Cultivation of Schwann cells from fresh and non-fresh adult equine peripheral nerves.

BACKGROUND: Over the past 25 years, acquired equine polyneuropathy (AEP) has emerged as a neurological disease in Scandinavian horses. This condition is characterized by histopathological features including the presence of Schwann cell (SC) inclusions. Cultivated equine SCs would serve as a valuable resource for investigations of factors triggering this Schwannopathy. Ideally, cells should be sampled for cultivation from fresh nerves immediately after death of the animal, however the availability of fresh material is limited, due to the inconsistent case load and the inherent technical and practical challenges to collection of samples in the field. This study aimed to cultivate SCs from adult equine peripheral nerves and assess their ability to survive in sampled nerve material over time to simulate harvesting of SCs in field situations. NEW METHODS: Peripheral nerves from five non-neurological horses were used. After euthanasia, both fresh and non-fresh nerve samples were harvested from each horse. Flow cytometry was employed to confirm the cellular identity and to determine the SC purity. RESULTS: The results revealed successful establishment of SC cultures from adult equine peripheral nerves, with the potential to achieve high SC purity from both fresh and non-fresh nerve samples. COMPARISON WITH EXISTING METHOD: While most SC isolation methods focus on harvest of cells from fresh nerve materials from laboratory animals, our approach highlights the possibility of utilizing SC cultures from field-harvested and transported nerve samples from horses. CONCLUSIONS: We describe a method for isolating SCs with high purity from both fresh and non-fresh peripheral nerves of adult horses.

The Barriers to Rapid Reperfusion in Acute ST-Elevation Myocardial Infarction.

INTRODUCTION: This study aimed to quantify the contribution of various obstacles to timely reperfusion therapy in acute ST-elevation myocardial infarction (STEMI) and to improve performance in a mixed remote rural/urban region. METHODS: From November 1, 2020 to April 23, 2021, patients with acute STEMI were prospectively monitored with the critical time intervals, treatment modalities, and outcomes registered. Selected clinical decision-makers in 11 hospitals were appointed as improvement agents and systematically provided with weekly updated information about absolute and relative performance. Suggestions for improvements were invited and shared. RESULTS: Only 29% of the 146 patients received reperfusion therapy within recommended time limits [prehospital thrombolysis, 2/48; in-hospital thrombolysis, 0/20; primary percutaneous coronary intervention (pPCI), 37/68, with median intervals from the first medical contact of 44, 49, and 133 min, respectively]. Efficiency varied considerably between health trusts: median time from the first medical contact to prehospital thrombolysis ranged from 29 to 54 min (hazard ratio 4.89). The predominant, remediable causes for delays were erroneous tactical choices and protracted electrocardiographic diagnostication, decision-making, and administration of fibrinolytic medication. During the trial, the time to pPCI was non-significantly reduced. CONCLUSION: We found several targets for system improvements in order to mitigate reperfusion delays along the entire chain of care, regardless of reperfusion modality chosen. More patients should receive prehospital thrombolysis. The most important measures will be training to ensure a more efficient on-site workflow, improved protocols and infrastructure facilitating the communication between first responders and in-hospital clinicians, and education emphasizing prehospital transport times. CLINICAL TRIALS IDENTIFIER: NCT04614805.

Post-myocardial infarction rehabilitation and secondary prevention in hospitals. / Rehabilitering og sekundærforebygging etter hjerteinfarkt ved sykehus.

BACKGROUND: Norwegian studies have documented poor cardiovascular risk factor control and a high incidence of new cardiovascular events in myocardial infarction patients. There is little knowledge about the scope of secondary prevention treatment and cardiac rehabilitation in Norwegian hospitals. Therefore, we wanted to conduct a survey of discharge routines and outpatient follow-up after myocardial infarction. MATERIAL AND METHOD: In October 2018, the heads of cardiology departments and nurse managers/physiotherapists at cardiology outpatient clinics at all Norwegian hospitals (N = 51) were contacted and asked to take part in a telephone interview. RESULTS: A total of 40 doctors (78 %) and 51 nurses/physiotherapists (100 %) conducted the telephone interview. Eleven hospitals used standardised discharge summary templates with treatment targets and expected follow-up. Ten hospitals offered routine outpatient follow-up. A total of 47 hospitals (92 %) offered multidisciplinary cardiac rehabilitation, 'heart school' classes or cardiac exercise training, and of these 9 (18 %) offered multidisciplinary comprehensive cardiac rehabilitation in line with international recommendations. INTERPRETATION: The survey revealed considerable differences in reported discharge routines and the provision of cardiac rehabilitation and outpatient follow-up at Norwegian hospitals.

Employment status three years after percutaneous coronary intervention and predictors for being employed: A nationwide prospective cohort study.

BACKGROUND: Vocational support is recommended for patients in cardiac rehabilitation (CR), as returning to work is important in patients social readjusting after an acute coronary event. Information is lacking on whether CR leads to higher long-term employment after percutaneous coronary intervention (PCI). AIMS: The aims of this study were to determine employment status three years after PCI, to compare employment status between CR participants and CR non-participants and to assess predictors for employment. METHODS: We included first-time PCI patients from the NorStent trial, who were of working age (<63 years; n = 2488) at a three-year follow-up. Employment status and CR participation were assessed using a self-report questionnaire. Propensity score method was used in comparing employment status of CR participants and CR non-participants. RESULTS: Seventy per cent of participants who were <60 years of age at the index event were employed at follow-up and CR participation had no effect on employment status. Being male, living with a partner and attaining higher levels of education were associated with a higher chance of being employed, while being older, prior cardiovascular morbidity and smoking status were associated with lower chance of being employed at follow-up. CONCLUSION: Because a significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization, updated incentives should be implemented to promote vocational support. Such programmes should focus on females, patients lacking higher education and patients who are living alone, as they are more likely to remain unemployed.

Cardiovascular nurses' adherence to practice standards in in-hospital telemetry monitoring.

BACKGROUND: Correct electrode placement and proper skin preparation for cardiac telemetry monitoring of patients at risk for arrhythmias increase the quality of the arrhythmic surveillance. Inconsistent arrhythmia surveillance can compromise patient safety and care outcomes. An inspection of international literature demonstrates that nurses generally do not adhere to cardiac monitoring standards. AIM: The aims of this study were to determine cardiovascular nurses' knowledge of and adherence to practice standards for cardiac surveillance and whether their knowledge and practice improves over time. STUDY DESIGN: A comparative study design was applied, and data were obtained by survey methodology. METHODS: Nurse delegates at the Annual National Congress on Cardiovascular Nursing in Norway completed surveys in 2011 and 2017 (delegates from 44 and 38 hospitals, respectively). RESULTS: In total, 363 cardiac nurses (70%) responded to the questionnaires. Of these, 95% were female, with a mean age of 41 years. In 2011, 97% of participants were unaware of international practice standards. However, by 2017 unawareness decreased to 78% (P < .001). Despite their lack of knowledge of practice standards, 94% of participants often or always prepared patients' skin for telemetry; this improved from 2011 to 2017 (P = .001). Overall, 73% of nurses never or seldom scrubbed or washed the patients' skin before electrode placement, and 38% of the electrodes were misplaced. In 2011, 49% of nurses used protective telemetry covers; this increased to 80% in 2017 (P < .001). Overall, 64% always informed patients of the purpose of cardiac monitoring. CONCLUSION: A significant percentage of nurses fail to adhere to recommendations for electrode placement, skin preparation and providing patients with telemetry information. In order to raise the quality of arrhythmic surveillance, investment in educational programmes in cardiac telemetry monitoring is required. RELEVANCE TO CLINICAL PRACTICE: Improved in-hospital telemetry practice is required to ensure patient safety and better care outcomes.

Cardiac rehabilitation and symptoms of anxiety and depression after percutaneous coronary intervention.

Background Anxiety and depression are related to coronary heart disease, and psychological support is recommended in cardiac rehabilitation. Purpose The aims of this study were: to compare the prevalence of anxiety and depression with respect to cardiac rehabilitation participation among patients who have been treated with percutaneous coronary intervention; to examine prevalence of anxiety and depression among percutaneous coronary intervention patients compared to the general population; and to identify predictors of symptomatic anxiety and depression among percutaneous coronary intervention patients. Methods We included 9013 patients undergoing first-time percutaneous coronary intervention. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale in a representative sample of 775 patients at baseline and after three years of follow-up, and in the entire cohort at three-year follow-up. Results Cardiac rehabilitation participants had more anxiety and depression than cardiac rehabilitation non-participants at baseline, and both groups had a more anxiety than the general population. The levels of anxiety and depression fell significantly during three years of follow-up, but the changes did not differ between cardiac rehabilitation participants and cardiac rehabilitation non-participants. Three years after percutaneous coronary intervention the prevalence of anxiety was 32% ( p < 0.001), higher among cardiac rehabilitation participants compared to cardiac rehabilitation non-participants. Female gender and younger age were associated with anxiety, whereas older age, lower levels of education and cardiovascular morbidity were associated with depression. Conclusion The levels of anxiety and depression were prevalent among percutaneous coronary intervention patients and the levels were not affected by cardiac rehabilitation participation. Anxiety is prevalent among female and younger patients, whereas depression is related to older age and cardiovascular co-morbidity.

Cardiac rehabilitation after percutaneous coronary intervention: Results from a nationwide survey.

AIM: The purpose of this study was to estimate the proportion of Norwegian coronary heart disease patients participating in cardiac rehabilitation programmes after percutaneous coronary intervention, and to determine predictors of cardiac rehabilitation participation. METHODS: Participants were patients enrolled in the Norwegian Coronary Stent Trial. We assessed cardiac rehabilitation participation in 9013 of these patients who had undergone their first percutaneous coronary intervention during 2008-2011. Of these, 7068 patients (82%) completed a self-administered questionnaire on cardiac rehabilitation participation within three years after their percutaneous coronary intervention. RESULTS: Twenty-eight per cent of the participants reported engaging in cardiac rehabilitation. Participation rate differed among the four regional health authorities in Norway, varying from 20%-31%. Patients undergoing percutaneous coronary intervention for an acute coronary syndrome were more likely to participate in cardiac rehabilitation than patients with stable angina (odds ratio 3.2; 95% confidence interval 2.74-3.76). A multivariate statistical model revealed that men had a 28% lower probability ( p<0.001) of participating in cardiac rehabilitation, and the odds of attending cardiac rehabilitation decreased with increasing age ( p<0.001). Contributors to higher odds of cardiac rehabilitation participation were educational level >12 years (odds ratio 1.50; 95% confidence interval 1.32-1.71) and body mass index>25 (odds ratio 1.19; 95% confidence interval 1.05-1.36). Prior coronary artery bypass graft was associated with lower odds of cardiac rehabilitation participation (odds ratio 0.47; 95% confidence interval 0.32-0.70) Conclusion: The estimated cardiac rehabilitation participation rate among patients undergoing first-time percutaneous coronary intervention is low in Norway. The typical participant is young, overweight, well-educated, and had an acute coronary event. These results varied by geographical region.

Changes in self-reported health and quality of life in octogenarian patients one month after transcatheter aortic valve implantation.

BACKGROUND: In addition to favourable results regarding mortality and morbidity it is important to identify the impact transcatheter aortic valve implantation (TAVI) has on patients' quality of life. AIMS: The aims were: (i) to describe clinical characteristics, self-reported health and quality of life in octogenarians before TAVI intervention; (ii) to determine changes in self-reported health and quality of life one month after TAVI; and (iii) to establish the clinical importance of the findings. METHODS: A prospective cohort study was conducted on consecutively enrolled octogenarians with severe aortic stenosis undergoing TAVI ( N = 65). Self-reported health and quality of life were recorded at baseline and one month later using two global questions from the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF), the generic Short Form Health 12 and the disease-specific Minnesota Living with Heart Failure Questionnaire. RESULTS: One month after TAVI, WHOQOL-BREF showed that self-reported health improved moderately ( p < 0.001), while quality of life improved slightly, but not statistically significantly ( p = 0.06). There were changes in all Short Form Health 12 domains, except social functioning and role emotional. The estimated changes were 3.6 to 5.8 with large confidence intervals. The Physical Component Summary increased statistically significantly from baseline to 30 days (30.6-34.7; p = 0.02), but the Mental Component Summary did not (46.9-50.0; p = 0.13). CONCLUSION: Despite being an advanced treatment performed in a high risk population, TAVI in octogenarians improves short-term self-reported global health and generic physical health and quality of life. These patient-reported outcomes have importance, particularly in this age group.

Gender differences in the assessment and treatment of myocardial infarction. / Kjønnsforskjeller i utredning og behandling av hjerteinfarkt.

BACKGROUND: Previous studies have shown that there are gender-related differences in the assessment and treatment of myocardial infarction, despite international guidelines that prescribe identical treatment for women and men. We investigated whether these differences occurred in Norway. MATERIAL AND METHOD: All patients admitted to Norwegian hospitals with myocardial infarction from 1 January 2013 to 31 December 2014 and registered in the Norwegian Myocardial Infarction Registry were included. Data from the registry were used to analyse differences in the assessment, treatment, complications and survival of women and men in different age groups. RESULTS: A total of 26 447 myocardial infarctions were registered in the Norwegian Myocardial Infarction Registry in the period 2013 ­ 2014. Fewer women than men were assessed by means of coronary angiography. Percutaneous coronary intervention (PCI) was used to virtually the same extent for both genders if coronary stenosis was found. Women were recommended secondary prophylactic medication to a lesser extent than men. There were no major differences between men and women in the incidence of complications in the course following myocardial infarction or in survival. INTERPRETATION: Fewer women than men suffering acute myocardial infarction were assessed by means of coronary angiography, and women were recommended secondary prophylactic medication less often than men. The reason for the gender differences is not known, but comorbidity and a potentially greater risk of adverse reactions in women may be contributory factors. The different views of doctors providing treatment may also play a part.

Spatial and temporal distribution of incidence of acquired equine polyneuropathy in Norway and Sweden, 1995-2012.

BACKGROUND: Acquired equine polyneuropathy (AEP) is an emerging disease in horses in Sweden, Norway and Finland since 1995. Affected horses show bilateral pelvic limb knuckling and weakness, sometimes progressing to recumbency and euthanasia. The aetiology is unknown but is thought to be non-infectious and non-genetic, though possibly toxic or toxico-infectious. The objectives of this study were to describe the spatial, temporal and spatio-temporal features of AEP in Norway and Sweden for the period of 1995 to 2012. Data from all documented case farms (n = 136) were used. Space-time interaction clustering of case farms was investigated with a retrospective space-time scan statistic with a space-time permutation model, the space-time K-function and the Jacquez k nearest neighbour (kNN) test. RESULTS: There was a clear seasonality in disease occurrence, as 123 case farms presented their first case from January to May. However, there was large variation in the number of case farms between years. Case farms were more numerous in certain regions. Despite the larger horse population in Sweden, 120 of the case farms were in Norway. Space-time clustering was supported by the K-function and partly by the space-time scan, but not by the Jacquez k nearest neighbour (kNN) test. CONCLUSIONS: The results suggest an aetiology for AEP where the exposure is not consistent in time, but varies during and between years, assuming that the incubation period does not vary greatly. The results further suggest that the exposure varies between regions as well. Two out of three different analytical methods supported spatio-temporal clustering of case farms, which rendered inconclusive results. The negative result in the kNN test might be explained by lack of power, which is due to the small number of outbreaks in relation to the size of the study area and length of the study period, and further by the low to moderate power of methods to detect space-time clustering when the background population is unknown. Further research is needed to study how management, meteorological variables and other factors with local or regional differences may explain outbreaks of AEP.

Surgical and conservative management of bilateral dynamic laryngeal collapse associated with poll flexion in harness race horses.

OBJECTIVE: To test the hypothesis that in bilateral dynamic laryngeal collapse associated with poll flexion, vocal fold collapse (VFC) is the initial abnormal event that induces further laryngeal collapse, and that racing performance would therefore be substantially improved after bilateral ventriculocordectomy in affected individuals. STUDY DESIGN: Retrospective study. ANIMALS: Twenty-six horses. METHODS: Medical records (1998-2006) of harness racehorses admitted for high-speed treadmill videoendoscopy (HSTV) that had bilateral dynamic laryngeal collapse associated with poll flexion were reviewed. Race records, owner interviews, and follow-up HSTV were used to evaluate outcome after either surgical treatment including bilateral ventriculocordectomy or conservative management. RESULTS: Bilateral dynamic laryngeal collapse, defined as bilateral VFC with concurrent arytenoid cartilage collapse (ACC), was identified in 26 horses. Norwegian Coldblooded Trotters (NCT) were overrepresented. Sixteen horses had surgical treatment and 10 were treated conservatively. Return to racing and racing performance was not improved within or between groups after the treatment. On follow-up HSTV of 6 surgically treated horses, there was no residual soft tissue collapse in the ventral portion of the rima glottidis; however, ACC and other abnormalities were still evident. CONCLUSION: Bilateral ventriculocordectomy resolved VFC, but failed to stabilize the arytenoid cartilages or to significantly improve racing performance. CLINICAL RELEVANCE: Bilateral dynamic laryngeal collapse associated with poll flexion is a serious performance-limiting upper respiratory tract disorder that is overrepresented in NCT racehorses. Our results suggest that VFC is not the initiating event in this complex obstructive airway disorder for which there is currently no consistently effective treatment.