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  • 101. Jansson, Margareta
    et al.
    Geijer, Håkan
    Örebro University, Department of Clinical Medicine.
    Persliden, Jan
    Örebro University, Department of Clinical Medicine.
    Andersson, Torbjörn
    Örebro University, Department of Clinical Medicine.
    Reducing dose in urography while maintaining image quality - a comparison of storage phosphor plates and a flat-panel detector2006In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 16, no 1, p. 221-226Article in journal (Refereed)
    Abstract [en]

    The introduction of new flat-panel detector technology often forces us to accept too high dose levels as proposed by the manufacturers. We need a tool to compare the image quality of a new system with the accepted standard. The aim of this study was to obtain a comparable image quality for two systems-storage phosphor plates and a flat-panel system using intravenous urography (IVU) as a clinical model. The image quality figure was calculated using a contrast-detail phantom (CDRAD) for the two evaluated systems. This allowed us to set a dose for the flat-panel system that gave equivalent image quality to the storage phosphor plates. This reduced detector dose was used in an evaluation of clinical images to find out if the dose reduction from the phantom study indeed resulted in images of equal clinical image quality. The image quality was assessed using image criteria of the European guidelines for IVU with visual grading analysis. Equivalent image quality in image pairs was achieved at 30% of the dose. The CDRAD contrast-detail phantom makes it possible to find dose levels that give equal image quality using different imaging systems.

  • 102.
    Jansson, Stefan P. O.
    et al.
    Örebro University, Department of Clinical Medicine.
    Andersson, D. K. G.
    Svärdsudd, K.
    Prevalence and incidence rate of diabetes mellitus in a Swedish community during 30 years of follow-up2007In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 50, no 4, p. 703-710Article in journal (Refereed)
    Abstract [en]

    Increasing diabetes prevalence has been reported in most European countries in the last 20 years. In this study we report on the development of prevalence and incidence of diabetes from 1972 to 2001 in Laxa, a rural community in central Sweden. A diabetes register was established at the primary healthcare centre (PHCC) in Laxa, beginning in 1972 and based on data from clinical records at the PHCC, nearby hospitals and private practitioners in the area. In addition, case-finding procedures involving 85% of the residents aged 35 to 79 years old was performed from 1983 onwards. During the study period a total of 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. The age-standardised incidence rates for type 1 diabetes mellitus and type 2 diabetes mellitus were 0.15 and 3.03 cases per 1,000 population, respectively. No increase in incidence over time was detected for either forms of diabetes. Age-standardised prevalence for women and men increased from 28.3 and 25.9, respectively, per 1,000 in 1972 to 45 and 46.3 per 1,000 in 1988 (p < 0.0001), thereafter falling to a mean of 43.5 per 1,000 for women, while men had a mean of 44.9 per 1,000 for the rest of the study period. The prevalence of diabetes mellitus in Laxa is high, but has not increased during the last 13 years. The incidence rate was relatively stable over the whole 30-year period.

  • 103.
    Jansson, Stefan P.O.
    et al.
    Örebro University, Department of Clinical Medicine. Uppsala Univ, Dept Publ Hlth & Caring Sci, Family Med & Clin Epidemiol Sect, Uppsala, Sweden.
    Andersson, Dan K.G.
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Family Med & Clin Epidemiol Sect, Uppsala, Sweden; Natl Board Hlth & Welf, Div Reg Supervis Author, Orebro, Sweden.
    Svärdsudd, Kurt
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Family Med & Clin Epidemiol Sect, Uppsala, Sweden.
    Mortality trends in subjects with and without diabetes during 33 years of follow up2009In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 33, no 3, p. 551-556Article in journal (Refereed)
    Abstract [en]

    Objective: Mortality rates have declined substantially over the past decades in the general population, but the situation among diabetic subjects is less clear. The aim of this study was to analyze mortality trends in diabetic and nondiabetic subjects during 1972–2004.

    Research design and methods: Since 1972, all patients with diabetes are entered in a diabetes register at Laxå Primary Health Care Center; 776 incident cases were recorded up to 2001. The register has been supplemented with a nondiabetic population of 3,880 subjects and with data from the National Cause of Death Register during 1972 to 2004.

    Results: During the 33-year follow-up period, 233 (62.0%) diabetic women and 240 (60.0%) diabetic men and 995 (52.9%) nondiabetic women and 1,082 (54.1%) nondiabetic men died. The age-adjusted hazard ratio (HR) for all-cause mortality among diabetic and nondiabetic subjects was 1.17 (P < 0.0021) for all, 1.22 (P < 0.007) for women, and 1.13 (P = 0.095) for men. The corresponding cardiovascular disease (CVD) mortality HRs were 1.33 (P < 0.0001), 1.41 (P < 0.0003), and 1.27 (P < 0.0093), respectively. The CVD mortality reduction across time was significant in nondiabetic subjects (P < 0.0001) and in men with diabetes (P = 0.014) but not in diabetic women (P = 0.69). The results regarding coronary heart disease (CHD) were similar (P < 0.0001, P < 0.006, and P = 0.17, respectively). The CVD and CHD mortality rate change across time was fairly linear in all groups.

    Conclusions: Diabetic subjects had less mortality rate reduction during follow-up than nondiabetic subjects. However the excess mortality risk for diabetic subjects was smaller than that found in other studies.

  • 104.
    Jatta, Ken
    Örebro University, Department of Clinical Medicine.
    Inflammation in atherosclerosis2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Consequences of atherosclerosis may result in a number of diseases of the cardiovascular system that represent serious health problems and major causes of morbidity and mortality worldwide. Although it is initially considered as disease of fibro-lipid and thrombus deposition in the arterial wall, it also involves an ongoing inflammatory response.

    Normally, the inflammatory response is considered as a protective defence mechanism of the body. However, if the inflammation gets out of proportion to the threat it is dealing with, it may then result in a sustained chronic disorder and thus may underlie the initial stage of atherogenesis. The work of this thesis focuses on the expression of cytokines/chemokines and the vascular transcriptional response to inflammation, i.e. LPS in atherosclerosis. This has mainly been studied in animal models of atherosclerosis; consequently, we set out to investigate these events using human material in vitro (human carotid lesions).

    Employing quantitative analysis, we were able to detect a significant induction of protein and mRNA of the cytokines IL-1β, IL-6, IL-10 and TNF-α and the chemokines IL-8 and MCP-1 by LPS in both atherosclerotic and non-atherosclerotic vessels. In contrast, LPS induction of TNF-α, IL-1β and IL-10 was solely observed in the lesions, but not in normal arteries. In addition, the impact of IL-1 gene polymorphism on the risk of myocardial infarction (MI) was estimated by DNA genotyping of 387 survivors of a first MI and 387 sex and age-matched control subjects. We found no statistically significant differences in either genotypic distribution or allelic frequencies of IL-1β (-511) or IL-1Ra (VNTR) polymorphisms between first-time survivors of myocardial infarction and their age-matched healthy controls. Incontrast, our results demonstrated a strong association between the IL-1Ra genotype and severity of angiographically determined coronary artery disease in post-MI patients. To further investigate the vascular response to inflammation, we used gene array analysis to evaluate the human vascular transcriptional response to LPS of non-atherosclerotic human renal arteries compared to carotid lesions. In LPS treated renal arteries, 54% of the transcripts gave a detectable signal, where 4% were upregulated and 3.8% down-regulated. In the LPS stimulated carotid lesions, 44% of transcripts were detected. In this latter group, 5.1% of transcripts were increased and 3.3% decreased. Interestingly, a newly identified virus-inducible antiviral protein, CMV inducible gene 5/viperin (Cig5), was among the most strongly induced gene in both normal and atherosclerotic biopsies. Single gene analysis revealed viperin in the endothelium of human atherosclerotic lesions. Further, viperin was induced in vascular cells by inflammatory stimuli and CMV infection.

    In conclusion we show that atherosclerotic vessels produce more proinflammatory cytokines/chemokines than normal vessels. Interestingly, our results indicate that LPS enhances the expression of cytokines/chemokines in a similar pattern both in lesions and normal arteries. However, the response is stronger in atherosclerotic lesions. Furthermore, our results suggest that genetic polymorphisms within the IL-1Ra loci may influence the severity of CAD. Finally, the CMV inducible gene 5/viperin have been identified as a putative culprit molecule in vascular inflammation and atherosclerosis.

    List of papers
    1. Lipopolysaccharide-induced cytokine and chemokine expression in human carotid lesions
    Open this publication in new window or tab >>Lipopolysaccharide-induced cytokine and chemokine expression in human carotid lesions
    Show others...
    2005 (English)In: Journal of Vascular Research, ISSN 1018-1172, E-ISSN 1423-0135, Vol. 42, no 3, p. 266-271Article in journal (Refereed) Published
    Abstract [en]

    The release of cytokines and chemokines from activated immune-competent cells plays a crucial role in determining the pathology of the atherogenic progress. We investigated the effect of bacterial lipopolysaccharide (LPS) on cytokine/chemokine expression in carotid lesions and normal renal arteries. The lesions or renal arteries were incubated for 6 h at 37 degrees C in serum-free media treated with or without LPS. After LPS treatment, increased protein levels of IL-1beta, IL-6, IL-8, IL-10, TNF-alpha and MCP-1 were observed in the culture medium from the lesions measured with cytometric bead array. We were able to detect the induction of IL-1beta, IL-6, IL-8, IL-10, TNF-alpha and MCP-1 mRNA in the lesions after stimulation with LPS using real-time PCR. In renal arteries, LPS also induces mRNA expression of all chemokines and cytokines investigated with the exception of IL-6. However, LPS induces significantly higher levels of TNF-alpha, IL-1beta and IL-10 mRNA in lesions compared to renal arteries. The results suggest that infectious agents are capable of enhancing the production of cytokines/chemokines in an already ongoing inflammatory process such as in atherosclerosis, and that low levels of circulating LPS may affect the levels of pro-inflammatory cytokines much more in atherosclerotic vessels than in normal vessels and may contribute to the development of the atherosclerotic lesion.

