oru.sePublications
Change search
Refine search result
123456 51 - 100 of 254
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 51.
    Dreifaldt, Ann Charlotte
    et al.
    Örebro University, Department of Clinical Medicine.
    Werner, Bo
    Carlberg, Michael
    Hardell, Lennart
    Vaccinations and chronic illness in Swedish children preceding diagnosis of leukemia, malignant lymphoma or brain tumorManuscript (preprint) (Other academic)
  • 52.
    Duberg, Ann-Sofi
    et al.
    Örebro University, Department of Clinical Medicine.
    Nordström, Marie
    Törner, Anna
    Reichard, Olle
    Strauss, Reinhild
    Janzon, Ragnhild
    Bäck, Erik
    Örebro University, Department of Clinical Medicine.
    Ekdahl, Karl
    Non-Hodgkin's lymphoma and other nonhepatic malignancies in Swedish patients with hepatitis C virus infection2005In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 41, no 3, p. 652-659Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the association between hepatitis C virus (HCV) infection and non-Hodgkin's lymphoma (NHL), multiple myeloma (MM), thyroid cancer (TC), chronic lymphatic leukemia (CLL), acute lymphatic leukemia (ALL), and Hodgkin's lymphoma (HL). A Swedish cohort of 27,150 HCV-infected persons notified during 1990-2000 was included in the study. The database was linked to other national registers to calculate the observation time, expressed as person-years, and to identify all incident malignancies in the cohort. The patients were stratified according to assumed time of previous HCV infection. The relative risk of malignancy was expressed as a standardized incidence ratio (SIR)-the observed number compared to the expected number. During 1990-2000 there were 50 NHL, 15 MM, 14 ALL, 8 TC, 6 CLL, and 4 HL diagnoses in the cohort. Altogether, 20 NHL, 7 MM, 5 TC, 4 CLL, 1 ALL, and 1 HL patient fulfilled the criteria to be included in the statistical analysis. The observation time was 122,272 person-years. The risk of NHL and MM was significantly increased in the stratum with more than 15 years of infection (SIR 1.89 [95% CI, 1.10-3.03] and 2.54 [95% CI, 1.11-5.69], respectively). The association was not significant in TC or CLL. In conclusion, we report the incidence of several malignancies in a nationwide cohort of HCV-infected persons. Although the delayed diagnosis of HCV probably has resulted in an underestimation of the risk, this study showed a significantly increased risk of NHL and MM.

  • 53.
    Ekelund, Ulf
    et al.
    Örebro University, Department of Health Sciences.
    Poortvliet, Eric
    Yngve, Agneta
    Hurtig-Wennlöf, Anita
    Örebro University, Department of Clinical Medicine.
    Nilsson, Andreas
    Örebro University, Department of Health Sciences.
    Sjöström, Michael
    Heart rate as an indicator of the intensity of physical activity in human adolescents2001In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 85, no 3-4, p. 244-249Article in journal (Refereed)
    Abstract [en]

    The aims of this study were, in a group of adolescents, firstly to identify the absolute heart rates (HR) and the percentages of maximal heart rates (HRmax) corresponding to 40%, 60% and 80% of peak oxygen uptake (PVO2), secondly to identify absolute and relative (%PVO2) oxygen uptakes (VO2) corresponding to HR of 120, 140 and 160 beats.min-1, and thirdly to examine a possible effect of fatness and fitness on the relationship between HR and VO2. The subjects were 127 (60 boys, 67 girls) adolescents with a mean age of 14.8 (SD 0.3) years. The HR and VO2 were measured by means of an incremental exercise test to exhaustion. Linear regressions were performed for the HR-VO2 and VO2-HR relationships using absolute and relative (%HRmax, %PVO2) data for each individual. From these regressions, target HR and VO2 were computed. Average target HR corresponding to 40%, 60% and 80% of PVO2 were: 119 (SD 9), 145 (SD 9), 171 (SD 8), and 120 (SD 10), 146 (SD 8), 172 (SD 8) beats.min-1 for boys and girls, respectively. Average VO2 corresponding to HR of 120, 140 and 160 beats.min-1 were: 22 (SD 5), 30 (SD 5), 38 (SD 6) and 18 (SD 4), 24 (SD 4), 31 (SD 4) mlO2.kg-1.min-1 for boys and girls, respectively. An analysis of covariance showed a significant fitness effect (P < 0.001) for predicted VO2 at all HR studied. The results suggest that the use of absolute HR to define exercise intensity levels when assessing young people's physical activity using HR monitoring detracts from the validity of the interpretation of the data.

  • 54. Ellingsen, Jan Eirik
    et al.
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Wennerberg, Ann
    Holmén, Anders
    Improved Retention and Bone-to-Implant Contact with Fluoride-Modified Titanium Implants2004In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 19, no 5, p. 659-666Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of the present study was to investigate whether a fluoride modification of the titanium surface would have an effect on bone response after implantation. Materials and Methods: Titanium-oxide–blasted titanium implants with and without fluoride modification were investigated in a rabbit tibia model. Quantitative analysis of surface roughness, biomechanical interlocking, and in vivo tissue reactions in rabbit bone at 1 and 3 months after placement were compared. Results: The fluoride-modified test implants had a slightly smoother surface (Sa: 0.91 ± 0.14 µm) than the unmodified control implants (Sa: 1.12 ± 0.24 µm). Significantly higher removal torque values (85 ± 16 Ncm vs 54 ± 12 Ncm) and shear strength between bone and implants (23 ± 9 N/mm2 vs 15 ± 5 N/mm2) were measured for the fluoride-modified implants after 3 months. The histomorphometric evaluations demonstrated higher bone-to-implant contact for test implants at 1 month (35% ± 14% vs 26% ± 8%) and 3 months (39% ± 11% vs 31% ± 6%) after placement. Discussion: Implant surface modification with fluoride may result in morphologic and physiochemical phenomena that are of significance for the bone response. Another possible explanation for the findings in the present study is that a surface modification changes the surface chemical structures to be more suitable for bone bonding. Conclusion: Based on the biomechanical and histomorphometric data, the fluoride-modified titanium implants demonstrated a firmer bone anchorage than the unmodified titanium implants. These implants achieved greater bone integration than unmodified titanium implants after a shorter healing time. (More than 50 references.)

  • 55.
    Eriksson Crommert, Martin
    Örebro University, Department of Clinical Medicine.
    Trunk muscle reactions to sudden loading in a position without vertical postural demand2008Conference paper (Refereed)
  • 56.
    Falk, Gabriella
    et al.
    Örebro University, Department of Clinical Medicine.
    Ivarsson, Ann-Britt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Brynhildsen, Jan
    Teenagers' struggles with contraceptive use: do adults help enough?2010Conference paper (Refereed)
  • 57. Falk, Gabriella
    et al.
    Östlund, Ingrid
    Örebro University, Department of Clinical Medicine.
    Magnuson, Anders
    Schollin, Jens
    Örebro University, Department of Clinical Medicine.
    Nilsson, Kerstin
    Örebro University, Department of Clinical Medicine.
    Teenage mothers: a high-risk group for new unintended pregnancies2006In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 74, no 6, p. 471-475Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: One of the targets of national health programs is to prevent unintended pregnancies, especially among teenagers. It is well established that these often lead to abortion. Preventive programs aimed at decreasing abortion rates should identify target groups at risk for unintended pregnancies.

    PURPOSE: This study was conducted to determine whether young mothers under 20 years of age constitute a group at risk for new unintended pregnancies.

    METHODS: A retrospective cohort study comprising teenagers giving birth to their first child from 1996 to 2000 was performed at Orebro University Hospital, Sweden. Data were collected from antenatal and medical records with particular regard to compliance with the postpartum visit and to whether a contraceptive method was prescribed. Information concerning repeat pregnancies during the 12 months after delivery was obtained.

    RESULTS: A total of 250 deliveries were recorded; 70% of the mothers attended the postpartum visit, and 71% received contraceptive prescriptions. At the 12-month follow-up, 56 (25%) had a new pregnancy, and of those, 20 (36%) had a legal abortion, making the abortion rate fivefold higher than expected in this age group.

  • 58. Falk, Lars
    et al.
    Lindberg, Margret
    Jurstrand, Margaretha
    Örebro University, Department of Clinical Medicine.
    Bäckman, Anders
    Örebro University, School of Medical Sciences.
    Olcén, Per
    Fredlund, Hans
    Örebro University, School of Health Sciences.
    Genotyping of Chlamydia trachomatis would improve contact tracing2003In: Sexually Transmitted Diseases, ISSN 0148-5717, E-ISSN 1537-4521, Vol. 30, no 3, p. 205-210Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 59. Fernell, Elisabeth
    et al.
    Karagiannakis, Aristea
    Örebro University, Department of Clinical Medicine.
    Edman, Gunnar
    Bjerkenstedt, Lars
    Wiesel, Frits-Axel
    Venizelos, Nikolaos
    Örebro University, Department of Clinical Medicine.
    Aberrant amino acid transport in fibroblasts from children with autism2007In: Neuroscience Letters, ISSN 0304-3940, E-ISSN 1872-7972, Vol. 418, no 1, p. 82-86Article in journal (Refereed)
    Abstract [en]

    Autism is a developmental, cognitive disorder clinically characterized by impaired social interaction, communication and restricted behaviours. The present study was designed to explore whether an abnormality in transport of tyrosine and/or alanine is present in children with autism. Skin biopsies were obtained from 11 children with autism (9 boys and 2 girls) fulfilling the DSM-IV diagnostic criteria for autistic disorder and 11 healthy male control children. Transport of amino acids tyrosine and alanine across the cell membrane of cultured fibroblasts was studied by the cluster tray method. The maximal transport capacity, Vmax and the affinity constant of the amino acid binding sites, Km, were determined. Significantly increased Vmax for alanine (p = 0.014) and increased Km for tyrosine (p = 0.007) were found in children with autism. The increased transport capacity of alanine across the cell membrane and decreased affinity for transport sites of tyrosine indicates the involvement of two major amino acid transport systems (L- and A-system) in children with autism. This may influence the transport of several other amino acids across the blood–brain-barrier. The significance of the findings has to be further explored. © 2007 Elsevier Ireland Ltd. All rights reserved

  • 60.
    Forsström, Katrin
    Örebro University, Department of Clinical Medicine.
    Analysis of mean corpuscular volume and mean corpuscular haemoglobin value of blood donors rejected for low haemoglobin at Christian Medical College and Hospital in Vellore, India.2006Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Iron deficiency anaemia is the most common anaemia in India and nutritional iron deficiency is the cause of 90 % of the anaemias. MCV and MCH values below reference ranges indicate iron deficiency anaemia.

    The aim of this study was to analyze the MCV and MCH values in blood donors rejected for low haemoglobin to find out if they are anaemic. Then, based on the results, discuss if there’s a possibility to lower the cut off value for haemoglobin in blood donations at Christian Medical College and Hospital in Vellore, India.

    The blood bank at CMCH uses the copper sulphate method only to determine if the haemoglobin value is below or over 125 g/l, which is the cut off value for donating blood in India. The normal ranges for haemoglobin are 110 - 150 g/l for women and 130 - 170 g/l for men at CMCH which means that the hospital looses several healthy blood donors unnecessarily.

    The results of this study show that if the haemoglobin cut off value is lowered to 115 g/l,

    66.4 % of the rejected donors will still have a normal MCV and MCH value. Among the women, there are 85.7 % who have MCV and MCH values within reference range which speaks for a lowering of the Hb cut off value for women to 115 g/l. For men however, there were only 30 % that were within the MCV and MCH reference range and therefore a lowering of the Hb cut off value is not justified.

  • 61. Franke Stenport, Victoria
    et al.
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Enamel matrix derivative and titanium implants: An experimental pilot study in the rabbit2003In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 30, no 4, p. 359-363Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of present study was to evaluate if an enamel matrix derivative (Emdogain®) may enhance bone formation and osseointegration of titanium implants, using a well-documented rabbit model.

    Material and methods: Thirty-six threaded commercially pure titanium (cp.ti.) implants were inserted in six New Zealand white rabbits. One implant was placed in each femur and two in each tibia. Prior to implant insertion approximately 0.5 mL of Emdogain (EMD) (test) or the vehicle gel (PGA: propylene glycol alginate) (control) was injected into the surgically prepared implant site. The follow-up time was 6 weeks. Biomechanical evaluations by resonance frequency analysis (RFA) and removal torque measurements (RTQ) were performed. Histomorphometrical quantifications were made on ground sections by measurements of the percentage of bone-to-metal contact, bone area inside the threads as well as outside the threads (mirror image). Bone lengths along the implant surface were also measured and used for shear strength calculations.

    Results: The results demonstrated no beneficial effects from the EMD treatment on bone formation around titanium implants in any of the tested parameters. Significant differences were demonstrated with removal torque test and shear force calculations for the control implants. No other parameter demonstrated a statistically significant difference.

    Conclusion: The results of the present study may indicate that EMD does not contribute to bone formation around titanium implants. This observation may indicate that the bone formation that occurs after EMD treatment in periodontal defects is the result of functional adaptation. However, further research is required to evaluate the effect of EMD treatment on bone formation.

  • 62. Franke Stenport, Victoria
    et al.
    Johansson, Carina B.
    Örebro University, Department of Health Sciences. Örebro University, Department of Clinical Medicine.
    Sawase, Takashi
    Yamasaki, Yasuharu
    Oida, Shinichiro
    FGF-4 and titanium implants: a pilot study in rabbit bone2003In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 14, no 3, p. 363-368Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the effect of a local single injection of amino-terminally truncated recombinant human fibroblast growth factor-4 (rhFGF-4s) on titanium implant incorporation in a rabbit bone.

    Material and methods: Thirty-six threaded titanium implants were inserted into the femur and tibia of six rabbits. Three weeks prior to implant insertion 10 μg of FGF-4 in an altelocollagen carrier or the carrier alone was injected into the intended implant sites.

    Biomechanical evaluation by (i) resonance frequency analysis and (ii) peak removal torque measurements was performed after 6 weeks. The implants with surrounding tissue were processed to undecalcified ground sections followed by light-microscopic quantifications of the bone in threaded area and the apical parts of the implants.

    Results: A general trend, however not statistically significant, with higher mean values obtained in the above-mentioned tests was found. The FGF-4-treated implants revealed a significantly increased bone area in the apical part of the implants compared to the corresponding control implants.

    Conclusion: A local single injection of rhFGF-4 may stimulate bone formation around titanium implants in bone. However, further research is required to confirm these results, understand the mechanisms of FGF, and establish optimal dose and delivery methods.

  • 63. Franke-Stenport, V.
    et al.
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Commercially pure titanium and titanium alloy implants in bone in vivo study after 16weeks2005Conference paper (Refereed)
  • 64. Franke-Stenport, Victoria
    et al.
    Johansson, Carina B.
    Örebro University, Department of Health Sciences. Örebro University, Department of Clinical Medicine.
    Joo Heo, S.
    Aspenberg, P.
    Albrektsson, T.
    Titanium implants and BMP-7 in bone: an experimental model in the rabbit2003In: Journal of materials science. Materials in medicine, ISSN 0957-4530, E-ISSN 1573-4838, Vol. 14, no 3, p. 247-254Article in journal (Refereed)
    Abstract [en]

    This study evaluates the effect of rhBMP-7/OP-1 on the osseointegration of commercially pure titanium implants in an experimental implant model in rabbits. Threaded titanium implants with two transverse parallel canals were inserted in the femur and tibia of rabbits. The canals were filled with, 10 microg of BMP-7/collagen carrier, pure collagen carrier or were left empty as a control. The stiffness of the implant fixation was evaluated by Resonance Frequency Analysis (RFA) at baseline and four weeks postoperatively. Percentage of bone ingrowth in the canals was measured on microradiographs. Histomorphometry along the threaded part of the implants was performed on 15 microm thin sections. The results from the RFA demonstrated a higher mean value for the BMP-7 treated implants in the tibia than the carrier treated implants but not compared to the control implants. The control implants in the tibia demonstrated more bone ingrowth in the upper canal than to the carrier or the BMP-7 treated implants. Apart from these differences there were no significant effects of BMP. In this study BMP-7 did not contribute to any substantially improved bone anchorage of titanium implants.

  • 65. Friberg, Ö.
    et al.
    Dahlin, L.-G.
    Söderquist, Bo
    Örebro University, Department of Clinical Medicine.
    Källman, J.
    Örebro University, Department of Clinical Medicine.
    Svedjeholm, R.
    Influence of more than six sternal fixation wires on the incidence of deep sternal wound infection2006In: The thoracic and cardiovascular surgeon, ISSN 0171-6425, E-ISSN 1439-1902, Vol. 54, no 7, p. 468-473Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of the present study was to examine the influence of the number of sternal fixation wires used on deep sternal wound infection rate and to analyze any possible interaction between this and local collagen-gentamicin prophylaxis evaluated in a previous trial. METHODS: The number of sternal fixation wires in all patients from one of two participating centers was counted. The patients were categorized according to six or fewer (standard technique, ST group) vs. seven or more wires (extra wires, XW group). RESULTS: The incidence of deep sternal wound infection was 4.2 % in the ST group and 0.4 % in the XW group ( P = 0.001). An analysis of the effect of local gentamicin, excluding the ST group from the analysis, showed an approximately 70 % reduction in sternal wound infection for all depths. CONCLUSION: This study supports the theory that additional fixation wires at the lower sternum actually reduce the incidence of deep wound infections. We suggest that a rigid sternal fixation is required to achieve the full benefit of local collagen-gentamicin prophylaxis.

  • 66. Friberg, Örjan
    et al.
    Dahlin, Lars-Göran
    Levin, Lars-Åke
    Magnusson, Anders
    Granfeldt, Hans
    Källman, Jan
    Örebro University, Department of Clinical Medicine.
    Svedjeholm, Rolf
    Cost effectiveness of local collagen-gentamicin as prophylaxis for sternal wound infections in different risk groups2006In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 40, no 2, p. 117-125Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: In a randomized trial addition of local collagen-gentamicin in the sternal wound reduced the rate of sternal wound infection (SWI) to about 50% compared to intravenous prophylaxis alone. The aim of the present study was to evaluate the economic rationale for its use in every-day clinical practice. This includes the question whether high-risk groups that may have particular benefit should be identified. DESIGN: For each patient with SWI in the trial the costs attributable to the SWI were calculated. Risk factors for SWI were identified and any heterogeneity of the effect of the prophylaxis examined. RESULTS: The mean cost of a SWI was about 14500 Euros. A cost effectiveness analysis showed that the prophylaxis was cost saving. The positive net balance was even higher in risk groups. Assignment to the control group, overweight, diabetes, younger age, mammarian artery use, left ventricular ejection fraction <35% and longer operation time were independent risk factors for infection. CONCLUSION: The addition of local collagen-gentamicin to intravenous antibiotic prophylaxis was dominant, i.e. resulted in both lower costs and fewer wound infections.

  • 67. Gidlöf, Andreas C.
    et al.
    Ocaya, Pauline
    Örebro University, School of Health and Medical Sciences.
    Krivospitskaya, Olesya
    Örebro University, Department of Clinical Medicine.
    Sirsjö, Allan
    Örebro University, School of Health and Medical Sciences.
    Vitamin A: a drug for prevention of restenosis/reocclusion after percutaneous coronary intervention?2008In: Clinical Science, ISSN 0143-5221, E-ISSN 1470-8736, Vol. 114, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    The re-establishment of adequate blood flow in a vessel with a reduced lumen due to an atherosclerotic plaque by percutaneous vascular intervention is a well established procedure. However, the long-term outcome of such interventions is negatively influenced by the development of intimal hyperplasia/restenosis. Although extensively researched, this still represents a significant clinical problem. Retinoids, i.e. natural and synthetic derivates of vitamin A, represent a potential therapeutic compound, since they have been shown to influence the vast majority of processes that ultimately lead to reocclusion of the injured vessel. Retinoids exert their effects at the transcriptional level through their nuclear receptors. Targeting multiple processes, i.e. proliferation, migration, extracellular matrix composition and cell differentiation, as well as coagulation/fibrinolysis, should increase their future role in the prevention of restenosis. The purpose of this review is to summarize the diverse effects of retinoids on pathobiological and biological processes activated at sites of vascular injury with particular emphasis on intimal hyperplasia/restenosis after endovascular interventions.

  • 68. Gidlöf, Andreas C.
    et al.
    Ocaya, Pauline
    Örebro University, Department of Clinical Medicine.
    Olofsson, Peder S.
    Törmä, Hans
    Sirsjö, Allan
    Örebro University, Department of Clinical Medicine.
    Differences in retinol metabolism and proliferative response between neointimal and medial smooth muscle cells2006In: Journal of Vascular Research, ISSN 1018-1172, E-ISSN 1423-0135, Vol. 43, no 4, p. 392-398Article in journal (Refereed)
    Abstract [en]

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

  • 69.
    Gustafsson, Hanna
    Örebro University, Department of Clinical Medicine.
    Jämförelse av intima-mediatjocklek mellan höger och vänster a. carotis communis uppmätt med ultraljud2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Genom att mäta intima-mediatjockleken (IMT) i a. carotis med hjälp av ultraljud får man information om tidiga aterosklerotiska förändringar i kärlväggen. Tidigare studier har visat att IMT är större på vänster sidas a. carotis communis (CCA) jämfört med höger sidas CCA. Detta har lett till forskning för att se om det finns någon korrelation mellan ökad IMT på vänster CCA och en ökad prevalens av vänstersidig stroke. Olika studier har dock visat olika resultat i denna fråga. Syftet med denna studie var att undersöka om det finns någon sidoskillnad på IMT mellan höger och vänster sidas CCA hos friska personer. IMT mättes i höger och vänster CCA med hjälp av ultraljud på 10 kvinnor och 10 män i åldern 40-67 år. De delades sedan in i åldersgrupperna 40-49, 50-59 och 60-69 år. Ingen signifikant skillnad mellan sidorna kunde ses vare sig i hela gruppen, när kvinnor och män jämfördes var för sig eller när de olika åldersgrupperna jämfördes.

