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Point-of-care musculoskeletal ultrasound for hemophilic arthropathy : a scoping review of scanning protocols by the Imaging Expert Working Group of the International Prophylaxis Study Group
No full textBackground: People with hemophilia (PwH) or von Willebrand disease (VWD) are at risk of joint bleeding, which can lead to hemophilic arthropathy. Point-of-care musculoskeletal ultrasound (POC-MSKUS) is increasingly used to detect joint bleeds, but a comprehensive compilation of available independent scanning protocols and their respective measurement properties is missing. Objectives: This study aimed to identify all existing POC-MSKUS scanning protocols and their reported measurement properties in PwH or people with VWD. Methods: A scoping review was conducted using Embase, MEDLINE, and CINAHL (March 2025). Studies were included if they were peer-reviewed; published in English; used an experimental, observational, or review design; and examined POC-MSKUS for joint disease in children or adults with hemophilia A, hemophilia B, or VWD. Extracted data included scanning protocol characteristics and measurement properties such as reliability (interrater and intrarater), construct validity (convergent and known groups), criterion validity (concurrent and predictive), and responsiveness. Results: Of 926 identified studies, 134 met the inclusion criteria (3 systematic reviews, 7 experimental studies, 75 observational studies, 39 narrative reviews, and 10 studies using other acceptable designs). Thirteen POC-MSKUS scanning protocols were identified. Among the 70 studies assessing measurement properties, reliability was reported in 12 studies, construct validity in 43 studies, criterion validity in 20 studies, and responsiveness in 5 studies. Predictive validity (2 studies) and responsiveness were the least reported properties. Conclusion: Several POC-MSKUS scanning protocols exist, with predictive validity and responsiveness being the least established measurement properties. Future research should focus on prospective and experimental studies to establish these properties in POC-MSKUS protocols for PwH and people with VWD
Validation and proposal of a clinical intervention cutoff in fetal scalp blood for the point-of care-lactate meter StatStrip®2
No full textIntroduction: This multicenter, prospective observational study aimed to evaluate the performance of the StatStrip® Lactate 2 (Nova Biomedical, Waltham, US) point-of-care device for fetal blood lactate measurement and to determine the corresponding lactate value equivalent to the established intervention cutoff used with the outgoing StatStrip® Lactate device. Material and Methods: The study was conducted from August 2024 to February 2025 at two maternity clinics in Sweden and one in Denmark. It included women with singleton pregnancies (≥35 + 0 weeks) undergoing fetal blood sampling due to non-reassuring intrapartal fetal heart rate patterns during labor. Fetal scalp blood sampling (FBS) lactate concentrations were measured using both StatStrip® Lactate and StatStrip® Lactate2. The first StatStrip® Lactate measurement guided clinical decisions, while subsequent StatStrip® Lactate2 measurements were recorded for validation and establishment of a conversion equation by linear regression. Additionally, arterial and venous umbilical cord blood samples were analyzed by both ABL 800 (Radiometer, Denmark) and StatStrip® Lactate2 for validation. Results: Blood samples from 349 fetuses were included, with 549 parallel FBS lactate samples. StatStrip® Lactate2 concentrations correlated with StatStrip® Lactate (r = 0.94;p ≤ 0.001). A conversion equation was retrieved: StatStrip® Lactate2 = (1.4 × StatStrip® Lactate) − 0.28. From 37 paired umbilical cord blood samples, the correlation between lactate concentrations by StatStrip® Lactate2 and ABL800 was r = 0.99 (p ≤ 0.001) in arterial blood and r = 0.98 (p ≤ 0.001) in venous blood. Mean coefficients of variation for lactate concentrations >3.0 mmol/L were 8.2% in fetal scalp blood and 3.8% in umbilical cord blood. Conclusions: A fetal blood lactate concentration ≥7.0 mmol/L measured by StatStrip®Lactate2 corresponds to the established intervention cutoff lactate value ≥5.2 mmol/L measured by StatStrip®Lactate. Precision was acceptable but may be improved by using the mean of two measurements, particularly when the first result falls between 6.0 and 8.0 mmol/L. We also recommend ensuring the correct sampling techniques to minimize preanalytical variation
Prospective long-term follow-up of sexuality and body image in women with primary vulvar cancer
No full textObjective: To investigate the development of sexual activity, sexual function, and body image in women with primary vulvar cancer from the time of diagnosis to 24 months after the end of treatment. Methods: This nationwide prospective cohort study assessed health-related quality of life in women with newly diagnosed vulvar cancer using validated patient-reported outcome measures (EORTC-QLQ-VU34 [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Vulva 34], Supportive Care Needs Survey Short Form) and self-constructed questions at diagnosis, and at 3, 12, and 24 months after the end of treatment. For this study, outcomes concerning sexuality and body image were analyzed. Results were displayed as mean scale scores and proportions. The longitudinal changes of scale and item scores were estimated by linear mixed-effects models with patient random intercept for continuous/numerical outcomes, and by generalized linear mixed models for binary response variables. Results: Between August 2019 and August 2021, 138 of 153 consenting women (90%) returned at least 1 questionnaire, and 90 women (59%) completed the questionnaires at all 4 time points. Sexual activity increased from 9.8% at diagnosis to 22.8% after 24 months (odds of being sexually active at 24 months were 6 times higher than at baseline, p = .003). Vulvar cancer was one of the reasons for not being sexually active for 37.5% of the participants at baseline and 26.9% at 24 months. Most women (73.5%) were not satisfied with their sex life at baseline. At least at one time point, 25.4% of the women found sex important, and 32.6% needed help with changes in sexual feelings. The mean scale scores of sexual functioning and body image did not change over time. Conclusions: Sexual activity was low, largely due to the vulvar cancer diagnosis. Most women were not satisfied with their sex life. A substantial proportion of the women found sex important and expressed a need for help with sexual feelings
The southwestern Baltic Sea–Kattegat area: a hotspot for the lichen genus Xanthoria s.l.
No full textNational leadership for legislating longer product lifetimes: French policies and their interaction with European Union policies
No full textCurrently, the European Union (EU) is the “green leader”, globally, in adopting policies to support longer product lifetimes. One reason for this state of affairs is that EU Member States are adopting progressive policies, which put pressure on the EU to set EU-wide laws to replace national ones. The main reason for this situation is that national rules may lead to distortions in trade in the EU Single Market, as corporations will find it difficult to be able to comply with different national rules and would prefer EU-wide standards. Currently, France is the undisputed leader in adopting policies for longer lifetimes, through policies including criminalization of planned obsolescence, modulated fees, repair policies, banning destruction of unsold products, and national indexes for repairability and durability of products. When the EU adopts similar policies, this can have several positive implications, but there can also be negative effects, for instance that the EU rules are less progressive than the national ones. The aim of this paper is to discuss the key benefits and drawbacks with EU harmonization of national rules, using France as an example. This paper maps the key French policies supporting longer product lifetimes and the upcoming EU rules aiming for EU-wide harmonization. Finally, we describe one policy where EU rules are likely to be less progressive than the French ones, mandatory repair information to consumers, to exemplify key trade-offs with harmonization
Gut inflammation is associated with structural spinal damage in axial spondyloarthritis – results from the observational SPARTAKUS cohort
No full textBackground: In axial spondyloarthritis (axSpA), 5–10% of patients have comorbid inflammatory bowel disease (IBD). Beyond that, 50–60% display histologic inflammation in ileum/colon biopsies, and fecal calprotectin (F-calprotectin) is elevated in relation to healthy controls. Prior studies have shown such, often subclinical, gut inflammation in axSpA to be associated with more active disease, as measured by clinical indices as well as magnetic resonance imaging – both known risk factors for structural spinal damage development. In light of this, in the current study we aimed to examine whether gut inflammation, assessed by F-calprotectin, is associated with more structural spinal damage in axSpA. Methods: Patients with well-characterized non-radiographic or radiographic axSpA (nr-axSpA/r-axSpA; n = 76/152), according to ASAS or modified New York criteria, enrolled in a population-based cohort study in southern Sweden, were assessed for structural spinal damage (modified Stoke ankylosing spondylitis spinal score [mSASSS]) and gut inflammation (F-calprotectin). mSASSS values were compared between patients with normal (< 50 mg/kg), moderately elevated (50–149 mg/kg) or distinctly elevated (≥ 150 mg/kg) F-calprotectin, reflecting no/some/evident gut inflammation, respectively (one-way ANOVA). Moreover, logistic regression was applied to explore if elevated F-calprotectin (≥ 50 mg/kg) was associated with mSASSS values above the median, adjusted for sex, symptom duration, HLA-B27 status, smoking, CRP, NSAID and anti-TNF therapy. Analyses limited to r-axSpA were also performed. Results: In both axSpA patients overall and separately in r-axSpA, mSASSS distributions differed significantly between subjects with normal/moderately/distinctly elevated F-calprotectin, with more damage observed in those with higher F-calprotectin levels. Furthermore, elevated F-calprotectin (≥ 50 mg/kg) was associated with mSASSS values above the median, in both the entire axSpA group (adjusted odds ratio [OR] 2.2 [95%CI 1.1–4.2]); and in r-axSpA alone (adjusted OR 2.9 [1.2–7.1]). Conclusion: In the current study, the presence of gut inflammation, assessed by F-calprotectin, was cross-sectionally associated with more structural damage in the spine in patients with axSpA, even after adjustments for known risk factors for spinal damage. Prospective studies are, however, needed to investigate whether gut inflammation may be a predictor of spinal radiographic progression in axSpA
Surface Properties of p-GaN and Formation of Nickel Metal Contacts
No full textNickel (Ni) is the key component in ohmic contacts for Mg-doped p-GaN, but the detailed formation mechanisms of the ohmic contact have not yet been understood. In this work, the effect of potassium hydroxide (KOH)-based chemical treatment on the surface of p-GaN is investigated using X-ray photoelectron spectroscopy (XPS), scanning tunneling microscopy (STM), and low-energy electron diffraction (LEED). Ni metal contacts on the chemically treated p-GaN surface are studied using transfer length method (TLM) and synchrotron radiation photoelectron spectroscopy (SR-XPS). The chemical treatment of p-GaN improves the brightness of the (1x1) hexagonal diffraction pattern in LEED and keeps the 2D terrace structure in STM visible. Concomitantly, XPS shows that the amount of O, C, and Mg–O bonds at the surface were reduced. Ni/p-GaN provided an ohmic contact after annealing in ultra-high vacuum (UHV) at 500 °C. Simultaneously, SR-XPS shows the diffusion of Ga to Ni and the formation of a previously unreported Ga 3d component, which has a surprisingly narrow line shape, indicating that it originates from a crystalline interface phase. Diffusion of Ga is discussed to cause Ga vacancies and acceptor levels in the bandgap increasing carrier tunneling, thus enabling ohmic contact
Metabolite Profiles of Heart Failure, Central Hemodynamic Derangement, and Response to Heart Transplantation
No full textBACKGROUND: Heart failure (HF) is characterized by hemodynamic derangements that are likely to mediate systemic metabolic perturbations but limited data are available. Plasma metabolite profiling provides opportunities for comprehensive investigation of such perturbations. Here, we aimed to characterize plasma profiles that associate with HF and their relationship with central hemodynamics, symptom burden, and response to restoration of cardiac function by heart transplantation. METHODS: Untargeted metabolite profiling was conducted with mass spectrometry in 2 independent case–control samples. RESULTS: In total, 89 of 797 studied metabolites were significantly associated with HF in both cohorts with concordant directionality. Amino acid, carbohydrate, and nucleotide metabolites were enriched for association with HF and were consistently increased in HF cases. A subset of patients with advanced HF subsequently underwent heart transplantation, after which 17 of the 89 metabolites returned significantly toward healthy control levels. These 17 metabolites represent increased catecholamine and heme metabolism, conjugated bile acids, kynurenine pathway mediators, spermidine metabolism, and allantoin, as well as tricarboxylic acid cycle and glycolysis intermediates. Most of these metabolites associated with symptom burden and at least 1 of 12 central hemodynamic parameters, primarily relating to either increased systemic or pulmonary venous congestion, lower cardiac output, or lower left ventricular stroke work. CONCLUSIONS: We comprehensively identified metabolite profiles associated with HF and central hemodynamics that reverse by cardiac transplantation. Increased levels of most metabolites also associated with higher symptom burden. Our findings provide perspectives on the metabolic consequences of HF with potential implications for noninvasive monitoring and tailored therapy
Heart failure in Southern Sweden (HISS) : a cross-sectional analysis of primary care patients’ characteristics and physicians’ adherence to guideline-directed medical therapy
No full textObjectives We aimed to describe clinical and diagnostic characteristics of primary care patients with heart failure and physicians’ adherence to guideline-directed medical therapy (GDMT) for treating chronic heart failure. Design Cross-sectional study based on baseline data from the prospective primary care-based study Heart failure in Southern Sweden (HISS). Setting Patients with heart failure were included from 20 primary healthcare centres in the southernmost region of Sweden (Skåne). Participants Between 2020 and 2023, patients were included in HISS, resulting in a total of 587 participants. Of these, 558 patients (95% of the HISS participants) had available data on left ventricular ejection fraction and were included in this study. Adult patients aged 18 years or older diagnosed with heart failure (International Classification of Diseases, 10th Revision codes I50, I11.0, I42, I43) were considered eligible for inclusion in HISS. Community-dwelling patients with assisted care were excluded. Primary and secondary outcomes The primary outcome measures were distribution of heart failure subtypes and prescribed medications. The secondary outcomes were temporal trends in GDMT and the association between physicians’ adherence to GDMT and clinical characteristics of patients, using logistic regression models. Results Heart failure with preserved ejection fraction (HFpEF) was the most prevalent subtype (42%), followed by mildly reduced (30%) and reduced ejection fraction (HFrEF, 28%). Among patients with HFrEF, 20% were prescribed the recommended GDMT according to the European Society of Cardiology (ESC) 2021 guidelines, which consisted of a renin-angiotensin system inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a sodium-glucose 2 inhibitor. We observed no significant change in the prescribing trends for the quadruple therapy in patients with HFrEF when comparing the 2 years before and after the publication of the ESC 2021 guidelines. Similarly, we observed no association between patient characteristics and the prescription of GDMT according to ESC 2021 for patients with HFrEF. Conclusion HFpEF was the most prevalent subtype, with conclusive and recent echocardiography data among two-thirds of the cohort. Temporal trends in prescription patterns showed no appreciable increase in the use of GDMT for HFrEF during the two years following guideline publication compared with the two preceding years. These findings indicate a need for inclusion of primary care patients as a basis for intensified medical recommendations and implementation strategies
Longitudinal functional connectivity during rest and task is differentially related to Alzheimer’s pathology and episodic memory in older adults
No full textChanges in functional connectivity (FC) strength involving the medial temporal lobe (MTL) and posteromedial cortex (PMC) are related to early Alzheimer’s pathology and alterations in episodic memory performance in cognitively unimpaired older adults, but their dynamics remain unclear. We examined how longitudinal changes in FC involving MTL and PMC during resting-state, episodic memory encoding, and retrieval relate to subsequent amyloid- and tau-PET burden, longitudinal episodic memory performance, and the APOE4 genotype in 152 cognitively unimpaired older adults from the PREVENT-AD cohort. We found APOE4- and fMRI paradigm-dependent associations of change in FC strength with pathology burden and change in episodic memory performance. Decreasing FC over time, or “hypoconnectivity”, within PMC during rest in APOE4 carriers and during retrieval in APOE4 non-carriers was related to more amyloid and tau, respectively. Conversely, increasing FC over time, or “hyperconnectivity”, within MTL during encoding in APOE4 carriers and between MTL and PMC during retrieval independent of APOE4 status was related to more tau. Further, increasing FC between MTL and PMC during rest, unlike during encoding, was beneficial for episodic memory. Our study highlights that pathology-related episodic memory network changes manifest differently during rest and task and have differential implications for episodic memory trajectories