Cell saver processing mitigates the negative effects of wound blood on platelet function.

BACKGROUND: Wound blood is highly activated and has poor haemostatic properties. Recent data suggest that retransfusion of unwashed wound blood may impair haemostasis. We hypothesized that cell saver processing of wound blood before retransfusion reduces the negative effects. METHODS: Wound blood was collected from 16 cardiac surgery patients during cardiopulmonary bypass. One portion of the wound blood was processed in a cell saver and one portion left unprocessed. Increasing amounts of unprocessed blood (10% and 20% of the systemic blood volume) or corresponding volumes of processed blood were added ex vivo to whole blood samples from the same patient. Clot formation was assessed by modified thromboelastometry (ROTEM(®) ) and platelet function with impedance aggregometry (Multiplate(®) ). RESULTS: Addition of unprocessed wound blood significantly impaired clot formation and platelet aggregability. Cell saver processing before addition did not influence clot formation but abolished completely the negative effects of wound blood on platelet aggregability tested with all agonists. Median adenosine diphosphate-induced platelet aggregation was 51 (25th and 75th percentiles 42-69) when 20% processed cardiotomy suction blood was added vs. 34 (24-52) U when 20% unprocessed blood was added, P < 0.001. The corresponding figures for arachidonic acid-, thrombin receptor activating peptide- and collagen-induced aggregation was 21 (17-51) vs. 13 (10-25) U, 112 (87-128) vs. 78 (65-103) U and 58 (50-73) vs. 33 (28-44) U, respectively, all P < 0.001). CONCLUSION: The results suggest that cell saver processing before retransfusion mitigates the negative effects of wound blood on platelet function despite that cell saver processing reduces platelet count.

Colorectal cancer screening with fecal immunochemical testing or primary colonoscopy: An analysis of health equity based on a randomised trial.

Background: We have addressed health equity attained by fecal immunochemical testing (FIT) and primary colonoscopy (PCOL), respectively, in the randomised controlled screening trial SCREESCO conducted in Sweden. Methods: We analysed data on the individuals recruited between March 2014, and March 2020, within the study registered with ClinicalTrials.gov, NCT02078804. Swedish population registry data on educational level, household income, country of birth, and marital status were linked to each 60-year-old man and woman who had been randomised to two rounds of FIT 2 years apart (n = 60,123) or once-only PCOL (n = 30,390). Furthermore, we geo-coded each study individual to his/her residential area and assessed neighbourhood-level data on deprivation, proportion of non-Western immigrants, population density, and average distance to healthcare center for colonoscopy. We estimated adjusted associations of each covariate with the colonoscopy attendance proportion out of all invited to respective arms; ie, the preferred outcome for addressing health equity. In the FIT arm, the test uptake and the colonoscopy uptake among the test positives were considered as the secondary outcomes. Findings: We found a marked socioeconomic gradient in the colonoscopy attendance proportion in the PCOL arm (adjusted odds ratio [95% credibility interval] between the groups categorised in the highest vs. lowest national quartile for household income: 2·20 [2·01-2·42]) in parallel with the gradient in the test uptake of the FIT × 2 screening (2·08 [1·96-2·20]). The corresponding gradient in the colonoscopy attendance proportion out of all invited to FIT was less pronounced (1·29 [1·16-1·42]), due to higher proportions of FIT positives in socioeconomically disadvantaged groups. Interpretation: The unintended risk of exacerbating inequalities in health by organised colorectal cancer screening may be higher with a PCOL strategy than a FIT strategy, despite parallel socioeconomic gradients in uptake. Funding: This work was supported by the Swedish Cancer Society under Grant 20 0719. CB and US provided economic support from the Swedish Research Council for Health, Working life, and Welfare under Grant 2020-00962.

Sense of coherence and disability and the relationship with life satisfaction 6-15 years after traumatic brain injury in northern Sweden.

The objective of the study was to assess sense of coherence (SOC) many years after traumatic brain injury (TBI) and explore the relationship between SOC and self-rated life satisfaction (LS) as well as measures of functioning and disability, sex, age at injury, injury severity and time post-injury. Sixty-six individuals (aged 18-65 years) who were 6-15 years post-injury were interviewed. Data on SOC (SOC-13 item scale), measures of functioning and disability (Mayo-Portland Adaptability Inventory, MPAI-4), LS (Satisfaction with Life Scale, SWLS), and sex, age at injury, injury severity and time post-injury were analysed with hierarchical multiple regression analyses. The results showed that SOC in the study group did not differ from the general population and was strongly associated with LS. Regression analyses revealed that emotional factors, social participation, SOC, and time since injury, were more influential than sex, age at injury, and injury severity in explaining LS. It was concluded that SOC in this group of individuals with TBI who were many years post-injury was similar to nondisabled individuals. SOC, together with emotional factors, social participation and injury-related factors, were determinants of LS. These results confirm that LS after TBI is a complex phenomenon dependent on several factors that are important targets for rehabilitation professionals.

Health-related quality-of-life and life satisfaction 6-15 years after traumatic brain injuries in northern Sweden.

OBJECTIVE: To describe health-related quality-of-life (HRQoL) and life satisfaction many years after a traumatic brain injury (TBI) and assess possible associations with variables related to the time of injury and follow-up and the individuals' self-appraisal of the impact of the TBI. METHOD: Sixty-seven individuals (18-65 years), on average 10 years post-injury, were interviewed. Data on HRQoL, using the SF-36 questionnaire, were compared with a Swedish age- and sex-matched reference sample, and life satisfaction, using the Satisfaction With Life Scale (SWLS), were compared with a nationwide Swedish sample of students. The participant's self-appraisal of the TBI was assessed with two supplementary questions. Data were analysed with hierarchical multiple regression analyses. RESULTS: HRQoL as well as life satisfaction were lower compared with the reference samples. From the regression analyses, the individuals' own appraisal of the impact of the TBI and whether they were vocationally productive or not were strongly associated with their current physical health and life satisfaction. CONCLUSION: These results confirm the importance of TBI as a cause of long-term disability and the impact of the injury on the individuals' self-perceived values of health, quality-of-life and life satisfaction.

Functioning and disability 6-15 years after traumatic brain injuries in northern Sweden.

OBJECTIVES: To assess long-term functioning and disability after traumatic brain injury (TBI). MATERIAL AND METHODS: Individuals (n = 88) in Norrbotten, northern Sweden, who had been transferred for neurosurgical care were assessed with internationally established TBI outcome measures 6-15 years post-injury. RESULTS: There was an improvement in overall outcome from discharge from inpatient rehabilitation to follow-up. Many individuals had a high degree of motor and cognitive functioning, which enabled them to live independently in their own home without assistance, but there remained a disability related to community reintegration and social participation. This affected their productivity and to some degree their marital stability. The remaining disability and reduced productivity were related to the age at injury and the injury severity. CONCLUSIONS: Our data showed that individuals with a TBI can achieve and maintain a high degree of functioning many years after the injury. Increasing age and a greater injury severity contributed to their long-term disability.

Bridge to heart transplantation with the HeartMate device in Gothenburg, Sweden.

BACKGROUND: Patients rapidly deteriorating while waiting for heart transplantation present a major problem. Our strategy for this entity is the HeartMate left ventricular assist device (LVAD) VELVAS, an electrically driven implantable LVAD. Herein we report our initial experience. METHODS: The medical records of all the patients who received HeartMate LVAS at our institution were reviewed. RESULTS: From January 1997 through May 2004, 19 patients received a HeartMate. The mean age was 39 (15 to 61) years and 84% were men. The diagnoses were: dilated cardiomyopathy (n = 8), ischemic heart disease (n = 6), myocarditis (n = 3), congenital heart disease (n = 1), and hypertrophic cardiomyopathy (n = 1). Mean time on LVAD was 113 (10 to 353) days. Ten patients were discharged from the hospital to their homes awaiting transplant or recovery. Three patients showed recovery of heart function and were subsequently weaned from mechanical support. Thirteen patients underwent heart transplantation. Three patients died during LVAD treatment. Major adverse events occurred in nine patients, including severe right heart failure (n = 3), severe bleeding (n = 3), stroke (n = 1), hepatic failure (n = 1), and septicemia (n = 2). Nine of the 13 transplanted patients are alive and well today. CONCLUSION: HeartMate LVAS is a valuable option for patients rapidly deteriorating while awaiting a heart transplant. Our results are comparable with those reported from larger centers.

Influence of an experimental hindlimb maldevelopment on axon number and nodal spacing in the rat sciatic nerve.

In neonatal rat pups the femoral and tibial epiphyseal cartilages on the left side were coagulated with a microcautery device. The subsequent femoral and tibial growth in length was markedly restricted on the left side, but the foot and the pelvic region exhibited normal longitudinal growth. After 6 months the sciatic nerves were removed from both sides. Electron microscopic analysis of nerve specimens from the stunted side revealed that the number of axons was 20% less compared to control specimens. Light microscopic examination of teased preparations showed a normal nodal spacing in the pelvic segment but abnormally short internodes in the femoral segment of the left sciatic nerve. These results suggest that the number of axons in the rat sciatic nerve adapts to a target maldevelopment that sets in neonatally, and that internodal elongation during development proceeds according to the local growth in length of the nerve rather than to the length growth of the whole nerve.

The effect of long endurance running on natural killer cells in marathoners.

Ten experienced marathoners were exercised 3 h in the laboratory. Blood samples were collected at 0 h baseline, 1 h exercise, and 5 min, 1.5 h, 6 h, and 21 h recovery and were analyzed for total number of lymphocytes expressing membrane antigens found on natural killer (NK) cells. NK activity was also measured. Four of the seven subpopulations of lymphocytes studied, Leu-11+19+, Leu-11+19-, Leu-11+7-, and Leu-19+11-, showed significant within-subject effects over time, using repeated measures ANOVA. Simple contrasts with baseline values showed that, at 1.5 h and 21 h recovery, total number of lymphocytes bearing three different combinations of NK markers, Leu-11+19+, Leu-11+19-, and Leu-11+7-, were significantly decreased when compared with baseline values. At 1.5 h recovery, NK activity was significantly decreased below baseline levels for four of the six effector NK cell/target K562 myelogenous leukemia cell (E:T) ratios tested. At 6 h recovery, NK activity was still decreased significantly with the 12.5:1 and 3:1 E:T ratios. By 21 h recovery, NK activity did not differ significantly from baseline levels. Cortisol levels at 5 min post-exercise were negatively correlated with NK activity at 1.5 h recovery (r = -0.62, P = 0.05, 50:1 E:T ratio; r = -0.66, P = 0.04, 25:1 E:T ratio). Further research is needed to elucidate the effect these changes have on host immunosurveillance and immunoresponsiveness in vivo.

The use of ordered mixtures for improving the dissolution rate of low solubility compounds.

The dissolution rate of micronized griseofulvin has been investigated, both for the agglomerated raw material and the material formulated as an ordered mixture, by means of the USP XX paddle method. During the experiments, which were performed at sink condition and constant temperature, the effects of adding a surfactant and of agitation were tested. The ordered mixture with sodium chloride gave a fast dissolution rate, practically independent of the test parameters. Micronized griseofulvin alone gave dissolution profiles that were improved by adding polysorbate 80 and by increased agitation, but the dissolution rates obtained were much lower than those for the ordered mixture. It was concluded that the rate limiting step in the dissolution of griseofulvin as the raw material is the penetration of the dissolution medium into the agglomerates. With an ordered mixture, these agglomerates were deaggregated during the mixing process, producing a system in which the entire external surface area of the primary particles was exposed to the dissolution medium. This conclusion was supported by calculation of the contact surface areas taking part in the dissolution process for the systems tested. The procedure developed in this study could be applied to preformulation work where a cohesive, low solubility drug of hydrophobic nature is to be formulated.

The assault and battery panorama at a county hospital in Sweden.

All patients who had been assaulted and battered and who consulted the surgical emergency service at the county hospital were included. Forty seven cases were registered during a 5-month period, representing 1.1% of the surgical emergency patients. There were 31 males and 16 females. No case of child assault was recorded. About 55% of the males were between the ages of 20 and 29, whereas the females were relatively evenly distributed between 20 and 50 years of age. The patient material was analysed regarding social conditions, in what way the injury had originated and also the degree of severity of the injury. The social background and the presence of alcohol use or abuse were, as expected, important factors. Males were, as a rule, assaulted outside the home, females mostly at home. A few of the assault cases were legally prosecuted. The need for follow-up welfare measures was judged as considerable.

Perceptions of health and risk management among home care workers in Sweden.

BACKGROUND: Municipal home care workers provide high-quality services to an increasing proportion of elderly people living in private homes. The work environments and working conditions of these workers vary to a great extent, implying rapid priority-making among both employers and employees to ensure that the work can be performed in a safe way. OBJECTIVES: This study aims to examine home care workers' perceptions of health, risks, working conditions, and risk management within their organization. METHOD: The study was based on cross-sectional data collected from home care service staff in a municipality in the north of Sweden. Nursing assistants and care aides (n = 133) replied to a self-administered questionnaire. Descriptive statistics and between-group differences were analysed. RESULTS: Home care work was perceived to require high levels of professional skill and ingenuity, a good psychosocial work situation, but required a high physical workload. The general health, the capacity and self-efficacy of the staff in relation to work were good. Difficulty in performing risk assessments and following safety regulations due to lack of time, equipment, and information were identified. CONCLUSION: There is a need to increase participation in risk assessments among the staff, improve management support, structures, and cooperation with other divisions of the social services and the medical care organizations.

Deep venous thrombosis of the lower limb: no difference in duration of symptoms between proximal and distal disease.

In deep vein thrombosis (DVT) of the lower limb, the location of the thrombosis determines how great the risk of pulmonary embolism is. We set out to determine whether the duration of lower limb DVT symptoms could be a predictive factor for the location of the thrombosis. We retrospectively collected a series of 100 lower limb phlebography examinations that were positive for DVT and divided the group into 2 subgroups proximal disease (ie, above the knee) or distal disease (ie, below the knee). The subgroups were then plotted against the individual duration of the symptoms. Of the 100 DVTs, 58% were proximal, while 42% were distal. The average duration of the symptoms was 6.3 days for patients with proximal disease and 6.2 days for patients with distal disease. We, therefore, found no difference in symptom duration between patients with proximal and distal lower limb DVT. This may imply that the duration of the DVT symptoms does not represent a predictive factor for DVT-caused pulmonary embolism.

Demographics, injury characteristics and outcome of traumatic brain injuries in northern Sweden.

OBJECTIVES - To describe demographics, injury characteristics and outcome of traumatic brain injury (TBI) in northern Sweden over 10 years. MATERIAL AND METHODS - Data were retrospectively collected on those individuals (n = 332) in Norrbotten, northern Sweden, with a TBI who had been transferred for neurosurgical care from 1992 to 2001. RESULTS - A majority were older men with a mild TBI and an acute or chronic subdural hematoma following a fall. Younger individuals were fewer but had more often a severe TBI from a traffic accident. Most individuals received post-acute care and brain injury rehabilitation. A majority had a moderate or severe disability, but many were discharged back home with no major changes in their physical or social environment. CONCLUSIONS - Our data confirm the relationship between age, cause of injury, injury severity and outcome in relation to TBI and underscore the need for prevention as well as the importance of TBI as a cause of long-term disability.

Effects of long-endurance running on immune system parameters and lymphocyte function in experienced marathoners.

The extent and duration of changes in leukocyte subsets, lymphocyte subpopulations, spontaneous blastogenesis, cortisol, and catecholamines were measured in ten experienced marathoners, who ran 3 h to exhaustion in a laboratory setting. Blood samples were taken at baseline, 1 h of exercise, and 5 min, 1.5 h, 6 h, and 21 h of recovery. The 3-h endurance run was associated with significant leukocytosis, granulocytosis, neutrophilia, monocytosis, and eosinopenia during recovery. All of these parameters except for eosinophils returned to normal by 21 h of recovery. Total lymphocyte count increased 31% at 1 h of exercise, then decreased 19% at 1.5 h of recovery when compared with baseline values. T cell count showed no significant changes, but B cell lymphocytosis was measured at 5 min and 6 h of recovery. T helper/T suppressor ratio (H/S) was significantly elevated 39% at both 1.5 h and 21 h of recovery due to the decrease in number of T suppressor cells. Spontaneous blastogenesis was significantly increased 52% by 1 h of exercise and remained elevated throughout recovery. The increase in cortisol from baseline to 1.5 h of recovery correlated positively with the increase in both total leukocyte count (r = 0.78, P = 0.008) and granulocyte count (r = 0.81, P = 0.005). Our results suggest that exhaustive endurance exercise in marathon runners is associated with many significant perturbations in immune system parameters, most of which return to normal levels at 21 h of recovery.