  • 70.
    Gustafsson, Mattias
    Örebro University, Department of Clinical Medicine.
    Vilken betydelse har skelettscintigrafi vid diagnos av scaphoideumfraktur?2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    En scaphoideumfraktur är den vanligaste frakturen bland karpalbenen i handen. Frakturen orsakas vanligen av ett kraftigt extensionsvåld mot handleden.

    Scaphoideums stora rörlighet i handen och dess begränsade blodförsörjning bidrar till att scaphoideumfrakturer kan vara svårläkta.

    Scaphoideumfrakturer kan vara svåra att påvisa på konventionell röntgen, även vid upprepade undersökningar. Visar konventionell röntgen ett negativt resultat, men klinisk misstanke om fraktur kvarstår, finns olika undersökningsmetoder att tillgå för att en säker diagnos ska kunna ställas.

    Syftet med den här litteraturstudien var att undersöka betydelsen av skelettscintigrafi som undersökningsmetod vid diagnos av scaphoideumfraktur.

    Resultatet visar att skelettscintigrafi har stor betydelse vid diagnos av en scaphoideumfraktur.

    Kan inte en säker diagnos ställas på konventionell röntgen är skelettscintigrafi en metod som båda kan påvisa och exkludera en scaphoideumfraktur.

  • 71.
    Hadad, Ronza
    Örebro University, Department of Clinical Medicine.
    Neisseria gonorrhoeae populationen i Sverige under 2005 - serologiska och genetiska karaktäristika2006Student thesis
    Abstract [sv]

    Neisseria gonorrhoeae orsakar den sexuellt överförbara sjukdomen gonorré som fortfarande utgör ett stort folkhälsoproblem världen över. Karaktärisering av bakterien för epidemiologiska syften är mycket viktigt för att en begränsning av sjukdomen. Serologisk karaktärisering av yttermembranproteinet PorB indelar isolat i de serologiska grupperna PorB1a och PorB1b och ytterligare i serologiska varianter (serovarer). Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) innefattar sekvensering av porB genen samt genen för transferrinbindande protein subenhet B. Gensekvenserna kan med NG-MAST tilldelas specifika allelnummer via en internetbaserad databas och som tillsammans ger upphov till en sekvenstyp (ST). Syftet var att beskriva den cirkulerande populationen av N. gonorrhoeae isolat i Sverige under 2005 genom serologisk karaktärisering samt ett urval av isolaten med genetiska metoder och jämföra de två vanligaste systemen för serologisk karaktärisering, Pharmacia och Genetic systems. Det var en högst diversifierad N. gonorrhoeae population som cirkulerade i Sverige under 2005. Resultatet av serovarbestämningen visade på en relativt låg överensstämmelse mellan de olika systemen av monoklonala antikroppar och den genetiska karaktäriseringen visade på en ökad diskriminering och det identifierades relativt många nya ST. Det höga antalet av skilda serovarer och genetiska varianter kan spegla en hög import av stammar från andra länder, suboptimal diagnostik eller inkomplett partnerspårning. Många kluster av isolat med samma serovar och ST identifierades dock vilket kan reflektera att flera smittkedjor existerar. NG-MAST kan komplettera den serologiska karaktäriseringen eller på sikt ersätta den.

  • 72. Halfvarson, Jonas
    et al.
    Jess, Tine
    Magnuson, Anders
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Orholm, Marianne
    Tysk, Curt
    Örebro University, Department of Clinical Medicine.
    Binder, Vibeke
    Järnerot, Gunnar
    Environmental factors in inflammatory bowel disease: a co-twin control study of a Swedish-Danish twin population2006In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 12, no 10, p. 925-933Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Genetics and environmental factors are implicated in the etiology of inflammatory bowel disease (IBD). We studied environmental factors in a population-based Swedish-Danish twin cohort using the co-twin control method.

    SUBJECTS AND METHODS:

    A questionnaire was sent to 317 twin pairs regarding markers of exposures in the following areas: infections/colonization and diet as well as smoking, appendectomy, and oral contraceptives. Odds ratios (OR) were calculated by conditional logistic regression. When confounding appeared plausible, multivariate conditional logistic regression was added. The questions were also divided into topic groups, and adjustment was made for multiple testing within each of the groups.

    RESULTS:

    The response rate to the questionnaire was 83%. In consideration of the study design, only discordant pairs were included (Crohn's disease [CD], n = 102; ulcerative colitis [UC], n = 125). Recurrent gastrointestinal infections were associated with both UC (OR, 8.0; 95% confidence interval [CI], 1.0-64) and CD (OR, 5.5; 95% CI, 1.2-25). Hospitalization for gastrointestinal infections was associated with CD (OR, 12; 95% CI, 1.6-92). Smoking was inversely associated with UC (OR, 0.4; 95% CI, 0.2-0.9) and associated with CD (OR, 2.9; 95% CI, 1.2-7.1).

    CONCLUSIONS:

    The observed associations indicate that markers of possible infectious events may influence the risk of IBD. Some of these effects might be mediated by long-term changes in gut flora or alterations in reactivity to the flora. The influence of smoking in IBD was confirmed.

  • 73.
    Hammer, Ann
    et al.
    Örebro University, Department of Clinical Medicine.
    Lindmark, Birgitta
    Uppsala universitet.
    Test-retest intra-rater reliability of grip force in patients with stroke2003In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, no 4, p. 189-194Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Coefficients of repeatability and reproducibility can be guides in differentiating between real changes and measurement error. The aim was to evaluate test-retest intra-rater reliability of a clinical procedure measuring grip force with Grippit in stroke patients, to assess relationship between grip force of the hands and between sustained and peak grip force. PATIENTS AND METHODS: Eighteen patients were tested using the Grippit at two occasions one hour apart. Each occasion comprised three consecutive trials per hand. RESULTS: The paretic hand needs to score a 50 N change within and between occasions to exceed the measurement error in 95% of the observations, irrespective of calculation method. Expressed by CV(within) the measurement error was 10%. There was no learning or fatigue effect during measuring. There was a wide variation between subjects but the mean ratio between sides was 0.66. The mean ratio between sustained and peak grip force was 0.80-0.84. CONCLUSION: The measurement errors were acceptable and the instrument can be recommended for the use in stroke patients at a department of rehabilitation medicine.

  • 74.
    Hammer, Ann
    et al.
    Örebro University, Department of Clinical Medicine.
    Nilsagård, Ylva
    Örebro University Hospital, Örebro, Sweden.
    Forsberg, Anette
    Örebro County Council, Örebro, Sweden.
    Pepa, Helena
    Örebro University Hospital, Örebro, Sweden.
    Skargren, Elisabeth
    Linköping University, Linköping, Sweden.
    Öberg, Birgitta
    Linköping University, Linköping, Sweden.
    Evaluation of therapeutic riding (Sweden)/hippotherapy (United States): a single-subject experimental design study replicated in eleven patients with multiple sclerosis2005In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 21, no 1, p. 51-77Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate whether therapeutic riding (TR, Sweden) hippotherapy (HT, United States) may affect balance, gait, spasticity, functional strength, coordination, pain, self-rated level of muscle tension (SRLMT), activities of daily living (ADL), and health-related quality of life. Eleven patients with multiple sclerosis (MS) were studied in a single-subject experimental design iSSED) study, type A-B-A. The intervention comprised ten weekly TR/HT sessions of 30 minutes each. The subjects were measured a maximum of 13 times. Physical tests were: the Berg balance scale, talking a figure of eight, the timed up and go test, 10 m walking, the modified Ashworth scale, the Index of Muscle Function, the Birgitta Lindmark motor assessment, part B, and individual measurements. Self-rated measures were. the Visual Analog Scale for pain, a scale for SRLMT, the Patient-Specific Functional Scale for ADL, and the SF-36. Data were analyzed visually, semi-statistically and considering clinical significance. Results showed improvement for ten subjects in one or more of the variables, particularly balance, and some improvements were also seen in pain, muscle tension, and ADL. Changes in SF-36 were mostly positive, with an improvement in Role-Emotional seen in eight patients. Conclusively, balance and Role-Emotional were the variables most often improved, but TR/HT appeared to benefit the subjects differently.

  • 75. Hardell, Lennart
    et al.
    Dreifaldt, Ann Charlotte
    Örebro University, Department of Clinical Medicine.
    Breast-feeding duration and the risk of malignant diseases in childhood in Sweden2001In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 55, no 3, p. 179-185Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To evaluate childhood cancer in relation to duration of breast-feeding.

    SETTING:

    Sweden. Records from Child Healthcare Centres were scrutinised regarding information on breast-feeding and other health-related items.

    SUBJECTS:

    All children aged 0-14 y with a malignant disease (benign brain tumours included) during the time period 1988-91 (n = 962) were identified from the Swedish Cancer Register. An equal number of controls matched for sex and age were selected from the Swedish Birth Register.

    RESULTS:

    Information was obtained for 835 cases and 860 controls. Overall, duration of breast-feeding did not influence the risk for a malignant disease in this age group. However, breast-feeding > or = 1 month increased the risk for non-Hodgkin's lymphoma (NHL) yielding an odds ratio (OR) 5.5 with 95% confidence interval (CI) 1.2-25. Breast-feeding 1 -< 6 months gave OR 5.1, CI 1.1-24 and > 6 months gave OR 7.0, CI 1.3-37 with a significant trend (P = 0.04). Adjustment for maternal and birth-related co-variates gave similar results. For other malignancies no significant changes of the risk were obtained.

