Skåne University Hospital (Swedish: Skånes universitetssjukhus, SUS) is a university hospital in Scania, Sweden. The hospital was founded in 2010 through the merger of the two university hospitals in Lund and Malmö.
The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.
Abstract Background Routine use of surgical drains after abdominal operations has largely been abandoned over the past decades. Studies have failed to demonstrate benefits of routine drainage following liver, gallbladder, gastric, and colorectal surgeries. Until recently, intraoperative placement of abdominal drains was the gold standard in pancreatoduodenectomies (PDs) due to concerns about uncontrolled postoperative pancreatic fistula (POPF). A large randomized trial in 2014 reported increased mortality in patients without postoperative drain placement. However, as the study did not stratify participants based on their preoperative risk of developing a POPF, further research is needed. Limited evidence from a non-randomized cohort suggests that omitting drains may be safe in very low-risk settings. However, a larger comparative study, including a broader range of PD cases, is necessary to confirm these findings. Methods This is a two-arm, randomized, controlled, non-blinded, multicenter trial comparing intra-abdominal drain placement with no drain placement during planned pancreatoduodenectomies (PDs). Eligible patients who meet the inclusion criteria will be assessed for their individual risk of postoperative pancreatic fistula (POPF) using a risk scoring system. They will then be randomized into either the drain placement or no drain placement group. The groups will be compared using the chi-square test for categorical variables and Fisher’s exact test. Logistic regression models will be used to calculate odds ratios for morbidity. Univariable and multivariable models will assess the impact of drain placement on clinical outcomes. Discussion This trial aims to determine whether omitting routine intraoperative drain placement reduces the risk of complications in patients undergoing pancreatoduodenectomy (PD). It will provide level 1 evidence on the association between routine intra-abdominal drainage and postoperative complications in patients with a low to intermediate risk of developing a postoperative pancreatic fistula (POPF). The findings will contribute to future treatment guidelines by expanding the available knowledge on optimal drainage strategies. Trial registration ClinicalTrials.gov Identifier: NCT05270564. Registered on February 16 2022.
High-dose methotrexate (HDMTX) is a cornerstone in pediatric oncology, but delayed methotrexate elimination (DME) can cause severe toxicity. Rescue therapy typically combines folinic acid (FA) and glucarpidase (GP), yet current guidelines recommend pausing FA around GP administration due to presumed interference. This study aimed to determine whether FA affects GP efficacy in metabolizing methotrexate and to assess the impact on folate metabolites. An ex vivo model was developed using human plasma spiked with clinically relevant concentrations of methotrexate and FA, with or without GP. Samples were analyzed by mass spectrometry to quantify methotrexate, FA, and related metabolites. Additional experiments included blood from pediatric patients receiving HDMTX per ALLTogether protocol. GP rapidly metabolized > 99
BACKGROUND:Evidence indicates that artificial intelligence (AI) can improve mammography screening by increasing cancer detection and reducing screen reading workload, but its effect on interval cancers (primary breast cancers diagnosed between two screening rounds or within 2 years after the last scheduled screening that were not detected at screening) is unknown. We aimed to compare the interval cancer rate in AI-supported mammography screening with standard double reading without AI. METHODS:In this Swedish randomised, controlled, non-inferiority, single-blinded, population-based screening accuracy trial, participants were allocated in a 1:1 ratio to either AI-supported mammography screening (the intervention group) or standard double reading without AI (the control group). AI was used to triage examinations to single or double reading by radiologists and for detection support. This is a protocol-defined analysis of the primary outcome, interval cancer rate, with a 20% non-inferiority margin. Secondary outcomes reported in this analysis are interval cancer characteristics, sensitivity, specificity, and sensitivity by age, breast density, and cancer type (in-situ and invasive). Other secondary outcomes from the trial that have been previously reported are referenced in the Methods section of this Article. The trial is registered with ClinicalTrials.gov (NCT04838756) and is complete. FINDINGS:Between April 12, 2021, and Dec 7, 2022, 105 934 women were randomly assigned to the intervention or control group, of whom 19 were excluded from the analysis. Median age was 53·8 years (IQR 46·5-63·3) in the intervention group and 53·7 years (46·5-63·2) in the control group. Interval cancer rates were 1·55 (95% CI 1·23-1·92) and 1·76 (1·42-2·15) per 1000 participants in the intervention and control group respectively, a non-inferior proportion ratio of 0·88 (95% CI 0·65-1·18; p=0·41). Descriptively, the intervention group had fewer interval cancers that were invasive (75 vs 89), T2+ (38 vs 48), or non-luminal A (43 vs 59) than the control group. Sensitivity was higher in the intervention group (80·5% [95% CI 76·4-84·2]) than the control group (73·8% [68·9-78·3]; p=0·031), an effect consistent across age and breast density, and for invasive cancer but not for in-situ cancer. Specificity was 98·5% (95% CI 98·4-98·6) for both groups (p=0·88). INTERPRETATION:AI-supported mammography screening showed consistently favourable outcomes compared with standard double reading, with a non-inferior interval cancer rate, fewer interval cancers with unfavourable characteristics, higher sensitivity, and the same specificity, while also reducing screen reading workload. These findings imply that AI-supported mammography screening can efficiently improve screening performance compared with standard double reading and may be considered for implementation in clinical practice. FUNDING:Swedish Cancer Society, Confederation of Regional Cancer Centres, Swedish governmental funding for clinical research.