    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-3082 (URN)10.1159/000085721 (DOI)
    Available from: 2006-05-11 Created: 2006-05-11 Last updated: 2017-12-14Bibliographically approved
    2. The antiviral cytomegalovirus inducible gene 5/viperin is expressed in atherosclerosis and regulated by proinflammatory agents
    Open this publication in new window or tab >>The antiviral cytomegalovirus inducible gene 5/viperin is expressed in atherosclerosis and regulated by proinflammatory agents
    Show others...
    2005 (English)In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 25, no 7, p. 113-116Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE:

    Inflammatory processes play an important role in atherosclerosis, and increasing evidence implies that microbial pathogens and proinflammatory cytokines are involved in the development and activation of atherosclerotic lesions. To find new inflammatory genes, we explored the vascular transcriptional response to an activator of innate immunity bacterial lipopolysaccharides (LPSs).

    METHODS AND RESULTS:

    Gene arrays identified the cytomegalovirus-inducible gene 5 (cig5)/viperin among the genes most potently induced by LPS in human vascular biopsies. Viperin was expressed by endothelial cells in atherosclerotic arteries and significantly elevated in atherosclerotic compared with normal arteries. In culture, cytomegalovirus infection, interferon-gamma, and LPS induced viperin expression.

    CONCLUSIONS:

    Viperin is expressed in atherosclerosis and induced in vascular cells by inflammatory stimuli and cytomegalovirus infection. The putative functions of viperin in atherosclerosis may relate to disease-associated microbes.

    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-3083 (URN)10.1161/01.ATV.0000170130.85334.38 (DOI)15890971 (PubMedID)
    Available from: 2006-05-11 Created: 2006-05-11 Last updated: 2017-12-14Bibliographically approved
    3. Interleukin-1 receptor antagonist and the relation to cardiovascular disease
    Open this publication in new window or tab >>Interleukin-1 receptor antagonist and the relation to cardiovascular disease
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    (English)Manuscript (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-3084 (URN)
    Available from: 2006-05-11 Created: 2006-05-11 Last updated: 2017-10-18Bibliographically approved
    4. Expression of IL-1b, IL-1R1 I and IL-1Ra in human aortic smooth muscle cells: effects of all-trans retinoic acid
    Open this publication in new window or tab >>Expression of IL-1b, IL-1R1 I and IL-1Ra in human aortic smooth muscle cells: effects of all-trans retinoic acid
    Show others...
    2006 (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-3085 (URN)
    Available from: 2006-05-11 Created: 2006-05-11 Last updated: 2017-10-18Bibliographically approved
  • 105.
    Jatta, Ken
    et al.
    Örebro University, Department of Clinical Medicine.
    Olofsson, Peder
    Ghaderi, Mehran
    Samnegård, Ann
    Eriksson, Per
    Sirsjö, Allan
    Örebro University, Department of Clinical Medicine.
    Interleukin-1 receptor antagonist and the relation to cardiovascular diseaseManuscript (Other academic)
  • 106.
    Jatta, Ken
    et al.
    Örebro University, Department of Clinical Medicine.
    Wågsäter, Dick
    Örebro University, Department of Clinical Medicine.
    Norgren, Lars
    Stenberg, Björn
    Sirsjö, Allan
    Örebro University, Department of Clinical Medicine.
    Lipopolysaccharide-induced cytokine and chemokine expression in human carotid lesions2005In: Journal of Vascular Research, ISSN 1018-1172, E-ISSN 1423-0135, Vol. 42, no 3, p. 266-271Article in journal (Refereed)
    Abstract [en]

    The release of cytokines and chemokines from activated immune-competent cells plays a crucial role in determining the pathology of the atherogenic progress. We investigated the effect of bacterial lipopolysaccharide (LPS) on cytokine/chemokine expression in carotid lesions and normal renal arteries. The lesions or renal arteries were incubated for 6 h at 37 degrees C in serum-free media treated with or without LPS. After LPS treatment, increased protein levels of IL-1beta, IL-6, IL-8, IL-10, TNF-alpha and MCP-1 were observed in the culture medium from the lesions measured with cytometric bead array. We were able to detect the induction of IL-1beta, IL-6, IL-8, IL-10, TNF-alpha and MCP-1 mRNA in the lesions after stimulation with LPS using real-time PCR. In renal arteries, LPS also induces mRNA expression of all chemokines and cytokines investigated with the exception of IL-6. However, LPS induces significantly higher levels of TNF-alpha, IL-1beta and IL-10 mRNA in lesions compared to renal arteries. The results suggest that infectious agents are capable of enhancing the production of cytokines/chemokines in an already ongoing inflammatory process such as in atherosclerosis, and that low levels of circulating LPS may affect the levels of pro-inflammatory cytokines much more in atherosclerotic vessels than in normal vessels and may contribute to the development of the atherosclerotic lesion.

  • 107.
    Johansson, Bengt
    et al.
    Örebro University, Department of Clinical Medicine.
    Persson, Essie
    Örebro University, Department of Clinical Medicine.
    Westman, Gunnar
    Örebro University, Department of Clinical Medicine.
    Persliden, Jan
    Örebro University, Department of Clinical Medicine.
    Phantom study of radiation doses outside the target volume brachytherapy versus external radiotherapy of early breast cancer2003In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 69, no 1, p. 107-112Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Brachytherapy is sometimes suggested as an adjuvant treatment after surgery of some tumours. When introducing this, it would be useful to have an estimate of the dose distribution to different body sites, both near and distant to target, comparing conventional external irradiation to brachytherapy. The aim of the present study was to determine radiation doses with both methods at different body sites, near and distant to target, in an experimental situation on an operated left sided breast cancer on a female Alderson phantom. METHODS: Five external beam treatments with isocentric tangential fields were given by a linear accelerator. A specified dose of 1.0 Gy was given to the whole left sided breast volume. Five interstitial brachytherapy treatments were given to the upper, lateral quadrant of the left breast by a two plane, 10 needles implant. A dose of 1.0 Gy specified according to the Paris system was administered by a pulsed dose rate afterloading machine. Absorbed dose in different fixed dose points were measured by thermoluminescence dosimeters. RESULTS: Both methods yielded an absorbed dose of the same size to the bone marrow and internal organs distant to target, 1.0-1.4% of the prescribed dose. There was a trend of lower doses to the lower half of the trunk and higher doses to the upper half of the trunk, respectively, by brachytherapy. A 90% reduction of absorbed dose with brachytherapy compared to external irradiation was found in the near-target region within 5 cm from target boundary where parts of the left lung and the heart are situated. If an adjuvant dose of 50 Gy is given with the external radiotherapy and brachytherapy, the absorbed dose in a part of the myocardium could be reduced from 31.8 to 2.1 Gy. CONCLUSIONS: Near target, brachytherapy yielded a considerably lower absorbed dose which is of special importance when considering radiation effects on the myocard and lungs. We could not demonstrate any difference of importance, in absorbed dose to dose points distant to target.

  • 108.
    Johansson, Carina B.
    et al.
    Örebro University, Department of Clinical Medicine.
    Lindblad, J.
    Sarve, H.
    Bernhardt, R.
    Beckmann, F.
    Herzen, J.
    Borgefors, G.
    Scharnweber, D.
    Improving the knowledge of integration of medical devices in bone: a comparison of 3D STμCT data to histomorphometrical data obtained on cut and ground sections2007Report (Other (popular science, discussion, etc.))
  • 109.
    Johansson, Carina B.
    et al.
    Örebro University, Department of Clinical Medicine.
    Sul, Y. T.
    Albrektsson, T.
    Biochemical bonding of biomaterial2005Conference paper (Refereed)
  • 110.
    Johansson, Jessica
    Örebro University, Department of Clinical Medicine.
    Effect of interleukin-1beta on tyrosine uptake in fibroblasts of schizophrenic patients and healthy controls2007Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    A repeated finding in schizophrenic patients is an aberrant tyrosine transport, shown in fibroblast cell model. Altered levels of the pro-inflammatory cytokine interleukin-1beta (IL-1β) are indicated in schizophrenic patients and IL-1β has shown to have inhibitory effect on amino acid transport systems. Based on these findings, the aim of this study was to examine the effect of IL-1β on tyrosine uptake in fibroblasts of schizophrenic patients and healthy controls. Fibroblast cell lines from schizophrenic patients (n=10) and healthy controls (n=10) were treated with IL-1β and uptake of 14C (U)-L-tyrosine was measured using the cluster tray method. Fibroblasts untreated with IL-1β were used as controls. Treatment with IL-1β significantly inhibited the tyrosine uptake in fibroblasts of schizophrenic patients and controls. No difference in uptake levels between fibroblasts of schizophrenic patients and controls was found. This study provides one potential explanation for the aberrant tyrosine transport seen in patients with schizophrenia and thus combines the immunological and neuropharmacological factors implicated in the pathophysiology/etiology of schizophrenia.

  • 111. Johansson, P.
    et al.
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Does tissue fixation and sample thickness matter in bone-biology research?2005Conference paper (Refereed)
  • 112.
    Jonsson, Jonny
    Örebro University, Department of Clinical Medicine.
    Hur säker är ekokardiografi för mätning av LVEF?: Jämförelse mot gated SPECT MPS2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    How correct is LVEF calculated by echocardiography?

    Comparison with gated SPECT.

    LVEF is an important measurement for evaluating prognosis and treatment at heart diseases.

    Aim: The aim was to analyse echocardiography and four different models at echocardiography (MRR, Teichholtz, Simpsons biplan and visual estimation) for measuring LVEF value and to investigate if echocardiography is dependent of the echocardiographer. The reference method was gated SPECT (g-SPECT).

    Patients/method: 133 patients who had undergone echocardiography and g-SPECT at the university hospital of Örebro within 202 days of each other were analysed retrospectively. The correlation (r), significance (p), difference and agreement between the two methods where calculated. Agreement were visualised by Bland-Altman plot. A p-value of 0,05 were considered significant and an agreement of < 20 LVEF % were considered acceptable.

    Results: The agreement and correlation between echocardiography and g-SPECT was acceptable (r=0,779, p<0,001, limits of agreement + 20,8; - 11,6).

    The agreement and correlation for the calculation models Simpsons biplan method and visual estimation on echocardiography were acceptable (r=0,86 and 0,79, p<0,001, limits of agreement + 19,1;-5,7 and + 19,5;-11,7).

    The agreement and correlation for the calculation models MRR and Teichholtz method on echocardiography was not acceptable (r=0,46 and 0,47, p + 30,1;-18,9 and + 23,7;-11,1). Echocardiography was not dependent on the echocardiographer (p=0,419).

    Conclusion: Echocardiography has an acceptable agreement with the reference method but the agreement is different for the different models. The results must be viewed critically since the reference method contains multiple sources of errors.

  • 113. Jonsson, Maria
    et al.
    Nordén-Lindeberg, Solveig
    Östlund, Ingrid
    Örebro University, Department of Clinical Medicine.
    Hanson, Ulf
    Örebro University, School of Health and Medical Sciences.
    Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 7, p. 745-750Article in journal (Refereed)
    Abstract [en]

    Objective. Evaluate obstetric characteristics during the last two hours of labor in neonates born with acidemia. Design. Case-control study. Setting. Delivery units at two university hospitals in Sweden. Study population. Out of 28,486 deliveries during 1994-2004, 305 neonates had an umbilical artery pH value <7.05 at birth. Methods. Cases: neonates with an umbilical artery pH < 7.05. Controls were neonates with pH ≥ 7.05 and an Apgar score ≥7 at 5 minutes. Obstetric characteristics, cardiotocographic patterns and oxytocin treatment during the last two hours of labor were recorded. Results. In the univariate analysis, ≥6 contractions/10 minutes (odds ratio (OR) 4.94, 95% confidence interval (CI) 3.25-7.49), oxytocin use (OR 2.20, 95% CI 1.66-2.92), bearing down ≥45 minutes (OR 1.77, 95% CI 1.31-2.38) and occipito-posterior position (OR 2.18, 95% CI 1.19-3.98) were associated with acidemia at birth. In the multivariate analysis, only ≥6 contractions/10 minutes (OR 5.36, 95% CI 3.32-8.65) and oxytocin use (OR 1.89, 95% CI 1.21-2.97) were associated with acidemia at birth. Among cases with ≥6 contractions/10 minutes, 75% had been treated with oxytocin. Pathological cardiotocographic patterns occurred in 68.8% of cases and in 26.1% of controls (p<0.001). Conclusion. A hyperactive uterine contraction pattern and oxytocin use are the most important risk factors for acidemia at birth. The increased uterine activity was related to overstimulation in the majority of cases. The duration of bearing down is less important when uterine contraction frequency has been considered.

  • 114.
    Jurstrand, Margaretha
    Örebro University, Department of Clinical Medicine.
    Detection of Chlamydia trachomatis and Mycoplasma genitalium by genetic and serological methods2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Chlamydia trachomatis infections are associated with a spectrum of clinical diseases including urethritis, prostatitis and epididymitis among men and cervicitis and pelvic inflammatory disease (PID), with an increased risk of infertility and ectopic pregnancy (EP), among women. In the search for other pathogens causing urethritis, Mycoplasma genitalium was isolated from urethral specimens from two men with acute urethritis (1980). Mycoplasma bacteria are extremely difficult to isolate by culture, and clinical studies have been possible only after the advent of the first PCR-based detection method. M. genitalium has been found to be associated with lower genital tract infections in both men and women. Finding evidence for a connection between M. genitalium and upper genital tract infections in women is still of major importance.

    The aim in papers I and II was to develop a PCR method for genetic characterization of clinical C. trachomatis isolates by sequence analysis of the omp1 gene, and to study the distribution of genotypes within sexual networks and determine if genotyping would improve partner notification. The method was used to determine the genotypes of C. trachomatis in 237 positive urogenital and/or urine specimens from men and women attending the STDClinic in Örebro during one year. Sequence analysis of the omp1 gene revealed that the most prevalent genotypes corresponded to C. trachomatis serovar E (47%), followed by F (17%), and K (9%). There were 161 networks found and specimens were sequenced from at least two patients in 47 networks. In seven of these 47 networks there were discrepant genotypes. In the largest network comprising 26 individuals two different C. trachomatis genotypes were found, and one partner had urethritis due to a Mycoplasma genitalium infection but was C. trachomatis negative.

    The need for a new method for M. genitalium DNA detection was one reason for study III. An existing conventional PCR protocol for detection of M. genitalium DNA was further developed into a real-time PCR (RT-PCR) with hybridisation probes. In order to evaluate the RT-PCR assay with clinical material, specimens from 398 men and 301 women attending the STD Clinic in Örebro were analysed, using the RT-PCR assay, and also by the well established conventional PCR in Copenhagen. Using the conventional PCR method as “gold standard”, the sensitivity for the RT-PCR assay was 72.2% and 68.2% and the specificity was 99.7% and 98.6%, respectively, in urogenital specimens from men and women.

    The aim in paper IV was to adapt a Triton X-114 extracted Lipid-Associated Membrane Protein (LAMP) Enzyme Immuno Assays (EIA) method to detect antibodies against M. genitalium and to evaluate the association between M. genitalium and PID and EP, using sera sampled in Örebro during the 1980s, and also to compare the number of sera having M. genitalium antibodies against those having C. trachomatis antibodies, using a commercial anti- Chlamydia trachomatis EIA assay. No statistical significant association could be demonstrated between M. genitalium antibodies and PID or EP in our serum material. However, a slight trend toward association was found when focusing on younger individuals. Antibodies against C. trachomatis were found to be significantly associated with PID and EP.

    List of papers
    1. Characterization of Chlamydia trachomatis omp1 genotypes among sexually transmitted disease patients in Sweden
    Open this publication in new window or tab >>Characterization of Chlamydia trachomatis omp1 genotypes among sexually transmitted disease patients in Sweden
    Show others...
    2001 (English)In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 39, no 11, p. 3915-3919Article in journal (Refereed) Published
    Abstract [en]

    A method for detection and genotyping of genital Chlamydia trachomatis infections based on omp1 gene amplification and sequencing was developed. DNA was extracted from urogenital or urine samples using a Chelex-based method, and an approximately 1,100-bp-long fragment from the omp1 gene was directly amplified and sequenced. Genotyping was performed by BLAST similarity search, and phylogenetic tree analysis was used to illustrate the evolutionary relationships between clinical isolates and reference strains. The method was used to determine the genotypes of C. trachomatis in 237 positive urogenital and/or urine specimens collected at a Swedish sexually transmitted disease clinic during 1 year. The most common genotypes corresponded to serotypes E (47%) and F (17%). The omp1 gene was highly conserved for genotype E (106 of 112 samples without any mutation) and F (41 of 42 samples without any mutation) strains but appear slightly less conserved for genotypes G (n = 6) and H (n = 6), where the sequences displayed one to four nucleotide substitutions relative to the reference sequence. Genotyping of samples collected at the follow-up visit indicated that two patients had become reinfected, while three other patients suffered treatment failure or reinfection. One woman appeared to have a mixed infection with two different C. trachomatis strains. This omp1 genotyping method had a high reproducibility and could be used for epidemiological characterization of sexually transmitted Chlamydia infections.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3194 (URN)10.1128/JCM.39.11.3915-3919.2001 (DOI)11682507 (PubMedID)
    Available from: 2006-11-17 Created: 2006-11-17 Last updated: 2017-12-14Bibliographically approved
    2. Genotyping of Chlamydia trachomatis would improve contact tracing
    Open this publication in new window or tab >>Genotyping of Chlamydia trachomatis would improve contact tracing
    Show others...
    2003 (English)In: Sexually Transmitted Diseases, ISSN 0148-5717, E-ISSN 1537-4521, Vol. 30, no 3, p. 205-210Article in journal (Refereed) Published
    Abstract [en]

    Background: The reported number of genital Chlamydia trachomatis infections has increased 15% annually since 1997 in Sweden. Inaccurate partner notification might be one reason.

    Goal: The goals were to determine if genotyping of C trachomatis would improve partner notification and to study the duration of infection.

    Study Design: Sexual networks were constructed. C trachomatis isolates from 231 individuals attending the Örebro STD clinic during 1 year were typed by sequencing of the omp1 gene.

    Results: All individuals were traced and diagnoses were established in 30 of 161 networks. More than one genotype was seen in seven networks. The mean duration of C trachomatis infection in each network was calculated to be 23 weeks.

    Conclusion: Genotyping could be a useful tool in partner notification when there are discrepant or uncommon genotypes. Limited clinic catchment areas create information difficulties that obstruct accurate contact tracing.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3195 (URN)10.1097/00007435-200303000-00005 (DOI)
    Available from: 2006-11-17 Created: 2006-11-17 Last updated: 2017-12-14Bibliographically approved
    3. Detection of Mycoplasma genitalium in urogenital specimens by real-time PCR and by conventional PCR assay
    Open this publication in new window or tab >>Detection of Mycoplasma genitalium in urogenital specimens by real-time PCR and by conventional PCR assay
    Show others...
    2005 (English)In: Journal of Medical Microbiology, ISSN 0022-2615, E-ISSN 1473-5644, Vol. 54, no 1, p. 23-29Article in journal (Refereed) Published
    Abstract [en]

    A real-time LightCycler PCR (LC-PCR) with hybridization probesfor detection of Mycoplasma genitalium in endocervical and firstvoid urine specimens was developed and compared to a conventionalPCR. The primers for both assays were identical and designedto amplify a 427 bp fragment of the 16S rRNA gene of M. genitalium.The LC-PCR assay had a detection limit of < 5 bacterial genomesper reaction when dilutions of genomic DNA from a type strainof M. genitalium were tested. First void urine from 398 menand first void urine and endocervical specimens from 301 womenattending an STD clinic were analysed by LC-PCR and by the conventionalPCR. Using the conventional PCR as reference, the LC-PCR hada specificity of 99.7 % and a sensitivity of 72.2 % for thedetection of M. genitalium in first void urine samples frommen. There was no significant difference in the performanceof the LC-PCR assay compared to the conventional PCR when endocervicalswabs were considered (58 and 65 %, respectively) or with aset of endocervical swab/urine specimens for which the LC-PCRassay detected 73 % of the infections (specificity = 98.6 %and sensitivity = 68.2 %) while the conventional PCR detected85 % of the infections. With female urine specimens there wasa significant difference between the two assays (38 and 73 %,respectively; P = 0.01 McNemar's test). This illustrates theneed to analyse both endocervical and urine specimens, becauseM. genitalium DNA was detected in only one of the two specimensin a great number of the M. genitalium-infected women. The lowersensitivity of the LC-PCR assay was probably caused by a combinationof inhibition and limitations regarding the amount of templateDNA. The LC-PCR assay was easy to perform and the simultaneousamplification and detection eliminated the need for furtherhandling of PCR products. With improvement in sample preparationmethods and increased volumes of the template DNA, the LC-PCRassay could be a useful routine diagnostic method.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3196 (URN)10.1099/jmm.0.45732-0 (DOI)
    Available from: 2006-11-17 Created: 2006-11-17 Last updated: 2017-12-14Bibliographically approved
    4. A serological study of the role of Mycoplasma genitalium in pelvic inflammatory disease and ectopic pregnancy:  
    Open this publication in new window or tab >>A serological study of the role of Mycoplasma genitalium in pelvic inflammatory disease and ectopic pregnancy:  
    Show others...
    (English)Manuscript (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3197 (URN)
    Available from: 2006-11-17 Created: 2006-11-17 Last updated: 2017-10-18Bibliographically approved
  • 115.
    Jurstrand, Margaretha
    et al.
    Örebro University, Department of Clinical Medicine.
    Falk, Lars
    Fredlund, Hans
    Örebro University Hospital.
    Lindberg, Margareta
    Olcén, Per
    Andersson, Sören
    Persson, Kenneth
    Albert, Jan
    Bäckman, Anders
    Örebro University Hospital.
    Characterization of Chlamydia trachomatis omp1 genotypes among sexually transmitted disease patients in Sweden2001In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 39, no 11, p. 3915-3919Article in journal (Refereed)
    Abstract [en]

    A method for detection and genotyping of genital Chlamydia trachomatis infections based on omp1 gene amplification and sequencing was developed. DNA was extracted from urogenital or urine samples using a Chelex-based method, and an approximately 1,100-bp-long fragment from the omp1 gene was directly amplified and sequenced. Genotyping was performed by BLAST similarity search, and phylogenetic tree analysis was used to illustrate the evolutionary relationships between clinical isolates and reference strains. The method was used to determine the genotypes of C. trachomatis in 237 positive urogenital and/or urine specimens collected at a Swedish sexually transmitted disease clinic during 1 year. The most common genotypes corresponded to serotypes E (47%) and F (17%). The omp1 gene was highly conserved for genotype E (106 of 112 samples without any mutation) and F (41 of 42 samples without any mutation) strains but appear slightly less conserved for genotypes G (n = 6) and H (n = 6), where the sequences displayed one to four nucleotide substitutions relative to the reference sequence. Genotyping of samples collected at the follow-up visit indicated that two patients had become reinfected, while three other patients suffered treatment failure or reinfection. One woman appeared to have a mixed infection with two different C. trachomatis strains. This omp1 genotyping method had a high reproducibility and could be used for epidemiological characterization of sexually transmitted Chlamydia infections.

  • 116.
    Jurstrand, Margaretha
    et al.
    Örebro University, Department of Clinical Medicine.
    Jensen, Jörgen Skov
    Fredlund, Hans
    Falk, Lars
    Mölling, Paula
    Detection of Mycoplasma genitalium in urogenital specimens by real-time PCR and by conventional PCR assay2005In: Journal of Medical Microbiology, ISSN 0022-2615, E-ISSN 1473-5644, Vol. 54, no 1, p. 23-29Article in journal (Refereed)
    Abstract [en]

    A real-time LightCycler PCR (LC-PCR) with hybridization probesfor detection of Mycoplasma genitalium in endocervical and firstvoid urine specimens was developed and compared to a conventionalPCR. The primers for both assays were identical and designedto amplify a 427 bp fragment of the 16S rRNA gene of M. genitalium.The LC-PCR assay had a detection limit of < 5 bacterial genomesper reaction when dilutions of genomic DNA from a type strainof M. genitalium were tested. First void urine from 398 menand first void urine and endocervical specimens from 301 womenattending an STD clinic were analysed by LC-PCR and by the conventionalPCR. Using the conventional PCR as reference, the LC-PCR hada specificity of 99.7 % and a sensitivity of 72.2 % for thedetection of M. genitalium in first void urine samples frommen. There was no significant difference in the performanceof the LC-PCR assay compared to the conventional PCR when endocervicalswabs were considered (58 and 65 %, respectively) or with aset of endocervical swab/urine specimens for which the LC-PCRassay detected 73 % of the infections (specificity = 98.6 %and sensitivity = 68.2 %) while the conventional PCR detected85 % of the infections. With female urine specimens there wasa significant difference between the two assays (38 and 73 %,respectively; P = 0.01 McNemar's test). This illustrates theneed to analyse both endocervical and urine specimens, becauseM. genitalium DNA was detected in only one of the two specimensin a great number of the M. genitalium-infected women. The lowersensitivity of the LC-PCR assay was probably caused by a combinationof inhibition and limitations regarding the amount of templateDNA. The LC-PCR assay was easy to perform and the simultaneousamplification and detection eliminated the need for furtherhandling of PCR products. With improvement in sample preparationmethods and increased volumes of the template DNA, the LC-PCRassay could be a useful routine diagnostic method.

  • 117.
    Jurstrand, Margaretha
    et al.
    Örebro University, Department of Clinical Medicine.
    Jensen, Jörgen Skov
    Magnuson, Anders
    Kamwendo, Francis
    Fredlund, Hans
    A serological study of the role of Mycoplasma genitalium in pelvic inflammatory disease and ectopic pregnancy:  Manuscript (Other academic)
  • 118. Järnerot, G.
    et al.
    Halfvarson, Jonas
    Tysk, Curt
    Örebro University, Department of Clinical Medicine.
    Twin studies in inflammatory bowel disease: a review2007In: Austral - Asian Journal of Cancer, ISSN 0972-2556, Vol. 6, no 1, p. 29-33Article in journal (Other academic)
  • 119. Kesek, Milos
    et al.
    Bjorklund, Erik
    Jernberg, Tomas
    Lindahl, Bertil
    Xue, Joel
    Englund, Anders
    Örebro University, Department of Clinical Medicine.
    Non-dipolar content of the T-wave as a measure of repolarization inhomogeneity in ST-elevation myocardial infarction2006In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 26, no 6, p. 362-370Article in journal (Refereed)
    Abstract [en]

    The non-dipolar content of the T-wave, i.e. the component of the signal, which cannot be explained by a dipolar model, has been suggested as a measure of the local repolarization inhomogeneity. Our purpose was to study the non-dipolar content of the T-wave during the initial course of ST-elevation myocardial infarction (STEMI), when local repolarization inhomogeneity presumably is markedly increased. Twelve-lead ECG was semicontinuously collected in 211 patients with STEMI, treated with a thrombolytic agent. The T-wave was processed by principal component analysis. The absolute and relative T-wave residues were used as measures of the non-dipolar content. The median values for each hour and for the entire monitoring time were computed. Changes in the parameters were closer studied in two windows, 0-10 respectively, 11-24 h after start of ECG-monitoring. The median of the absolute T-wave residue during the entire monitoring period was 25 000 units in the STEMI-group and 13 500 units in the comparison group. The median for hour 1 was 36 500 units and 28 800 units for hour 2. The decrease was greater in patients with >or=50% resolution of the ST-elevation at 60 min. The moment of change, identified by cumulative sum-method, showed no correlation to the time for 50% ST-resolution. We conclude, that patients with thrombolysed STEMI have an increased non-dipolar content of the T-wave. Resolution of the ST-elevation is associated with a decrease. The increased non-dipolar content reflects a property of the repolarization phase, which is related to but separated from the ST-elevation.

  • 120.
    Kjellin, Lars
    et al.
    Örebro University, Department of Clinical Medicine.
    Engström, Ingemar
    Örebro University, Department of Clinical Medicine.
    Tvångsvård av barn och ungdomar saknar enhetlig, nationell praxis: enkätstudie visar på stora regionala variationer2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 42, p. 3162-3164Article in journal (Refereed)
  • 121.
    Kjellin, Lars
    et al.
    Örebro University, Department of Clinical Medicine.
    Høyer, Georg
    Engberg, Marianne
    Kaltiala-Heino, Rittakerttu
    Sigurjónsdóttir, Maria
    Differences in perceived coercion at admission to psychiatric hospitals in the Nordic countries2006In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 41, no 3, p. 241-247Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: International variation in compulsory admissions to psychiatric care has mainly been studied in terms of civil commitment rates. The objectives of this study were to compare and analyse the levels of perceived coercion at admission to psychiatric in-patient care among the Nordic countries and between centres within these countries, in relation to legal prerequisites and clinical practice. METHOD: From one to four centres each in Denmark, Iceland, Norway, Finland and Sweden, a total of 426 legally committed and 494 formally voluntarily admitted patients were interviewed within 5 days from admission. RESULTS: The proportion of committed patients reporting high levels of perceived coercion varied among countries (from 49% in Norway to 100% in Iceland), and in Sweden, only, among centres (from 29 to 90%). No clear variations in this respect were found among voluntary patients. A wide concept of coercion in the Civil Commitment Act and no legal possibility of detention of voluntary patients were associated to low levels of perceived coercion at admission among committed patients. CONCLUSION: For committed patients, differences in national legal prerequisites among countries were reflected in differences in perceived coercion. The results from Sweden also indicate that local care traditions may account for variation among centres within countries.

  • 122. Klasson-Heggebø, L.
    et al.
    Andersen, L. B.
    Hurtig-Wennlöf, Anita
    Örebro University, Department of Clinical Medicine.
    Sardinha, L. B.
    Harro, M.
    Froberg, K.
    Anderssen, S. A.
    Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children and adolescents2006In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 40, no 1, p. 25-29; discussion 25Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To measure the graded relation between cardiorespiratory fitness and sum of skinfolds, waist circumference, and blood pressure in children and adolescents participating in the European youth heart study.

    METHODS:

    The participants were 4072 children and adolescents (aged 9 and 15) from Denmark, Portugal, Estonia, and Norway. Cardiorespiratory fitness was indirectly determined using a maximal ergometer cycle test. The sum of four skinfolds, waist circumference, and blood pressure were assessed with a standardised protocol. Linear regression analysis was used to test the graded relation between cardiorespiratory fitness and the dependent variables adjusted for pubertal stage, sex, and country.

    RESULTS:

    A significant curvilinear graded relation was found between cardiorespiratory fitness and waist circumference and sum of skinfolds (partial r2 for cardiorespiratory fitness was 0.09-0.26 for the different sexes and age groups). Systolic and diastolic blood pressure also showed a curvilinear relation with cardiorespiratory fitness, and fitness explained 2% of the variance in systolic blood pressure. The difference in systolic blood pressure between the least and most fit was 6 mm Hg.

    CONCLUSION:

    A curvilinear graded relation was found between cardiorespiratory fitness and waist circumference, sum of skinfolds, and systolic blood pressure. The greatest difference in these health variables was observed between low and moderate fitness levels.

  • 123.
    Kollén, Lena
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bjerlemo, Berit
    Möller, Claes
    Örebro University, Department of Clinical Medicine.
    Evaluation of treatment in benign paroxysmal positional vertigo (BPPV)2006In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 8, no 3, p. 106-115Article in journal (Refereed)
    Abstract [en]

    Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. The prognosis is good, usually with spontaneous remission within three months, but symptoms may last. Patients were consecutively evaluated before and 1, 6 and 12 months after treatment, to evaluate the long-term effects of the Semont manoeuvre and Brandt & Daroff exercises. The subjects were 17 patients (13 women and four men, mean age 52 years) who had suffered from BPPV for more than three months. The Semont manoeuvre was performed. Patients with vertigo after two Semont manoeuvres were instructed to perform Brandt & Daroff exercises. Follow-up was done by the Dix–Hallpike test, measurement of static/dynamic balance and a health questionnaire; for the vertigo, a visual analogue scale (VAS) was used. Three of 17 patients still suffered from vertigo after 12 months but the nystagmus during the Dix–Hallpike test was significantly decreased. At the end of the study, nine of 17 patients still experienced unsteadiness during standing and walking. It is of importance to perform not only manoeuvres and Brandt & Daroff exercises but also to instruct the patient in vestibular rehabilitation including static/dynamic balance exercises in order to reduce unsteadiness.

  • 124. Koskela, Anita
    et al.
    Ivarsson, M.
    Sul, Y. T.
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Svensson, B.
    In vivo and in vitro tests of adhesion to biomaterials2007Conference paper (Refereed)
  • 125. Lagerström, Folke
    et al.
    Engfeldt, Peter
    Örebro University, Department of Clinical Medicine.
    Holmberg, Hans
    C-reactive protein in diagnosis of community-acquired pneumonia in adult patients in primary care2006In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 38, no 11-12, p. 964-969Article in journal (Refereed)
    Abstract [en]

    The usefulness of non-specific inflammatory parameters for the diagnosis of community- acquired pneumonia (CAP) in primary care is not settled. The aim of this study was to assess the value of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell count (WBC) for this purpose. These inflammatory parameters, as well as the aetiological agents, were studied in 82 patients with radiologically confirmed CAP. CRP was elevated (>5 mg/l) in 76 patients, with a median value of 65 mg/l. 25 patients had a value of over 100 mg/l. In 32 patients the CRP levels were <50 mg/l and in 17 patients they were <20 mg/l. ESR varied from 5 to 100 mm/h, with a median value of 53 mm/h; in 21 patients the value was <30 mm/h. WBC varied from 4.4 to 21.4x10(9)/l, with a median value of 9.8x10(9)/l. No associations between the levels of the inflammatory parameters and the various aetiologies were found. It is concluded that the examined inflammatory parameters did not contribute notably in the routine diagnosis of CAP established by clinical measures.

  • 126. Landgren, Ola
    et al.
    Björkholm, Magnus
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Hjalgrim, Henrik
    Sjöberg, Jan
    Goldin, Lynn R.
    Askling, Johan
    Personal and family history of autoimmune diabetes mellitus and susceptibility to young-adult-onset Hodgkin lymphoma2006In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 118, no 2, p. 449-452Article in journal (Refereed)
    Abstract [en]

    Young-adult-onset (15-44 years of age) Hodgkin lymphoma (HL) is believed to arise as a consequence of late primary infection in susceptible individuals. The properties of this susceptibility remain little understood. We have previously reported an increased occurrence of HL in patients with rheumatoid arthritis and among their offspring, suggesting that susceptibility to autoimmunity might be of importance also in the pathogenesis of HL. To explore this hypothesis, we assessed the association of personal and family history of diabetes mellitus, with risk of subsequent HL in a population-based case-control study, including as cases all individuals diagnosed with HL above 15 years of age 1964-1999 (n = 6,873) in Sweden, and matched population controls (n = 12,565). First-degree relatives of cases and controls were identified through linkage with the Multi-generation Register. We identified discharges listing diabetes mellitus through linkage with the Inpatient Register (1964-2000). We used odds ratios (OR) as measures of relative risk. Cases with young-adult-onset HL were less likely to have a personal (OR =0.5, 95% CI 0.2-1.1) or family (OR =0.7, 95% CI 0.6-0.8) history of diabetes mellitus. In contrast, HL diagnosed at older ages was neither associated with a personal (OR =1.0) nor family (OR =1.0) history of diabetes mellitus. These findings suggests that characteristics of the immune system associated with conditions such as diabetes mellitus type I are of importance in the pathogenesis of young-adult-onset HL.

    Copyright 2005 Wiley-Liss, Inc.

  • 127. Langford, Richard M.
    et al.
    Rawal, Narinder
    Örebro University, Department of Clinical Medicine.
    A new needle-free PCA system: the fentanyl iontophoretic transdermal system [Editorial]2006In: Acute Pain, ISSN 1366-0071, E-ISSN 1873-6319, Vol. 8, no 4, p. 151-153Article in journal (Other academic)
  • 128. Larsson, Susanna C.
    et al.
    Bergkvist, Leif
    Rutegård, Jörgen
    Örebro University, Department of Clinical Medicine.
    Giovannucci, Edward
    Wolk, Alicja
    Calcium and dairy food intakes are inversely associated with colorectal cancer risk in the Cohort of Swedish Men2006In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 83, no 3, p. 667-673Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recent epidemiologic studies have generally reported a modest inverse association between calcium intake and the risk of colorectal cancer. However, findings pertaining to specific subsites in the colorectum have been conflicting. OBJECTIVE: Our objective was to prospectively examine the relations between intakes of calcium and dairy foods and the risk of colorectal cancer, overall and by anatomic subsite, in men from the Cohort of Swedish Men. DESIGN: In 1997, 45 306 men aged 45-79 y and without a history of cancer completed a food-frequency questionnaire. The men were followed through 31 December 2004. RESULTS: During a mean follow-up of 6.7 y, we ascertained 449 incident cases of colorectal cancer. After adjustment for age and other known or potential risk factors, the multivariate rate ratio (RR) of colorectal cancer for men in the highest quartile of total calcium intake compared with those in the lowest quartile was 0.68 (95% CI: 0.51, 0.91; P for trend = 0.01). A high consumption of dairy foods was also associated with a lower risk of colorectal cancer. The multivariate RR of colorectal cancer for > or = 7 servings/d of total dairy foods compared with <2 servings/d was 0.46 (0.30, 0.71; P for trend = 0.01). For cancer subsites, the corresponding RRs were 0.37 (0.16, 0.88) for proximal colon, 0.43 (0.20, 0.93) for distal colon, and 0.48 (0.23, 0.99) for rectum. CONCLUSION: Our findings provide support for inverse associations between intakes of calcium and dairy foods and the risk of colorectal cancer.

  • 129. Larsson, Susanna C.
    et al.
    Rutegård, Jörgen
    Örebro University, Department of Clinical Medicine.
    Bergkvist, Leif
    Wolk, Alicja
    Physical activity, obesity, and risk of colon and rectal cancer in a cohort of Swedish men2006In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 42, no 15, p. 2590-2597Article in journal (Refereed)
    Abstract [en]

    We investigated the association between physical activity and colorectal cancer risk in a cohort of Swedish men. Information on physical activity was obtained at baseline in 1997 with a self-administered questionnaire from 45,906 men who were cancer-free at enrollment. During a mean follow-up of 7.1 years, 496 cases of colorectal cancer occurred. Leisure-time physical activity was inversely associated with colorectal cancer risk; the multivariate hazard ratio (HR) for 60 min or more per day of leisure-time physical activity compared with less than 10 min per day was 0.57 (95% CI 0.41-0.79; P for trend=0.001). Results were similar for colon (HR=0.56; 95% CI 0.37-0.83) and rectal cancer (HR=0.59; 95% CI 0.34-1.02). Home/housework activity was inversely associated with colon cancer risk (HR=0.68; 95% CI 0.48-0.96). No association was observed for work/occupational activity. These results support a role of physical activity in reducing the risk of colon and rectal cancer.

  • 130.
    Larzon, Thomas
    et al.
    Örebro University, Department of Clinical Medicine.
    Friberg, Örjan
    Lund, Philip
    Eliasson, Ken
    Ågren, Göran
    Arbeus, Mikael
    Intrakardiell leiomyomatos - benign tumör som kan ge dödligt förlopp: radikal kirurgi ger säkraste resultat2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 30-31, p. 2220-2222Article in journal (Refereed)
  • 131.
    Larzon, Thomas
    et al.
    Örebro University, Department of Clinical Medicine.
    Geijer, Håkan
    Gruber, Göran
    Popek, Robert
    Norgren, Lars
    Fascia suturing of large access sites after endovascular treatment of aortic aneurysms and dissections2006In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 13, no 2, p. 152-157Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate a technique for closure of a femoral artery access in which the cribriform fascia covering the common femoral artery is sutured.

    METHODS: A consecutive series of 127 patients (103 men; median age 74 years, range 45- 89) underwent endovascular aortic aneurysm repair between August 2001 and September 2004. Twelve patients underwent a secondary intervention for a total of 139 procedures in the group. Sixty-one (43.9%) of the 139 operations were acute. Among the 257 femoral arteries used for access, a fascia suturing technique was performed in 131 (51.0%). Data were collected for analysis of access site complications, bleeding, thrombosis, pseudoaneurysm, and stenosis. A subgroup of 72 patients had ankle-brachial indexes (ABI) recorded; another subgroup of 50 patients were also investigated by duplex ultrasonography.

    RESULTS: Complications occurred in 18 (13.7%) of the 131 sutured cases. The majority (n = 16) arose within 24 hours: 8 cases of perioperative bleeding or thrombosis required open surgery and 8 cases were reoperated within 24 hours for bleeding (n = 4), thrombosis (n = 3), and 1 intimal dissection. The acute failure rate was 12.2%. Two patients had late complications: 1 case of neuralgia and 1 pseudoaneurysm that required acute surgery 28 months postoperatively. The ABI did not change significantly from pre- to postoperatively in the 72 patients examined. Five patients with stenoses did not have a reduction in ABI. In the 66 sites examined with ultrasound in 50 patients, 3 minor pseudoaneurysms were detected.

    CONCLUSION: The fascia suturing technique for closure of a femoral artery access during endovascular repair of aortic diseases is feasible, even in acute situations. Failures can be managed easily. Late complications requiring additional procedures are rare.

  • 132.
    Larzon, Thomas
    et al.
    Örebro University, Department of Clinical Medicine.
    Lindgren, Rickard
    Norgren, Lars
    Endovascular treatment of ruptured abdominal aortic aneurysms: a shift of the paradigm?2005In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 12, no 5, p. 548-555Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA) to the results with open surgery.

    METHODS: Between May 2001 and January 2004, 50 patients were diagnosed with rAAA. Fifteen (30%) patients (14 men; median age 73 years, range 58-85) underwent EVAR, while 26 (52%) patients (23 men; median age 75 years, range 60-84) had open surgery. Nine (18%) patients (5 men; median age 86 years, range 77-91) were not operated upon. Circulatory shock was defined as systolic blood pressure<80 mmHg. Mortality was defined as death within 30 days after operation; in cases where hospital stay exceeded 30 days, in-hospital mortality was registered. Five risk factors (age>76 years, loss of consciousness, hemoglobin<90 g/L, creatinine>190 micromol/L, and electrocardiographic ischemia) were analyzed.

    RESULTS: In the EVAR group, 93% (14/15) of the aneurysms were excluded from the bloodstream; there were 2 (13%) conversions: 1 intraoperatively for stent-graft migration and another owing to dissection prior to hospital discharge. Mortality after open surgery was 46% (12/26) versus 13% (2/15) in the EVAR group (p>0.05). Univariate analysis without considering variables other than mortality resulted in OR 5.4 (95% CI 0.9 to 58; p=0.07). Considering risk factors and shock, multivariate analysis resulted in OR 6.5 (95% CI 0.8 to 96; p=0.08). In the EVAR group, 60% (9/15) had complications; in the group with open surgery, the complication rate was 85% (22/26; p=0.13).

    CONCLUSIONS: It is possible to treat rAAA with EVAR. Hypotensive patients can, at least initially, be operated under local anesthesia to stabilize blood pressure utilizing a percutaneously inserted occlusion balloon. There was a trend in our study for reduced mortality and morbidity with EVAR, but further studies are required to conclude whether EVAR significantly increases survival and reduces complications.

  • 133.
    Lindberg, Hedda
    Örebro University, Department of Clinical Medicine.
    Undersökning av symmetri/asymmetri av VEP (visual evoked potentials) hos friska försökspersoner: insamling av referensmaterial för diagnostik av albinism.2009Report (Other (popular science, discussion, etc.))
    Abstract [en]

     

    Denna studie gick ut på att genomföra VEP (visual evoked potentials) hos friska försökspersoner med aviskt att undersöka synnervskorsningen (chiasma opticum). Vid VEP stimuleras synnerven till aktivitet vilken därefter kan avläsas via elektroder över syncortex. Vid chiasma opticum korsar en del av fibrerna från varje synnerv över till den andra sidan av hjärnan. De fibrer som korsar är de som kommer från näthinnans mediala delar medan de som inte korsar kommer från näthinnans temporala delar. Albinism är en sjukdom som påverkar synnerven framförallt i chiasma opticum, vilket leder till en avvikande korsning av fibrerna (oliksidig asymmetri). Vid oliksidig asymmetri korsar även temporala fibrer vid chiasma opticum. Syftet med studien var att utföra VEP anpassat för frågeställningen albinism hos friska försökspersoner. Detta skulle sedan användas som referensmaterial för att underlätta diagnostiken av albinism. I studien ingick 21 friska frivilliga försökspersoner. VEP utfördes med tre aktiva elektroder över occipitalloben, elektroderna Oz, O1, och O2 placerades enligt det internationella 10-20 systemet. Därefter stimulerades ett öga i taget med flash- och pattern reversal stimulering. Kurvorna studerades sedan visuellt samt med en mer kvantitativ metod över pattern reversal kurvorna. Resultatet tydde på att VEP med tre aktiva elektroder var en bra metod för att påvisa om oliksidig asymmetri förekom. Resultatet påvisade att asymmetri förekommer normalt hos samtliga försökspersoner. Denna påvisade asymmetri berodde dock inte på en abnorm chiasma opticum utan berodde på andra yttre faktorer. Studien resulterade i ett referensmaterial som visade att normala försökspersoner bör ha ett VEP med liknande lateralisation för de subtraherade potentialskillnadskurvorna. Både flash och pattern reversal stimuleringen påvisade oliksidig asymmetri hos en försöksperson vardera, emellertid hos olika försökspersoner. Dessa resultat ansågs vara falskt positiva. Flash gav upphov till fler artefakter, därför ansågs den visuella bearbetningen och beräkning av potentialskillnaderna över P100 vid pattern reversal stimuleringen vara en bättre metod för att utesluta diagnosen albinism.

     

  • 134. Lindbäck, Emma
    et al.
    Islam, Sohidul
    Unemo, Magnus
    Örebro University, Department of Clinical Medicine.
    Lang, Camilla
    Wretlind, Bengt
    Transformation of ciprofloxacin-resistant Neisseria gonorrhoeae gyrA, parE and porB1b genes2006In: International Journal of Antimicrobial Agents, ISSN 0924-8579, E-ISSN 1872-7913, Vol. 28, no 3, p. 206-211Article in journal (Refereed)
    Abstract [en]

    In several transformation experiments, we have shown that introduction of an alteration in GyrA at position 95 of a ciprofloxacin-susceptible Neisseria gonorrhoeae strain (minimum inhibitory concentration (MIC) 0.008 mg/L) increases the MIC to 0.064 mg/L. Two alterations (positions 91 and 95) increase the MIC to 0.125-0.25 mg/L. Transformants with ciprofloxacin MICs of 0.5-16 mg/L were obtained from a moderately ciprofloxacin-resistant strain (MIC 0.25 mg/L). These transformants had alterations in the gene for PorB1b and probably other genes. In one transformant, an alteration in ParE was also introduced, which probably contributed to ciprofloxacin resistance. The ciprofloxacin-resistant transformants had the donor porB1b sequence, and most of them also had altered serovars. We conclude that alterations in N. gonorrhoeae PorB1b could be involved in ciprofloxacin resistance.

  • 135. Lindbäck, Emma
    et al.
    Unemo, Magnus
    Örebro University, Department of Clinical Medicine.
    Akhras, Michael
    Gharizadeh, Baback
    Fredlund, Hans
    Örebro University, Department of Clinical Medicine.
    Pourmand, Nader
    Wretlind, Bengt
    Pyrosequencing of the DNA gyrase gene in Neisseria species: effective indicator of ciprofloxacin resistance in Neisseria gonorrhoeae2006In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 114, no 12, p. 837-841Article in journal (Refereed)
    Abstract [en]

    The quinolone resistance determining region (QRDR) of the gyrA gene in ciprofloxacin-susceptible strains (n=53) and strains of Neisseria spp. with reduced susceptibility (n=70) was determined by the pyrosequencing method. Results showed that the QRDR of the gyrA gene is an effective molecular indicator of resistance to ciprofloxacin in Neisseria gonorrhoeae, and presumably in Neisseria meningitidis, but not in all other Neisseria spp. This sequence was not unique for N. gonorrhoeae and seems unsuitable for species verification of N. gonorrhoeae. However, whether it is also possible to use this region for verification depends on the specificity of the primary screening method used.

  • 136.
    Ludvigsson, Jonas F.
    Örebro University, Department of Clinical Medicine.
    Epidemiological study of constipation and other gastrointestinal symptoms in 8000 children2006In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 5, p. 573-580Article in journal (Refereed)
    Abstract [en]

    AIM: Adult studies indicate that gastrointestinal symptoms vary with sex and socioeconomic status. We examined socioeconomic factors, infant sex, smoking and gastrointestinal symptoms, especially constipation, in 2.5 year-old children. METHODS: This study was part of a prospective cohort study of children born 01.10.97-01.10.99 (the ABIS study; All Babies in Southeast Sweden). Socioeconomic factors, infant sex, smoking were analyzed vs. constipation, diarrhoea, anorexia, abdominal pain, meteorism and vomiting using logistic regression. All data were obtained through questionnaires distributed at infant birth, at 1 and 2.5 years of age. RESULTS: Out of 8341 children, 539 (6.5%) suffered from constipation. In a backward stepwise regression analysis (AOR; and 95% CI AOR = are given within brackets), constipation correlated with low maternal education (1.60; 1.08-2.35), female sex (1.52; 1.23-1.85), living in a large community with >3000 inhabitants (1.35; 1.09-1.64) and having no older siblings (1.28; 1.04-1.59). Smoking during pregnancy was linked to diarrhoea (multivariate analysis: 1.76; 1.02-3.02), anorexia (univariate analysis: 1.43; 1.09-1.87) and meteorism (univariate analysis: 1.58; 1.11-2.27). Adjusting for confounders, paracetamol use was linked to a five-fold increased risk of anorexia (5.12; 1.26-20.70). CONCLUSIONS: This study indicates that socioeconomic status, infant sex and parental smoking, are associated with gastrointestinal symptoms in children.

  • 137.
    Ludvigsson, Jonas F.
    Örebro University, Department of Clinical Medicine.
    Kort om kohort2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 12, p. 943-944Article in journal (Refereed)
  • 138.
    Ludvigsson, Jonas F.
    et al.
    Örebro University, Department of Clinical Medicine.
    Askling, J.
    Ekbom, A.
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Diagnosis underlying appendectomy and coeliac disease risk2006In: Digestive and Liver Disease, ISSN 1590-8658, E-ISSN 1878-3562, Vol. 38, no 11, p. 823-828Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Earlier studies suggest that appendectomy is associated with a substantially reduced risk of certain types of bowel inflammation such as ulcerative colitis, particularly where the underlying diagnosis is acute appendicitis. Previous research on appendectomy and coeliac disease is inconsistent, based on small numbers with retrospective data collection, and has not differentiated between different diagnoses underlying appendectomy.

    OBJECTIVE:

    To investigate the association of diagnosis underlying appendectomy with coeliac disease.

    METHODS:

    We used Cox regression to study the risk of later appendectomy in more than 14,000 individuals with coeliac disease and 68,000 referents without coeliac disease, identified through the Swedish National Registers 1964-2003, and conditional logistic regression to study the risk of coeliac disease associated with a history of prior appendectomy. Appendectomy was categorised according to the underlying diagnosis: perforated appendicitis, non-perforated appendicitis, and appendectomy without appendicitis.

    RESULTS:

    Overall, coeliac disease was negatively associated with perforated appendicitis (hazard ratio=0.78, 95% confidence interval=0.60-1.01), not associated with non-perforated appendicitis (hazard ratio=1.11, 95% confidence interval=0.99-1.25), but positively associated with appendectomy without appendicitis (hazard ratio=1.58, 95% confidence interval=1.32-1.89). The magnitudes of the relative risks were similar irrespective of whether coeliac disease occurred prior to or after appendectomy.

    CONCLUSION:

    Coeliac disease and perforated appendicitis are negatively associated irrespective of the timing of the conditions. Not surprisingly, CD increases the risk for appendectomy without appendicitis.

  • 139.
    Ludvigsson, Jonas F.
    et al.
    Örebro University, Department of Clinical Medicine.
    Eylert, Maike
    Ilonen, Jorma
    Ludvigson, Johnny
    Vaarala, Outi
    Effect of HLA DQ2, dietary exposure and coeliac disease on the development of antibody response to gliadin in children2006In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, no 8, p. 919-928Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the effect of HLA DQ2, dietary history and development of coeliac disease (CD) on the induction of antibody response to wheat gliadin and cow's milk, beta-lactoglobulin between 1 and 2.5 years of age in children who developed CD and in healthy children. MATERIAL AND METHODS: Infants participating in a birth cohort study (the ABIS study) in Sweden were studied. Thirty-nine children developed CD (=cases), confirmed through biopsy, during follow-up until 2.5-5 years of age. A total of 181 healthy control children were matched for duration of exclusive breast-feeding, birth-weight, gender, maternal smoking and season of birth. IgG and IgA antigliadin and anti-beta-lactoglobulin antibodies were measured using enzyme immunoassay (EIA). The effects of HLA-risk genotypes, DQ2 and DQ8, on CD were also considered. RESULTS: Children who developed CD had higher IgG and IgA antigliadin and anti-beta-lactoglobulin antibody levels at 1 year of age than controls (all comparisons: p<0.001). Similar differences were seen between cases with as yet undiagnosed CD by 1 year of age and controls, and also when cases were compared with HLA-matched controls. Higher levels of IgG and IgA antibodies to beta-lactoglobulin (p=0.003; p=0.001), but not to gliadin, were found in treated cases versus controls at 2.5 years of age. HLA-DQ2-positive healthy children had lower levels of IgG and IgA antigliadin antibodies than HLA-DQ2 negative controls at 1 year of age (p=0.004; p=0.012). CONCLUSIONS: Enhanced humoral response emerging not only to gliadin, but also to other food antigens seems to be primarily associated with CD. Poor induction of antibody response to wheat gliadin in healthy children with the HLA-DQ2 risk molecule could at least partly explain the genetic predisposition to gluten intolerance and CD.

  • 140.
    Ludvigsson, Jonas F.
    et al.
    Örebro University, Department of Clinical Medicine.
    Ludvigsson, Johnny
    Ekbom, Anders
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Celiac disease and risk of subsequent type 1 diabetes: a general population cohort study of children and adolescents2006In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 29, no 11, p. 2483-2488Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    Earlier studies suggest that children with type 1 diabetes are more likely to have a subsequent diagnosis of celiac disease. However, research is sparse on the risk of subsequent type 1 diabetes in individuals with celiac disease. We sought to determine the risk of subsequent type 1 diabetes diagnosed before the age of 20 years in children and adolescents with celiac disease in a national, general population-based cohort.

    RESEARCH DESIGN AND METHODS:

    We identified 9,243 children with a diagnosis of celiac disease in the Swedish national inpatient register between 1964 and 2003. We then identified five reference individuals matched at time of diagnosis for age, calendar year, sex, and county (n = 45,680). Only individuals with >1 year of follow-up after study entry (diagnosis of celiac disease) were included in the analyses.

    RESULTS:

    Celiac disease was associated with a statistically significantly increased risk of subsequent type 1 diabetes before age 20 years (hazard ratio 2.4 [95% CI 1.9-3.0], P < 0.001). This risk increase was seen regardless of whether celiac disease was first diagnosed between 0 and 2 (2.2 [1.7-2.9], P < 0.001) or 3 and 20 (3.4 [1.9-6.1], P < 0.001) years of age. Individuals with prior celiac disease were also at increased risk of ketoacidosis or diabetic coma before the age of 20 years (2.3 [1.4-3.9], P = 0.001).

    CONCLUSIONS:

    Children with celiac disease are at increased risk of subsequent type 1 diabetes. This risk increase is low considering that 95% of individuals with celiac disease are HLA-DQ2 positive.

  • 141.
    Ludvigsson, Jonas F.
    et al.
    Örebro University, Department of Clinical Medicine.
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Ekbom, Anders
    Coeliac disease in the father and risk of adverse pregnancy outcome: a population-based cohort study2006In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, no 2, p. 178-185Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The risk of adverse foetal outcomes was investigated in offspring to men with coeliac disease (CD) diagnosed prior to infant birth and in offspring to men who did not receive a diagnosis of CD until after the delivery.

    MATERIAL AND METHODS:

    A cohort study was based on national registry data restricted to women aged 15-44 years with singleton live-born infants, with linkage between the Swedish national birth registry (1973-2001) and the national inpatient registry (1964-2001). A total of 1059 offspring to men who had received a diagnosis of CD were included: 554 offspring to men diagnosed prior to birth and 505 offspring to men diagnosed after infant birth.

    RESULTS:

    Undiagnosed CD in the father was associated with an increased risk of caesarean section (adjusted odds ratio (AOR)=1.83; 95% confidence interval (CI) for AOR=1.13-2.95; p=0.014) but was otherwise not linked to adverse pregnancy outcome: (intrauterine growth retardation (OR=1.37; 95% CI=0.91-2.07), low birth-weight (OR=1.41; 95% CI=0.93-2.12), very low birth-weight (OR=1.21; 95% CI=0.39-3.77), preterm birth (OR=1.10; 95% CI=0.74-1.62), and very preterm (OR=0.62; 95% CI=0.09-4.40)). A paternal diagnosis of CD made before infant birth was not associated with adverse foetal outcome.

    CONCLUSIONS:

    CD in the father is not a risk factor for unfavourable foetal outcome. The increased risk for caesarean section in offspring to men with undiagnosed CD in this study may be due to multiple comparisons.

  • 142.
    Ludvigsson, Jonas F.
    et al.
    Örebro University, Department of Clinical Medicine.
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Olén, Ola
    Ekbom, Anders
    Ludvigsson, Johnny
    Fored, Michael
    Coeliac disease and risk of renal disease: a general population cohort study2006In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 21, no 7, p. 1809-1815Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Coeliac disease (CD) may be a risk factor for renal disease.

    METHODS:

    We investigated the risk of any form of glomerulonephritis (GN) (acute, chronic and non-specified), chronic glomerulonephritis (CGN) and renal replacement therapy including dialysis treatment and kidney transplantation (KT) in patients with CD in a general population-based cohort study. We used Cox regression to assess the risk of renal disease in 14,336 patients who had received a diagnosis of CD (1964-2003) and 69,875 reference individuals matched for age, calendar year, sex and county. Patients were identified using the Swedish Hospital Discharge Registry. Follow-up began 1 year after study entry.

    RESULTS:

    CD was associated with an increased risk of any form of GN (hazard ratio (HR) = 1.64; 95% confidence intervals (CI) = 1.01-2.66; P = 0.046; 89 events), CGN (HR = 2.65; 95% CI = 1.34-5.24; P = 0.005; 39 events), dialysis (HR = 3.48; 95% CI = 2.26-5.37; P < 0.001; 102 positive events) and KT (HR = 3.15; 95% CI = 1.29-7.71; P = 0.012; 22 events).

    CONCLUSION:

    We suggest that immune characteristics associated with CD increase the risk of chronic renal disease. Individuals with CD may also be at a moderately increased risk of any form of GN.

  • 143.
    Lundberg, Gunilla A.
    Örebro University, Department of Clinical Medicine.
    A rapid one-tube PCR method for simultaneously differentiating homozygotes and heterozygotes of the Sp1 binding site polymorphism in collagen type I alpha 12007In: Molecular and Cellular Probes, ISSN 1044-7431, E-ISSN 1095-9327, Vol. 21, no 3, p. 239-241Article in journal (Refereed)
    Abstract [en]

    Rapid detection of single-base changes is fundamental to molecular medicine. PCR amplification of specific alleles (PASA) has previously been used as a rapid method of genotyping single-nucleotide changes, but one reaction is required for each allele. This paper describes a Bidirectional PASA (Bi-PASA) method, which was developed to distinguish between homozygotes and heterozygotes in one PCR reaction. The method is tested using the Sp1 polymorphism in Collagen type la I. The results demonstrate that Bi-PASA is a simple and rapid method for detecting the zygosity of the polymorphism in a single PCR reaction. (c) 2006 Elsevier Ltd. All rights reserved.

  • 144. Lundbäck, David
    et al.
    Fredlund, Hans
    Örebro University, Department of Clinical Medicine.
    Berglund, Torsten
    Wretlind, Bengt
    Unemo, Magnus
    Örebro University, Department of Clinical Medicine.
    Molecular epidemiology of Neisseria gonorrhoeae- identification of the first presumed Swedish transmission chain of an azithromycin-resistant strain2006In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 114, no 1, p. 67-71Article in journal (Refereed)
    Abstract [en]

    In the present study, 10 azithromycin-resistant Neisseria gonorrhoeae isolates from 6 Swedish male patients in 2004, 3 sporadic Swedish azithromycin-resistant N. gonorrhoeae isolates from recent years and one Swedish N. gonorrhoeae isolate from 2003 that was susceptible to azithromycin but assigned the same serological variant (serovar), i.e. IB-37, as the isolates from 2004 were included. The isolates were characterized phenotypically using antibiograms and serovar determination and genetically with pulsed-field gel electrophoresis (PFGE), entire porB gene sequencing and N. gonorrhoeae multiantigen sequence typing (NG-MAST). The epidemiological information and the results of the thorough phenotypic characterisation and genetic characterisation identified the first presumed domestic transmission of one azithromycin-resistant N. gonorrhoeae strain in Sweden in 2004. This stresses the need for continuous surveillance of the antibiotic susceptibility of N. gonorrhoeae in order to identify emergence of new resistance, monitor the changing patterns of the susceptibility, and be able to update treatment recommendations on a regular basis.

  • 145. Lundstedt, G.
    et al.
    Edlund, B.
    Engström, Ingemar
    Örebro University, Department of Clinical Medicine.
    Thurfjell, B.
    Marcus, C.
    Eating disorder traits in obese children and adolescents2006In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 11, no 1, p. 45-50Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate the prevalence of eating disorder (ED) traits among obese children and adolescents. The Swedish version of the Eating Disorder Inventory for Children, consisting of 11 subscales, was administered to 150 obese patients during an extensive investigation of causes and risk factors in obesity at the Karolinska University Hospital at Huddinge. Patients aged 17-18 years (N=24) had a mean body mass index (BMI) of 40.7, SD 5.31, and patients aged 8-16 (N=126) had a mean body mass index standard deviation score (BMI SDS) of 6.18, SD 1.69. These patients were compared with 201 girls with a diagnosed ED from the COEAT project and with a control group of schoolchildren. The comparison between obese girls and boys showed that adolescent obese girls scored higher than obese boys on Drive for Thinness, Bulimia and Body Dissatisfaction. They also scored higher on Ineffectiveness, Interoceptive Awareness and Impulse Regulation. Obese girls were close to the girls with an ED on six of the subscales. Obese boys had a lower score of Asceticism than boys in the control group. The conclusion is that psychological traits associated with disordered eating appear among obese patients, particularly among the girls. However, these patients rarely satisfy any diagnostic criteria for ED during childhood or adolescence. Since obesity treatment currently assumes rational behavior, i.e. no EDs, it is important to discover ED traits at an early age in order to adapt treatment accordingly.

  • 146.
    Löf, Lennart
    et al.
    Örebro University, Department of Clinical Medicine.
    Berggren, Lars
    Örebro University, Department of Clinical Medicine.
    Ahlström, Gerd
    Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay--3 and 12 months after discharge2006In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 22, no 3, p. 154-166Article in journal (Refereed)
    Abstract [en]

    There is a lack of knowledge regarding how critically ill patients recall of the ICU and their life-threatening condition changes over time. The purpose of this study is to describe critically ill and ventilator-treated patients' recollections of both factual events and unreal experiences at 3 and 12 months following discharge from the ICU. The study is qualitative and encompasses nine critically ill ICU patients, ventilator-treated for more than 72 h. The participants were interviewed twice, at 3 and 12 months after their discharge from the ICU. The interviews were analysed using qualitative content analysis. The patients in this study reported unreal experiences, memory confusion and/or disturbances before admittance to the ICU and before their respirator treatment. Their "unreal experiences" were far clearer than their memories of factual occurrences. Patients' fragmentary memories of factual events and their recall of unreal experiences were practically unchanged after 12 month. Their unreal experiences could still be recalled and related after 12 months, but not with the same expression and feeling as earlier (3 months). The unreal experiences were not - after 12 months - their initial recollections, as they had been after 3 months. Conclusions: Patients' recollections of both factual events and unreal experiences show very little variation between 3 and 12 months. The stability of long-term memory after 12 months shows that the recollection of their experiences had been both traumatic and emotionally charged. This study shows that critically ill patients were affected by cognitive disturbances and/or disturbed memory before their arrival at the ICU. This result indicates the need of ICU follow-up clinics.

  • 147. Matthiessen, Peter
    et al.
    Hallböök, Olof
    Rutegård, Jörgen
    Örebro University, Department of Clinical Medicine.
    Sjödahl, Rune
    Population-based study of risk factors for postoperative death after anterior resection of the rectum2006In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 93, no 4, p. 498-503Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this population-based study was to analyse risk factors for death within 30 days after anterior resection of the rectum. METHODS: Between 1987 and 1995 a total of 6833 patients underwent elective anterior resection of the rectum in Sweden. One hundred and forty of these patients died within 30 days or during the initial hospital stay. These patients were compared with a randomly chosen cohort of 423 patients who underwent the same operation during the same interval, and were alive after 30 days and discharged from hospital. The association between death and 12 putative risk factors was studied. RESULTS: The mortality rate after elective anterior resection was 2.1 per cent (140 of 6833). The incidence of clinical anastomotic leakage was 42.1 per cent (59 of 140) among those who died and 10.9 per cent (46 of 423) in the cohort group. Multivariate regression analysis identified clinical leakage, increased age, male sex, Dukes' 'D' stage and intraoperative adverse events as independent risk factors for death within 30 days. CONCLUSION: Clinical anastomotic leakage was a major cause of postoperative death after anterior resection.

  • 148.
    Moberg, Elin
    Örebro University, Department of Clinical Medicine.
    Sammanställnig av Quantitativ EEG metod för analys av primär demens mad fokus på lätt demens2007Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning

    Denna rapport har som syfte att sammanställa forsknings studier om Qantitativ Elektro Encephalo Grafi (QEEG) som diagnos metod för patienter med primär demens och utifrån detta försöka ta fram en metod som kan användas kliniskt.

    Primär demens finns i olika former den vanligaste är Alzheimers sjukdom som står för ca 60% av fallen om man räknar totalt. Den andra stora gruppen är vaskulär demens som beror på minskad blodtillförsel till hjärnas vävnader detta av olika orsaker. Det är också vanligt att dessa två kan vara blandade och så orsaka demensen.

    EEG används för att se elektrisk aktivitet från hjärnans yta och av det erhålles en bild av funktionen. Vid demens blir EEG långsammare och detta är vad man letar efter när man genom QEEG försöker ställa diagnosen demens.

    Åtta studier sammanfattas vad det gäller metoden för QEEG analys. Av detta togs en prov metod fram som går ut på viloregistreringar, som man sedan analyserar två 15 sekunders epoker, i 6 bipolära avledningar som ger bra täcknig av hjärnans olika områden utom det frontala där analys ej görs pga artefakter. Denna provanalys gjordes på 7 försökspersoner 3 friska och 4 dementa. Värdena från dessa analyser bearbetades numeriskt så man tog fram olika kvoter och sammanlagda energier.

    Resultaten visar att det som man får störst skillnad i mellan friska och dementa är mängden energi i alfa frekvens bandet och sedan syns en skillnad i total energi.

    Det finns flera problem som måste lösas innan detta blir en bra klinisk metod bla måste referens material tas fram för patientgrupperna som ska undersökas. Slutsatsen som kan dras är att mer jobb behövs men att detta har potential att bli en mycket användbar klinisk metod.

  • 149. Mogensen, Christian B.
    et al.
    Sörensen, Jeff
    Björkman, Anders
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Algorithm for the diagnosis of anaemia without laboratory facilities among small children in a malaria endemic area of rural Tanzania2006In: Acta Tropica, ISSN 0001-706X, E-ISSN 1873-6254, Vol. 99, no 2-3, p. 119-125Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Anaemia among small children in tropical Africa is common and often caused by infection with Plasmodium falciparum. The diagnosis of anaemia is difficult without a laboratory estimation of haemoglobin. The aim of this study was to examine if clinical findings related to malaria and anaemia would help to detect moderate and/or severe anaemia in children in rural Tanzania.

    METHODS:

    Children between 6 and 36 months were examined by health workers in an Out Patient Department (OPD) to detect severe anaemia (packed cell volume, PCV< or =20%) and in a cross sectional survey at village level to identify moderate anaemia (PCV 21-25%). History of recent fever and treatments was recorded and a clinical examination was performed.

    FINDINGS:

    In the survey, comparison of 65 moderately anaemic children with 373 mild/non anaemic children revealed no differences in history of fever or in the clinical examination. In the OPD comparison of 100 severely anaemic children with 116 non-severely anaemic control children revealed that pallor, respiratory rate, number of fever days last week, deteriorated general condition, heart rate, age, splenomegaly, low body weight and elevated body temperature were all indicators of severe 'anaemia, only pallor, respiratory rate, fever days and palpable spleen however, remained associated with severe anaemia in multiple regression analysis. The combination of any pallor and either respiratory rate >55/min or fever >3 days, could predict severe anaemia with a sensitivity of 96% and a specificity of 71%. This was better than the currently recommended signs of severe pallor or an approximation of the Integrated Management of Childhood Illness (IMCI) criteria's for referral of children.

    INTERPRETATION:

    At primary health care level detection of severe anaemia can be improved by information about fever duration and determination of respiratory rate in children with pallor.

  • 150.
    Montgomery, Scott M.
    et al.
    Örebro University, Department of Clinical Medicine.
    Ehlin, A.
    Sacker, A.
    Breast feeding and resilience against psychosocial stress2006In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 91, no 12, p. 990-994Article in journal (Refereed)
    Abstract [en]

    Background: Some early life exposures may result in a well controlled stress response, which can reduce stress related anxiety. Breast feeding may be a marker of some relevant exposures.

    Aims: To assess whether breast feeding is associated with modification of the relation between parental divorce and anxiety.

    Methods: Observational study using longitudinal birth cohort data. Linear regression was used to assess whether breast feeding modifies the association of parental divorce/separation with anxiety using stratification and interaction testing. Data were obtained from the 1970 British Cohort Study, which is following the lives of those born in one week in 1970 and living in Great Britain. This study uses information collected at birth and at ages 5 and 10 years for 8958 subjects. Class teachers answered a question on anxiety among 10 year olds using an analogue scale (range 0–50) that was log transformed to minimise skewness.

    Results: Among 5672 non-breast fed subjects, parental divorce/separation was associated with a statistically significantly raised risk of anxiety, with a regression coefficient (95% CI) of 9.4 (6.1 to 12.8). Among the breast fed group this association was much lower: 2.2 (−2.6 to 7.0). Interaction testing confirmed statistically significant effect modification by breast feeding, independent of simultaneous adjustment for multiple potential confounding factors, producing an interaction coefficient of −7.0 (−12.8 to −1.2), indicating a 7% reduction in anxiety after adjustment.

    Conclusions: Breast feeding is associated with resilience against the psychosocial stress linked with parental divorce/separation. This could be because breast feeding is a marker of exposures related to maternal characteristics and parent–child interaction.

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