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  • 401.
    Barbarroja, Nuria
    et al.
    Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom; Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, Córdoba, Spain.
    Rodriguez-Cuenca, Sergio
    Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
    Nygren, Heli
    VTT Technical Research Centre of Finland, Espoo, Finland.
    Camargo, Antonio
    Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom; Lipids and Atherosclerosis Research Unit, Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, Córdoba, Spain.
    Pirraco, Ana
    Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom; Department of Biochemistry (U38-FCT), Faculty of Medicine, University of Porto, Porto, Portugal.
    Relat, Joana
    Departament de Bioquímica i Biologia Molecular, Universitat de Barcelona, Barcelona, Spain.
    Cuadrado, Irene
    Departamento de Farmacología, Universidad Complutense de Madrid, Madrid, Spain.
    Pellegrinelli, Vanessa
    Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
    Medina-Gomez, Gema
    Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
    Lopez-Pedrera, Chary
    Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, Córdoba, Spain.
    Tinahones, Francisco J.
    CIBER in Physiopathology of Obesity and Nutrition (CB06/03), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Biomédica de Málaga, Hospital Virgen de la Victoria, Malaga, Spain.
    Symons, J. David
    College of Health, University of Utah, Salt Lake City UT, United States; Division of Endocrinology, Metabolism, and Diabetes, University of Utah, Salt Lake City UT, United States.
    Summers, Scott A.
    Program in Cardiovascular and Metabolic Disorders, Duke-National University, Singapore Graduate Medical School, Singapore, Singapore.
    Oresic, Matej
    Örebro universitet, Institutionen för medicinska vetenskaper. VTT Technical Research Centre of Finland, Espoo, Finland; Steno Diabetes Center, Gentofte, Denmark.
    Vidal-Puig, Antonio
    Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom; Wellcome Trust Sanger Institute, Hinxton, United Kingdom.
    Increased dihydroceramide/ceramide ratio mediated by defective expression of degs1 impairs adipocyte differentiation and function2015Ingår i: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 64, nr 4, s. 1180-1192Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Adipose tissue dysfunction is an important determinant of obesity-associated, lipid-induced metabolic complications. Ceramides are well-known mediators of lipid-induced insulin resistance in peripheral organs such as muscle. DEGS1 is the desaturase catalyzing the last step in the main ceramide biosynthetic pathway. Functional suppression of DEGS1 activity results in substantial changes in ceramide species likely to affect fundamental biological functions such as oxidative stress, cell survival, and proliferation. Here, we show that degs1 expression is specifically decreased in the adipose tissue of obese patients and murine models of genetic and nutritional obesity. Moreover, loss-of-function experiments using pharmacological or genetic ablation of DEGS1 in preadipocytes prevented adipogenesis and decreased lipid accumulation. This was associated with elevated oxidative stress, cellular death, and blockage of the cell cycle. These effects were coupled with increased dihydroceramide content. Finally, we validated in vivo that pharmacological inhibition of DEGS1 impairs adipocyte differentiation. These data identify DEGS1 as a new potential target to restore adipose tissue function and prevent obesity-associated metabolic disturbances.

  • 402.
    Bark, Matthias
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Standardprojektioner av scaphoideum i det akuta skedet vid frakturfrågeställning2012Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Ladda ner fulltext (pdf)
    Standardprojektioner av scaphoideum i det akuta skedet vid frakturfrågeställning
  • 403.
    Bark, Tor
    et al.
    Department of Surgery and Medicine, Karolinska Hospital, Stockholm, sweden.
    Engervall, Per A.
    Department of Surgery and Medicine, Karolinska Hospital, Stockholm, Sweden.
    Katouli, Mohammad
    Center for Microbiology and Tumorbiology, Karolinska Institute, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Oral Diagnostic Sciences, Karolinska Institute, Huddinge, Sweden.
    Loftenius, Annika
    Department of Oral Diagnostic Sciences, Karolinska Institute, Huddinge, Sweden.
    Möllby, Roland
    Center for Microbiology and Tumorbiology, Karolinska Institute, Stockholm, Sweden.
    Svenberg, Torgny E.
    Center for Microbiology and Tumorbiology, Karolinska Institute, Stockholm, Sweden.
    Oral arginine supplementation does not prevent bacterial translocation afterhemorrhagic stress in the rat1998Ingår i: Surgical Research Communications, ISSN 0882-9233, Vol. 19, s. 269-277Artikel i tidskrift (Refereegranskat)
  • 404.
    Bark, Tor
    et al.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Katouli, Mohammad
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Möllby, R.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Svenberg, Torgny E.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Bacterial translocation after non-lethal hemorrhage in the rat1993Ingår i: Circulatory Shock, ISSN 0092-6213, Vol. 41, nr 1, s. 60-65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Translocation of enteric bacteria has been suggested to compromise patients in severe catabolic stress. Mechanisms for this route of infection are not known. In this study, ratswere subjected to hemorrhage without reinfusion during 60 min, total blood loss was 3.28 +/- 0.14 ml/100 g BW. Control groups consisted of sham-operated animals without bleeding, and rats not operated at all. The mean number of viable bacteria found in mesenteric lymph nodes (MLN) of bled animals was 168 +/- 45 colony forming units (c.f.u./MLN), significantly higher compared to sham operated (5 +/- 3 c.f.u./MLN) and not operated (0 +/- 0 c.f.u./MLN) controls (P < 0.01). Cultures from MLN were positive in 7/9 rats after bleeding, in 3/9 of sham operated, and in 0/6 of non-instrumented control animals. No positive blood cultures were isolated. Escherichia coli was the dominant species found in MLN. A biochemical fingerprinting method (the PhP system) was used to identify translocating strains of E. coli among strains found in cecum. The method was also used to compare translocating strains between different animals. Our findings reveal that bacteria translocate to MLN after hemorrhage. Some phenotypes of E. coli strains translocate more frequently than others, suggesting that they have properties facilitating translocation.

  • 405.
    Bark, Tor
    et al.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Katouli, Mohammad
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Möllby, R.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Svenberg, Torgny E.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Glutamine supplementation does not prevent bacterial translocation after non-lethal haemorrhage in rats1995Ingår i: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 161, nr 1, s. 3-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

    To find out whether supplementation of an enteral diet with glutamine would reduce translocation of bacteria to mesenteric lymph nodes or blood after major haemorrhage in rats.

    DESIGN:

    Open randomised study.

    SETTING:

    University departments of surgery and microbiology, Sweden.

    MATERIAL:

    49 Sprague-Dawley rats.

    INTERVENTIONS:

    Rats were fed enterally for 7 days on diets supplemented with either glutamine or an isonitrogenous amount of non-essential amino acids. After feeding, 8 experimental and 8 control rats underwent sham operation; 9 and 7, respectively, underwent moderate haemorrhage (to 65 mm Hg); and 9 and 8, respectively, underwent severe haemorrhage (50 mm Hg) without reinfusion.

    MAIN OUTCOME MEASURES:

    Microbiological analyses of samples of blood and mesenteric lymph nodes taken 24 hours after haemorrhage.

    RESULTS:

    The median (interquartile) number of colony forming units/mesenteric lymph nodes after moderate haemorrhage in animals who were given glutamine supplementation was 11 (0-34) and in control animals 20 (0-178). After severe haemorrhage the corresponding figures were 199 (10-310) and 22 (0-187). No pathogens were isolated from blood cultures.

    CONCLUSION:

    Glutamine supplementation before haemorrhage did not reduce bacterial translocation to mesenteric lymph nodes in this rat model.

  • 406.
    Barmparas, Galinos
    et al.
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Harada, Megan Y.
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Ko, Ara
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Dhillon, Navpreet K.
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Smith, Eric J. T.
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Li, Tong
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery, Division of Trauma and Emergency Surgery.
    Ley, Eric J.
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    The Effect of Early Positive Cultures on Mortality in Ventilated Trauma Patients2018Ingår i: Surgical Infections, ISSN 1096-2964, E-ISSN 1557-8674, Vol. 19, nr 4, s. 410-416Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The purpose was to examine the incidence of positive cultures in a highly susceptible subset of trauma patients admitted to the surgical intensive care unit (SICU) for mechanical ventilation and to examine the impact of their timing on outcomes.

    Patients and Methods: A retrospective review was conducted of blunt trauma patients admitted to the SICU for mechanical ventilation at a level I trauma center over a five-year period. All urine, blood, and sputum cultures were abstracted. Patients with at least one positive culture were compared with those with negative or no cultures. The primary outcome was mortality. A Cox regression model with a time-dependent variable was utilized to calculate the adjusted hazard ratio (AHR).

    Results: The median age of 635 patients meeting inclusion criteria was 46 and 74.2% were male. A total of 298 patients (46.9%) had at least one positive culture, with 28.9% occurring within two days of admission. Patients with positive cultures were more likely to be severely injured with an injury severity score (ISS) 16 (68.5% vs. 45.1%, p<0.001). Overall mortality was 22%. Patients who had their first positive culture within two and three days from admission had a significantly higher AHR for mortality (AHR: 14.46, p<0.001 and AHR: 10.59, p=0.028, respectively) compared to patients with a positive culture at day six or later.

    Conclusions: Early positive cultures are common among trauma patients requiring mechanical ventilation and are associated with higher mortality. Early identification with damage control cultures obtained on admission to aid with early targeted treatment might be justified.

  • 407.
    Barth, Henrik
    et al.
    Department of Ophthalmology, Lund University Hospital, Biomedicinskt centrum (BMC), Lund, Sweden.
    Crafoord, Sven
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Ophthalmology, Örebro University Hospital, Örebro, Sweden.
    Andréasson, Sten
    Department of Ophthalmology, Lund University Hospital, Biomedicinskt centrum (BMC), Lund, Sweden.
    Ghosh, Fredrik
    Department of Ophthalmology, Lund University Hospital, Biomedicinskt centrum (BMC), Lund, Sweden.
    A cross-linked hyaluronic acid hydrogel (Healaflow(®)) as a novel vitreous substitute2016Ingår i: Graefe's Archives for Clinical and Experimental Ophthalmology, ISSN 0721-832X, E-ISSN 1435-702X, Vol. 254, nr 4, s. 697-703Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Vitrectomy requires the substitution of the natural vitreous, as well as tamponading of retinal breaks. Clinically available alternatives such as gas and silicone oil have side effects such as inflammation, secondary glaucoma, cataract, and a need for head posturing. In this study, a hydrogel of cross-linked sodium hyaluronic acid (Healaflow(®)) is evaluated for use as a novel vitreous substitute.

    Methods: A combined 25-20-gauge pars plana vitrectomy with posterior vitreous detachment was performed in the right eye of twelve pigmented rabbits, with subsequent injection of approximately 1 ml Healaflow(®). Clinical evaluation, measurement of intraocular pressure (IOP), and full-field ERG were performed postoperatively. The rabbits were sacrificed at different time-points between 42 and 105 days. After enucleation, the eyes were examined macroscopically, photographed, and prepared for histological examination with routine microscopy and immunohistochemistry.

    Results: Healaflow(®) was successfully used with standard surgical procedures and remained translucent but did lose most of its viscosity during the postoperative period. One rabbit was lost due to unrelated causes. In two eyes iatrogenic partial retinal detachments were seen, and in two eyes significant cataract developed due to intra-operative complications. ERG-recordings revealed no toxic effect on rod or cone function. Routine microscopy and immunohistochemistry demonstrated normal morphology with some Müller cell activation (up-regulation of glial acidic fibrillary protein, GFAP) compared to unoperated eyes and no significant DNA-fragmentation (TUNEL-assay).

    Conclusions: Healaflow® did not affect retinal morphology or function negatively during long-term use as a vitreous substitute, making it highly interesting in this setting. An estimated retention time of a few weeks suggests potential for use as a short-term tamponade. Future work will include an increased ratio of cross-linking to prolong the structural integrity of the gel.

  • 408.
    Barth, Henrik
    et al.
    Department of Ophthalmology, Lund University, BMC D10,, Lund, Sweden.
    Crafoord, Sven
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Ophthalmology, Faculty of Medicine and Health, Örebro University Hospital, Orebro, Sweden.
    Arnér, Karin
    Department of Ophthalmology, Lund University, BMC D10, Lund, Sweden.
    Ghosh, Fredrik
    Department of Ophthalmology, Lund University, BMC D10, Lund, Sweden.
    Inflammatory responses after vitrectomy with vitreous substitutes in a rabbit model2019Ingår i: Graefe's Archives for Clinical and Experimental Ophthalmology, ISSN 0721-832X, E-ISSN 1435-702X, Vol. 257, nr 4, s. 769-783Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To investigate the inflammatory response of current and future potential vitreous substitutes in an experimental in vivo vitrectomy model.

    METHODS: Twenty-five gauge pars plana vitrectomy was performed in the right eye of 60 pigmented rabbits, with subsequent injection of 0.5-1.0 ml of Healaflow® (cross-linked hyaluronic acid, n = 12), Bio-Alcamid® (polyalkylimide, n = 8), silicone oil (n = 12), or balanced saline solution (BSS, n = 28). Postoperative clinical evaluation was performed; and the rabbits were sacrificed at 1 day, 1 week, or 1 month. The eyecups were then examined macroscopically; the retinas sectioned and stained with hematoxylin and eosin (Htx), and immunohistochemically labeled for glial fibrillary acidic protein (GFAP), CD45, galectin-3, CD68, and CD20. Unoperated left eyes from treated animals as well as eyes from untreated animals were used as controls.

    RESULTS: Vitrectomy without major complications was achieved in 46/60 eyes. The remaining 14 eyes were analyzed separately. One eye developed endophthalmitis after 1 week and was excluded. Eyes treated with Healaflow®, silicone oil, and BSS had a comparable appearance macroscopically and in Htx-stained sections, whereas Bio-Alcamid®-injected eyes exhibited increased macroscopic inflammation and severely affected retinas. GFAP upregulation was present in all treatment groups, most prominent in eyes treated with Bio-Alcamid® and silicone oil. Upregulation of CD45 and CD68 in the inner retina and vitreous space was most prominent with Bio-Alcamid® treatment, and these eyes together with their silicone oil-treated counterparts also displayed a stronger upregulation of CD20-labeled cells compared with remaining groups. General upregulation of galectin-3, mainly in the inner retina, was found in all groups. In eyes with perioperative complications, labeling of CD45, CD68, and especially GFAP was comparably high.

    CONCLUSIONS: We here describe differences in the postsurgery inflammatory profiles of existing and potential vitreous substitutes. Bio-Alcamid® and silicone oil display severe signs of gliosis and inflammation, whereas Healaflow® elicits minimal reactions comparable with BSS, highlighting its potential application as a vitreous substitute in a future clinical setting.

  • 409.
    Barth, Henrik
    et al.
    Lund University Hospital, Department of Ophthalmology, Lund, Sweden.
    Crafoord, Sven
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Ophthalmology.
    Ghosh, Fredrik K.
    Lund University Hospital, Department of Ophthalmology, Lund, Sweden.
    Developing a retinal detachment model for in vivo testing of vitreous substitutes with repeated pars plana vitrectomy2018Ingår i: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 59, nr 9, artikel-id 5941Artikel i tidskrift (Övrigt vetenskapligt)
  • 410.
    Barth, Henrik
    et al.
    Department of Ophthalmology, Lund University, Lund, Sweden .
    Crafoord, Sven
    Örebro universitet, Institutionen för läkarutbildning. Department of Ophthalmology, Örebro University Hospital, Örebro, Sweden.
    O'Shea, Timothy M.
    Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, USA .
    Pritchard, Christopher D.
    Harvard-Massachusetts Institute of Technology, Division of Health Sciences and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, USA .
    Langer, Robert
    Harvard-Massachusetts Institute of Technology, Division of Health Sciences and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, USA .
    Ghosh, Fredrik
    Department of Ophthalmology, Lund University, Lund, Sweden .
    A new model for in vitro testing of vitreous substitute candidates2014Ingår i: Graefe's Archives for Clinical and Experimental Ophthalmology, ISSN 0721-832X, E-ISSN 1435-702X, Vol. 252, nr 10, s. 1581-1592Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To describe a new model for in vitro assessment of novel vitreous substitute candidates.

    Methods: The biological impact of three vitreous substitute candidates was explored in a retinal explant culture model; a polyalkylimide hydrogel (Bio-Alcamid (R)), a two component hydrogel of 20 wt.% poly (ethylene glycol) in phosphate buffered saline (PEG) and a cross-linked sodium hyaluronic acid hydrogel (Healaflow (R)). The gels where applied to explanted adult rat retinas and then kept in culture for 2, 5 and 10 days. Gel-exposed explants were compared with explants incubated under standard tissue culture conditions. Cryosections of the specimens were stained with hematoxylin and eosin, immunohistochemical markers (GFAP, Vimentin, Neurofilament 160, PKC, Rhodopsin) and TUNEL.

    Results: Explants kept under standard conditions as well as PEG-exposed explants displayed disruption of retinal layers with moderate pyknosis of all neurons. They also displayed moderate labeling of apoptotic cells. Bio-Alcamid (R)-exposed explants displayed severe thinning and disruption of retinal layers with massive cell death. Healaflow (R)-treated explants displayed normal retinal lamination with significantly better preservation of retinal neurons compared with control specimens, and almost no signs of apoptosis. Retinas exposed to Healaflow (R) and retinas kept under standard conditions showed variable labeling of GFAP with generally low expression and some areas of upregulation. PEG-exposed retinas showed increased GFAP labeling and Bio-Alcamid (R)-exposed retinas showed sparse labeling of GFAP.

    Conclusions: Research into novel vitreous substitutes has important implications for both medical and surgical vitreoretinal disease. The in vitro model presented here provides a method of biocompatibility testing prior to more costly and cumbersome in vivo experiments. The explant culture system imposes reactions within the retina including disruption of layers, cell death and gliosis, and the progression of these reactions can be used for comparison of vitreous substitute candidates. Bio-Alcamid (R) had strong adverse effects on the retina which is consistent with results of prior in vivo trials. PEG gel elicits reactions similar to the control retinas whereas Healaflow (R) shows protection from culture-induced trauma indicating favorable biocompatibility.

  • 411.
    Barth, Henrik
    et al.
    Dept Ophthalmol, Lund Univ, Lund, Sweden.
    Crafoord, Sven W.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Dept Ophthalmology, Örebro University Hospital, Örebro, Sweden.
    Arner, Karin
    Dept Ophthalmol, Lund Univ, Lund, Sweden.
    Ghosh, Fredrik K.
    Dept Ophthalmol, Lund Univ, Lund, Sweden.
    Cellular CD68 and CD45r0 positive inflammatory responses of vitrectomy with vitreous substitutes2016Ingår i: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 57, nr 12Artikel i tidskrift (Refereegranskat)
  • 412.
    Bartha, Erzsebet
    et al.
    Karolinska University Hospital, Huddinge, Sweden.
    Bertilsson, Mathias
    Karolinska University Hospital, Huddinge, Sweden.
    Ahlstrand, Rebecca
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bell, Max
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Björne, Håkan
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Brattström, Olof
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Nilsson, Lena
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Semenas, Egidijus
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Wiklund, Andreas
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Kalman, Sigridur
    Periooperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
    Combining functional dependency and ASA III classification for risk stratification-predictors, risk factors, and outcomes following major surgery study (NCT02626546)2017Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, nr 8, s. 1011-1011Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: In elderly reclassification of ASA3 class by functional dependency improved prediction of postoperative mortality. We hypothesized that such a reclassification could improve the risk prediction of adverse outcomes also following high risk surgery.

    Method: We analyzed data collected by the PROFS study in four Swedish academic hospitals. The inclusion criteria were: adults, ASA≥3, major or xmajor/complex surgery (UK surgical severity coding). ASA 3 patients were reclassified into ASA 3a (functionally independent) and 3b (functionally dependent). The adverse outcomes were postoperative complications (yes/no) screened by Postoperative Morbidity Survey (days 3, 7, 10) and mortality (30-day). Complications graded ≥2 by Clavien-Dindo classification were considered. The predictive value of reclassification was analyzed by logistic regression models.

    Results: Between 2015 Nov2th and 2016 Feb19th 1089 patients were include; 13 were excluded (violation of inclusion criteria), 3 were lost to follow-up and 1073 were analyzed. ASA 3b (vs ASA 3a) patients had higher risk for mortality and for postoperative complications at days 7 and 10. ASA 4 (vs ASA 3) patients had higher risk of all adverse outcomes (Table 1). When age was added in the regression model ASA 3b patients still had higher risk for postoperative complications at day 10, but the significance disappeared when also urgency was added.

    Conclusion: The loss of significance by adding urgency in the model might be attributed to the dominance of urgent procedures in ASA3b and ASA4 groups. Reclassification of ASA 3 patients by dependency is recommended, as it may predict adverse outcomes and support clinical judgment.

  • 413.
    Bartha, Erzsebet
    et al.
    Karolinska University Hospital, Huddinge, Sweden.
    Helleberg, Johan
    Karolinska University Hospital, Huddinge, Sweden.
    Ahlstrand, Rebecca
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Bell, Max
    Karolinska University Hospital, Solna, Sweden.
    Björne, Hakan
    Karolinska University Hospital, Solna, Sweden.
    Brattström, Olof
    Karolinska University Hospital, Solna, Sweden.
    Nilsson, Lena
    University Hospital Linköping, Linköping, Sweden.
    Semenas, Egidijus
    Uppsala University Hospital, Uppsala, Sweden.
    Wiklund, Andreas
    Karolinska University Hospital, Solna, Sweden.
    Kalman, Sigridur
    Karolinska University Hospital, Huddinge, Sweden.
    Performance of prediction models of postoperative mortality in high-risk surgical patients in swedish university hospitals: Predictors, Risk factors and Outcome Following major Surgery study (PROFS study NCT02626546)2017Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, nr 8, s. 1056-1057Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: There are several progn ostic prediction models that estimate the probability of postoperative mortality. The role of these models is to support clinical decisions. Before implementation of a prediction model in routine care, it is necessary to analyze its performance in the target population. Our aim was to analyze the performance of four different prediction models of postoperative mortality in a high-risk surgical population.

    Methods: Data collected from 2015-11-01 until 2016-02-15 in a prospective consecutive observational study (PROFS study) in four university hospitals was used. The inclusion criteria were adult, ASA classification ≥3, and major/complex upper or lower gastrointestinal, urogenital or orthoped ic surgery (UK surgical severity codingA XA PPP). Four prediction models were evaluated: Surgical Outcome Risk Tool (SORT), Surgical APGAR, P-POSSUM and Surgical Risk Scale (SRS). The outcome measure was 90-day mortality. We evaluated the discrimination of the models by area under receiver operator characteristic curve (AUC ROC) before and after recalibration.

    Results: In total, 1 089 patients were included. Thirteen patients were excluded due to erroneous inclusion, and another three were lost to follow-up, so data from 1 073 was used in this analysis. The mean age was 73 years, the presence of malignancy was 41%, and 90-day mortality was 13% (n = 140). The SORT model had the best discrimination both before and after recalibration. The P-POSSUM model improved after recalibration. The SRS model overestimated, whereas the APGAR model underestimated, the risk of mortality.

    Conclusions: The original SORT model is promising and could be incorporated as decision support for high-risk surgical patients.

  • 414.
    Barzangi, Jir
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Dental Research Department, Public Dental Health Service.
    Unell, L.
    Dental Research Department, Public Dental Health Service, Örebro, Region Örebro County, Sweden; School of Health Sciences, Örebro University, Örebro, Sweden.
    Skovdahl, K.
    Faculty for Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
    Arnrup, Kristina
    Örebro universitet, Institutionen för hälsovetenskaper. Dental Research Department, Public Dental Health Service, Örebro, Region Örebro County, Sweden.
    Knowledge, experiences and attitudes of dental and health care personnel in Sweden towards infant dental enucleation2018Ingår i: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 19, nr 4, s. 229-237Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To examine self-rated knowledge of clinical experiences and attitudes towards the practice of infant dental enucleation among dental and health care personnel in Sweden.

    A questionnaire survey was performed among 776 licensed dental and health care personnel working in emergency departments, midwifery, child health centres, school health services and public dental health services in 10 Swedish cities. The response rate was 56.2% (n = 436).

    Fewer than a fifth of the respondents reported self-rated knowledge of the practice. Approximately 13% of personnel encountering children professionally believed they had seen subjected patients in their clinical practice. Personnel with self-rated knowledge and clinical experience worked mostly in dental care. Additionally, the personnel had diverging attitudes regarding agreement and disagreement concerning professional responsibility for patients subjected to or at risk of infant dental enucleation.

    The study indicated there is need for increased knowledge about the practice and for clarification of obligatory responsibilities among dental and health care personnel regarding management and prevention of cases of infant dental enucleation.

  • 415.
    Barzangi, Jir
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Publ Dent Serv, Västmanland Cty Council, Västerås, Sweden.
    Unell, Lennart
    Region Örebro län. Sch Hlth & Med Sci, Univ Örebro, Örebro, Sweden.
    Söderfeldt, Björn
    Publ Dent Serv, Postgrad Dent Educ Ctr, Örebro Cty Council, Örebro, Sweden; Fac Odontol, Dept Oral Publ Hlth, Malmö Univ, Malmö, Sweden .
    Arnrup, Kristina
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Publ Dent Serv, Postgrad Dent Educ Ctr, Örebro Cty Council, Örebro, Sweden.
    Infant dental enucleation: A literature review on a traditional remedial practice in East Africa2014Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, nr 3, s. 168-178Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objective. To summarize and review the literature on infant dental enucleation, a traditional remedial procedure prevalent mainly in East Africa.

    Materials and methods. Literature searches were made electronically using general and specialized search engines. The main search was performed through a systematic strategy in PubMed, comprising tabulated keywords, search codes, and translated and transliterated terms. Criteria for the selection of studies were designed to provide a general understanding of the procedure. The findings were synthesized into two sections: a summary of the population prevalence studies, and a thematic literature review.

    Results. An overview of the known prevalence and clinical specifications was established. Insight was gained into the purpose of the procedure and the factors influencing its performance. Diverging suggestions were seen with regard to the rationale for use of infant dental enucleation between different populations. Moreover, reports of complications and consequences involving the general health and the dentoalveolar structures of patients were examined.

    Conclusions. Prevalence, clinical features and risks of infant dental enucleation point to a need for greater awareness of the procedure. Further, there is a need for specific guidelines regarding management of suspected cases within dental and healthcare communities.

  • 416.
    Barzangi, Jir
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Publ Dent Serv, Västmanland Cty Council, Västerås, Sweden.
    Unell, Lennart
    Region Örebro län. Sch Hlth & Med Sci, Univ Örebro, Örebro, Sweden; Publ Dent Serv, Örebro Cty Council, Örebro, Sweden.
    Söderfeldt, Björn
    Publ Dent Serv, Örebro Cty Council, Örebro, Sweden; Fac Odontol, Dept Oral Publ Hlth, Malmö Univ, Malmö, Sweden .
    Bond, Jasmin
    Publ Dent Serv, Örebro Cty Council, Örebro, Sweden.
    Musse, Ifrah Ahmed
    Publ Dent Serv, Örebro Cty Council, Örebro, Sweden.
    Arnrup, Kristina
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Infant dental enucleation in an East African population in Sweden: a cross-sectional study on dental records2014Ingår i: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 24, nr 3, s. 209-214Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To examine the prevalence of infant dental enucleation (IDE) of primary canines, an East African traditional remedial procedure, in a multiethnic population of children in Sweden.

    Design: A cross-sectional study was conducted of dental records of 1133 patients (mean age 4.6years, SD +/- 1.4) attending one public dental service clinic in Sweden. The clinic was located in an area with a large multiethnic community. All were born within the years 2002-2006 and had received a check-up in one of the years 2007-2009. A registry was made of missing primary canines where no reason could be found. In documented cases, information about ethnic origin was extracted. Statistical grouping was made according to known East African ethnicities.

    Results: At least 36 ethnicities were recorded. Twenty-four (2.1%) patients were missing one or more canines according to the criteria for IDE. Significant difference was seen when comparison was made between patients of known East African ethnicities, of whom 20.8% (21/101) manifested findings consistent with the criteria, and the rest of the population (3/1032; P<0.001).

    Conclusions: Prevalence of cases suggestive of IDE among patients of East African origin points to a need for increased awareness within dental and healthcare communities.

  • 417.
    Barzinjy, Vian B.
    et al.
    Department of Medical Microbiology, College of Medicine, Hawler Medical University, Erbil, Iraq.
    Dabbagh, Rasool
    Department of Medical Microbiology, College of Medicine, Hawler Medical University, Erbil, Iraq.
    Saber, Amanj
    Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
    Fungal and Other Microorganisms Involved in Otomycosis in Hawler Area2009Ingår i: Middle East Journal of Internal Medicine, ISSN 1837-9052, Vol. 2, nr 1, s. 7-10Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Patients with clinical manifestations suggestive of otitis externa.

    Objective: To study the prevalence of mycotic infection in these patients.

    Methods: Ear swabs were taken from these patients and both direct examination and culture were done.

    Results: The most common pathogenic fungal isolates were Candida species (8.4%) and Aspergillus niger (4.2%). Conclusion: Besides Aspergillus and Candida species isolated in these patients, many bacteria were also seen. Dry climate, wearing head clothes, presence of middle ear infection, wearing hearing aids and swimming were predisposing factors for this infection.

  • 418.
    Basic, Vladimir T.
    et al.
    Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Tadele, Elsa
    Department of Clinical Medicine, Örebro University, Örebro, Sweden; Medical University of Giessen, Molecular Biology and Medicine of the Lung program, Giessen, Germany.
    Jacobsen, Annette
    Department of Clinical Medicine, Örebro University, Örebro, Sweden; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia.
    Sirsjö, Allan
    Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Abdel-Halim, Samy M.
    Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
    Chronic cigarette smoke exposureimpairs skeletal muscle regenerative capacity in murineCOPD/emphysema model.Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: Cigarette smoke (CS) is a well established risk factor in the development of COPD and irreversible airflow limitation. In contrast, the extent to which CS exposure contributes to development of peripheral skeletal muscle dysfunction and wasting remains largely unknown. Decline in skeletal muscle regenerative capacity has been previously reported in COPD patients.

    Methods: To investigate effects of chronic CS exposure on skeletal muscle regenerative capacity, 129/SvJ mice were exposed to CS for 6 months. The expression levels of myogenin, Jarid2, Znf496, Notch1, Pax7, Fgf1 and Myh3, which are known to regulate skeletal muscle myogenesis, were studied. Additionally, number of fibers with central nuclei, myonuclei number and mean fiber cross-sectional area were assessed.

    Results: Compared to controls, skeletal muscles from CS-exposed mice exhibited significantly decreased expression of Jarid2, coupled with enhanced expression of Znf496, Notch1, Pax7, Fgf1 and Myh3. Expression of myogenin, a marker of terminally differentiated myofibers, was reduced. Furthermore, reduced muscle fiber crosssectional area, increased number of fibers with central nuclei and reduced myonuclei number were also observed in CS-exposed animals.

    Conclusions: Taken together, current results provide evidence linking chronic CS exposure and an ongoing damage/repair process as well as impaired regenerative capacity in skeletal muscles of CS-exposed mice.

  • 419.
    Bask, Miia
    Department of Sociology, University of Bergen, Bergen, Norway.
    Patterns of Psycho-Social Distress Among Ageing Swedes2015Ingår i: Journal of Population Ageing, ISSN 1874-7884, E-ISSN 1874-7876, Vol. 8, nr 4, s. 261-278Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper examines psycho-social distress among middle-aged and elderly Swedes. We analysed data on 3221 individuals who were 55 to 99 years old. Based on a latent class analysis, we identified four latent classes. Two classes were associated with higher levels of psycho-social problem accumulation. The class with the lowest level of problem accumulation contained the greatest number of individuals, whereas the classes with the highest level of psycho-social distress contained the least number of individuals. The analysis showed that being a man, being married, being a native Swede, or having several hobbies was associated with a low likelihood of belonging to a latent class that was characterised by psycho-social distress. Moreover, being a woman, being between 55 and 65 years of age, or being a widow was associated with a high likelihood of belonging to a latent class that was characterised by the highest levels of problem accumulation.

  • 420.
    Bask, Miia
    Department of Sociology, University of Bergen, Bergen, Norway.
    Patterns of Psycho-Social Distress among Middle-Aged and Elderly Swedes2015Konferensbidrag (Refereegranskat)
  • 421.
    Bass, G. A.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
    Gillis, A. E.
    Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    European Society for Trauma and Emergency Surgery (ESTES), Cohort Studies Group
    Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated calculous biliary disease2020Ingår i: BJS open, ISSN 2474-9842Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Complicated acute biliary calculous disease poses clinical challenges. The European Society of Trauma and Emergency Surgery (ESTES) snapshot audit of complicated biliary calculous disease aims to make novel comparisons between self-reported institutional adherence to the Tokyo guidelines (TG18) and 'real-world' contemporary practice across Europe.

    METHODS: A preplanned analysis of a prospective observational multicentre audit that captured patients undergoing emergency admission for complicated biliary calculous disease (complicated cholecystitis, biliary pancreatitis, or choledocholithiasis with or without cholangitis) between 1 and 31 October 2018 was performed. An anonymized survey was administered to participating sites.

    RESULTS: Following an open call for participation, 25 centres from nine countries enrolled 338 patients. All centres completed the anonymized survey. Fifteen centres (60 per cent) self-reported that a minority of patients were treated surgically on index admission, favouring interval cholecystectomy. This was replicated in the snapshot audit, in which 152 of 338 patients (45·0 per cent) underwent index admission cholecystectomy, 17 (5·0 per cent) had interval cholecystectomy, and the remaining 169 (50·0 per cent) had not undergone surgery by the end of the 60-day follow-up. Centres that employed a dedicated acute care surgery model of care were more likely to perform index admission cholecystectomy compared with a traditional general surgery 'on call' service (57 versus 38 per cent respectively; odds ratio 2·14 (95 per cent c.i. 1·37 to 3·35), P < 0·001). Six centres (24 per cent) self-reported routinely performing blood cultures in acute cholecystitis; patient-level audit data revealed that blood cultures were done in 47 of 154 patients (30·5 per cent). No centre self-reported omitting antibiotics in the management of acute cholecystitis, and 144 of 154 (93·5 per cent) of patients in the snapshot audit received antibiotics during their index admission.

    CONCLUSION: Awareness of TG18 recommendations was high, but self-reported adherence and objective snapshot audit data showed low compliance with TG18 in patients with complicated acute biliary calculous disease.

  • 422.
    Batchelor, Tim J. P.
    et al.
    Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery.
    A surgical perspective of ERAS guidelines in thoracic surgery2019Ingår i: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 32, nr 1, s. 17-22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE OF REVIEW: Guidelines for enhanced recovery after surgery (ERAS) have recently been published for lung surgery. Although some of the recommendations are generic or focused on anesthetic and nursing care, other recommendations are more specific to a thoracic surgeon's practice. The present review concentrates on the surgical approach, optimal chest drain management, and the importance of early mobilization.

    RECENT FINDINGS: Most lung cancer resections are still performed via an open thoracotomy approach. If a thoracotomy is to be used, a muscle-sparing approach may result in reduced pain and better postoperative function. Sparing of the intercostal bundle also reduces pain. There is now evidence that minimally invasive surgery for early lung cancer results in superior patient outcomes. Postoperatively, single chest tubes should be used without the routine application of external suction. Digital drainage systems are more reliable and may produce superior outcomes. Conservative chest drain removal policies are unnecessary and impair patient recovery. Early mobilization protocols should be instigated to reduce postoperative complications.

    SUMMARY: The use of ERAS after lung surgery has the potential to improve patient outcomes. Although specific surgical elements are in the minority, thoracic surgeons should be involved in all aspects of perioperative care as part of the wider multidisciplinary team.

  • 423.
    Batchelor, Timothy J. P.
    et al.
    Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
    Rasburn, Neil J.
    Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
    Abdelnour-Berchtold, Etienne
    Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
    Brunelli, Alessandro
    Department of Thoracic Surgery, St. James’s University Hospital, Leeds, UK.
    Cerfolio, Robert J.
    Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA.
    Gonzalez, Michel
    Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery.
    Petersen, René H.
    Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Popescu, Wanda M.
    Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
    Slinger, Peter D.
    Department of Anesthesia, University Health Network – Toronto General Hospital, Toronto, ON, Canada.
    Naidu, Babu
    Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
    Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS)2019Ingår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 55, nr 1, s. 91-115Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Enhanced recovery after surgery is well established in specialties such as colorectal surgery. It is achieved through the introduction of multiple evidence-based perioperative measures that aim to diminish postoperative organ dysfunction while facilitating recovery. This review aims to present consensus recommendations for the optimal perioperative management of patients undergoing thoracic surgery (principally lung resection). A systematic review of meta-analyses, randomized controlled trials, large non-randomized studies and reviews was conducted for each protocol element. Smaller prospective and retrospective cohort studies were considered only when higher-level evidence was unavailable. The quality of the evidence base was graded by the authors and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society and the European Society for Thoracic Surgery. Recommendations were developed for a total of 45 enhanced recovery items covering topics related to preadmission, admission, intraoperative care and postoperative care. Most are based on good-quality studies. In some instances, good-quality data were not available, and subsequent recommendations are generic or based on data extrapolated from other specialties. In other cases, no recommendation can currently be made because either equipoise exists or there is a lack of available evidence. Recommendations are based not only on the quality of the evidence but also on the balance between desirable and undesirable effects. Key recommendations include preoperative counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anaesthetics to facilitate early emergence, regional anaesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive surgery, early chest drain removal, avoidance of urinary catheters and early mobilization after surgery. These guidelines outline recommendations for the perioperative management of patients undergoing lung surgery based on the best available evidence. As the recommendation grade for most of the elements is strong, the use of a systematic perioperative care pathway has the potential to improve outcomes after surgery.

