High levels of tissue plasminogen activator (tPA) antigen precede the development of type 2 diabetes in a longitudinal population study. The Northern Sweden MONICA Study

BACKGROUND: Impaired fibrinolysis is found in impaired glucose tolerance and type 2 diabetes, associated with components of the metabolic syndrome. There are no data concerning fibrinolysis in subjects with normal glucose tolerance that convert to diabetes. METHODS: We studied the activities of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) and the levels of tPA antigen (a marker of endothelial dysfunction) in 551 subjects with normal glucose tolerance in 1990 in relation to incident diabetes during nine years of follow-up. RESULTS: Subjects with diabetes at follow-up (n = 15) had significantly lower baseline tPA activity and higher PAI-1 activity and tPA antigen than non-converters. The risk of diabetes increased linearly across quartiles of PAI-activity (p = 0.007) and tPA antigen (p < 0.001) and decreased across quartiles of tPA activity (p = 0.026). The risk of diabetes with low tPA activity or high PAI-1 activity persisted after adjustment for age and sex but diminished to a non-significant level after further adjustments. The odds ratio of diabetes for high tPA antigen was 10.4 (95% confidence interval 2.7–40) adjusted for age and sex. After further adjustment for diastolic blood pressure, waist circumference, insulin, triglycerides, fasting and post load glucose the odds ratio was 6.5 (1.3–33, p = 0.024). CONCLUSIONS: Impaired fibrinolysis and endothelial dysfunction are evident in subjects with normal glucose tolerance who later develop diabetes. High tPA antigen is predictive of future diabetes independent from the metabolic syndrome

Adherence to the Swedish dietary guidelines and the impact on mortality and climate in a population-based cohort study

Abstract Objective: To assess the associations between adherence to the Swedish dietary guidelines and all-cause mortality (i.e. assessing the index’ ability to predict health outcomes), as well as levels of dietary greenhouse gas emissions (GHGEs). Design: A longitudinal study 1990–2016 within the population-based cohort Västerbotten Intervention Programme. Dietary data were based on FFQs. Diet quality was assessed by the Swedish Healthy Eating Index for Adults 2015 (SHEIA15), based on the 2015 Swedish dietary guidelines. Dietary GHGEs were estimated from life cycle assessment data including emissions from farm to industry gate. Hazard ratios (HR) and 95 % CI of all-cause mortality were evaluated with Cox proportional hazards regression, and differences in median GHGEs were tested between quintiles of SHEIA15 score using the Kruskal–Wallis one-way ANOVA test. Setting: Northern Sweden. Participants: In total, 49 124 women and 47 651 men, aged 35–65 years. Results: Median follow-up times were 16·0 years for women and 14·7 years for men, during which time 3074 women and 4212 men died. A consistent trend of lower all-cause mortality HR for both sexes with higher SHEIA15 scores was demonstrated. For women, the all-cause mortality HR was 0·81 ((95 % CI 0·71, 0·92); P = 0·001) and for men 0·90 ((95 % CI 0·81, 0·996); P = 0·041) between the quintile with the highest SHEIA15 score compared with the quintile with the lowest SHEIA15 score. A consistent trend of lower estimated dietary GHGEs among both sexes with higher SHEIA15 scores was also found. Conclusions: Adherence to Swedish dietary guidelines, estimated by SHEIA15, seems to promote longevity and reduce dietary climate impact

Трансоральная тиреоид- и паратиреоидэктомия: серия наблюдений

ЩИТОВИДНОЙ ЖЕЛЕЗЫ БОЛЕЗНИПАРАЩИТОВИДНЫХ ЖЕЛЕЗ БОЛЕЗНИОКОЛОЩИТОВИДНЫХ ЖЕЛЕЗ БОЛЕЗНИЭНДОКРИННЫЕ ХИРУРГИЧЕСКИЕ ОПЕРАЦИИХИРУРГИЯ ЭНДОКРИННЫХ ЖЕЛЕЗТИРЕОИДЭКТОМИЯЭНДОСКОПИЧЕСКАЯ ТЕХНИКАПАРАТИРЕОИДЭКТОМИЯОКОЛОЩИТОВИДНОЙ ЖЕЛЕЗЫ УДАЛЕНИЕТРАНСОРАЛЬНЫЙ ДОСТУПТРАНСОРАЛЬНАЯ ХИРУРГИЯ ШЕИДЕРМАТОЛОГИЧЕСКИЙ ИНДЕКСКАЧЕСТВО ЖИЗНИЦель. Представить результаты собственной серии трансоральных операций у пациентов с заболеваниями щитовидной и околощитовидных желез. Материал и методы. Трансоральная операция выполнена 20 женщинам и 1 мужчине. Все пациенты оперированы по поводу первичного заболевания и соответствовали критериям отбора на основании ультразвукового и цитологического исследований, гормонального фона, соматического статуса. Показаниями к операции в 17 случаях явился узловой зоб, в 2 случаях – диффузный токсический зоб, в 2 случаях – первичный гиперпаратиреоз, аденома околощитовидной железы. Хирургическая техника включала в себя трехпортовый доступ в нижнем своде преддверия рта и газовый способ поддержания рабочей полости. Для операции использовались стандартные лапароскопические инструменты и ультразвуковое энергетическое устройство. В послеоперационном периоде пациенты прошли тест по субъективной оценке эстетического результата операции с использованием опросника дерматологического индекса качества жизни. Результаты. Тиреоидэктомия выполнена 4 пациентам, 15 пациентам – гемитиреоидэктомия и 2 пациентам – паратиреоидэктомия. У одной пациентки трансоральная паратиреоидэктомия выполнена в составе симультанной операции по поводу синдрома множественной эндокринной неоплазии 1 типа. У двух пациентов после операции верифицирован папиллярный рак T1N0M0. Среднее время операции составило 196,1 мин (диапазон 110 – 300 мин). Средняя кровопотеря 39,5 мл (диапазон 10 – 300 мл). На девятой по счету операции потребовалась конверсия вследствие неконтролируемого кровотечения. В одном случае отмечен преходящий парез возвратного гортанного нерва, в одном случае гематома. После операции медиана и среднее значение дерматологического индекса качества жизни составили 1 (0; 4) и 2,05 соответственно, что свидетельствует о незначительном влиянии на качество жизни. Заключение. Трансоральная эндоскопическая операция на щитовидной и околощитовидных железах перспективна в отношении оптимального выбора у пациентов, желающих избежать рубца на шее.Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands. Methods. Transoral surgery was performed in women (n=20) and man (n=1). All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter – in 2 cases, parathyroid adenoma – in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of the dermatology life quality index. Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy – in 15 patients and parathyroidectomy – in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 – 300 min). Average blood loss – 39.5 ml (range 10 – 300 ml). The nineth operation required the conversion due to severe bleeding. In one case, the temporary recurrent laryngeal nerve (RLN) injury was reported, in one case – hematoma. After surgery, the median and average values of the dermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life. Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be the promising optimal choice in patients to avoid scarring on the neck

Modelling of Peripheral Fluid Accumulation after a Crystalloid Bolus in Female Volunteers – A Mathematical Study

Objective. To simultaneously model plasma dilution and urinary output in female volunteers

Food selection associated with sense of coherence in adults

BACKGROUND: Favorable dietary habits promote health, whereas unfavorable habits link to various chronic diseases. An individual's "sense of coherence" (SOC) is reported to correlate with prevalence of some diseases to which dietary habits are linked. However, understanding what determines an individual's dietary preferences and how to change his/her behavior remains limited. The aim of the present study was to evaluate associations between dietary intake and SOC in adults. METHODS: Diet intake was recorded by an 84-item semi-quantitative food frequency questionnaire and SOC was measured by the 13-item Antonovsky questionnaire in 2,446 men and 2,545 women (25–74 years old) from the population based northern Sweden MONICA screening in 1999. RESULTS: Intakes of energy, total and saturated fat, ascorbic acid, sucrose, and servings of fruits, vegetables, cereals, and sweets correlated with SOC among women, whereas intakes of total and saturated fat, ascorbic acid, fiber, and alcohol, and servings of fruits, vegetables, bread, bread and cereals, fish, and potatoes correlated with SOC among men. With a few exceptions, intakes of these nutrients/foods were significantly explained by SOC quartile scores in linear GLM models. Both women and men classified into the highest SOC quartile had significantly higher age-BMI-education standardized mean intakes of vegetables than those in the lowest quartiles. Women in the highest SOC quartile also had higher intake of fruits but lower intakes of energy, total and saturated fat, sucrose, and sweets. Projection to latent structures (PLS) multivariate modeling of intakes of the 84 food items and food aggregates simultaneously on SOC scores supported low SOC to coincide with a presumably less health promoting dietary preference, e.g. intake of pizza, soft drinks, candies, sausages for main course, hamburgers, mashed potato, chips and other snacks, potato salad, French fries, whereas men and women with high SOC scores were characterized by e.g. high intake of rye crisp whole meal bread, boiled potato, vegetables, berries, and fruits. CONCLUSION: Both men and women in the highest, as compared with the lowest, SOC score quartile reported more "healthy" food choices. Dietary habits for individuals in the lowest SOC quartile therefore may render a higher risk for various endemic diseases

Reported food intake and distribution of body fat: a repeated cross-sectional study

BACKGROUND: Body mass, as well as distribution of body fat, are predictors of both diabetes and cardiovascular disease. In Northern Sweden, despite a marked increase in average body mass, prevalence of diabetes was stagnant and myocardial infarctions decreased. A more favourable distribution of body fat is a possible contributing factor. This study investigates the relative importance of individual food items for time trends in waist circumference (WC) and hip circumference (HC) on a population level. METHODS: Independent cross-sectional surveys conducted in 1986, 1990, 1994 and 1999 in the two northernmost counties of Sweden with a common population of 250000. Randomly selected age stratified samples, altogether 2982 men and 3087 women aged 25–64 years. Questionnaires were completed and anthropometric measurements taken. For each food item, associations between frequency of consumption and waist and hip circumferences were estimated. Partial regression coefficients for every level of reported intake were multiplied with differences in proportion of the population reporting the corresponding levels of intake in 1986 and 1999. The sum of these product terms for every food item was the respective estimated impact on mean circumference. RESULTS: Time trends in reported food consumption associated with the more favourable gynoid distribution of adipose tissue were increased use of vegetable oil, pasta and 1.5% fat milk. Trends associated with abdominal obesity were increased consumption of beer in men and higher intake of hamburgers and French fried potatoes in women. CONCLUSION: Food trends as markers of time trends in body fat distribution have been identified. The method is a complement to conventional approaches to establish associations between food intake and disease risk on a population level

Modelling of peripheral fluid accumulation after a crystalloid bolus in female volunteers - a mathematical study

Objective. To simultaneously model plasma dilution and urinary output in female volunteers. Methods. Ten healthy female non-pregnant volunteers, aged 21-39 years (mean 29), with a bodyweight of 58-67kg (mean 62.5kg) participated. No oral fluid or food was allowed between midnight and completion of the experiment. The protocol included an infusion of acetated Ringers solution, 25ml/kg over 30min. Blood samples (4ml) were taken every 5min during the first 120min, and thereafter the sampling rate was every 10min until the end of the experiment at 240min. A standard bladder catheter connected to a drip counter to monitor urine excretion continuously was used. The data were analysed by empirical calculations as well as by a mathematical model. Results. Maximum urinary output rate was found to be 19 (13-31) ml/min. The subjects were likely to accumulate three times as much of the infused fluid peripherally as centrally; 1/=2.7 (2.0-5.7). Elimination efficacy, Eeff, was 24 (5-35), and the basal elimination kb was 1.11 (0.28-2.90). The total time delay Ttot of urinary output was estimated as 17 (11-31) min. Conclusion. The experimental results showed a large variability in spite of a homogenous volunteer group. It was possible to compute the infusion amount, plasma dilution and simultaneous urinary output for each consecutive time point and thereby the empirical peripheral fluid accumulation. The variability between individuals may be explained by differences in tissue and hormonal responses to fluid boluses, which needs to be further explored

Toward a more climate-sustainable diet : possible deleterious impacts on health when diet quality is ignored

BACKGROUND: Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets. OBJECTIVES: To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs. METHODS: Dietary data of 41,194 women and 39,141 men (35-65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact. RESULTS: Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men. CONCLUSIONS: The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation