To Örebro University

oru.seÖrebro University Publications
Change search
Refine search result
12 1 - 50 of 66
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Agvald, Per
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Adding, L. Christofer
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Kristofer F.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Lars E.
    Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
    Linnarsson, Dag
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Increased expired NO and roles of CO2 and endogenous NO after venous gas embolism in rabbits2006In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 97, no 2, p. 210-215Article in journal (Refereed)
    Abstract [en]

    Venous gas embolism (VGE) is a feared complication in diving, aviation, surgery and trauma. We hypothesized that air emboli in the lung circulation might change expired nitric oxide (FeNO). A single intravenous infusion of air was given (100 mul kg(-1)) to three groups of anaesthetized mechanically ventilated rabbits: (A) one with intact NO production, (B) one with intact NO production and where end-tidal CO(2) was controlled, and (C) one with endogenous NO synthesis blockade (L: -NAME, 30 mg kg(-1)). Air infusions resulted in increased FeNO of the control group from 20 (4) [mean (SD)] ppb to a peak value of 39 (4) ppb within 5 min (P < 0.05), and FeNO was still significantly elevated [27 (2) ppb] after 20 min (P < 0.05). Parallel to the NO increase there were significant decreases in end-tidal CO(2 )(ETCO(2)) and mean arterial pressure and an increase in insufflation pressure. In group B, when CO(2) was supplemented after air infusion, NO was suppressed (P = 0.033), but was still significantly elevated compared with pre-infusion control (P < 0.05). In group C, all animals died within 40 min of air infusion whereas all animals in the other groups were still alive at this time point. We conclude that venous air embolization increases FeNO, and that a part of this effect is due to the concomitant decrease in ETCO(2). Furthermore, an intact NO production may be critical for the tolerance to VGE. Finally, FeNO might have a potential in the diagnosis and monitoring of pulmonary gas embolism.

  • 2.
    Coccolini, Federico
    et al.
    General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
    Ceresoli, Marco
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Sadeghi, Mitra
    Department of Vascular Surgery, Västmanlands Hospital Västerås, Västerås, Sweden; Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Toivola, Asko
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Skoog, Per
    Department of Hybrid and Interventional Surgery, Unit of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Idoguchi, Koji
    Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano, Japan.
    Kon, Yuri
    Emergency and Critical Care Center, Hachinohe City Hospital, Hachinohe, Japan.
    Ishida, Tokiya
    Emergency and Critical Care Center, Ohta Nishinouchi Hospital, Koriyama, Japan.
    Matsumura, Yosuke
    Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; R Adams Cowley Shock Trauma Center, University of Maryland, College Park, MD, USA.
    Matsumoto, Junichi
    Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
    Reva, Viktor
    Department of War Surgery, Kirov Military Medical Academy, Saint Petersburg, Russia; Dzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russia.
    Maszkowski, Mariusz
    Department of Vascular Surgery, Västmanlands Hospital Västerås, Västerås, Sweden; Örebro University, Örebro, Sweden.
    Fugazzola, Paola
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Tomasoni, Matteo
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Cicuttin, Enrico
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Ansaloni, Luca
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Zaghi, Claudia
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Sibilla, Maria Grazia
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Cremonini, Camilla
    General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
    Bersztel, Adam
    Department of Vascular Surgery, Västmanlands Hospital Västerås, Västerås, Sweden; Örebro University, Örebro, Sweden.
    Caragounis, Eva-Corina
    Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Falkenberg, Mårten
    Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Handolin, Lauri
    Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
    Oosthuizen, George
    Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, University of KwaZulu-Natal College of Health Sciences, KwaZulu-Natal, Pietermaritzburg, South Africa.
    Szarka, Endre
    Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Manchev, Vassil
    Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, University of KwaZulu-Natal College of Health Sciences, KwaZulu-Natal, Pietermaritzburg, South Africa.
    Wannatoop, Tongporn
    Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Chang, Sung Wook
    Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea.
    Kessel, Boris
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Hebron, Dan
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Shaked, Gad
    Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel.
    Bala, Miklosh
    Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
    Ordoñez, Carlos A.
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili and Universidad Del Valle, Cali, Colombia.
    Hibert-Carius, Peter
    Department of Anesthesiology, Emergency and Intensive Care Medicine, Bergmannstrost Hospital Halle, Halle, Germany.
    Chiarugi, Massimo
    General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gamberini, Emiliano
    ICU Department Bufalini Hospital, Cesena, Italy.
    Agnoletti, Vanni
    ICU Department Bufalini Hospital, Cesena, Italy.
    Catena, Fausto
    Emergency Surgery Department, Parma University Hospital, Parma, Italy.
    Hörer, Tal M.
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry2020In: Updates in surgery, ISSN 2038-3312, Vol. 72, no 2, p. 527-536Article in journal (Refereed)
    Abstract [en]

    EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24 h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24 h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications.

  • 3.
    Dogan, Emanuel M.
    et al.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Jauring, Oskar
    Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Edström, Måns
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anesthesiology and Intensive Care.
    Intra-aortic and intra-caval balloon pump devices in experimental cardiac arrestManuscript (preprint) (Other academic)
  • 4.
    Dogan, Emanuel M.
    et al.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, SE-701 85, Örebro, Sweden. emanuel.dogan@regionorebrolan.se.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Jauring, Oskar
    Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, SE-701 85, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Edström, Måns
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anesthesiology and Intensive Care.
    Intra-aortic and Intra-caval Balloon Pump Devices in Experimental Non-traumatic Cardiac Arrest and Cardiopulmonary Resuscitation2023In: Journal of Cardiovascular Translational Research, ISSN 1937-5387, E-ISSN 1937-5395, Vol. 16, no 4, p. 948-955Article in journal (Refereed)
    Abstract [en]

    Intra-aortic balloon pump (IABP) use during CPR has been scarcely studied. Intra-caval balloon pump (ICBP) may decrease backward venous flow during CPR. Mechanical chest compressions (MCC) were initiated after 10 min of cardiac arrest in anesthetized pigs. After 5 min of MCC, IABP (n = 6) or ICBP (n = 6) was initiated. The MCC device and the IABP/ICBP had slightly different frequencies, inducing a progressive peak pressure phase shift. IABP inflation 0.15 s before MCC significantly increased mean arterial pressure (MAP) and carotid blood flow (CBF) compared to inflation 0.10 s after MCC and to MCC only. Coronary perfusion pressure significantly increased with IABP inflation 0.25 s before MCC compared to inflation at MCC. ICBP inflation before MCC significantly increased MAP and CBF compared to inflation after MCC but not compared to MCC only. This shows the potential of IABP in CPR when optimally synchronized with MCC. The effect of timing of intra-aortic balloon pump (IABP) inflation during mechanical chest compressions (MCC) on hemodynamics. Data from12 anesthetized pigs.

  • 5.
    Dogan, Emanuel M.
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Beskow, Linus
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences.
    Resuscitative Endovascular Balloon Occlusion of the Aorta in Experimental Cardiopulmonary Resuscitation: Aortic Occlusion Level Matters2019In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 52, no 1, p. 67-74Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Aortic occlusion during cardiopulmonary resuscitation (CPR) increases systemic arterial pressures. Correct thoracic placement during the resuscitative endovascular balloon occlusion of the aorta (REBOA) may be important for achieving effective CPR.

    HYPOTHESIS: The positioning of the REBOA in the thoracic aorta during CPR will affect systemic arterial pressures.

    METHODS: Cardiac arrest was induced in 27 anesthetized pigs. After 7 min of CPR with a mechanical compression device, REBOA in the thoracic descending aorta at heart level (zone Ib, REBOA-Ib, n = 9), at diaphragmatic level (zone Ic, REBOA-Ic, n = 9) or no occlusion (control, n = 9) was initiated. The primary outcome was systemic arterial pressures during CPR.

    RESULTS: During CPR, REBOA-Ic increased systolic blood pressure from 86 mmHg (confidence interval [CI] 71-101) to 128 mmHg (CI 107-150, P < 0.001). Simultaneously, mean and diastolic blood pressures increased significantly in REBOA-Ic (P < 0.001 and P = 0.006, respectively), and were higher than in REBOA-Ib (P = 0.04 and P = 0.02, respectively) and control (P = 0.005 and P = 0.003, respectively). REBOA-Ib did not significantly affect systemic blood pressures. Arterial pH decreased more in control than in REBOA-Ib and REBOA-Ic after occlusion (P = 0.004 and P = 0.005, respectively). Arterial lactate concentrations were lower in REBOA-Ic compared with control and REBOA-Ib (P = 0.04 and P < 0.001, respectively).

    CONCLUSIONS: Thoracic aortic occlusion in zone Ic during CPR may be more effective in increasing systemic arterial pressures than occlusion in zone Ib. REBOA during CPR was found to be associated with a more favorable acid-base status of circulating blood. If REBOA is used as an adjunct in CPR, it may be of importance to carefully determine the aortic occlusion level.The study was performed following approval of the Regional Animal Ethics Committee in Linköping, Sweden (application ID 418).

  • 6.
    Dogan, Emanuel M.
    et al.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Edström, Måns
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Martell, Erika A.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sandblom, Isabelle
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Marttala, Jens
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Krantz, Johannes
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences.
    Resuscitative endovascular balloon occlusion of the aorta in zone I versus zone III in a porcine model of non-traumatic cardiac arrest and cardiopulmonary resuscitation: A randomized study2020In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 151, p. 150-156Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) in zone I increases systemic blood pressure during cardiopulmonary resuscitation (CPR), while also obstructing the blood flow to distal organs. The aim of the study was to compare the effects on systemic blood pressure and visceral blood flow of REBOA-III (zone III, infrarenal) and REBOA-I (zone I, supraceliac) during non-traumatic cardiac arrest and CPR.

    METHODS: Cardiac arrest was induced in 61 anesthetized pigs. Thirty-two pigs were allocated to a hemodynamic study group where the primary outcomes were systemic arterial pressures and 29 pigs were allocated to a blood flow study group where the primary outcomes were superior mesenteric arterial (SMA) and internal carotid arterial (ICA) blood flow. After 7-8minutes of CPR with a mechanical compression device, REBOA-I, REBOA-III or no aortic occlusion (control group) were initiated after randomization.

    RESULTS: Systemic mean and diastolic arterial pressures were statistically higher during CPR with REBOA-I compared to REBOA-III (50mmHg and 16mmHg in REBOA-I vs 38mmHg and 1mmHg in REBOA-III). Systemic systolic, mean and diastolic arterial pressures were statistically elevated during CPR in the REBOA-I group compared to the controls. The SMA blood flow increased by 49% in REBOA-III but dropped to the levels of the controls within minutes. The ICA blood flow increased the most in REBOA-I compared to REBOA-III and the control group (54%, 19% and 0%, respectively).

    CONCLUSION: In experimental non-traumatic cardiac arrest and CPR, REBOA-I increased systemic blood pressures more than REBOA-III, and the potential enhancement of visceral organ blood flow by REBOA-III was short-lived.

