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The benefit of antibiotic prophylaxis is uncertain when performing transperineal prostate biopsies. Judicious use of antibiotics is required as antimicrobial resistance increases worldwide. We aimed to assess whether antibiotic prophylaxis can be omitted when performing transperineal prostate biopsies under local anaesthesia as an outpatient procedure.In this randomised, open-label, non-inferiority trial, we aimed to enrol all patients with a suspicion of prostate cancer undergoing transperineal prostate biopsies at two hospitals in Norway and Germany. Patients with a high risk of infection or ongoing infection were excluded. Patients were randomised (1:1) to receive intramuscular (in Norway) or intravenous (in Germany) 1·5 g cefuroxime antibiotic prophylaxis or not. Follow-up assessments were done after 2 weeks and 2 months. The primary outcome was rate of sepsis or urinary tract infections requiring hospitalisation within 2 months. The secondary outcome was the rate of urinary tract infections not requiring hospitalisation. These outcomes were assessed in all eligible randomly allocated participants with a prespecified non-inferiority margin of 4%. Biopsies were performed using an MRI-transrectal ultrasound fusion transperineal technique under local anaesthesia. Patients with a positive MRI underwent 2-4 biopsies per target; in addition, 8-12 systematic biopsies were performed in biopsy naive and MRI-negative patients. This study is registered with ClinicalTrials.gov, NCT04146142.Between Nov 11, 2019, and Feb 23, 2021, 792 patients were referred for biopsy, of whom 555 (70%) were randomly allocated to treatment groups. 277 (50%) patients received antibiotic prophylaxis and 276 (50%) did not; two (lt;1%) patients were excluded after randomisation because of unknown allergy to study drug. Sepsis or urinary tract infections requiring hospitalisation occurred in no patients given antibiotic prophylaxis (0%, 95% CI 0 to 1·37) or not given antibiotic prophylaxis (0%, 0 to 1·37; difference 0% [95% CI -1·37 to 1·37]). Urinary tract infections not requiring hospitalisation occurred in one patient given antibiotic prophylaxis (0·36%, 95% CI 0·01 to 2·00) and three patients not given antibiotic prophylaxis (1·09%, 0·37 to 3·15; difference 0·73% [95% CI -1·08 to 2·81]). The number needed to treat with antibiotic prophylaxis to avoid one infection was 137.The non-inferiority margin of 4% was not exceeded, suggesting rates of infections were not higher in patients not receiving antibiotic prophylaxis before transperineal prostate biopsy than in those receiving it. Therefore, antibiotic prophylaxis might be omitted in this population.Oslo University Hospital, Oslo, Norway and Vivantes Klinikum Am Urban, Berlin, Germany.

Precise electrode placement is essential for obtaining useful electromyographic (EMG) recordings. Our aim was to develop a protocol for computerized-tomography (CT) guided fine-wire (FW) electrode placement that permits confirmation of the final electrode position in the deep posterior cervical multifidus (CM). FW-EMG electrodes were custom-made from three 50-µm diameter Teflon-insulated platinum/iridium wires. The electrodes were inserted bilaterally in the CM in 15 healthy adult subjects through a 45-mm cannula under CT guidance. The final position of the electrode placement was confirmed in reconstructed 2D and 3D images. Electrode placement was within the fascial boundaries of the CM for 21 of the 25 successfully inserted FW-EMG electrodes. The distance from the electrode to the middle of the CM did not increase significantly with target depth until a breakpoint at 63.2 mm (95% CI 59.1–65.3), from where it increased by an additional 2.9 mm per mm increase in target depth (95% CI 1.3–6.6). Viable EMG was obtained from 21 electrodes. CT guided implantation provided excellent visual documentation in three dimensions of the final placement of the tip of the electrode bundle. The technique affords confidence in studies of motoneuron activity in CM.