    CONCLUSIONS:

    Overall, no association between duration of breast-feeding and childhood malignancies was found except for a significantly increased risk for NHL, but this was based on low numbers of cases and needs to be confirmed in other investigations

  • 76. Hederstierna, Christina
    et al.
    Möller, Claes
    Örebro University, Department of Clinical Medicine.
    Åhlman, Henrik
    Lundberg, Rebecca
    von Döbeln, Ulrika
    The prevalence of Connexin 26 mutations in the Swedish population2005In: Audiological Medicine, ISSN 1651-386X, E-ISSN 1651-3835, Vol. 3, no 3, p. 154-158Article in journal (Refereed)
    Abstract [en]

    Mutations in GJB2, the gene encoding the protein Connexin 26, have been shown to account for as much as 50% of autosomal recessive, non-syndromic childhood hearing loss (ARNSHL). Early, correct diagnosis and intervention have greatly improved the possibilities for these children in learning and developing language skills. In recent years, many reports from varied parts of the world have described the local scene of mutations in Connexin 26. The prevalence differs with geographic location and assessment procedures. Mutations in Connexin 26 have until recently been identified in very few cases in Sweden, Norway and Denmark, and nationwide population samples have not been studied in the Scandinavian countries. In this study we present the results of a large nationwide and a regional study of the prevalence of the 35delG, L90P and 167delT mutations of the GJB2 gene in Sweden. A total of 2052 samples (dried blood spots) were analysed. 1501 samples were collected representing all of Sweden and 551 samples from northern Sweden. The allele frequencies in Sweden were found to be 35delG, 0.83%; L90P, 0.30%; and 167delT, 0%. The prevalence of mutations in Connexin 26 in Sweden seems to be comparable to that in other northern European countries.

  • 77.
    Hermansson, Liselotte
    et al.
    Örebro University Hospital, Örebro, Sweden; Karolinska Institute, Stockholm, Sweden.
    Eliasson, A. C.
    Karolinska Institute, Stockholm, Sweden.
    Engström, Ingemar
    Örebro University, Department of Clinical Medicine.
    Psychosocial adjustment in Swedish children with upper-limb reduction deficiency and a myoelectric prosthetic hand2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 4, p. 479-88Article in journal (Refereed)
    Abstract [en]

    AIM: To study psychosocial adjustment and mental health in children with upper-limb reduction deficiency and a myoelectric prosthetic hand.

    METHODS: Sixty-two parents of children aged 8 to 18 y old answered a questionnaire concerning competence and behaviour/emotional problems in their children. Of the 62 children, 37 adolescents aged 11 to 18 y old answered questionnaires concerning competence, problems and mood state. The results were compared with Swedish normative data. The children were divided into five groups based on degree of myoelectric prosthetic use.

    RESULTS: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand showed social competence and behaviour/emotional problems similar to Swedish standardized norms. However, withdrawn behaviour was significantly higher in all children, social competence was significantly lower in girls, and social activities were significantly lower in older children with upper-limb reduction deficiency. There was a significant difference between prosthetic use groups. Non-users had significantly more delinquent behaviour problems than full-time users. There was an interaction between gender and prosthetic use in their affect on competence and behaviour/emotional problems, yielding two contrasting patterns.

    CONCLUSION: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand are as well adjusted psychosocially as their able-bodied peers. There are indications, however, of social stigmata related to the deficiency, which have to be considered differently in boys and girls.

  • 78. Hildebrand, Hans
    et al.
    Malmborg, Petter
    Askling, Johan
    Ekbom, Anders
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Early-life exposures associated with antibiotic use and risk of subsequent Crohn's disease2008In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 43, no 8, p. 961-966Article in journal (Refereed)
    Abstract [en]

    Objective. An inappropriate immune response to normal bowel flora is implicated in the etiology of Crohn's disease. Tolerance to bowel flora develops in infancy, so factors disrupting normal patterns of bowel colonization may increase the risk of Crohn's disease. The aim of this study was to test the hypothesis that antibiotic therapy between birth and age 5 years may disrupt the pattern of bowel colonization and increase the risk of Crohn's disease.

    Material and methods. Some 1098 patients with Crohn's disease and 6550 controls matched by delivery unit, year of birth, sex, and born between 1973 and 1997 were identified through the Swedish population registers. Seven inpatient diagnoses between birth and age 5 years associated with antibiotic therapy were identified by prospectively recorded data.

    Results. Of the seven diagnoses, only pneumonia and otitis media were sufficiently common for use in the analyses. Pneumonia and otitis media were not independent of each other in their association with Crohn's disease and the more important association was with pneumonia. Pneumonia by age 5 years was statistically significantly associated with both pediatric- and adult Crohn's disease, with odds ratios (and 95% CI) of 2.74 (1.04–7.21) and 4.94 (1.83–13.23), respectively. Pneumonia after age 5 years was not statistically significantly associated with Crohn's disease.

    Conclusions. Pneumonia prior to age 5 years, but not later, was associated with subsequent Crohn's disease and this may represent either susceptibility or causation. The results are consistent with early exposures influencing immune function, such as through disruption of bowel colonization, and thus increasing the risk of Crohn's disease.

  • 79. Hjelmevoll, Stig Ove
    et al.
    Olsen, Merethe Elise
    Ericson Sollid, Johanna U.
    Haaheim, Håkon
    Unemo, Magnus
    Örebro University, Department of Clinical Medicine.
    Skogen, Vegard
    A fast real-time polymerase chain reaction method for sensitive and specific detection of the Neisseria gonorrhoeae porA pseudogene2006In: Journal of Molecular Diagnostics, ISSN 1525-1578, E-ISSN 1943-7811, Vol. 8, no 5, p. 574-581Article in journal (Refereed)
    Abstract [en]

    Ever since the advent of molecular methods, the diagnostics of Neisseria gonorrhoeae has been troubled by false negative and false positive results compared with culture. Commensal Neisseria species and Neisseria meningitidis are closely related to N. gonorrhoeae and may cross-react when using molecular tests comprising too-low specificity. We have devised a real-time polymerase chain reaction (PCR), including an internal amplification control, that targets the N. gonorrhoeae porA pseudogene. DNA was automatically isolated on a BioRobot M48. Our subsequent PCR method amplified all of the different N. gonorrhoeae international reference strains (n = 34) and N. gonorrhoeae clinical isolates (n = 176) but not isolates of the 13 different nongonococcal Neisseria species (n = 68) that we tested. Furthermore, a panel of gram-negative bacterial (n = 18), gram-positive bacterial (n = 23), fungal (n = 1), and viral (n = 4) as well as human DNA did not amplify. The limit of detection was determined to be less than 7.5 genome equivalents/PCR reaction. In conclusion, the N. gonorrhoeae porA pseudogene real-time PCR developed in the present study is highly sensitive, specific, robust, rapid and reproducible, making it suitable for diagnosis of N. gonorrhoeae infection.

  • 80. Hoey, Hilary
    et al.
    McGee, Hannah M
    Fitzgerald, Michael
    Mortensen, Henrik B.
    Hougaard, Philip
    Lynggaard, Helle
    Skovlund, Sören E.
    Aanstoot, Henk-Jan
    Chiarelli, Francesco
    Daneman, Denis
    Danne, Thomas
    Dorchy, Harry
    Garandeau, Patrick
    Greene, Stephen
    Holl, Reinhard
    Kaprio, Eero
    Kocova, Mirjana
    Martul, Pedro
    Matsuura, Nobuo
    Robertson, Kenneth
    Schoenle, Eugen
    Sovik, Oddmund
    Swift, Peter
    Tsou, Rosa Maria
    Vanelli, Maurizio
    Åman, Jan
    Örebro University, Department of Clinical Medicine.
    Parent and health professional perspectives in the management of adolescents with diabetes: development of assessment instruments for international studies2006In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 15, no 6, p. 1033-1042Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Assessment of quality of life (QOL) in adolescents with diabetes requires patient, parent and health professional input. Psychometrically robust instruments to assess parent and professional perspectives are required. RESEARCH DESIGN AND METHODS: Questionnaires concerning adolescent QOL were developed for completion by parents and health professionals. In an international study assessing QOL in 2,101 adolescents with diabetes (median age 14 years, range 10-18; from 17 countries including Europe, Japan and North America), parents and health professionals completed their respective questionnaires between March and August 1998. RESULTS: Feasibility and acceptability of the new questionnaires were indicated by high questionnaire completion rates (adolescents 92%; parents 89%; health professionals 94%). Internal consistency was confirmed (Cronbach's alpha coefficients 0.80 parent; 0.86 health professional). Correlations of Diabetes Quality of Life Questionnaire for Youths (DQOLY) scores with parent and health professional global QOL ratings were generally low (r ranging from 0.12 to 0.36). Parent-rated burden decreased incrementally across adolescence, particularly for girls. Professional-rated burden followed a similar profile but only after age 15 years. Until then, burden was rated as uniformly high. Clinically relevant discrepancies in parent and professional burden scores were noted for one-parent families and families where adolescents had been referred for psychological help. In both cases, health professionals but not one-parent families perceived these as high burden situations. The clinical significance of this relates to the significantly poorer metabolic control recorded for adolescents in both situations. CONCLUSIONS: Parent and health professional questionnaires were found to have adequate internal consistency, and convergent and discriminant validity in relation to key clinical and QOL outcomes. The questionnaires are brief, easy to administer and score. They may also enable comparisons across countries and languages to facilitate development of international health outcome parameters. The inclusion of the parent and health professional perspectives completes a comprehensive assessment of adolescent QOL relevant to diabetes.

  • 81. Hosseini, Abolfazl
    et al.
    Koskela, Lotta Renström
    Ehrén, Ingrid
    Aguilar-Santelises, Miguel
    Sirsjö, Allan
    Örebro University, Department of Clinical Medicine.
    Wiklund, N. Peter
    Enhanced formation of nitric oxide in bladder carcinoma in situ and in BCG treated bladder cancer2006In: Nitric oxide, ISSN 1089-8603, E-ISSN 1089-8611, Vol. 15, no 4, p. 337-343Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to analyze endogenous nitric oxide (NO) formation and NO-synthase (NOS) gene expression in the urinary bladder from patients with urinary bladder cancer and to investigate the relationship between local NO formation, treatment with Bacillus Calmette Guerin (BCG) and clinical stage in bladder cancer patients. One hundred and three patients with bladder cancer were studied. Endogenous formation of NO was measured in 72 patients, including 6 patients with BCG treated bladder cancer and 6 tumor free control subjects. iNOS expression was analyzed at transcriptional and protein level in biopsies from 31 patients with bladder cancer by real time polymerase chain reaction (PCR) and Western blot (WB), respectively. Three patients in this group had received BCG treatment. Eight biopsies from normal bladder served as control for PCR and WB analysis. Patients with carcinoma in situ (CIS) had higher iNOS expression (p<0.01) and NO formation (p<0.01) than control subjects and patients with papillary tumors without concomitant CIS. Markedly increased iNOS expression (p<0.05) and NO formation (p<0.001) were also found in patients treated with BCG as compared to the other groups. In conclusion, the presence of elevated NO concentration and iNOS expression in the urinary bladder from BCG treated patients and patients with CIS further supports the notion that NO may be an important factor in bladder cancer biology and that the BCG effect on superficial bladder cancer may partly be due to stimulation of local NO formation.

  • 82. Hugosson, Elisabeth
    et al.
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Premji, Zul
    Troye-Blomberg, Marita
    Björkman, Anders
    Relationship between antipyretic effects and cytokine levels in uncomplicated falciparum malaria during different treatment regimes2006In: Acta Tropica, ISSN 0001-706X, E-ISSN 1873-6254, Vol. 99, no 1, p. 75-82Article in journal (Refereed)
    Abstract [en]

    We have previously shown that both chloroquine and paracetamol (acetaminophen) have antipyretic activity during treatment of acute uncomplicated Plasmodium falciparum malaria in children 1-4 years old. Here, we studied if this effect was accompanied by changes in plasma cytokine levels. The 104 children were treated with either chloroquine or sulfadoxine/pyrimethamine (SP) alone, SP+chloroquine or SP+paracetamol for 4 days. Cytokine levels were determined days 0, 2 and 3, body temperature every sixth hour until 72h and parasitemia once daily for 4 days. At admission, body temperature correlated with levels of IL-10, IFN-gamma and IL-6, and parasitemia correlated with IL-10 and IL-6. Except for TNF-alpha and IL-1beta, where no significant effect was found, all cytokine levels (IL-10, IFN-gamma, IL-6, IL-12, IL-13, IL-18 and IL-4) decreased up to day 2 (p<0.05). IL-6 levels continued to fall from days 2 to 3 (p<0.05), whereas increased levels were found for several cytokines (IL-12, IL-13, IL-18 and IL-1beta) (p<0.05). The antipyretic effects of chloroquine and paracetamol could not be related to any specific changes in the evaluated cytokine production or in Th1/Th2 or inflammatory/anti-inflammatory cytokine ratios. Alternative mechanisms for antipyretic effects and associations between fever and cytokine levels during uncomplicated P. falciparum malaria are therefore discussed.

  • 83.
    Hurtig Wennlöf, Anita
    et al.
    Örebro University, Department of Clinical Medicine.
    Yngve, Agneta
    Sjöström, Michael
    Sampling procedure, participation rates and representativeness in the Swedish part of the European Youth Heart Study (EYHS)2003In: Public Health Nutrition, ISSN 1368-9800, Vol. 6, no 3, p. 291-299Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The European Youth Heart Study (EYHS) is a cross-sectional, school-based population study on risk factors for future cardiovascular disease in children, with an overall participation rate in Sweden of about 50%. To study the representativeness of the participants in the Swedish part of EYHS, a comprehensive non-participant follow-up study was carried out.

    DESIGN:

    A structured multilevel analysis model was developed, addressing each level in the sampling procedure. The income, educational and occupational categories of the geographical regions of the study (level I), school catchment areas (level II) and parents (level III) were compared with official data. Participating and non-participating pupils (level IV) were compared through a questionnaire.

    SETTING:

    Thirty-seven state schools in two regions of Central Sweden (Orebro and southern Stockholm) were visited during the school year 1998/1999.

    SUBJECTS:

    Boys and girls aged 9 and 15 years were randomly sampled through a multiphase sampling procedure.

    RESULTS:

    Data for socio-economic status for levels I and II corresponded well to national and regional official data. At level III, non-manually working parents were slightly over-represented among parents of participating children. At level IV, non-participating subjects corresponded in most respects to participants with a few exceptions--mainly more interest in physical exercise among participants.

    CONCLUSIONS:

    Based on the knowledge from the non-participant study, we do not foresee problems regarding interpretation of the outcomes in the EYHS, despite the low participation rate.

  • 84.
    Hurtig-Wennlöf, Anita
    et al.
    Örebro University, Department of Clinical Medicine.
    Ruiz, Jonatan R.
    Harro, Maarike
    Sjöström, Michael
    Cardiorespiratory fitness relates more strongly than physical activity to cardiovascular disease risk factors in healthy children and adolescents: the European Youth Heart Study2007In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 14, no 4, p. 575-581Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physical activity and cardiorespiratory fitness are closely related to health variables in adults, especially those considered to be among risk factors for cardiovascular diseases. The possible tracking of cardiovascular disease risk factors from childhood to adulthood makes it important to increase our understanding of the complex relationships between physical activity, cardiorespiratory fitness and cardiovascular risk factors early in life.

    DESIGN: A cross-sectional, school-based study on healthy children and adolescents, aged 9-10 years (295 girls, 295 boys) and 15-16 years (302 girls, 233 boys) was performed during a school year in Sweden and Estonia, as part of the European Youth Heart Study.

    METHODS: Total physical activity, and minutes spent in inactivity and activity of moderate or higher intensity were measured by accelerometry. A maximal ergometer bike test was used for estimation of cardiorespiratory fitness. The risk factors included blood pressure and fasting blood levels of insulin, glucose, triglycerides, total cholesterol and high-density lipoprotein cholesterol.

    RESULTS: Canonical correlations between physical activity and cardiorespiratory fitness versus cardiovascular disease risk factors showed significant associations in both age and sex groups (rc=0.46-0.61, P<0.0001). The cardiorespiratory fitness was found to be the strongest contributor to these relationships. In girls high values of the physical activity variables were also associated with a favourable cardiovascular profile.

    CONCLUSIONS: Cardiorespiratory fitness relates more strongly to cardiovascular risk factors than components of objectively measured physical activity in children and adolescents. Physical activity becomes more important in the 15-year-old adolescents, indicating that these modifiable lifestyle factors increase in importance with age.

  • 85.
    Hurtig-Wennlöf, Anita
    et al.
    Örebro University, Department of Clinical Medicine.
    Yngve, Agneta
    Nilsson, Torbjörn K.
    Örebro University, Department of Clinical Medicine.
    Sjöström, Michael
    Serum lipids, glucose and insulin levels in healthy schoolchildren aged 9 and 15 years from Central Sweden: reference values in relation to biological, social and lifestyle factors2005In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 65, no 1, p. 65-76Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    There is a shortage of reference values for cardiovascular risk factors such as serum lipids, glucose and insulin related to biological, social and lifestyle factors for Swedish children and adolescents. Such values are needed for planning and evaluation of public health activities, and for clinical use.

    DESIGN AND METHODS:

    Data for this cross-sectional, school-based study were collected during a school year (September to May). A random sample of 1137 girls and boys aged 9 and 15 years from two locations in central Sweden participated in the study, and blood samples were taken from 969 of them.

    METHODS:

    Fasting serum blood samples were analysed for triglycerides, total cholesterol, high-density lipoprotein cholesterol, glucose and insulin. Physical examination included measurement of height, weight and pubertal status. Questionnaires provided family background data. Total physical activity was measured by accelerometer registration.

    RESULTS:

    Serum levels differed significantly between age and gender groups and were correlated to pubertal status. Neither genetic nor socio-economic background nor smoking status influenced the serum levels. Insulin levels were elevated in subjects with a body mass index in the highest decentile, compared with the levels in the rest of the subjects. The insulin levels were inversely associated with total physical activity, and physical activity varied with season.

    CONCLUSIONS:

    Pubertal status (biological age) should to be considered in the interpretation of serum values in schoolchildren rather than chronological age. The interpretation of insulin values should include both body mass index and physical activity level, and perhaps also season. Previously described regional differences in serum lipid levels in Swedish adults seem to be present also in children.

  • 86.
    Hurtig-Wennlöf, Anita
    et al.
    Örebro University, Department of Clinical Medicine.
    Yngve, Agneta
    Sjöström, Michael
    Changes in aerobic fitness in Swedish children and adolescents2006In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 3, no 1, p. 79-89Article in journal (Refereed)
    Abstract [en]

    Background: Steadily declining physical activity, especially among children, and the possible adverse health outcomes such behavior could precede, is a general concern. We evaluated whether a presumed decrease in physical activity has been accompanied with a decrease in aerobic fitness of Swedish children. Methods: A maximum cycle ergometer test  was performed in 935 children age 9 and 15 y, and the results were compared with previously reported data. Results: Estimated peak oxygen uptake (mL · kg-1 · min-1) in 9-y-old subjects was 37.3 in girls and 42.8 in boys; and in 15-y-olds, 40.4 in girls and 51.5 in boys. In the 9-y-olds, aerobic fitness remained lower in the current study compared to earlier data, but in the 15-y-olds the result did not differ from the 1952 data after adjustment for methodological differences. Conclusion: Our results suggest a change towards decreased aerobic fitness in 9-y-old, but not in 15-y-old, Swedish children during a 50-y time span.

  • 87.
    Hysing, Tommy
    Örebro University, Department of Clinical Medicine.
    Uppföljning av TSH`s beslutsgränser för analys av TPO-antikroppar2006Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Mätning av autoantikroppar mot tyreoperoxidas (TPO) är en

    viktig del för att diagnostisera autoimmun tyreoideafunktions rubbning. Hos det stora flertalet som har en autoimmun tyreoidea sjukdom hittar man TPO-antikroppar. Vid hypotyreos är det av betydelse att se om det finns TPO-antikroppar för att påvisa eller utesluta autoimmunitet som orsak till hypotyreosen.

    Ett problem är att det inte finns något allmänt accepterat referensintervall för TPO-antikroppar. I Sverige varierar det mellan 2 och 60 kIU/l beroende på vilken mätmetod som används.

    Syftet med denna undersökning är att se hur vanligt det är med förhöjda värden för tyreoidea stimulerande hormon (TSH) och hur fördelningen av antikroppar för tyreoidea peroxidas (TPO-antikroppar) ser ut vid normala och subnormala TSH-värden.

    De serumprover som ingick i undersökningen analyserades med en fluoroimmunoassay teknik på instrumentet AutoDELFIAÔ , Perkin-Elmer. Proverna valdes slumpmässigt från de rutinprover som kommer till laboratoriet.

    Mellan 8 – 13 % av de undersökta patientproverna har en lätt förhöjning (4,3 – 6,0 mIU/l) av TSH-värdena. Totalt för alla värden mer än 4,3 mIU/l är 15 %.

    Kvinnor har en högre andel av TPO-antikroppar jämfört med män vilket andra undersökningar också visat.

    Referensintervallet, < 35 kIU/l, för TPO-antikroppar är relevant gentemot frågeställningen. I den undersökta populationen är det ett prov som hamnar utanför detta intervall.

    44 % hade förhöjda värden på TPO-antikroppar vid måttligt förhöjda TSH värden, detta indikerar att analys av TPO-antikroppar bör göras när TSH visar värden > 4,3 mIU/l.

    Den metodjämförelse som gjordes mellan fluoroimmunoassay och kemiluminiscens visar på dålig korrelation.

    Denna undersökning är en pilotstudie för att kunna gå vidare med frågeställningar som

    - kan man korrigera på något sätt för de olikheter som uppenbarligen finns mellan de olika mätmetoderna

    - kan man ta bort spädningssteget i fluoroimmunoassay-metoden för att därigenom kunna sänka referensgränsen

  • 88.
    Hägglund, Doris
    et al.
    Örebro University, Department of Clinical Medicine.
    Ahlström, Gerd
    Örebro University.
    The meaning of women's experience of living with long-term urinary incontinence is powerless2009Conference paper (Refereed)
  • 89.
    Isaksson, Helena S.
    et al.
    Örebro University, Department of Clinical Medicine.
    Nilsson, Torbjörn K.
    Örebro University, Department of Clinical Medicine.
    Preanalytical aspects of quantitative TaqMan real-time RT-PCR: applications for TF and VEGF mRNA quantification2006In: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, Vol. 39, no 4, p. 373-377Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The present paper focuses on preanalytical aspects of tissue factor (TF) and vascular endothelial growth factor (VEGF) mRNA quantification: the choice of blood collection tubes and defining the time frame allowed before processing the sample. DESIGN AND METHODS: Blood was collected from healthy volunteers in K(3) EDTA tubes, CPT, endotoxin-free EndoTube tubes and in PAXgene tubes. Total RNA concentration was determined by absorbance readings at 260 nm with a GeneQuantII UV spectrophotometer. RNA quantity and quality were also determined by the Lab on a Chip technique (Agilent 2100 Bioanalyzer). Real-time RT-PCR assays were performed by the TaqMan technology. RESULTS: The more expensive PAXgene and CPT tubes and the Endo tubes did not give superior results from those obtained in inexpensive routine K(3) EDTA tubes. The PAXgene tubes preserved high molecular mass rRNA better than the other tubes. CONCLUSION: Both the PAXgene system and routine EDTA tubes are suitable for clinical purposes aimed at quantitation of mRNA for TF and VEGF. PAXgene yielded rRNA that was less degraded but had lower mRNA per microg extracted RNA. A time frame up to 24 h until sample processing is acceptable for TF and VEGF mRNA.

  • 90. Ivanoff, Carl-Johan
    et al.
    Widmark, Göran
    Johansson, Carina B.
    Örebro University, Department of Health Sciences. Örebro University, Department of Clinical Medicine.
    Wennerberg, Ann
    Histologic evaluation of bone response to oxidized and turned titanium micro-implants in human jawbone2003In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 18, no 3, p. 341-348Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    To evaluate the human bone tissue response to 2 surfaces (oxidized or turned) on commercially available titanium implants.

    MATERIALS AND METHODS:

    Screw-type turned (control) and oxidized (test) micro-implants were manufactured in the same manner as commercially available turned and oxidized (TiUnite, Brånemark System) implants. The thickness of the oxide layer of the test implants was on average 10 microm, corresponding to the oxide thickness of the apical part of the TiUnite implant. Twenty patients received 1 test and 1 control micro-implant each during implant surgery. Before placement, the surface topography of the implants was characterized with an optical confocal laser profilometer. After a mean healing period of 6.6 months in the maxilla and 3.5 months in the mandible, the micro-implants and surrounding tissue were removed with a trephine bur. Histologic sections were produced, and the specimens were analyzed histomorphometrically.

    RESULTS:

    Surface roughness and enlargement were greater for the oxidized implants than for the turned implants. All micro-implants, except for 2 controls, were found to be clinically stable at the time of retrieval. Histomorphometric evaluation demonstrated significantly higher bone-to-implant contact for the oxidized implants, whether placed in the maxilla or in the mandible. Significantly more bone was found inside the threaded area for the oxidized implants placed in the mandible and maxilla, but there was no difference between implants with regard to position (maxilla or mandible).

    DISCUSSION:

    The stronger bone response to the oxidized implants may have contributed to the fact that 2 control implants but no test implants were lost. The reason for these findings may depend on one or multiple differences of the surfaces between test and control implants: (1) the thicker oxide layer itself, (2) increased surface roughness, (3) different surface morphology in terms of porosity, or (4) change in crystal structure.

    CONCLUSION:

    The present histologic study in human jawbone demonstrated a significantly higher bone response for anodic oxidized titanium implants than for implants with a turned surface.

  • 91. Iversen, Peter
    et al.
    Johansson, Jan-Erik
    Örebro University, Department of Clinical Medicine.
    Lodding, Pär
    Kylmälä, Timo
    Lundmo, Per
    Klarskov, Peter
    Tammela, Teuvo L. J.
    Tasdemir, Ilker
    Morris, Thomas
    Armstrong, Jon
    Bicalutamide 150 mg in addition to standard care for patients with early non-metastatic prostate cancer: updated results from the Scandinavian Prostate Cancer Period Group-6 Study after a median follow-up period of 7.1 years2006In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 40, no 6, p. 441-452Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The Early Prostate Cancer (EPC) programme is evaluating the efficacy and tolerability of bicalutamide following standard care (radiotherapy, radical prostatectomy or watchful waiting) in patients with localized (T1-2, N0/Nx) or locally advanced (T3-4, any N; or any T, N + ) non-metastatic prostate cancer. Herein we report the latest findings after a median follow-up period of 7.1 years from the Scandinavian Prostate Cancer Group (SPCG)-6 study, one of three trials in the EPC programme. MATERIAL AND METHODS: A total of 1218 patients were randomized on a 1:1 basis to either bicalutamide 150 mg/day (n=607) or placebo (n=611) following standard care; 81.4% were followed conservatively (watchful waiting). The primary endpoints were objective progression-free survival (PFS) and overall survival (OS). RESULTS: In patients with localized disease there was no significant difference in PFS [hazard ratio (HR) 0.85; 95% CI 0.69-1.06; p=0.15] and a trend towards decreased OS with bicalutamide plus standard care compared with standard care alone (HR 1.23; 95% CI 0.96-1.58; p=0.11). In patients with locally advanced disease, bicalutamide significantly improved PFS, reducing the risk of progression by 53% compared with standard care alone (HR 0.47; 95% CI 0.37-0.59; p<0.001). The median time to progression was 8.8 years for bicalutamide plus standard care and 7.1 years for standard care alone. There was a significant improvement in OS with bicalutamide plus standard care, with a reduction in the risk of death of 35% versus standard care alone (HR 0.65; 95% CI 0.50-0.85; p=0.001). CONCLUSION: This analysis of the SPCG-6 study showed that bicalutamide plus standard care offers significant PFS and OS benefits for patients with locally advanced disease, but not for those with localized disease.

  • 92.
    Jacobsson, Susanne
    et al.
    Örebro University, Department of Clinical Medicine.
    Mölling, Paula
    Olcen, Per
    Seroprevalence of antibodies against fHbp and NadA, two potential vaccine antigens for Neisseria meningitidisManuscript (preprint) (Other academic)
    Abstract [en]

    The IgG antibody levels directed against fHbp and NadA, two potential vaccine antigens for Neisseria meningitidis, were examined in order to investigate the extent of natural immunisation against these antigens in different age groups. As a comparison, the IgG antibody levels against Haemophilus influenzae type b were examined.

    In the two youngest age groups, below 10 years of age, relatively low levels of both anti-fHbp and anti-NadA were measured. A 9-fold higher concentration of anti-fHbp was noted in the age groups up to 29 years of age to its peak at 30-39 years, followed by decreased levels with age. Anti-NadA showed a certain increase up to 9 years followed by an even increase up to 49 years.

  • 93.
    Jacobsson, Susanne
    et al.
    Örebro University, Department of Clinical Medicine.
    Thulin, Sara
    Mölling, Paula
    Unemo, Magnus
    Comanducci, Maurizio
    Rappuoli, Rino
    Olcén, Per
    Sequence constancies and variations in genes encoding three new meningococcal vaccine candidate antigens2006In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 24, no 12, p. 2161-2168Article in journal (Refereed)
    Abstract [en]

    By the strategy “reverse vaccinology” a number of new antigens have been identified in Neisseria meningitidis, which are potential candidates for a highly needed broad-spectrum meningococcal vaccine. In the present study we examined the prevalence, sequence constancies and variations of the genes encoding three of these new antigens designated, genome-derived neisserial antigen (GNA) 1870, GNA1946 and GNA2132. All three genes were present in all     N. meningitidis isolates tested. Concerning gna1870, three major variants of the gene sequences and deduced amino acid sequences were identified and 56% of the deduced amino acids were conserved in all isolates. In gna1946, 98% of the deduced amino acids were conserved and in gna2132, 54% of the deduced amino acids were conserved. Based on gene prevalence and conservation, all three antigens are promising candidates for an effective meningococcal vaccine against all N. meningitidis irrespective of serogroup.

  • 94. Jangpatarapongsa, Kulachart
    et al.
    Sirichaisinthop, Jeeraphat
    Sattabongkot, Jetsumon
    Cui, Liwang
    Montgomery, Scott M.
    Örebro University, Department of Clinical Medicine.
    Looareesuwan, Sornchai
    Troye-Blomberg, Marita
    Udomsangpetch, Rachanee
    Memory T cells protect against Plasmodium vivax infection2006In: Microbes and infection, ISSN 1286-4579, E-ISSN 1769-714X, Vol. 8, no 3, p. 680-686Article in journal (Refereed)
    Abstract [en]

    Immunity induced by Plasmodium vivax infection leads to memory T cell recruitment activated during "relapse" or "re-infection". This study aims to characterise memory T cells in patients with acute or convalescent P. vivax infection. Lymphocytes were collected from patients infected by P. vivax, immune controls and naive controls. The proportion of immature memory T cells, expressing CD45RO(+)CD27(+), and mature cells lacking CD27 was assessed. A statistically significant increase in the median percentage of memory T cell subsets expressing CD4(+) was observed in material from patients with an acute infection compared with that from either naive or immune controls. The high percentage of memory T cells in infected patients was maintained until 60 days post treatment. The immune controls living in a malaria endemic area had a somewhat increased proportion of memory T cell subsets expressing CD8(+). An approximately three-fold increase of these cell types was shown in patients with an acute infection and the level persisted until 60 days post treatment. Phenotypic characterisation of the peripheral lymphocytes during acute infection revealed that a large fraction of the lymphocytes carried the gammadelta phenotypes suggesting a role for these cells in the early response against P. vivax. Very low levels of P. vivax specific antibody were found. This might suggest that cell-mediated immunity may play a greater role in the development of naturally acquired protection against P. vivax infection than humoral immunity. Our results provide further insight into the mechanism of cell-mediated immunity to P. vivax infection that could be important for the future development of a successful vaccine and anti-malarial drug designation.

  • 95.
    Jansson, Kjell
    Örebro University, Department of Clinical Medicine.
    Intraperitoneal microdialysis: technique and results2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Microdialysis has recently developed from a laboratory research method of animals to a useful clinical tool to evaluate parameters suggesting tissue ischemia. It is now used in neurosurgery, plastic surgery and liver transplantation.

    Shock and multiple organ failure after surgery are rare but serious complications with a high mortality rate and splanchnic ischemia is an early and important step in this development. Splanchnic ischemia is leading to increased permeability of the intestinal mucosa and to activation of macrophages. Subsequent release of inflammatory mediators like cytokines initiates shock, which may result in multiple organ failure and death. The importance of splanchnic hypoxia/ischemia is investigated in these five studies in relation to activation of cytokines (intraperitoneal and systemic) during a normal recovery and in case of surgical complications after major gastrointestinal surgery.

    Postoperatively the metabolic substances, glucose, pyruvate, lactate and glycerol were analysed and the LP ratio was calculated using microdialysis intraperitoneally and subcutaneously. Two studies are focused on the activation of the immunologic system by measurement of the cytokines TNF-, IL-6 and IL-10 and the relationship between LP ratio and the cytokines. Three studies are describing the performance of intraperitoneal microdialysis, different responses depending on the site of measurement, the difference between intraperitoneal and subcutaneous measurements and normal values in postoperative gastrointestinal surgery. Patients with clinical complications are described separately.

    No adverse effects of the intraperitoneal measurement technique were seen. An increase of the intraperitoneal LP ratio and decrease of glucose were in several cases preceding clinical complications. Intraperitoneal LP ratio, glucose and cytokines were higher in the abdominal cavity compared to subcutaneous and systemic measurements in a normal postoperative recovery. An intraperitoneal correlation between TNF-a and the LP ratio was found. Intraperitoneal concentrations of the cytokines and the LP ratio were decreasing in parallel during a normal postoperative recovery.

    The intraperitoneal inflammatory response is higher, during a normal postoperative recovery as well as in patients suffering from complications, compared to systemic findings, emphazising the importance of the gastrointestinal tract as the source of early immunological reactions postoperatively. IPM enables safe and sensitive analysis of glucose, pyruvate, lactate and glycerol from the intraperitoneal organs measured in the intraperitoneal fluid.

    Measurement of the LP ratio with microdialysis seems to detect early splanchnic hypoxia/ischemia that correlates to the intraperitoneal inflammation. IPM may have a future as an important clinical tool for monitoring patients at risk of developing postoperative surgical complications.

    List of papers
    1. Human intraperitoneal microdialysis: increased lactate/pyruvate ratio suggests early visceral ischaemia
    Open this publication in new window or tab >>Human intraperitoneal microdialysis: increased lactate/pyruvate ratio suggests early visceral ischaemia
    Show others...
    2003 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 38, no 9, p. 1007-1011Article in journal (Refereed) Published
    Abstract [en]

    Background: Previous studies suggest that visceral ischaemia precedes shock and multiple organ failure, though methods for studying humans are lacking. We aimed to evaluate intraperitoneal microdialysis, a new technique for detecting splanchnic ischaemia in clinical practice. Methods: Right-sided hemicolectomy was performed in eight patients who were studied by microdialysis postoperatively for glucose, lactate, pyruvate and glycerol levels. Results: Six of the eight patients showed a normal postoperative course and had lactate/pyruvate ratios between 7.1 and 21.7, glucose between 4.5 and 14.3 &#114 mmol/L and glycerol between 10.4 and 296 &#114 &#55 mol/L. In one patient, intraperitoneal lactate/pyruvate ratio and glycerol increased and glucose decreased 5 &#114 h before low oxygenation appeared. Another patient exhibited a period of increased lactate/pyruvate ratio before a period of atrial fibrillation. Conclusion: Intraperitoneal microdialysis was performed safely. Two out of the eight patients exhibited changes of metabolic markers followed by clinical symptoms that were probably related to transient visceral ischaemia. Our findings suggest that intraperitoneal microdialysis may become a useful tool for monitoring splanchnic ischaemia in clinical practice.

    National Category
    Medical and Health Sciences Surgery
    Research subject
    Medicine; Surgery
    Identifiers
    urn:nbn:se:oru:diva-3152 (URN)10.1080/00365520310004065 (DOI)
    Available from: 2004-06-08 Created: 2004-06-08 Last updated: 2017-12-14Bibliographically approved
    2. Intraperitoneal cytokine response after major surgery: higher postoperative intraperitoneal versus systemic cytokine levels suggest the gastrointestinal tract as the major source of the postoperative inflammatory reaction
    Open this publication in new window or tab >>Intraperitoneal cytokine response after major surgery: higher postoperative intraperitoneal versus systemic cytokine levels suggest the gastrointestinal tract as the major source of the postoperative inflammatory reaction
    Show others...
    2004 (English)In: American Journal of Surgery, ISSN 0002-9610, E-ISSN 1879-1883, Vol. 187, no 3, p. 372-377Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Cytokine response is an important factor in the development of shock and organ failure. The aim of this study was to investigate intraperitoneal (peritoneal) and venous (systemic) postoperative cytokine release after major surgery.

    METHODS: Major abdominal surgery was performed in 19 patients. Preoperative systemic measurements and postoperative systemic and peritoneal measurements of C-reactive protein (CRP) and the cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin (IL-6), and IL-10 were performed.

    RESULTS: Significantly higher TNF-alpha, IL-6, and IL-10 peritoneal values were recorded compared with systemic values, whereas peritoneal CRP was significantly decreased. CRP increased significantly over time, whereas postoperative values of IL-6, IL-10, and peritoneal TNF-alpha decreased. Systemic TNF-alpha was constant over time, but values after emergent abdominal surgery showed a more extensive response. An additional effect of surgery and emergent abdominal disease was seen in increased TNF-alpha and IL-10 levels.

    CONCLUSIONS: Compared with systemic cytokines, peritoneal cytokines respond extensively after major surgery, indicating that measurement of peritoneal cytokines is a more sensible method to determine postoperative inflammatory reaction. A normal postoperative course is characterized by decreasing levels of peritoneal cytokines.

    National Category
    Medical and Health Sciences Surgery
    Research subject
    Medicine; Surgery
    Identifiers
    urn:nbn:se:oru:diva-3153 (URN)10.1016/j.amjsurg.2003.12.019 (DOI)15006565 (PubMedID)
    Available from: 2004-06-08 Created: 2004-06-08 Last updated: 2017-12-14Bibliographically approved
    3. Postoperative on line monitoring with intraperitoneal microdialysis is a sensitive clinical method for measuring increased anaerobic metabolism that correlates to the cytokine response
    Open this publication in new window or tab >>Postoperative on line monitoring with intraperitoneal microdialysis is a sensitive clinical method for measuring increased anaerobic metabolism that correlates to the cytokine response
    Show others...
    2004 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 39, no 5, p. 434-439Article in journal (Refereed) Published
    Abstract [en]

    Background: Visceral ischaemia and cytokine release are early stages in the development of shock and multiorgan failure. Because of lack of methods to measure anaerobic metabolism or visceral hypoxia in the early phase, diagnosis is not usually established until shock and organ failure are evident. Methods: Nineteen patients were studied postoperatively after major abdominal gastrointestinal surgery. A microdialysis catheter was placed intraperitoneally before closure of the abdomen. Analysis of glucose, pyruvate and lactate was performed every second hour and the ratio between lactate and pyruvate was calculated. Peritoneal fluid was collected from a peritoneal drainage for analysis of tumour necrosis factor alpha (TNF‐α) and interleukin 10 (IL‐10). Results: Sixteen of the patients had a normal postoperative course; the lactate/pyruvate ratio started at the level of 20 immediately postoperatively and decreased significantly during the first 45 postoperative hours (P = 0.007). A similar pattern was recorded for peritoneal TNF‐α, which decreased correspondingly (P = 0.003). A correlation coefficient of 0.303 (P < 0.001) between lactate/pyruvate ratio and TNF‐α was found. After an initial short increase, IL‐10 decreased over time (P < 0.001). Three of the patients had abnormalities in the microdialysis results, cytokines and clinical outcome. These patients are presented separately. Conclusions: A normal postoperative course results in a decrease in the intraperitoneal lactate/pyruvate ratio, TNF‐α and IL‐10. A correlation between the intraperitoneal lactate/pyruvate ratio and TNF‐α was found which suggests that intraperitoneal microdialysis is a sensitive, indirect method in analysing the postoperative intraperitoneal inflammatory response. A complicated postoperative course was preceded by increase of the peritoneal lactate/pyruvate ratio interpreted as splanchnic hypoxia and also an increased TNF‐α level.

    National Category
    Medical and Health Sciences Surgery
    Research subject
    Medicine; Surgery
    Identifiers
    urn:nbn:se:oru:diva-3154 (URN)10.1080/00365520310008548 (DOI)
    Available from: 2004-06-08 Created: 2004-06-08 Last updated: 2017-12-14Bibliographically approved
    4. Results of intraperitoneal microdialysis depend on the location of the catheter
    Open this publication in new window or tab >>Results of intraperitoneal microdialysis depend on the location of the catheter
    Show others...
    2004 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 64, no 1, p. 63-70Article in journal (Refereed) Published
    Abstract [en]

    Background and Objective: Intraperitoneal microdialysis was recently described as a method for early detection of visceral ischemia. The method seems safe and accurate. The intra-abdominal catheter used may imply variations in results depending on the location of the catheter. The aim of the study was to investigate possible differences in metabolic parameters obtained depending on various locations of the intra-abdominal catheter, compared with using the subcutaneous reference catheter. Method: After right-sided hemicolectomy in 12 patients, three catheters were placed and fixed intraperitoneally: one at the anastomosis, one in the omentum and one embedded between the small intestinal loops. A subcutaneous catheter placed in the pectoral region was used as reference. Analyses of lactate/pyruvate ratio and glucose and glycerol levels were done during a period of 45 hours postoperatively. Results: Lactate/pyruvate ratio decreased numerically at all three intraperitoneal locations during the study while the subcutaneous lactate/pyruvate ratio increased slightly. Significant differences between intraperitoneal and subcutaneous locations were found as well as differences between the three intraperitoneal locations. Highest values of the lactate/pyruvate ratio were found at the anastomosis, while the widest range was found at the small intestine. Subcutaneous glucose levels were lower while glycerol levels were higher compared with intraperitoneal values. Conclusions: In evaluating postoperative metabolism, intraperitoneal microdialysis is influenced by the location of the microdialysis catheter. The same pattern is, however, recorded over time. The juxta-anastomotic region and the small intestinal loop area seem to be the most reasonable locations for measurements.