  • 7.
    Duchesne, Juan
    et al.
    Tulane University School of Medicine, New Orleans, Louisiana, USA .
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic & Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic & Vascular Surgery.
    DuBose, Joseph
    R. Adams Cowley Shock Trauma, Baltimore Maryland, USA.
    Rasmusse, Todd E.
    Uniformed Services University of the Health Sciences, Bethesda Maryland, USA.
    Brenner, Megan
    Riverside University Health System, Riverside California, USA.
    Jacome, Tomas
    Our Lady of the Lake Regional Medical Center, Baton Rouge Louisiana, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic & Vascular Surgery.
    Tatum, Danielle
    Our Lady of the Lake Regional Medical Center, Baton Rouge Louisiana, USA.
    To Ultrasound or not to Ultrasound: A REBOA Femoral Access Analysis from the ABOTrauma and AORTA Registries2020In: Journal of endovascular resuscitation and trauma management, ISSN 2002-7567, Vol. 4, no 2, p. 80-87Article in journal (Refereed)
    Abstract [en]

    Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized adjunct in the management of non-compressible hemorrhage. Ultrasound (US)-guided femoral access has been taught as the best practice for femoral artery cannulation. However, there is a lack of evidence to support its use in patients in extremis with severe hemorrhage. We hypothesize that no differences in outcome will exist between US-guided and to blind percutaneous or cutdown access methods.

    Methods: This was an international, multicenter retrospective review of all patients managed with REBOA from the ABOTrauma Registry and the AORTA database. REBOA characteristics and outcomes were compared among puncture access methods. Significance was set at P < 0.05.

    Results: The cohort included 523 patients, primarily male (74%), blunt injured (77%), with median age 40 (27-58), and an Injury Severity Score of 34 (25-45). Percutaneous using external landmarks/palpation was the most common femoral puncture method (53%) used followed by US-guided (27.9%). There was no significant difference in overall complication rates (37.4% vs 34.9%; P = 0.615) or mortality (47.8% vs 50.3%; P = 0.599) between percutaneous and US-guided methods; however, access by cutdown was significantly associated with emergency department (ED) mortality (P = 0.004), 24 hour mortality (P = 0.002), and in-hospital mortality (P = 0.007).

    Conclusions: In patients with severe hemorrhage in need of REBOA placement, the percutaneous approach using anatomic landmarks and palpation, when compared with US-guided femoral access, was used more frequently without an increase in complications, access attempts, or mortality.

  • 8.
    Duchesne, Juan
    et al.
    Riverside University Health System, Riverside, California, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic & Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic & Vascular Surgery.
    DuBose, Joseph
    R. Adams Cowley Shock Trauma, Baltimore, Maryland, USA.
    Rasmussen, Todd E.
    Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
    Brenner, Megan
    Riverside University Health System, Riverside, California, USA.
    Jacome, Tomas
    Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic & Vascular Surgery.
    Tatum, Danielle
    Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA.
    Delta Systolic Blood Pressure (SBP) Can be a Stronger Predictor of Mortality Than Pre-Aortic Occlusion SBP in Non-Compressible Torso Hemorrhage: an Abotrauma and AORTA Analysis2021In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 56, no 1S, p. 30-36Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized adjunct for the management in patients with severe non-compressible torso hemorrhage (NCTH). Although guidelines have been developed to help with the best indications for REBOA utilization, no studies have addressed the significance of change in systolic blood pressure (ΔSBP) after REBOA insufflation. We hypothesized that ΔSBP would predict mortality in patients with NCTH and have utility as a surrogate marker for hemorrhage status.

    STUDY DESIGN: This was an international, multicenter retrospective review of all patients managed with REBOA from the ABOTrauma Registry and the AORTA database. ΔSBP was defined as the difference between pre- and post-REBOA insertion SBP. Based on post-insertion SBP, patient hemorrhage status was categorized as responder or non-responder. A non-responder was defined as a hypotensive patient with systolic blood pressure (SBP) < 90 mmHg after REBOA placement with full aortic occlusion. Significance was set at P < 0.05.

    RESULTS: A total of 524 patients with NCTH were included. Most (74%) were male, 77% blunt injured with a median (IQR) age of 40 (27 - 58) years and ISS 34 (25 - 45). Overall mortality was 51.0%. 20% of patients were classified as non-responders. Demographic and injury descriptors did not differ between groups. Mortality was significantly higher in non-responders vs responders (64% vs 46%, respectively; P = 0.001). Non-responders had lower median pre-insertion SBP (50mmHg vs 67mmHg; P < 0.001) and lower ΔSBP (20mmHg vs 48mmHg; P < 0.001).

    CONCLUSION: REBOA non-responders present and remain persistently hypotensive and are more likely to die than responders, indicating a potential direct correlation between ΔSBP as a surrogate marker of hemorrhage volume status and mortality. Future prospective studies will need to further elucidate the impact of Damage Control Resuscitation efforts on ΔSBP and mortality.

  • 9.
    Duchesne, Juan
    et al.
    Tulane Univiversity, New Orleans LA, USA.
    McGreevy, David
    Örebro University, School of Medical Sciences.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Brenner, Megan
    University of California Riverside, Riverside CA, USA.
    Rasmussen, Todd
    Uniformed Services University, Bethesda MD, USA.
    DuBose, Joseph
    University of Maryland, Baltimore MD, USA.
    Tatum, Danielle
    Our Lady Lake RMC, Baton Rouge LA, USA.
    IMPACT OF INTERMITTENT REBOA USE ON ISCHEMIA REPERFUSION INJURY: A TRANSLATIONAL ANALYSIS2020In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 53, no Suppl. 1, p. 24-24Article in journal (Other academic)
  • 10.
    Duchesne, Juan
    et al.
    Tulane Univiversity, New Orleans LA, USA.
    Tatum, Danielle
    Our Lady Lake RMC, Baton Rouge LA, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences.
    McGreevy, David
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    DuBose, Joseph
    R Adams Cowley Shock Trauma, Baltimore MD, USA.
    Brenner, Megan
    University of California, Riverside, Riverside CA, USA.
    IMPACT OF DELTA SYSTOLIC BLOOD PRESSURE AFTER REBOA PLACEMENT IN NON-COMPRESSIBLE TORSO HEMORRHAGE PATIENTS: AN ABOTRAUMA REGISTRY ANALYSIS2019In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 51, no 6, p. 159-159Article in journal (Other academic)
  • 11.
    Grenegård, Magnus
    et al.
    Örebro University, School of Medical Sciences.
    Koufaki, Maria
    Institute of Chemical Biology, National Hellenic Research Foundation, Athens, Greece.
    Zervou, Maria
    Institute of Chemical Biology, National Hellenic Research Foundation, Athens, Greece.
    Fotopoulou, Theano
    Institute of Chemical Biology, National Hellenic Research Foundation, Athens, Greece.
    Lindström, Eva
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Lindkvist, Madelene
    Örebro University, School of Medical Sciences.
    Fransén, Karin
    Örebro University, School of Medical Sciences.
    The cardioprotective, anti-inflammatory and antithrombotic piperazinyl-purine analogue MK177 is a bifunctional drug with promising therapeutic potential2023In: British Journal of Pharmacology, ISSN 0007-1188, E-ISSN 1476-5381, Vol. 180, no Suppl. 1, p. 158-159, article id P0855Article in journal (Other academic)
    Abstract [en]

    Introduction: Nitrate ester bearing 6-piperazinyl-purine analogues (denoted MK drugs) are cardioprotective in infarction animal models and act as inhibitors of Janus kinase (JAK) and Rho-associated kinase (ROCK) [1-3]. Despite the presence of nitrate ester moiety, the MK drugs do not release nitric oxide (NO).

    Methods: We utilized organic chemistry platforms to design a dinitrate ester derivative denoted MK177, cell-free and cellular assays to elucidate antithrom-botic and anti-ischemic mechanisms. Furthermore, we also used tissue models to analyze vasodilation, and animal models to evaluate drug activities in vivo.

    Results: In anesthetized pigs, intravenous infusion of MK177 produced“nitroglycerin-like”effects on vital parameters. Analysis of exhaled air confirmed release of NO. MK177 caused concentration-dependent relaxation of iliac arteries (87±6.8 % relaxation of precontracted arteries, mean value ±SD, n=5) and this effect was mediated by activation of the NO/cyclic GMP signaling pathway. It is noteworthy that other mononitrate or non-nitrate MKs did not cause NO-induced vasodilation. In cellular model systems, MK177 evoked antithrombotic effects by targeting ROCK in a NO-independent manner. Specifically, MK177 inhibited platelet aggregation induced by collagen (72±12.6 % inhibition of aggregation, mean value±SD, n=7). Western blot analyses confirmed that MK177 reduced ROCK-dependent phosphorylation of myosin phosphatase sub-unit (MYPT-1) in platelets. Finally, kinase screening assay revealed that MK177 concentration-dependently inhibited ROCK and JAK (Kd values around 5μM).

    Conclusion: We have developed a bifunctional drug molecule, MK177, that acts by NO-dependent and NO-independent mechanisms. MK 177 induced car-diovascular NO effects in vivo and relaxed vessels in vitro. MK177 also prevented blood platelet activation via NO-independent ROCK inhibition. The bifunctional nature of MK177 can be of significance in future management of thrombotic and ischemic disease. Collectively, the novel cardio-protective and bifunctional drug MK177 has promising therapeutic potential.

    References:

    1. Koufaki M, Fotopoulou T, Iliodromitis EK, Bibli SI, Zoga A, Kremastinos DT, Andreadou I. Discovery of 6-[4-(6-nitroxyhexanoyl)(piperazin-1-yl)]-9H-purine, as pharmacological post-conditioning agent. Bioorg Med Chem. 2012;20(19):5948-5956. https://doi.org/10.1016/j.bmc.2012.07.037

    2. Kardeby C, Paramel GV, Pournara D, Fotopoulou T, Sirsjö A, Koufaki M, Fransén K, Grenegård M. A novel purine analogue bearing nitrate ester prevents platelet activation by ROCK activity inhibition. Eur J Pharmacol. 2019;15(857):172428-172434. https://doi.org/10.1016/j.ejphar.2019.172428

    3. Paramel GV, Lindkvist M, Idosa BA, Sebina LS, Kardeby C, Fotopoulou T, Pournara D, Kritsi E, Ifanti E, Zervou M, Koufaki M, Grenegård M, Fransén K. Novel purine analogues regulate IL-1βrelease via inhibition of JAK activity in human aortic smooth muscle cells. Eur J Pharmacol. 2022;15(929):175128-175135. https://doi.org/10.1016/j.ejphar.2022.175128

  • 12.
    Guan, Na N.
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Kristofer F.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Wiklund, Peter N.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Lars E.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Release and inhibitory effects of prostaglandin D2 in guinea pig urinary bladder and the role of urothelium2014In: Biochimica et Biophysica Acta, ISSN 0006-3002, E-ISSN 1878-2434, Vol. 1840, no 12, p. 3443-3451Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While studying a urothelium-derived inhibitory factor in guinea pig urinary bladders we observed considerable release of prostanoids, including PGD2-like activity. The present study was carried out to identify the prostanoids and to study their roles in modulating guinea pig urinary bladder motility.

    METHODS: Release of PGE2 and PGD2 in isolated guinea pig urinary bladder preparations was analyzed by high performance liquid chromatography (HPLC) combined with bioassay on bladder strips. Isolated urothelium-intact (UI) or -denuded (UD) bladder strips were subjected to electrical field stimulation (EFS) and applications of PGE2 and PGD2.

    RESULTS: A resting release of 95±9 (n=5) nggtissue(-1)h(-1) PGE2-like activity and 210±34 (n=4) nggtissue(-1)h(-1) PGD2-like activity was found, where PGD2-like was subject to marked spontaneous inactivation during isolation. Prostanoids release was decreased by 70-90% by the cyclo-oxygenase inhibitor diclofenac in UI preparations. Urothelium removal decreased prostanoids release by more than 90%. PGE2 increased basal tone and spontaneous contractions, whereas PGD2 had little or no effect on these. Exogenous PGE2 enhanced and PGD2 inhibited contractile responses to EFS, exogenous acetylcholine- and ATP, whereas PGD2 caused marked dose-dependent inhibition. PGE2 and PGD2 effects were more pronounced in diclofenac-treated UD tissues.

    CONCLUSIONS: PGD2 and PGE2 are released from guinea pig bladder urothelium and PGD2 has inhibitory effects on bladder motility, mainly through a postjunctional action on smooth muscle responsiveness.

    GENERAL SIGNIFICANCE: The release and inhibitory effects merit further studies in relation to normal biological function as well as overactive bladder syndrome.

  • 13.
    Hurtsen, Anna Stene
    et al.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Centre for Clinical Research and Education, Karlstad Central Hospital, Karlstad, Sweden.
    Nilsson, Ilya Zorikhin
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Dogan, Emanuel M.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    A Comparative Study of Inhaled Nitric Oxide and an Intravenously Administered Nitric Oxide Donor in Acute Pulmonary Hypertension2020In: Drug Design, Development and Therapy, E-ISSN 1177-8881, Vol. 14, p. 635-644Article in journal (Refereed)
    Abstract [en]

    Purpose: Inhaled nitric oxide (iNO) selectively vasodilates the pulmonary circulation but the effects are sometimes insufficient. Available intravenous (iv) substances are non-selective and cause systemic side effects. The pulmonary and systemic effects of iNO and an iv mono-organic nitrite (PDNO) were compared in porcine models of acute pulmonary hypertension.

    Methods: In anesthetized piglets, dose-response experiments of iv PDNO at normal pulmonary arterial pressure (n=10) were executed. Dose-response experiments of iv PDNO (n=6) and iNO (n=7) were performed during pharmacologically induced pulmonary hypertension (U46619 iv). The effects of iv PDNO and iNO were also explored in 5 mins of hypoxia-induced increase in pulmonary pressure (n=2-4).

    Results: PDNO (15, 30, 45 and 60 nmol NO kg(-1) min(-)(1) iv) and iNO (5, 10, 20 and 40 ppm which corresponded to 56, 112, 227, 449 nmol NO kg(-1) min(-)(1), respectively) significantly decreased the U46619-increased mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance (PVR) to a similar degree without significant decreases in mean arterial pressure (MAP) or systemic vascular resistance (SVR). iNO caused increased levels of methemoglobin. At an equivalent delivered NO quantity (iNO 5 ppm and PDNO 45 nmol kg(-1) min(-)(1) iv), PDNO decreased PVR and SVR significantly more than iNO. Both drugs counteracted hypoxia-induced pulmonary vasoconstriction and they decreased the ratio of PVR and SVR in both settings.

    Conclusion: Intravenous PDNO was a more potent pulmonary vasodilator than iNO in pulmonary hypertension, with no severe side effects. Hence, this study supports the potential of iv PDNO in the treatment of acute pulmonary hypertension.

  • 14.
    Hurtsén, Anna Stene
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Centre for Clinical Research and Education, County Council of Värmland, Karlstad, Sweden.
    McGreevy, David T.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Karlsson, Christina
    Örebro University, School of Health Sciences.
    Frostell, Claes G.
    Anesthesiology and Intensive Care, Department of Clinical Sciences, Karolinska Institute at Danderyd Hospital, Stockholm, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    A randomized porcine study of hemorrhagic shock comparing end-tidal carbon dioxide targeted and proximal systolic blood pressure targeted partial resuscitative endovascular balloon occlusion of the aorta in the mitigation of metabolic injury2023In: Intensive Care Medicine Experimental, E-ISSN 2197-425X, Vol. 11, no 1, article id 18Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The definition of partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) is not yet determined and clinical markers of the degree of occlusion, metabolic effects and end-organ injury that are clinically monitored in real time are lacking. The aim of the study was to test the hypothesis that end-tidal carbon dioxide (ETCO2) targeted pREBOA causes less metabolic disturbance compared to proximal systolic blood pressure (SBP) targeted pREBOA in a porcine model of hemorrhagic shock.

    MATERIALS AND METHODS: Twenty anesthetized pigs (26-35 kg) were randomized to 45 min of either ETCO2 targeted pREBOA (pREBOAETCO2, ETCO2 90-110% of values before start of occlusion, n = 10) or proximal SBP targeted pREBOA (pREBOASBP, SBP 80-100 mmHg, n = 10), during controlled grade IV hemorrhagic shock. Autotransfusion and reperfusion over 3 h followed. Hemodynamic and respiratory parameters, blood samples and jejunal specimens were analyzed.

    RESULTS: ETCO2 was significantly higher in the pREBOAETCO2 group during the occlusion compared to the pREBOASBP group, whereas SBP, femoral arterial mean pressure and abdominal aortic blood flow were similar. During reperfusion, arterial and mesenteric lactate, plasma creatinine and plasma troponin concentrations were higher in the pREBOASBP group.

    CONCLUSIONS: In a porcine model of hemorrhagic shock, ETCO2 targeted pREBOA caused less metabolic disturbance and end-organ damage compared to proximal SBP targeted pREBOA, with no disadvantageous hemodynamic impact. End-tidal CO2 should be investigated in clinical studies as a complementary clinical tool for mitigating ischemic-reperfusion injury when using pREBOA.

  • 15.
    Hörer, Tal M.
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Cajander, Per
    Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Health, Örebro University Hospital and Örebro University, Örebro, Sweden.
    Jans, Anders
    Department of Surgery, Karlskoga Hospital, Karlskoga, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    A case of partial aortic balloon occlusion in an unstable multi-trauma patient2016In: Trauma, ISSN 1460-4086, E-ISSN 1477-0350, Vol. 18, no 2, p. 150-154Article in journal (Refereed)
    Abstract [en]

    The usage of aortic balloon occlusion or resuscitative endovascular balloon occlusion of the aorta in trauma management for bleeding control is increasing rapidly as an alternative to thoracotomy and aortic clamping. Little is known about the effects of partial occlusion of the aorta as a bridge to definitive treatment, but one of its advantages may be limited visceral organ ischemia. We describe the first known case of partial aortic balloon occlusion in trauma for reaching a targeted systolic blood pressure, which was used as an adjunctive tool in trauma management and as a bridge to definitive treatment.

  • 16.
    Hörer, Tal M.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Skoog, Per
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Oikonomakis, Ioannis
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Norgren, Lars
    Örebro University, School of Health and Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Jansson, Kjell
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Intraperitoneal Metabolic Consequences of Supraceliac Aortic Balloon Occlusion in an Experimental Animal Study Using Microdialysis2014In: Annals of Vascular Surgery, ISSN 0890-5096, E-ISSN 1615-5947, Vol. 28, no 5, p. 1286-1295Article in journal (Refereed)
    Abstract [en]

    Background: To investigate the effects of supraceliac aortic balloon occlusion (ABO) and superior mesenteric artery (SMA) occlusion on abdominal visceral metabolism in an animal model using intraperitoneal microdialysis (IPM) and laser Doppler flowmetry.

    Methods: A total of 9 pigs were subjected to ABO and 7 animals were subjected to SMA occlusion for 1 hour followed by 3 hours of reperfusion. Seven animals served as controls. Hemodynamic data, arterial blood samples, urinary output, and intestinal mucosal blood flow (IBF) were followed hourly. Intraperitoneal (i.p) glucose, glycerol, lactate, and pyruvate concentrations and lactate-to-pyruvate (lip) ratio were measured using IPM.

    Results: Compared with the baseline, ABO reduced IBF by 76% and decreased urinary output. SMA occlusion reduced IBF by 75% without affecting urinary output. ABO increased the i.p lip ratio from 18 at baseline, peaking at 46 in early reperfusion. SMA occlusion and reperfusion tended to increase the i.p lip ratio, peaking at 36 in early reperfusion. ABO increased the i.p glycerol concentration from 87 mu M at baseline to 579 p,M after 3 hours of reperfusion. SMA occlusion and reperfusion increased The i.p glycerol concentration but to a lesser degree.

    Conclusions: Supraceliac ABO caused severe hemodynamic, renal, and systemic metabolic disturbances compared with SMA occlusion, most likely because of the more extensive ischemia-reperfusion injury. The intra-abdominal metabolism, measured by microdialysis, was affected by both ABO and SMA occlusion but the most severe disturbances were caused by ABO. The i.p lip ratios and the glycerol concentrations increased during ischemia and reperfusion and may serve as markers of these events and indicate anaerobic metabolism and cell damages respectively.

  • 17.
    Hörer, Tal M.
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Skoog, Per
    Örebro University, School of Health Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review2016In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 42, no 5, p. 585-592Article, review/survey (Refereed)
    Abstract [en]

    EndoVascular and Hybrid Trauma Management (EVTM) is an emerging concept for the early treatment of trauma patients using aortic balloon occlusion (ABO), embolization agents and stent grafts to stop ongoing traumatic bleeding. These techniques have previously been implemented successfully in the treatment of ruptured aortic aneurysm.

    We describe our very recent experience of EVTM using ABO in bleeding patients and lessons learned over the last 20 years from the endovascular treatment of ruptured abdominal aortic aneurysms (rAAA). We also briefly describe current knowledge of ABO usage in trauma.

    A small series of educational cases in our hospital is described, where endovascular techniques were used to gain temporary hemorrhage control. The methods used for rAAA and their applicability to EVTM with a multidisciplinary approach are presented.

    Establishing femoral arterial access immediately on arrival at the emergency room and use of an angiography table in the surgical suite may facilitate EVTM at an early stage. ABO may be an effective method for the temporary stabilization of severely hemodynamically unstable patients with hemorrhagic shock, and may be useful as a bridge to definitive treatment of the bleeding patients.

    EVTM, including the usage of ABO, can be initiated on patient arrival and is feasible. Further data need to be collected to investigate proper indications for ABO, best clinical usage, results and potential complications. Accordingly, the ABOTrauma Registry has recently been set up. Existing experiences of EVTM and lessons from the endovascular treatment of rAAA may be useful in trauma management.