We aimed to investigate the determinants of attendance to a preventive health check program and to explore the homogeneity of the attenders. 4853 eligible persons living in the municipality of Randers, Denmark, from 2012 to 2013, aged 30–49 years, received an invitation to attend the ‘Check Your Health Preventive Program’. Data was obtained from the Danish National Registers. Socio-demographic factors, use of preventive services, morbidity were examined as determinants of attendance by Poisson regression analyses. A chi-squared automatic interaction detection decision tree analysis was used to identify mutually exclusive groups. In total, 55% of the invited population attended (49% men). Attenders were more likely to be: of higher age; immigrants; cohabiting; have: higher socio-economic status; higher use of preventive services and lower morbidity. Decision tree analysis revealed six groups, with the most important variable being income: 1) low income, low education (A = attendance rate: 38%; P = population size: 11%); 2) low income, education higher than 10 years, living alone (A: 41%; P: 5%); 3) low income, education higher than 10 years, cohabiting (A: 56%; P: 16%); 4) middle income (A: 60%; P: 34%); 5) high income, living alone (A: 56%; P: 4%); 6) high income, cohabiting (A: 69%; P: 30%). More than half of a general population voluntarily attended a general health check, despite a resource intensive offer. People with low resources had lower attendance rates. This study adds a detailed description of mutually exclusive groups of attenders, for use in future planning and implementation of preventive actions.

OBJECTIVES: Short-term rehospitalization and mortality are common events in older patients after a pneumonia admission, yet little knowledge exists on how to identify the patients at risk of these events. This knowledge is needed to ensure that health care attention is given to those with the highest needs. We therefore aimed to identify factors of importance for short-term rehospitalization and mortality in older patients after admission for pneumonia.DESIGN: Population-based cohort study.SETTING: The Danish nationwide registries.PARTICIPANTS: In total, 246,245 individuals aged 65-99 years who experienced 298,564 admissions for pneumonia from 2000 to 2016.METHODS: The explored factors in patients were demographic characteristics, health-seeking behavior, comorbidity, and medication use. A Cox proportional hazards model was used to calculate hazard ratios (HRs) for 30-day rehospitalization and 30-day mortality with 95% confidence intervals (CIs).RESULTS: Of the 298,564 admissions for pneumonia, 23.0% were rehospitalized and 8.1% died within 30 days of follow-up. Most of the investigated factors were significantly associated with these 2 outcomes. The HRs for rehospitalization ranged from 0.80 (95% CI 0.75-0.85) for old vs young age to 4.29 (95% CI 4.05-4.54) for many vs no prior admissions, whereas the HRs for mortality ranged from 0.87 (95% CI 0.83-0.91) for any vs no practical home care to 5.47 (95% CI 5.08-5.88) for old vs young age. Number of comorbidities, medications, and prior contacts to the health care system were associated with higher risk of both rehospitalization and mortality in a dose-response manner.CONCLUSIONS AND IMPLICATIONS: This study identified several potential factors of importance for short-term rehospitalization and mortality in older patients discharged after pneumonia. This knowledge can help physicians identify the patients with the highest need of care after admission for pneumonia, thus enabling efficient discharge planning and high-quality provision of care in primary care settings.

Post-thrombotic syndrome is a common complication after acute proximal deep vein thrombosis (DVT) and is associated with reduced quality of life and a substantial cost burden. In the 2-year results of the CaVenT study, additional catheter-directed thrombolysis reduced the risk of post-thrombotic syndrome by 14% compared with conventional therapy, but did not affect quality of life. In this study we report results at the 5-year follow-up, aiming to assess whether findings for post-thrombotic syndrome and quality of life have persisted.Between Jan 3, 2006, and Dec 22, 2009, we recruited patients aged 18-75 years with a first-time high proximal leg DVT from 20 hospitals in the Norwegian southeastern health region. With sealed envelopes, participants were randomly assigned (1:1) to standard treatment with compression stockings and anticoagulants (control group) or to standard treatment plus catheter-directed thrombolysis with alteplase within 21 days from symptom onset. Pre-specified outcomes in this analysis were post-thrombotic syndrome at 5 years as assessed with the Villalta score and scores for quality of life at 5 years with EQ-5D and the disease-specific VEINES-QOL/Sym. Analyses were by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00251771.At 5 year follow-up (last date Oct 14, 2014), data were available for 176 patients (84% of the 209 patients originally randomised)--87 originally assigned to catheter-directed thrombolysis and 89 originally assigned to the control group. 37 patients (43%; 95% CI 33-53) allocated to catheter-directed thrombolysis developed post-thrombotic syndrome, compared with 63 (71%; 95% CI 61-79) allocated to the control group (p0·0001), corresponding to an absolute risk reduction of 28% (95% CI 14-42) and a number needed to treat of 4 (95% CI 2-7). Four (5%) patients assigned to catheter-directed thrombolysis and one (1%) to standard treatment had severe post-thrombotic syndrome (Villalta score ≥ 15 or presence of an ulcer). Quality-of-life scores with either assessment scale did not differ between the treatment groups.Additional catheter-directed thrombolysis resulted in a persistent and increased clinical benefit during follow-up for up to 5 years, supporting the use of additional catheter-directed thrombolysis in patients with extensive proximal DVT. However, allocation to this therapy did not lead to better quality of life. The optimal endovascular thrombolytic approach needs further investigation.Southeastern Norway Regional Health Authority, the Research Council of Norway, University of Oslo, Oslo University Hospital.

