Intermittent pneumatic compression reduces the risk of deep vein thrombosis during post-operative lower limb immobilisation : a prospective randomised trial of acute ruptures of the Achilles tendon.

Deep vein thrombosis is a common complication when immobilising the lower limb after surgery. We hypothesised that adjuvant intermittent pneumatic compression (IPC) during post-operative outpatient immobilisation of the lower limb could reduce the incidence of deep vein thrombosis (DVT). A total of 150 patients with acute Achilles tendon rupture were randomised to either treatment with IPC for six hours daily (n = 74) under an orthosis or treatment as usual (n = 74) in a plaster cast. At two weeks post-operatively the incidence of DVT was assessed using compression duplex ultrasound (CDU) by two ultrasonographers blinded to treatment. After the IPC intervention had ended, all patients were immobilised in the orthosis for another four weeks and a second CDU was performed. Trial registration: www.clinicaltrials.gov; NCT01317160. At two weeks the DVT rate was 21% in the IPC group and 38% in the control group (OR = 2.36; 95% CI 1.11 to 5.01). Age > 39 years was found to be a strong risk factor for DVT (OR = 4.84; 95% CI 2.14 to 10.96). Treatment with IPC corrected for age reduced the risk significantly (OR = 0.36; 95% CI 0.16 to 0.80). At six weeks, however, the frequency of DVT was 49% in the IPC group and 51% in the control group (OR = 0.94; 95% CI 0.49 to 1.83). IPC seems to be an effective method of reducing the risk of early DVT in leg-immobilised outpatients. A high risk of DVT during prolonged immobilisation warrants further study.Swedish Research CouncilStockholm County Council and Karolinska InstitutetAccepte

To what extent does surrounding landscape explain stand-level occurrence of conservation-relevant species in fragmented boreal and hemi-boreal forest?-a systematic review protocol

Background: Silviculture and land-use change has reduced the amount of natural forest worldwide and left what remains confined to isolated fragments or stands. To understand processes governing species occurrence in such stands, much attention has been given to stand-level factors such as size, structure, and deadwood amount. However, the surrounding matrix will directly impact species dispersal and persistence, and the link between the surrounding landscape configuration, composition and history, and stand-level species occurrence has received insufficient attention. Thus, to facilitate optimisation of forest management and species conservation, we propose a review addressing 'To what extent does surrounding landscape explain stand-level occurrence of conservation-relevant species in fragmented boreal and hemi-boreal forest?'.Methods: The proposed systematic review will identify and synthesise relevant articles following the CEE guidelines for evidence synthesis and the ROSES standards. A search for peer-reviewed and grey literature will be conducted using four databases, two online search engines, and 36 specialist websites. Identified articles will be screened for eligibility in a two-step process; first on title and abstract, and second on the full text. Screening will be based on predefined eligibility criteria related to a PECO-model; population being boreal and hemi-boreal forest, exposure being fragmentation, comparator being landscapes with alternative composition, configuration, or history, and outcome being occurrence (i.e., presence and/or abundance) of conservation-relevant species. All articles that pass the full-text screening will go through study validity assessment and data extraction, and be part of a narrative review. If enough studies prove comparable, quantitative meta-analyses will also be performed. The objective of the narrative review and the meta-analyses will be to address the primary question as well as six secondary questions, and to identify important knowledge gaps

Reduced time to surgery improves patient-reported outcome after achilles tendon rupture.

Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols, however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred and twenty-eight ATR patients treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on a free slot in the operating theatre and neither surgeon nor patient could affect TTS. Patients were assigned into three groups according to trichotomized TTS; short- (72hours). Patient-reported outcome at one-year was assessed using the validated Achilles tendon Total Rupture Score, with scores>80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (peri- and postoperative) and deep venous thrombosis were assessed. Results: Shorter TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared to 44% (95% CI, 33%-56%) of the patients 3 with long TTS (p=.002), and with the intermediate TTS group in between (63%, 95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS 1.4% (95% CI, 1%-4%) as compared to those with intermediate TTS 11% (95% CI, 2%-21%) (p=.035) and to patients with long TTS 14.8% (95% CI, 7%-23%) (p=.003). The risk of sustaining a deep venous thrombosis was not statistically significant different among the three groups (p=.15). Conclusion: Patients with acute ATR operated on within 48 hours after injury yielded better outcomes and a lower number of adverse events compared to patients operated on after 72 hours. These results conform to evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols.Swedish Research Council (project nr. 2012-3510)Accepte

Ageing, deep vein thrombosis and male gender predict poor outcome after acute Achilles tendon rupture

Background: Patients with acute Achilles tendon rupture (ATR) exhibit prolonged healing, high incidence of deep venous thrombosis (DVT) and a wide variation of functional outcome. This extensive discrepancy in outcome may be explained by a lack of knowledge of detrimental factors, and subsequent shortage of adequate interventions. Methods: A total of 111 patients (84 men, 16 women; mean age 40.3±8.4) with acute total ATR were prospectively assessed. At one year post-operatively a uniform outcome score, Achilles Combined Outcome Score (ACOS), was obtained by combining three validated, independent, outcome measures: Achilles tendon Total Rupture Score, heel-rise height test, and limb symmetry heel-rise height. Candidate predictors of ACOS included; treatment, sex, age, smoking, body mass index (BMI), time to surgery, physical activity level pre- and post-injury, symptoms, quality of life and DVT-incidence. Results: Three independent variables correlated significantly with the dichotomized outcome score ACOS, while the other factors demonstrated no correlation. Low age (40 or less=0; above 40=1) was the strongest independent predictor of developing a good outcome at one year after ATR (OR= 0.20, 95 % C.I. 0.08 – 0.51), followed by female gender (Man= 1; Woman= 2) (OR= 4.18, 95 % C.I. 1.01 – 17.24). Notably, patients without a DVT (No=0, Yes=1) during post-operative immobilization experienced a better outcome (OR= 0.31, 95 % C.I. 0.12 – 0.80). Conclusion: DVT during leg immobilization, aging and male gender are independent negative predictors of outcome in patients with acute ATR. Age and gender should be further studied as to pinpoint the underlying causes leading to poor outcome. To enhance the outcome after ATR the first clinical focus should be on DVT-prevention during immobilization, possibly by usage of mechanical compression therapy and early weight bearing and mobilization.The Swedish Research CouncilDJOStockholm County Council and Karolinska InstitutetSwedish National Centre for Sports ResearchAccepte

Outcome of a psychosocial health promotion intervention aimed at improving physical health and reducing alcohol use in patients with schizophrenia and psychotic disorders (MINT)

Background: Life expectancy is reduced by 19 years in men and 17 in women with psychosis in Sweden, largely due to cardiovascular disease. Aim: Assess whether a psychosocial health promotion intervention improves cardiometabolic risk factors, quality of life, and severity of illness in patients with psychotic disorders more than treatment as usual. Methods: A pragmatic intervention trial testing a manual-based multi-component health promotion intervention targeting patients with psychosis. The Swedish intervention was adapted from IMPaCT therapy, a health-promotion program based on motivational interviewing and cognitive behavioral therapy, designed to be incorporated into routine care. The intervention group consisted of 119 patients and a control group of 570 patients from specialized psychosis departments. Outcome variables were assessed 6 months before intervention during the run-in period, again at the start of intervention, and 12 months after the intervention began. The control group received treatment as usual. Results: The intervention had no significant effect on any of the outcome variables. However, BMI, waist circumference, systolic BP, heart rate, HbA1c, general health, and Clinical Global Impressions Scale score improved significantly during the run-in period before the start of the active intervention (observer effect). The multi-component design meant that treatment effects could only be calculated for the intervention as a whole. Conclusion: The results of the intervention are similar to those of the U.K. IMPaCT study, in which the modular health-promotion intervention had little effect on cardiovascular risk indicators. However, in the current study, the run-in period had a positive effect on cardiometabolic risk factors

Rocky pine forests in the High Coast Region in Sweden: structure, dynamics and history

Almost all forests in Sweden are managed and only a small fraction are considered natural. One exception is low productive forests where, due to their limited economical value, natural dynamics still dominate. One example is the Scots pine (Pinus sylvestris L.) forests occurring on rocky and nutrient-poor hilltops. Although these forests represent a regionally common forest type with a high degree of naturalness, their dynamics, structure and history are poorly known. We investigated the structure, human impact and fire history in eight rocky pine forests in the High Coast Area in eastern Sweden, initially identified as good representatives of this forest type. This was done by sampling and measuring tree sizes, -ages, fire-scarred trees, as well as dead wood volumes and quality along three transects at each site. The structure was diverse with a sparse layer of trees (basal area 9 m(2) and 640 trees larger than 10 cm ha(-1)) in various sizes and ages; 13 trees ha(-1) were more than 300 years old. Dead wood (DW), snags and logs in all stages of decay, was present and although the actual DW (pine) volume (4.4 m(3) ha(-1)) and number of units (53 ha(-1)) was low, the DW share of total wood volume was 18% on average. Dead wood can be present for several centuries after death; we found examples of both snags and logs that had been dead more than 300 years. Frequent fires have occurred, with an average cycle of 40 years between fires. Most fires occurred between 1500-1900 and many of them (13) during the 1600s. However, fires were probably small since most fire years were only represented at one site and often only in one or a few samples. The rocky pine forests in the High Coast Area are representative of undisturbed forests with low human impact, exhibiting old-growth characteristics and are valuable habitats for organisms connected to sun-exposed DW. Management of protected rocky pine forests may well include small-scale restoration fires and the limited DW volumes should he protected

Effect of Debarking Water from Norway Spruce (Picea abies) on the Growth of Five Species of Wood-Decaying Fungi

Norway spruce (Picea abies) debarking water is an aqueous extract obtained as waste from the debarking of logs at paper mills. The debarking water contains a mixture of natural compounds that can exhibit diverse biological activities, potentially including fungicidal activity on some species of wood-decaying fungi. Thus, we investigated the growth rates of such fungi on agar plates to which debarking water extracts had been added. The experiment included five wood-decaying fungi, viz. Gloeophyllum sepiarium, Oligoporus lateritius, Ischnoderma benzoinum, Junghuhnia luteoalba, and Phlebia sp. Growth reduction was observed for all species at the highest tested concentrations of freeze-dried and ethanol-extracted debarking water, the ethyl acetate-soluble fraction and the diethyl ether-soluble fraction. However, the magnitude of the effect varied between different species and strains of individual species. The brown-rot fungi G. sepiarium and O. lateritius were generally the most sensitive species, with the growth of all tested strains being completely inhibited by the ethyl acetate-soluble fraction. These results indicate that development of antifungal wood-protecting agents from debarking water could potentially be a way to make use of a low-value industrial waste