  • 424.
    Batra, Gorav
    et al.
    Uppsala Clinical Research Center, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Ahlsson, Anders
    Department of Cardiothoracic and Vascular Surgery, School of Medicine and Health, Örebro University, Örebro, Sweden.
    Lindahl, Bertil
    Uppsala Clinical Research Center, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Lindhagen, Lars
    Uppsala Clinical Research Center, Uppsala, Sweden.
    Wickbom, Anders
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiothoracic and Vascular Surgery.
    Oldgren, Jonas
    Uppsala Clinical Research Center, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Atrial fibrillation in patients undergoing coronary artery surgery is associated with adverse outcome2019Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, nr 1, s. 70-77Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim was to determine the association between atrial fibrillation (AF) and outcome in patients undergoing coronary artery bypass grafting (CABG).

    METHODS: All patients undergoing CABG between January 2010 and June 2013 were identified in the Swedish Heart Surgery Registry. Outcomes studied were all-cause mortality, cardiovascular mortality, myocardial infarction, congestive heart failure, ischemic stroke, and recurrent AF. Patients with history of AF prior to surgery (preoperative AF) and patients without history of AF but with AF episodes post-surgery (postoperative AF) were compared to patients with no AF using adjusted Cox regression models.

    RESULTS: Among 9,107 identified patients, 8.1% (n = 737) had preoperative AF, and 25.1% (n = 2,290) had postoperative AF. Median follow-up was 2.2 years. Compared to no AF, preoperative AF was associated with higher risk of all-cause mortality, adjusted hazard ratio with 95% confidence interval (HR) 1.76 (1.33-2.33); cardiovascular mortality, HR 2.43 (1.68-3.50); and congestive heart failure, HR 2.21 (1.72-2.84). Postoperative AF was associated with risk of all-cause mortality, HR 1.27 (1.01-1.60); cardiovascular mortality, HR 1.52 (1.10-2.11); congestive heart failure, HR 1.47 (1.18-1.83); and recurrent AF, HR 4.38 (2.46-7.78). No significant association was observed between pre- or postoperative AF and risk for myocardial infarction and ischemic stroke.

    CONCLUSIONS: Approximately 1 in 3 patients undergoing CABG had pre- or postoperative AF. Patients with pre- or postoperative AF were at higher risk of all-cause mortality, cardiovascular mortality, and congestive heart failure, but not of myocardial infarction or ischemic stroke. Postoperative AF was associated with higher risk of recurrent AF.

  • 425.
    Batyrbekova, Nurgul
    et al.
    Department of Biostatistics, Scandinavian Development Services AB.
    Aleman, Soo
    Karolinska Institute, Stockholm, Sweden.
    Lybeck, Charlotte
    Örebro universitet, Institutionen för medicinska vetenskaper. Infectious Diseases.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Duberg, Ann-Sofi
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hepatitis C virus infection and the temporal trends in the risk of liver cancer: a national register-based cohort study in Sweden2020Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 29, nr 1, s. 63-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In many countries, including Sweden, the birth cohorts with the highest prevalence of hepatitis C virus (HCV) infection have now reached the ages with high risk of primary liver cancer (PLC). The aims were to investigate the temporal trends in PLC incidence and the relative risks of PLC among people diagnosed with HCV-infection between 1990 and 2015.

    METHODS: The HCV-cohort (n: 52,853) was compared with a matched non-HCV comparison-cohort (n: 523,649). Both the Cancer (CR) and Death registers (DR) were used for follow-up. The crude and age-standardised PLC incidence rates were calculated. The relative risk was estimated as standardized incidence ratios (SIR) and as hazard ratios (HR) using stratified Cox hazards regression.

    RESULTS: There were 1,609 with PLC-diagnosis in the HCV-cohort, the annual number increased continuously with the crude incidence rate reaching 4.56 per 1,000 person-years in 2013, while remaining low and stable in the comparison-cohort. In the HCV-cohort, the age-standardised PLC incidence rates per 1,000 person-years remained relatively constant at 2.64 (95% CI: 1.54, 3.75) in 2000 and 3.31 (2.51, 4.12) in 2014. The highest SIR was 73 (65.9, 79.5) among those infected for 35-40 years; and the highest HR was 65.9 (55.9, 77.6) for men and 62.2 (31.9, 121.1) for women.

    CONCLUSIONS: There was a considerable increase in PLC-incidence over time and an extremely high relative risk in the population with HCV-infection for more than 35 years.

    IMPACT: The national HCV-associated PLC-incidence should be monitored in future studies to evaluate the effect of DAA-treatment.

  • 426.
    Baumgart, Juliane
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Obstetrics and Gynecology.
    Nilsson, Kerstin
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Evers, A. Stavreus
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Kallak, T. Kunovac
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Kushnir, M. M.
    ARUP Institute for Clinical and Experimental Pathology, Salt Lake City UT, USA; Department of Pathology, University of Utah School of Medicine, Salt Lake City, USA; Analytical Chemistry/Department of Chemistry, Biomedical Center and SciLife Laboratory, Uppsala University, Uppsala, Sweden.
    Bergquist, J.
    Department of Pathology, University of Utah School of Medicine, Salt Lake City UT, USA; Analytical Chemistry/Department of Chemistry, Biomedical Center and SciLife Laboratory, Uppsala University, Uppsala, Sweden.
    Poromaa, I. Sundström
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Androgen levels during adjuvant endocrine therapy in postmenopausal breast cancer patients2014Ingår i: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 17, nr 1, s. 48-54Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate plasma steroid hormone levels in postmenopausal breast cancer patients with and without adjuvant endocrine therapy and in healthy postmenopausal women.

    Methods: Steroid hormone levels in postmenopausal breast cancer patients treated with aromatase inhibitors (n = 32) were compared with breast cancer patients treated with tamoxifen (n = 34), breast cancer patients without adjuvant endocrine therapy (n = 15), and healthy postmenopausal women (n = 56). Pregnenolone, 17-hydroxypregnenolone, 17-hydroxyprogesterone, 11-deoxycortisol, cortisol, cortisone, dehydroepiandrosterone (DHEA), androstenedione, total testosterone, dihydrotestosterone, estrone and estradiol were measured using liquid chromatography-tandem mass spectrometry. Sex hormone binding globulin was measured by solid-phase chemiluminescent immunometric assays, and the free androgen index was calculated.

    Results: Aromatase inhibitor users did not differ in dihydrotestosterone, total testosterone, androstenedione, DHEA, or free androgen index levels from healthy controls or untreated breast cancer patients. The highest total testosterone levels were found in tamoxifen-treated women, who had significantly higher plasma concentrations than both women treated with aromatase inhibitors and breast cancer patients without adjuvant treatment. Concentrations of cortisol and cortisone were significantly greater in aromatase inhibitor users as well as tamoxifen users, in comparison with healthy controls and untreated breast cancer patients. Aromatase inhibitor users had lower estrone and estradiol plasma concentrations than all other groups.

    Conclusion: Adjuvant treatment with aromatase inhibitors or tamoxifen was associated with increased cortisol and cortisone plasma concentrations as well as decreased estradiol concentrations. Androgen levels were elevated in tamoxifen-treated women but not in aromatase inhibitor users.

  • 427.
    Baumgart, Juliane
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Obstetrics and Gynecology.
    Nilsson, Kerstin
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Obstetrics and Gynecology.
    Evers, Anneli Stavreus
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Kallak, Theodora Kunovac
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Poromaa, Inger Sundström
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Sexual dysfunction in women on adjuvant endocrine therapy after breast cancer2013Ingår i: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 20, nr 2, s. 162-168Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The goal of this study was to investigate sexual function in postmenopausal breast cancer patients treated with aromatase inhibitors.

    Methods: A population-based, cross-sectional study was conducted among postmenopausal breast cancer patients on adjuvant endocrine treatment and age-matched controls with and without estrogen treatment. Sexual function was assessed with a standardized questionnaire.

    Results: In all, 42.4% of aromatase inhibitor-treated breast cancer patients were dissatisfied with their sex life in general, and 50.0% reported low sexual interest; this was significantly more common than in tamoxifen-treated patients and controls (P < 0.05). Aromatase inhibitorYtreated patients reported insufficient lubrication in 73.9% and dyspareunia in 56.5% of cases, which were significantly more common than in controls, irrespective of hormonal use (P < 0.05). Tamoxifen-treated patients reported significantly more dyspareunia (31.3%; P < 0.05) but resembled controls in all other concerns.

    Conclusions: Our findings suggest that sexual dysfunction in aromatase inhibitorYtreated women is a greatly underestimated problem.

  • 428.
    Baylis, Rebecca
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ewald, Uwe
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Gradin, Maria
    Region Örebro län.
    Nyqvist, Kerstin Hedberg
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Rubertsson, Christine
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Blomqvist, Ylva Thernstrom
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    First-time events between parents and preterm infants are affected by the designs and routines of neonatal intensive care units2014Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, nr 10, s. 1045-1052Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: Early parental bonding with preterm babies is particularly important, and the aim of our study was to explore when parents experienced what they regarded as important events for the first time while their infant was in the neonatal intensive care unit (NICU).

    Methods: The study was part of a longitudinal project on Kangaroo Mother Care at two Swedish university hospitals. The parents of 81 infants completed questionnaires during their infants' hospital stay.

    Results: Most parents saw and touched their infants immediately after birth, but only a few could hold them skin to skin or swaddle them. Other important events identified by parents included the first time they performed care giving activities and did so independently, interaction and closeness with the infant, signs of the infant's recovery and integration into the family. The timing of the events depended on the physical design of the NICU, whether parents' could stay with their infant round-the-clock and when they were allowed to provide care under supervision and on their own.

    Conclusion: The design and routines of the NICU dictated when parents first interacted with their infants. Clinical guidelines that facilitate early contact with preterm babies can help parents to make the transition to their parental role.

  • 429.
    Bazargani, Farhan
    et al.
    Region Örebro län. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Jacobson, Sven
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Lennartsson, Bertil
    Postgraduate Dental Education Center, Örebro, Sweden.
    A comparative evaluation of lingual retainer failure bonded with or without liquid resin: A randomized clinical study with 2-year follow-up2012Ingår i: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 82, nr 1, s. 84-87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To prospectively evaluate and compare the effect of liquid resin on lingual retainer failure after a 2-year follow-up.

    Materials and Methods: Fifty-two patients (26 males, 26 females) with a mean age of 18.3 +/- 1.3 years at follow-up, were randomized into two groups: the resin group and the nonresin group. The lingual retainers in the resin group were bonded to the enamel surfaces with two-step bonding resin, Optibond FL, and Tetric EvoFlow. The nonresin group followed the same procedure of bonding retainers but without applying the Optibond FL. Retainer failure, calculus accumulation, and discoloration of composite pads adjacent to the retainers during the 2-year observation period were registered, compared, and statistically analyzed with a Fisher's exact test and chi-square test.

    Results: In the resin group, the incidence of retainer failure was 4% and occurred at the composite-wire interface; in the nonresin group, the incidence was 27% and occurred at the enamel-composite interface. The difference between the groups was statistically significant (P =.049). The incidences of calculus accumulation and discoloration adjacent to the composite pads were 27% and 69% (P =.003 and P <.001) higher in the nonresin group, respectively.

    Conclusion: Application of resin in bonding of lingual retainers appears to reduce the incidence of retainer failure as well as the incidence of calculus accumulation and discoloration adjacent to the composite pads. (Angle Orthod. 2012;82:84-87.)

  • 430.
    Bazargani, Farhan
    et al.
    Region Örebro län. Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden.
    Magnuson, Anders
    Clin Epidemiol & Biostat Unit, Örebro Univ Hosp, Örebro, Sweden.
    Dolati, Ali
    Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden.
    Lennartsson, Bertil
    Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden.
    Palatally displaced maxillary canines: factors influencing duration and cost of treatment2013Ingår i: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 35, nr 3, s. 310-316Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this retrospective study was to assess the relationship between the initial position of palatally displaced canines (PDCs) on panoramic radiographs and the duration of the orthodontic treatment and further to estimate the costs of the treatment. Data from panoramic radiographs and patient records of 66 consecutive patients (mean age 14.9 +/- 1.7 years) with PDC were analysed. The initial position of the canine, the distance between the canine cusp tip and the occlusal plane, and the inclination of the canine were significantly associated with treatment duration both unadjusted and adjusted for background characteristics. The average estimated cost of the treatment of PDC was euro3200 per case. The total annual cost for treatment of PDC in Sweden may therefore be estimated at euro600 0000. In this study, duration of treatment averaged 17 months for canines displaced in impaction zone 1 or 2, 2.6 [95% confidence interval (CI) -1.0 to 6.2] months longer for those in impaction zone 3, and 7.6 (95% CI 4.1-11.1) months longer for canines displaced in impaction zone 4 or 5. This information makes it easier, through study of the panoramic radiograph, to estimate the duration of treatment and to give patients more precise information about the expected length of their treatment.

  • 431.
    Bazzo, M. L.
    et al.
    Molecular Biology, Microbiology and Serology Laboratory, Federal University of Santa Catarina, Florianópolis, Brazil.
    Golfetto, L.
    Molecular Biology, Microbiology and Serology Laboratory, Federal University of Santa Catarina, Florianópolis, Brazil.
    Gaspar, P. C.
    Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasilia, Brazil.
    Pires, A. F.
    Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasilia, Brazil; University of Brasilia Postgraduate Program in Collective Health, Brasilia, Brazil.
    Ramos, M. C.
    Brazilian STD Society, Porto Alegre, Brazil.
    Franchini, M.
    Laboratory Consultant, Brasília, Brazil.
    Ferreira, W. A.
    Alfredo da Mata Foundation, Manaus, Brazil.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Benzaken, A. S.
    Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasilia, Brazil.
    First nationwide antimicrobial susceptibility surveillance for Neisseria gonorrhoeae in Brazil, 2015-162018Ingår i: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 73, nr 7, s. 1854-1861Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major public health concerns globally. Enhanced AMR surveillance for gonococci is essential worldwide; however, recent quality-assured gonococcal AMR surveillance in Latin America, including Brazil, has been limited. Our aims were to (i) establish the first nationwide gonococcal AMR surveillance, quality assured according to WHO standards, in Brazil, and (ii) describe the antimicrobial susceptibility of clinical gonococcal isolates collected from 2015 to 2016 in all five main regions (seven sentinel sites) of Brazil.

    Methods: Gonococcal isolates from 550 men with urethral discharge were examined for susceptibility to ceftriaxone, cefixime, azithromycin, ciprofloxacin, benzylpenicillin and tetracycline using the agar dilution method, according to CLSI recommendations and quality assured according to WHO standards.

    Results: The levels of resistance (intermediate susceptibility) to tetracycline, ciprofloxacin, benzylpenicillin and azithromycin were 61.6%(34.2%), 55.6%(0.5%), 37.1% (60.4%) and 6.9% (8.9%), respectively. All isolates were susceptible to ceftriaxone and cefixime using the US CLSI breakpoints. However, according to the European EUCAST cefixime breakpoints, 0.2% (n= 1) of isolates were cefixime resistant and 6.9% (n = 38) of isolates had a cefixime MIC bordering on resistance.

    Conclusions: This study describes the first national surveillance of gonococcal AMR in Brazil, which was quality assured according to WHO standards. The high resistance to ciprofloxacin (which promptly informed a revision of the Brazilian sexually transmitted infection treatment guideline), emerging resistance to azithromycin and decreasing susceptibility to extended-spectrum cephalosporins necessitate continuous surveillance of gonococcal AMR and ideally treatment failures, and increased awareness when prescribing treatment in Brazil.

  • 432.
    Beckman, K.
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; St Goran Hosp, Stockholm City Council, Stockholm, Sweden.
    Mittendorfer-Rutz, E.
    Department of Clinical Neuroscience, Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, P.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Almqvist, C
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Runeson, B.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; St Goran Hosp, Stockholm City Council, Stockholm, Sweden.
    Dahlin, M.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; St Goran Hosp, Stockholm City Council, Stockholm, Sweden.
    Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort2016Ingår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, nr 16, s. 3397-3405Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.

    Method: We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.

    Results: Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9-20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8-6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7-3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.

    Conclusion: We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.

  • 433.
    Beckman, Karin
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm City Council, St Göran's Hospital, Stockholm, Sweden.
    Mittendorfer-Rutz, Ellenor
    Department of Clinical Neuroscience, Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
    Waern, Margda
    Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Runeson, Bo
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm City Council, St Göran's Hospital, Stockholm, Sweden.
    Dahlin, Marie
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm City Council, St Göran's Hospital, Stockholm, Sweden.
    Method of self-harm in adolescents and young adults and risk of subsequent suicide2018Ingår i: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610, Vol. 59, nr 5, s. 948-956Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Self-harm is common in youth and an important risk factor for suicide. Certain self-harm methods might indicate a higher risk of suicide. The main aim of this study was to determine whether some methods of self-harm in adolescents (10-17 years) and young adults (18-24 years) are associated with a particularly high risk of suicide. A secondary aim was to ascertain how different self-harm methods might affect the probability of psychiatric follow-up.

    METHOD: Five Swedish registers were linked in a national population-based cohort study. All nonfatal self-harm events recorded in specialist health care, excluding psychiatry and primary care services, among 10-24 year olds between 2000 and 2009 were included. Methods were classified as poisoning, cutting/piercing, violent method (gassing, hanging, strangulation/suffocation, drowning, jumping and firearms), other and multiple methods. Hazard Ratios (HR) for suicide were calculated in Cox regression models for each method with poisoning as the reference. Odds Ratios (OR) for psychiatric inpatient care were determined in logistic regression models. Analyses were adjusted for important covariates and stratified by age group and treatment setting (inpatient/outpatient).

    RESULTS: Among adolescents with initial medical hospitalisation, use of a violent method was associated with a near eightfold increase in HR for suicide compared to self-poisoning in the adjusted analysis [HR 7.8; 95% confidence interval (CI) 3.2-19.0]. Among hospitalised young adult women, adjusted HRs were elevated fourfold for both cutting [4.0 (1.9-8.8)] and violent methods [3.9 (1.5-10.6)]. Method of self-harm did not affect suicide risk in young adult men. Adolescents using violent methods had an increased probability of psychiatric inpatient care following initial treatment for self-harm.

    CONCLUSIONS: Violent self-harm requiring medical hospitalisation may signal particularly high risk of future suicide in adolescents (both sexes) and in young adult women. For the latter group this is the case for cutting requiring hospitalisation as well.

  • 434.
    Befekadu, Rahel
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine, Section for Transfusion Medicine.
    Christiansen, Kjeld
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Larsson, Anders
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Grenegård, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Cardiovascular Research Centre,.
    Increased plasma cathepsin S and trombospondin-1 in patients with acute ST-segment elevation myocardial infarction2019Ingår i: Cardiology Journal, ISSN 1897-5593, Vol. 26, nr 4, s. 385-393Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The role of cathepsins in the pathological progression of atherosclerotic lesions in ischemic heart disease have been defined in detail more than numerous times. This investigation examined the platelet-specific biomarker trombospondin-1 (TSP-1) and platelet function ex vivo, and compared this with cathepsin S (Cat-S; a biomarker unrelated to platelet activation but also associated this with increased mortality risk) in patients with ST-segment elevation myocardial infarction (STEMI).

    Methods: The STEMI patients were divided into two groups depending on the degree of coronary vessel occlusion: those with closed (n = 90) and open culprit vessel (n = 40). Cat-S and TSP-1 were analyzed before, 1-3 days after and 3 months after percutanous coronary intervention (PCI).

    Results: During acute STEMI, plasma TSP-1 was significantly elevated in patients with closed culprit lesions, but rapidly declined after PCI. In fact, TSP-1 after PCI was significantly lower inpatient samples compared to healthy individuals. In comparison, plasma Cat-S was significantly elevated both before and after PCI. In patients with closed culprit lesions, Cat-S was significantly higher compared to patients with open culprit lesions 3 months after PCI. Although troponin-I were higher (p < 0.01) in patients with closed culprit lesion, there was no correlation with Cat-S and TSP-1.

    Conclusions: Cat-S but not TSP-1 may be a useful risk biomarker in relation to the severity of STEMI. However, the causality of Cat-S as a predictor for long-term mortality in STEMI remains to be ascertained in future studies.

  • 435.
    Beger, Richard D.
    et al.
    Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, USA.
    Dunn, Warwick
    School of Biosciences, Phenome Centre Birmingham and Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK.
    Schmidt, Michael A.
    Advanced Pattern Analysis and Countermeasures Group, Research Innovation Center, Colorado State University, Fort Collins, USA.
    Gross, Steven S.
    Department of Pharmacology, Weill Cornell Medical College, New York, USA.
    Kirwan, Jennifer A.
    School of Biosciences, University of Birmingham, Birmingham, UK.
    Cascante, Marta
    Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain; Institute of Biomedicine of Universitat de Barcelona (IBUB) and CSIC-Associated Unit, Barcelona, Spain.
    Brennan, Lorraine
    UCD Institute of Food and Health, UCD, Belfield, Ireland.
    Wishart, David S.
    Departments of Computing Science and Biological Sciences, University of Alberta, Edmonton, Canada.
    Oresic, Matej
    Turku Centre for Biotechnology, University of Turku, Turku, Finland.
    Hankemeier, Thomas
    Division of Analytical Biosciences and Cluster Systems Pharmacology, Leiden Academic Centre for Drug Research, Leiden University & Netherlands Metabolomics Centre, Leiden, The Netherlands.
    Broadhurst, David I.
    School of Science, Edith Cowan University, Perth, Australia.
    Lane, Andrew N.
    Center for Environmental Systems Biochemistry, Department Toxicology and Cancer Biology, Markey Cancer Center, Lexington, USA.
    Suhre, Karsten
    Department of Physiology and Biophysics, Weill Cornell Medical College in Qatar, Doha, Qatar.
    Kastenmüller, Gabi
    Institute of Bioinformatics and Systems Biology, Helmholtz Center Munich, Oberschleißheim, Germany.
    Sumner, Susan J.
    Discovery Sciences, RTI International, Research Triangle Park, Durham, USA.
    Thiele, Ines
    University of Luxembourg, Luxembourg Centre for Systems Biomedicine, Campus Belval, Esch-Sur-Alzette, Luxembourg.
    Fiehn, Oliver
    West Coast Metabolomics Center, UC Davis, Davis, USA; Biochemistry Department, King Abdulaziz University, Jeddah, Saudi Arabia.
    Kaddurah-Daouk, Rima
    Psychiatry and Behavioral Sciences, Duke Internal Medicine and Duke Institute for Brain Sciences and Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, USA.
    Metabolomics enables precision medicine: "A White Paper, Community Perspective"2016Ingår i: Metabolomics, ISSN 1573-3882, E-ISSN 1573-3890, Vol. 12, nr 10, artikel-id 149Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION BACKGROUND TO METABOLOMICS: Metabolomics is the comprehensive study of the metabolome, the repertoire of biochemicals (or small molecules) present in cells, tissues, and body fluids. The study of metabolism at the global or "-omics" level is a rapidly growing field that has the potential to have a profound impact upon medical practice. At the center of metabolomics, is the concept that a person's metabolic state provides a close representation of that individual's overall health status. This metabolic state reflects what has been encoded by the genome, and modified by diet, environmental factors, and the gut microbiome. The metabolic profile provides a quantifiable readout of biochemical state from normal physiology to diverse pathophysiologies in a manner that is often not obvious from gene expression analyses. Today, clinicians capture only a very small part of the information contained in the metabolome, as they routinely measure only a narrow set of blood chemistry analytes to assess health and disease states. Examples include measuring glucose to monitor diabetes, measuring cholesterol and high density lipoprotein/low density lipoprotein ratio to assess cardiovascular health, BUN and creatinine for renal disorders, and measuring a panel of metabolites to diagnose potential inborn errors of metabolism in neonates.

    OBJECTIVES OF WHITE PAPER—EXPECTED TREATMENT OUTCOMES AND METABOLOMICS ENABLING TOOL FOR PRECISION MEDICINE: We anticipate that the narrow range of chemical analyses in current use by the medical community today will be replaced in the future by analyses that reveal a far more comprehensive metabolic signature. This signature is expected to describe global biochemical aberrations that reflect patterns of variance in states of wellness, more accurately describe specific diseases and their progression, and greatly aid in differential diagnosis. Such future metabolic signatures will: (1) provide predictive, prognostic, diagnostic, and surrogate markers of diverse disease states; (2) inform on underlying molecular mechanisms of diseases; (3) allow for sub-classification of diseases, and stratification of patients based on metabolic pathways impacted; (4) reveal biomarkers for drug response phenotypes, providing an effective means to predict variation in a subject's response to treatment (pharmacometabolomics); (5) define a metabotype for each specific genotype, offering a functional read-out for genetic variants: (6) provide a means to monitor response and recurrence of diseases, such as cancers: (7) describe the molecular landscape in human performance applications and extreme environments. Importantly, sophisticated metabolomic analytical platforms and informatics tools have recently been developed that make it possible to measure thousands of metabolites in blood, other body fluids, and tissues. Such tools also enable more robust analysis of response to treatment. New insights have been gained about mechanisms of diseases, including neuropsychiatric disorders, cardiovascular disease, cancers, diabetes and a range of pathologies. A series of ground breaking studies supported by National Institute of Health (NIH) through the Pharmacometabolomics Research Network and its partnership with the Pharmacogenomics Research Network illustrate how a patient's metabotype at baseline, prior to treatment, during treatment, and post-treatment, can inform about treatment outcomes and variations in responsiveness to drugs (e.g., statins, antidepressants, antihypertensives and antiplatelet therapies). These studies along with several others also exemplify how metabolomics data can complement and inform genetic data in defining ethnic, sex, and gender basis for variation in responses to treatment, which illustrates how pharmacometabolomics and pharmacogenomics are complementary and powerful tools for precision medicine.

    CONCLUSIONS KEY SCIENTIFIC CONCEPTS AND RECOMMENDATIONS FOR PRECISION MEDICINE: Our metabolomics community believes that inclusion of metabolomics data in precision medicine initiatives is timely and will provide an extremely valuable layer of data that compliments and informs other data obtained by these important initiatives. Our Metabolomics Society, through its "Precision Medicine and Pharmacometabolomics Task Group", with input from our metabolomics community at large, has developed this White Paper where we discuss the value and approaches for including metabolomics data in large precision medicine initiatives. This White Paper offers recommendations for the selection of state of-the-art metabolomics platforms and approaches that offer the widest biochemical coverage, considers critical sample collection and preservation, as well as standardization of measurements, among other important topics. We anticipate that our metabolomics community will have representation in large precision medicine initiatives to provide input with regard to sample acquisition/preservation, selection of optimal omics technologies, and key issues regarding data collection, interpretation, and dissemination. We strongly recommend the collection and biobanking of samples for precision medicine initiatives that will take into consideration needs for large-scale metabolic phenotyping studies.

  • 436.
    Behrens, Thomas
    et al.
    Bremen Institute of Prevention Research & Social Medicine, Bremen, Germany; Institute of Prevention & Occupational Medicine of German Social Accidents Insurance, Bochum, Germany.
    Lynge, Elsebeth
    Inst Publ Hlth, Univ Copenhagen, Copenhagen, Denmark..
    Cree, Ian
    Inst Ophthalmol, University College London (UCL), London, England.
    Lutz, Jean-Michel
    National Institute for Cancer Epidemiology and Registration (NICER), Univ Zurich, Zurich, Switzerland.
    Eriksson, Mikael
    Dept of Oncology, Lund University Hospital, Lund, Sweden..
    Guenel, Pascal
    Centre de recherche en épidémiologie et santé des populations (CESP), French National Institute of Health and Medical Research (INSERM), Villejuif, France; Univ Paris Sud, Villejuif, France.
    Merletti, Franco
    Cancer Epidemiology Unit, Univ Turin, Piemonte, Italy; ll Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO), Piemonte, Italy.
    Morales-Suarez-Varela, Maria
    Dept of Prevention Medicine, Unit Public Health & Environmental Care, University Valencia, Valencia, Spain; CIBER Act Epidemiology & Public Health, Res Grp CIBER CB06, Valencia, Spain; Center Public Health Research CSISP, Valencia, Spain.
    Afonso, Noemia
    Med Oncol Serv, Inst Portugues Oncol Francisco Gentil, Oporto, Portugal.
    Stengrevics, Aivars
    Latvia Canc Registry, Riga, Latvia.
    Fevotte, Joelle
    Umrestte UCB Lyon 1 InVS Inrets, Lyon, France.
    Sabroe, Svend
    Dept Epidemiol, Univ Aarhus, Aarhus, Denmark..
    Llopis-Gonzalez, Agustin
    Dept Prevent Med, Unit Publ Hlth & Environm Care, Univ Valencia, Valencia, Spain; CIBER Act Epidemiol & Publ Hlth, Res Grp CIBER CB06, Valencia, Spain.
    Gorini, Giuseppe
    Environm & Occupat Epidemiol Unit, ISPO Canc Prevent & Res Inst, Florence, Italy.
    Hardell, Lennart
    Department of Oncology, Örebro University Hospital, Region Örebro län, Örebro, Sweden.
    Stang, Andreas
    Inst Clin Epidemiol, Univ Halle Wittenberg, Halle, Germany; Inst Med Informat Biometry & Epidemiol, Univ Duisburg Essen, Essen, Germany..
    Ahrens, Wolfgang
    Bremen Inst Prevent Res & Social Med, Bremen, Germany; Inst Med Informat Biometry & Epidemiol, Univ Duisburg Essen, Essen, Germany.
    Pesticide exposure in farming and forestry and the risk of uveal melanoma2012Ingår i: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 23, nr 1, s. 141-151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Since pesticides are disputed risk factors for uveal melanoma, we studied the association between occupational pesticide exposure and uveal melanoma risk in a case-control study from nine European countries.

    Incident cases of uveal melanoma and population as well as hospital controls were included and frequency-matched by country, 5-year age groups and sex. Self-reported exposure was quantified with respect to duration of exposure and pesticide application method. We calculated the exposure intensity level based on application method and use of personal protective equipment. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by unconditional logistic regression analyses and adjusted for several potential confounders.

    293 case and 3,198 control subjects were interviewed. We did not identify positive associations with activities in farming or forestry, pesticide application or pesticide mixing. No consistent positive associations were seen with exposure intensity level scores either. The only statistically significantly raised association in this study was for exposure to chemical fertilizers in forestry (OR = 8.93; 95% CI 1.73-42.13), but this observation was based on only six exposed subjects. Results did not change when we restricted analyses to morphologically verified cases and excluded proxy interviews as well as cancer controls. We did not observe effect modification by sex or eye color.

    Risk estimates for pesticide exposures and occupational activities in agriculture and forestry were not increased and did not indicate a hormonal mechanism due to these exposures.

  • 437.
    Bejerot, Susanne
    Karolinska Institute, Stockholm, Sweden.
    An autistic dimension: a proposed subtype of obsessive-compulsive disorder2007Ingår i: Autism, ISSN 1362-3613, E-ISSN 1461-7005, Vol. 11, nr 2, s. 101-110Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This article focuses on the possibility that autism spectrum disorder (ASD: Asperger syndrome, autism and atypical autism) in its milder forms may be clinically important among a substantial proportion of patients with obsessive-compulsive disorder (OCD), and discusses OCD subtypes based on this proposition. The hypothesis derives from extensive clinical experience of OCD and ASD, and literature searches on MEDLINE. Neuropsychological deficits are more common in OCD than in panic disorder and depression. Moreover, obsessive-compulsive and schizotypal personality disorders are over-represented in OCD. These may constitute mis-perceived clinical manifestations of ASD. Furthermore, repetitive behaviours and hoarding are common in Asperger syndrome. It is suggested that the comorbidity results in a more severe and treatment resistant form of OCD. OCD with comorbid ASD should be recognized as a valid OCD subtype, analogous to OCD with comorbid tics. An odd personality, with paranoid, schizotypal, avoidant or obsessive-compulsive traits, may indicate these autistic dimensions in OCD patients.

  • 438.
    Bejerot, Susanne
    Institutionen för klinisk neurovetenskap, Karolins­ka institutet, Stockholm, Sweden.
    Ett överlappande och föränderligt landskap: [An overlapping and changing landscape]2014Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, nr 39Artikel i tidskrift (Refereegranskat)
  • 439. Bejerot, Susanne
    Ingen tjänar på att det går inflation i autismspektrumbegreppet: [No one benefits from inflation of the autism spectrum concept]2010Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 47, s. 2978-2930Artikel i tidskrift (Refereegranskat)
  • 440.
    Bejerot, Susanne
    institutionen för neurovetenskap, psykiatri, Uppsala universitet, Uppsala, Sweden.
    Kapsulotomi vid tvångssyndrom, en överflödig behandlingsform? Läkemedel och beteendeterapi ger god effekt: [Is capsulotomy in obsessive-compulsive syndromes an unnecessary therapeutic method? Good results with drug therapy and behavior therapy]1998Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 95, nr 45, s. 5003-5005Artikel i tidskrift (Refereegranskat)
    Ladda ner fulltext (pdf)
    Kapsulotomi vid tvångssyndrom en överflödig behandlingsform?
  • 441. Bejerot, Susanne
    Kvalitetsregister – hot mot vårdkvalitet, arbetsmiljö och klinisk forskning?: [Quality registry--a threat against quality of health care, occupational environment and clinical research?]2009Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 14, s. 986-986Artikel i tidskrift (Refereegranskat)
  • 442. Bejerot, Susanne
    Medicinsk kommentar: Psykokirurgi idag – en kritisk betraktelse. Svåra biverkningar av kapsulotomi visar sig efter 50 års användning: [Psychosurgery today--a critical reflection. Severe adverse effects of capsulotomy seen after 50 years of use]2003Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, nr 32-33, s. 2502-2504Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Kapsulotomi – »det sista halmstrået« för behandling av terapirefraktärt, invalidiserande tvångssyndrom – har i Sverige under lång tid rapporterats ha försumbara risker.

    Efter export av metoden till USA är resultaten mindre framgångsrika. Biverkningar av frontallobstyp kan möjligen progrediera många år efter ingreppet.

    Kritik har nyligen riktats mot bristen på långtidsuppföljningar och studier med oberoende bedömare.

    Trots att kapsulotomi utförts under lång tid är det vetenskapliga kunskapsläget otillräckligt. Bland annat är frågan om terapiresistens och biverkningar knapphändigt belysta.

    Ett referat av en uppföljning av personer som genomgått kapsulotomi publiceras i detta nummer. Denna vetenskapligt invändningsfria studie visar betydligt mindre gynnsamma resultat än vad tidigare studier gjort.

  • 443. Bejerot, Susanne
    Psychosurgery for obsessive-compulsive disorder: concerns remain2003Ingår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 107, nr 4, s. 241-243Artikel i tidskrift (Refereegranskat)
  • 444. Bejerot, Susanne
    Ska toppstyrd registerforskarindustri ersätta patientnära forskning? : [Is top directed registry research industry to substitute near-patient research?]2009Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 30-31, s. 1918-1918Artikel i tidskrift (Refereegranskat)
  • 445.
    Bejerot, Susanne
    Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    The relationship between poor motor skills and neurodevelopmental disorders2011Ingår i: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 53, nr 9, s. 779-779Artikel i tidskrift (Refereegranskat)
  • 446. Bejerot, Susanne
    Tvångssyndromet. Nya aspekter på psykiatrins kameleont: [The obsessive-compulsive syndrome: new aspects of a psychiatric chameleon]1992Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 89, nr 36, s. 2842-2844Artikel i tidskrift (Refereegranskat)
  • 447. Bejerot, Susanne
    Upprättelse! Diagnos kan bli vändpunkt för vuxna med ADHD/autismspektrumstörning: [Rehabilitation! Diagnosis can be a turning point for adults with ADHD/autism spectrum disorders]2004Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, nr 42, s. 3222-3223Artikel i tidskrift (Refereegranskat)
  • 448. Bejerot, Susanne
    Utestängd patientgrupp. Nytänkande krävs för vuxna med ADHD/Tourette/autismspektrumtillstånd: [Excluded patient group. A new approach is necessary for adults with ADHD/Tourette syndrome/autism spectrum disorders]2006Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, nr 19, s. 1508-1508Artikel i tidskrift (Refereegranskat)
  • 449.
    Bejerot, Susanne
    et al.
    Department of Neuroscience. Psychiatry, University Hospital, Uppsala, Sweden.
    Bodlund, O.
    Department of Psychiatry, University Hospital, Umeå, Sweden.
    Response to high doses of citalopram in treatment-resistant obsessive-compulsive disorder1998Ingår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 98, nr 5, s. 423-424Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We report a severe case of obsessive-compulsive disorder (OCD) that responded to very high doses of citalopram (160 mg/day) after a poor response to clomipramine 250 mg/day for several years, alone or in combination with buspirone 30 mg/day or flupenthixol 4 mg/day. The patient had previously been submitted for capsulotomy which was declined, probably due to the magical content of her obsessions, which resembled delusions.

  • 450.
    Bejerot, Susanne
    et al.
    Norra Stockholms psykiatri, Stockholm, Sweden.
    Bruno, Kai
    BUP Brommaplan, Stockholm, Sweden.
    Gerland, Gunilla
    Lindquist, Lars
    Infektionskliniken, Karolinska universitetssjukhuset, Huddinge, Sweden.
    Nordin, Viviann
    Sachsska barn- och ungdomssjukhuset, Södersjukhuset, Stockholm, Sweden.
    Pelling, Henrik
    BUP-kliniken, Akademiska sjukhuset, Uppsala, Sweden.
    Humble, Mats B.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Misstänk PANDAS hos barn med akuta neuropsykiatriska symptom. Infektion bakom sjukdomen [Suspect PANDAS in children with acute neuropsychiatric symptoms. Infection behind the disease]: långvarig antibiotikabehandling bör övervägas  [long-term antibiotic therapy should be considered]2013Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, nr 41, s. 1803-1803, artikel-id CDCDArtikel i tidskrift (Refereegranskat)
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