    National Category
    Medical and Health Sciences Surgery
    Research subject
    Medicine; Surgery
    Identifiers
    urn:nbn:se:oru:diva-3155 (URN)10.1080/00365510410004100 (DOI)
    Available from: 2004-06-08 Created: 2004-06-08 Last updated: 2017-12-14Bibliographically approved
    5. Normal values and differences between intraperitoneal and subcutaneous microdialysis in patients after non‐complicated gastrointestinal surgery
    Open this publication in new window or tab >>Normal values and differences between intraperitoneal and subcutaneous microdialysis in patients after non‐complicated gastrointestinal surgery
    Show others...
    2005 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 65, no 4, p. 273-282Article in journal (Refereed) Published
    Abstract [en]

    Objective. Visceral ischemia is an early event in the development of shock and organ failure. Microdialysis has been presented as a promising method for detection of visceral hypoxia and ischemia. The aim of this study was to investigate differences in the metabolic response measured by microdialysis between intraperitoneal and subcutaneous locations and to estimate normal values of lactate/pyruvate ratio, glucose and glycerol. Material and methods. Intraperitoneal and subcutaneous metabolic responses were compared regarding lacate/pyruvate ratio, glucose and glycerol, during 45 postoperative hours in 33 patients undergoing various non‐complicated elective major gastrointestinal surgery. Results. Intraperitoneal lactate/pyruvate ratio started around 15 and decreased over time, while subcutaneous levels were stable around 9. Glucose levels were higher intraperitoneally and increased rapidly during the first 9 h to 8.6 mM, while the subcutaneous levels increased during 21 h to 7.5 mM. Intraperitoneal glycerol levels were stable around 100 µM, while subcutaneous values started around 230 µM and then increased. Conclusions. In a non‐complicated postoperative course the lactate/pyruvate ratio and glucose levels are higher intraperitoneally, suggesting a higher postoperative intraperitoneal metabolism. Glycerol levels are higher and increase subcutaneously, suggesting increased postoperative energy demand, particularly in the visceral organs, as being responsible for the lipolysis seen in the subcutaneous tissue.

    National Category
    Medical and Health Sciences Surgery
    Research subject
    Medicine; Surgery
    Identifiers
    urn:nbn:se:oru:diva-3156 (URN)10.1080/00365510510013802 (DOI)
    Available from: 2004-06-08 Created: 2004-06-08 Last updated: 2017-12-14Bibliographically approved
  • 96.
    Jansson, Kjell
    et al.
    Örebro University, Department of Clinical Medicine.
    Jansson, M.
    Andersson, M.
    Magnuson, A.
    Ungerstedt, U.
    Norgren, L.
    Normal values and differences between intraperitoneal and subcutaneous microdialysis in patients after non‐complicated gastrointestinal surgery2005In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 65, no 4, p. 273-282Article in journal (Refereed)
    Abstract [en]

    Objective. Visceral ischemia is an early event in the development of shock and organ failure. Microdialysis has been presented as a promising method for detection of visceral hypoxia and ischemia. The aim of this study was to investigate differences in the metabolic response measured by microdialysis between intraperitoneal and subcutaneous locations and to estimate normal values of lactate/pyruvate ratio, glucose and glycerol. Material and methods. Intraperitoneal and subcutaneous metabolic responses were compared regarding lacate/pyruvate ratio, glucose and glycerol, during 45 postoperative hours in 33 patients undergoing various non‐complicated elective major gastrointestinal surgery. Results. Intraperitoneal lactate/pyruvate ratio started around 15 and decreased over time, while subcutaneous levels were stable around 9. Glucose levels were higher intraperitoneally and increased rapidly during the first 9 h to 8.6 mM, while the subcutaneous levels increased during 21 h to 7.5 mM. Intraperitoneal glycerol levels were stable around 100 µM, while subcutaneous values started around 230 µM and then increased. Conclusions. In a non‐complicated postoperative course the lactate/pyruvate ratio and glucose levels are higher intraperitoneally, suggesting a higher postoperative intraperitoneal metabolism. Glycerol levels are higher and increase subcutaneously, suggesting increased postoperative energy demand, particularly in the visceral organs, as being responsible for the lipolysis seen in the subcutaneous tissue.

  • 97.
    Jansson, Kjell
    et al.
    Örebro University, Department of Clinical Medicine.
    Redler, B.
    Truedsson, L.
    Magnuson, A.
    Ungerstedt, U.
    Norgren, L.
    Postoperative on line monitoring with intraperitoneal microdialysis is a sensitive clinical method for measuring increased anaerobic metabolism that correlates to the cytokine response2004In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 39, no 5, p. 434-439Article in journal (Refereed)
    Abstract [en]

    Background: Visceral ischaemia and cytokine release are early stages in the development of shock and multiorgan failure. Because of lack of methods to measure anaerobic metabolism or visceral hypoxia in the early phase, diagnosis is not usually established until shock and organ failure are evident. Methods: Nineteen patients were studied postoperatively after major abdominal gastrointestinal surgery. A microdialysis catheter was placed intraperitoneally before closure of the abdomen. Analysis of glucose, pyruvate and lactate was performed every second hour and the ratio between lactate and pyruvate was calculated. Peritoneal fluid was collected from a peritoneal drainage for analysis of tumour necrosis factor alpha (TNF‐α) and interleukin 10 (IL‐10). Results: Sixteen of the patients had a normal postoperative course; the lactate/pyruvate ratio started at the level of 20 immediately postoperatively and decreased significantly during the first 45 postoperative hours (P = 0.007). A similar pattern was recorded for peritoneal TNF‐α, which decreased correspondingly (P = 0.003). A correlation coefficient of 0.303 (P < 0.001) between lactate/pyruvate ratio and TNF‐α was found. After an initial short increase, IL‐10 decreased over time (P < 0.001). Three of the patients had abnormalities in the microdialysis results, cytokines and clinical outcome. These patients are presented separately. Conclusions: A normal postoperative course results in a decrease in the intraperitoneal lactate/pyruvate ratio, TNF‐α and IL‐10. A correlation between the intraperitoneal lactate/pyruvate ratio and TNF‐α was found which suggests that intraperitoneal microdialysis is a sensitive, indirect method in analysing the postoperative intraperitoneal inflammatory response. A complicated postoperative course was preceded by increase of the peritoneal lactate/pyruvate ratio interpreted as splanchnic hypoxia and also an increased TNF‐α level.

  • 98.
    Jansson, Kjell
    et al.
    Örebro University, Department of Clinical Medicine.
    Redler, Britt
    Truedsson, Lennart
    Magnuson, Anders
    Matthiessen, Peter
    Andersson, Magnus
    Norgren, Lars
    Intraperitoneal cytokine response after major surgery: higher postoperative intraperitoneal versus systemic cytokine levels suggest the gastrointestinal tract as the major source of the postoperative inflammatory reaction2004In: American Journal of Surgery, ISSN 0002-9610, E-ISSN 1879-1883, Vol. 187, no 3, p. 372-377Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cytokine response is an important factor in the development of shock and organ failure. The aim of this study was to investigate intraperitoneal (peritoneal) and venous (systemic) postoperative cytokine release after major surgery.

    METHODS: Major abdominal surgery was performed in 19 patients. Preoperative systemic measurements and postoperative systemic and peritoneal measurements of C-reactive protein (CRP) and the cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin (IL-6), and IL-10 were performed.

    RESULTS: Significantly higher TNF-alpha, IL-6, and IL-10 peritoneal values were recorded compared with systemic values, whereas peritoneal CRP was significantly decreased. CRP increased significantly over time, whereas postoperative values of IL-6, IL-10, and peritoneal TNF-alpha decreased. Systemic TNF-alpha was constant over time, but values after emergent abdominal surgery showed a more extensive response. An additional effect of surgery and emergent abdominal disease was seen in increased TNF-alpha and IL-10 levels.

    CONCLUSIONS: Compared with systemic cytokines, peritoneal cytokines respond extensively after major surgery, indicating that measurement of peritoneal cytokines is a more sensible method to determine postoperative inflammatory reaction. A normal postoperative course is characterized by decreasing levels of peritoneal cytokines.

  • 99.
    Jansson, Kjell
    et al.
    Örebro University, Department of Clinical Medicine.
    Strand, I.
    Redler, Britt
    Magnuson, Anders
    Ungerstedt, U.
    Norgren, Lars
    Results of intraperitoneal microdialysis depend on the location of the catheter2004In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 64, no 1, p. 63-70Article in journal (Refereed)
    Abstract [en]

    Background and Objective: Intraperitoneal microdialysis was recently described as a method for early detection of visceral ischemia. The method seems safe and accurate. The intra-abdominal catheter used may imply variations in results depending on the location of the catheter. The aim of the study was to investigate possible differences in metabolic parameters obtained depending on various locations of the intra-abdominal catheter, compared with using the subcutaneous reference catheter. Method: After right-sided hemicolectomy in 12 patients, three catheters were placed and fixed intraperitoneally: one at the anastomosis, one in the omentum and one embedded between the small intestinal loops. A subcutaneous catheter placed in the pectoral region was used as reference. Analyses of lactate/pyruvate ratio and glucose and glycerol levels were done during a period of 45 hours postoperatively. Results: Lactate/pyruvate ratio decreased numerically at all three intraperitoneal locations during the study while the subcutaneous lactate/pyruvate ratio increased slightly. Significant differences between intraperitoneal and subcutaneous locations were found as well as differences between the three intraperitoneal locations. Highest values of the lactate/pyruvate ratio were found at the anastomosis, while the widest range was found at the small intestine. Subcutaneous glucose levels were lower while glycerol levels were higher compared with intraperitoneal values. Conclusions: In evaluating postoperative metabolism, intraperitoneal microdialysis is influenced by the location of the microdialysis catheter. The same pattern is, however, recorded over time. The juxta-anastomotic region and the small intestinal loop area seem to be the most reasonable locations for measurements.

  • 100.
    Jansson, Kjell
    et al.
    Örebro University, Department of Clinical Medicine.
    Ungerstedt, J.
    Jonsson, T.
    Redler, B.
    Andersson, M.
    Ungerstedt, U.
    Norgren, L.
    Human intraperitoneal microdialysis: increased lactate/pyruvate ratio suggests early visceral ischaemia2003In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 38, no 9, p. 1007-1011Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies suggest that visceral ischaemia precedes shock and multiple organ failure, though methods for studying humans are lacking. We aimed to evaluate intraperitoneal microdialysis, a new technique for detecting splanchnic ischaemia in clinical practice. Methods: Right-sided hemicolectomy was performed in eight patients who were studied by microdialysis postoperatively for glucose, lactate, pyruvate and glycerol levels. Results: Six of the eight patients showed a normal postoperative course and had lactate/pyruvate ratios between 7.1 and 21.7, glucose between 4.5 and 14.3 &#114 mmol/L and glycerol between 10.4 and 296 &#114 &#55 mol/L. In one patient, intraperitoneal lactate/pyruvate ratio and glycerol increased and glucose decreased 5 &#114 h before low oxygenation appeared. Another patient exhibited a period of increased lactate/pyruvate ratio before a period of atrial fibrillation. Conclusion: Intraperitoneal microdialysis was performed safely. Two out of the eight patients exhibited changes of metabolic markers followed by clinical symptoms that were probably related to transient visceral ischaemia. Our findings suggest that intraperitoneal microdialysis may become a useful tool for monitoring splanchnic ischaemia in clinical practice.

123456 51 - 100 of 254
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf