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Abstract Background Despite accumulating evidence of an association between air pollution and renal disease, studies on the association between long-term exposure to air pollution and renal function are still contradictory. This study aimed to investigate this association in a large population with relatively low exposure and with improved estimation of renal function as well as renal injury biomarkers. Methods We performed a cross-sectional analysis in the middle-aged general population participating in the Swedish CardioPulmonary bioImaging Study (SCAPIS; n = 30 154). Individual 10-year exposure to total and locally emitted fine particulate matter (PM2.5), inhalable particulate matter (PM10), and nitrogen oxides (NOx) were modelled using high-resolution dispersion models. Linear regression models were used to estimate associations between exposures and estimated glomerular filtration rate (eGFR, combined creatinine and cystatin C) and serum levels of renal injury biomarkers (KIM-1, MCP-1, IL-6, IL-18, MMP-2, MMP-7, MMP-9, FGF-23, and uric acid), with consideration of potential confounders. Results Median long-term PM2.5 exposure was 6.2 µg/m3. Almost all participants had a normal renal function and median eGFR was 99.2 mL/min/1.73 m2. PM2.5 exposure was associated with 1.3% (95% CI 0.6, 2.0) higher eGFR per 2.03 µg/m3 (interquartile range, IQR). PM2.5 exposure was also associated with elevated serum matrix metalloproteinase 2 (MMP-2) concentration, with 7.2% (95% CI 1.9, 12.8) higher MMP-2 per 2.03 µg/m3. There was a tendency towards an association between PM10 and higher levels of uric acid, but no associations were found with the other biomarkers. Associations with other air pollutants were null or inconsistent. Conclusion In this large general population sample at low exposure levels, we found a surprising association between PM2.5 exposure and a higher renal filtration. It seems unlikely that particle function would improve renal function. However, increased filtration is an early sign of renal injury and may be related to the relatively healthy population at comparatively low exposure levels. Furthermore, PM2.5 exposure was associated with higher serum concentrations of MMP-2, an early indicator of renal and cardiovascular pathology.

Abstract Male reproductive impairment has been linked with an increased risk of numerous non-communicable diseases. Yet, epidemiological data on renal disease among subfertile men is scarce. Therefore, by using male childlessness as a proxy for male infertility, we aimed to investigate its association with renal function. Data was sourced from a population-based cohort including 22,444 men. After exclusion of men aged

Background and Objectives: Navigation systems are designed to enhance surgical precision, improving patient outcomes and reducing the risk of implant misplacement. In this study, we have evaluated a novel orthopedic surgical platform that utilizes CT imaging with AI-based algorithms to automate several critical aspects of total hip arthroplasty. It contains three modules—preoperative planning, navigation during surgery, and follow-up analysis. The primary objective of the current study was to evaluate the precision of the navigation tool in cup placement, i.e., whether the information displayed for navigation correctly reflected the actual position of the implant. Materials and Methods: Surgery outcomes of 15 inter-rater measurements on human cadavers and 18 surgeries on patients who underwent total hip replacement using the navigation tool were analyzed. Results: In the inter-rater assessment, the mean errors were −0.31 ± 1.42° for anteversion, 1.06 ± 1.73° for inclination, and −0.94 ± 1.76 mm for cup position depth. In patients’ surgeries, the mean errors were −0.07 ± 2.72° for anteversion, −0.2 ± 0.86° for inclination, and 0.28 ± 0.78 mm for cup depth. Conclusions: The navigation tool offers intra-operative guidance on notable precision in cup placement, thereby effectively mitigating the risk of cup malpositioning outside the patient-specific safe zone.

Abstract Background In Europe, Ixodes ricinus (Acari: Ixodidae) is the most widespread and abundant tick species, acting as a vector for several microorganisms of medical and veterinary importance. In Northern and Central Europe, the tick has a bimodal activity pattern consisting of a peak in spring to the beginning of summer and a second peak at the end of summer. However, several findings of ticks on animals during winter have been reported, which raises the question of whether this is an overwintering strategy or whether ticks are active during winter in Scandinavia. The objectives of our study were to determine (i) whether ticks were active and finding hosts during winter, (ii) whether they parasitize their hosts, and (iii) what climatic factors—i.e., temperature, snow depth and precipitation—govern tick winter activity. Methods Throughout three winter seasons, we examined wild-living and free-ranging roe deer (Capreolus capreolus) for ticks on 332 occasions. In total, 140 individual roe deer were captured in two climatically contrasting sites in south-central Sweden, Grimsö and the Bogesund research area, respectively. We re-examined individual roe deer up to 10 times within the same winter or approximately once a week (mean 10 days, median 7 days between re-examinations) and recorded the absence or presence of ticks on the animals, and tested to what extent meteorological factors affected tick activity. To determine the attachment day, we used the coxal/scutal index of 18 nymphs and 47 female ticks. Results In total, 243 I. ricinus were collected from 301 roe deer captures between 14 December and 28 February at the Bogesund study site during three subsequent years (2013/2014–2015/2016). We found attached ticks every third to every second examination (32%, 48% and 32% of the examinations, respectively). However, we collected only three I. ricinus females from 31 roe deer captures at the Grimsö study site between 17 December 2015 and 26 February 2016. At the Bogesund study site, based on 192 captures of previously examined deer, we collected 121 ticks, and ticks were found at 33%, 48% and 26% of the examinations during the respective winters. The probability of finding an attached tick on a roe deer at a temperature of −5 °C was > 8% ± 5 (SE), and that probability increased to almost 20% ± 7 (SE) if the air temperature increased to 5 °C. Conclusions To the best of our knowledge, this is the first time that winter-active nymphs and female ticks have been documented to attach and feed on roe deer during winter (December to February) in Scandinavia. The main weather conditions regulating winter activity for females were temperature and precipitation, and the lowest estimated air temperature for finding an active tick was well below 5 °C. The behaviour of winter-active and blood-feeding ticks was documented over several winters and in two contrasting areas, implying that it is a common phenomenon that should be investigated more thoroughly, since it may have important consequences for the epidemiology of tick-borne pathogens.

Background: Over the past decades, accumulating research on erythropoietin (EPO) and its receptor (EPOR) has revealed various neuroprotective actions and upregulation in hypoxic conditions. To our knowledge, EPOR protein levels in the hippocampus and isocortex have never been measured. Therefore, the aim of this study was to measure EPOR protein in the hippocampus (HPC) and prefrontal cortex (PFC). Further objectives were to examine the effects of exposure to normobaric hypoxia of various degrees and durations on EPOR protein and to explore how long-lasting these effects were. Method: Adult C57BL/6 mice were randomized into a control group (N = 12) or various hypoxia groups (N = 5–11). Mice were exposed to three different O2 concentrations (10 %, 12 %, or 18 %) for 8 h a day for 5 days and sacrificed immediately after the last exposure. The effect of exposure to 12 % O2 for 1 day and 4 weeks (8 h per day) at this survival time was also examined. Additionally, groups of mice were exposed to 12 % O2 for 1 or 5 days (8 h per day) and euthanized at various times (up to 3 weeks) thereafter to examine the duration of EPOR protein regulation in the HPC and the PFC. EPOR protein was detected with a sandwich-ELISA method. Results: EPOR protein was present in the HPC and PFC, at 206.64 ± 43.98 pg/mg and 184.25 ± 48.21 pg/mg, respectively. The highest increase in EPOR protein was observed in the HPC after 5 days of 8 h exposure to 12 % O2 and was most pronounced 24 h after last exposure. The effect of hypoxia normalized within one week after the last exposure. Conclusion: This study successfully measured hippocampal EPOR protein and showed a significant association between normobaric hypoxia and acute EPOR elevation. It is our hope that this study can provide guidance to future research on the neuroprotective effects of EPO.

BackgroundEarly life factors may predict cardiovascular disease (CVD), but the pathways are still unclear. There is emerging evidence of an association of early life factors with apolipoproteins, which are linked to CVD. The study objective was to assess the associations between birth variables and adult apolipoproteins (apoA1 and apoB, and their ratio) in a population-based cohort.MethodsThe LifeGene Study is a prospective cohort comprising index participants randomly sampled from the general population. Blood samples were collected between 2009 and 2016. In this sub-study, we used birth variables, obtained from a national registry for all participants born 1973 or later, including birth weight and gestational age, while adult CVD risk factors included age, sex, body mass index (BMI), lipids, and smoking history. We employed univariate and multivariate general linear regression to explore associations between birth variables, lipid levels and other adult CVD risk factors. The outcomes included non-fasting apoA1 and apoB and their ratio, as well as total cholesterol and triglycerides. A total of 10,093 participants with both birth information and lipoprotein levels at screening were included. Of these, nearly 42.5% were men (n = 4292) and 57.5% were women (n = 5801).ResultsThe mean (standard deviation) age of men was 30.2 (5.7) years, and for women 28.9 (5.8) years. There was an increase of 0.022 g/L in apoA1 levels per 1 kg increase in birth weight (p = 0.005) after adjusting for age, sex, BMI, gestational age, and smoking history. Similarly, there was a decrease of 0.023 g/L in apoB levels per 1 kg increase in birth weight (pConclusionsLower birth weight was associated with an adverse adult apolipoprotein pattern, i.e., a higher apoB/apoA1 ratio, indicating increased risk of future CVD manifestations. The study highlights the need of preconception care and pregnancy interventions that aim at improving maternal and child outcomes with long-term impacts for prevention of cardiovascular disease by influencing lipid levels.

Background and purpose: Radiostereometry (RSA) is the current gold standard for evaluating early implant migration. CT-based migration analysis is a promising method, with fewer handling requirements compared with RSA and no need for implanted bone-markers. We aimed to evaluate agreement between a new artificial intelligence (AI)-based CT-RSA and model-based RSA (MBRSA) in measuring migration of cup and stem in total hip arthroplasty (THA). Patients and methods: 30 patients with THA for primary osteoarthritis (OA) were included. RSA examinations were performed on the first postoperative day, and at 2 weeks, 3 months, 1, 2, and 5 years after surgery. A low-dose CT scan was done at 2 weeks and 5 years. The agreement between the migration results obtained from MBRSA and AI-based CT-RSA was assessed using Bland–Altman plots. Results: Stem migration (y-translation) between 2 weeks and 5 years, for the primary outcome measure, was –0.18 (95% confidence interval [CI] –0.31 to –0.05) mm with MBRSA and –0.36 (CI –0.53 to –0.19) mm with AI-based CT-RSA. Corresponding proximal migration of the cup (y-translation) was 0.06 (CI 0.02–0.09) mm and 0.02 (CI –0.01 to 0.05) mm, respectively. The mean difference for all stem and cup comparisons was within the range of MBRSA precision. The AI-based CT-RSA showed no intra- or interobserver variability. Conclusion: We found good agreement between the AI-based CT-RSA and MBRSA in measuring postoperative implant migration. AI-based CT-RSA ensures user independence and delivers consistent results.

Introduction: This randomized, controlled pilot trial evaluated the efficacy of a brief internet-based recovery training intervention targeting a clinical sample of distressed employees. Method: A sample of 69 employees with elevated symptoms of stress were assigned randomly to a five-week guided recovery training intervention (iRTP, n = 35) or a wait-list control (WLC, n = 34). The study was conducted in Sweden and participants enrolled via an open recruitment strategy. Self-report data were collected pre- and post-intervention, then six and 12 months after the intervention. The primary outcome measure was the Recovery Experience Questionnaire (REQ. The secondary outcome measures gauged other relevant mental and work-related health outcomes. Participants in the wait-list control group received access to iRTP after the six-month follow-up. Results: Compared with the controls, participants in the intervention group showed a significant and large overall improvement on the primary outcome REQ (d = 0.93), and small to moderate effects on the secondary outcomes including, perceived stress (d = 0.48), anxiety (d = 0.49), quality of life (d = 0.47), and work ability (d = 0.47) during post-assessment. No significant differences were found at any time point regarding burnout, exhaustion, depression, physical exercise, work experience, or sickness absences. Conclusion: This pilot trial is one of the first to examine a brief recovery training program's efficacy, suggesting that employees across a wide range of professions could learn how to recover from elevated stress symptoms. This type of accessible and brief recovery intervention could potentially prevent and reduce the negative effects of stress, as well as improve recovery and quality of life. However, more research is needed with larger samples before further conclusions can be drawn. Trial Registration: The study was registered at Clinical Trials (clinicaltrials.gov) number NCT05220592.

ABSTRACTDespite aggressive treatment, the 5-year event-free survival rate for children with high-risk neuroblastoma is

Abstract Incidence of tick-borne encephalitis (TBE) has increased during the last years in Scandinavia, but the underlying mechanism is not understood. TBE human case data reported between 2010 and 2021 were aggregated into postal codes within Örebro County, south-central Sweden, along with tick abundance and environmental data to analyse spatial patterns and identify drivers of TBE. We identified a substantial and continuing increase of TBE incidence in Örebro County during the study period. Spatial cluster analyses showed significant hotspots (higher number of cases than expected) in the southern and northern parts of Örebro County, whereas a cold spot (lower number of cases than expected) was found in the central part comprising Örebro municipality. Generalised linear models showed that the risk of acquiring TBE increased by 12.5% and 72.3% for every percent increase in relative humidity and proportion of wetland forest, respectively, whereas the risk decreased by 52.8% for every degree Celsius increase in annual temperature range. However, models had relatively low goodness of fit (R2

The present study reports on the development of a questionnaire that evaluates children's experiences of their physical classroom environment, activities and interactions. It also explores the psychometric properties of the questionnaire and how acoustical characteristics of the classroom, class size and student characteristics (age, sex and Swedish as a second language) influence the self-reported outcomes. After development, the questionnaire name should read Activities and Interactions in the Classroom were administered to 101 students (7.9-10.7 years old). Demographic information about the students was collected from parents. The psychometric properties including test-retest reliability are good but can be improved by reducing the number of items. Acoustical characteristics of the classrooms and student characteristics did not predict questionnaire outcomes. As the acoustical conditions in students' classrooms were close to optimal, communication fostering support should be in focus. The present questionnaire can be used to assess young students' experiences of their classroom environment and learning situations.

Background: To make students more interested and engaged in science, new teaching approaches have been developed aiming at higher order thinking. Context-based learning approaches emanate from an idea that science content knowledge should be presented in a relevant context for students to improve their learning outcomes as well as making them more engaged in science. Previous research on context-based learning approaches has shown positive results; however, researchers and teachers need to explicitly consider which aspects of the contextual settings young students perceive as interesting and relevant to improve chemistry education. Purpose: In this paper, the constructs of 'interest' and 'relevance' are explored to analyse which aspects of open-ended chemistry problems engage students. Sample and Design: Both qualitative interview data and quantitative survey data are elaborated on in three subsequent studies with Swedish upper secondary chemistry students. Students' statements when discussing contextualisation of chemistry problems are analysed in relation to analytical frameworks to explore students' perceived interest and relevance. Results: The results highlight the importance of connections to personal dimensions in chemistry to make students more engaged and interested in chemistry. The language of the context-based problems is also found essential as the students indicate trigger-words in the tasks influencing perceived interest and relevance. This in combination with students' distinction between high interest as a positive feeling, and high relevance as something important or worthwhile, are important results from this study. Conclusion: From the results, conclusions are drawn to help researchers and teachers develop chemistry problems aiming for higher order thinking, but at the same time are found interesting and relevant for the students.

There is a rising tendency for students in higher education not to attend lectures. Therefore, the aim of the study was to describe the reasoning behind nursing students' decisions on whether or not to attend lectures. This qualitative study was performed in a nursing education programme at a Swedish University. One hundred and thirty-one students participated. Data were collected through a questionnaire comprising open-ended questions. Qualitative content analysis was performed. The results are presented in eight categories: four concerning "reasons for attending lectures" and four concerning "reasons for not attending lectures." Decisions, both to attend and to not attend lectures, were based on conscious choices guided by the students' self-governing of their own personal needs for learning.

Ammonia is a deleterious pollutant present in municipal wastewater that can be hazardous if released into the environment. There is a need for the development of novel processes to advance ammonium removal technologies. Partial nitritation (PN) and anaerobic ammonia oxidation (anammox) are modern treatment processes that can be combined to provide energy-efficient ammonia removal; however, these processes have been shown to be challenging to implement as a two-stage system. New methods to achieve steady PN need to be discovered. Free nitrous acid (FNA) exposure has been explored as a possible strategy for achieving PN; however, exposure time to FNA and FNA dosage is dependent on the treatment system. For biofilm technologies, such as the moving bed biofilm reactor and biofilm characteristics, including biofilm thickness, can cause inconsistent results. Therefore, this study compares defined maximal biofilm thickness with undefined biofilm thickness and their capacity to achieve PN using FNA. This study found that a defined maximal biofilm thickness designed carrier maintained a thin biofilm capable of achieving PN after FNA exposure while the undefined biofilm thickness designed carrier was not suitable for stable PN. HIGHLIGHTS There is a need for new and robust strategies to achieve stable partial nitritation using attached-growth technologies.; Thin biofilm has shown potential for enhanced free nitrous acid (FNA) inhibition of nitrite-oxidizing bacteria (NOB) activity.; Maximal biofilm thickness and undefined thickness carriers studied for FNA inhibition.; Maximal biofilm thickness carriers show NOB inhibition at 3 h of FNA exposure.; Undefined thickness carriers are not capable of achieving NOB inhibition with FNA exposure.;

Cardiovascular disease (CVD) remains one of the leading causes for increased morbidity and mortality in chronic kidney disease (CKD). Kidney transplantation is the preferred treatment option for CKD G5. Improved perioperative and postoperative care, personalized immunosuppressive regimes, and refined matching procedures of kidney transplants improves cardiovascular health in the early posttransplant period. However, the long-term burden of CVD is considerable. Previously underrecognized, the role of the complement system alongside innate immunity, inflammaging, structural changes in the glomerular filtration barrier and early vascular ageing also seem to play an important role in the posttransplant management. This review provides up-to-date knowledge on these pathways that may influence the cardiovascular and renal continuum and identifies potential targets for future therapies. Arterial destiffening strategies and the applicability of sodium-glucose cotransporter 2 inhibitors and their role in cardiovascular health after kidney transplantation are also addressed.

Background and Objectives: Navigation systems are designed to enhance surgical precision, improving patient outcomes and reducing the risk of implant misplacement. In this study, we have evaluated a novel orthopedic surgical platform that utilizes CT imaging with AI-based algorithms to automate several critical aspects of total hip arthroplasty. It contains three modules—preoperative planning, navigation during surgery, and follow-up analysis. The primary objective of the current study was to evaluate the precision of the navigation tool in cup placement, i.e., whether the information displayed for navigation correctly reflected the actual position of the implant. Materials and Methods: Surgery outcomes of 15 inter-rater measurements on human cadavers and 18 surgeries on patients who underwent total hip replacement using the navigation tool were analyzed. Results: In the inter-rater assessment, the mean errors were −0.31 ± 1.42° for anteversion, 1.06 ± 1.73° for inclination, and −0.94 ± 1.76 mm for cup position depth. In patients' surgeries, the mean errors were −0.07 ± 2.72° for anteversion, −0.2 ± 0.86° for inclination, and 0.28 ± 0.78 mm for cup depth. Conclusions: The navigation tool offers intra-operative guidance on notable precision in cup placement, thereby effectively mitigating the risk of cup malpositioning outside the patient-specific safe zone. [ABSTRACT FROM AUTHOR]

Abstract Deranged renal filtration of mid-sized (5–30 kDa) compared to smaller molecules ( 0.9 (HRadj 1.6 [95% CI 1.1–2.5]). In elderly women eGFRcysC/eGFRcrea ratio

Abstract Aims This study aimed to investigate the association between the ‘Shrunken pore syndrome’ (SPS) and risk of death, 30 day rehospitalization, and health‐related quality of life (QoL) in heart failure (HF) patients. SPS is characterized by a difference in renal filtration between cystatin C and creatinine, resulting in a low eGFRcystatin C/eGFRcreatinine ratio. Methods and results A total of 373 patients hospitalized for HF [mean age 74.8 (±12.1) years; 118 (31.6%) women] were retrieved from the HeARt and brain failure inVESTigation trial (HARVEST‐Malmö). Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) formulas were used for estimation of glomerular filtration rate (eGFR). Presence of SPS was defined as eGFRcystatin C ≤ 60% of eGFRcreatinine. In Cox regression multivariate models, associations between SPS, risk of death (median follow‐up time 1.8 years), and risk of 30 day rehospitalization were studied. Associations between SPS and impaired QoL were studied using multivariate logistic regressions. In multivariate models, SPS was associated with all‐cause mortality [124 events; hazard ratio (HR) 1.99; 95% confidence interval (95% CI) 1.23–3.21; P = 0.005] and with 30 day rehospitalization (70 events; HR 1.82; CI 95% 1.04–3.18; P = 0.036). Analyses of QoL, based on a Kansas City Cardiomyopathy Questionnaire overall score

Abstract Background It has been shown that individuals with obesity have a higher risk for chronic kidney disease (CKD). However, it is unclear which measure of obesity is most useful for prediction of CKD in the general population. The aim of this large prospective study was to explore the association between several anthropometric measures of obesity, i. e., body mass index (BMI), waist circumference (WC), waist circumference to height ratio (WHtR), waist-to-hip ratio (WHR), percentage of body fat (BF%), weight, height and incidence of hospitalizations due to CKD, in a population-based cohort study. Methods The ‘Malmö Diet and Cancer Study (MDCS)’ cohort in Sweden was examined during 1991 to 1996. A total of 28,449 subjects underwent measurement of anthropometric measures and blood pressure and filled out a questionnaire. Incidence of in- and outpatient hospital visits for CKD was monitored from the baseline examination over a mean follow-up of 18 years. Cox proportional hazards regression was used to explore the association between anthropometric measures and incidence of CKD, with adjustments for risk factors. Results The final study population included 26,723 subjects, 45-73 years old at baseline. Higher values of BMI, WC, WHR, WHtR and weight were associated with an increased risk of developing CKD in both men and women. Only in women, higher values of BF% was associated with higher risk of CKD. Comparing the 4th vs 1st quartile of the obesity measure, the highest hazard ratio (HR) for CKD in men was observed for BMI, HR 1.51 (95% CI: 1.18-1.94) and weight (HR 1.52 (95% CI: 1.19-1.94). For women the highest HR for CKD was observed for BF%, HR 2.01 (95% CI: 1.45-2.78). Conclusions In this large prospective study, all anthropometric measures of obesity were associated with a substantially increased incidence of CKD, except for BF% in men. Some measures were slightly more predictive for the risk of CKD than others such as BMI and weight in men and BF% in women. In clinical daily practice use of all anthropometric measures of obesity might be equally useful to assess the risk of developing CKD. This study supports the strong evidence for an association between obesity and CKD.

Abstract Background The relationship between growth differentiation factor 15 (GDF-15) and the development of chronic kidney disease (CKD) is still unclear. We sought to examine whether plasma GDF-15 was related to incident CKD and kidney function decline using a large prospective cohort study. Methods 4318 participants of the Malmö Diet and Cancer Study-Cardiovascular Cohort were examined in 1991-1994. Incidence of CKD was followed prospectively by linkage with national patient registers. Estimated glomerular filtration rate (eGFR) was available for all participants at baseline, and was re-measured in a subgroup of 2744 subjects after 16.6 ± 1.49 years. Incidence of CKD was examined in relation to GDF-15 using Cox regression analysis. Logistic regression was used to examine the association of GDF-15 with eGFR change and eGFR-based CKD. Models were carefully corrected for potential confounders including baseline eGFR, N-terminal pro-B-type natriuretic peptide, and competing risk from death. Results 165 patients developed CKD after 19.2 ± 4.04 years of follow-up. The adjusted hazard ratio (95% confidence interval, CI) for CKD in 4th versus 1st quartile of GDF-15 was 2.37 (1.33, 4.24) (p for trend

Abstract Background Wasting is a common complication of kidney failure that leads to weight loss and poor outcomes. Recent experimental data identified parathyroid hormone (PTH) as a driver of adipose tissue browning and wasting, but little is known about the relations among secondary hyperparathyroidism, weight loss, and risk of mortality in dialysis patients. Methods We included 42,319 chronic in‐centre haemodialysis patients from the Dialysis Outcomes and Practice Patterns Study phases 2–6 (2002–2018). Linear mixed models were used to estimate the association between baseline PTH and percent weight change over 12 months, adjusting for country, demographics, comorbidities, and labs. Accelerated failure time models were used to assess 12 month weight loss as a mediator between baseline high PTH and mortality after 12 months. Results Baseline PTH was inversely associated with 12 month weight change: 12 month weight loss >5% was observed in 21%, 18%, 18%, 17%, 15%, and 14% of patients for PTH ≥600 pg/mL, 450–600, 300–450, 150–300, 50–150, and