Immune complement activation is attenuated by surface nanotopography

The immune complement (IC) is a cell-free protein cascade system, and the first part of the innate immune system to recognize foreign objects that enter the body. Elevated activation of the system from, for example, biomaterials or medical devices can result in both local and systemic adverse effects and eventually loss of function or rejection of the biomaterial. Here, the researchers have studied the effect of surface nanotopography on the activation of the IC system. By a simple nonlithographic process, gold nanoparticles with an average size of 58 nm were immobilized on a smooth gold substrate, creating surfaces where a nanostructure is introduced without changing the surface chemistry. The activation of the IC on smooth and nanostructured surfaces was viewed with fluorescence microscopy and quantified with quartz crystal microbalance with dissipation monitoring in human serum. Additionally, the ability of pre-adsorbed human immunoglobulin G (IgG) (a potent activator of the IC) to activate the IC after a change in surface hydrophobicity was studied. It was found that the activation of the IC was significantly attenuated on nanostructured surfaces with nearly a 50% reduction, even after pre-adsorption with IgG. An increase in surface hydrophobicity blunted this effect. The possible role of the curvature of the nanoparticles for the orientation of adsorbed IgG molecules, and how this can affect the subsequent activation of the IC, are discussed. The present findings are important for further understanding of how surface nanotopography affects complex protein adsorption, and for the future development of biomaterials and blood-contacting devices

The Modified Chimney Technique With a Thoracic Aortic Stent Graft to Preserve the Blood Flow of the Left Common Carotid Artery for Treating Descending Thoracic Aortic Aneurysm and Dissection

While thoracic endovascular aortic repair is an effective treatment option for descending thoracic aorta pathology, it does have limitations. The main limitation is related to the anatomical difficulties when disease involves the aortic arch. A fenestrated, branched aortic stent graft and hybrid operation has been introduced to overcome this limitation, but it is a custom-made device and is time consuming to manufacture. Furthermore, these devices cannot be used in an emergency setting. We report two patients with massive descending thoracic aortic aneurysm and ruptured aortic dissection very near the aortic arch who underwent a procedure which we named the modified chimney technique. The modified chimney technique can be used as a treatment option in such an emergency situation or as a rescue procedure when aortic pathology is involved near the supra-aortic vessels

Effects of intrauterine exposure to synthetic glucocorticoids on fetal, newborn, and infant hypothalamic-pituitary-adrenal axis function in humans : a systematic review

BACKGROUND: Synthetic glucocorticoids are commonly used in reproductive medicine. Fetal organ systems are highly sensitive to changes in the intrauterine environment, including overexposure to glucocorticoids. Structural and functional alterations resulting from such changes may persist throughout life and have been associated with diverse diseases. One system that could be particularly sensitive to fetal glucocorticoid overexposure is the hypothalamic-pituitary-adrenal (hpa) axis. Many human studies have investigated this possibility, but a systematic review to identify consistent, emergent findings is lacking. METHODS: We systematically review 49 human studies, assessing the effects of intrauterine exposure to synthetic glucocorticoids on fetal, neonate, and infant hpa function. RESULTS: Study quality varied considerably, but the main findings held true after restricting the analyses to higher-quality studies: intrauterine exposure to synthetic glucocorticoids reduces offspring hpa activity under unstimulated conditions after pain but not pharmacological challenge. Although reduced unstimulated hpa function appears to recover within the first 2 wk postpartum, blunted hpa reactivity to pain is likely to persist throughout the first 4 months of life. There is some evidence that the magnitude of the effects is correlated with the total amount of glucocorticoids administered and varies with the time interval between glucocorticoid exposure and hpa assessment. CONCLUSIONS: This systematic review has allowed the demonstration of the way in which intrauterine exposure to various regimens of synthetic glucocorticoids affects various forms of hpa function. As such, it guides future studies in terms of which variables need to be focused on in order to further strengthen the understanding of such therapy, whilst continuing to profit from its clinical benefits

Technical and Clinical Outcome of Talent versus Endurant Endografts for Endovascular Aortic Aneurysm Repair

The technical evolution of endografts for the interventional management of infrarenal abdominal aortic aneurysms (AAA) has allowed a continuous expansion of indications. This study compares the established Talent endograft with its successor, the Endurant endograft, taking individual aortoiliac anatomy into account.From June 2007 to December 2010, 35 patients with AAA were treated with a Talent endograft (33 men) and 36 patients with an Endurant endograft (34 men). Aortoiliac anatomy was evaluated in detail using preinterventional computed tomography angiography. The 30-day outcome of both groups were compared regarding technical and clinical success as well as complications including endoleaks.The Endurant group included more patients with unfavorable anatomy (kinking of pelvic arteries, p = 0.017; shorter proximal neck, p = 0.084). Primary technical success was 91.4% in the Talent group and 100% in the Endurant group (p = 0.115). Type 1 endoleaks occurred in 5.7% of patients in the Talent group and in 2.8% of those in the Endurant group (p = 0.614). Type 3 endoleaks only occurred in the Talent group (2.9% of patients; p = 0.493). Type 2 endoleaks were significantly less common in the Endurant group than in the Talent group (8.3% versus 28.6%; p = 0.035). Rates of major and minor complications were not significantly different between both groups. Primary clinical success was significantly better in the Endurant group (97.2%) than in the Talent group (80.0%) (p = 0.028).Endurant endografts appear to have better technical and clinical outcome in patients with difficult aortoiliac anatomy, significantly reducing the occurrence of type 2 endoleaks

Status Update and Interim Results from the Asymptomatic Carotid Surgery Trial-2 (ACST-2)

Objectives: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. Methods: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. Results: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical treatment. For 691 patients undergoing intervention with at least 1-month follow-up and Rankin scoring at 6 months for any stroke, the overall serious cardiovascular event rate of periprocedural (within 30 days) disabling stroke, fatal myocardial infarction, and death at 30 days was 1.0%. Conclusions: Early ACST-2 results suggest contemporary carotid intervention for asymptomatic stenosis has a low risk of serious morbidity and mortality, on par with other recent trials. The trial continues to recruit, to monitor periprocedural events and all types of stroke, aiming to randomize up to 5,000 patients to determine any differential outcomes between interventions. Clinical trial: ISRCTN21144362. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

Aspects on preoperative evaluation prior to EVAR of AAA

Abdominal Aortic Aneurysms, AAA, is mainly a silent disease that mainly affects elderly males with a history of tobacco use, but when rupture occur most affected dies. Endovascular aneurysm repair (EVAR) has made it possible to treat more fragile and elderly patients with advanced co-morbidities. The benefit of EVAR might be questionable in relation to all cause mortality in some patients. Hence, the need for a proper preoperative evaluation in relation to long term mortality is warranted and the indication for operation should be balanced against the risk of rupture during the patients expected remaining lifetime. The aims of this thesis were to assess (I) cardiovascular predictors, (II) preoperative echocardiographic findings, (III) lung function determinants for all cause long term mortality, and to (IV) compare preoperative evaluation by a vascular physician with a standardized workup protocol. Data from patients undergoing elective standard EVAR for AAA between 1998–2011 at Vascular Center, Malmö, Skåne University Hospital, form the basis of this thesis. Paper I showed that myocardial ischemia on electrocardiogram, ECG, (HR 1.6 [95% CI 1.1–2.4]) and anemia,(HR 1.5 [95% CI 1.0–2.1]), were found to be independent predictors for long-term mortality. Paper II showed that severe heart valve disease measured with echocardiography, was prevalent in 8.7% among the EVAR patients and was an independent predictor for 1-year mortality (OR 3.5 [95% CI 1.2–10.7]). Paper III showed that chronic obstructive pulmonary disease, COPD, grade ≥3 measured with spirometry, or blood gas levels of PaO2 < 8.0 kPa (HR 2.1 [95% CI 1.2–3.4]), chronic kidney disease, stage ≥3 (HR 1.6 [95% CI 1.1–2.2]) and age ≥80 years (HR 1.6 [95% CI 1.0–2.3]), were found to be independently associated with long-term mortality. Paper IV showed that preoperative evaluation by a vascular physician between 2007 and 2011, versus the standardized evaluation protocol between 1998 and 2006, resulted in increased dosage of antihypertensive, platelet aggregation inhibitors and lipid lowering agents with 40%, 24% and 31%, respectively, reduced costs in preoperative patient evaluation (p<0.001), but there was no change in long-term mortality (p=0.24). In conclusion, assessment with preoperative ECG, echocardiography, spirometry, hemoglobin and GFR predicts long term mortality, and strengthens the need of formal evaluation for a better patient selection for elective EVAR of AAA. A preoperative assessment by a vascular physician did not affect mortality but a better pharmacological control of cardiovascular risk factors was obtained

Jakten på kompetens : En fallstudie om det strategiska HRM-arbetet i el-och energibranschen

  Datum: 2023-05-29  Nivå: Magisteruppsats Företagsekonomi, 15 hp   Akademi: Akademin för Ekonomi, Samhälle och Teknik, Mälardalens Universitet  Författare: Hennström Moa (99/02/24)      Ohrlander David (97/08/10)  Titel: Jakten på kompetens - En fallstudie om det strategiska HRM-arbetet i el-och energibranschen.  Handledare: Magnus Linderström  Nyckelord: Talent Management, Talang, HRM system, Strategisk HRM, Kompetensförsörjning, Kompetensutveckling, Skills gap.   Forskningsfrågor: Hur arbetar cheferna strategiskt med HRM-system och Talent Managementpå enheten “Elnät” på Eskilstuna/Strängnäs Energi och Miljö, och hur upplever medarbetarna detta arbete? Vilka möjligheter och utmaningar upplever chefer och medarbetare att det finns med kompetensförsörjning och kompetensutveckling? Hur arbetar cheferna på affärsområdet “Elnät“ för att förebygga och hantera skills gap?   Syfte: Syftet med denna fallstudie är att med utgångspunkt i ett managementperspektiv undersöka hur arbetet med HRM-system genom TM gestaltar sig i praktiken, för att få en ökad förståelse och djupare inblick i fenomenens tillämpning och praktiska utövande. Detta kommer att efterforskas med hjälp av en mixad metod, genom att explorativt undersöka förhållandet mellan chefers och medarbetares syn på utövandet av HRM-system och TM. Vidare ämnar studien att undersöka om det finns ett skills gap och i sådant fall generera en förståelse för hur det hanteras och förebyggs i praktiken.   Metod: I denna studie användes en fallstudie där den empiriska datan samlades in genom en mixad metod. Den kvalitativa datan har insamlats genom semistrukturerade intervjuer med cheferna medan den kvantitativa datan innefattas av ett enkätformulär som chefernas medarbetare gavs möjlighet att besvara. Tillvägagångssättet har varit abduktivt med en explorativ ansats, i syfte att åstadkomma nya upptäckter och perspektiv på fenomenen som undersökts, där det abduktiva förhållningssättet tillåter att ändra inriktning och bygga vidare på den teoretiska referensramen baserat på den empiriska insamlingen. Detta valdes för att uppnå högsta möjliga anpassningsbarhet under studiens genomförande.  Slutsats: ESEM arbetar med deras HRM-system i fyra steg: handledning av nyanställda, utvecklingssamtal, utbildning och individuella utvecklingsplaner för varje anställd. Möjligheterna kring utvecklingssamtalen är också för medarbetarna att uttrycka deras önskan att antingen vidareutveckla sig och sin kompetens inom deras valda arbetsområde, för att uppnå en spetskompetens eller bredda sin kompetens genom att arbeta på en annan avdelning. Detta är menat att öka chanserna för de anställda att avancera i karriären. Utmaningarna för ESEM är bristen på teoretisk och praktisk överlappning på utbildningssystemen och det faktiska arbetet. Den största utmaningen har dock visat sig vara bristen på människor som innefattar rätt kompetens inom branschen. Detta kan temporärt men kostsamt bryggas genom att kortsiktigt hyra in konsulter för att utföra det nödvändiga arbetet. För att förebygga skills gap arbetar ESEM aktivt med att attrahera potentiella medarbetare genom att marknadsföra branschen. Soft skills prioriteras genom ESEM:s kärnvärden: schyssta, pålitliga, modiga och nära.  Date: 2023-05-29   Level: Master thesis in Business Administration, 15 cr  Institution: School of Business, Society and Engineering, Mälardalen University  Authors: Hennström Moa (99/02/24)          Ohrlander David (97/08/10)  Title: The Hunt for Competence - A case study of the strategic HRM work in the electric-energy industry   Supervisor: Magnus Linderström   Keywords: Talent Management, Talen, HRM-system, Strategic HRM, Competence provision, Competence development, Skills gap. Research questions: How do the company leaders work strategically with the HRM-system andTalent Management within “Elnät” at Eskilstuna/Strängnäs Energi och Miljö, and how do the employees experience this work? What opportunities and challenges do company leaders and employees experience concerning competence provision and competence development? How do the company leaders at the business department “Elnät” work to prohibit and manage skills gaps? Purpose: The purpose of this case study is to through a management perspective investigate how the work with an HRM-system through TM is carried out in practice, in order to create an enhanced understanding and deeper insight in the application of both of these phenomena and its practical performance. This will be researched and presented through mixed methods, by exploratively investigating the relationship between company leaders and employees' outlook at the practical performance of an HRM-system and TM. The study will also look to figure out whether there’s a skills gap and if so, how it’s dealt with and prohibited in company practice.   Method: This paper was carried out through a case study where the empirical data was collected through mixed methods. The qualitative data was collected through semi structured interviews with company leaders, while the quantitative data was collected through questionnaires sent out to the company leaders’ employees. The course of action for this study has been abductive with an explorative approach, with the purpose of discovering and creating a perspective of the researched phenomena, where it is allowed to switch directions of and altering the theoretical framework, even after the empirical data has been gathered. This was favored in order to acquire the highest possible ability to adapt during the conducted research.   Conclusion: ESEM work through their HRM system with supervision from company leaders for newly employed, formal meetings with company leaders and their employees, further education that is negotiated through these formal meetings and through creating an individual development plan for each employee. The possibilities regarding the formal meetings are also for the employee to express their wishes to either further enhance their competence within their chosen field, to acquire a talent, or to broaden their competence by working with another department. This is meant to enhance chances to advance in the career of the employees. The challenges for ESEM and its HRM-system is the lack of theoretical and practical overlapping between education systems and the actual line of work. The biggest challenge however is the lack of people who are competent within the field altogether. This can be temporarily but costly bridged by acquiring short term consultants to perform the necessary work. To prevent the skills gap, ESEM are active in attracting potential employees through marketing the line of work. Soft skills are prioritized through ESEM:s core values: Agreeable, reliable, brave and approachable.