  • 18.
    Hörer, Tal M.
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Skoog, Per
    Örebro University, School of Health Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Quell, Robin
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Souza, Domingos R.
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    No-touch technique for radiocephalic arteriovenous fistula - surgical technique and preliminary results2016In: Journal of Vascular Access, ISSN 1129-7298, E-ISSN 1724-6032, Vol. 17, no 1, p. 6-12Article in journal (Refereed)
    Abstract [en]

    Purpose: The radiocephalic arteriovenous fistula (RC-AVF) has significant failure rates due to occlusions and failure to mature. The size and quality of the veins are considerable limiting factors for the procedure. The aim of this pilot study was to describe the No-Touch technique (NTT) to create RC-AVF and present the results up to 1 year of follow-up.

    Methods: Thirty-one consecutive patients who were referred for surgery for a RC-AVF were included (17 men, mean age 63 years, range 35-84) and operated by NTT where the vein and artery were dissected with a tissue cushion around it. Twenty-two patients had small veins or arteries (<= 2 mm), 12 patients had a small cephalic vein (<= 2 mm), and the mean distal cephalic vein diameter was 2.4 mm (range 1.0-4.1 mm).

    Results: Technical surgical success and immediate patency were obtained in all patients. Clinical success was achieved in 23 of the 27 (85%) patients who required hemodialysis. The proportion of primary patency at 30 days and 6 months was 84% and 64%, respectively. Secondary patency at 30 days and 6 months was 97% and 83%, respectively. At 1-year follow-up, primary patency was 54% and secondary patency was 80%. There was no major difference in patency due to preoperative vein diameter.

    Conclusions: The results of this study indicate that NTT can be used for primary radio-cephalic fistula surgery with very good results. This method offers the potential to create a RC-AVF in patients who are not usually considered appropriate for a distal arm fistula due to a small cephalic vein.

  • 19. Jansen, Jan
    et al.
    the EVTM group, -
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences.
    Management of the REBOA patient in the intensive care unit2017In: Top Stent: The art of EndoVascular hybrid Trauma and bleeding Management, Örebro University Hospital , 2017, p. 195-203Chapter in book (Other academic)
  • 20.
    Mathisen, Sven Ross
    et al.
    Department of Vascular Surgery, Innlandet Hospital Trust, Hamar, Norway.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    A Single Center Study of ProGlide Used for Closure of Large-Bore Puncture Holes After EVAR for AAA2021In: Vascular and Endovascular Surgery, ISSN 1538-5744, E-ISSN 1938-9116, Vol. 55, no 8, p. 798-803Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The objective of this study was to evaluate the primary and assisted secondary percutaneous and non-invasive technical success of the ProGlide device on all-comers in a consecutive case series of percutaneous endovascular aortic aneurysm repair (P-EVAR).

    METHOD: A single-center consecutive case series where 434 elective and acute P-EVAR procedures were registered prospectively between May 2011 and July 2017. The mean age was 74.5 years ± SD 11.4 years. 82.3% of the patients were male. All patients were pre-planned from CT angiography. Percutaneous access punctures, performed in local anesthesia in the common femoral artery, with a final introducer size between 12-22 Fr OD were included and stratified in 2 groups, 12-16 Fr and 17-22 Fr.

    RESULTS: By screening 868 access groins 22 groins were excluded. Of the remaining 846 groins, intended to be treated with ProGlide, 9 groins were excluded peri-procedurally and treated with the Fascia Suture Technique or surgical cutdown. The remaining 837 groins had access closure with ProGlide, with a mean value of 2.15 devices per groin with a slight significant difference between the 2 stratification groups. Primary ProGlide technical success was achieved in 68.1% of the groins. Secondary percutaneous or non-invasive technical success was achieved in 96.9%. Here there was no statistically significant difference between the 2 stratification groups. Thirty-one (3.7%) groin complications were registered during 30-day follow-up and 17 required additional treatment. Total mortality was 2.8%. None of these deaths were related to the access site.

    CONCLUSION: ProGlide by itself has a significant failure rate in the closure of large-bore access holes on an unselected cohort of patients eligible for P-EVAR. However, together with adjunct percutaneous or non-invasive methods a success rate of 97% can be achieved. The access complication rate was lower than 4% at 30-day follow-up.

  • 21.
    McGreevy, David
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Abu-Zidan, Fikri M.
    Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates.
    Sadeghi, Mitra
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Toivola, Asko
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Skoog, Per
    Department of Hybrid and Interventional Surgery, Unit of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Idoguchi, Koji
    Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano, Japan.
    Kon, Yuri
    Emergency and Critical Care Center, Hachinohe City Hospital, Hachinohe, Japan.
    Ishida, Tokiya
    Emergency and Critical Care Center, Ohta Nishinouchi Hospital, Koriyama, Japan.
    Matsumura, Yosuke
    Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
    Matsumoto, Junichi
    Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
    Reva, Viktor
    Department of War Surgery, Kirov Military Medical Academy, Saint Petersburg, RussiaDzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russia .
    Maszkowski, Mariusz
    Västmanlands Hospital Västerås, Department of Vascular Surgery, Örebro University, Örebro, Sweden.
    Bersztel, Adam
    Västmanlands Hospital Västerås, Department of Vascular Surgery, Örebro University, Örebro, Sweden.
    Caragounis, Eva-Corina
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Falkenberg, Mårten
    Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Handolin, Lauri
    Helsinki University Hospital, Department of Orthopedics and Traumatology, University of Helsinki, Helsinki, Finland.
    Oosthuizen, George
    Ngwelezana Surgery and Trauma, Department of Surgery, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa.
    Szarka, Endre
    Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal College of Health Sciences, Pietermaritzburg, KwaZulu-Natal, South Africa.
    Manchev, Vassil
    Department of Surgery. Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Wannatoop, Tongporn
    Department of Surgery. Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Chang, Sung Wook
    Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea.
    Kessel, Boris
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Hebron, Dan
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Shaked, Gad
    Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel.
    Bala, Miklosh
    Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
    Coccolini, Federico
    Department of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
    Ansaloni, Luca
    Department of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
    Ordoñez, Carlos A
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili and Universidad Del Valle, Cali, Colombia.
    Dogan, Emanuel M.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Manning, James E.
    Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
    Hibert-Carius, Peter
    Department of Anesthesiology, Emergency and Intensive Care Medicine, Bergmannstrost Hospital Halle, Halle, Germany.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Feasibility and Clinical Outcome of Reboa in Patients with Impending Traumatic Cardiac Arrest2020In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 54, no 2, p. 218-223Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may improve Systolic Blood Pressure (SBP) in hypovolemic shock. It has, however, not been studied in patients with impending traumatic cardiac arrest (ITCA). We aimed to study the feasibility and clinical outcome of REBOA in patients with ITCA using data from the ABOTrauma Registry.

    METHODS: Retrospective and prospective data on the use of REBOA from 16 centers globally were collected. SBP was measured both at pre- and post-REBOA inflation. Data collected included patients' demography, vascular access technique, number of attempts, catheter size, operator, zone and duration of occlusion, and clinical outcome.

    RESULTS: There were 74 patients in this high-risk patient group. REBOA was performed on all patients. A 7-10Fr catheter was used in 66.7%, 58.5% were placed on the first attempt, 52.1% through blind insertion and 93.2% inflated in Zone I, 64.8% for a period of 30 to 60 minutes, 82.1% by ER doctors, trauma surgeons or vascular surgeons. SBP significantly improved to 90 mmHg following the inflation of REBOA. 36.6% of the patients survived.

    CONCLUSIONS: Our study has shown that REBOA may be performed in patients with ITCA, SBP can be elevated and 36.6% of the patients survived if REBOA placement is successful.

  • 22.
    McGreevy, David
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Björklund, Janina
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hemodynamic Effect of Resuscitative Endovascular Balloon Occlusion Of The Aorta In Hemodynamic Instability Secondary To Acute Cardiac Tamponade In A Porcine Model2022In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 57, no 2, p. 291-297Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The pre-hospital use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is increasing, although remains controversial, in part because of suggested contraindications such as acute cardiac tamponade (ACT). As both the pre-hospital and in-hospital use of REBOA might potentially occur with concurrent ACT, knowledge of the hemodynamic effect of REBOA in this setting is crucial. This study, therefore, aimed at investigating the physiological effects of REBOA in hemodynamic instability secondary to ACT in a porcine model. We hypothesize that REBOA can temporarily increase systemic blood pressure and carotid blood flow, and prolong survival, in hemodynamic shock caused by ACT.

    METHODS: Fourteen pigs (24-38 kg) underwent ACT, through true cardiac injury and hemorrhage into the pericardial space, and were allowed to hemodynamically deteriorate. At a systolic blood pressure (SBP) of 50 mmHg (SBP50) they were randomized to total occlusion REBOA in zone 1 or to a control group. Survival, hemodynamic parameters, carotid blood flow (CBF), femoral blood flow (FBF), cardiac output (CO), end-tidal CO2 and arterial blood gas parameters were analyzed.

    RESULTS: REBOA intervention was associated with a significant increase in SBP (50 mmHg to 74 mmHg, p = 0.016) and CBF (110 mL/min to 195 mL/min, p = 0.031), with no change in CO, compared to the control group. At 20 minutes after SBP50, the survival rate in the intervention group was 86% and in the control group 14%, with time to death being significantly longer in the intervention group.

    CONCLUSIONS: This randomized animal study demonstrates that REBOA can help provide hemodynamic stabilization and prolong survival in hemodynamic shock provoked by ACT. It is important to stress that our study does not change the fact that urgent pericardiocentesis or cardiac surgery is, and should remain, the standard optimal treatment for ACT.

    Level of evidence: Prospective, randomized, experimental animal study. Basic science study, therapeutic.

    Download full text (pdf)
    Fulltext
  • 23.
    McGreevy, David
    et al.
    Örebro University, School of Medical Sciences.
    Dogan, Emanuel
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Toivola, Asko
    Bilos, Linda
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Endovascular Resuscitation with Aortic Balloon Occlusion in Non-Trauma Cases: First use of ER-REBOA in Europe2017In: Journal of Endovascular Resuscitation and Trauma Management, ISSN 2002-7567, no 1, p. 42-49Article in journal (Refereed)
    Abstract [en]

    Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is currently evolving and being used worldwide for trauma management. Smaller sheath devices for REBOA and new advances in endovascular resuscitation methods suggest the potential for the procedure to be utilized in hemodynamically unstable non-trau-matic patients.

    Methods: We describe five adult patients that underwent hemodynamic control using the 7 Fr sheath ER-REBOA™ catheters for non-traumatic hemorrhagic instability at Örebro University Hospital between February 2017 and June 2017.

    Results: The ER-REBOA™ catheter was inserted and used successfully for temporary blood pressure stabilization as part of an endovascular resuscitation process.

    Conclusion: The ER-REBOA™ catheter for endovascular resuscitation may be an additional method for temporary hemodynamic stabilization in the treatment of non-traumatic patients. Furthermore, the ER-REBOA™ catheter may be a potential addition to advanced cardiac life support in the management of non-traumatic cardiac arrest.

  • 24.
    McGreevy, David
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Dogan, S.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Oscarsson, V.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Vergari, M.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Eliasson, K.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Norgren, L.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Metabolic Response to Claudication in Peripheral Arterial Disease: a Microdialysis pilot study2019In: Annals of Vascular Surgery, ISSN 0890-5096, E-ISSN 1615-5947, Vol. 58, p. 134-141Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: In a pilot study investigate the possible use of microdialysis in the calf muscle to assess the metabolic response to intermittent claudication (IC). In addition, evaluate the simultaneous systemic inflammatory reaction.

    METHODS: With one microdialysis catheter in the gastrocnemic muscle and one subcutaneously in the pectoral region (as a reference), and a peripheral venous catheter, dialysate and venous blood sampling was performed before, during and after walking on a treadmill to maximal tolerable claudication (controls 10 minutes).

    RESULTS: A total of 9 participants were recruited, six patients with IC and three healthy controls. At baseline, IC and control subjects did not differ in metabolic findings (glucose, lactate, pyruvate, glycerol) in the gastrocnemic muscle. Subcutaneous glucose concentration was higher in controls. After physical exertion, gastrocnemic and subcutaneous glycerol, lactate and pyruvate concentrations increased in IC subjects. Plasma concentrations of Tumor Necrosis Factor--α (TNF- α), Interleucin-6 (IL-6), Interleucin-1ß (IL-1ß), Hepatocyte Growth Factor (HGF) and Vascular Endothelial Growth Factor (VEGF) were higher in IC subjects at baseline, and TNF-α, (IL-6) and Interleukin-18 (IL-18) increased after walking as did IL-6 and (IL-1ß) in controls. The muscle catheters did not show any signs of causing harm.

    CONCLUSIONS: Microdialysis can be used to study the ongoing metabolic response during walking and claudication. Our results suggest both an acute local and a systemic inflammatory reaction during development of claudication pain.

  • 25.
    McGreevy, David
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Sadeghi, Mitra
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro University Hospital, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA2022In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 48, no 1, p. 307-313Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe.

    METHODS: Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020.

    RESULTS: A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7-8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0-63) to 95 mmHg (70-121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days.

    CONCLUSIONS: Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

  • 26.
    McGreevy, David T.
    et al.
    Örebro University, School of Medical Sciences.
    Björklund, Janina
    Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Hemodynamic Effects of Resuscitative Endovascular Balloon Occlusion of the Aorta During Hemodynamic Instability Secondary to Acute Cardiac Tamponade in a Porcine Model2022In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 75, no 4, p. 18S-19SArticle in journal (Other academic)
  • 27.
    McGreevy, David T.
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Pirouzram, Artai
    Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden.
    Gidlund, Khatereh Djavani
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    A 12-year experience of endovascular repair for ruptured abdominal aortic aneurysms in all patients2023In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 77, no 3, p. 741-749Article in journal (Refereed)
    Abstract [en]

    Objective: Endovascular aneurysm repair (EVAR) has been increasingly performed for ruptured abdominal aortic aneurysms (rAAAs). However, multiple randomized trials have failed to demonstrate a survival benefit compared with open aortic surgery. During a 12-year period, 100% of patients without a history of aneurysm surgery had undergone EVAR for a rAAA at orebro University Hospital, with no emergent open aortic surgery performed. In the present study, we evaluated the mortality and technical success during this "EVAR-only" period.

    Methods: A single-center, retrospective observational study was conducted. We identified all patients who had presented to Orebro University Hospital with a rAAA between October 2009 and September 2021. Patients with isolated iliac artery, thoracic, and thoracoabdominal aortic ruptures were not included. Patients who had received previous aortic interventions (open or endovascular) and patients who had received palliative treatment instead of surgical intervention were also excluded. The patient characteristics, perioperative and postoperative data, and mortality rate were investigated.

    Results: EVAR had been performed in 100 patients. Preoperative hemodynamic instability had been present in 54 patients (54%), and 18 (18%) had undergone aortic balloon occlusion. The aneurysm location was infrarenal in 89 patients (89%). Bifurcated stent grafts had been used in 97 patients (97%), and adjunct endovascular techniques had been used for 27 patients (27%). Of 98 patients, EVAR had been performed with the patient under local anesthesia for 62 patients (63%). Peri-and postoperative complications at 30 days had occurred in 20 of 100 patients (20%) and 22 of 79 patients (28%), respectively. The overall mortality at 30 days was 27% (27 of 100 patients), and the mortality for those with an isolated infrarenal rAAA was 24% (21 of 89 patients). The overall mortality at 1 year was 39% (39 of 100 patients) and for those with an isolated infrarenal rAAA was 37% (33 of 89 patients). The presence of preoperative hemodynamic instability and the use of ABO were statistically significantly and independently associated with increased 30-day mortality on multivariate logistic regression analysis.

    Conclusions: All 100 patients who had undergone surgery for a rAAA had been treated using EVAR and endovascular adjuncts, with a relatively low mortality rate, thus continuing the "EVAR-only" approach. A low proportion of rAAA patients were considered surgically unsuitable. These findings support the applicability of EVAR for the treatment of all rAAAs at suitable centers.

  • 28.
    Nilsson, Kristofer F.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    NO enigma in pulmonary embolism2007In: Acta Physiologica, ISSN 1748-1708, E-ISSN 1748-1716, Vol. 191, no 3, p. 169-169Article in journal (Refereed)
  • 29.
    Nilsson, Kristofer F.
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Postoperative critical care management considerations2020In: Endovascular resuscitation and trauma management: Bleeding and Haemodynamic Control / [ed] Hörer, T., DuBose, J.J., Rasmussen, T., White, J.M., Springer, 2020, p. 229-242Chapter in book (Other academic)
  • 30.
    Nilsson, Kristofer F.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Gozdzik, Waldemar
    Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland.
    Frostell, Claes
    Department of Anesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden.
    Zielinski, Stanislaw
    Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland.
    Zielinska, Marzena
    Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland.
    Ratajczak, Kornel
    Department and Clinic of Surgery, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
    Skrzypczak, Piotr
    Department and Clinic of Surgery, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
    Rodziewicz, Sylwia
    Department and Clinic of Surgery, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
    Albert, Johanna
    Department of Surgery, Danderyd Hospital, Stockholm, Sweden.
    Gustafsson, Lars E.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Organic mononitrites of 1,2-propanediol act as an effective NO-releasing vasodilator in pulmonary hypertension and exhibit no cross-tolerance with nitroglycerin in anesthetized pigs2018In: Drug Design, Development and Therapy, E-ISSN 1177-8881, Vol. 12, p. 685-694Article in journal (Refereed)
    Abstract [en]

    Purpose: Clinically available intravenous (IV) nitric oxide (NO) donor drugs such as nitroglycerin (GTN) cause systemic hypotension and/or tolerance development. In a porcine model, novel NO donor compounds - the organic mononitrites of 1,2-propanediol (PDNO) were compared to GTN with regard to pulmonary selectivity and tolerance development. The vasodilatory effects of inorganic nitrite were investigated.

    Materials and methods: In anesthetized piglets, central hemodynamics were monitored. At normal pulmonary vascular resistance (PVR), IV infusions of PDNO (15-60 nmol kg(-1) min(-1)), GTN (13-132 nmol kg(-1) min(-1)), and inorganic nitrite (dosed as PDNO) were administered. At increased PVR (by U46619 IV), IV infusions of PDNO (60-240 nmol kg(-1) min(-1)) and GTN (75-300 nmol kg(-1) min(-1)) before and after a 5 h infusion of GTN (45 nmol kg-1 min-1) were given.

    Results: At normal PVR, PDNO (n=12) and GTN (n=7) caused significant dose-dependent decreases in mean systemic and pulmonary arterial pressures, whereas inorganic nitrite (n=13) had no significant effect. At increased PVR, PDNO (n=6) and GTN (n=6) significantly decreased mean systemic and pulmonary pressures and resistances, but only PDNO reduced the ratio between pulmonary and systemic vascular resistances significantly. After the 5 h GTN infusion, the hemodynamic response to GTN infusions (n=6) was significantly suppressed, whereas PDNO (n=6) produced similar hemodynamic effects to those observed before the GTN infusion.

    Conclusion: PDNO is a vasodilator with selectivity for pulmonary circulation exhibiting no cross-tolerance to GTN, but GTN causes non selective vasodilatation with substantial tolerance development in the pulmonary and systemic circulations. Inorganic nitrite has no vasodilatory properties at relevant doses.

  • 31.
    Nilsson, Kristofer F.
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gozdzik, Waldemar
    Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland.
    Zielinski, Stanislaw
    Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland.
    Ratajczak, Kornel
    Veterinary Center of Nicolaus Copernicus University in Toruń, Toruń, Poland.
    Göranson, Sofie P.
    Department of Anesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden.
    Rodziewicz, Sylwia
    Department and Clinic of Surgery, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
    Harbut, Piotr
    Department of Anesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden.
    Barteczko-Grajek, Barbara
    Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland.
    Albert, Johanna
    Department of Anesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden.
    Frostell, Claes
    Department of Anesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden.
    Pulmonary Vasodilation by Intravenous Infusion of Organic Mononitrites of 1,2-Propanediol in Acute Pulmonary Hypertension Induced by Aortic Cross Clamping and Reperfusion: A Comparison with Nitroglycerin in Anesthetised Pigs2020In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 54, no 1, p. 119-127Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Suprarenal aortic cross clamping (SRACC) and reperfusion may cause acute pulmonary hypertension and multiple organ failure.

    HYPOTHESIS: The organic mononitrites of 1,2-propanediol (PDNO), an NO donor with a very short half-life, is a more efficient pulmonary vasodilator and attenuator of end-organ damage and inflammation without significant side effects compared to nitroglycerin and inorganic nitrite in a porcine SRACC model.

    METHODS: Anesthetised and instrumented domestic pigs were randomised to either of four IV infusions until the end of the experiment (n = 10 per group): saline (control), PDNO (45 nmol kg min), nitroglycerin (44 nmol kg min), or inorganic nitrite (a dose corresponding to PDNO). Thereafter, all animals were subjected to 90 minutes of SRACC and 10 hours of reperfusion and protocolised resuscitation. Hemodynamic and respiratory variables as well as blood samples were collected and analysed.

    RESULTS: During reperfusion, mean pulmonary arterial pressure and pulmonary vascular resistance were significantly lower, and stroke volume was significantly higher in the PDNO group compared to the control, nitroglycerin, and inorganic nitrite groups. In parallel, mean arterial pressure, arterial oxygenation, and fraction of methaemoglobin were similar in all groups. The serum concentration of creatinine and tumour necrosis factor alpha were lower in the PDNO group compared to the control group during reperfusion.

    CONCLUSIONS: PDNO was an effective pulmonary vasodilator and appeared superior to nitroglycerin and inorganic nitrite, without causing significant systemic hypotension, impaired arterial oxygenation, or methaemoglobin formation in an animal model of SRACC and reperfusion. Also, PDNO may have kidney-protective effects and anti-inflammatory properties.

  • 32.
    Nilsson, Kristofer F.
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Grishina, V. A.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Glaumann, C.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, L. E.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm.
    Estimation of endogenous adenosine activity at adenosine receptors in guinea-pig ileum using a new pharmacological method2010In: Acta Physiologica, ISSN 1748-1708, E-ISSN 1748-1716, Vol. 199, no 2, p. 231-241Article in journal (Refereed)
    Abstract [en]

    AIM: Adenosine modulates neurotransmission and in the intestine adenosine is continuously released both from nerves and from smooth muscle. The main effect is modulation of contractile activity by inhibition of neurotransmitter release and by direct smooth muscle relaxation. Estimation of adenosine concentration at the receptors is difficult due to metabolic inactivation. We hypothesized that endogenous adenosine concentrations can be calculated by using adenosine receptor antagonist and agonist and dose ratio (DR) equations.

    METHODS: Plexus-containing guinea-pig ileum longitudinal smooth muscle preparations were made to contract intermittently by electrical field stimulation in organ baths. Schild plot regressions were constructed with 2-chloroadenosine (agonist) and 8-(p-sulfophenyl)theophylline (8-PST; antagonist). In separate experiments the reversing or enhancing effect of 8-PST and the inhibiting effect of 2-chloroadenosine (CADO) were analysed in the absence or presence of an adenosine uptake inhibitor (dilazep), and nucleoside overflow was measured by HPLC.

    RESULTS: Using the obtained DR, baseline adenosine concentration was calculated to 28 nm expressed as CADO activity, which increased dose dependently after addition of 10(-6) m dilazep to 150 nm (P < 0.05). HPLC measurements yielded a lower fractional increment (80%) in adenosine during dilazep, than found in the pharmacological determination (440%).

    CONCLUSION: Endogenous adenosine is an important modulator of intestinal neuro-effector activity, operating in the linear part of the dose-response curve. Other adenosine-like agonists might contribute to neuromodulation and the derived formulas can be used to calculate endogenous agonist activity, which is markedly affected by nucleoside uptake inhibition. The method described should be suitable for other endogenous signalling molecules in many biological systems.

  • 33.
    Nilsson, Kristofer F.
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, L. E.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Adding, L. C.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Linnarsson, D.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Agvald, P.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Increase in exhaled nitric oxide and protective role of the nitric oxide system in experimental pulmonary embolism2007In: British Journal of Pharmacology, ISSN 0007-1188, E-ISSN 1476-5381, Vol. 150, no 4, p. 494-501Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Pulmonary embolism (PE) represents a real diagnostic challenge. PE is associated with pulmonary hypertension due to pulmonary vascular obstruction and vasoconstriction. We recently reported that pulmonary gas embolism transiently increases exhaled nitric oxide (FENO), but it is not known whether solid emboli may alter FENO, and whether an intact endogenous NO synthesis has a beneficial effect in experimental solid pulmonary embolism.

    EXPERIMENTAL APPROACH: We used anaesthetised and ventilated rabbits in these experiments. To mimic PE, a single intravenous infusion of homogenized autologous skeletal muscle tissue (MPE) was given to rabbits with intact NO production (MPE of 60, 15, or 7.5 mg kg(-1); group 1) and to another group (group 2) with inhibited NO synthesis (L-NAME 30 mg kg(-1); MPE of 7.5, 15 or 30 mg kg(-1)).

    KEY RESULTS: In group 1, after MPE, FENO increased rapidly and dose-dependently and FENO was still significantly elevated after 60 min with the two highest emboli doses. All these animals survived more than 60 min after embolization. In group 2, MPE of 7.5, 15 and 30 mg kg(-1), in combination with NO synthesis inhibition, resulted in 67%, 50% and 25% survival at 60 min respectively, representing a statistically significant decrease in survival. Cardiovascular and blood-gas changes after MPE were intensified by pre-treatment with NO synthesis inhibitor.

    CONCLUSIONS AND IMPLICATIONS: We conclude that solid PE causes a sustained, dose-dependent increase in FENO, giving FENO a diagnostic potential in PE. Furthermore, intact NO production appears critical for tolerance to acute PE.

  • 34.
    Nilsson, Kristofer F.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden; Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gustafsson, Lars E.
    Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
    Treatment with new organic nitrites in pulmonary hypertension of acute experimental pulmonary embolism2019In: Pharmacology Research & Perspectives, E-ISSN 2052-1707, Vol. 7, no 1, article id e00462Article in journal (Refereed)
    Abstract [en]

    Acute pulmonary embolism may cause right heart failure due to increased pulmonary vascular resistance and arterial hypoxemia. Effective vasodilator therapy of the pulmonary hypertension is highly needed. Therefore, we investigated the effects of a newly developed effective pulmonary vasodilator, the organic mononitrites of 1,2-propanediol (PDNO), in a rabbit model of acute pulmonary embolism. In anesthetized and ventilated rabbits, systemic and pulmonary hemodynamics, exhaled nitric oxide (NO), plasma nitrite concentration, and blood gases were monitored. First, dose response experiments with intravenous and left heart ventricle infusions of PDNO and inorganic nitrite were done in naive animals and in pulmonary hypertension induced by a thromboxane A(2) analogue. Second, acute pulmonary embolism was induced and either PDNO or placebo were administered intravenously within 20 minutes and evaluated within 1 hour after pulmonary embolization. PDNO intravenously, in contrast to inorganic nitrite intravenously, increased exhaled NO and counteracted pulmonary hypertension and vasodilated the systemic circulation, dose-dependently, thereby showing efficient NO donation. Pulmonary embolization induced pulmonary hypertension and gas exchange disturbances. PDNO significantly decreased and normalized pulmonary vascular resistance and the right ventricle rate-pressure product, without causing tolerance, with no significant side effects on the systemic circulation, nor on blood-gas values or on methemoglobin formation. In conclusion, PDNO is a NO donor and an efficient vasodilator in the pulmonary circulation. Treatment with this or similar organic nitrites intravenously may be a future option to avoid right heart failure in life-threatening acute pulmonary embolism.

  • 35.
    Nilsson, Kristofer F.
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Lundgren, Michael
    nalyscentrum, Stockholm, Sweden.
    Agvald, Per
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Adding, Chistofer
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Linnarsson, Dag
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Lars
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Formation of new bioactive organic nitrites and their identification with gas chromatography-mass spectrometry and liquid chromatography coupled to nitrite reduction2011In: Biochemical Pharmacology, ISSN 0006-2952, E-ISSN 1356-1839, Vol. 82, no 3, p. 248-259Article in journal (Refereed)
    Abstract [en]

    Nitric oxide (NO) donors, notably organic nitrates and nitrites are used therapeutically but tolerance develops rapidly, making the use of e.g. nitroglycerin difficult. NO donation in the pulmonary vascular bed might be useful in critically ill patients. Organic nitrites are not associated with tachyphylaxis but may induce methaemoglobinemia and systemic hypotension which might hamper their use. We hypothesised that new lung-selective NO donors can be identified by utilizing exhaled NO as measure for pulmonary NO donation and systemic arterial pressure to monitor hypotension and tolerance development. Solutions of alcohols and carbohydrates were reacted with NO gas and administered to ventilated rabbits for evaluation of in vivo NO donation. Chemical characterization was made by liquid chromatography with on-line nitrite reduction (LC-NO) and by gas chromatography-mass spectrometry (GC-MS). In vivo experiments showed that the hydroxyl-containing compounds treated with NO gas yielded potent NO donors, via nitrosylation to organic nitrites. Analyses by LC-NO showed that the reaction products were able to release NO in vitro. In GC-MS the reaction products were determined to be the organic nitrites, where some are new chemical entities. Non-polar donors preferentially increased exhaled NO with less effect on systemic blood pressure whereas more polar molecules had larger effects on systemic blood pressure and less on exhaled NO. We conclude that new organic nitrites suitable for intravenous administration are produced by reacting NO gas and certain hydroxyl-containing compounds in aqueous solutions. Selectivity of different organic nitrites towards the pulmonary and systemic circulation, respectively, may be determined by molecular polarity.

  • 36.
    Nilsson, Kristofer F.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Sandin, John
    Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Lars E.
    Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Frithiof, Robert
    Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Section of Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden.
    The novel nitric oxide donor PDNO attenuates ovine ischemia-reperfusion induced renal failure2017In: Intensive Care Medicine Experimental, E-ISSN 2197-425X, Vol. 5, no 1, article id 29Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Renal ischemia-reperfusion injury is a common cause of acute kidney injury in intensive care and surgery. Recently, novel organic mononitrites of 1,2-propanediol (PDNO) were synthesized and shown to rapidly and controllably deploy nitric oxide in the circulation when administered intravenously. We hypothesized that intravenous infusion of PDNO during renal ischemia reperfusion would improve post-ischemic renal function and microcirculation.

    METHODS: Sixteen sheep were anesthetized, mechanically ventilated, and surgically instrumented. The left renal artery was clamped for 90 min, and the effects of ischemia were studied for a total of 8 h. Fifteen minutes prior to the release of the clamp, intravenous infusions of PDNO (n = 8) or vehicle (1,2 propanediol + inorganic nitrite, n = 8) were initiated (180 nmol/kg/min for 30 min, thereafter 60 nmol/kg/min for the remainder of the experiment).

    RESULTS: Renal artery blood flow, cortical and medullary perfusion, and diuresis and creatinine clearance decreased in the left kidney post ischemia. However, in the sheep treated with PDNO, diuresis and creatinine clearance in the left kidney were significantly higher post ischemia compared to vehicle-treated animals (1.7 ± 0.5 vs 0.7 ± 0.3 ml/kg/h, p = 0.04 and 7.5 ± 2.1 vs 1.7 ± 0.6 ml/min, p = 0.02, respectively). Left renal medullary perfusion and oxygen uptake were higher in the PDNO group (73 ± 9 vs 37 ± 5% of baseline, p = 0.004 and 2.6 ± 0.4 vs 1.6 ± 0.3 ml/min, p = 0.02, respectively). PDNO significantly increased renal oxygen consumption and reduced the oxygen utilization for sodium reabsorption (p = 0.03 for both). Mean arterial blood pressure was significantly reduced by PDNO (83 ± 3 vs 94 ± 3 mmHg, p = 0.02) but was still within normal limits. Total renal blood flow was not affected, and there were no signs of increased blood methemoglobin concentrations or tachyphylaxis.

    CONCLUSIONS: The novel nitric oxide donor PDNO improved renal function after ischemia. PDNO also prevented the persistent reduction in medullary perfusion during reperfusion and improved renal oxygen utilization without severe side effects.

  • 37.
    Oikonomakis, Ioannis
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery.
    Brodin, David
    Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Skoog, Per
    Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg.
    Seilitz, Jenny
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Meehan, Adrian D.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Geriatrics.
    Jansson, Kjell
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Altered mRNA expression due to rectum perforation in a porcine model: A pilot studyManuscript (preprint) (Other academic)
  • 38.
    Oikonomakis, Ioannis
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    Brodin, David
    Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Skoog, Per
    Örebro University, School of Health Sciences. Department of Vascular Surgery and Institute of Medicine Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden.
    Seilitz, Jenny
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Meehan, Adrian David
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Geriatrics.
    Jansson, Kjell
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    Altered mRNA Expression Due to Rectal Perforation in a Porcine Model: A Pilot Study2022In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 42, no 6, p. 2827-2833Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Anastomotic leakage is the most serious and unwelcome complication in rectal surgery. It has a great impact on postoperative morbidity and mortality. In this pilot study, changes of mRNA expression in blood were analyzed in an animal model designed to imitate anastomotic leakage.

    MATERIALS AND METHODS: Twelve pigs were randomized into two groups: A sham-operated control group and an experimental group in which iatrogenic rectal perforation was performed. The changes in the mRNA expression at 4 hours after creating the perforation were studied. Microarray analysis was performed using Gene Chip whole porcine genome array. mRNA expression of 19,124 genes was investigated.

    RESULTS: Significantly increased levels of genes with a fold change greater than 2 were found, including 276 coding for unknown proteins and 48 coding for known proteins. Eleven of those which coded for known proteins were up-regulated with a fold change >4.

    CONCLUSION: Eleven known genes were highly up-regulated after rectal perforation. These genes were mainly involved in inflammatory response, intracellular signaling and cell membrane regulation. Their corresponding proteins might potentially be clinical biomarkers of anastomotic leakage and should be evaluated in further clinical studies.

  • 39.
    Oikonomakis, Ioannis
    et al.
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular.
    Skoog, Per
    Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden, Gothenburg, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular.
    Jansson, Kjell Sigvard
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Early metabolic and inflammatory intraperitoneal changes after rectum perforation2020In: Annals of coloproctology, ISSN 2287-9714, Vol. 36, no 6, p. 374-381Article in journal (Refereed)
    Abstract [en]

    Purpose: Anastomotic leakage (AL) is the most dreaded complication in rectal surgery. It has a great impact on postoperative morbidity and mortality. This animal model, in which we have studied postoperative metabolic and inflammatory changes, is designed to imitate an AL.

    Methods: Twelve pigs were randomized into 2 groups. In the experimental group, an iatrogenic rectal perforation was performed, with the control group having a sham operation. The 2 groups were followed for 10 hours after operation with regard to vital parameters, arterial lactate, and cytokines interleukin (IL) 1, IL6, and IL10 in the blood and intraperitoneally. Intraperitoneal microdialysis analyses of glucose, lactate, glycerol, and pyruvate were performed and the lactate/pyruvate ratio was calculated.

    Results: Glucose levels were lower in the experimental group after 4 hours. After 7 hours, lactate and lactate/pyruvate ratio was higher in the experimental group. At the same time intraperitoneal cytokines IL6 and IL10 were higher in the experimental group. Blood samples showed higher IL6 after 7 hours in the experimental group.

    Conclusion: In this study, several significant differences between the groups in metabolic and inflammatory values were detected. Further clinical studies are recommended to evaluate the importance of intraperitoneal metabolic and inflammatory analyses as a diagnostic tool for early identification of an AL.

  • 40.
    Oikonomakis, Ioannis
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Colorectal Unit.
    Jansson, Daniel
    School of Rudbeck, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department ofCardiothoracic and Vascular Surgery.
    Skoog, Per
    Department of Vascular Surgery, Institute of Medicine, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Jansson, Kjell
    Department of Surgery, Colorectal Unit, Örebro University Hospital, Örebro, Sweden.
    Results of postoperative microdialysis intraperitoneal and at the anastomosis in patients developing anastomotic leakage after rectal cancer surgery2019In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 54, no 10, p. 1261-1268Article in journal (Refereed)
    Abstract [en]

    Introduction: Anastomotic leakage postoperatively in patients operated with rectum resection and primary anastomosis is a common and feared complication. We have studied seven patients with an anastomotic leakage after surgery and compared them with 13 patients without complications.

    Methods: Metabolic measurements with microdialysis were done during the first seven postoperative days, with measurements of glucose, pyruvate, lactate and glycerol. The lactate/pyruvate ratio was calculated. Measurements were performed subcutaneously, intraperitoneally and at the anastomosis. The inflammatory cytokines, IL 6 and IL 10, were measured intravenously and intraperitoneally 48 hours postoperatively.

    Results: Intravenous and intraperitoneal IL 6 were higher in the leakage group. Around the small intestine (intraperitoneally), we found that patients developing anastomotic leakage had higher lactate and lactate/pyruvate ratio immediately after surgery. They also showed lower glycerol levels. At the anastomosis, we found higher lactate and lactate/pyruvate ratio in anastomotic leak patients after the fourth postoperative day.

    Conclusions: The results indicate that a possible mechanism behind an anastomotic leakage is an impaired circulation and thus insufficient saturation to the small intestine peroperatively. This develops into an inflammation both intraperitoneally and intravenously, which, if not reversed, spread within the gastrointestinal tract. The colorectal anastomosis is the most vulnerable part of the gastrointestinal tract postoperatively and hypoxia and inflammation may occur there, and an anastomosis leakage will be the consequence.

  • 41.
    Oikonomakis, Ioannis
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Colorectal Unit.
    Jansson, Daniel T.
    Medical University of Gdansk, Poland.
    Skoog, Per
    Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden; Faculty of Medicine and Health, Örebro.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Meehan, Adrian D.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Geriatrics.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Jansson, Kjell
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Fully covered self-expandable metal stent placed over a colon anastomosis in an animal model: A pilot study of colon metabolism over the stentManuscript (preprint) (Other academic)
  • 42.
    Oikonomakis, Ioannis
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Colorectal Unit.
    Jansson, Daniel T.
    Medical University of Gdansk, Gdansk, Poland.
    Skoog, Per
    Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden; Örebro University, Faculty of Medicine and Health, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Meehan, Adrian D
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Geriatrics.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Jansson, Kjell
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Colorectal Unit.
    Fully covered self-expandable metal stent placed over a stapled colon anastomosis in an animal model: A pilot study of colon metabolism over the stent2022In: Journal of Gastroenterology and Hepatology Open (JGH Open), E-ISSN 2397-9070, Vol. 6, no 5, p. 338-343Article in journal (Refereed)
    Abstract [en]

    Background and Aim: Anastomotic leakage (AL) in colorectal resection and primary anastomosis is a common and feared complication. Fully covered self-expandable metal stents (FCSEMSs) have been used for the treatment of AL. It is still unknown whether FCSEMSs affect anastomosis healing negatively by causing ischemia. In an animal study, we investigated the metabolic effects over a FCSEMS covering a stapled colon anastomosis.

    Methods: Seven pigs were investigated using microdialysis after laparotomy, colon resection, and anastomosis with stent placement. Measurements were done at the proximal and distal ends of the anastomosis and at a reference catheter placed at the small intestine. Measurements of glucose, pyruvate, lactate, glycerol, and the lactate/ pyruvate ratio (L/P) were carried out.

    Results: Lactate and L/P were significantly higher at the oral part of the anastomosis, while glucose showed a small declining tendency. At the distal part of the anastomosis, glucose decreased significantly after the resection but did not reach zero. Lactate increased significantly whereas L/P increased only slightly. Glycerol levels were stable.

    Conclusion: Colon resection caused initially hypermetabolism in the intestinal ends next to the resection site. This hypermetabolism neither deteriorated nor turned into ischemia during the initial postoperative course, but the start of hypoxemia could not be excluded during the study and after the placement of an FCSEMS.

  • 43.
    Pirouzram, Artai
    et al.
    Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Sweden.
    Hamam, Leonardo
    Department of Surgery, Höglandssjukhuset Eksjö, Region Jönköping County Council, Sweden.
    Wallin, Göran
    Örebro University, School of Medical Sciences. Department of Surgery.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Novel Experimental Technique to Create Size-Controlled Retroperitoneal Bleeding in the Infrarenal Aorta of Anesthetized Pigs2021In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 16, no 4, p. 379-385Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Rupture of abdominal aortic aneurysm (rAAA) with a contained retroperitoneal hematoma is potentially fatal. Physiological studies are difficult to perform in patients suffering from life-threatening conditions such as rAAA. A translational model of the condition is therefore needed. The aim was to develop and validate an endovascular animal model for retroperitoneal bleeding of the abdominal aorta with contained hematoma.

    METHODS: = 6). Onset of bleeding was verified by angiography and macroscopically examined on completion of the experiments. Survival up to 180 min was the primary outcome. Hemodynamic and metabolic markers in arterial blood were secondary outcomes.

    RESULTS: = 0.002), but not when comparing the 6 mm and 8 mm groups. Systemic hypotension, arterial acidosis, and lactatemia were provoked in the 6 mm and 8 mm groups but not in the 4 mm group.

    CONCLUSIONS: A porcine model for a controlled contained left posterolateral retroperitoneal bleeding was created using endovascular methods and validated. This model makes it possible to study the pathophysiology of a retroperitoneal hematoma.

  • 44.
    Sadeghi, Mitra
    et al.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Dogan, Emanuel M.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Karlsson, Christina
    Örebro University, School of Health Sciences.
    Jansson, Kjell
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Seilitz, Jenny
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Skoog, Per
    Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Total resuscitative endovascular balloon occlusion of the aorta causes inflammatory activation and organ damage within 30 minutes of occlusion in normovolemic pigs2020In: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 20, no 1, article id 43Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) causes physiological, metabolic, end-organ and inflammatory changes that need to be addressed for better management of severely injured patients. The aim of this study was to investigate occlusion time-dependent metabolic, end-organ and inflammatory effects of total REBOA in Zone I in a normovolemic animal model.

    METHODS: Twenty-four pigs (25-35 kg) were randomized to total occlusion REBOA in Zone I for either 15, 30, 60 min (REBOA15, REBOA30, and REBOA60, respectively) or to a control group, followed by 3-h reperfusion. Hemodynamic variables, metabolic and inflammatory response, intraperitoneal and intrahepatic microdialysis, and plasma markers of end-organ injuries were measured during intervention and reperfusion. Intestinal histopathology was performed.

    RESULTS: Mean arterial pressure and cardiac output increased significantly in all REBOA groups during occlusion and blood flow in the superior mesenteric artery and urinary production subsided during intervention. Metabolic acidosis with increased intraperitoneal and intrahepatic concentrations of lactate and glycerol was most pronounced in REBOA30 and REBOA60 during reperfusion and did not normalize at the end of reperfusion in REBOA60. Inflammatory response showed a significant and persistent increase of pro- and anti-inflammatory cytokines during reperfusion in REBOA30 and was most pronounced in REBOA60. Plasma concentrations of liver, kidney, pancreatic and skeletal muscle enzymes were significantly increased at the end of reperfusion in REBOA30 and REBOA60. Significant intestinal mucosal damage was present in REBOA30 and REBOA60.

    CONCLUSION: Total REBOA caused severe systemic and intra-abdominal metabolic disturbances, organ damage and inflammatory activation already at 30 min of occlusion.

  • 45.
    Sadeghi, Mitra
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Dogan, Emanuel M.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Karlsson, Christina
    Örebro University, School of Health Sciences.
    Jansson, Kjell
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Seilitz, Jenny
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Skoog, Per
    Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Total resuscitative endovascular balloon occlusion of the aorta causes inflammatory activation and organ damage within 30 minutes of occlusion in normovolemic pigsManuscript (preprint) (Other academic)
  • 46.
    Sadeghi, Mitra
    et al.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hurtsén, Anna Stene
    Centre for Clinical Research and Education, County Council of Värmland, Karlstad, Sweden.
    Tegenfalk, Josephine
    School of Health Sciences, Örebro University, Örebro, Sweden.
    Skoog, Per
    Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden.
    Jansson, Kjell
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    End-Tidal Carbon Dioxide as an Indicator of Partial REBOA and Distal Organ Metabolism in Normovolemia and Hemorrhagic Shock in Anesthetized Pigs2021In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 56, no 4, p. 647-654Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: It is difficult to estimate the ischemic consequences when using partial resuscitative endovascular balloon occlusion of the aorta (REBOA). The aim was to investigate if end-tidal carbon dioxide (ETCO2) is correlated to degree of aortic occlusion, measured as distal aortic blood flow, and distal organ metabolism, estimated as systemic oxygen consumption (VO2), in a porcine model of normovolemia and hemorrhagic shock.

    MATERIALS AND METHODS: Nine anesthetized pigs (25-32 kg) were subjected to incremental steps of zone 1 aortic occlusion (reducing distal aortic blood flow by 33%, 66% and 100%) during normovolemia and hemorrhagic grade IV shock. Hemodynamic and respiratory variables, and blood samples, were measured. Systemic VO2 was correlated to ETCO2 and measures of partial occlusion previously described.

    RESULTS: Aortic occlusion gradually lowered distal blood flow and pressure, whereas ETCO2, VO2 and carbon dioxide production decreased at 66% and 100% aortic occlusion. Aortic blood flow correlated significantly to ETCO2 during both normovolemia and hemorrhage (R=0.84 and 0.83, respectively) and to femoral mean pressure (R = 0.92 and 0.83, respectively). Systemic VO2 correlated strongly to ETCO2 during both normovolemia and hemorrhage (R = 0.91 and 0.79, respectively), blood flow of the superior mesenteric artery (R = 0.77 and 0.85, respectively) and abdominal aorta (R = 0.78 and 0.78, respectively), but less to femoral blood pressure (R = 0.71 and 0.54, respectively).

    CONCLUSION: End-tidal carbon dioxide was correlated to distal aortic blood flow and VO2 during incremental degrees of aortic occlusion thereby potentially reflecting the degree of aortic occlusion and the ischemic consequences of partial REBOA. Further studies of ETCO2, and potential confounders, in partial REBOA are needed before clinical use.

  • 47.
    Sadeghi, Mitra
    et al.
    Örebro University, School of Medical Sciences. Department of Vascular Surgery, Västmanlands Hospital, Västerås, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Forsman, Daniel
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Dogan, Emanuel M.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Jansson, Kjell
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Kindler, Csaba
    Department of Pathology, Västmanlands Hospital Västerås, Västerås, Sweden.
    Skoog, Per
    Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Blood pressure targeting by partial REBOA is possible in severe hemorrhagic shock in pigs and produces less circulatory, metabolic and inflammatory sequelae than total REBOA2018In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 49, no 12, p. 2132-2141Article in journal (Refereed)
    Abstract [en]

    Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective adjunct in exsanguinating torso hemorrhage, but causes ischemic injury to distal organs. The aim was to investigate whether blood pressure targeting by partial REBOA (pREBOA) is possible in porcine severe hemorrhagic shock and to compare pREBOA and total REBOA (tREBOA) regarding hemodynamic, metabolic and inflammatory effects.

    Methods: Eighteen anesthetized pigs were exposed to induced controlled hemorrhage to a systolic blood pressure (SBP) of 50 mmHg and randomized into three groups of thoracic REBOA: 30 min of pREBOA (target SBP 80-100 mmHg), tREBOA, and control. They were then resuscitated by autologous transfusion and monitored for 3 h. Hemodynamics, blood gases, mesenteric blood flow, intraperitoneal metabolites, organ damage markers, histopathology from the small bowel, and inflammatory markers were analyzed.

    Results: Severe hemorrhagic shock was induced in all groups. In pREBOA the targeted blood pressure was reached. The mesenteric blood flow was sustained in pREBOA, while it was completely obstructed in tREBOA. Arterial pH was lower, and lactate and troponin levels were significantly higher in tREBOA than in pREBOA and controls during the reperfusion period. Intraperitoneal metabolites, the cytokine response and histological analyses from the small bowel were most affected in the tREBOA compared to the pREBOA and control groups.

    Conclusion: Partial REBOA allows blood pressure titration while maintaining perfusion to distal organs, and reduces the ischemic burden in a state of severe hemorrhagic shock. Partial REBOA may lower the risks of post-resuscitation metabolic and inflammatory impacts, and organ dysfunction. (C) 2018 Published by Elsevier Ltd.

  • 48.
    Sadeghi, Mitra
    et al.
    Örebro University, School of Medical Sciences. Västmanlands Hospital, Västerås, Sweden; Department of Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Department of Cardiothoracic and Vascular Surgery Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Pirouzram, Artai
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden .
    Toivola, Asko
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Skoog, Per
    Department of Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Idoguchi, Koji
    Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano, Japan.
    Kon, Yuri
    Emergency and Critical Care Center, Hachinohe City Hospital, Hachinohe, Japan.
    Ishida, Tokiya
    Emergency and Critical Care Center, Ohta Nishinouchi Hospital, Koriyama, Japan.
    Matsumara, Y.
    Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; R Adams Cowley Shock Trauma Center, University of Maryland, College Park MD, United States.
    Matsumoto, Junichi
    Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
    Reva, Viktor A.
    Department of War Surgery, Kirov Military Medical Academy, Saint Petersburg, Russian Federation; Dzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russian Federation.
    Maszkowski, M.
    Västmanlands Hospital, Västerås, Sweden; Department of Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Bersztel, Adam
    Västmanlands Hospital, Västerås, Sweden; Department of Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Caragounis, Eva Corina
    Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Falkenberg, Mårten P.
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Handolin, Lauri E.
    Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
    Kessel, Boris J.
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Hebron, Dan
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Coccolini, Federico
    Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Ansaloni, Luca
    Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Madurska, Marta J.
    Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
    Morrison, Jonathan James
    Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
    Hörer, Tal Martin
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    The use of aortic balloon occlusion in traumatic shock: first report from the ABO trauma registry2018In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 491-501Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique for temporary stabilization of patients with non-compressible torso hemorrhage. This technique has been increasingly used worldwide during the past decade. Despite the good outcomes of translational studies, clinical studies are divided. The aim of this multicenter-international study was to capture REBOA-specific data and outcomes.

    METHODS: REBOA practicing centers were invited to join this online register, which was established in September 2014. REBOA cases were reported, both retrospective and prospective. Demographics, injury patterns, hemodynamic variables, REBOA-specific data, complications and 30-days mortality were reported.

    RESULTS: Ninety-six cases from 6 different countries were reported between 2011 and 2016. Mean age was 52 ± 22 years and 88% of the cases were blunt trauma with a median injury severity score (ISS) of 41 (IQR 29-50). In the majority of the cases, Zone I REBOA was used. Median systolic blood pressure before balloon inflation was 60 mmHg (IQR 40-80), which increased to 100 mmHg (IQR 80-128) after inflation. Continuous occlusion was applied in 52% of the patients, and 48% received non-continuous occlusion. Occlusion time longer than 60 min was reported as 38 and 14% in the non-continuous and continuous groups, respectively. Complications, such as extremity compartment syndrome (n = 3), were only noted in the continuous occlusion group. The 30-day mortality for non-continuous REBOA was 48%, and 64% for continuous occlusion.

    CONCLUSIONS: This observational multicenter study presents results regarding continuous and non-continuous REBOA with favorable outcomes. However, further prospective studies are needed to be able to draw conclusions on morbidity and mortality.

  • 49.
    Sadeghi, Mitra
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Stene Hurtsén, Anna
    Centre for Clinical Research and Education, County Council of Värmland, Karlstad, Sweden.
    Tegenfalk, Josephine
    School of Health Sciences, Örebro University, Örebro, Sweden.
    Skoog, Per
    Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden.
    Jansson, Kjell
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    End-tidal carbon dioxide as an indicator of partial REBOA and distal organ metabolism in normovolemia and hemorrhagic shock in anesthetized pigsManuscript (preprint) (Other academic)
  • 50.
    Seifu, Daniel
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Biochemistry, Addis Ababa University, Addis Ababa, Ethiopia; Department of Biochemistry, Division of Biomedical Sciences, School of medicine, University of Global Health Equity, Kigali, Rwanda.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic and Vascular Surgery, Örebro University, Örebro, Sweden.
    Chawla, Rajinder
    Department of Biochemistry, Addis Ababa University, Addis Ababa, Ethiopia.
    Genet, Solomon
    Department of Biochemistry, Addis Ababa University, Addis Ababa, Ethiopia.
    Holst, Mikael
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Debella, Asfaw
    Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
    Hellström, Per M.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Detection and isolation of intestinal muscle relaxant substances from the root of Taverniera abyssinica A. Rich2023In: Journal of Ethnopharmacology, ISSN 0378-8741, E-ISSN 1872-7573, Vol. 312, article id 116498Article in journal (Refereed)
    Abstract [en]

    ETHNOPHARMACOLOGICAL RELEVANCE: In Ethiopian traditional medicine the root of Taverniera abyssinica A.Rich is known as a remedy for sudden gastrointestinal cramping and fever. In this study we have isolated and identified the bioactive principle of Taverniera abyssinica that exerts effects on isolated smooth muscle tissues of the rabbit duodenum and guinea-pig ileum.

    AIM OF THE STUDY: To isolate and purify the bioactive principle from the root of Taverniera abyssinica A.Rich by bioassay-guided fractionation, HPLC purification and masspectrometry, with further investigation of its bioactivity on isolated smooth muscle strips.

    MATERIALS AND METHODS: Roots of Taverniera abyssinica A.Rich extracted in 75% methanol/water were fractioned with a reverse phase column and then subjected to HPLC purification. Each fraction collected from the HPLC was tested for its bioactivity using electric field stimulation-evoked contractions of the rabbit duodenum and guinea-pig ileum. Finally, detailed structural analysis of the fraction displaying significant bioactivity was made by mass spectrometry.

    RESULTS: Through bioassay-guided fractionation and HPLC purification the bioactive fractions were identified. These were tested for bioactivity on isolated smooth muscle strips which showed about 50% inhibition of contractions evoked by electric field stimulation. These compounds were identified as formononetin, afrormosin and tectorigenin by using masspectrometry applying relevant standards for detection.

    CONCLUSION: The traditionally claimed smooth muscle-relaxing effect of the roots of Taverniera abyssinica A.Rich is essentially due the three isolated and purified the two isoflavones formononetin, afrormosin as well as the metoxyisoflavone tectorigenin, along with possibly other not yet purified bioactive substances, however with similar smooth muscle-relaxing properties.

12 1 - 50 of 66
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf