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  • 151.
    Montgomery, Scott M.
    et al.
    Örebro University, Department of Clinical Medicine.
    Ehlin, A.
    Sacker, A.
    Pre-pubertal growth and cognitive function2006In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 91, no 1, p. 61-62Article in journal (Refereed)
    Abstract [en]

    British longitudinal data were used to investigate the association of heights at 22 months and 5 years with a digit recall test at age 10 years. Greater height, particularly at 5 years, was associated with higher scores, suggesting that some exposures influence both growth and capability for cognitive function.

  • 152. Morita, M.
    et al.
    Al-Chalabi, A.
    Andersen, P. M.
    Hosler, B.
    Sapp, P.
    Englund, E.
    Mitchell, J. E.
    Habgood, J. J.
    de Belleroche, J.
    Xi, J.
    Jongjaroenprasert, W.
    Horvitz, H. R.
    Gunnarsson, Lars-Gunnar
    Örebro University, Department of Clinical Medicine.
    Brown, R. H.
    A locus on chromosome 9p confers susceptibility to ALS and frontotemporal dementia2006In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 66, no 6, p. 839-844Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To perform genetic linkage analysis in a family affected with ALS and frontotemporal dementia (FTD). METHODS: The authors performed a genome-wide linkage analysis of a four-generation, 50-member Scandinavian family in which five individuals were diagnosed with ALS and nine with FTD. Linkage calculations assuming autosomal dominant inheritance of a single neurodegenerative disease manifesting as either ALS or FTD with age-dependent penetrance were performed. Further analyses for ALS alone and FTD alone were performed. A parametric logarithm of odds (lod) score of 2.0 or greater was required for further study of a potential locus and crossover (haplotype) analysis. RESULTS: A new ALS-FTD locus was identified between markers D9s1870 and D9s1791 on human chromosome 9p21.3-p13.3. A maximum multipoint lod score of 3.00 was obtained between markers D9s1121 and D9s2154. Crossover analysis indicates this region covers approximately 21.8 cM, or 14Mb. CONCLUSIONS: A locus on chromosome 9p21.3-p13.3 is linked to ALS-FTD.

  • 153.
    Myrin, Jan
    Örebro University, Department of Clinical Medicine.
    Hjärtfrekensvariabilitet: Forskningsöversikt samt upprättande av metod för kliniskt bruk med speciellt fokus på störningars inverkan på resultat2006Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Avsikten med arbetet är att genom litteraturstudier teckna en bild av dagens kunskapsläge då det gäller HRV-metoden, se vid vilka sjukdomar/tillstånd som HRV idag anses ge kliniskt intressant information, söka/finna felkällor som ligger i metodens analysarbete och upprätta en metodbeskrivning för kliniskt bruk beträffande HRV analys vid bandspelarregistrering av EKG, samt genom en experimentell del undersöka om störningar i form av muskel och rörelseartefakter försvårar/omöjliggör analysen av holterregistrering för HRV-analys.

  • 154.
    Möller, Claes
    Örebro University, Department of Clinical Medicine.
    Alström syndrom2006In: Medicinsk axess : vetenskaplig, oberoende medicinsk tidskrift, ISSN 1652-9782, no 3, p. 70-73Article in journal (Refereed)
  • 155.
    Möller, Claes
    Örebro University, Department of Clinical Medicine.
    Genetisk diagnostik av hörselnedsättningar2004In: Incitament : för en hälso- & sjukvård i förvandling, ISSN 1103-503X, no 13, p. 175-178Article in journal (Other academic)
  • 156.
    Möllgård, Lars
    et al.
    Karolinska Institutet.
    Prenkert, Malin
    Örebro University, Department of Nursing and Caring Sciences.
    Smolowicz, Adam
    Paul, Christer
    Karolinska Institutet.
    Tidefelt, Ulf
    Örebro University, Department of Clinical Medicine.
    In vitro chemosensitivity testing of selected myeloid cells in acute myeloid leukemia 2003In: Leukemia and Lymphoma, ISSN 1042-8194, E-ISSN 1029-2403, Vol. 44, no 5, p. 783-789Article in journal (Refereed)
    Abstract [en]

    In several studies different chemosensitivity assays have been examined in acute myeloid leukemia (AML). Some have shown that in vitro chemosensitivity testing is an independent prognostic factor but so far no one has been able to show that the use of these methods can improve treatment outcome. In an attempt to improve in vitro chemosensitivity testing in AML we wanted to establish and evaluate a new flow cytometry chemosensitivity assay. After 4 days of incubation viable mononuclear myeloid cells were identified by the exclusion of propidium iodide in CD13 or CD33 positive cells. Sixty-eight samples from 64 AML patients were included. In this study, we showed that the flow cytometry method is feasible in AML and we also found some correlations to clinical data. The secondary AML at diagnosis showed an in vitro resistance to etoposide and amsacrine that was significantly higher compared to de novo AML at diagnosis (p = 0.04 and p = 0.02). When AML patients at diagnosis were compared to resistant disease/relapse patients there was a significantly higher effect of ara-C in the diagnosis group (p = 0.03). Responders and non-responders were compared in vitro but we found no significant differences. In vitro mitoxantrone was more effective in multidrug resistance (MDR) negative cells compared to MDR positive cells (p < 0.01). This new method is feasible and makes it possible to selectively evaluate the effect of cytotoxic drugs in myeloid cells. Further studies with a larger group of patients are needed to evaluate the predictive value of the assay.

  • 157.
    Neander, Kerstin
    et al.
    Örebro University, Department of Clinical Medicine.
    Skott, Carola
    Important meetings with important persons: narratives from families facing adversity and their key figures2006In: Qualitative Social Work, ISSN 1473-3250, E-ISSN 1741-3117, Vol. 5, no 3, p. 295-311Article in journal (Refereed)
    Abstract [en]

    In this study families that have struggled with their relationships to their children have identified people who have had a positive influence on the child or the family. By enabling meetings between the parents and these key figures the participants were given an opportunity to together recall their contact. The aim of the study was to examine the understanding they constructed of these beneficial processes. Interpretation according to Max van Manen’s hermeneuticp-phenomenological method led to the crystallization of a number of central themes. These themes together constitute the following whole: these are narratives about ‘emerging mutual trust’, which ‘overcomes obstacles’. The key figures or ‘important persons’ have a ‘clear orientation’ in their occupation and they work in ‘the essential everyday world’ to find and establish ‘contexts that nourish development’ in children and parents. The outcome of this is the creation of ‘new narratives’ that replace the old ones.

  • 158. Netuveli, Gopalakrishnan
    et al.
    Wiggins, Richard D.
    Hildon, Zoe
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Blane, David
    Quality of life at older ages: evidence from the English longitudinal study of aging (wave 1)2006In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 60, no 4, p. 357-363Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate whether longstanding illnesses, social context, and current socioeconomic circumstances predict quality of life.

    Design: Secondary analysis of wave 1 of the English longitudinal study of aging. Missing data were imputed and multiple regression analyses conducted.

    Setting: England, 2002

    Participants: Nationally representative sample of non-institutionalised adults living in England (n = 11 234, 54.5% women, age 65.1 (SD 10.2) years).

    Main outcome measure: Quality of life as measured by CASP-19, a 19 item Likert scaled index.

    Results: The quality of life was reduced by depression (β −0.265), poor perceived financial situation (β −0.157), limitations in mobility (β −0.124), difficulties with everyday activities (β −0.112), and limiting longstanding illness (β −0.112). The quality of life was improved by trusting relationships with family (β 0.105) and friends (β 0.078), frequent contacts with friends (β 0.059), living in good neighbourhoods (β 0.103), and having two cars (β 0.066). The regression models explained 48% variation in CASP-19 scores. There were slight differences between age groups and between men and women.

    Conclusions: Efforts to improve quality of life in early old age need to address financial hardships, functionally limiting disease, lack of at least one trusting relationship, and inability to move out of a disfavoured neighbourhood. There is the potential for improved quality of life in early old age (the third age) if these factors are controlled.

  • 159.
    Nevonen, Lauri
    et al.
    Örebro University, Department of Clinical Medicine.
    Broberg, Anders G
    A comparison of sequenced individual and group psychotherapy for patients with bulimia nervosa2006In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 39, no 2, p. 117-127Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The current study examined the effectiveness of individual (IND) versus group (GRP) therapy for patients with bulimia nervosa (BN), using a manual of sequenced treatment with cognitive-behavioral therapy (CBT) followed by interpersonal psychotherapy (IPT). METHOD: Eighty-six participants with BN were matched and randomized to 23 sessions of IND or GRP. Participants were measured pretreatment and posttreatment and at 1-year and 2.5-year follow-ups using both intent-to-treat and completer samples. RESULTS: The intent-to-treat analysis revealed that the percentage of participants recovered and remitted was equivalent between IND and GRP. Significant group differences were found between completers on binge eating and compensatory behavior with greater improvement for IND. On most measures, effect sizes were larger for IND at 1-year follow-up. CONCLUSION: Sequencing CBT and IPT worked well in both IND and GRP formats. We found few outcome differences between IND as opposed to GRP.

  • 160.
    Nevonen, Lauri
    et al.
    Örebro University, Department of Clinical Medicine.
    Clinton, David
    Norring, Claes
    Validating the EDI-2 in three Swedish female samples: eating disorders patients, psychiatric outpatients and normal controls2006In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 60, no 1, p. 44-50Article in journal (Refereed)
    Abstract [en]

    The aim of the current study was to validate the Eating Disorders Inventory 2 (EDI-2) in a Swedish population by investigating how it discriminates between three female samples aged 18 to 50 years: patients with eating disorders (n = 978), psychiatric outpatients (n = 106) and normal controls (n = 602), as well as between different eating disorder diagnoses. The internal consistency of the EDI-2 was above 0.70 for most subscales. The EDI-2 discriminated well between patients with eating disorders and normal controls on all subscales. On the symptom-related subscales, eating disorder patients scored highest followed by psychiatric controls and normals. All subscales except Perfectionism, Interoceptive awareness and Asceticism discriminated eating disorder patients and psychiatric controls. Bulimia patients scored higher than anorexics on the symptom subscales. It is concluded that the EDI-2 discriminates well between eating disorder patients and both psychiatric and normal controls.

  • 161.
    Nikitidou, Litsa
    Örebro University, Department of Clinical Medicine.
    Påverkan av vaskulär endotelial tillväxtfaktorreceptor 2 på temporallobsepilepsi hos möss2008Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Vascular endothelial growth factor (VEGF) has been proven to have neuroprotective effects in the central nervous system. After epileptic seizure the expression of VEGF is increased to protect the cells from dying. The aim of this study was to examine whether an overexpression of the vascular endothelial growth factor receptor 2 (VEGFR-2) has an impact on the development of epilepsy and the epileptic seizures. Mice with overexpression of VEGFR-2 and wild-type mice, as control, were used. Electrode implantations were made where an electrode was implanted in the ventral hippocampus and one reference electrode in the temporal muscle. Kindling, an animal model for stimulation was used, to give the animals epileptic seizures. The mice were stimulated once a day at their threshold, which is the current which leads to at least five second discharge seen on the electroencephalogram (EEG). They were stimulated until they got three stage 5 seizures. Four weeks after the last stimulation the threshold was remeasured. Results showed that there was a difference in the threshold measurements before kindling and a significance in the duration of stage 0, 1 and 2. This shows that there is a protection against the development of epilepsy.

  • 162.
    Nilsagård, Ylva
    et al.
    Örebro University, Department of Clinical Medicine.
    Denison, Eva
    Gunnarsson, Lars-Gunnar
    Örebro University, Department of Clinical Medicine.
    Evaluation of a single session with cooling garment for persons with multiple sclerosis: a randomized trial2006In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, Vol. 1, no 4, p. 225-233Article in journal (Refereed)
  • 163.
    Nilsagård, Ylva
    et al.
    Örebro University, Department of Clinical Medicine.
    Hammer, Ann
    Örebro University, Department of Clinical Medicine.
    Timed up and go – ett test i tiden: en litteraturöversikt2003In: Nordisk Fysioterapi, ISSN 1402-3024, Vol. 7, no 3, p. 32-48Article, review/survey (Refereed)
    Abstract [en]

    The Timed Up and Go-test (TUG) measures balance/physical mobility. The aim of this review was to illustrate TUG's developmental steps, describe the different modifications of TUG and the efforts that has been made to test validity and reliability and finally in what other types of studies it have been used. A literature search in Medline and Cinahl was carried through and resulted in 100 abstracts that were analyzed and categorized according to their content. Some variants of TUG describe adding a manual or cognitive task and calculating the difference in time between TUG and TUG manual/ cognitive; diffTUG. Reliability and validity has been demonstrated to be high for older people. There is some disagreement regarding TUG's predictive value for falls. TUG has been used in effect-, survey- and correlationstudies, and as criterioninstrument as well as in reviews. TUG may in it's simplicity be recommended both in clinical environment and for research purposes, especially for older people.

  • 164.
    Nilsagård, Ylva
    et al.
    Örebro University, Department of Clinical Medicine.
    Lundholm, Cecilia
    Gunnarsson, Lars-Gunnar
    Örebro University, Department of Clinical Medicine.
    Denison, Eva
    Clinical relevance using timed walk tests and 'timed up and go' testing in persons with multiple sclerosis2007In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 12, no 2, p. 105-14Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: One must understand the potentials and limitations of all tests used to evaluate interventions. The aim of the present study was to clarify the reproducibility, smallest percentage difference needed to be able to detect a genuine change and correlation regarding the 10-m and 30-m timed walks (10TW 30TW) and the 'timed up and go' (TUG) test in people with moderate multiple sclerosis (MS).

    METHOD: A repeated-measures design was used, with randomization into two groups and different time intervals used for testing. The 10TW and 30TW were performed three times and TUG twice at each testing. Self-selected speed was used for 10TW and forced speed (quickly but safely) for 30TW and TUG. Forty-three people were tested on three occasions within one week. Each person was tested at approximately the same time of the day and by the same physiotherapist on each occasion.

    RESULTS: The reproducibility was very high. For a single testing occasion, the intraclass correlation was 0.97 for the 10TW and 0.98 for the 30TW and TUG. The smallest percentage difference needed to be able to detect a genuine change in the entire study group was approximately -23% or +31% for either the 1OTW or TUG. It was evident from the 30TW testing results that lower values applied to those with less (-14% to +17%) rather than more (-38% or +60%) disability. The correlation between all tests for the entire study group was 0.85 (0.76-0.91).

    CONCLUSION: It is sufficient to use only one attempt and to choose only one of the tests when evaluating people with moderate MS. In the case of the 30TW greater attention must be paid to the degree of disability when determining the smallest percentage difference needed to establish a genuine change, than

  • 165.
    Nordin Olsson, Inger
    Örebro University, Department of Clinical Medicine.
    Patientfokus i läkemedelsöversyner på särskilda äldreboenden2008Conference paper (Other academic)
  • 166.
    Norén, Torbjörn
    Örebro University, Department of Clinical Medicine.
    Clostridium difficile: epidemiology and antibiotic resistance2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Clostridium difficile is a spore-forming toxin-producing intestinal bacterium abundant in soils and waters. This pathogen relies on increased growth by a disturbed intestinal microflora and the production of two cytotoxins, toxin A and toxin B, which may cause anything from mild self-limiting C. difficile associated diarrhea (CDAD) to severe and fatal pseudomembranous colitis (PMC). Typically CDAD following antibiotic therapy is due either to overgrowth of endogenous C. difficile or through spores transmitted from the environment. The hospital setting provides frequent antibiotic use and the source of numerous infective spores from CDAD patients, the environment or nursing staff. Today we experience a 10-fold increase of incidence in the US and Canada (1991-2003) apparently due to a current epidemic C. difficile strain (NAP1/027). Current incidence from Canada is estimated to 156/100 000 compared to 50/100 000 in Sweden 1995.

    In the following thesis, investigations of CDAD in Örebro County in central Sweden resulted in the discovery an epidemic nosocomial C. difficile strain (SE17, serogroup C), found to be clindamycin-resistant. The majority of the isolates carried a gene (ermB) related to this resitance. We found an overall incidence during 1999-2000 of 97/100 000 or, if including recurrent episodes, 135/100 000 i.e. more than 100% increase since 1995. The incidence among hospitalized individuals was 1300-fold that in the community and 78% of episodes were classified as hospital-associated. This reflects a 37-fold difference in antibiotic consumption, as well as the predominance of the resistant SE17 hospital-associated strain (22% of hospital isolates compared to 6% of community isolates, p=0.008). Only 10% of the recurrent cases were found to be reinfections indicating that CDAD is mainly caused by endogenous strains and not by hospital transmission.

    Recent reports on failure of standard metronidazole therapy urge for alternative treatment agents and fusidic acid has been proven as effective in the treatment of CDAD. We could verify this, but in both treatment groups we found that persistence of C. difficile isolates post-treatment related to an increased risk of recurrent CDAD compared to the patients who were culture negative at follow-up (p=0.03). Most importantly, 55% of patients with follow-up isolates and who had been treated with fusidic acid, the strains had developed fusidic acid resistance. The corresponding pre-treatment identity of isolate genotype indicated selection of mutants. Relating to the known fusA resistance mechanism in Staphylococcus aureus we used the published sequence for this gene in Clostridium perfringens and found homologous fusA in the sequence of the referent strain C. difficile 630. Comparing fusA of the resistant mutants with the initial wild-type isolates, we identified novel mutations in fusA as the genetic key to fusidic acid resistance in C. difficile.

    List of papers
    1. Clindamycin resistant strains of Clostridium difficile isolated from cases of C. difficile associated diarrhea (CDAD) in a hospital in Sweden
    Open this publication in new window or tab >>Clindamycin resistant strains of Clostridium difficile isolated from cases of C. difficile associated diarrhea (CDAD) in a hospital in Sweden
    Show others...
    2002 (English)In: Diagnostic microbiology and infectious disease, ISSN 0732-8893, E-ISSN 1879-0070, Vol. 42, no 2, p. 149-151Article in journal (Refereed) Published
    Abstract [en]

    Fifty three strains of C. difficile recovered from the stools of 13 patients with clinical C. difficile associated diarrhea (CDAD) were analyzed for the presence of the ermB gene, for toxigenicity and fingerprinting profile by PCR based assays. Forty five percent of the isolates were resistant to clindamycin and positive for the ermB gene. All clindamycin resistant isolates were ermB positive and belonged to the same fingerprinting group, suggesting clonal spread. These preliminary results suggest that clindamycin resistant isolates may be common etiologic agents of CDAD in Sweden.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3198 (URN)10.1016/S0732-8893(01)00337-6 (DOI)
    Available from: 2006-11-23 Created: 2006-11-23 Last updated: 2017-12-14Bibliographically approved
    2. Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county
    Open this publication in new window or tab >>Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county
    Show others...
    2004 (English)In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 42, no 8, p. 3635-3643Article in journal (Refereed) Published
    Abstract [en]

    All episodes of Clostridium difficile associated diarrhea (CDAD) diagnosed in a defined population of 274,000 including one tertiary and two primary hospitals and their catchment areas were studied during 12 months. The annual CDAD incidence in the county was 97 primary episodes per 100,000, and 78% of all episodes were classified as hospital associated with a mean incidence of 5.3 (range, 1.4 to 6.5) primary episodes per 1,000 admissions. The incidence among hospitalized individuals was 1,300-fold higher than that in the community (33,700 versus 25 primary episodes per 100,000 persons per year), reflecting a 37-fold difference in antibiotic consumption (477 versus 13 defined daily doses [DDD]/1,000 persons/day) and other risk factors. Three tertiary hospital wards with the highest incidence (13 to 36 per 1,000) had CDAD patients of high age (median age of 80 years versus 70 years for other wards, P < 0.001), long hospital stay (up to 25 days versus 4 days), or a high antibiotic consumption rate (up to 2,427 versus 421 DDD/1,000 bed days). PCR ribotyping of C. difficile isolates available from 330 of 372 CDAD episodes indicated nosocomial acquisition of the strain in 17 to 27% of hospital-associated cases, depending on the time interval between index and secondary cases allowed (2 months or up to 12 months), and only 10% of recurrences were due to a new strain of C. difficile (apparent reinfection). In other words, most primary and recurring episodes were apparently caused by the patient's endogenous strain rather than by one of hospital origin. Typing also indicated that a majority of C. difficile strains belonged to international serotypes, and the distribution of types was similar within and outside hospitals and in primary and relapsing CDAD. However, type SE17 was an exception, comprising 22% of hospital isolates compared to 6% of community isolates (P = 0.008) and causing many minor clusters and a silent nosocomial outbreak including 36 to 44% of the CDAD episodes in the three high-incidence wards.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-15678 (URN)10.1128/jcm.42.8.3635-3643.2004 (DOI)000223286500038 ()
    Available from: 2011-05-24 Created: 2011-05-24 Last updated: 2017-12-11Bibliographically approved
    3. Frequent emergence of resistance in Clostridium difficile during treatment of C-difficile-associated diarrhea with Fusidic acid
    Open this publication in new window or tab >>Frequent emergence of resistance in Clostridium difficile during treatment of C-difficile-associated diarrhea with Fusidic acid
    Show others...
    2006 (English)In: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 50, no 9, p. 3028-3032Article in journal (Refereed) Published
    Abstract [en]

    Samples from patients with Clostridium difficile-associated diarrhea (CDAD) that were randomized to fusidic acid (n = 59) or metronidazole (n = 55) therapy for 7 days were cultured for Clostridium difficile in feces on days 1, 8 to 13, and 35 to 40. Of the patients who were culture positive only before treatment, 77% (36/47) were permanently cured (no treatment failure and no clinical recurrence), compared to 54% (22/41) of those with persistence of C. difficile at one or both follow-ups (P = 0.03). A similar association between bacterial persistence and a worse outcome of therapy was seen in both treatment groups. Resistance to fusidic acid was found in 1 of 88 pretherapy isolates available, plus in at least 1 subsequent isolate from 55% (11/20) of patients who remained culture-positive after fusidic acid therapy. In 10 of these 11 patients, the resistant follow-up isolate(s) belonged to the same PCR ribotype as the susceptible day 1 isolate, confirming frequent emergence of resistance to fusidic acid during treatment. Despite this, 5 of these 11 patients were permanently cured with fusidic acid, relative to 5 of 9 patients with susceptible C. difficile at follow-up (P = 1.0). None of the 36 PCR ribotypes of C. difficile identified was associated with any particular clinical outcome or emergence of fusidic acid resistance. In conclusion, culture positivity for C. difficile was common after both fusidic acid and metronidazole therapy and was associated with treatment failure or recurrence of CDAD. Development of resistance in C. difficile was frequent in patients given fusidic acid, but it was without apparent negative impact on therapeutic efficacy in the actual CDAD episode.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-15679 (URN)10.1128/AAC.00019-06 (DOI)000240297000019 ()
    Available from: 2011-05-24 Created: 2011-05-24 Last updated: 2017-12-11Bibliographically approved
    4. Nucleotide polymorphisms in fusA associated with post-therapy fusidic acid resistance in Clostridium difficile
    Open this publication in new window or tab >>Nucleotide polymorphisms in fusA associated with post-therapy fusidic acid resistance in Clostridium difficile
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-15681 (URN)
    Available from: 2011-05-24 Created: 2011-05-24 Last updated: 2017-10-17Bibliographically approved
  • 167.
    Norén, Torbjörn
    et al.
    Örebro University, Department of Clinical Medicine.
    Tang-Feldman, Yayarayma
    Cohen, Stuart H.
    Silva Jr, Joseph
    Olcén, Per
    Clindamycin resistant strains of Clostridium difficile isolated from cases of C. difficile associated diarrhea (CDAD) in a hospital in Sweden2002In: Diagnostic microbiology and infectious disease, ISSN 0732-8893, E-ISSN 1879-0070, Vol. 42, no 2, p. 149-151Article in journal (Refereed)
    Abstract [en]

    Fifty three strains of C. difficile recovered from the stools of 13 patients with clinical C. difficile associated diarrhea (CDAD) were analyzed for the presence of the ermB gene, for toxigenicity and fingerprinting profile by PCR based assays. Forty five percent of the isolates were resistant to clindamycin and positive for the ermB gene. All clindamycin resistant isolates were ermB positive and belonged to the same fingerprinting group, suggesting clonal spread. These preliminary results suggest that clindamycin resistant isolates may be common etiologic agents of CDAD in Sweden.

  • 168.
    Norén, Torbjörn
    et al.
    Örebro University, Department of Clinical Medicine.
    Wullt, M.
    Åkerlund, Thomas
    Bäck, Erik
    Örebro University, Department of Clinical Medicine.
    Odenholt, I.
    Burman, L. G.
    Frequent emergence of resistance in Clostridium difficile during treatment of C-difficile-associated diarrhea with Fusidic acid2006In: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 50, no 9, p. 3028-3032Article in journal (Refereed)
    Abstract [en]

    Samples from patients with Clostridium difficile-associated diarrhea (CDAD) that were randomized to fusidic acid (n = 59) or metronidazole (n = 55) therapy for 7 days were cultured for Clostridium difficile in feces on days 1, 8 to 13, and 35 to 40. Of the patients who were culture positive only before treatment, 77% (36/47) were permanently cured (no treatment failure and no clinical recurrence), compared to 54% (22/41) of those with persistence of C. difficile at one or both follow-ups (P = 0.03). A similar association between bacterial persistence and a worse outcome of therapy was seen in both treatment groups. Resistance to fusidic acid was found in 1 of 88 pretherapy isolates available, plus in at least 1 subsequent isolate from 55% (11/20) of patients who remained culture-positive after fusidic acid therapy. In 10 of these 11 patients, the resistant follow-up isolate(s) belonged to the same PCR ribotype as the susceptible day 1 isolate, confirming frequent emergence of resistance to fusidic acid during treatment. Despite this, 5 of these 11 patients were permanently cured with fusidic acid, relative to 5 of 9 patients with susceptible C. difficile at follow-up (P = 1.0). None of the 36 PCR ribotypes of C. difficile identified was associated with any particular clinical outcome or emergence of fusidic acid resistance. In conclusion, culture positivity for C. difficile was common after both fusidic acid and metronidazole therapy and was associated with treatment failure or recurrence of CDAD. Development of resistance in C. difficile was frequent in patients given fusidic acid, but it was without apparent negative impact on therapeutic efficacy in the actual CDAD episode.

  • 169.
    Norén, Torbjörn
    et al.
    Örebro University, Department of Clinical Medicine.
    Åkerlund, T.
    Bäck, Erik
    Örebro University, Department of Clinical Medicine.
    Sjöberg, L.
    Persson, I.
    Alriksson, I.
    Burman, L. G.
    Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county2004In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 42, no 8, p. 3635-3643Article in journal (Refereed)
    Abstract [en]

    All episodes of Clostridium difficile associated diarrhea (CDAD) diagnosed in a defined population of 274,000 including one tertiary and two primary hospitals and their catchment areas were studied during 12 months. The annual CDAD incidence in the county was 97 primary episodes per 100,000, and 78% of all episodes were classified as hospital associated with a mean incidence of 5.3 (range, 1.4 to 6.5) primary episodes per 1,000 admissions. The incidence among hospitalized individuals was 1,300-fold higher than that in the community (33,700 versus 25 primary episodes per 100,000 persons per year), reflecting a 37-fold difference in antibiotic consumption (477 versus 13 defined daily doses [DDD]/1,000 persons/day) and other risk factors. Three tertiary hospital wards with the highest incidence (13 to 36 per 1,000) had CDAD patients of high age (median age of 80 years versus 70 years for other wards, P < 0.001), long hospital stay (up to 25 days versus 4 days), or a high antibiotic consumption rate (up to 2,427 versus 421 DDD/1,000 bed days). PCR ribotyping of C. difficile isolates available from 330 of 372 CDAD episodes indicated nosocomial acquisition of the strain in 17 to 27% of hospital-associated cases, depending on the time interval between index and secondary cases allowed (2 months or up to 12 months), and only 10% of recurrences were due to a new strain of C. difficile (apparent reinfection). In other words, most primary and recurring episodes were apparently caused by the patient's endogenous strain rather than by one of hospital origin. Typing also indicated that a majority of C. difficile strains belonged to international serotypes, and the distribution of types was similar within and outside hospitals and in primary and relapsing CDAD. However, type SE17 was an exception, comprising 22% of hospital isolates compared to 6% of community isolates (P = 0.008) and causing many minor clusters and a silent nosocomial outbreak including 36 to 44% of the CDAD episodes in the three high-incidence wards.

  • 170.
    Norén, Torbjörn
    et al.
    Örebro University, Department of Clinical Medicine.
    Åkerlund, T.
    Wullt, M.
    Burman, L. G.
    Unemo, M.
    Nucleotide polymorphisms in fusA associated with post-therapy fusidic acid resistance in Clostridium difficileManuscript (preprint) (Other academic)
  • 171. Nyhlin, N.
    et al.
    Bohr, J.
    Eriksson, S.
    Tysk, Curt
    Örebro University, Department of Clinical Medicine.
    Systematic review: microscopic colitis2006In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 23, no 11, p. 1525-1534Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Collagenous and lymphocytic colitis are fairly common causes of chronic non-bloody diarrhoea, especially in elderly female. AIM: To present a systematic review of microscopic colitis. METHODS: A PubMed search using the MeSH terms microscopic colitis, collagenous colitis, lymphocytic colitis and chronic diarrhoea was performed. RESULTS: Annual incidence of each disorder is 4-6/100,000 inhabitants. The aetiology is unknown. Clinical characteristics are well described and there is an association with autoimmune diseases. Budesonide is the best-documented short-term treatment of collagenous colitis. In meta-analysis pooled odds ratio for clinical response after 6-8 weeks of treatment was 12.3 (95% CI: 5.5-27.5) in comparison with placebo. The evidence for bismuth subsalicylate is weaker and the effectiveness of other alternatives such as loperamide, cholestyramine, aminosalicylates, probiotics, or Boswellia serrata extract is unknown. Although unproven, in unresponsive severe disease azathioprine or methotrexate may be tried. No controlled trials have been carried out in lymphocytic colitis. The long-term prognosis of microscopic colitis is good, serious complications are rare and there is no increased mortality. CONCLUSIONS: Clinical and epidemiological aspects of microscopic colitis are well described. Budesonide is the best-documented short-term therapy in collagenous colitis, but the optimal long-term strategy needs further study. Controlled treatment data of lymphocytic colitis are awaited for.

  • 172.
    Ocaya, Pauline
    Örebro University, Department of Clinical Medicine.
    Retinoid metabolism and signalling in vascular smooth muscle cells2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Smooth muscle cells (SMCs) play a major role in cardiovascular diseases. In advanced atherosclerosis, blood flow is impaired due to reduced luminal diameter. Percutaneous vascular interventions, including balloon angioplasty and stent-application are commonly used for the re-establishment of luminal size and improvement of tissue perfusion. However, the benefit of vascular interventions is hampered by re-stenosis. The molecular basis of re-stenosis is not fully elucidated and so far, no successful treatment is clinically available. Re-stenosis, which is proposed to be a response to mechanical injury, involves the activation of multiple processes including inflammation, SMC migration and proliferation, and is characterized by vessel remodelling and intimal hyperplasia.

    Retinoids have been shown to regulate several processes activated at site of vascular injury including inflammation, SMC migration and proliferation, and have been demonstrated to inhibit SMC proliferation and reduce intimal hyperplasia. Thus, retinoids are potential candidates in the treatment of certain vascular disorders. Retinoid metabolism is complex and involves a repertoire of proteins including retinoic acid synthesizing and catabolizing enzymes. The purpose of this study was to investigate retinoid metabolism in vascular cells, more specifically to find key points in the regulation of retinoid metabolism in vascular SMCs and atherosclerotic lesions.

    We demonstrate that different phenotypes of SMCs exhibit differences in retinoid metabolism, which suggests a link between retinoid metabolism and the SMC phenotype. Vascular SMCs and atherosclerotic lesions expressed cytochrome P450 isoform 26 (CYP26) enzymes, which are involved in retinoid catabolism. Our studies reveal the presence of a negative feedback loop, in which retinoids induce its inactivation by inducing CYP26 expression in vascular SMCs and atherosclerotic lesions. Moreover, inhibition of CYP26 potently blocked retinoid catabolism and resulted in retinoid-like effects in SMCs, indicating that CYP26 is an important endogenous modulator of retinoid metabolism in vascular cells. In atherosclerotic lesions and vascular SMCs, decreased retinoid catabolism and hence, increased retinoid availability, resulted in increased expression of retinoid-responsive genes.

    Since retinoids reduce intimal hyperplasia in animal models, our studies suggest that CYP26 inhibitors may provide an alternative to exogenous retinoid administration. Thus, CYP26 inhibitors may offer a new therapeutic approach to vascular proliferative disorders.

    List of papers
    1. Differences in retinol metabolism and proliferative response between neointimal and medial smooth muscle cells
    Open this publication in new window or tab >>Differences in retinol metabolism and proliferative response between neointimal and medial smooth muscle cells
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    2006 (English)In: Journal of Vascular Research, ISSN 1018-1172, E-ISSN 1423-0135, Vol. 43, no 4, p. 392-398Article in journal (Refereed) Published
    Abstract [en]

    Vascular disease is multifactorial and smooth muscle cells (SMCs) play a key role. Retinoids have been shown to influence many disease-promoting processes including proliferation and differentiation in the vessel wall. Phenotypic heterogeneity of vascular SMCs is a well-known phenomenon and phenotypic modulation of SMCs precedes intimal hyperplasia. The SMCs that constitute the intimal hyperplasia demonstrate a distinct phenotype and differ in gene expression compared to medial SMCs. Cellular retinol-binding protein-1 (CRBP-I), involved in retinoid metabolism, is highly expressed in intimal SMCs, indicating altered retinoid metabolism in this subset of cells. The aim of this study was to evaluate the metabolism of all-trans ROH (atROH), the circulating prohormone to active retinoids, in vascular SMCs of different phenotypes. The results show an increased uptake of atROH in intimal SMCs compared to medial SMCs as well as increased expression of the retinoid-metabolizing enzymes retinol dehydrogenase-5 and retinal dehydrogenase-1 and, in conjunction with this gene expression, increased production of all-trans retinoic acid (atRA). Furthermore, the retinoic acid-catabolizing enzyme CYP26A1 is expressed at higher levels in medial SMCs compared to intimal SMCs. Thus, both retinoid activation and deactivation processes are in operation. To analyze if the difference in ROH metabolism was also correlated to differences in the biological response to retinol, the effects of ROH on proliferation of SMCs with this phenotypic heterogeneity were studied. We found that intimal SMCs showed a dose- and time-dependent growth inhibition when treated with atROH in contrast to medial SMCs, in which atROH had a mitogenic effect. This study shows, for the first time, that (1) vascular SMCs are able to synthesize biologically active atRA from the prohormone atROH, (2) intimal SMCs have a higher capacity to internalize atROH and metabolize atROH into atRA compared to medial SMCs and (3) atROH inhibits growth of intimal SMCs, but induces medial SMC growth.

    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-2840 (URN)10.1159/000094415 (DOI)
    Available from: 2007-05-11 Created: 2007-05-11 Last updated: 2017-12-14Bibliographically approved
    2. CYP26 inhibitor R115866 increases retinoid signaling in intimal smooth muscle cells
    Open this publication in new window or tab >>CYP26 inhibitor R115866 increases retinoid signaling in intimal smooth muscle cells
    Show others...
    2007 (English)In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 27, no 7, p. 1542-1548Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: Intimal smooth muscle cells (SMCs) are dedifferentiated SMCs that have a powerful ability to proliferate and migrate. This cell-type is responsible for the development of intimal hyperplasia after vascular angioplasty. Retinoids, especially all-trans retinoid acid, are known to regulate many processes activated at sites of vascular injury, including modulation of SMC phenotype and inhibition of SMC proliferation. Intracellular levels of active retinoids are under firm control. A key enzyme is the all-trans retinoic acid-degrading enzyme cytochrome p450 isoform 26 (CYP26). Thus, an alternative approach to exogenous retinoid administration could be to increase the intracellular level of all-trans retinoic acid by blocking CYP26-mediated degradation of retinoids.

    METHODS AND RESULTS: Vascular intimal and medial SMCs expressed CYP26A1 and B1 mRNA. Although medial cells remained unaffected, treatment with the CYP26-inhibitor R115866 significantly increased cellular levels of all-trans retinoic acid in intimal SMCs. The increased levels of all-trans retinoic acid induced retinoid-regulated genes and decreased mitogenesis.

    CONCLUSIONS: Blocking of the CYP26-mediated catabolism mimics the effects of exogenously administrated active retinoids on intimal SMCs. Therefore, CYP26-inhibitors offer a potential new therapeutic approach to vascular proliferative disorders.

    Place, publisher, year, edition, pages
    Baltimore, Md: Lippincott Williams & Wilkins, 2007
    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-2841 (URN)10.1161/ATVBAHA.106.138602 (DOI)
    Available from: 2007-05-11 Created: 2007-05-11 Last updated: 2017-12-14Bibliographically approved
    3. The importance of CYP26 in the regulation of atRA metabolism in human atherosclerotic lesions and aortic smooth muscle cells
    Open this publication in new window or tab >>The importance of CYP26 in the regulation of atRA metabolism in human atherosclerotic lesions and aortic smooth muscle cells
    Show others...
    (English)Manuscript (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-2842 (URN)
    Available from: 2007-05-11 Created: 2007-05-11 Last updated: 2017-10-18Bibliographically approved
    4. Expression of IL-1β, IL-1 receptor type I and IL-1 receptor antagonist in human aortic smooth muscle cells: effects of all-trans-retinoic acid
    Open this publication in new window or tab >>Expression of IL-1β, IL-1 receptor type I and IL-1 receptor antagonist in human aortic smooth muscle cells: effects of all-trans-retinoic acid
    Show others...
    2006 (English)In: Journal of Vascular Research, ISSN 1018-1172, E-ISSN 1423-0135, Vol. 43, no 4, p. 377-382Article in journal (Refereed) Published
    Abstract [en]

    The proinflammatory cytokine interleukin (IL)-1β and the IL-1 receptor antagonist are expressed by atherosclerotic plaques and may be linked to the development of atherosclerosis. Existing evidence shows that retinoids and their receptors are involved in inflammatory response and that they are found in atherosclerotic plaques. In all-trans-retinoic acid (atRA)-treated human aortic smooth muscle cells (AOSMC), significant increases in IL-1β levels were observed, compared with untreated cells. Examination of IL-1 receptor antagonist and IL-1 receptor type I levels did not show any difference between atRA-treated and -untreated AOSMC. The results show that atRA-treated AOSMC express both the precursor (33 kDa) and the active form (17 kDa) of the IL-1β protein. atRA-treated carotid lesions showed significantly elevated IL-1β mRNA levels (2.9 ± 2.33) compared with untreated lesions (2.0 ± 1.77; p < 0.05). These results support the role of atRA as a regulator of inflammation such as in atherosclerosis.

    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-2843 (URN)10.1159/000094258 (DOI)
    Available from: 2007-05-11 Created: 2007-05-11 Last updated: 2017-12-14Bibliographically approved
  • 173.
    Ocaya, Pauline A.
    et al.
    Örebro University, Department of Clinical Medicine.
    Gidlöf, Andreas C.
    Olofsson, Peder S.
    Norgren, Lars
    Törmä, Hans
    Sirsjö, Allan
    Örebro University, Department of Clinical Medicine.
    The importance of CYP26 in the regulation of atRA metabolism in human atherosclerotic lesions and aortic smooth muscle cellsManuscript (Other academic)
  • 174.
    Ocaya, Pauline
    et al.
    Örebro University, Department of Clinical Medicine.
    Gidlöf, Andreas C.
    Olofsson, Peder S.
    Törmä, Hans
    Sirsjö, Allan
    Örebro University, School of Health and Medical Sciences.
    CYP26 inhibitor R115866 increases retinoid signaling in intimal smooth muscle cells2007In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 27, no 7, p. 1542-1548Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Intimal smooth muscle cells (SMCs) are dedifferentiated SMCs that have a powerful ability to proliferate and migrate. This cell-type is responsible for the development of intimal hyperplasia after vascular angioplasty. Retinoids, especially all-trans retinoid acid, are known to regulate many processes activated at sites of vascular injury, including modulation of SMC phenotype and inhibition of SMC proliferation. Intracellular levels of active retinoids are under firm control. A key enzyme is the all-trans retinoic acid-degrading enzyme cytochrome p450 isoform 26 (CYP26). Thus, an alternative approach to exogenous retinoid administration could be to increase the intracellular level of all-trans retinoic acid by blocking CYP26-mediated degradation of retinoids.

    METHODS AND RESULTS: Vascular intimal and medial SMCs expressed CYP26A1 and B1 mRNA. Although medial cells remained unaffected, treatment with the CYP26-inhibitor R115866 significantly increased cellular levels of all-trans retinoic acid in intimal SMCs. The increased levels of all-trans retinoic acid induced retinoid-regulated genes and decreased mitogenesis.

    CONCLUSIONS: Blocking of the CYP26-mediated catabolism mimics the effects of exogenously administrated active retinoids on intimal SMCs. Therefore, CYP26-inhibitors offer a potential new therapeutic approach to vascular proliferative disorders.

  • 175. Olofsson, Peder
    et al.
    Jatta, Ken
    Örebro University, Department of Clinical Medicine.
    Wågsäter, Dick
    Gredmark, Sara
    Hedin, Ulf
    Paulsson-Berne, Gabrielle
    Söderberg-Nauclér, Cecilia
    Hansson, Göran
    Sirsjö, Allan
    Örebro University, Department of Clinical Medicine.
    The antiviral cytomegalovirus inducible gene 5/viperin is expressed in atherosclerosis and regulated by proinflammatory agents2005In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 25, no 7, p. 113-116Article in journal (Refereed)
    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.

  • 176. Olofsson, Peder S.
    et al.
    Söderström, Leif A.
    Wågsäter, Dick
    Örebro University, School of Health and Medical Sciences.
    Sheikine, Yuri
    Ocaya, Pauline
    Örebro University, Department of Clinical Medicine.
    Lang, François
    Rabu, Catherine
    Chen, Lieping
    Rudling, Mats
    Aukrust, Pål
    Hedin, Ulf
    Paulsson-Berne, Gabrielle
    Sirsjö, Allan
    Örebro University, School of Health and Medical Sciences.
    Hansson, Göran K.
    CD137 is expressed in human atherosclerosis and promotes development of plaque inflammation in hypercholesterolemic mice2008In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 117, no 10, p. 1292-1301Article in journal (Refereed)
    Abstract [en]

    Background— Atherosclerosis is a multifactorial disease in which inflammatory processes play an important role. Inflammation underlies lesion evolution at all stages, from establishment to plaque rupture and thrombosis. Costimulatory molecules of the tumor necrosis factor superfamily such as CD40/CD40L and OX40/OX40L have been implicated in atherosclerosis. Methods and Results— This study shows that the tumor necrosis factor superfamily members CD137 and CD137 ligand (CD137L), which play a major role in several autoimmune diseases, may constitute a pathogenic pair in atherogenesis. We detected CD137 protein in human atherosclerotic lesions not only on T cells but also on endothelial cells and showed that CD137 in cultured endothelial cells and smooth muscle cells was induced by proinflammatory cytokines implicated in atherosclerosis. Activation of CD137 by CD137L induced adhesion molecule expression on endothelial cells and reduced smooth muscle cell proliferation. In addition, treatment of atherosclerosis-prone apolipoprotein E–deficient mice with a CD137 agonist caused increased inflammation. T-cell infiltration, mainly of CD8+ cells, and expression of the murine major histocompatibility complex class II molecule I-Ab increased significantly in atherosclerotic lesions, as did the aortic expression of proinflammatory cytokines. Conclusions— Taken together, these observations suggest that CD137-CD137L interactions in the vasculature may contribute to the progression of atherosclerosis via augmented leukocyte recruitment, increased inflammation, and development of a more disease-prone phenotype.

  • 177.
    Olsen, Birgitta
    et al.
    Örebro University, Department of Clinical Medicine.
    Hadad, Ronza
    Fredlund, Hans
    Örebro University, Department of Clinical Medicine.
    Unemo, Magnus
    Örebro University, Department of Clinical Medicine.
    A view of the Neisseria gonorrhoeae population in Sweden in 2005: phenotypic and genetic characterisation2006Conference paper (Other academic)
    Abstract [en]

    Aims

    To phenotypically and genotypically characterise clinical N. gonorrhoeae isolates transmitted in Sweden during 2005 and to compare with characteristics of N. gonorrhoeae populations in other countries.

    Introduction

    In Sweden, the gonorrhoea incidence decreased from the beginning of the 1970s to 1996. From 1997 the incidence has almost annually increased, mainly due to a rise in domestic cases of young heterosexuals of both sexes and homosexual men. Furthermore, during recent decades resistance to most of the traditional antibiotics used in the treatment of gonorrhoea has rapidly increased worldwide. Availability of effective diagnostics, treatment and surveillance of epidemiological characteristics (antibiotic susceptibility, serovars and genotypes) are main tools for control of the transmission of infection.

    Materials, Methods & Results

    N. gonorrhoeae isolates (n=175) cultured in Sweden in 2005 and received at the Swedish Reference Laboratory for Pathogenic Neisseria were included. Phenotypic characterisation was performed by antibiotic susceptibility testing and serovar determination using both Genetic systems (GS) and Pharmacia (Ph) panels of monoclonal antibodies (MAbs). Genetic characterisation was performed using N. gonorrhoeae multiantigen sequence typing (NG-MAST) that analyses more variable segments of the porB gene (490 bp) and of the tbpB gene (390 bp).

    All isolates were susceptible to cefixime, ceftriaxone, and spectinomycin. The levels of intermediate susceptibility and resistance to azithromycin, ciprofloxacin, and ampicillin were 2.3%, 49.7% and 75.3%, respectively (Table 1). Fifty-seven (33%) of the isolates were -lactamase producing.

    In total, 33 of the isolates were determined as serogroup WI (PorB1a). These were assigned nine different GS-serovars and seven different Ph-serovars. Two of the PorB1a isolates were not serotypeable using Ph MAbs. The remaining 142 isolates were determined as serogroup WII/III (PorB1b). These isolates were assigned 18 different GS-serovars and 38 different Ph-serovars.

    The isolates displayed 66 and 56 divergent NG-MAST porB and tbpB alleles, respectively. These resulted in assignment of 95 different sequence types (STs), of which 34 have not been previously described. ST40 (n=15), ST225 (n=12), ST1813 (n=9), ST5 (n=8), ST753 (n=6), ST323 (n=5), and ST211 (n=4), were the most prevalent STs. Four STs were represented by three isolates, 20 STs by two isolates and 64 STs by single isolates (Figure 1).

    Conclusions

    A highly diverse N. gonorrhoeae population was transmitted in Sweden during 2005, which can reflect importation of strains from abroad, and/or in some geographic areas suboptimal diagnostics and incomplete epidemiological surveillance. However, many clusters of isolates, which can reflect the existence of several transmission chains, were also identified.

    Serovar determination is still fairly effective, rapid, inexpensive, easily performed and remains a valuable primary epidemiological marker of N. gonorrhoeae, which can supplement the superior genetic characterisation.

  • 178.
    Olsen, Birgitta
    et al.
    Örebro University, Department of Clinical Medicine.
    Lan, P. T.
    Stålsby Lundborg, Cecilia
    Tran, Hau Khang
    Unemo, Magnus
    Örebro University, Department of Clinical Medicine.
    First ever population-based assessment of Mycoplasma genitalium in Vietnam: low prevalence among married women of reproductive age in rural areas2008Conference paper (Other academic)
    Abstract [en]

    Objective: To analyse the prevalence of Mycoplasma genitalium infection in a population-based study among sexually active married women from a demographic surveillance site in a rural geographical area of Vietnam.

    Materials and Methods: Women, 18-49 years of age, were randomly selected to participate. DNA was isolated from endocervical swabs sampled from 990 participating women. The M. genitalium MgPa adhesion gene was detected using a real-time PCR with TaqMan probe

    Results: Eight (0.8% [95% confidence interval, 0.25-1.35%]) of the included women were infected with M. genitalium. Two of these positive women reported clinical symptoms. One additional M. genitalium positive but symptom-free woman, however, showed clinical signs of vaginitis. None of the M. genitalium positive women was concomitantly infected with Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum or HIV. Furthermore, there was no obvious association between M. genitalium infection and vaginal douching, use of intra-uterine device (IUD), or occurrence of bacterial vaginosis, candidiasis, or Trichomonas vaginalis.

    Conclusions: The prevalence of M. genitalium among sexually active married women in Vietnam was relatively low. However, more large, well-designed and appropriately performed studies in other population groups including unmarried women and men, and in other geographical areas, rural as well as urban, are crucial in order to extract any evidence-based conclusions regarding the overall prevalence of STIs, including M. genitalium infections, in the Vietnamese society. The present study compiled with such future studies may form the basis for a national sexual health strategy for prevention, diagnosis, and surveillance of STIs, including M. genitalium infections, in Vietnam.

  • 179. Olsson-Strömberg, U.
    et al.
    Höglund, M.
    Björkholm, M.
    Braide, I.
    Carlson, K.
    Gahrton, G.
    Grimfors, G.
    Hast, R.
    Lerner, R.
    Linder, O.
    Ljungman, P.
    Löfvenberg, E.
    Malm, C.
    Nilsson, P. G.
    Paul, C.
    Rödjer, S.
    Stenke, L.
    Tidefelt, Ulf
    Örebro University, Department of Clinical Medicine.
    Turesson, I.
    Udén, A. M.
    Wahlin, A.
    Vilen, L.
    Winqvist, I.
    Zettervall, O.
    Öberg, G.
    Simonsson, B.
    Successful mobilization of Ph-negative blood stem cells with intensive chemotherapy + G-CSF in patients with chronic myelogenous leukemia in first chronic phase2006In: Leukemia and Lymphoma, ISSN 1042-8194, E-ISSN 1029-2403, Vol. 47, no 9, p. 1768-1773Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to investigate the feasibility of mobilizing Philadelphia chromosome negative (Ph-) blood stem cells (BSC) with intensive chemotherapy and lenograstim (G-CSF) in patients with CML in first chronic phase (CP1). During 1994-1999 12 centers included 37 patients <56 years. All patients received 6 months' IFN, stopping at median 36 (1-290) days prior to the mobilization chemotherapy. All received one cycle of daunorubicin 50 mg/m2 and 1 hour infusion on days 1-3, and cytarabine (ara-C) 200 mg/m2 24 hours' i.v. infusion on days 1-7 (DA) followed by G-CSF 526 microg s.c. once daily from day 8 after the start of chemotherapy. Leukaphereses were initiated when the number of CD 34+ cells was >5/microl blood. Patients mobilizing poorly could receive a 4-day cycle of chemotherapy with mitoxantrone 12 mg/m2/day and 1 hour i.v infusion, etoposide 100 mg/m2/day and 1 hour i.v. infusion and ara-C 1 g/m2/twice a day with 2 hours' i.v infusion (MEA) or a second DA, followed by G-CSF 526 microg s.c once daily from day 8 after the start of chemotherapy. Twenty-seven patients received one cycle of chemotherapy and G-CSF, whereas 10 were mobilized twice. Twenty-three patients (62%) were successfully (MNC >3.5 x 10(8)/kg, CFU-GM >1.0 x 10(4)/kg, CD34+ cells >2.0 x 10(6)/kg and no Ph+ cells in the apheresis product) [n = 16] or partially successfully (as defined above but 1-34% Ph+ cells in the apheresis product) [n = 7] mobilized. There was no mortality during the mobilization procedure. Twenty-one/23 patients subsequently underwent auto-SCT. The time with PMN <0.5 x 10(9)/l was 10 (range 7-49) and with platelets <20 x 10(9)/l was also 10 (2-173) days. There was no transplant related mortality. The estimated 5-year overall survival after auto-SCT was 68% (95% CI 47 - 90%), with a median follow-up time of 5.2 years.We conclude that in a significant proportion of patients with CML in CP 1, intensive chemotherapy combined with G-CSF mobilizes Ph- BSC sufficient for use in auto-SCT.

  • 180. Olsson-Strömberg, Ulla
    et al.
    Höglund, Martin
    Björkholm, Magnus
    Braide, Inger
    Carlson, Karin
    Gahrton, Gösta
    Grimfors, Gunnar
    Hast, Robert
    Lerner, Rickard
    Linder, Olle
    Ljungman, Per
    Löfvenberg, Eva
    Malm, Claes
    Nilsson, Per-Gunnar
    Paul, Christer
    Rödjer, Stig
    Stenke, Leif
    Tidefelt, Ulf
    Örebro University, Department of Clinical Medicine.
    Turesson, Ingemar
    Udén, Ann-Marie
    Wahlin, Anders
    Vilén, Lars
    Winqvist, Ingemar
    Zettervall, Olle
    Öberg, Gunnar
    Simonsson, Bengt
    Successful mobilization of Ph-negative blood stem cells with intensive chemotherapy + G-CSF in patients with chronic myelogenous leukemia in first chronic phase2006In: Leukemia and Lymphoma, ISSN 1042-8194, E-ISSN 1029-2403, Vol. 47, no 9, p. 1768-1773Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to investigate the feasibility of mobilizing Philadelphia chromosome negative (Ph-) blood stem cells (BSC) with intensive chemotherapy and lenograstim (G-CSF) in patients with CML in first chronic phase (CP1). During 1994-1999 12 centers included 37 patients <56 years. All patients received 6 months' IFN, stopping at median 36 (1-290) days prior to the mobilization chemotherapy. All received one cycle of daunorubicin 50 mg/m2 and 1 hour infusion on days 1-3, and cytarabine (ara-C) 200 mg/m2 24 hours' i.v. infusion on days 1-7 (DA) followed by G-CSF 526 microg s.c. once daily from day 8 after the start of chemotherapy. Leukaphereses were initiated when the number of CD 34+ cells was >5/microl blood. Patients mobilizing poorly could receive a 4-day cycle of chemotherapy with mitoxantrone 12 mg/m2/day and 1 hour i.v infusion, etoposide 100 mg/m2/day and 1 hour i.v. infusion and ara-C 1 g/m2/twice a day with 2 hours' i.v infusion (MEA) or a second DA, followed by G-CSF 526 microg s.c once daily from day 8 after the start of chemotherapy. Twenty-seven patients received one cycle of chemotherapy and G-CSF, whereas 10 were mobilized twice. Twenty-three patients (62%) were successfully (MNC >3.5 x 10(8)/kg, CFU-GM >1.0 x 10(4)/kg, CD34+ cells >2.0 x 10(6)/kg and no Ph+ cells in the apheresis product) [n = 16] or partially successfully (as defined above but 1-34% Ph+ cells in the apheresis product) [n = 7] mobilized. There was no mortality during the mobilization procedure. Twenty-one/23 patients subsequently underwent auto-SCT. The time with PMN <0.5 x 10(9)/l was 10 (range 7-49) and with platelets <20 x 10(9)/l was also 10 (2-173) days. There was no transplant related mortality. The estimated 5-year overall survival after auto-SCT was 68% (95% CI 47 - 90%), with a median follow-up time of 5.2 years.We conclude that in a significant proportion of patients with CML in CP 1, intensive chemotherapy combined with G-CSF mobilizes Ph- BSC sufficient for use in auto-SCT.

  • 181. Osika, Walter
    et al.
    Ehlin, Anna
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Does height modify the risk of angina associated with economic adversity?2006In: Economics and Human Biology, ISSN 1570-677x, Vol. 4, no 3, p. 398-411Article in journal (Refereed)
    Abstract [en]

    Adult height partly reflects childhood exposures, and we hypothesise that some exposures impairing growth may also increase susceptibility to coronary heart disease—angina pectoris (angina)—risks, such that shorter adults may be more susceptible to some exposures in adulthood that are risks for heart disease. This hypothesis is tested among all adults who participated in the National Health Interview Survey (USA), 1997–2000 [The National Health Survey, 1997–2000. Data file documentation, National Health Interview Survey (machine-readable data file and documentation). National Center for Health Statistics, Hyattsville, Maryland, http://www.cdc.gov/nchs/nhis.htm]. In the entire study population, height was negatively associated with angina and after adjustment for potential confounding factors; the odds ratio (and 95% confidence interval) for angina risk associated with the tallest height fifth compared with the shortest fifth is 0.77 (0.97, 0.88). The association of low income (less than US$ 20,000) with angina was assessed separately in each of five height strata defined by fifths of the height distribution. The magnitude of this association is lower in the shortest than the tallest height fifth, with odds ratios of 1.18 and 1.60, respectively (effect modification). The unexpected results may be explained by the following: childhood adversity resulting in shorter stature may confer resilience against adult economic adversity; the relative disadvantage of low income may be perceived more keenly by those of taller stature thereby increasing stress and thus disease risk; or health-promoting characteristics associated with taller stature may be less effective in the face of adult economic adversity in the low-income group.

  • 182.
    Oskarsson, Eva
    et al.
    Örebro University, Department of Clinical Medicine.
    Gustafsson, Björn-Erik
    Örebro University, Department of Clinical Medicine.
    Pettersson, Kurt
    Handkirugiska kliniken, Örebro universitetssjukhus.
    Piehl Aulin, Karin
    Örebro University, Department of Clinical Medicine.
    Decreased intramuscular blood flow in patients with lateral epicondylitis2007In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 17, no 3, p. 211-215Article in journal (Refereed)
    Abstract [en]

    The purpose of this pilot study was to investigate intramuscular microcirculation in extensor carpi radialis brevis (ECRB) in patients with lateral epicondylitis.

    Ten patients with unilateral epicondylitis, mean duration of symptoms of 39 (12-96) months participated. The diagnosis was based on clinical examination and none was under treatment for the last 6 months. Isometric handgrip strength, 2-pinch grip strength and muscle strength during radial deviation and dorsal extension was determined. Functional perceived pain was evaluated by a modified BRS and perceived pain during contraction by VAS. Intramuscular and skin blood flow was recorded by a laser-Doppler flowmetry system technique (LDF) during stable temperature condition.

    Intramuscular blood flow was significantly lower in the affected side, 22.7 ± 9.8 PU as compared to 35.2 ± 11.9 PU in the control side (P = 0.01). There was no difference in skin blood flow or temperature between affected and control side. A positive correlation was found between duration of symptoms and the difference in intramuscular blood flow between affected and control arm (r = 0.65, P = 0.06).

    The present data indicate that decreased microcirculation and anaerobic metabolism in ECRB may contribute to the lateral epicondylitis symptoms.

  • 183.
    Oskarsson, Eva
    et al.
    Örebro University, Department of Clinical Medicine.
    Piehl Aulin, Karin
    Örebro University, Department of Clinical Medicine.
    Gustafsson, B-E
    Pettersson, K
    Orebro University Hospital.
    Improved intramuscular blood flow and normalized metabolism in lateral epicondylitis after botulinum toxin treatment2009In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 3, p. 323-328Article in journal (Refereed)
    Abstract [en]

    Lateral epicondylitis is a common cause of elbow pain, and decreased microcirculation in extensor carpi radialis brevis (ECRB) has recently been suggested to contribute to the symptoms. The purpose of this pilot study was to investigate the treatment response after injection of botulinum toxin type A. Ten patients with unilateral epicondylitis and decreased intramuscular blood flow in ECRB participated. Handgrip, 2-pinch grip and muscle strength during radial deviation and dorsal extension of the wrist were recorded. Perceived pain during contraction was evaluated with the Visual Analogue Scale (VAS) and function in daily activities was assessed using the Disability of Arm, Shoulder and Hand instrument (DASH) and the Canadian Occupational Performance Measure instrument (COPM). Intramuscular blood flow was recorded by laser Doppler flowmetry, and microdialysis was used to analyze muscle metabolism. The difference in intramuscular blood flow between the control and the affected side had decreased 3 and 12 months after treatment (P=0.03). Lactate concentration at the 12-month follow-up had decreased (P=0.02); perceived pain was reduced and function in daily activities had improved. Injection of botulinum toxin is an alternative treatment for epicondylitis. Symptom relief may be due to enhanced microcirculation causing an aerobic metabolism.

  • 184.
    Paulson-Karlsson, Gunilla
    et al.
    Örebro University, Department of Clinical Medicine.
    Engström, Ingemar
    Örebro University, Department of Clinical Medicine.
    Nevonen, Lauri
    Örebro University, Department of Clinical Medicine.
    Anorexia nervosa: 18- and 36-months follow-up2007Conference paper (Refereed)
  • 185.
    Paulson-Karlsson, Gunilla
    et al.
    Örebro University, Department of Clinical Medicine. Anorexia-Bulimia Unit, Queen Silvia Children’s Hospital, Göteborg, Sweden.
    Nevonen, Lauri
    Örebro University, Department of Clinical Medicine. Child and Adolescent Psychiatry Centre, Queen Silvia Children’s Hospital, Göteborg, Sweden.
    Engström, Ingemar
    Örebro University, Department of Clinical Medicine.
    Anorexia nervosa: treatment satisfaction2006In: Journal of Family Therapy, ISSN 0163-4445, E-ISSN 1467-6427, Vol. 28, no 3, p. 293-306Article in journal (Refereed)
    Abstract [en]

    Patient satisfaction plays a central role in treatment alliance and outcome. Investigating patient expectations and experiences of treatment sheds light on its importance. This study examines adolescent anorexia nervosa patients and their parents' satisfaction with family-based treatment. Patients and parents answered a questionnaire at the eighteen-month follow-up focusing on expectations and experiences of treatment, therapists, aims of treatment and accomplishment. The results show that 73 per cent of the patients and 83 per cent of the parents felt that their pre-treatment expectations had been fulfilled. The majority agreed that individual patient sessions and parental sessions were of great help, while the patients valued family therapy sessions as being less helpful than did parents. In overall terms, parents were more pleased with the therapists than were the patients. These data suggest that family-based treatment with individual sessions for patients, in parallel with parental sessions combined with family sessions, corresponds well to patients' and parents' treatment expectations.

  • 186. Peerzada, Jehanna M.
    et al.
    Schollin, Jens
    Örebro University, Department of Clinical Medicine.
    Håkansson, Stellan
    Delivery room decision-making for extremely preterm infants in Sweden2006In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 117, no 6, p. 1988-1995Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess neonatologists' attitudes and practices regarding treatment of extremely preterm infants in the delivery room, particularly in response to parental wishes. STUDY DESIGN: Cross-sectional survey of all neonatologists in Sweden registered with the Swedish Pediatric Society. RESULTS: The response rate was 71% (88 of 124 neonatologists). At 24[1/7] to 24[6/7] weeks of gestation, 68% of neonatologists considered treatment clearly beneficial; at 25[1/7] to 25[6/7] weeks of gestation, 93% considered it clearly beneficial. When respondents consider treatment clearly beneficial, 97% reported that they would resuscitate in the delivery room despite parental requests to withhold treatment. At or below 23[0/7] weeks of gestation, 94% of neonatologists considered treatment futile. Nineteen percent reported that they would provide what they consider futile treatment at parental request. When respondents consider treatment to be of uncertain benefit, 99% reported that they would resuscitate when parents request it, 99% reported that they would resuscitate when parents are unsure, and 25% reported that they would follow parental requests to withhold treatment. CONCLUSION: Although neonatologists' attitudes and practices varied, respondents to our survey in general envisioned little parental role in delivery room decision-making for extremely preterm infants.

  • 187. Persson, Lennart
    et al.
    Söderquist, Bo
    Engervall, Per
    Vikerfors, Tomas
    Hansson, Lars-Olof
    Tidefelt, Ulf
    Örebro University, Department of Clinical Medicine.
    Assessment of systemic inflammation markers to differentiate a stable from a deteriorating clinical course in patients with febrile neutropenia2005In: European Journal of Haematology, ISSN 0902-4441, E-ISSN 1600-0609, Vol. 74, no 4, p. 297-303Article in journal (Refereed)
    Abstract [en]

    In this study, we evaluated the predictive values of procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6) and serum amyloid A (SAA) for determining the clinical course in febrile neutropenic patients. Daily plasma analyses during the fever course were performed in 101 episodes with fever and chemotherapy-induced neutropenia (neutrophil count <0.5 x 10(9)/L). Procalcitonin (PCT) and IL-6 values were significantly higher in febrile episodes in patients who developed complications. Procalcitonin with a cut-off value of < or =0.4 ng/mL or IL-6 < or =50 pg/mL 3 d after fever onset indicated daily high negative predictive values (NPVs) (91-100%) for episodes with complications. No marker could predict deterioration; however, daily low plasma concentrations of PCT or IL-6 during the first 8 d of fever were found to be a good predictor of no subsequent complications in neutropenic patients and therefore to be a helpful tool for limiting anti-microbial therapy.

  • 188. Poortvliet, Eric
    et al.
    Yngve, Agneta
    Ekelund, Ulf
    Örebro University, School of Health and Medical Sciences.
    Hurtig-Wennlöf, Anita
    Örebro University, Department of Clinical Medicine.
    Nilsson, Andreas
    Hagströmer, Maria
    Sjöström, Michael
    The European Youth Heart Survey (EYHS): an international study that addresses the multi-dimensional issues of CVD risk factors2003In: Forum of nutrition, ISSN 1660-0347, Vol. 56, p. 254-256Article in journal (Refereed)
  • 189. Ramires, P. A.
    et al.
    Wennerberg, Ann
    Johansson, Carina B.
    Örebro University, Department of Health Sciences. Örebro University, Department of Clinical Medicine.
    Cosentino, F.
    Tundo, S.
    Milella, E.
    Biological behavior of sol-gel coated dental implants2003In: Journal of materials science. Materials in medicine, ISSN 0957-4530, E-ISSN 1573-4838, Vol. 14, no 6, p. 539-545Article in journal (Refereed)
    Abstract [en]

    The biocompatibility of dental implants coated with titania/hydroxyapatite (HA) and titania/bioactive glass (BG) composites obtained via sol-gel process was investigated using an in vitro and in vivo model. A device for the in vitro testing of screw-shaped dental implants was developed, in order to well compare the two experimental models studying the behavior of human MG63 osteoblast-like cells seeded onto a particular geometry. The expression of some biochemical parameters of osteoblastic phenotype (alkaline phosphatase specific activity, collagen and osteocalcin production) and some indications on cells morphology obtained by scanning electron microscopy were evaluated. The in vitro and in vivo models were compared after implants insertion in rabbit tibia and femur. The removal torque and histomorphometric parameters (percentage of bone in contact with implant surface and the amount of bone inside the threaded area) were examined. A good agreement was found between the in vitro and in vivo models. These experiments showed better performances of HA and BG sol-gel coated dental implants with respect to uncoated titanium; in particular, it was found that in vitro the HA coating stimulates osteoblastic cells in producing higher level of ALP and collagen, whereas in vivo this surface modification resulted in a higher removal torque and a larger bone-implant contact area. This behavior could be ascribed to the morphology and the chemical composition of the implants with rough and bioactive surfaces.

  • 190. Reigstad, O.
    et al.
    Franke-Stenport, V.
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Wennerberg, A.
    Rökkum, M.
    Reigstad, A.
    Improved bone ingrowth and fixation with a thin calcium phosphate coating intended for complete resorption2007In: Journal of biomedical materials research. Part B, Applied biomaterials, ISSN 1552-4973, Vol. 83B, no 1, p. 9-15Article in journal (Refereed)
    Abstract [en]

    Bonit is claimed to be a resorbable electrochemically deposited calcium phosphate coating consisting mainly of brushite, which is a hydroxyapatite precursor. This study involved a comparison of Ti6Al4V screw-shaped implants with and without a 15 +/- 5 microm Bonit coating in rabbit tibia and femur, after 6 and 12 weeks of insertion. The biomechanical removal torque test showed significantly increased values for the coated implants after 12 weeks (p < 0.05) but not after 6 weeks of integration. Higher bone-implant contact was found for the coated implants in the tibia after 6 weeks and for both tibial and femoral screws after 12 weeks (p < 0.05). There was no difference in the inflammatory reaction around the implants, and possible grains of the coating could be detected after 6 weeks, but not after 12 weeks of follow-up. This unloaded short-term study has shown promising results for the easily applicable and resorbable coat (Bonit) compared to uncoated titanium-alloy implants.

  • 191. Reikerås, Olav
    et al.
    Johansson, Carina B.
    Örebro University, Department of Health Sciences. Örebro University, Department of Clinical Medicine.
    Sundfeldt, Mikael
    icke ÖU.
    Bone Ingrowths to Press-Fit and Loose-Fit Implants: Comparisons between Titanium and Hydroxyapatite2006In: Journal of long-term effects of medical implants, ISSN 1050-6934, E-ISSN 1940-4379, Vol. 6, no 2, p. 157-164Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate whether the coating of titanium (Ti) implants with hydroxyapatite (HA) might create a better fixation when titanium implants are implanted into a gap. In each of 16 rats, the medullary cavity of both femurs was entered by an awl from the trochanteric area. With steel burrs it was successively reamed to a diameter of 1.5 mm. In a random manner the proximal part of the cavity in half of the bones was reamed once again to a diameter of 2.0 mm. Nails with a diameter of 1.5 mm and a length of 34 mm were then inserted into the medullary cavity of these bones with press fit at the distal half and a gap to the bone in the proximal half. In the remaining bones the whole medullary canal was reamed to a diameter of 2.0 mm, and nails with a diameter of 2.0 mm and a length of 34 mm were introduced. In all cases, either a pure Ti nail or a Ti nail entirely plasma sprayed with HA was used in a random manner. The surface roughness of the pure Ti was characterized by Ra 2.6 microm and Rt 22 microm. Ra of HA was 7.5 microm and Rt 52 microm. At sacrifice after 16 weeks, both femurs were dissected free from soft tissues and then immersed in fixative. A specimen slice of about 5 mm in thickness was prepared from the subtrochanteric region with a water-cooled band saw. Sample preparation for undecalcified tissue followed the internal guidelines at the laboratories of the Department of Biomaterials/Handicap Research. Generally, bone contact to the nails with HA coating was more predictable than was bone contact to the Ti nails. But due to rather large variations in bone contact between the samples, statistical analyses revealed non-significant differences between the 4 groups (p = 0.083). There were no significant differences between Ti and HA coated nails of 2.0 mm (p = 0.633), nor between Ti and HA coated nails of 1.5 mm (p = 0.924). The pooled values for the 2.0 mm nails showed significantly higher bone bonding contact than the pooled values of the 1.5 mm nails (p = 0.011). Our results, then, indicate that bone bonding contact to implants with a loose fit insertion is less predictable than in press fit insertion, and HA coating seemed to be more predictable than pure Ti. However, due to large variations between the samples, the differences did not reach significant levels.

  • 192. Rizzo, Nico S.
    et al.
    Ruiz, Jonatan R.
    Hurtig-Wennlöf, Anita
    Örebro University, Department of Clinical Medicine.
    Ortega, Francisco B.
    Sjöström, Michael
    Relationship of physical activity, fitness, and fatness with clustered metabolic risk in children and adolescents: the European youth heart study2007In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 150, no 4, p. 388-394Article in journal (Refereed)
    Abstract [en]

    Objectives To examine the associations of physical activity (PA) at different levels and intensities and cardiorespiratory fitness (CRF) with a clustering of metabolic risk factors in children and adolescents with special consideration of body fat. Study design Total PA and intensity levels were measured by accelerometry in children (9 years, n = 273) and adolescents (15 years, n = 256). CRF was measured with a maximal ergometer bike test. Measured outcomes included fasting insulin, glucose, triglycerides, total and high-density lipoprotein cholesterol, blood pressure, and body fat. A metabolic risk score (MRS) was computed as the mean of the standardized outcome scores. A “non-obesity-MRS” was computed omitting body fat from the MRS. Analysis of variance and multiple regressions were used in the analysis. Results Total and vigorous PA was inversely significantly associated with MRS in adolescent girls, the group with lowest PA, becoming insignificant when CRF was introduced in the analysis. Significant regression coefficients of total PA and CRF on non-obesity–MRS diminished when body fat was entered in the analysis. Conclusions CRF is more strongly correlated to metabolic risk than total PA, whereas body fat appears to have a pivotal role in the association of CRF with metabolic risk.

  • 193. Roman-Emanuel, C.
    et al.
    Hägglund, Doris
    Örebro University, Department of Clinical Medicine.
    The operating room nurses experiences of the medical equipment in their daily work2009Conference paper (Refereed)
  • 194. Romanos, G.
    et al.
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Immediate Loading with Complete Implant-Supported Restorations in an Edentulous Heavy Smoker: histologic and histomorphometric analyses2005In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 20, no 2, p. 282-290Article in journal (Refereed)
    Abstract [en]

    The clinical case presented is that of an edentulous female patient, a heavy smoker, who received implant-supported complete restorations in the maxilla and mandible using the immediate loading concept according to the Ankylos implant system. The patient received 12 commercially pure titanium (grade 2) Ankylos implants, 6 in the maxilla and 6 in the mandible. The implants were loaded immediately after surgery with temporary acrylic resin prostheses fabricated chairside using a prefabricated customized splint. The definitive ceramometal restorations were seated 4 months after surgery. Clinical and radiologic evaluation at 7 months after implant placement indicated functional bone anchorage of all implants, despite the patient being a smoker and having poor bone quality. The patient died 7 months after implant placement because of lung cancer; however, there was no known disease at the time of implant placement. After her death, the implants with the surrounding tissues were removed en bloc and examined histologically and histomorphometrically using undecalcified cut and ground sections. All implants were osseointegrated to some extent and surrounded by lamellar bone. However, around the upper, nonthreaded parts of the implants, much of the bone had been resorbed. In this region, fibrous connective tissue was in close contact with the titanium surface. Epithelial proliferation with pocket formation could not be observed in any of the implants. The histomorphometric evaluation of bone-implant contact in threads demonstrated a mean of approximately 51% of the available surface and a mean bone volume of approximately 52%, with a tendency toward greater contact and volume around the implants in the maxilla. If the nonthreaded cylindric portions of the implants were included, mean bone-implant contact was 46% and mean bone volume was 47%.

  • 195. Ruiz, Jonatan R.
    et al.
    Hurtig-Wennlöf, Anita
    Örebro University, Department of Clinical Medicine.
    Ortega, Francisco B.
    Patterson, Emma
    Nilsson, Torbjörn K.
    Örebro University, Department of Clinical Medicine.
    Castillo, Manuel J.
    Sjöström, Michael
    Homocysteine levels in children and adolescents are associated with the methylenetetrahydrofolate reductase 677C>T genotype, but not with physical activity, fitness or fatness: the European Youth Heart Study2007In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 97, no 2, p. 255-262Article in journal (Refereed)
    Abstract [en]

    To examine the associations of total plasma homocysteine (tHcy) with physical activity, cardiorespiratory fitness and fatness in children and adolescents, a cross-sectional study of 301 children (9–10 years old) and 379 adolescents (15–16 years old) was conducted. Physical activity was measured by accelerometry. Cardiorespiratory fitness was measured with a maximal ergometer bike test. Body fat was derived from the sum of five skinfold thicknesses. Genotyping for the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism was done by DNA sequencing. Fasting tHcy level was the outcome variable. Multiple regressions were used to determine the degree to which variance in tHcy was explained by physical activity, cardiorespiratory fitness and body fat, after controlling for potential confounders including MTHFR 677C>T genotype. tHcy levels were neither associated with any measure of level and pattern of physical activity nor with data on cardiorespiratory fitness, or body fat, in any age group after controlling for potential confounders including MTHFR 677C>T and even when subgroups 677TT and 677CC+CT were analysed separately. Mean values of tHcy were significantly higher in the TT subgroup compared with CC and CT subgroups in children (TT 7·4 μmol/l, CC 6·3 μmol/l, CT 6·6 μmol/l, P < 0·001 and P = 0·019, respectively) and adolescents (TT 16·9 μmol/l, CC 8·3 μmol/l, CT 9·0 μmol/l, both P < 0·001). The results suggest that physical activity, fitness and body fat are not associated with tHcy levels in children and adolescents, even after controlling for presence of the MTHFR 677C>T genotype, the main influence on tHcy levels in these subjects.

  • 196. Ruiz, Jonatan R.
    et al.
    Ortega, Francisco B.
    Rizzo, Nico S.
    Villa, Inga
    Hurtig-Wennlöf, Anita
    Örebro University, Department of Clinical Medicine.
    Oja, Leila
    Sjöström, Michael
    High cardiovascular fitness is associated with low metabolic risk score in children: the European Youth Heart Study2007In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 61, no 3, p. 350-355Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to examine the associations of cardiovascular fitness (CVF) with a clustering of metabolic risk factors in children, and to examine whether there is a CVF level associated with a low metabolic risk. CVF was estimated by a maximal ergometer bike test on 873 randomly selected children from Sweden and Estonia. Additional measured outcomes included fasting insulin, glucose, triglycerides, HDLC, blood pressure, and the sum of five skinfolds. A metabolic risk score was computed as the mean of the standardized outcomes scores. A risk score <75th percentile was considered to indicate a low metabolic risk. CVF was negatively associated with clustering of metabolic risk factors in children. Receiver operating characteristic curve analysis showed a significant discriminatory accuracy of CVF in identifying the low/high metabolic risk in girls and boys (p < 0.001). The CVF level for a low metabolic risk was 37.0 and 42.1 mL/kg/min in girls and boys, respectively. These levels are similar to the health-related threshold values of CVF suggested by worldwide recognized organizations. In conclusion, the results suggest a hypothetical CVF level for having a low metabolic risk, which should be further tested in longitudinal and/or intervention studies. Abbreviations: AUC, area under the curve CVF, cardiovascular fitness ROC, receiver operating characteristic

  • 197. Ruiz, Jonatan R.
    et al.
    Rizzo, Nico S.
    Hurtig-Wennlöf, Anita
    Örebro University, Department of Clinical Medicine.
    Ortega, Francisco B.
    Wärnberg, Julia
    Sjöström, Michael
    Relations of total physical activity and intensity to fitness and fatness in children: the European Youth Heart Study2006In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 84, no 2, p. 299-303Article in journal (Refereed)
    Abstract [en]

    Background: It is unclear how the amount and intensity of physical activity (PA) are associated with cardiovascular fitness (CVF) and body fatness in children.

    Objective: We aimed to examine the associations of total PA and intensity levels to CVF and fatness in children.

    Design: A cross-sectional study of 780 children aged 9–10 y from Sweden and Estonia was conducted. PA was measured by accelerometry and was expressed as min/d of total PA, moderate PA, and vigorous PA. CVF was measured with a maximal ergometer bike test and was expressed as W/kg. Body fat was derived from the sum of 5 skinfold-thickness measurements. Multiple regression analysis was used to determine the degree to which variance in CVF and body fat was explained by PA, after control for age, sex, and study location.

    Results: Lower body fat was significantly associated with higher levels of vigorous PA, but not with moderate or total PA. Those children who engaged in >40 min vigorous PA/d had lower body fat than did those who engaged in 10–18 min vigorous PA/d. Total PA, moderate PA, and vigorous PA were positively associated with CVF. Those children who engaged in >40 min vigorous PA/d had higher CVF than did those who accumulated <18 min vigorous PA/d.

    Conclusions: The results suggest that PA of vigorous intensity may have a greater effect on preventing obesity in children than does PA of lower intensity, whereas both total and at least moderate to vigorous PA may improve children's CVF.

  • 198. Sadeghi, André M.
    et al.
    Eriksson, Kristina
    Kimberling, William J.
    Sjöström, Anders
    Möller, Claes
    Örebro University, Department of Clinical Medicine.
    Longterm visual prognosis in Usher syndrome types 1 and 22006In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 84, no 4, p. 537-544Article in journal (Refereed)
    Abstract [en]

    Purpose: To estimate the age at diagnosis of retinitis pigmentosa and to determine visual acuity deterioration, visual field impairment and the frequency of cataracts in Usher syndrome types 1 and 2.

    Methods: We carried out a retrospective study of 328 affected subjects with Usher syndrome types 1 and 2. Study subjects were divided into seven different age groups by decade. Data were analysed using descriptive statistics, general linear model anova and survival analysis.

    Results: Retinitis pigmentosa was diagnosed significantly earlier in subjects with Usher syndrome type 1 than in those with type 2. Visual acuity was significantly more impaired in affected subjects with Usher syndrome type 1 than in those with type 2 from 50 years of age onwards. Survival analysis revealed a significant difference in visual field loss (≤ 10 degrees) between the two groups, with type 2 subjects tending to be more impaired, while comparison indicated no significant differences between the groups in any of the other visual field categories. Cataract was found to be generally more common in Usher syndrome type 1 than type 2.

    Conclusions: Progressive loss of visual acuity and visual field begins to be substantial between the second and third decades of life in both Usher types. The rate of degeneration varies between individuals in both groups. The data are useful for the counselling of affected subjects with Usher syndrome types 1 and 2.

  • 199. Sadeghi, Mehdi
    et al.
    Cohn, Edward S.
    Kimberling, William J.
    Tranebjaerg, Lisbeth
    Möller, Claes
    Örebro University, Department of Clinical Medicine.
    Audiological and vestibular features in affected subjects with USH3: a genotype/phenotype correlation2005In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 44, no 5, p. 307-316Article in journal (Refereed)
    Abstract [en]

    The aims were to compare the genotype/phenotype relationship between USH3 mutations and the consequent hearing and vestibular phenotype; and to compare hearing loss (HL) progression between Usher syndrome types IB, IIA and USH3. Genetic, audiometric and vestibular examinations were performed in 28 subjects with USH3. Five different mutations in USH3 were identified. Severe HL was present from an early age (4 to 6 years) in 35% of subjects with USH3. Progression of HL begins in the first decade, and approximately 50% of subjects with USH3 become profoundly deaf by age 40. Various vestibular abnormalities were found in about half (10/22) of the tested subjects with USH3. Depending on the severity of HL, subjects with USH3 might be misdiagnosed as either Usher type IB or IIA. The results from this study can be used as discriminatory features in differential diagnosis of this syndrome.

  • 200. Sarve, H.
    et al.
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Lindblad, J.
    Quantitative estimation of bone growth in the proximity of implants2007Conference paper (Refereed)
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