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Abstract Objective To explore trends in prognosis and use of glucose-lowering drugs (GLD) in patients with diabetes and coronary artery disease (CAD). Research design and methods All patients with diabetes and CAD undergoing a coronary angiography between 2010 and 2021 according to the Swedish Angiography and Angioplasty Registry were included. Information on GLD (dispended 6 months before or after coronary angiography) was collected from the Swedish Prescribed Drug Registry. Data on major cardiovascular events (MACE; mortality, myocardial infarction, stroke, heart failure) through December 2021 were obtained from national registries. Cox proportional survival analysis was used to assess outcomes where cardioprotective GLD (any of Sodium Glucose Lowering Transport 2 receptor inhibitors [SGLT2i] and Glucagon Like Peptide Receptor Agonists [GLP-1 RA]) served as a reference. Results Among all patients (n = 38,671), 31% had stable CAD, and 69% suffered an acute myocardial infarction. Mean age was 69 years, 67% were male, and 81% were on GLD. The use of cardioprotective GLD increased rapidly in recent years (2016–2021; 7–47%) and was more common in younger patients (66 vs. 68 years) and men (72.9% vs. 67.1%) than other GLD. Furthermore, compared with other GLD, the use of cardioprotective GLD was more common in patients with a less frequent history of heart failure (5.0% vs. 6.8%), myocardial infarction (7.7% vs. 10.5%) and chronic kidney disease (3.7% vs. 5.2%). The adjusted hazard ratio (HR) (95% CI) for MACE was greater in patients on other GLD than in those on cardioprotective GLD (1.10; 1.03–1.17, p = 0.004). Trend analyses for the years 2010–2019 revealed improved one-year MACE in patients with diabetes and CAD (year 2019 vs. 2010; 0.90; 0.81-1.00, p = 0.045), while 1-year mortality was unchanged. Conclusions The prescription pattern of diabetes medication is changing quickly in patients with diabetes and CAD; however, there are worrying signals of inefficient use prioritizing cardioprotective GLD to younger and healthier individuals at lower cardiovascular risk. Despite this, there are improving trends in 1-year morbidity.

Background: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) is associated with poor outcomes and is often regarded as inferior to native vessel PCI. We investigated clinical outcomes of SVG-PCI using contemporary drug-eluting stents (DES), in a complete, nationwide population. Methods: The complete Swedish Coronary Angiography and Angioplasty Registry (SCAAR) was used to identify all patients in Sweden who underwent SVG-PCI with a contemporary DES between 2013 and 2020. Baseline characteristics, procedures, and outcomes were described. Results: A total of 2198 SVG-PCI procedures with 3106 contemporary DES were included. Patients had a high incidence of comorbidities such as diabetes (40%), prior myocardial infarction (MI) (69%), and acute coronary syndrome (74%) at presentation. SVG-PCI procedures commonly involved multiple DES (41%). Native vessel PCI, in addition to SVG-PCI, was performed in only 13% of procedures. At 1 year, adverse clinical outcomes were frequent as exemplified by any death (9.2%), MI (9.1%), or revascularization (21.1%), whereas stent and lesion-related outcomes on a patient level were less common: stent thrombosis (1.2%), in-stent restenosis (4.3%) and target lesion revascularization (4.3%). Similarly, at 3 years, clinical outcomes were frequent: death (19.8%), MI (21.1%), revascularization (32.8%); and stent-related outcomes were less common: stent thrombosis (2.9%), restenosis (10.8), and target lesion revascularization (13.6%). Conclusions: In this nationwide cohort of patients who underwent SVG-PCI with contemporary DES, patients were characterized by a high-risk profile and high rates of adverse clinical events. However, the incidence of stent and lesion-related events was low.

The state of preservation of documents from the historically significant Azzolino collection at the Swedish National Archives has been investigated and analyses carried out of the iron gall inks. The collection shows varied levels of iron gall ink corrosion. An initial visual condition survey was followed by characterisation of the writing ink with XRF spectrometry on a selection of documents. The aim was to investigate whether ink composition could be related to author or geography, and in turn to level of ink corrosion, which could then serve as a basis for decisions on treatment options. Results indicate a relative purity of the inks in this collection in terms of high iron content and low levels of other elements, entailing that elemental analysis is not a good tool to predict potential deterioration of ink in single documents from this historical context. XRF-mapping showed a possibility for discerning authors by ink composition, contributing meaningful information to questions of attribution and historical context for these documents. A tendency for the ink of Queen Christina to contain more copper than inks from the other authors, and the indication that some inks contain calcium, may be of note for further study.

During the Garden Lupine’s two centuries of presence in Sweden, its apprehension has been marked by cultural reconfigurations – from an appreciated garden plant, through being a token for Swedish midsummer to being deemed an invasive alien species and ecological threat. With the purpose of deepening the understanding of how environmental management works as a nexus of nature and culture, this article analyzes ‘The Great Lupine Combat Day’, to show how the lifecycle of plants and culturally imbued actions and preferences interact. By employing ethnographic methods and qualitative source material to enable a cultural analysis of the traditionalization of eradicating invasive species, the article shows how this annual event ties together an established annual calendar, the life cycle and visuality of plants, biodiversity crises, an idealized aesthetics feature of Swedish nature, and eradication practices. In essence, the management of the Garden Lupine serves as a reminder of how nature is always culture. [ABSTRACT FROM AUTHOR]

Abstract We evaluated the performance of 11 SARS-CoV-2 antibody tests using a reference set of heat-inactivated samples from 278 unexposed persons and 258 COVID-19 patients, some of whom contributed serial samples. The reference set included samples with a variation in SARS-CoV-2 IgG antibody titers, as determined by an in-house immunofluorescence assay (IFA). The five evaluated rapid diagnostic tests had a specificity of 99.0% and a sensitivity that ranged from 56.3 to 81.6% and decreased with low IFA IgG titers. The specificity was > 99% for five out of six platform-based tests, and when assessed using samples collected ≥ 22 days after symptom onset, two assays had a sensitivity of > 96%. These two assays also detected samples with low IFA titers more frequently than the other assays. In conclusion, the evaluated antibody tests showed a heterogeneity in their performances and only a few tests performed well with samples having low IFA IgG titers, an important aspect for diagnostics and epidemiological investigations.

Background Dysglycemia at acute myocardial infarction (AMI) is common and is associated with mortality. Information on other outcomes is less well explored in patients without diabetes in a long‐term perspective. We aimed to explore the relationship between admission glucose level and long‐term outcomes in patients with AMI without diabetes in a nationwide setting. Methods and Results Patients without diabetes (n=45 468) with AMI registered in SWEDEHEART (Swedish Web–System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) and admission glucose ≤11 mmol/L (≤198 mg/dL) were followed for outcomes (AMI, heart failure, stroke, renal failure, and death) between 2012 and 2017 (mean follow‐up time 3.3±1.7 years). The association between categorized glucose levels and outcomes was assessed in adjusted Cox proportional hazards regression analyses (glucose levels 4.0–6.0 mmol/L [72–109 mg/dL] as reference). Further nonfatal complications and their associated mortality were explored (patients without events served as a reference). A glucose level of 7.8–11.0 mmol/L (140–198 mg/dL) was associated with hospitalization for heart failure (hazard ratio [HR] 1.40 [95% CI, 1.30–1.51], P

A five-month-old, 3.8 kg intact male Maine coon cat presented for dyspnea characterized by increased respiratory effort in addition to open-mouth breathing. Thoracic radiographs showed pectus excavatum, enlarged cardiac silhouette, and generalized interstitial patterns. Echocardiography revealed normal left atrial (LA) and left ventricular dimensions. A large tubular structure, suspected to be a distended pulmonary vein (PV), was identified as draining into the LA. Severe eccentric and concentric right ventricular hypertrophy and paradoxical septal motion were noted. Based on Doppler echocardiography, both pulmonary venous and pulmonary artery pressure was severely elevated. Clinical, radiographic, and echocardiographic abnormalities were hypothesized to result from pulmonary vein stenosis (PVS), causing severely elevated pulmonary venous pressures and resulting in clinical signs of left-sided congestive heart failure (L-CHF) and severe post-capillary pulmonary hypertension (Pc-PH). The prognosis for good quality of life was assessed as poor, and the owner elected euthanasia. Necropsy confirmed the presence of PVS with severe dilation of the PVs draining all but the left cranial lung lobe. All lung lobes except the left cranial lobe had increased tissue density and a mottled cut surface. This case report shows that, in rare cases, both L-CHF and Pc-PH may be present without LA enlargement. To the authors’ knowledge, this is the first report on PVS in veterinary medicine.

Abstract Background To assess the relationship between radiation doses to the coronary arteries (CAs) and location of a coronary stenosis that required intervention after three-dimensional conformal radiotherapy (3DCRT) for breast cancer (BC). Methods The study population consisted of 182 women treated for BC in Sweden between 1992 and 2012. All women received 3DCRT and subsequently underwent coronary angiography due to a suspected coronary event. CA segments were delineated in the patient’s original planning-CT and radiation doses were recalculated based on the dose distribution of the original radiotherapy (RT) plan. The location of the CA stenosis that required intervention was identified from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Logistic regression analysis was used to assess the relationship between CA radiation doses and risk of a later coronary intervention at this specific location. Results The odds ratio (OR) varied by radiation dose to the mid left anterior descending artery (LAD) (p = 0.005). Women receiving mean doses of 1–5 Gray (Gy) to the mid LAD had an adjusted OR of 0.90 (95% CI 0.47–1.74) for a later coronary intervention compared to women receiving mean doses of 0–1 Gy to the mid LAD. In women receiving mean doses of 5–20 Gy to the mid LAD, an adjusted OR of 1.24 (95% CI 0.52–2.95) was observed, which increased to an OR of 5.23 (95% CI 2.01–13.6) for mean doses over 20 Gy, when compared to women receiving mean doses of 0–1 Gy to the mid LAD. Conclusions In women receiving conventional 3DCRT for BC between 1992 and 2012, radiation doses to the LAD remained high and were associated with an increased requirement of coronary intervention in mid LAD. The results support that the LAD radiation dose should be considered in RT treatment planning and that the dose should be kept as low as possible. Minimising the dose to LAD is expected to diminish the risk of later radiation-induced stenosis.

Pathogens associated with haemorrhagic fever commonly have zoonotic origins. The first documented imported case of likely viral severe haemorrhagic fever in Sweden occurred in 1990. Despite extensive study, no aetiological agent was identified. Following retrospective investigation with total RNA-sequencing of samples collected between 7 and 36 days from onset of symptoms we identified dengue virus 3 (DENV-3) and a human pegivirus (HPgV). We conclude that the patient likely suffered from haemorrhagic symptoms due to an atypical severe and undiagnosed dengue infection.

Inland waterways and their connections to marine transport systems constitute a substantial resource for the establishment of green infrastructures, flood prevention, and environmental conservation. However, these developments have numerous inherent environmental hazards such as water and air pollution, a loss of habitats, increased coastal erosion, the transfer of invasive species between connected watercourses and lakes, and the transport of pollutants through watercourses to coastal areas. Climate change may aggravate these environmental problems through changing temperatures, reduced precipitation, enhancing the adverse impact of excess nutrient discharge, and the entry of invasive species. In this study, we analyse the main European inland waterway corridors and their branches to assess the ecological viability of a pan-European inland waterway network. The environmental viability of such network depends on the right assessment of ecosystem services and protection of biodiversity. A model structure for landscape conservation, green infrastructure development, water replenishment, and ecosystem reconstruction is proposed, considering a sustainable combination of multimodal inland waterway and rail transport.