Strategies to improve macroencapsulated islet graft survival

Chronic immunosuppressive therapy may have severe side-effects. In cell transplantation, the graft can be encapsulated within a membrane chamber, providing a physical barrier against the immune system. The cell graft then becomes dependent on the diffusion of nutrients and oxygen from the surrounding microcirculation. A major drawback has been the formation of avascular fibrotic tissue around the chamber. The immunoprotective device studied (TheraCyte ) has an outer membrane inducing neovascularization. However, major parts of the encapsulated graft are still lost soon after transplantation, probably because of relative hypoxia and malnutrition. The overall aim of this thesis was to assess various strategies to improve islet graft survival in the device, using rodent models. The purpose of the first paper was to improve the method for histological evaluation of the vascularization around the device. Vascular profiles within various distances from the membrane surface were counted at different times and then correlated with glucose kinetics. We found that the vascular profiles within 100 ìm had the highest correlations with glucose kinetics and concluded that vessels within this distance are important for the exchange of small molecules between the circulation and the device s lumen. Therefore, we recommend that 100 ìm should be used in histological evaluations of the membrane vascularization. In the second paper we hypothesized that preimplantation of the device should improve encapsulated islet graft survival. Previous studies have indicated that it takes up to 3 months for recovery of the microcirculation after membrane implantation. Therefore, we implanted empty devices and transplanted islets 3 months later in these chambers. This approach significantly improved the cure rates of diabetic animals, and the islet dose required for cure was reduced by about 10 times. Morphometry evaluations confirmed increased graft survival in preimplanted devices. The third paper aimed at evaluating the effects of exendin-4 treatment on the metabolic outcome after islet transplantation. Exendin-4 inhibits islet apoptosis, stimulates islet differentiation and regeneration and has beneficial effects on peripheral tissues. We found that exendin-4 treatment significantly improved the metabolic outcome after free islet transplantation to the renal subcapsular site. The benefit lasted longer than the treatment, suggesting that exendin-4 had long-standing effects on the islet graft. This substance seems to be an interesting new approach to improve the survival also of encapsulated islet grafts. In the last paper we evaluated the risk of recipient sensitization using macroencapsulated islets. A heterotopic heart graft was transplanted one month after free or encapsulated islet transplantation. The time-to-rejection was significantly shorter in the free islet group, while it did not differ between encapsulated islet graft recipients and naive animals. We therefore conclude that the device protects against sensitization, at least during the first month after transplantation. Today, side-effects of the immunosuppressive therapy are one of the main limiting factors for the use of islet transplantation. If immunoprotection could be achieved by encapsulation of the islet graft, it should be possible to widen the indications. This thesis describes promising strategies to improve the survival of macroencapsulated islet grafts, which might contribute to make macroencapsulation a clinical reality

GDPR - Den digitala marknadsföringens motståndare? : En kvalitativ studie som undersöker hur företag som arbetar med digital marknadsföring påverkas av GDPR-lagen

The General Data Protection Regulation (GDPR) is the name of the new data protection regulation applicable to all member of EU, which will enure May 25th 2018. The law means that companies need to review their personal data usage in order to adapt to the requirements set by GDPR. Organizations working with digital marketing have long used individuals' personal data to adapt advertising to the customers of the company. Therefore, the purpose of the study is to explain how companies involved in digital marketing are affected by the enuring of the new data protection regulation. The essay was based on information on the strategy for digital marketing, personal information and CRM systems in different formats. The survey has also been based on a change table that describes some of the requirements that comes with GDPR. The starting point of the study is a qualitative approach, where the method of data collection consisted of semistructured interviews. The interviews have been conducted with five respondents who in one way or another have insight into the forthcoming law.  This survey has answered the research question "How are companies involved in digital marketing affected by the GDPR-law? ”. All respondents had a serious approach to the law, where the conclusion showed that companies working with digital marketing in one way or another would be affected by GDPR. This depends on their way of working. The impact of the GDPR also provided positive aspects regarding the creation of long-term relationships between companies and their customers.

Should we Refrain from Performing Oophorectomy in Conjunction with Radical Cystectomy for Bladder Cancer?

Radical cystectomy with neoadjuvant chemotherapy is the gold standard for treating muscle-invasive bladder cancer. Women subjected to radical cystectomy are frequently postmenopausal, and the median age for bladder cancer diagnosis in women in Sweden is currently 73 yr (Swedish National Bladder Cancer Register). Traditionally, most women treated with radical cystectomy have undergone simultaneous bilateral oophorectomy and hysterosalpingectomy to diminish the risk of later ovarian disease and ovarian bladder cancer recurrence, but also the belief that there is no impact on health or health-related quality of life associated with oophorectomy and the fact that it might be easier surgery to take the ovarian pedicles, rather than sparing the ovaries. However, pelvic organ preservation is considered in some younger women to diminish postoperative functional impairment. Based on recent literature in several areas related to oophorectomy, we question the rationale and arguments for performing oophorectomy in women in conjunction with radical cystectomy for bladder cancer. It can be questioned whether routine bilateral oophorectomy during radical cystectomy is advisable in premenopausal women, and the same might also apply to selected postmenopausal women

THE NURSING NEEDS OF PERSONS WITH DISABILITIES IN NEPAL - A CAREGIVERS PERSPECTIVE

Bakgrund: Det är brist på studier av vårdgivarnas behov i södra Asien. Studien kommer förhoppningsvis att leda till bättre vård för personer med funktionshinder och arbetsmiljö för vårdgivarna. Syfte: Beskriva vårdgivares erfarenheter i vård av funktionshindrade. Metoder: Semi-strukturerade bandade intervjuer genomfördes med vårdgivare. Vårdgivare definierades som vem som helst över arton år på alla utbildningsnivåer med erfarenhet av vård av funktionshindrade. Intervjuerna genomfördes i två boenden, ett sjukhus och ett rehabiliteringscenter i Katmandu. Den engelska data transkriberades i verbatim och analyserades med hjälp av kvalitativ innehållsanalys. Resultat: De upptäckta kategorierna var dagliga livet, långsiktiga förändringar, organisation och uppfattning. Slutsatser: Tillgång till utbildning, rehabilitering, sysselsättning och kollektivtrafik behövs. Ökad tillgång till hjälpmedel är också efterfrågad. En samhällsförändring med förbättrad kunskap om funktionshinder, ökad acceptans och strukturer för att undvika inkomstförlust. Nyckelord: Nepal, omvårdnadsbehov, personer med funktionshinder, vårdgivareBackground: There is a lack of studies made on the needs of caregivers of persons with disabilities in south asia. The study will hopefully lead to better care for persons with disabilities and work environment for the caregivers. Aim: The aim was to describe the experiences from caregivers about caring for people with disabilities. Methods: Semi-structured taped interviews were conducted with caregivers. Eight caregivers were interviewed, one was a physiotherapist, three were employed caregivers and four were relatives. Six interviews were in nepali with a translator and two in english. Caregivers were defined as anyone above eighteen years at any level of education with experience of providing care for persons with disabilities. The interviews were conducted in two shelters, one hospitals and one rehabilitation centre in Kathmandu. The english data was transcribed in verbatim and analyzed using qualitative content analysis. Results: The discovered subcategories were daily life, organization, long term life changes and perceptions. Conclusions: Accessibility to education, rehabilitation, employment and public transport is needed. Increased access to assistive devices is also requested. A societal change with improved knowledge about disabilities, increased acceptance and structures to avoid a loss of income. Key terms: caregiver, Nepal, nursing needs, persons with disabilitie

Port-site Metastases After Robot-assisted Radical Cystectomy: Is There a Publication Bias?

To access publisher's full text version of this article click on the hyperlink belowSwedish Cancer Society Gosta Jonsson Research Foundation Lund Medical Faculty (ALF

Robot-assisted nephroureterectomy for upper tract urothelial carcinoma—feasibility and complications : a single center experience

Background: Robot-assisted nephroureterectomy (RANU) is the primary treatment for upper tract urothelial carcinoma (UTUC) at our hospital for patients with clinical stage less than T2, and for patients with invasive tumours, but unfit for major surgery. Objective: To assess peri-operative conditions and outcomes of RANU at our unit, and to evaluate the safety of the procedure. Methods: The medical records of all 166 patients undergoing RANU for suspected UTUC and followed for more than three months in a large university hospital in Sweden were reviewed retrospectively. After the exclusion of twenty patients because of previous cystectomy, simultaneous surgical procedure, or other tumour types than UTUC in the pathological report, 146 patients remained for the analyses. The primary endpoint was complication rate according to Clavien-Dindo at 90 days. Secondary endpoints were perioperative bleeding, violation of oncological surgical principles, hospital stay, and re-admission within 90 days. Results: The median age was 75 [(Inter Quartile Range) IQR 70–80] years and 57% of the patients had an ASA score above 2. According to Clavien-Dindo, one patient had a grade 3 complication, and no patient had a grade 4–5 complication. The median blood loss was 50 (IQR 20–100) ml and the median hospital stay was 6 (IQR 5–7) days. Twelve patients were re-admitted to the hospital within 90 days (eight with urinary tract infection/haematuria, one with hematoma, and three with other diseases). Conclusion: Robot-assisted nephroureterectomy is a safe procedure for patients with upper tract urothelial carcinoma, with a low risk of major surgical complications