Evaluating complications in below-knee skin cancer surgery after introduction of preoperative appointments : A 2-year retrospective cohort study

Below-knee dermatological surgery has a high risk of complications such as wound infection, bleeding, and necrosis. In this study, we evaluated the impact of preoperative appointments on complication risks. We searched the medical records of the Helsinki University Central Hospital (HUS) Dermatosurgery unit for all below-knee surgeries during 2016, when no preoperative nurse appointments were carried out, and compared it with 2018, when preoperative appointments for risk patients were introduced. The study included 187 patients in 2016 and 179 patients in 2018, of whom 68 (about one third) attended preoperative appointments. At the appointments, risk factors were evaluated, and compression therapy was introduced when possible. The results show complication rates of 13.4% in 2016 vs 10.1% in 2018 (P = .33), despite significantly higher risks in the 2018 patient group. The odds ratio for complications in appointment attendees vs non-attendees was reduced after adjustments to 0.58; however, this was insignificant (P = .47). The odds of complications for skin grafts were considerably higher: 11.33 vs other surgery techniques (P = .00). In conclusion, the introduction of preoperative appointments appeared to reduce complications in below-knee surgery. For graft reconstructions, complication risk is high, even with carefully planned pre- and postoperative care. Further studies are needed to evaluate preventable risk factors of below-knee graft reconstructions.Peer reviewe

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Exploring Cosmic Origins with CORE: Cluster Science

We examine the cosmological constraints that can be achieved with a galaxy cluster survey with the future CORE space mission. Using realistic simulations of the millimeter sky, produced with the latest version of the Planck Sky Model, we characterize the CORE cluster catalogues as a function of the main mission performance parameters. We pay particular attention to telescope size, key to improved angular resolution, and discuss the comparison and the complementarity of CORE with ambitious future ground-based CMB experiments that could be deployed in the next decade. A possible CORE mission concept with a 150 cm diameter primary mirror can detect of the order of 50,000 clusters through the thermal Sunyaev-Zeldovich effect (SZE). The total yield increases (decreases) by 25% when increasing (decreasing) the mirror diameter by 30 cm. The 150 cm telescope configuration will detect the most massive clusters (> 1014 M) at redshift z > 1.5 over the whole sky, although the exact number above this redshift is tied to the uncertain evolution of the cluster SZE flux-mass relation; assuming self-similar evolution, CORE will detect ∼ 500 clusters at redshift z > 1.5. This changes to 800 (200) when increasing (decreasing) the mirror size by 30 cm. CORE will be able to measure individual cluster halo masses through lensing of the cosmic microwave background anisotropies with a 1-σ sensitivity of 4 × 1014M, for a 120 cm aperture telescope, and 1014M for a 180 cm one. From the ground, we estimate that, for example, a survey with about 150,000 detectors at the focus of 350 cm telescopes observing 65% of the sky from Atacama would be shallower than CORE and detect about 11,000 clusters, while a survey from the South Pole with the same number of detectors observing 25% of sky with a 10 m telescope is expected to be deeper and to detect about 70,000 clusters. When combined with such a South Pole survey, CORE would reach a limiting mass of M500 ∼ 2 − 3 × 1013Mand detect 220,000 clusters (5 sigma detection limit). Cosmological constraints from CORE cluster counts alone are competitive with other scheduled large scale structure surveys in the 2020’s for measuring the dark energy equation-of-state parameters w0 and wa (σw0 = 0.28, σwa = 0.31). In combination with primary CMB constraints, CORE cluster counts can further reduce these error bars on w0 and wa to 0.05 and 0.13 respectively, and constrain the sum of the neutrino masses, Σmν, to 39 meV (1 sigma). The wide frequency coverage of CORE, 60 - 600 GHz, will enable measurement of the relativistic thermal SZE by stacking clusters. Contamination by dust emission from the clusters, however, makes constraining the temperature of the intracluster medium difficult. The kinetic SZE pairwise momentum will be extracted with S/N = 70 in the foreground-cleaned CMB map. Measurements of TCMB(z) using CORE clusters will establish competitive constraints on the evolution of the CMB temperature: (1+z) 1−β , with an uncertainty of σβ . 2.7×10−3 at low redshift (z . 1). The wide frequency coverage also enables clean extraction of a map of the diffuse SZE signal over the sky, substantially reducing contamination by foregrounds compared to the Planck SZE map extraction. Our analysis of the one-dimensional distribution of Compton-y values in the simulated map finds an order of magnitude improvement in constraints on σ8 over the Planck result, demonstrating the potential of this cosmological probe with CORE