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  • Public defence: 2017-12-15 09:15 Örebro universitet, Campus USÖ, hörsal C1, Örebro
    Isaksson, Helena
    Örebro University, School of Medical Sciences.
    Clinical studies of RNA as a prognostic and diagnostic marker for disease2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Technologies for RNA detection are evolving rapidly and gives an op-portunity for discovery of new markers for early detection of complex diseases. Today in clinical work we rely on signs and symptoms in com-bination with the measurement of protein levels for diagnosis. The quick turnaround time of mRNA synthesis may provide an earlier diagnostic signal than protein-based biomarkers assays, in acute dramatic condi-tions such as acute mesenteric ischemia (AMI), for early detection of cancer, as prognostic tool in cancer treatment and as an aid in difficult diagnosis of unknown origin.

    The main goals of this thesis was to apply a whole genome approach to study different complex diseases to evaluate the applicability of RNA as a diagnostic or prognostic marker for disease, preferably from an easily accessible source such as peripheral blood. This was investigated in an animal model with induced AMI, a cohort of ovarian cancer patients and in a single-patient study of a girl with a severe inflammatory syn-drome.

    Through this thesis we have gained insight into how gene expression is regulated in ischemic intestinal tissue.

    We found that a peripheral blood test can distinguish between ovarian cancer patients with or without residual tumour mass after surgery with the help of expression analysis of six genes. We also found that gene expressions of three genes can predict overall survival in peripheral whole blood from ovarian cancer patients. And that gene expression profiles indeed can significantly distinguish between two groups of high and low risk ovarian cancer. In the single-patient study, we tried but failed to device a successful treatment before it was too late. Neverthe-less, the things we learned and the case studies that were published may serve as a diagnostic tool for clinicians facing similar syndromes.

    List of papers
    1. Altered mRNA Expression due to Acute Mesenteric Ischaemia in a Porcine Model
    Open this publication in new window or tab >>Altered mRNA Expression due to Acute Mesenteric Ischaemia in a Porcine Model
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    2011 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 41, no 2, 281-287 p.Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Messenger RNA (mRNA) changes in the small intestine in response to acute mesenteric ischaemia (AMI) could offer novel diagnostic possibilities, but have not been described. The aim was to characterize the mRNA response to experimental AMI. Materials and methods: Twelve pigs underwent catheterisation of the superior mesenteric artery with injection of polivinylalcohol embolisation particles or sodium chloride. Laparotomy and intestinal tissue sampling were performed. Microarray analysis was performed using the GeneChip (R) whole porcine genome array. Results: Seven down-regulated cellular pathways were associated with protein, lipid and carbohydrate metabolism. Seventeen up-regulated pathways were associated with inflammatory and immunological activity, regulation of extracellular matrix and decreased cellular proliferation. Thrombospondin (THS), monocyte chemoattractant protein 1(MCP-1) and gap junction alpha 1(GJA-1) were consistently up-regulated in all embolised pigs. Genes encoding earlier proposed biomarkers for AMI were up-regulated, such as lactate dehydrogenase and creatine kinase, or down-regulated, such as intestinal fatty acid binding protein and glutathione S-transferase. Conclusion: This study describes the intestinal tissue response on a gene expression level to AMI. THS, MCP-1 and GJA-1 were consistently up-regulated by ischaemia, whereas earlier proposed biomarkers for AMI were not. Gene expression may not be directly linked to the use of the corresponding proteins as potential clinical biomarkers. (C) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-18783 (URN)10.1016/j.ejvs.2010.09.012 (DOI)000288469000022 ()21095140 (PubMedID)2-s2.0-79651475389 (Scopus ID)
    Available from: 2011-09-29 Created: 2011-09-29 Last updated: 2017-11-24Bibliographically approved
    2. Whole blood RNA expression profiles in ovarian cancer patients with or without residual tumors after primary cytoreductive surgery
    Open this publication in new window or tab >>Whole blood RNA expression profiles in ovarian cancer patients with or without residual tumors after primary cytoreductive surgery
    2012 (English)In: Oncology Reports, ISSN 1021-335X, E-ISSN 1791-2431, Vol. 27, no 5, 1331-1335 p.Article in journal (Refereed) Published
    Abstract [en]

    Significant improvements in the treatment results of ovarian cancer have been achieved during the last decades, but further improvements require additional methods identifying signs of the disease and its biological behavior, preferably by a simple blood test. We hypothesized that peripheral blood leukocytes may express genes that carry such clinical information. Therefore, we studied the relative gene expressions of 168 cancer- and metastasis-specific genes in blood samples from ovarian cancer patients with different prognoses after primary cytoreductive surgery. Total RNA was extracted from whole blood and the relative gene expression profile of 168 genes were analyzed using real-time qPCR assays. Two groups of patients were analyzed; one group with residual tumor mass after primary surgery, and one group where the tumor was macroscopically radically resected, resulting in no visible tumor mass left behind. The group with the remaining tumor mass after surgery showed significantly different gene expression profiles compared to the group with no remaining tumor mass. Differences were noted for the metastasis associated 1 family, member 2 gene (MTA2), the TNF, alpha-catenin, interleukin 1 beta, the KiSS-1 metastasis suppressor and the matrix metalloproteinase 10 genes. All genes were downregulated with a fold-change between 1.15 to 1.57; there were no upregulated genes. Thus, a signature of genes involved in metastasis, invasion and inflammation was found to be significantly downregulated in native unstimulated blood leukocytes from ovarian cancer patients with a poor prognosis. Preoperatively it may serve as a guide to the biology of the tumor and postoperatively in the optimization of adjuvant treatment of ovarian cancer patients.

    Place, publisher, year, edition, pages
    Athens, Greece: Spandidos Publications Ltd., 2012
    Keyword
    Seropapillary ovarian cancer, residual tumor, leukocyte gene expression, whole blood RNA expression
    National Category
    Medical and Health Sciences Cancer and Oncology
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-23093 (URN)10.3892/or.2012.1680 (DOI)000302202600005 ()22322362 (PubMedID)2-s2.0-84858269622 (Scopus ID)
    Note

    Funding Agencies:

    Lions' Cancer Research Foundation 

    Research Committee of Orebro County Council 

    Available from: 2012-05-31 Created: 2012-05-31 Last updated: 2017-12-07Bibliographically approved
    3. Whole genome expression profiling of blood cells in ovarian cancer patients: prognostic impact of the CYP1B1, MTSS1, NCALD, and NOP14 genes
    Open this publication in new window or tab >>Whole genome expression profiling of blood cells in ovarian cancer patients: prognostic impact of the CYP1B1, MTSS1, NCALD, and NOP14 genes
    2014 (English)In: OncoTarget, ISSN 1949-2553, E-ISSN 1949-2553, Vol. 5, no 12, 4040-4049 p.Article in journal (Refereed) Published
    Abstract [en]

    Ovarian cancer patients with different tumor stages and cell differentiation might be distinguished from each other by gene expression profiles in whole blood cell mRNA by the Affymetrix Human Gene 1.0 ST Array. We also examined if there is any association with other clinical variables, response to therapy, and residual tumor burden after surgery. Patients were divided into two groups, one with poor prognosis, advanced stage and poorly differentiated tumors (n = 22), and one group with good prognosis, early stage and well-to medium differentiated tumors (n = 11). Six genes were found to be differentially expressed: the PDIA3, LYAR, NOP14, NCALD and MTSS1 genes were down-regulated and the CYP1B1 gene expression was up-regulated in the poor prognosis group, all with p value <0.05, adjusted for mass comparison. In survival analyses, CYP1B1, MTSS1, NCALD and NOP14 remained significantly different (p<0.05). Patient groups did not differ in any transcript related to acute phase or immune responses. This minimal gene expression signature of prognostic ovarian cancer-related genes opens up an avenue for more practicable monitoring of ovarian cancer patients by simple peripheral blood tests, which may evolve into a tool to guide selection of curative and postoperative supportive therapies.

    Place, publisher, year, edition, pages
    Impact press, 2014
    Keyword
    ovarian cancer, whole genome profiling, prognosis, mRNA, NCALD, MTSS1, PDA3, CYP1B1, NOP14, LYAR
    National Category
    Cancer and Oncology
    Research subject
    Oncology
    Identifiers
    urn:nbn:se:oru:diva-36179 (URN)000339055200007 ()24961659 (PubMedID)2-s2.0-84905090787 (Scopus ID)
    Note

    Funding Agencies:

    Research Committee of Örebro County Council

    Foundation for Gynecological Oncology, Örebro

    Lions' Cancer Research Foundation, Uppsala-Örebro

    Available from: 2014-09-02 Created: 2014-08-28 Last updated: 2017-12-05Bibliographically approved
    4. Tissue zinc levels in a child with hypercalprotectinaemia and hyperzincaemia: a case report and a review of the literature
    Open this publication in new window or tab >>Tissue zinc levels in a child with hypercalprotectinaemia and hyperzincaemia: a case report and a review of the literature
    2012 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 72, no 1, 34-38 p.Article, review/survey (Refereed) Published
    Abstract [en]

    Background: A girl suffering from a rare syndrome of unknown aetiology, termed hypercalprotectinaemia, was evaluated for tissue zinc status, because calprotectin is a protein which chelates Zn at multiple binding-sites, which might have affected the distribution of Zn in her body.

    Methods: Measurement of serum, urine, hair and nail zinc (Zn) concentration, complemented with measurement of total Zn in ultrafiltrates of plasma.

    Results: Her serum Zn concentration was 105-133 mu mol/L. Zn levels in her hair (102 mu g/g), nail (90 mu g/g) and urine (3-12 mu mol/L; 20-80 mu g/dL) were all at the lower end of the reference intervals described in the sparse literature. Zn concentrations in ultrafiltrates of plasma were below the detection limit (<100 nmol/L). Thus, the elevated serum Zn did not translate into a similarly increased level of Zn in any of the tissues tested, nor in free Zn concentrations. Instead it appeared to be a result of Zn being chelated to binder proteins, most probably calprotectin.

    Conclusion: Her grossly elevated serum calprotectin concentration is probably able to raise circulating total Zn concentrations without raising ionized concentrations, but this Zn remains confined to the circulating blood as well as to excreted body fluids, particularly faeces.

    Place, publisher, year, edition, pages
    London, United Kingdom: Informa Healthcare, 2012
    Keyword
    Tissue zinc, zinc excretion, calprotectin, inflammation, growth retardation
    National Category
    Medical Biotechnology Clinical Laboratory Medicine
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-21627 (URN)10.3109/00365513.2011.623177 (DOI)000299283700005 ()22017170 (PubMedID)2-s2.0-84856056036 (Scopus ID)
    Available from: 2012-02-14 Created: 2012-02-14 Last updated: 2017-12-07Bibliographically approved
    5. Whole genome microarray expression analysis in blood leucocytes identifies pathways linked to signs and symptoms of a patient with hypercalprotectinaemia and hyperzincaemia
    Open this publication in new window or tab >>Whole genome microarray expression analysis in blood leucocytes identifies pathways linked to signs and symptoms of a patient with hypercalprotectinaemia and hyperzincaemia
    Show others...
    2017 (English)In: Clinical and Experimental Immunology, ISSN 0009-9104, E-ISSN 1365-2249Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    A child, 2 yr with the "hypercalprotectinemia with hyperzincemia" clinical syndrome presented with atypical symptoms and signs, notably persistent fever of around 38°C, thrombocythaemia of >700 x 10(9) /L, and a predominance of persistent intestinal symptoms. In an effort to find a cure by identifying the dysregulated pathways we analyzed whole-genome mRNA expression by the Affymetrix HG U133 PLUS 2.0 array on three occasions 3 to 5 months apart. Major upregulation was demonstrated for the JAK/STAT pathway including in particular CD177, S100A8, S100A9, and S100A12, accounting for the thrombocytosis; a large number of interleukins, their receptors, and activators, accounting for the febrile apathic state; and the HMBG1 gene, possibly accounting for part of the intestinal symptoms. These results show that gene expression array technology may assist the clinician in the diagnostic workup of individual patients with suspected syndromal states of unknown origin, and the expression data can guide the selection of optimal treatment directed at the identified target pathways.

    Place, publisher, year, edition, pages
    West Sussex, United Kingdom: Wiley-Blackwell Publishing Inc., 2017
    Keyword
    Hyperzincaemia, expression array, fever, hypercalprotectinaemia, thrombocytemia
    National Category
    Medical Genetics
    Identifiers
    urn:nbn:se:oru:diva-61444 (URN)10.1111/cei.13064 (DOI)28984903 (PubMedID)
    Available from: 2017-11-02 Created: 2017-11-02 Last updated: 2017-12-06Bibliographically approved
  • Public defence: 2017-12-15 13:00 Örebro universitet, Campus Grythyttan, Gastronomiska teatern,, Grythyttan
    Wellton, Lotte
    Örebro University, School of Hospitality, Culinary Arts & Meal Science.
    Making Meals in Restaurants: Daily Practices and Professional Ideals2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Thanks to the gastronomic development in recent decades in Sweden, the restaurant industry is growing significantly and has opportunities to attract new and wider groups of labour. However, despite media images of successful chefs and culinary creativity, there is a common perception of tiring working conditions and low wages that prevent restaurants from attracting staff.

    The overall aim of this thesis is to elucidate how professionalism is done and reproduced inside the restaurant industry by means of practice theory and the Five Aspects Meal Model. By an empirically grounded understanding of daily practices in small restaurants the thesis will show and explain how professionalism including leadership, is formed and understood among restaurant practitioners. Additionally by conceptualizing professionalism in restaurant work the thesis will provide a solid basis for the discussion of how knowledge transfer in the restaurant industry can develop. The scientific methods used in two studies were qualitative: interviews with owners/managers/head chefs of small restaurants in a tourist resort and in four major cities in Sweden, and indepth workplace observations including talks with the owners/managers/head chefs and their staff.

    The results show how daily work in restaurants contain conflicting practices, such as timeconsuming workload and slow knowledge growth together with lack of control and planning that collide with expectations of creativity and development. Leadership in restaurant kitchens is dependent on knowledge of materiality and ability to show and guide staff as well as having overview and foresight in the daily work. The results also suggests that professionalism in the industry entails practices of mastering the materiality, observant management and, time use including loyal perseverance. The thesis contributes to an indepth discussion of professionalism in restaurants and the industry’s ability to develop time-use, leadership, and new ways of learning, in order to attract and retain staff.

    List of papers
    1. Restaurant practices: time, planning, knowledge and dreams
    Open this publication in new window or tab >>Restaurant practices: time, planning, knowledge and dreams
    2017 (English)In: Scandinavian Journal of Hospitality and Tourism, ISSN 1502-2250, E-ISSN 1502-2269, Vol. 17, no 3, 297-311 p.Article in journal (Refereed) Published
    Abstract [en]

    This paper contributes to research on restaurant work, which plays an important role in culinary arts research. The aim of this study was to make visible and elucidate the daily work practices in eight small restaurants in a seasonal tourist destination on the Southeast coast of Sweden. The central methods used were observations and participant observations and interviews, along with an e-mail questionnaire and examination of published information concerning all the restaurants. By means of practice theory, three central elements were used to identify and understand the configuration of the activities involved in daily work in small seasonal restaurants. These three elements, knowledge/competence, technologies/materiality and creation of meaning, formed four practices. The practices identified in this study were managing time and seasons; planning, strategising and controlling; knowing and having skills; and dreams and lifestyle. The conclusion of the study indicates that small restaurant practices may be conflicting, as they involve an extremely time-consuming workload, vague planning and lingering knowledge growth in contrast to the ideas of creativity and development that are a part of the restaurant owners’ dreams and lifestyle.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2017
    Keyword
    Small restaurants, practice theory, lifestyle, seasonality, culinary arts
    National Category
    Social Sciences Interdisciplinary Sociology
    Research subject
    Culinary Arts and Meal Science
    Identifiers
    urn:nbn:se:oru:diva-50954 (URN)10.1080/15022250.2016.1176951 (DOI)000404855300005 ()2-s2.0-84974827629 (Scopus ID)
    Note

    Funding Agency:

    Swedish Tourism & Hospitality Industry 

    Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2017-11-17Bibliographically approved
    2. Making Meals in Small Seasonal Restaurants
    Open this publication in new window or tab >>Making Meals in Small Seasonal Restaurants
    2016 (English)In: Journal of Culinary Science & Technology, ISSN 1542-8052, E-ISSN 1542-8044Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    Since restaurateurs can benefit by analyzing the production of meals, particularly with the dominant framework for meal experiences, the five aspects meal model (FAMM), this study examined FAMM’s relevance as an analytical tool for understanding meal production via field observations and interviews in eight small restaurants in a rural destination in Sweden. Results showed that FAMM’s aspect of the management control system and the factor of time are critical to the entire meal production process in restaurants. This article closes with a discussion of FAMM’s usefulness as a qualitative checklist for restaurateurs.

    Place, publisher, year, edition, pages
    Taylor & Francis Group, 2016
    Keyword
    Insider perspective, management control system, the five aspects meal model, time use, tourist destinations
    National Category
    Social Sciences Interdisciplinary
    Research subject
    Culinary Arts and Meal Science
    Identifiers
    urn:nbn:se:oru:diva-53312 (URN)10.1080/15428052.2016.1242445 (DOI)
    Available from: 2016-10-27 Created: 2016-10-27 Last updated: 2017-11-29Bibliographically approved
    3. “Just trained to be a chef, not a leader”: A study of head chef practices
    Open this publication in new window or tab >>“Just trained to be a chef, not a leader”: A study of head chef practices
    2017 (English)In: International Journal of Hospitality & Tourism Administration, ISSN 1525-6480, E-ISSN 1525-6499, 1-23 p.Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    Hierarchical manners and taxing work complicate the picture of the restaurant industry, a sector in great need of personnel. There is little scientific research on daily work in restaurants. Through interviews and observations in restaurant kitchens, three head chef practices were detected: “Master the materiality” is a stipulation for leading kitchens, but does not imply leadership aspirations; “show and guide” is teambuilding through which standards are reinforced by the presence of leaders while allowing coworkers some freedom; and “overview and foresight” involves nonhierarchical supervision by head chefs during service. These practices make sense to head chefs as they enhance product quality and their reputations as professionals. The study points to a horizontal leadership in the restaurant industry and a possible new order for growth and development.

    Place, publisher, year, edition, pages
    Routledge, 2017
    Keyword
    Restaurants; practice theory, “interview to the double”, leadership, craft knowledge
    National Category
    Social Sciences Interdisciplinary
    Research subject
    Culinary Arts and Meal Science
    Identifiers
    urn:nbn:se:oru:diva-62655 (URN)10.1080/15256480.2017.1397584 (DOI)
    Available from: 2017-11-17 Created: 2017-11-17 Last updated: 2017-11-17Bibliographically approved
    4. ‘We are service people and we stay until the job is done’: Enactments of Professionalism in Restaurants and the Role of Workplace Training
    Open this publication in new window or tab >>‘We are service people and we stay until the job is done’: Enactments of Professionalism in Restaurants and the Role of Workplace Training
    (English)Manuscript (preprint) (Other academic)
    National Category
    Social Sciences Interdisciplinary
    Research subject
    Culinary Arts and Meal Science
    Identifiers
    urn:nbn:se:oru:diva-62656 (URN)
    Available from: 2017-11-17 Created: 2017-11-17 Last updated: 2017-11-17Bibliographically approved
  • Public defence: 2018-01-10 09:15 Örebro universitet, Prismahuset, Hörsal 1, Örebro
    Billinger, Stefan
    Örebro University, School of Health Sciences.
    Klassrumsobservationer av elevers användning av implicit inlärd information2018Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2018-01-12 10:00 Örebro universitet, Billbergska huset, Hörsal B, Örebro
    Bjurlid, Filip
    Örebro University, School of Science and Technology.
    Polybrominated dibenzo-p-dioxins and furans: from source of emission to human exposure2018Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2018-01-19 09:00 Örebro universitet, Campus USÖ, hörsal C2, Örebro
    Fengsrud, Espen
    Örebro University, School of Medical Sciences.
    Atrial fibrillation: endoscopic ablation and postoperative studies2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Atrial fibrillation (AF) is associated with an increased risk of stroke, heart failure and cardiovascular death. Initial treatment focuses on rhythm or rate control and anticoagulation after risk assessment. Catheter abla-tion (CA) is an option in highly symptomatic patients but is less effective in long-standing persistent AF(LSPAF). Total endoscopic ablation is an alternative, but its clinical role needs further evaluation. In patients undergoing aortocoronary bypass graft (CABG) surgery, up to 9 % present with preoperative AF. One-third experience postoperative AF, which is associated with increased hospital stay, risk of stroke and decreased long-term survival. The long-term effects on heart rhythm have not been studied.

    Methods and Results: 571 patients undergoing CABG from 1999 to 2000 were followed for six years. Postoperative AF was the strongest independent risk factor for late AF and an age-independent risk factor for late mortality. 615 pa-tients from the same cohort, including patients with preoperative AF, were fol-lowed up at 15 years. Death due to cerebral ischaemia, heart failure and sudden death were most common in the pre- and postoperative AF groups. The presence of pre- or postoperative AF was an independent risk factor for late mortality.

    In our first ten patients, total endoscopic ablation of AF using a right-sided unilateral approach was feasible and safe with acceptable results. 36 patients with symptomatic LSPAF were then randomized to total endoscopic ablation or rate control. Loop recorders were implanted in all patients. In the control group, all patients were in permanent AF for 12 months. In the ablation group, 12/15 patients (80%) were in SR without antiarrhythmic drugs at 12 months. Median freedom of AF at 3–12 months was 95%, and 8/15 (53%) had an AF burden of < 5%. Myocardial function, physical working capacity(PWC) and subjective physical and mental health improved.

    Conclusions: Postoperative AF patients have an eightfold increased risk of future AF and a doubled long-term cardiovascular mortality. Both pre- or post-operative AF in CABG patients is a major risk factor for late cardiovascular morbidity and mortality. Total endoscopic ablation of AF is feasible and safe. In patients with LSPAF, it significantly reduced AF burden at 12 months compared with controls. Myocardial function, PWC and subjective physical and mental health improved.

    List of papers
    1. Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality
    Open this publication in new window or tab >>Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality
    2010 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 37, no 6, 1353-1359 p.Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: This article presents a study of postoperative atrial fibrillation (AF) and its long-term effects on mortality and heart rhythm.

    METHODS: The study cohort consisted of 571 patients with no history of AF who underwent primary aortocoronary bypass surgery from 1999 to 2000. Postoperative AF occurred in 165/571 patients (28.9%). After a median follow-up of 6 years, questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.6% of all patients. Data from hospitalisations due to arrhythmia or stroke during follow-up were analysed. The causes of death were obtained for deceased patients.

    RESULTS: In postoperative AF patients, 25.4% had atrial fibrillation at follow-up compared with 3.6% of patients with no AF at surgery (p<0.001). An episode of postoperative AF was the strongest independent risk factor for development of late AF, with an adjusted risk ratio of 8.31 (95% confidence interval (CI) 4.20-16.43). Mortality was 29.7% (49 deaths/165 patients) in the AF group and 14.8% (60 deaths/406 patients) in the non-AF group (p<0.001). Death due to cerebral ischaemia was more common in the postoperative AF group (4.2% vs 0.2%, p<0.001), as was death due to myocardial infarction (6.7% vs 3.0%, p=0.041). Postoperative AF was an age-independent risk factor for late mortality, with an adjusted hazard ratio of 1.57 (95% CI 1.05-2.34).

    CONCLUSIONS: Postoperative AF patients have an eightfold increased risk of developing AF in the future, and a doubled long-term cardiovascular mortality.

    Keyword
    Atrial fibrillation; Bypass; Surgery; Follow-up studies; Survival
    National Category
    Cardiac and Cardiovascular Systems
    Research subject
    Cardiology
    Identifiers
    urn:nbn:se:oru:diva-35559 (URN)10.1016/j.ejcts.2009.12.033 (DOI)000279086500020 ()20138531 (PubMedID)2-s2.0-77952584268 (Scopus ID)
    Available from: 2014-06-27 Created: 2014-06-27 Last updated: 2017-12-12Bibliographically approved
    2. Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact
    Open this publication in new window or tab >>Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact
    2017 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 51, no 1, 21-27 p.Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To study pre- and postoperative atrial fibrillation and its long-term effects in a cohort of aortocoronary bypass surgery patients.

    Design: Altogether 615 patients undergoing aortocoronary bypass graft surgery in 1999-2000 were studied. Forty-four (7%) had preoperative atrial fibrillation. Postoperative atrial fibrillation occurred in 165/615 patients (27%) while 406/615 patients (66%) had no atrial fibrillation. After a median follow-up of 15 years, symptoms and medication in survivors were recorded, and cause of death in the deceased was obtained.

    Results: Death due to cerebral ischaemia was most common in the pre- and postoperative atrial fibrillation groups (7% and 5%, respectively, v. 2% among those without atrial fibrillation, p = 0.038), as were death due to heart failure (18% and 14%, v. 7%, p = 0.007) and sudden death (9% and 5%, v. 2%, p = 0.029). The presence of pre- or postoperative atrial fibrillation was an independent risk factor for late mortality (hazard ratios 1.47 (1.02-2.12) and 1.28 (1.01-1.63), respectively).

    Conclusions: Patients with pre- or postoperative atrial fibrillation undergoing aortocoronary bypass surgery have increased long-term mortality and risk of cerebral ischemic and cardiovascular death compared with patients in sinus rhythm.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2017
    Keyword
    Atrial fibrillation, bypass surgery, cerebral ischaemia, anticoagulation, survival
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:oru:diva-52180 (URN)10.1080/14017431.2016.1234065 (DOI)000392468400004 ()27615545 (PubMedID)2-s2.0-84988640946 (Scopus ID)
    Note

    Funding Agency:

    Research Committee, Orebro University Hospital  136/04

    Available from: 2016-09-21 Created: 2016-09-14 Last updated: 2017-12-12Bibliographically approved
    3. Total endoscopic ablation of atrial fibrillation
    Open this publication in new window or tab >>Total endoscopic ablation of atrial fibrillation
    2015 (English)In: Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery, ISSN 1813-9175Article in journal (Refereed) Published
    Abstract [en]

    Total endoscopic ablation of atrial fibrillation is a treatment option in symptomatic patients after unsuccessful catheter ablation or when catheter ablation is considered inappropriate. We describe a technique of endoscopic ablation of the left atrium using temperature-controlled unipolar or bipolar radiofrequency. A left atrial box lesion encircling the pulmonary veins is created using three ports in the right hemithorax. The technical aspects and preliminary results of the procedure are discussed.

    Place, publisher, year, edition, pages
    Oxford University Press, 2015
    Keyword
    Ablation; Atrial fibrillation; Endoscopy; Radiofrequency energy
    National Category
    Surgery
    Research subject
    Surgery esp. Thoracic and Cardivascular Surgery
    Identifiers
    urn:nbn:se:oru:diva-50201 (URN)10.1093/mmcts/mmv010 (DOI)26079408 (PubMedID)2-s2.0-84944929578 (Scopus ID)
    Available from: 2016-07-04 Created: 2016-05-04 Last updated: 2017-12-12Bibliographically approved
    4. Total endoscopic ablation of patients with long-standing persistent atrial fibrillation: a randomized controlled study
    Open this publication in new window or tab >>Total endoscopic ablation of patients with long-standing persistent atrial fibrillation: a randomized controlled study
    Show others...
    2016 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 23, no 2, 292-298 p.Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Total endoscopic ablation of atrial fibrillation is an alternative to catheter ablation, but its clinical role needs further evaluation. The aim of this study was to compare total endoscopic ablation with rate control in patients with long-standing persistent atrial fibrillation and to examine the effect of endoscopic ablation on heart rhythm, symptoms, physical working capacity and myocardial function during 1 year of follow-up.

    Methods: In a prospective controlled study, 36 patients aged >50 years with symptomatic long-standing persistent atrial fibrillation were randomized to either total endoscopic ablation (n = 17, after two drop-outs before ablation n = 15) or rate control therapy (n = 19). In the ablation group, a box lesion encircling the pulmonary veins was performed, using temperature-controlled radiofrequency energy. Loop recorders were implanted in all patients. Echocardiography and quality-of-life assessment were performed at 6 and 12 months, and physical working capacity assessment at 6 months.

    Results: There was no mortality or thromboembolic event. In the control group, all patients were in permanent atrial fibrillation during 12 months of follow-up. In the ablation group, the proportion of patients in sinus rhythm without antiarrhythmic drugs was 12/15 (80%) at 12 months. The median freedom of atrial fibrillation at 3-12 months was 95% in the ablation group and the proportion of patients with an atrial fibrillation burden of <5% at 3-12 months was 8/15 (53%). The left ventricular ejection fraction increased during follow-up in the ablation group compared with the control group (from 53.7 ± 8.6 to 58.8 ± 6.5%, P = 0.003), combined with a reduction in the left atrial area (from 29.2 ± 5.5 to 27.2 ± 6.3 cm(2), P = 0.002). The physical working capacity increased in the ablation group compared with the control group (from 94 ± 21.4 to 102.9 ± 14.4%, P = 0.011). The subjective physical and mental capacity scale also improved during follow-up in the ablation group, but not in the control group (P =0.003 and 0.018, respectively).

    Conclusions: Total endoscopic ablation in patients with long-standing persistent atrial fibrillation significantly reduced atrial fibrillation burden 12 months after intervention compared with controls. The left ventricular function, physical working capacity and subjective physical and mental health were improved. These results need to be confirmed in larger randomized trials.

    Place, publisher, year, edition, pages
    Oxford, United Kingdom: Oxford University Press, 2016
    Keyword
    Atrial fibrillation, ablation, endoscopy, randomized trial, implantable loop recorder
    National Category
    Surgery Cardiac and Cardiovascular Systems
    Research subject
    Surgery esp. Thoracic and Cardivascular Surgery; Cardiology
    Identifiers
    urn:nbn:se:oru:diva-50200 (URN)10.1093/icvts/ivw088 (DOI)000383248800021 ()27068249 (PubMedID)2-s2.0-84981165123 (Scopus ID)
    Note

    Funding Agency:

    Research Committee of Örebro University Hospital

    Available from: 2016-07-04 Created: 2016-05-04 Last updated: 2017-12-12Bibliographically approved
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