROM AUTHOR]

In this longitudinal study on Danes born 1980–2000, the objectives were to identify and describe trajectories of childhood poverty and explore their association with trajectories of contacts with the healthcare system. Children born in Denmark from 1980–2000 were linked to national registers. Parental disposable income information was obtained for each year of the child's life from 0–16 years. Group-based trajectory modeling was used to identify trajectories of childhood poverty. The outcome was trajectories of contacts with the healthcare system identified with group-based multi-trajectory modeling. The associations between childhood poverty trajectories and trajectories of contacts with the healthcare system were estimated using multinomial logistic regression. Four distinct groups of childhood poverty trajectories were identified. The largest group (87 %) had very low probability of childhood poverty, and the smallest group (2 %) had high probability of persistent poverty throughout childhood. Two groups experienced either early (5 %) or late (6 %) poverty in childhood. Early and late childhood poverty were associated with higher odds of being in the psychiatric use group in both sexes, and with higher odds of being in the low use and high use groups in women. Persistent poverty was associated with higher odds of being in the low use group and lower odds of being in the high use group and the psychiatric use group in both sexes. In conclusion, childhood poverty is associated with healthcare contacts in adolescence and early adulthood in Denmark. • Identified four distinct trajectories of childhood poverty. • Early and late poverty was associated with a high number of healthcare contacts. • Persistent poverty was associated with the lowest odds ratios of psychiatric contacts. [ABSTRACT FROM AUTHOR]

• Patients with Lyme neuroborreliosis use analgesics from three months before diagnosis. • This suggests a diagnostic delay of Lyme neuroborreliosis of up to three months. • Use of analgesics quickly declined after diagnosis of Lyme neuroborreliosis. • Few patients with Lyme neuroborreliosis may have need of analgesics for up to 2.5 years. • This indicates a good prognosis, but some patients may have persistent symptoms. Radicular pain is the most predominant symptom among adults with Lyme neuroborreliosis (LNB) but the duration preceding and following diagnosis remains unknown. We aimed to investigate whether patients with LNB have increased obtainment of analgesics before and after diagnosis and for how long. We performed a nationwide, population-based, matched cohort study (2009–2021). all Danish residents with LNB (positive Borrelia burgdorferi intrathecal antibody index test and cerebrospinal fluid pleocytosis) were included. To form a comparison cohort, individuals from the general population were randomly extracted and matched 10:1 to patients with LNB on age and sex. Outcomes were obtainment of simple analgesics, antiepileptics, tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors, tramadol, and other opioids. We calculated monthly and six-monthly proportions of individuals with obtainment of analgesics and absolute risk differences. 1,056 patients with LNB and 10,560 comparison cohort members were included. An increased proportion of patients with LNB obtained analgesics from 3 months before study inclusion, especially simple analgesics, tramadol, and other opioids. Within the 0–1-month period after study inclusion, patients with LNB most frequently obtained simple analgesics (15 %), antiepileptics (11 %), and tramadol (10 %). Thereafter, obtainment of analgesics declined within a few months. A slightly larger proportion of patients with LNB obtained antiepileptics up to 2.5 years after diagnosis. Up to 3 months preceding diagnosis, LNB was preceded by increased obtainment of analgesics, which suggests diagnostic delay. Importantly, most patients with LNB did not obtain analgesics after the immediate disease course, although obtainment remained more frequent up to 2.5 years after. [ABSTRACT FROM AUTHOR]

This study investigates vocal outcome after cordectomy by transoral CO 2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy. Prospective, longitudinal, quasi-experimental time series. Consecutively included patients (n = 155) with LIN (n = 84) or NNL (n = 71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings. Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy. Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands. [ABSTRACT FROM AUTHOR]

Managed forests represent a major fraction of the global forest area and are known to host impoverished biodiversity compared to natural forests. The effect of forest management has focused mainly on aggregated community metrics such as species richness of single taxa and on simplistic managed vs. unmanaged comparisons. However, the effect of forest management is expected to vary among species and taxa and to be contingent on site-specific conditions. In this study, we focus on fine-scale multi-taxon biodiversity patterns to disentangle the impact of forest management on the forest structure and the abiotic soil conditions of the stands. We base our comparisons on carefully selected pairs of managed and unmanaged stands to minimize regional differences that could confound the effects of management. We found that the total effect of forest management on alpha diversity was positive on plants and rove beetles, neutral on ground beetles and mosses, and negative on crane flies, fungi, and lichens. However, using joint species distribution modeling we show that individual species' responses to the local underlying soil conditions can be as important as the forest structural changes induced by management, but this varied among the different taxa. Based on these responses we disclose synergies and trade-offs among some of the taxa. Our results indicate that the balance between forest management and abiotic conditions can shape the patterns of forest multi-taxon biodiversity. Considering these conditions can be important in predicting the response of biodiversity to forest management and act as key criteria when prioritizing areas for the conservation of biodiversity. [Display omitted] • Species richness alone provides limited insight into the effects of forest management on biodiversity. • Species-level analysis reveals the intricate relationship between forest structure, soil conditions, and species diversity. • Lichens and fungi respond positively to natural forest structures, underscoring their role as ecological indicators. • Incorporating species-level analysis unveils patterns overlooked by traditional metrics. [ABSTRACT FROM AUTHOR]

Many epilepsy-associated genes have been identified over the last three decades, revealing a remarkable molecular heterogeneity with the shared outcome of recurrent seizures. Information about the genetic landscape of epilepsies is scattered throughout the literature and answering the simple question of how many genes are associated with epilepsy is not straightforward. Here, we present a computationally driven analytical review of epilepsy-associated genes using the complete scientific literature in PubMed. Based on our search criteria, we identified a total of 738 epilepsy-associated genes. We further classified these genes into two Tiers. A broad gene list of 738 epilepsy-associated genes (Tier 2) and a narrow gene list composed of 143 epilepsy-associated genes (Tier 1). Our search criteria do not reflect the degree of association. The average yearly number of identified epilepsy-associated genes between 1992 and 2021 was 4.8. However, most of these genes were only identified in the last decade (2010–2019). Ion channels represent the largest class of epilepsy-associated genes. For many of these, both gain- and loss-of-function effects have been associated with epilepsy in recent years. We identify 28 genes frequently reported with heterogenous variant effects which should be considered for variant interpretation. Overall, our study provides an updated and manually curated list of epilepsy-related genes together with additional annotations and classifications reflecting the current genetic landscape of epilepsy. • We present a computationally driven review of epilepsy-associated genes using the literature available in PubMed. • We identify 738 Tier 2 and an additional subset of 143 Tier 1 epilepsy genes that were manually curated. • Ion channels represent the largest class of epilepsy-associated genes. • For many of these, both gain- and loss-of-function effects have been associated with epilepsy in recent years. • Overall, our study provides a data-driven overview of the past and current genetic landscape of epilepsy. We present a computationally driven review of epilepsy-associated genes using the complete scientific literature available in PubMed. We identify 738 Tier 2 and an additional subset of 143 Tier 1 epilepsy genes that were manually curated. The majority of associations were made in the last decade. We also identify 28 genes frequently reported with heterogenous variant effects which should be considered for variant interpretation. Ion channels represent the largest class of epilepsy-associated genes. For many of these, both gain- and loss-of-function effects have been associated with epilepsy in recent years. Overall, our study provides a data-driven overview of the past and current genetic landscape of epilepsy. [ABSTRACT FROM AUTHOR]