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[Treatment of non-metastatic prostate cancer]. [非转移性前列腺癌的治疗]。
Pub Date : 2024-04-22
Johan Stranne, Stefan Carlsson, Adalsteinn Gunnlaugsson, Jon Kindblom, Anna Lantz, Ola Bratt

There is a long history of curative treatment of prostate cancer. However, as prostate cancer often grows very slowly, and symptoms do not have time to develop during a person's lifetime, a more tentative approach has become more and more common in many cases. This may be through either watchful waiting or active surveillance. In the first case palliative hormonal treatment is given in the case of progression, in the latter curative treatment would be the choice. When treatment is deemed necessary for localized disease, surgery and radiotherapy are considered equivalent in terms of efficacy and overall risk of side effects. For locally advanced disease, radiotherapy is the recommended first-hand choice outside the SPCG 15 study. Focal treatment, which may lead to less side effects than surgery or radiotherapy, is not recommended outside trial settings due to lack of long-term follow-up data.

前列腺癌的根治性治疗由来已久。然而,由于前列腺癌通常生长非常缓慢,而且症状在患者一生中都没有时间出现,因此在许多病例中越来越多地采用暂缓治疗的方法。这种方法可以是观察等待,也可以是积极监测。在前一种情况下,如果病情恶化,就会进行姑息性荷尔蒙治疗,而在后一种情况下,则会选择治愈性治疗。当认为有必要对局部疾病进行治疗时,就疗效和副作用的总体风险而言,手术和放疗被认为是同等的。对于局部晚期疾病,放疗是 SPCG 15 研究之外推荐的第一选择。局部治疗可能比手术或放疗的副作用更小,但由于缺乏长期随访数据,在试验环境之外不建议采用局部治疗。
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引用次数: 0
[Prostate cancer - diagnostics and screening]. [前列腺癌--诊断和筛查]。
Pub Date : 2024-04-22
Rebecka Arnsrud Godtman, Ola Bratt, Tobias Nordström, Jonas Wallström, Jonas Hugosson

Prostate-specific antigen (PSA) based screening is controversial, even though randomised trials show that screening can reduce prostate cancer mortality. The main reason is that screening leads to overdiagnosis of indolent cancers that would never have surfaced clinically in the absence of screening. Recently, several large studies have shown that magnetic resonance imaging (MRI) improves prostate cancer diagnostics. With MRI, up to half of all men with elevated PSA values can be spared a biopsy. When a biopsy is needed, the needles can be directed towards the suspicious area in the prostate, which increases the detection of clinically significant tumors. In Sweden, regional programmes with organised prostate cancer testing were introduced in 2020. These programmes aim to make prostate cancer testing more standardized, efficient, and equitable. In the future, biomarkers and AI-based systems will likely be important to further improve prostate cancer diagnostics.

尽管随机试验显示筛查可以降低前列腺癌死亡率,但基于前列腺特异性抗原(PSA)的筛查仍存在争议。主要原因是筛查会导致过度诊断一些不严重的癌症,而这些癌症在没有筛查的情况下根本不会出现在临床上。最近,几项大型研究表明,磁共振成像(MRI)可改善前列腺癌的诊断。通过磁共振成像,多达一半的 PSA 值升高的男性可以免于活组织检查。在需要进行活组织检查时,可将针头对准前列腺的可疑区域,从而提高对有临床意义的肿瘤的检出率。瑞典于 2020 年推出了有组织的前列腺癌检测区域计划。这些计划旨在使前列腺癌检测更加标准化、高效和公平。未来,生物标记物和基于人工智能的系统可能对进一步改善前列腺癌诊断非常重要。
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引用次数: 0
Vem har ansvaret för fortsatt läkemedelsbehandling? 谁负责继续用药?
Pub Date : 2024-04-18
Mikael Hoffmann, Magnus Isacson, Rikard Lövström
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引用次数: 0
Mänskliga embryon ska inte ha samma rättsstatus som barn. 人类胚胎不应享有与儿童相同的法律地位。
Pub Date : 2024-04-12
Christina Bergh, Kersti Lundin
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引用次数: 0
Graviditetsregistret – nationell täckning uppnås under 2024. 妊娠登记--2024 年实现全国覆盖。
Pub Date : 2024-04-10
Teresia Svanvik, Kerstin Petersson, Yvonne Skogsdal, Peter Conner, Charlotte Elvander, Michael Algovik, Linda Rilby, Michaela Granfors
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引用次数: 0
[Palliative care in paediatric oncology - a national parental perspective]. [儿科肿瘤中的姑息治疗--全国父母的视角]。
Pub Date : 2024-04-09
Margaretha Stenmarker, Lilian Pohlkamp, Josefin Sveen, Ulrika Kreicbergs

The WHO definition of paediatric palliative care (PPC) emphasises the role of active multidimensional care, carried out with interdisciplinary competence, and providing support to the entire family. The aim of the current national study was to investigate whether parents perceived that their child received palliative care (PC) before the child died of cancer and the parent's view of the care during the child's last month of life. In 2016, parents (n=226) completed a study-specific survey, and a majority reported that their child had received PC with good professional competence. However, many parents reported that the child was greatly affected by pain in the last month of life. Geographical differences indicated that parents who live in sparsely populated areas to a lesser extent reported that their child received PC. Lastly, our conclusion is that access to equal PPC and improved symptom control is crucial for children and their families.

世界卫生组织(WHO)对儿科姑息关怀(PPC)的定义强调了积极的多维关怀的作用,通过跨学科能力来实施,并为整个家庭提供支持。本项全国性研究旨在调查父母是否认为其子女在癌症去世前接受了姑息关怀(PC),以及父母对子女生命最后一个月的关怀的看法。2016 年,家长(n=226)完成了一项针对研究的调查,大多数家长表示他们的孩子接受了专业能力良好的姑息治疗。然而,许多家长表示,孩子在生命的最后一个月受到疼痛的极大影响。地域差异表明,居住在人口稀少地区的家长对其子女接受 PC 治疗的报告较少。最后,我们的结论是,获得平等的 PCPC 和改善症状控制对儿童及其家庭至关重要。
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引用次数: 0
[High-degree atrioventricular (AV) block]. [高度房室传导阻滞]。
Pub Date : 2024-04-09
Peter Hammarlund, Erik Ljungström, Daniel Bremell

In elderly patients high-degree atrioventricular (AV) block is often due to irreversible degeneration of the cardiac conduction system. Reversible causes must however be excluded prior to pacemaker implantation. In younger patients reversible causes are more likely, as well as more unusual etiologies. Lyme carditis is a rare, but reversible cause of AV block. It is a manifestation of Lyme borreliosis - an infectious disease caused by the bacteria Borrelia burgdorferi. Lyme carditis should particularly be considered in young and middle-aged patients with a high-degree AV block. When pretest probability is intermediate to high, a positive serological test makes the diagnosis of Lyme carditis highly likely. In these cases antibiotic treatment may revert the conduction disturbance, thus preventing unnecessary implantation of a permanent pacemaker.

在老年患者中,高度房室传导阻滞通常是由于心脏传导系统发生了不可逆转的退化。不过,在植入起搏器之前必须排除可逆性病因。在年轻患者中,可逆性病因和不常见病因的可能性更大。莱姆心肌炎是房室传导阻滞的一种罕见但可逆的病因。它是莱姆包虫病的一种表现形式--一种由鲍氏包虫病细菌引起的传染性疾病。对于患有高度房室传导阻滞的中青年患者,尤其应考虑莱姆病心肌炎。当检测前概率为中高水平时,血清学检测呈阳性就极有可能诊断为莱姆心肌炎。在这些病例中,抗生素治疗可使传导障碍逆转,从而避免不必要地植入永久性心脏起搏器。
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引用次数: 0
[Registration of national health registry-based research]. [以国家健康登记册为基础的研究登记]。
Pub Date : 2024-04-08
Cathrine Axfors, Ole Fröbert, Perrine Janiaud, Emmanuel Zavalis, Lars G Hemkens, John P A Ioannidis

In medical research as a whole, frequent inaccurate or biased findings are of international concern. One measure against reporting biases is study registration before the start of data collection (preregistration), preferably together with the statistical analysis plan. This meta-research study systematically evaluated registration of Swedish observational research based on national health registries. In a random sample of registry-based observational studies published 2010-2022, very few were preregistered with a publicly available analysis plan (<1 procent). Ideas from the meta-research literature can be leveraged to strengthen the brand of Swedish registry-based observational studies and counteract reporting bias.

在整个医学研究中,经常出现不准确或有偏见的研究结果是国际关注的问题。防止报告偏差的措施之一是在数据收集开始前进行研究注册(预注册),最好与统计分析计划一起进行。这项元研究系统地评估了瑞典基于国家健康登记的观察性研究的登记情况。在对 2010-2022 年发表的基于登记册的观察性研究进行的随机抽样中,只有极少数研究进行了预注册,并公开了分析计划 (
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引用次数: 0
[An increasing prevalence of epilepsy and stagnating or decreasing health care resources makes nationwide implementation challenging]. [癫痫发病率不断上升,而医疗资源却停滞不前或不断减少,这使得在全国范围内开展这项工作具有挑战性]。
Pub Date : 2024-04-08
Johan Zelano

The Swedish national guidelines for epilepsy stipulate regular health care contacts in the years following diagnosis, referral for epilepsy surgery in cases of pharmacoresistant epilepsy, multidisciplinary teams, and adequate patient information particularly for women of childbearing age. The last years have seen advances in many research areas of relevance for the basic epilepsy care, and Sweden has contributed regarding pharmacotherapy, seizure-related risks, sudden unexpected death in epilepsy (SUDEP), and digital tools. An increasing prevalence of epilepsy and stagnating or decreasing health care resources makes nationwide implementation of this knowledge challenging and increases the risk of unequal access to care. Innovation and focus on prioritized groups, such as newly diagnosed and persons with pharmacoresistant epilepsy or comorbidities, will be needed.

瑞典国家癫痫指南规定,在确诊后的数年内要定期与医疗保健机构联系,在出现药物耐药性癫痫的情况下要转诊接受癫痫手术治疗,建立多学科团队,并为患者(尤其是育龄妇女)提供充分的信息。过去几年中,与癫痫基础护理相关的许多研究领域都取得了进展,瑞典在药物治疗、癫痫发作相关风险、癫痫意外猝死(SUDEP)和数字化工具方面也做出了贡献。癫痫发病率的不断上升以及医疗资源的停滞或减少,使得在全国范围内实施这些知识具有挑战性,并增加了获得护理机会不平等的风险。我们需要创新,并将重点放在优先群体上,如新诊断的癫痫患者和药物耐受性癫痫患者或合并症患者。
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引用次数: 0
[Psychedelic psychiatry]. [迷幻精神病学]。
Pub Date : 2024-04-04
Evana López, Hampus Yngwe, Maria Beckman, Mikael Tiger, Fredrik Hieronymus, Johan Lundberg

In the last 20 years there has been an increased interest in research on psychedelic compounds for treatment of psychiatric conditions such as depression, anxiety and substance use disorders. Despite existing treatments being efficacious for many patients, this is not the case for up to a third of the patients with depression. Additionally, treatments are often long and associated with side effects. This review focuses on the psychedelic compound psilocybin, a serotonin-2A-receptor agonist that has been seen to reduce depression and anxiety in patients after administration of only a single dose, with effects lasting several weeks. Recent findings from phase II studies suggest that psilocybin treatment for depression is safe and efficacious. A phase III study is currently recruiting. Whether psychedelics will become a part of standard healthcare remains to be seen, but findings do give rise to cautious optimism.

近 20 年来,人们对迷幻化合物治疗抑郁症、焦虑症和药物使用障碍等精神疾病的研究兴趣日益浓厚。尽管现有的治疗方法对许多患者有效,但对多达三分之一的抑郁症患者来说却并非如此。此外,治疗时间往往较长,而且还伴有副作用。本综述重点介绍迷幻化合物迷幻素,它是一种 5-羟色胺-2A-受体激动剂,患者只需服用一次就能减轻抑郁和焦虑,疗效可持续数周。最近的 II 期研究结果表明,西洛赛宾治疗抑郁症安全有效。目前正在招募第三期研究人员。迷幻药是否会成为标准医疗保健的一部分还有待观察,但研究结果确实令人谨慎乐观。
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引用次数: 0
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