Introduction Type 2 diabetes negatively impacts sexual health. Only limited information is available regarding sexual health among sexually inactive patients with type 2 diabetes. Aim The aim of this study was to examine the prevalence of sexual concerns among sexually active and sexually inactive men and women with type 2 diabetes and of sexual dysfunction (SD) among sexually active. Methods Data from the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care-Denmark study was used. A total of 1,170 Danish patients with screen-detected type 2 diabetes attended a health examination, including assessment of sexual concerns using self-report questionnaires and of SD using the Female Sexual Function Index (FSFI-R) and the International Index of Erectile Function (IIEF-5) instruments. Main Outcome Measures The main outcome measures used regarding sexual concerns are the following: prevalence of failure to fill sexual needs, of experiencing sexual distress, finding it important to have a good sexual life, and additionally, prevalence of SD. Results Data regarding sexual activity status during the last 12 months were available among 583 men and 377 women. Seventeen percent of men and 47% of women reported to be sexually inactive, among whom 57% of men and 42% of women reported failure to fill sexual needs; 31% of men and 10% of women that it was important to have a good sexual life, and 32% of men and 11% of women that they were experiencing sexual distress. Around half of men and women were excluded from the SD analysis, mainly because of reporting lack of sexual intercourse during the last 4 weeks. Among those included, 54% of men and 12% of women were found to have SD. Conclusions Sexual inactivity is highly prevalent among middle-aged and older men and women with early type 2 diabetes and these patients often have sexual concerns. The high exclusion rates when assessing SD using the FSFI-R and IIEF-5 instruments makes it difficult to draw conclusions regarding the prevalence. Sexual health should be broadly assessed in both sexually active and sexually inactive people with type 2 diabetes.

Objective Weight loss is important for prevention of type 2 diabetes and an accurate self-perceived body image can promote weight reduction. We evaluated the association of self-perceived body image with body mass index (BMI) and type 2 diabetes. Methods Data from the Danish ADDITION-PRO cohort study (2009–2011) were used. A total of 2082 men and women attended a health examination including assessment of BMI, waist circumference, the Stunkard scale of self-perceived obesity and an oral glucose tolerance test for assessment of diabetes risk. Results Mean (SD) age was 66.2 (6.9) years and 24% were obese (BMI ≥ 30 kg/m 2 ). However, only 7% of obese men and 11% of obese women perceived themselves as obese. Among obese women, for a given level of BMI and waist circumference, one unit higher self-perceived body image was associated with 52% (95% CI: 14–73) lower risk of having type 2 diabetes and 45% (95% CI: 12–65) lower risk of having pre-diabetes. Overweight, but not obese, men had a 35% (95% CI: 36–56) lower risk of type 2 diabetes per unit increase in body image. Conclusions Obese individuals seem to underestimate their body shape. However, having a realistic body image (higher self-perceived obesity) is independently associated with lower diabetes risk. Self-perceived body image might serve as a valuable tool for type 2 diabetes risk assessment.

Studiet undersøger, om socioøkonomisk position (SEP) har betydning for opnåelse af behandlingsmål blandt personer fundet med type 2 diabetes gennem screening i almen praksis i 5.9 års follow-up.Studiet viste generelt forbedring i HbA1c, kolesterol og blodtryk fra baseline til follow-up. Dette blev fundet uanset uddannelsesniveau, indkomstniveau, beskæftigelse eller samlivsstatus. Studiet viste også at evnen til at opnå behandlingsmål for metaboliske risikofaktorer ikke blev modificeret af SEP. Imidlertid indløste personer med lavt uddannelses- og lavt indkomstniveau i intensiv behandling recept på antihypertensiv medicin i højere grad end personer med højere uddannelse og indkomst. Studiet bygger på data fra 1533 personer i alderen 40-69 år, som fik konstateret type 2-diabetes ved screening i almen praksis, 2001-2006. Undersøgelsen udgør en del af ADDITION-studie, der er et samarbejde mellem Storbritannien, Holland og Danmark med fokus på diabetes i almen praksis. Disse fund indikerer, at tidlig opsporing af type 2-diabetes og tidlig igangsættelse af behandling ikke introducerede social ulighed i opnåelse af behandlingsmål for metaboliske risikofaktorer. AIMS: To examine whether socioeconomic position (SEP) was associated with change in cardiovascular risk factors and meeting treatment targets for cardiovascular risk factors among individuals with screen-detected Type 2 DM at six-year follow-up.METHODS: The study population was 1533 people with Type 2 DM identified from at stepwise diabetes screening programme in general practice during 2001-2006 in the ADDITION-Denmark study. The ADDITION-study was performed as a randomised trial but the two randomisation groups were analysed as one cohort in this study. Cardiovascular risk factors were measured at baseline and repeated at follow-up (mean: 5.9 [1.4] years). Information on SEP, redeemed antihypertensive and lipid-lowering treatment were obtained from Danish registers. Multivariate analyses were performed to estimate change in cardiovascular risk factors and difference in meeting treatment targets.RESULTS: The change in HbA1c, cholesterol, blood pressure and BMI were virtually the same across educational level, income level, occupational status or cohabiting status. Overall, the ability to meet treatment targets for HbA1c, cholesterol and blood pressure was not modified by SEP-group. A higher proportion of people with lower educational level or lower income level in the intensive care redeemed anti-hypertensive treatment compared to people with higher educational or income levels.CONCLUSION: Screen-detection and early treatment onset did not introduce socioeconomic inequality in metabolic control in people with screen-detected Type 2 DM at six-year follow-up.

Introduction The social inequality gradient in the prognosis of diabetes is well-established but it is unclear whether this inequality gradient extends to the use of general practice among persons with diabetes. Methods A nationwide, population-based cohort study was conducted including 137,492 persons with incident diabetes aged 40–79 years and 687,460 reference persons with no history of diabetes matched on gender and age. Information on diabetes was obtained from the National Diabetes Register, socioeconomic position (SEP) from Statistics Denmark and number of general practice consultations from the National Health Insurance Service Registry. Consultation rates for different SEP-groups during the first year after index day were compared. Results Overall, persons with diabetes had 4.8 (95%CI: 4.7–4.8) more consultations in general practice during the first year after their diagnosis than reference persons with no history of diabetes. This additional consultation rate increased with decreasing SEP, e.g. 5.8 (95%CI: 5.6–6.0) for women aged 40–54 years with the lowest educational level and 4.9 (95%CI: 4.7–5.1) for women with the highest educational level. Conclusion Persons with diabetes had nearly five additional consultations with their general practitioner during the first year after their diagnosis and the number was higher for those with the lowest SEP.

Studiet tyder på, at intensiv behandling af patienter med diabetes opdaget ved screening reducerer totaldødeligheden. 163.185 personer i alderen fra 40 til 69 år blev tilsendt et risikospørgeskema for diabetes. Studiet ser på totaldødeligheden blandt de 20.916 personer, som havde høj risiko for diabetes, og derfor mødte til screening for diabetes ved egen læge. På basis af blodsukkerstatus på tidspunktet for screening kunne de fremmødte klassificeres som havende normal glukose tolerance (17.322, NGT), høj risiko for diabetes (2425, IFG-IFG) eller diabetes opdaget ved screening (1169, DM). Langtidsblodsukkeret (HbA1c)på screeningstidspunktet viste sig at kunne forudsige dødelig 7 år senere. Blandt patienter uden diabetes steg dødeligheden med stigende HbA1c (fra 4,4% til 13,1%), mens det modsatte var tilfældet blandt diabetikerne (fra 12,4% til 6,5%). Dødeligheden blandt de diabetikere, som havde højst HbA1c på screeningstidspunktet var ikke signifikant højere end blandt personer, som ikke havde diabetes og et lavt HbA1c (6,5% mod 4,4%). Blandt diabetikere med lavt HbA1c på diagnosetidspunktet var dødeligheden dobbelt så stor som blandt diabetikerne med højt HbA1c på diagnosetidspunktet (12,4% mod 6,5%). Samtidig kunne det konstateres at patienter med diabetes blev behandlet mere intensivt med blodsukkersænkende-, blodtrykssænkende- og kolesterolsænkende medicin des højere HbA1c var på diagnosetidspunktet. Studiet tyder således på, at intensiv behandling af patienter med diabetes opdaget ved screening reducerer totaldødeligheden. To study all-cause mortality and pharmacological treatment intensity in relation to baseline glucose metabolism and HbA1c following high risk screening for diabetes in primary care.

Summary Background Conventional anticoagulant treatment for acute deep vein thrombosis (DVT) effectively prevents thrombus extension and recurrence, but does not dissolve the clot, and many patients develop post-thrombotic syndrome (PTS). We aimed to examine whether additional treatment with catheter-directed thrombolysis (CDT) using alteplase reduced development of PTS. Methods Participants in this open-label, randomised controlled trial were recruited from 20 hospitals in the Norwegian southeastern health region. Patients aged 18–75 years with a first-time iliofemoral DVT were included within 21 days from symptom onset. Patients were randomly assigned (1:1) by picking lowest number of sealed envelopes to conventional treatment alone or additional CDT. Randomisation was stratified for involvement of the pelvic veins with blocks of six. We assessed two co-primary outcomes: frequency of PTS as assessed by Villalta score at 24 months, and iliofemoral patency after 6 months. Analyses were by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00251771. Findings 209 patients were randomly assigned to treatment groups (108 control, 101 CDT). At completion of 24 months' follow-up, data for clinical status were available for 189 patients (90%; 99 control, 90 CDT). At 24 months, 37 (41·1%, 95% CI 31·5–51·4) patients allocated additional CDT presented with PTS compared with 55 (55·6%, 95% CI 45·7–65·0) in the control group (p=0·047). The difference in PTS corresponds to an absolute risk reduction of 14·4% (95% CI 0·2–27·9), and the number needed to treat was 7 (95% CI 4–502). Iliofemoral patency after 6 months was reported in 58 patients (65·9%, 95% CI 55·5–75·0) on CDT versus 45 (47·4%, 37·6–57·3) on control (p=0·012). 20 bleeding complications related to CDT included three major and five clinically relevant bleeds. Interpretation Additional CDT should be considered in patients with a high proximal DVT and low risk of bleeding. Funding South-Eastern Norway Regional Health Authority; Research Council of Norway; University of Oslo; Oslo University Hospital.

Summary. Background: Approximately one in four patients with acute proximal deep vein thrombosis (DVT) given anticoagulation and compression therapy develop post-thrombotic syndrome (PTS). Accelerated removal of thrombus by thrombolytic agents may increase patency and prevent PTS. Objectives: To assess short-term efficacy of additional catheter-directed thrombolysis (CDT) compared with standard treatment alone. Patients and methods: Open, multicenter, randomized, controlled trial. Patients (18–75 years) with iliofemoral DVT and symptoms

We evaluated variations in glucose measurements and the reproducibility of glucose tolerance classification in a high-risk screening setting in general practice. Screening for diabetes was performed in persons aged 40-69 years. Based on capillary fasting (FBG) and 2-h blood glucose (2 hBG) individuals with impaired fasting glycaemia (IFG), impaired glucose tolerance (IGT) and diabetes had a second test done after 14 days. Intra-individual coefficients of variation (CV) were estimated in each glucose tolerance class using the approximation CV(2)(x)=var(ln(x)). Bland-Altman plots with limits of agreement were made. In the total population, the CV(intra) was 7.9% and 13.8% for FBG and 2 hBG, respectively. Limits of agreement ranged from -1.15 to 1.67 mmol/l for FBG and from - 2.62 to 3.27 mmol/l for 2 hBG. One individual with IFG and 22.5% with IGT had diabetes at the second test, 76.1% with diabetes had this diagnosis confirmed, and about 30% with IFG and IGT had normal glucose tolerance at the second test. The expected values of repeated capillary blood glucose measurements were about+/-1 and+/-3 mmol/l for FBG and 2 hBG, respectively. Yet, 70% of high-risk prediabetic individuals were persistently classified with abnormal glucose regulation; diabetes was confirmed in 76% of the cases.

Background The conventional treatment of acute deep vein thrombosis (DVT) is anticoagulation and compression therapy, as recommended in the international guidelines. Anticoagulation prevents recurrent venous thrombosis, pulmonary embolism, and death. Compression therapy reduces the risk of developing long-term sequelae, that is, postthrombotic syndrome (PTS). Evaluation of systemic thrombolysis has shown effective thrombolysis and a likely reduction in PTS but at the cost of increased risk of bleeding complications. Catheter-directed thrombolysis (CDT) was introduced for rapid removal of thrombi and salvage of venous valves with less systemic thrombolytic effect, and is being offered to selected patients with iliofemoral DVT to prevent development of PTS. Case series have shown technical and thrombolytic success; however, no randomized studies have evaluated the long-term clinical effects of venous CDT. The aim of the CaVenT study is to investigate the role of adjunctive CDT by evaluating its clinical efficacy and safety compared with conventional treatment alone in patients with acute iliofemoral DVT. Methods The CaVenT study is an open, randomized, controlled, clinical trial. We plan to include 200 patients who will receive either CDT, in addition to conventional treatment, or conventional treatment alone. The primary outcome measures are patency at 6 months and prevalence of PTS at 2 years. Conclusion Implementation of the CaVenT study will be a contribution toward evidence-based medicine in the treatment of acute proximal DVT of the leg. Any documentation of improved functional outcome will have a significant impact on clinical practice for this patient group and may lead to a modification of existing international guidelines.

Aim To answer: (1) Do we have effective treatments to improve prognosis for those identified at risk of Type-2 diabetes? (2) Will prevention be cost-effective? Methods A systematic search was done in PubMed using the following search strategy: “diabetes AND prevention AND (IFG OR IGT)”. Restrictions were: “English, Meta-Analysis, Randomized Controlled Trial, Review, Humans”. Results Few randomised controlled preventive trials were found. Almost all were done in research settings in people with high risk of developing Type-2 diabetes. It seems possible to either delay or prevent Type-2 diabetes through lifestyle interventions and medication. Cost–utility analyses are few in number and come to very different conclusions as to whether health policy should promote prevention of Type-2 diabetes. Conclusion Intervention studies using lifestyle counselling and drug therapy in research settings illustrate promising results with lowering of the incidence of Type-2 diabetes, meaning that Type-2 diabetes can be delayed or prevented. It is, however, questionable whether these interventions are cost-effective. We need studies in routine clinical settings evaluating morbidity, mortality and cost-effectiveness as primary outcomes. While waiting for these studies to prove cost-effective, patients with pre-diabetes should be treated according to their 10-year risk of cardiovascular disease following present guidelines.

ObjectivesTo compare the effect of optimal medical treatment only (OMT) with OMT combined with percutaneous transluminal angioplasty (OMT+PTA) in patients with intermittent claudication (IC).DesignA single centre prospective, randomised study. Quality of life (QoL) was the primary outcome measure. Secondary measures were ankle-brachial-index (ABI), treadmill walking distances and mortality.MethodsFrom a total of 434 patients considered for inclusion into the trial, only 56 patients with disabling IC fulfilled the inclusion criteria. The patients were randomised into treatment groups consisting of 28 patients each and followed for 2 years. ABI and treadmill walking distances were measured in addition to the visual analogue scale (VAS) for pain evaluation, and QoL assessment using the Short Form (SF-36 and Claudication Scale (CLAU-S).ResultsThe demographic data in the 2 groups were almost identical. After 2 years of follow-up the ABI, the treadmill walking distances and the VAS were significant improved in the group treated with OMT+PTA, compared to the group treated with OMT only (p

Sonazoid is a new contrast agent for ultrasound imaging. The product is an aqueous suspension of perfluorobutane microbubbles coated with phospholipids obtained from hydrogenated egg phosphatidylserine (H-EPS). A normal-phase high-performance liquid chromatographic (HPLC) method with evaporative light scattering detection was developed for quantification of free fatty acids, phosphatidylserine and phosphatidic acid in H-EPS and Sonazoid. Separation of the lipids was carried out on an HPLC diol column and a gradient of chloroform and methanol with 0.2% formic acid titrated to pH 7.5 with ammonia. The calibration standards contained stearic acid, distearoyl-phosphatidic acid (DSPA) and distearoyl-phosphatidylserine (DSPS) in the concentration range of 0.016-1.0mg/ml (0.4-25microg injected). The method was validated with a limit of quantification of the three lipids set to 0.4microg (approximately 20-60microM). The best fit of the three calibration curves were obtained when the logarithmic transformed theoretical lipid concentration was plotted against the logarithmic transformed area under the peak and fitted to a second order polynomial equation. Stearic acid, DSPA and DSPS were analysed with an intermediate precision ranging from 4.4% to 5.3% R.S.D. and they were extracted from an aqueous suspension with a recovery ranging from 103.3% to 113.3%. The sum of total phospholipid concentration determined in H-EPS ranged from 96.4% to 103.2% of the theoretical values. The lipids in the ultrasound product were quantitated with a repeatability ranging from 6.2% to 11.7% R.S.D.

Objective/background The objective was to assess the technical success, patency, and clinical outcome after stent placement for chronic obstruction of the inferior vena cava (IVC). Methods A retrospective analysis was carried out of patients with chronic IVC obstruction verified with computed tomography and/or magnetic resonance venography, accepted for stent placement at the Norwegian National Unit for Reconstructive Deep Venous Surgery from March 2010 to September 2015. Clinical status was categorized according to the CEAP classification and symptom severity was assessed using venous clinical severity score (VCSS). Stent patency was evaluated by colour duplex ultrasound. Large -diameter Wallstents were placed in the IVC and concurrent iliac and femoral obstructions via right internal jugular and femoral vein access. Sixteen patients presented with symptoms of chronic venous disease. Four patients had symptoms assumed to be related to a reduced cardiac preload. Twelve patients had IVC occlusion and eight had stenosis. Median follow-up was 25 months (range 3–70 months). Results Stent placement in the IVC was successful in 19 of 20 patients. Primary patency after 24 months was 67% and secondary patency 83%. Fifteen of 19 patients had open stents at final follow-up. Re-interventions were performed in four patients and included catheter directed thrombolysis in all and adjunctive stenting in three. Thirteen of 19 patients (68%) reported a sustained and significant clinical improvement. Mean VCSS improved from 8.5 (range 3–25) at baseline to 7 (range 2–23) at final follow-up ( p = .007). There were no peri-procedural or long-term complications. Conclusion The endovascular approach with stent placement for chronic IVC obstruction is a safe treatment option that should be offered to patients who otherwise have little opportunity for sustained clinical improvement.

70 J/cm) for SSV. The complete occlusion of the treated saphenous vein was defined as absence of flow on color Doppler imaging and was achieved in 174/177 (98.3%) subjects at 4 weeks and 132/135 (97.7) patients at 12 months. Partial occlusion was observed in three patients and was defined as reflux >3 cm distal to the junction. The mean length of non-occluded stump at the junction between saphenous vein and deep vein was 0.5 cm (range 3.6 to 5.0 cm) 4 weeks postoperative. Mean postoperative reduction of the diameter of GSV and SSV at 1 year was 40% and 56% respectively (p< 0.05%). In the early postoperative phase paraesthesia was observed in 15/177 (8.5%), ecchymosis in 4/177 (2.3%), lymphocoele in 1/ 177 (0.6%), hyperpigmentation in 1/177 (0.6%). Endovenous heat induced thrombus (EHIT) propagation was observed in 4/177 (2.3%) subjects. There were no skin burns or phlebitis. No patient reported severe pain. The mean postoperative pain intensity (Visual Analog Scale) was 1.3. The mean convalescence period was 2 days (1e30 d). No long-term complications and recurrent reflux was observed at 1 year follow-up. Conclusion: ELT using Thulium laser (1940 nm) with radial fiber efficiently eliminates the reflux in the saphenous veins by occlusion and significant diameter reduction with no reflux recurrence at 1 year follow up. The complication rates are less or comparable to the other endothermal and surgical procedures. These benefits are offered with low postoperative pain, analgesia requirement and rapid convalescence.

The understanding of the solar wind is based upon Parker's (1958) description of a thermally driven subsonic - supersonic outflow from a fully ionized electron-proton corona. The basic physical processes of thermally driven solar wind models are discussed. Also studied are the effect of alpha particles in the corona on the solar wind proton flux. The acceleration of the solar wind by Alfven waves is discussed.