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  • 1.
    A. Proko, Romina
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Deskriptiv studie av Multimodal Rehabilitering 1-deltagare i västra Region Örebro Län: - förändring i självskattning av ångest/depression och basal kroppskännedom efter åtta veckors intervention2019Independent thesis Basic level (degree of Bachelor of Fine Arts), 10 poäng / 15 hpOppgave
  • 2.
    Aam, Stina
    et al.
    Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Gynnild, Mari Nordbø
    Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Stroke Unit, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Munthe-Kaas, Ragnhild
    Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Saltvedt, Ingvild
    Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Lydersen, Stian
    Department of Mental Health, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
    Knapskog, Anne-Brita
    Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
    Ihle-Hansen, Hege
    Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
    Ellekjær, Hanne
    Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Stroke Unit, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Eldholm, Rannveig Sakshaug
    Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Fure, Brynjar
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Internal Medicine, Central Hospital, Karlstad, Sweden.
    The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study2021Inngår i: Frontiers in Neurology, E-ISSN 1664-2295, Vol. 12, artikkel-id 678794Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI.

    Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI.

    Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR =12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively).

    Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.

  • 3.
    Aaro, Martina
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Polypharmacy and Inappropriate Drug Use among Elderly Patients admitted to a Short-Term Nursing Home in Örebro2017Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
    Fulltekst (pdf)
    Polypharmacy and Inappropriate Drug Use among Elderly Patients admitted to a Short-Term Nursing Home in Örebro
  • 4.
    Abawi, Akram
    Örebro universitet, Institutionen för medicinska vetenskaper.
    The effect of TGF-B1 and Fetal Bovine Serum on Sema 7A. Expression: An in Vitro study on Bone Marrow derived MSC from patients vith BCR-ABL negative Myeloproliferative neoplasms2017Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
  • 5.
    Abawi, Akram
    et al.
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Samano, Ninos
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Centre.
    Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease: A Single-Center Experience2023Inngår i: Brazilian Journal of Cardiovascular Surgery, ISSN 0102-7638, E-ISSN 1678-9741, Vol. 39, nr 1, artikkel-id e20220461Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease.

    METHODS: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint.

    RESULTS: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found.

    CONCLUSION: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.

  • 6.
    Abdelhadi, Dania
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Impulsivitet hos barn med ADHD: En systematisk litteraturstudie om Go/No-Go tester och effekten av centralstimulerande läkemedel: En systematisk litteraturstudie om Go/No-Go tester och effekten av centralstimulerande läkemedel2023Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
  • 7.
    Abdo Ibrahim, Adam
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Icke- insättande/avbrytande av livsuppehållande behandling– Ett etiskt dilemma2021Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Ingen kan fly från döden. Det är en process som ställer en inför psykiska, fysiska, sociala men främst existentiella utmaningar och svårigheter. Intensivvården med dess livsuppehållande behandling är en ung konst. Exempelvis började maskiner för artificiell ventilation användas under 50- talet. I vår nutid omfattas vård i livets slutskede av den palliativa vården. Socialstyrelsen publicerade 1992 en handbok som gav vägledning i form av riktlinjer om vissa etiska frågor bakom livsuppehållande behandling.

    Syfte: Att skapa en överblick över de juridiska dimensionerna i beslutet om att avstå från eller avbryta livsuppehållande medicinska åtgärder, och att granska de viktigaste etiska argumenten kring denna fråga.

    Metod: Studien baserades på en texttolkande, hermeneutisk metod. Begrepps- och argumentationsanalys genomfördes. Relevant litteratur valdes utifrån projektarbetets frågeställning som sedan analyserades ur ett etiskt perspektiv.

    Resultat: Exempel på livsuppehållande behandlingar är andningsunderstödjande behandlingar så som respirator, assisterad cirkulation i form av HLR samt dialys eller tillförsel av blodprodukter, vätska och näring. En patient som är beslutskapabel har rätt att neka livsuppehållande behandling. Om patienten inte är beslutskapabel ska de som känner patienten bäst i samråd med vårdteamet besluta vad patienten hade önskat om denne var beslutskapabel. Ett ställningstagande bör alltid utgå från patientens bästa intresse.

    Slutsats: Att endast utgå från vetenskap och beprövad erfarenhet kan i vissa ögon ses som >hjärtlöst<. Beslutet måste vara baserat på empati, medmänsklighet, vetenskap, beprövad erfarenhet men framför allt med patientens bästa intresse i absoluta fokus.

    Fulltekst (pdf)
    Icke- insättande/avbrytande av livsuppehållande behandling– Ett etiskt dilemma
  • 8.
    Abduljabbar, Zahra Athab
    et al.
    Specialist Dental Clinic, Folktandvården Sörmland AB, Mälar Hospital, Eskilstuna, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Prosthodontics/Dental Materials Science, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Svensson, Krister G
    Swedish Armed Forces HQ, Surgeon General's Department, Stockholm, Sweden.
    Hjalmarsson, Lars
    Specialist Dental Clinic, Folktandvården Sörmland AB, Mälar Hospital, Eskilstuna, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Prosthodontics/Dental Materials Science, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Franke Stenport, Victoria
    Department of Prosthodontics/Dental Materials Science, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eliasson, Alf
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Dental Research Department.
    Chewing side preference and laterality in patients treated with unilateral posterior implant-supported fixed partial prostheses2022Inngår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 49, nr 11, s. 1080-1086Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: It is not clear to what extent chewing is improved by unilateral oral rehabilitation with implant-supported fixed partial prostheses (ISFPPs).

    AIM: This study aimed to investigate whether patients treated with unilateral ISFPPs in the maxilla use their prostheses during mastication to the same extent as they used their contralateral natural teeth. A further aim was to investigate whether there is a correlation between preferred chewing side and laterality.

    MATERIAL AND METHODS: Chewing side preference was assessed in 15 participants treated with unilateral ISFPPs in the maxilla. The first, second, third, fifth, and tenth chewing cycles were assessed, and the test was repeated ten times. All participants also answered a questionnaire about their chewing side preference.

    RESULTS: Most of the participants presented bilateral chewing, but two (13%) chewed only on the ISFPP. There was no statistically significant association between the objectively assessed chewing side and dental status (natural teeth or ISFPPs) during any of the recorded chewing cycles (p >.1). There were statistically significant correlations between both the subjectively reported usually preferred chewing side and the subjective chewing side preference during the test, and the objectively assessed chewing side for the first three chewing cycles (p <.01). No correlation was found between handedness and the objectively assessed chewing side.

    CONCLUSION: In the present study, most participants chewed bilaterally, and chewing was performed both on the ISFPP and on the natural teeth. No correlation was found between the preferred chewing side, objectively or subjectively determined, and laterality.

  • 9.
    Abdulkadir, Zakaria
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hur hanteras akut lugnande injektion i psykiatrin ochvilka förbättringar kan göras utifrån relevant kunskap?2020Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund

    Det saknas tillräckligt med kunskap om medicinerna som används vid akut lugnandeinjektion (ALI) och evidensen som finns visar allvarliga biverkningar vid intag av dessamediciner. De riktlinjer som finns kring ALI baseras mestadels på klinisk erfarenhet och påen svag vetenskaplig grund. Denna studie syftar till att undersöka personalens erfarenheteroch tankar kring ALI i slutenvårdspsykiatrin i Region Örebro län.

    Syfte

    Syftet med studien var att undersöka hur ALI i psykiatrin hanteras och vilka förbättringarsom kan göras utifrån relevant kunskap?

    Metod

    En kvalitativ intervjustudie där Flanagans Critical Incident Technique användes. 5 personal från psykiatrin intervjuades, en kompletterande telefonintervju gjordes, Direct ContentAnalys användes för att analysera och sammanställa data.

    Resultat

    Resultatet visade att situationer med hot och våld och tillvägagångssätt vid ALI hanteradesenligt riktlinjer. De mediciner som läkare använde vid ALI var enligt rekommendationer fråntidigare studier. Efter injektion av ALI observerades patienten och vitalparametrar togs vilketär enligt riktlinjer. I intervjuerna framkom att vissa situationer kunde hanteras bättre, t.ex. nären döv patient blev agiterad. Det framkom även att personal efterfrågade tydligare rutiner ochbättre struktur för att ny personal ska delges seniora kollegors erfarenhet och kunskap.

    Slutsats

    Riktlinjer efterföljs på slutenvårdspsykiatrin i Region Örebro län. Men ny personal behöverbättre färdigheter för att kunna hantera agiterade patienter. Samt behövs det forskas mer påalternativa metoder.

    Fulltekst (pdf)
    fulltext
  • 10.
    Abdulla, Lana
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Recurrent or non-recurrent tamoxifen treated breast cancer2016Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
  • 11.
    Abedi, Natasha
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Retinopathy of prematurity (ROP) in Örebro : a 10-yearperspective2020Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [en]

    Background: The survival rate of premature infants has increased in Sweden over the pastdecade. Preterm infants run the risk of developing a potentially blinding disease known asretinopathy of prematurity (ROP). A recent Swedish national study showed that the frequencyof ROP has increased over the past years and there are regional differences across the country.

    Aim: Our aim was to evaluate the frequency of ROP in Örebro region (Örebro) and comparewith the rest of Sweden over a 10-year period.

    Methods: A retrospective cohort study was conducted on all premature infants born beforegestational week 31, screened for ROP in Örebro, from 2008 to 2017. Data such as number ofinfants, birth weight (BW), gestational age (GA) and ROP-outcome was retrieved from anational quality register; SWEDROP. Comparisons were made with national data during thesame time-period.

    Results:The study included 200 infants with a median GA of 28.4 weeks and BW 1144 grams.Of the screened infants 99 (49.5%) developed ROP and 20 (10%) were treated during the studyperiod. During the study period, mild ROP decreased (p=0.024), severe ROP increased(p=0.032), however there was no change in ROP-treated infants (p=0.159). The percentage ofROP-treated infants was higher in Örebro than the rest of Sweden (p=0.024).

    Conclusion: Our study showed that the frequency of mild ROP decreased in Örebro whilstsevere ROP increased during the 10-year period. The frequency of infants treated for ROP wassignificantly higher in Örebro compared to the rest of Sweden.

    Fulltekst (pdf)
    fulltext
  • 12.
    Abou El Khair, Ahmad
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Jämförelse mellan prognostiska markörer vid intensivvårdskrävandesepsis på universitetssjukhuset Örebro2019Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Sepsis är ett allvarligt tillstånd som är vanligt förekommande och medför en hög riskför mortalitet. Trots den vanliga förekomsten råder en stor okunnighet om tillståndet. I många århar olika markörer på akutmottagningen studerats, för att ta reda på vilka markörer som äreffektivast på att förutsäga en patients sjukdomsutveckling och utfall. Det finns än idag en storoenighet bland forskare om vilka markörer som är bäst. Laktat, andningsfrekvens (RR;respiratory rate) och base excess (BE) har använts som prognostiska markörer tidigare, menvilken av dem som är bäst är okänt. För behandling av sepsis finns det riktlinjer som säger attantibiotika bör administreras inom en timme efter ankomst till akutmottagningen. Det har visatsig vara avgörande för prognosen hur snabbt antibiotika sätts in.

    Syfte: Att jämföra det prognostiska värdet hos laktat med respirationsfrekvens (RR) med Baseexcess(BE) i blodet, samt att undersöka hur väl de nationella riktlinjerna för initial behandling avsepsis har följts och vilken inverkan på patientutfall detta har.

    Metod: En retrospektiv journalgranskningsstudie gjordes på alla patienter som har vårdats försepsis på IVA på Universitetssjukhuset Örebro under perioden juli 2017 – juli 2018. Utav totalt 62patienter som selekterades ur ett sepsisregister kunde 50 stycken inkluderas i undersökningen.Studiepopulationen indelades i två grupper: mortalitet inom 30 dagar eller ej.

    Resultat: Av de inkluderade 50 patienterna avled 12 stycken (24%) och 38 stycken (76%)utvecklade septisk chock, 42 stycken (88 %) fick vätska administrerat inom 1 h och 26 stycken (52%) fick antibiotika inom 1 h. Mann Whitney U-test visade att fördelningen av laktatvärden (p =0,166), andningsfrekvensvärden (p = 0,059) och base excess-nivåer (p = 0,077) hos gruppen meddödsfall inom 30 dagar jämfört med gruppen utan dödsfall inom 30 dagar inte var statistisktsignifikanta. Log rank test visade: laktat > 4 mmol/l (p = 0,136), RR ≥ 30/min (p = 0,037), BE < -3mmol/l (p = 0,802), antibiotika administrerat inom 1 h (p = 0,636).

    Slutsats: Andningsfrekvens var en bättre prognostisk markör på akutmottagningen än laktat ochbase excess. En otillfredsställande låg andel av patienterna fick antibiotika inom en timme efterankomst till akutmottagningen. Administrering av antibiotika inom en timme efter ankomst tillakutmottagning visade sig inte vara avgörande för prognosen.

    Fulltekst (pdf)
    fulltext
  • 13.
    Abou El Khair, Ahmad
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Recurrenceof atrial fibrillationafter catheter ablationin overweight patients2021Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
    Abstract [en]

    Introduction: Overweight and obesity are associated with onset and progression of atrial fibrillation (AF). Catheter ablation is considered a safe and curative therapy in advanced stages of AF.In this retrospective study wewanted toinvestigate the impact of overweight and obesity on AF-recurrence after ablation,in patients with symptomatic AF undergoing successful elective catheter ablation.Methods:The study population included 90 patients with symptomatic AF who received elective catheter ablation at University Hospital Örebro between 2015-2016. Patients were categorized into 3 study groups: Lean (<25.0 kg/m2), Overweight (25.0-29.9 kg/m2) and Obese (≥30 kg/m2). Recurrence was defined as clinical symptoms and electrocardiogram (ECG)recording consistent with AF within 3 -12 months after ablation.Fisher’s exact test was used to compare AF-recurrence between BMI groups. Results:Out of 90 patients included, 3 were excluded due to missing data. BMI-categories consisted of 17 (19.6%) lean, 47 (54.0%) overweight and 23 (26,4%) obesepatients. Recurrence rates in the different groups were 5.9% in the lean group, 29.8%in the overweight group and 17.4% in the obese group.Compared to lean patients, AF-recurrence was statistically significantly higher in the overweight population (p=0.04), but not in the obese population (p=0.3). BMI was not an independent predictor of AF-recurrence after ablation in the univariate (p=0.52) and multivariate logistic regression analysis (p=0.18).Conclusion:Compared to lean patients,recurrence of AF after catheter ablation was statistically significantly higher in overweight patients, but not in obese patients. BMI seemed not to be an independent predictor of AF-recurrence.

     

    Fulltekst (pdf)
    fulltext
  • 14.
    Abuhasanein, Suleiman
    et al.
    Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Surgery, Urology Section, NU Hospital Group, Uddevalla, Sweden.
    Chaves, Vanessa
    Department of Surgery, Urology Section, NU Hospital Group, Uddevalla, Sweden.
    Mohsen, Ali Moustafa
    Department of Surgery, Urology Section, NU Hospital Group, Uddevalla, Sweden.
    Al-Haddad, Jasmine
    Department of Surgery, Urology Section, NU Hospital Group, Uddevalla, Sweden.
    Sunila, Merete
    Department of Surgery, Urology Section, NU Hospital Group, Uddevalla, Sweden.
    Ströck, Viveka
    Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Göteborg, Region Västra Götaland, Sweden.
    Jerlström, Tomas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Urology.
    Liedberg, Fredrik
    Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden.
    Swärd, Jesper
    Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Gårdmark, Truls
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Jahnson, Staffan
    Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
    Kjölhede, Henrik
    Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Göteborg, Region Västra Götaland, Sweden.
    Diagnostic value of repeated comprehensive investigation with CT urography and cystoscopy for recurrent macroscopic haematuria2024Inngår i: BJUI Compass, E-ISSN 2688-4526, Vol. 5, nr 2, s. 253-260Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To perform a descriptive analysis of a series of patients with recurrent macroscopic haematuria after a primary standard evaluation including computed tomography urography (CTU) and cystoscopy negative for urinary bladder cancer (UBC) and upper tract urothelial cancer (UTUC) and to identify potential factors associated with occurrence of recurrent macroscopic haematuria.

    Methods: All patients older than 50 years who underwent urological investigation for macroscopic haematuria with both cystoscopy and CTU 2015-2017 were retrospectively reviewed. A descriptive analysis of the primary and later investigations for recurrent macroscopic haematuria was performed. To investigate the association between explanatory variables and the occurrence of recurrent macroscopic haematuria, a Poisson regression analysis was performed.

    Results: A total of 1395 eligible individuals with primary standard investigation negative for UBC and UTUC were included. During a median follow-up of 6.2 (IQR 5.3-7) years, 248 (18%) patients had recurrent macroscopic haematuria, of whom six patients were diagnosed with UBC, two with prostate cancer, one with renal cell carcinoma and one had a suspected UTUC at the repeated investigation. Within 3 years, 148 patients (11%) experienced recurrent macroscopic haematuria, of whom two patients were diagnosed with low-grade UBC (TaG1-2), one with T2G3 UBC and one with low-risk prostate cancer. The presence of an indwelling catheter, use of antithrombotic medication, pathological findings at CTU or cystoscopy or history of pelvic radiotherapy were all statistically significant independent predictors for increased risk for recurrent macroscopic haematuria.

    Conclusion: In the case of recurrent macroscopic haematuria within 3 years of primary standard evaluation for urinary tract cancer, there was a low risk of later urological malignancies in patients initially negative for UBC and UTUC. Therefore, waiting 3 years before conducting another complete investigation in cases of recurrent macroscopic haematuria might be appropriate.

  • 15.
    Abuhasanein, Suleiman
    et al.
    Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of surgery, Urology section, NU Hospital Group, Uddevalla, Region Västra Götaland, Sweden.
    Jahnson, Staffan
    Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
    Aljabery, Firas
    Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
    Gårdmark, Truls
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Jerlström, Tomas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Urology.
    Liedberg, Fredrik
    Department of Urology, Skåne University Hospital, Malmö, Sweden and Institution of Translational Medicine, Lund University, Malmö, Sweden.
    Sherif, Amir
    Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
    Ströck, Viveka
    Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden.
    Kjölhede, Henrik
    Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden.
    Do not throw out the baby with the bath water2022Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 56, nr 3, s. 235-236Artikkel i tidsskrift (Annet vitenskapelig)
  • 16.
    Abuhasanein, Suleiman
    et al.
    Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Surgery, Urology Section, NU Hospital Group, Trollhättan, Sweden.
    Jahnson, Staffan
    Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
    Aljabery, Firas
    Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
    Gårdmark, Truls
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Jerlström, Tomas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Urology.
    Liedberg, Fredrik
    Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden.
    Sherif, Amir
    Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
    Ströck, Viveka
    Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden.
    Kjölhede, Henrik
    Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden.
    Standardized care pathways for patients with suspected urinary bladder cancer: the Swedish experience2022Inngår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 56, nr 3, s. 227-232Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To compare time intervals to diagnosis and treatment, tumor characteristics, and management in patients with primary urinary bladder cancer, diagnosed before and after the implementation of a standardized care pathway (SCP) in Sweden.

    MATERIALS AND METHODS: Data from the Swedish National Register of Urinary Bladder Cancer was studied before (2011-2015) and after (2016-2019) SCP. Data about time from referral to transurethral resection of bladder tumor (TURBT), patients and tumor characteristics, and management were analyzed. Subgroup analyses were performed for cT1 and cT2-4 tumors.

    RESULTS: Out of 26,795 patients, median time to TURBT decreased from 37 to 27 days after the implementation of SCP. While the proportion of cT2-T4 tumors decreased slightly (22-21%, p < 0.001), this change was not stable over time and the proportions cN + and cM1 remained unchanged. In the subgroups with cT1 and cT2-4 tumors, the median time to TURBT decreased and the proportions of patients discussed at a multidisciplinary team conference (MDTC) increased after SCP. In neither of these subgroups was a change in the proportions of cN + and cM1 observed, while treatment according to guidelines increased after SCP in the cT1 group.

    CONCLUSION: After the implementation of SCP, time from referral to TURBT decreased and the proportion of patients discussed at MDTC increased, although not at the levels recommended by guidelines. Thus, our findings point to the need for measures to increase adherence to SCP recommendations and to guidelines.

  • 17.
    Abzhandadze, Tamar
    et al.
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hoang, Minh Tuan
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Mo, Minjia
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
    Mostafaei, Shayan
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jurado, Pol Grau
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
    Xu, Hong
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
    Johnell, Kristina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    von Euler, Mia
    Örebro universitet, Institutionen för medicinska vetenskaper. Faculty of Medicine and Health, Department of Neurology and Rehabilitation, Örebro University, Örebro, Sweden.
    Eriksdotter, Maria
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden.
    Garcia-Ptacek, Sara
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden.
    COVID-19 Pandemic and Stroke Care in Patients With Dementia Compared to Other Stroke Patients2024Inngår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 25, nr 7, artikkel-id 105011Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: The primary objective of this study was to examine the impact of the COVID-19 pandemic on the quality of stroke care for patients with preexisting dementia, compared with patients who had only stroke. The secondary aim was to investigate how the quality of stroke care changed during the pandemic and post-pandemic periods compared with the pre-pandemic period in patients with preexisting dementia.

    DESIGN: A registry-based, nationwide cohort study in Sweden.

    SETTING AND PARTICIPANTS: We included patients with a first stroke between 2019 and 2022, both with and without dementia. The study periods were defined as follows: pre-pandemic (January 1, 2019, to February 29, 2020), COVID-19 pandemic (March 1, 2020, to February 24, 2022), and post-COVID-19 pandemic period (February 25, 2022, to September 19, 2022). The outcomes examined were the following quality indicators of stroke care, suggested by the national guideline of stroke care in Sweden: stroke admission site, performance of swallowing assessment, reperfusion treatment, assessment for rehabilitation, and early supported discharge.

    METHODS: The associations were studied through group comparisons and binary logistic regressions.

    RESULTS: Of the 21,795 stroke patients, 1357 had documented preexisting dementia, and 20,438 had stroke without a dementia diagnosis. Throughout all study periods, a significantly lower proportion of stroke patients with preexisting dementia, compared with stroke-only patients, received reperfusion treatment, assessments for rehabilitation, and early supported discharge from stroke units. In the subgroup of stroke patients with preexisting dementia, no significant associations were found regarding the quality indicators of stroke care before, during, and after the pandemic.

    CONCLUSIONS AND IMPLICATIONS: Disparities in quality of stroke care were observed between stroke patients with preexisting dementia and those with only stroke during the COVID-19 pandemic. However, there were no statistically significant differences in stroke care for patients with dementia across the pandemic.

  • 18.
    Acevedo, Reinaldo
    et al.
    Biologic Evaluation Department, Finlay Institute of Vaccines, Havana, Cuba.
    Bai, Xilian
    Meningococcal Reference Unit, Public Health England, Manchester, UK.
    Borrow, Ray
    Meningococcal Reference Unit, Public Health England, Manchester, UK.
    Caugant, Dominique A.
    Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
    Carlos, Josefina
    Department of Pediatrics, College of Medicine, University of the East – Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines.
    Ceyhan, Mehmet
    Faculty of Medicine, Department of Pediatric Infectious Diseases, Hacettepe University, Ankara, Turkey.
    Christensen, Hannah
    Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
    Climent, Yanet
    Biologic Evaluation Department, Finlay Institute of Vaccines, Havana, Cuba.
    De Wals, Philippe
    Department of Social and Preventive Medicine, Laval University, Quebec City QC, Canada.
    Dinleyici, Ener Cagri
    Department of Paediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey.
    Echaniz-Aviles, Gabriela
    Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, México.
    Hakawi, Ahmed
    Infectious Diseases Control, Ministry of Health, Riyadh, Saudi Arabia.
    Kamiya, Hajime
    Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan.
    Karachaliou, Andromachi
    Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
    Lucidarme, Jay
    Meningococcal Reference Unit, Public Health England, Manchester, UK.
    Meiring, Susan
    Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.
    Mironov, Konstantin
    Central Research Institute of Epidemiology, Moscow, Russian Federation.
    Safadi, Marco A. P.
    Department of Pediatrics, FCM Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
    Shao, Zhujun
    National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China.
    Smith, Vinny
    Meningitis Research Foundation, Bristol, UK.
    Steffen, Robert
    Department of Epidemiology and Prevention of Infectious Diseases, WHO Collaborating Centre for Travellers’ Health, University of Zurich, Zurich, Switzerland.
    Stenmark, Bianca
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Laboratory Medicine.
    Taha, Muhamed-Kheir
    Institut Pasteur, National Reference Centre for Meningococci, Paris, France.
    Trotter, Caroline
    Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
    Vazquez, Julio A.
    National Centre of Microbiology, Institute of Health Carlos III, Madrid, Spain.
    Zhu, Bingqing
    National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China.
    The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations2019Inngår i: Expert Review of Vaccines, ISSN 1476-0584, E-ISSN 1744-8395, Vol. 18, nr 1, s. 15-30Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Introduction: The 2018 Global Meningococcal Initiative (GMI) meeting focused on evolving invasive meningococcal disease (IMD) epidemiology, surveillance, and protection strategies worldwide, with emphasis on emerging antibiotic resistance and protection of high-risk populations. The GMI is comprised of a multidisciplinary group of scientists and clinicians representing institutions from several continents.

    Areas covered: Given that the incidence and prevalence of IMD continually varies both geographically and temporally, and surveillance systems differ worldwide, the true burden of IMD remains unknown. Genomic alterations may increase the epidemic potential of meningococcal strains. Vaccination and (to a lesser extent) antimicrobial prophylaxis are the mainstays of IMD prevention. Experiences from across the globe advocate the use of conjugate vaccines, with promising evidence growing for protein vaccines. Multivalent vaccines can broaden protection against IMD. Application of protection strategies to high-risk groups, including individuals with asplenia, complement deficiencies and human immunodeficiency virus, laboratory workers, persons receiving eculizumab, and men who have sex with men, as well as attendees at mass gatherings, may prevent outbreaks. There was, however, evidence that reduced susceptibility to antibiotics was increasing worldwide.

    Expert commentary: The current GMI global recommendations were reinforced, with several other global initiatives underway to support IMD protection and prevention.

  • 19.
    Adams, A.
    et al.
    Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom.
    Kalla, R.
    Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom.
    Vatn, S.
    Institute of Clinical Medicine, EpiGen, University of Oslo, Oslo, Norway.
    Bonfiglio, F.
    BioCruces Health Research Institue, Bilbao, Spain.
    Nimmo, E.
    Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom.
    Kennedy, N.
    Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom.
    Ventham, N.
    Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom.
    Vatn, M.
    Institute of Clinical Medicine, EpiGen, University of Oslo, Oslo, Norway.
    Ricanek, P.
    Department of Gastroenterology, Akershus University, Akershus, Norway.
    Bergemalm, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Söderholm, J.
    Department of Surgery, Linköping University Hospital, Linköping, Sweden;.
    Pierik, M.
    Department of Gastroenterology and Hepatology, Maastricht University Medical Center (MUMC), Maastricht, Netherlands.
    Törkvist, L.
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Gomollon, F.
    University Hospital Clinic Lozano Blesa, Zaragoza, Spain.
    Gut, I.
    CNAG-CRG Centre for Genomic Regulation, Barcelona Institute of Science and Technology, Barcelona, Spain.
    Jahnsen, J.
    Institute of Clinical Medicine, EpiGen, University of Oslo, Oslo, Norway.
    Satsangi, J.
    Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom.
    Epigenetic alterations at diagnosis predict susceptibility, prognosis and treatment escalation in inflammatory bowel disease - IBD Character2017Inngår i: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 11, nr Suppl. 1, s. S108-S108Artikkel i tidsskrift (Fagfellevurdert)
  • 20.
    Adolfsson, Emma
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine.
    Helenius, Gisela
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine.
    Friberg, Örjan
    Department of Cardiothoracic Surgery, Faculty of Health, Örebro University, Örebro, Sweden.
    Samano, Ninos
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiothoracic Surgery.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    Johansson, Karin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Laboratory Medicine.
    Bone marrow- and adipose tissue-derived mesenchymal stem cells from donors with coronary artery disease: growth, yield, gene expression and the effect of oxygen concentration2020Inngår i: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 80, nr 4, s. 318-326Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Mesenchymal stem cells (MSCs) for cardiovascular cell therapy are procured from different sources including bone marrow and adipose tissue. Differently located MSCs differ in growth potential, differentiation ability and gene expression when cultured in vitro, and studies show different healing abilities for different MSC subgroups. In this study, bone marrow derived MSCs (BMSCs) and adipose tissue derived MSCs (ADSCs) from six human donors with coronary artery disease were compared for growth potential and expression of target genes (Angpt1, LIF, HGF, TGF-β1 and VEGF-A) in response to exposure to 1% and 5% O2, for up to 48 h. We found greater growth of ADSCs compared to BMSCs. ADSCs expressed higher levels of Angpt1, LIF and TGF-β1 and equal levels of VEGF-A and HGF as BMSCs. In BMSCs, exposure to low oxygen resulted in upregulation of TGF-β1, whereas other target genes were unaffected. Upregulation was only present at 1% O2. In ADSCs, LIF was upregulated in both oxygen concentrations, whereas Angpt1 was upregulated only at 1% O2. Different response to reduced oxygen culture conditions is of relevance when expanding cells in vitro prior to administration. These findings indicate ADSCs as better suited for cardiovascular cell therapy compared to BMSCs.

  • 21.
    Adolfsson, Emma
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine.
    Jonasson, Jon
    Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Kashyap, Aniruddh
    Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Nordensköld, Anna
    Department of Cardiology, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Green, Anna
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Laboratory Medicine.
    CNV-Z; a new tool for detecting copy number variation in next generation sequencing data2023Inngår i: SoftwareX, E-ISSN 2352-7110, Vol. 24, artikkel-id 101530Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We developed an efficient approach to diagnostic copy number analysis of targeted gene panel or whole exome sequence (WES) data. Here we present CNV-Z as a new tool for detection of copy number variants (CNVs). Deletions and duplications of chromosomal regions are widely implicated in both genomic evolution and genetic disorders. However, calling CNVs from targeted or exome sequence data is challenging. In most cases, the copy number of a chromosomal region is estimated as the depth of reads mapping to a certain bin or sliding window divided by the expected number of reads derived from a set of reference samples. This approach will inevitably miss smaller CNVs on an irregular basis, and quite frequently results in a disturbing number of false positive CNVs. We developed an alternative approach to detect CNVs based on deviation from expected read depth per position, instead of region. Cautiously used, the cohort of samples in the same run will do as a reference. With appropriate filtering, given high quality DNA and a set of suitable reference samples, CNV-Z detects CNVs ranging in length from one nucleotide to an entire chromosome, with few false positives. Performance is proved by benchmarking using both in-house targeted gene panel NGS data and a publicly available NGS dataset, both sets with multiplex ligation-dependent amplification probe (MLPA) validated CNVs. The outcome shows that CNV-Z detects single- and multi-exonic CNVs with high specificity and sensitivity using different kind of NGS data. On gene level, CNV-Z shows both excellent sensitivity and specificity. Compared to competing CNV callers, CNV-Z shows higher specificity and positive predictive value for detecting exonic CNVs.

  • 22.
    Adolfsson, Emma
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine, Örebro University Hospital, Sweden.
    Qvick, Alvida
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine, Örebro University Hospital, Sweden.
    Gréen, Henrik
    Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
    Kling, Daniel
    Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
    Gunnarsson, Cecilia
    Department of Clinical Genetics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Centre for Rare Diseases in South East Region of Sweden, Linköping University, Linköping, Sweden.
    Jonasson, Jon
    Department of Laboratory Medicine, Örebro University Hospital, Sweden; Department of Clinical Genetics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Green, Anna
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Laboratory Medicine, Örebro University Hospital, Sweden.
    Technical in-depth comparison of two massive parallel DNA-sequencing methods for formalin-fixed paraffin-embedded tissue from victims of sudden cardiac death2021Inngår i: Forensic Science International: Genetics, ISSN 1872-4973, E-ISSN 1878-0326, Vol. 53, artikkel-id 102522Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Sudden cardiac death (SCD) is a tragic and traumatic event. SCD is often associated with hereditary genetic disease and in such cases, sequencing of stored formalin fixed paraffin embedded (FFPE) tissue is often crucial in trying to find a causal genetic variant. This study was designed to compare two massive parallel sequencing assays for differences in sensitivity and precision regarding variants related to SCD in FFPE material. From eight cases of SCD where DNA from blood had been sequenced using HaloPlex, corresponding FFPE samples were collected six years later. DNA from FFPE samples were amplified using HaloPlex HS, sequenced on MiSeq, representing the first method, as well as amplified using modified Twist and sequenced on NextSeq, representing the second method. Molecular barcodes were included to distinguish artefacts from true variants. In both approaches, read coverage, uniformity and variant detection were compared using genomic DNA isolated from blood and corresponding FFPE tissue, respectively. In terms of coverage uniformity, Twist performed better than HaloPlex HS for FFPE samples. Despite higher overall coverage, amplicon-based HaloPlex technologies, both for blood and FFPE tissue, suffered from design and/or performance issues resulting in genes lacking complete coverage. Although Twist had considerably lower overall mean coverage, high uniformity resulted in equal or higher fraction of genes covered at ≥ 20X. By comparing variants found in the matched samples in a pre-defined cardiodiagnostic gene panel, HaloPlex HS for FFPE material resulted in high sensitivity, 98.0% (range 96.6-100%), and high precision, 99.9% (range 99.5-100%) for moderately fragmented samples, but suffered from reduced sensitivity (range 74.2-91.1%) in more severely fragmented samples due to lack of coverage. Twist had high sensitivity, 97.8% (range 96.8-98.7%) and high precision, 99.9% (range 99.3-100%) in all analyzed samples, including the severely fragmented samples.

  • 23.
    Adolfsson, Lars
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Orthopedics, Linköping University, Linköping, Sweden.
    What keeps a shoulder stable - Is there an ideal method for anterior stabilisation?2024Inngår i: Shoulder & Elbow, ISSN 1758-5732, Vol. 16, nr 1, s. 4-7Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    The gleno-humeral joint is by far the most mobile in the human body but also afflicted by dislocations, predominantly anterior. Surgical stabilisation is often successful but failures not uncommon. The following review describes potential causes of failure and highlights the need of adapting surgical methods to pathomorphology.

  • 24.
    Adolfsson, Peter
    et al.
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, The Hospital of Halland Kungsbacka, Kungsbacka, Sweden.
    Hanas, Ragnar
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden.
    Zaharieva, Dessi P.
    Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA.
    Dovc, Klemen
    Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, Ljubljana, Slovenia.
    Jendle, Johan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Automated Insulin Delivery Systems in Pediatric Type 1 Diabetes: A Narrative Review2024Inngår i: Journal of Diabetes Science and Technology, E-ISSN 1932-2968, artikkel-id 19322968241248404Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    This narrative review assesses the use of automated insulin delivery (AID) systems in managing persons with type 1 diabetes (PWD) in the pediatric population. It outlines current research, the differences between various AID systems currently on the market and the challenges faced, and discusses potential opportunities for further advancements within this field. Furthermore, the narrative review includes various expert opinions on how different AID systems can be used in the event of challenges with rapidly changing insulin requirements. These include examples, such as during illness with increased or decreased insulin requirements and during physical activity of different intensities or durations. Case descriptions give examples of scenarios with added user-initiated actions depending on the type of AID system used. The authors also discuss how another AID system could have been used in these situations.

  • 25.
    af Edholm, Karolina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lidman, Christer
    Karolinska University Hospital, Solna, Sweden.
    Andersson, Sören
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Solders, Göran
    Karolinska Institutet, Stockholm, Sweden.
    Paucar, Martin
    Karolinska University Hospital, Solna, Sweden.
    Clinical Reasoning: Leg weakness and stiffness at the emergency room2019Inngår i: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 92, nr 6, s. E622-E625Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    A 48-year-old woman from the Maghreb came to the emergency department with insidious gait difficulties, urgency, and constipation starting 6 months prior to the visit. The patient's complaints consisted of weakness, stiffness, and pain in her legs. Her medical history consisted of Hashimoto thyroiditis and breast cancer, with the latter having motivated surgery 4 months prior to admission. Histopathologic examination had demonstrated ductal cancer sensitive to estrogen and mapping with sentinel node biopsy ruled out metastasis. For that reason, the patient was treated with local radiation given weekly over 1 month and treatment with tamoxifen was started. Physical examination upon admission demonstrated weakness and spasticity in both legs. Reflexes were brisk; bilateral nonsustained foot clonus and Babinski sign were also present. Bilateral dorsal flexion was reduced, but vibration and sensation to touch and pinprick were normal. Sphincter tonus was reduced; systemic manifestations such as myalgias, fever, skin rashes, uveitis, sicca, and arthritic joints were absent.

  • 26.
    Affas, Fatin
    et al.
    Karolinska Inst, Solna, Sweden.
    Nygårds, Eva-Britt
    Karolinska Inst, Solna, Sweden.
    Stiller, Carl-Olav
    Karolinska Univ Hosp, Solna, Sweden.
    Wretenberg, Per
    Örebro universitet, Institutionen för medicinska vetenskaper. Karolinska Inst, Solna, Sweden.
    Olofsson, Christina
    Karolinska Inst, Solna, Sweden.
    Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block2011Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 82, nr 4, s. 441-447Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND PURPOSE: Pain after total knee arthroplasty (TKA) is usually severe, and epidural analgesia or femoral nerve block has been considered to be an effective pain treatment. Recently, local infiltration analgesia (LIA) has become increasingly popular but the outcome of this method regarding the analgesic effect has not been fully evaluated. We compared local infiltration analgesia and femoral block with regard to analgesia and morphine demand during the first 24 h after TKA.

    METHODS: 40 patients undergoing TKA under spinal anesthesia were randomized to receive femoral nerve block (group F) or peri- and intraarticular infiltration analgesia (group LIA) with a mixture containing ropivacaine, ketorolac, and epinephrine. All patients had access to intravenous patient-controlled analgesia (PCA) with morphine postoperatively. Pain intensity at rest and upon movement was assessed on a numeric rating scale (0-10) on an hourly basis over 24 h if the patients were awake.

    RESULTS: The average pain at rest was marginally lower with LIA (1.6) than with femoral block (2.2). Total morphine consumption per kg was similar between the 2 groups. Ancillary analysis revealed that 1 of 20 patients in the LIA group reported a pain intensity of > 7 upon movement, as compared to 7 out of 19 in the femoral block group (p = 0.04).

    INTERPRETATION: Both LIA and femoral block provide good analgesia after TKA. LIA may be considered to be superior to femoral block since it is cheaper and easier to perform.

  • 27.
    Afshar, Mastaneh
    et al.
    Department of Biomedicine, Aarhus University, Aarhus, Denmark.
    Poehlein, Anja
    Department of Genomic and Applied Microbiology, Institute of Microbiology and Genetics, University of Göttingen, Göttingen, Germany.
    Söderquist, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Brüggemann, Holger
    Department of Biomedicine, Aarhus University, Aarhus, Denmark.
    Complete Genome Sequences of Two Staphylococcus saccharolyticus Strains Isolated from Prosthetic Joint Infections2021Inngår i: Microbiology Resource Announcements, E-ISSN 2576-098X, Vol. 10, nr 10, artikkel-id e00157-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Staphylococcus saccharolyticus is a human skin bacterium and is occasionally associated with prosthetic joint infections (PJIs). Here, we report the complete genome sequences of two strains that were isolated from shoulder and hip PJIs. The genomes show signs of reductive evolution; around 21% of all coding sequences are inactivated by frameshift mutations.

  • 28.
    Afshari, Mariam
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Oral and Maxillofacial Surgery.
    Hakeberg, Magnus
    Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Public Dental Service, Region Västra Götaland, Sweden.
    Wide, Ulla
    Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Public Dental Service, Region Västra Götaland, Sweden.
    Bazargani, Farhan
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden; Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Cardemil, Carina
    Unit of Cranio- & Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Kashani, Hossein
    Department of Oral & Maxillofacial Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Development of an oral health-related quality of life questionnaire on neurosensory disturbances after orthognathic surgery - a pilot study2022Inngår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 80, nr 8, s. 635-640Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Development of a new questionnaire, Oral Health-Related Quality of Life - Neurosensory Disturbances after Orthognathic Surgery (OHRQL-NDO), designed to measure the effects of neurosensory disturbance (NSD) on patients' oral health-related quality of life (OHRQL) and to evaluate reliability and validity of this questionnaire.

    Materials and methods: A questionnaire including 11 items was constructed. Thirty patients with NSD affecting the lower lip and/or chin following orthognathic surgery were included. Convergent validity was assessed by comparing OHRQL-NDO with OHIP-14 and two global questions. Test-retest reliability was assessed by asking the patients to complete OHRQL-NDO at two different occasions with an interval of two to three weeks.

    Results: The internal consistency, measured with Cronbach's alpha, was 0.84. The test-retest reliability, measured with ICC, was 0.89 (95% CI 0.77-0.95). The correlation between the mean sum score for the OHRQL-NDO and the mean sum score for the OHIP-14 was r = 0.75, using Pearson correlation coefficient. The correlations between the mean total score for the OHRQL-NDO and the global questions 1 and 2 were r = 0.74 and r = 0.72, respectively.

    Conclusions: The current instrument OHRQL-NDO is a promising test, but needs further development to better capture the different aspects of OHRQL. Further tests of the questionnaire must follow in other samples to finalize the instrument.

  • 29.
    Agardh, Carl-David
    et al.
    Lund University, Lund, Sweden.
    Ahrén, Bo
    Lund University, Lund, Sweden.
    Hanås, Ragnar
    Jansson, Stefan
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Uppsala University, Uppsala, Sweden.
    Smith, Ulf
    Gothenburg University, Gothenburg, Sweden.
    Toft, Eva
    Karolinska Institutet, Stockholm, Sweden.
    Östenson, Claes-Göran
    Karolinska Institutet, Stockholm, Sweden.
    Varning för okritisk användning av överviktskirurgi vid typ 2-diabetes2012Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, nr 25, s. 1208-1209Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Överviktskirurgi diskuteras nu som ett behandlingsalternativ även för patienter med typ 2-diabetes där BMI inte överstiger nuvarande indikationsgräns 35 kg/m2. Artikelförfattarna vill varna för en sådan utveckling i avvaktan på kritisk värdering av denna typ av kirurgi.

  • 30.
    Agrawal, M.
    et al.
    The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA.
    Shrestha, Sarita
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Corn, G.
    Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark.
    Nielsen, N. M.
    Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark.
    Frisch, M.
    Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark.
    Colombel, J. F.
    The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA.
    Jess, T.
    Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark.
    The epidemiology of inflammatory bowel diseases among immigrants to Denmark: A population-based cohort study2020Inngår i: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 14, nr Suppl. 1, s. S006-S007Artikkel i tidsskrift (Annet vitenskapelig)
  • 31.
    Agrawal, Manasi
    et al.
    The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
    Corn, Giulia
    Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark.
    Shrestha, Sarita
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Nielsen, Nete Munk
    Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark.
    Frisch, Morten
    Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark.
    Colombel, Jean-Frederic
    The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
    Jess, Tine
    Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark.
    Inflammatory bowel diseases among first-generation and second-generation immigrants in Denmark: a population-based cohort study2021Inngår i: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 70, nr 6, s. 1037-1043Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Our objective was to estimate the relative risk of IBD among first-generation and second-generation immigrants in Denmark compared with native Danes.

    DESIGN: Using national registries, we established a cohort of Danish residents between 1977 and 2018. Cohort members with known country of birth were followed for Crohn's disease (CD) and ulcerative colitis (UC) diagnoses. Incidence rate ratios (IRRs) served as measures of relative risk and were calculated by log-linear Poisson regression, using rates among native Danes as reference, stratified by IBD risk in parental country of birth, and among first-generation immigrants by age at immigration and duration of stay in Denmark.

    RESULTS: Among 8.7 million Danes, 4156 first-generation and 898 second-generation immigrants were diagnosed with CD or UC. Overall, comparing first-generation immigrants with native Danes, the IRR was 0.80 (95% CI 0.76 to 0.84) for CD and 0.74 (95% CI 0.71 to 0.77) for UC. The IRR of IBD increased with ≥20 years stay in Denmark. The IRR of CD increased with immigration at ≥40 years of age. Comparing second-generation immigrants with native Danes, the IRR of IBD was 0.97 (95% CI 0.91 to 1.04). There was significant interaction with sex, with higher IRR of IBD in male than in female immigrants.

    CONCLUSION: Relative to native Danish men and women, IBD risk among first-generation immigrants was lower, reflected the risk in their parental country of birth and increased with ≥20 years stay in Denmark. For second-generation immigrants, relative risk of IBD was lower only among women. These complex patterns suggest the role of environmental IBD risk factors.

  • 32.
    Aguirre, Isabelle
    Örebro universitet, Institutionen för medicinska vetenskaper.
    PROVTAGNING FÖR SARS-COV-2 I REGION ÖREBRO LÄN: – BETYDELSE AV TILLGÅNG OCH ÅLDER2022Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
  • 33.
    Ah, Rebecka
    et al.
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    BChir, M. B.
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Geijer, Håkan
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Taha, Kardo
    Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Pourhossein-Sarmeh, Sahar
    Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Talving, Peep
    Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, Tallinn, Estonia; Department of Surgery, University of Tartu, Estonia.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery.
    Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients2019Inngår i: Bulletin of emergency and trauma, ISSN 2322-2522, Vol. 7, nr 3, s. 223-231Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy.

    Methods: All geriatric patients (≥65 years) undergoing emergency laparotomy at a single university hospital between 1/2015 and 12/2016 were included in this cohort study. Demographics and outcomes were retrospectively collected from medical records. Association between prognostic markers and 30-day mortality was assessed using Poisson and backward stepwise regression models. Prognostic value was assessed using receiver operating characteristic (ROC) curves.

    Results: =0.004) while osteopenia was not. P-POSSUM had poor prognostic value for 30-day mortality with an area under the ROC curve (AUC) of 0.59. The prognostic value of P-POSSUM improved significantly when adjusting for patient covariates (AUC=0.83).

    Conclusion: P-POSSUM and osteopenia alone hardly predict 30-day mortality in geriatric patients following emergency laparotomy. P-POSSUM adjusted for other patient covariates improves the prediction.

  • 34.
    Ahl, Rebecka
    Örebro universitet, Institutionen för medicinska vetenskaper.
    The Association Between Beta-Blockade and Clinical Outcomes in the Context of Surgical and Traumatic Stress2019Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Traumatic injury and major abdominal surgery are areas in general surgery associated with high rates of morbidity and mortality. The overall colorectal cancer surgery mortality rate is around 4%, with that for emergency surgery more than twice as high as for planned. Surgical morbidity varies between 25% and 45%. Around half of trauma patients develop low mood. In one quarter of patients this becomes permanent. Depression is known to impede physical rehabilitation and recovery. The onset of physiological stress, driven by adrenergic hyperactivity following traumatic and surgical injury is hypothesized to contribute to these adverse outcomes. Interest has therefore been sparked into blocking adrenergic receptor activation.

    Papers I and II investigated the role of beta-blocker therapy in preventing post-traumatic depression following severe traumatic brain injury (Paper I) and severe extracranial injury (Paper II). The Karolinska University Hospital Trauma Registry was used to identify patients admitted between 2007 and 2011. In Paper I (n = 545), patients on pre-injury beta-blocker therapy were matched to beta-blocker naïve patients with equivalent injury burden. Results revealed that beta-blocked patients exhibited a 60% reduced risk of needing antidepressant therapy within one year of trauma. In Paper II (n = 596), the lack of beta-blocker use before extracranial trauma was linked to a three-fold increase in the risk of antidepressant initiation.

    Papers III-V explored the role of pre-operative beta-blocker therapy in patients undergoing surgery for colorectal cancer between 2007 and 2016, identified using the nationwide Swedish Colorectal Cancer Registry. Paper III (n = 3,187) identified a 69% reduction in the risk of 30-day mortality in beta-blocked patients. Paper IV (n = 22,337) outlined long-term survival benefits for patients on beta-blocker therapy prior to undergoing elective surgery for colon cancer. Beta-blocked patients showed a risk reduction of 42% for 1-year all-cause mortality and 18% for 5-year cancerspecific mortality. Similarly, patients on beta-blocker therapy who underwent surgery for rectal cancer demonstrated improved survival up to one year after surgery with a risk reduction of 57% and a reduction in anastomotic failure and infectious complications in Paper V (n = 11,966).

    Delarbeid
    1. Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?
    Åpne denne publikasjonen i ny fane eller vindu >>Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?
    2017 (engelsk)Inngår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, nr 1, s. 101-105Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Introduction: Depressive symptoms occur in approximately half of trauma patients, negatively impacting on functional outcome and quality of life following severe head injury. Pontine noradrenaline has been shown to increase upon trauma and associated beta-adrenergic receptor activation appears to consolidate memory formation of traumatic events. Blocking adrenergic activity reduces physiological stress responses during recall of traumatic memories and impairs memory, implying a potential therapeutic role of beta-blockers. This study examines the effect of pre-admission beta-blockade on post-traumatic depression.

    Methods: All adult trauma patients (>= 18 years) with severe, isolated traumatic brain injury (intracranial Abbreviated Injury Scale score (AIS) >= 3 and extracranial AIS <3) were recruited from the trauma registry of an urban university hospital between 2007 and 2011. Exclusion criteria were in-hospital deaths and prescription of antidepressants up to one year prior to admission. Pre- and post-admission beta-blocker and antidepressant therapy data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. Patients with and without pre-admission beta-blockers were matched 1: 1 by age, gender, Glasgow Coma Scale, Injury Severity Score and head AIS. Analysis was carried out using McNemar's and Student's t-test for categorical and continuous data, respectively.

    Results: A total of 545 patients met the study criteria. Of these, 15% (n = 80) were prescribed beta-blockers. After propensity matching, 80 matched pairs were analyzed. 33% (n = 26) of non beta-blocked patients developed post-traumatic depression, compared to only 18% (n = 14) in the beta-blocked group (p = 0.04). There were no significant differences in ICU (mean days: 5.8 (SD 10.5) vs. 5.6 (SD 7.2), p = 0.85) or hospital length of stay (mean days: 21 (SD 21) vs. 21 (SD 20), p = 0.94) between cohorts.

    Conclusion: beta-blockade appears to act prophylactically and significantly reduces the risk of posttraumatic depression in patients suffering from isolated severe traumatic brain injuries. Further prospective randomized studies are warranted to validate this finding.

    sted, utgiver, år, opplag, sider
    Elsevier, 2017
    Emneord
    Traumatic brain injury, Beta-blockade, Depression
    HSV kategori
    Identifikatorer
    urn:nbn:se:oru:diva-54816 (URN)10.1016/j.injury.2016.10.041 (DOI)000390544600018 ()2-s2.0-85005893752 (Scopus ID)
    Tilgjengelig fra: 2017-01-19 Laget: 2017-01-19 Sist oppdatert: 2024-03-06bibliografisk kontrollert
    2. Corrigendum to "Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?": [Injury 48 (2017) 101–105]
    Åpne denne publikasjonen i ny fane eller vindu >>Corrigendum to "Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?": [Injury 48 (2017) 101–105]
    2017 (engelsk)Inngår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, nr 11, s. 2612-2612Artikkel i tidsskrift (Fagfellevurdert) Published
    sted, utgiver, år, opplag, sider
    Elsevier, 2017
    HSV kategori
    Identifikatorer
    urn:nbn:se:oru:diva-62779 (URN)10.1016/j.injury.2017.09.017 (DOI)000414228200042 ()28965685 (PubMedID)2-s2.0-85030663249 (Scopus ID)
    Tilgjengelig fra: 2017-11-24 Laget: 2017-11-24 Sist oppdatert: 2024-03-06bibliografisk kontrollert
    3. Does beta-blockade reduce the risk of depression in patients with isolated severe extracranial injuries?
    Åpne denne publikasjonen i ny fane eller vindu >>Does beta-blockade reduce the risk of depression in patients with isolated severe extracranial injuries?
    Vise andre…
    2017 (engelsk)Inngår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 41, nr 7, s. 1801-1806Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    BACKGROUND: Approximately half of trauma patients develop post-traumatic depression. It is suggested that beta-blockade impairs trauma memory recollection, reducing depressive symptoms. This study investigates the effect of early beta-blockade on depression following severe traumatic injuries in patients without significant brain injury.

    METHODS: Patients were identified by retrospectively reviewing the trauma registry at an urban university hospital between 2007 and 2011. Severe extracranial injuries were defined as extracranial injuries with Abbreviated Injury Scale score ≥3, intracranial Abbreviated Injury Scale score <3 and an Injury Severity Score ≥16. In-hospital deaths and patients prescribed antidepressant therapy ≤1 year prior to admission were excluded. Patients were stratified into groups based on pre-admission beta-blocker status. The primary outcome was post-traumatic depression, defined as receiving antidepressants ≤1 year following trauma.

    RESULTS: Five hundred and ninety-six patients met the inclusion criteria with 11.4% prescribed pre-admission beta-blockade. Patients receiving beta-blockers were significantly older (57 ± 18 vs. 42 ± 17 years, p < 0.001) with lower Glasgow Coma Scale score (12 ± 3 vs. 14 ± 2, p < 0.001). The beta-blocked cohort spent significantly longer in hospital (21 ± 20 vs. 15 ± 17 days, p < 0.01) and intensive care (4 ± 7 vs. 3 ± 5 days, p = 0.01). A forward logistic regression model was applied and predicted lack of beta-blockade to be associated with increased risk of depression (OR 2.7, 95% CI 1.1-7.2, p = 0.04). After adjusting for group differences, patients lacking beta-blockers demonstrated an increased risk of depression (AOR 3.3, 95% CI 1.2-8.6, p = 0.02).

    CONCLUSIONS: Pre-admission beta-blockade is associated with a significantly reduced risk of depression following severe traumatic injury. Further investigation is needed to determine the beneficial effects of beta-blockade in these instances.

    sted, utgiver, år, opplag, sider
    New York: Springer, 2017
    HSV kategori
    Forskningsprogram
    Kirurgi
    Identifikatorer
    urn:nbn:se:oru:diva-57385 (URN)10.1007/s00268-017-3935-5 (DOI)000403056400020 ()28265730 (PubMedID)2-s2.0-85014574094 (Scopus ID)
    Tilgjengelig fra: 2017-05-08 Laget: 2017-05-08 Sist oppdatert: 2024-03-06bibliografisk kontrollert
    4. Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery
    Åpne denne publikasjonen i ny fane eller vindu >>Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery
    Vise andre…
    2019 (engelsk)Inngår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, nr 4, s. 477-483Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    BACKGROUND: Emergency colorectal cancer surgery is associated with significant mortality. Induced adrenergic hyperactivity is thought to be an important contributor. Downregulating the effects of circulating catecholamines may reduce the risk of adverse outcomes. This study assessed whether regular preoperative beta-blockade reduced mortality after emergency colonic cancer surgery.

    METHODS: This cohort study used the prospectively collected Swedish Colorectal Cancer Registry to recruit all adult patients requiring emergency colonic cancer surgery between 2011 and 2016. Patients were subdivided into those receiving regular beta-blocker therapy before surgery and those who were not (control). Demographics and clinical outcomes were compared. Risk factors for 30-day mortality were evaluated using Poisson regression analysis.

    RESULTS: A total of 3187 patients were included, of whom 685 (21·5 per cent) used regular beta-blocker therapy before surgery. The overall 30-day mortality rate was significantly reduced in the beta-blocker group compared with controls: 3·1 (95 per cent c.i. 1·9 to 4·7) versus 8·6 (7·6 to 9·8) per cent respectively (P < 0·001). Beta-blocker therapy was the only modifiable protective factor identified in multivariable analysis of 30-day all-cause mortality (incidence rate ratio 0·31, 95 per cent c.i. 0·20 to 0·47; P < 0·001) and was associated with a significant reduction in death of cardiovascular, respiratory, sepsis and multiple organ failure origin.

    CONCLUSION: Preoperative beta-blocker therapy may be associated with a reduction in 30-day mortality following emergency colonic cancer surgery.

    sted, utgiver, år, opplag, sider
    John Wiley & Sons, 2019
    HSV kategori
    Identifikatorer
    urn:nbn:se:oru:diva-69119 (URN)10.1002/bjs.10988 (DOI)000459801800023 ()30259967 (PubMedID)2-s2.0-85053878738 (Scopus ID)
    Konferanse
    The Sixth Enhanced Recovery After Surgery World Congress, Stockholm, Sweden, May 2018.
    Merknad

    Published in abstract form as Clin Nutr 2018; 25 : 168. (DOI: 10.1016/j.clnesp.2018.03.009)

    The study was registered on 7 July 2017 with the Open Database for Research in Sweden. It was funded by the Örebro University Research Committee.

    Tilgjengelig fra: 2018-10-01 Laget: 2018-10-01 Sist oppdatert: 2024-03-06bibliografisk kontrollert
    5. The Effects of Beta-Blocker Therapy on Mortality After Elective Colon Cancer Surgery
    Åpne denne publikasjonen i ny fane eller vindu >>The Effects of Beta-Blocker Therapy on Mortality After Elective Colon Cancer Surgery
    Vise andre…
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    HSV kategori
    Identifikatorer
    urn:nbn:se:oru:diva-74247 (URN)
    Tilgjengelig fra: 2019-05-13 Laget: 2019-05-13 Sist oppdatert: 2024-03-06bibliografisk kontrollert
    6. β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes
    Åpne denne publikasjonen i ny fane eller vindu >>β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes
    Vise andre…
    2020 (engelsk)Inngår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, nr 1, s. 140-146Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    OBJECTIVE: To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.

    BACKGROUND: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking.

    METHODS: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model.

    RESULTS: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37-0.52, P < 0.001).

    CONCLUSIONS: Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.

    sted, utgiver, år, opplag, sider
    Lippincott Williams & Wilkins, 2020
    Emneord
    beta-blocker, mortality, rectal cancer, surgery
    HSV kategori
    Identifikatorer
    urn:nbn:se:oru:diva-74248 (URN)10.1097/SLA.0000000000002970 (DOI)000525016300026 ()30048321 (PubMedID)2-s2.0-85077036188 (Scopus ID)
    Tilgjengelig fra: 2019-05-13 Laget: 2019-05-13 Sist oppdatert: 2024-03-06bibliografisk kontrollert
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  • 35.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Barmparas, Galinos
    Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Ley, Eric J.
    Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA.
    Wallin, Göran
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Does beta-blockade reduce the risk of depression in patients with isolated severe extracranial injuries?2017Inngår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 41, nr 7, s. 1801-1806Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Approximately half of trauma patients develop post-traumatic depression. It is suggested that beta-blockade impairs trauma memory recollection, reducing depressive symptoms. This study investigates the effect of early beta-blockade on depression following severe traumatic injuries in patients without significant brain injury.

    METHODS: Patients were identified by retrospectively reviewing the trauma registry at an urban university hospital between 2007 and 2011. Severe extracranial injuries were defined as extracranial injuries with Abbreviated Injury Scale score ≥3, intracranial Abbreviated Injury Scale score <3 and an Injury Severity Score ≥16. In-hospital deaths and patients prescribed antidepressant therapy ≤1 year prior to admission were excluded. Patients were stratified into groups based on pre-admission beta-blocker status. The primary outcome was post-traumatic depression, defined as receiving antidepressants ≤1 year following trauma.

    RESULTS: Five hundred and ninety-six patients met the inclusion criteria with 11.4% prescribed pre-admission beta-blockade. Patients receiving beta-blockers were significantly older (57 ± 18 vs. 42 ± 17 years, p < 0.001) with lower Glasgow Coma Scale score (12 ± 3 vs. 14 ± 2, p < 0.001). The beta-blocked cohort spent significantly longer in hospital (21 ± 20 vs. 15 ± 17 days, p < 0.01) and intensive care (4 ± 7 vs. 3 ± 5 days, p = 0.01). A forward logistic regression model was applied and predicted lack of beta-blockade to be associated with increased risk of depression (OR 2.7, 95% CI 1.1-7.2, p = 0.04). After adjusting for group differences, patients lacking beta-blockers demonstrated an increased risk of depression (AOR 3.3, 95% CI 1.2-8.6, p = 0.02).

    CONCLUSIONS: Pre-admission beta-blockade is associated with a significantly reduced risk of depression following severe traumatic injury. Further investigation is needed to determine the beneficial effects of beta-blockade in these instances.

  • 36.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Sweden Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Forssten, Maximilian Peter
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Pourlotfi, Arvid
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Bass, Gary Alan
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Medicine, Penn Presbyterian Medical Center, Philadelphia, PA, USA.
    Matthiessen, Peter
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Colorectal Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Sweden.
    The Association Between Revised Cardiac Risk Index and Postoperative Mortality Following Elective Colon Cancer Surgery: A Retrospective Nationwide Cohort Study2021Inngår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 111, nr 1, artikkel-id 14574969211037588Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Despite improvements in the perioperative care during the last decades for oncologic colon resection, there is still a substantial risk for postoperative complications and mortality. Opportunities exist for improvement in preoperative risk stratification in this patient population. We hypothesize that the Revised Cardiac Risk Index, a user-friendly tool, could better identify patients with high postoperative mortality risks.

    METHODS: A retrospective analysis of operated patients between the years 2007 and 2017 was undertaken, using the prospectively recorded Swedish Colorectal Cancer Registry, which has a 99.5% national coverage for all cases of colon cancer. Patients were cross-referenced with the Swedish National Board of Health and Welfare dataset, a government registry of mortality and comorbidity data. Revised Cardiac Risk Index (RCRI) scores were calculated for each patient and stratified into four groups (RCRI 1, 2, 3, ⩾ 4). A Poisson regression model with robust standard errors of variance was employed to correlate the 90-day postoperative survival with each level of the Revised Cardiac Risk Index.

    RESULTS: A total of 24,198 patients met the study inclusion criteria. 90-day postoperative mortality increased from 2.4% in patients with RCRI 1 to 10.1% in patients with RCRI ⩾ 4 (p < 0.001). Adjusted 90-day postoperative mortality increased linearly with an increasing RCRI, where an RCRI of 2, 3, and ≥ 4 respectively led to a 46%, 80%, and 167% increased risk of mortality compared to RCRI 1 (p < 0.001).

    CONCLUSIONS: A strong association between an increasing Revised Cardiac Risk Index score and increased 90-day postoperative mortality risk was detected. The Revised Cardiac Risk Index may facilitate risk stratification of patients undergoing elective colon cancer surgery.

  • 37.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Lindgren, Rickard
    Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Solna, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Örebro, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Risk factors for depression following traumatic injury: An epidemiological study from a scandinavian trauma center2017Inngår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, nr 5, s. 1082-1087Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: A significant proportion of patients suffer depression following traumatic injuries. Once manifested, major depression is challenging to overcome and its presence risks impairing the potential for physical rehabilitation and functional recovery. Risk stratification for early detection and intervention in these instances is important. This study aims to investigate patient and injury characteristics associated with an increased risk for depression.

    METHODS: All patients with traumatic injuries were recruited from the trauma registry of an urban university hospital between 2007 and 2012. Patient and injury characteristics as well as outcomes were collected for analysis. Patients under the age of eighteen, prescribed antidepressants within one year of admission, in-hospital deaths and deaths within 30days of trauma were excluded. Pre- and post-admission antidepressant data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. To isolate independent risk factors for depression a multivariable forward stepwise logistic regression model was deployed.

    RESULTS: A total of 5981 patients met the inclusion criteria of whom 9.2% (n=551) developed post-traumatic depression. The mean age of the cohort was 42 [standard deviation (SD) 18] years and 27.1% (n=1620) were females. The mean injury severity score was 9 (SD 9) with 18.4% (n=1100) of the patients assigned a score of at least 16. Six variables were identified as independent predictors for post-traumatic depression. Factors relating to the patient were female gender and age. Injury-specific variables were penetrating trauma and GCS score of≤8 on admission. Furthermore, intensive care admission and increasing hospital length of stay were predictors of depression.

    CONCLUSION: Several risk factors associated with the development of post-traumatic depression were identified. A better targeted in-hospital screening and patient-centered follow up can be offered taking these risk factors into consideration.

  • 38.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden.
    Matthiessen, P.
    School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Fang, X.
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; .
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery.
    Lindgren, R.
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery2019Inngår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, nr 4, s. 477-483Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Emergency colorectal cancer surgery is associated with significant mortality. Induced adrenergic hyperactivity is thought to be an important contributor. Downregulating the effects of circulating catecholamines may reduce the risk of adverse outcomes. This study assessed whether regular preoperative beta-blockade reduced mortality after emergency colonic cancer surgery.

    METHODS: This cohort study used the prospectively collected Swedish Colorectal Cancer Registry to recruit all adult patients requiring emergency colonic cancer surgery between 2011 and 2016. Patients were subdivided into those receiving regular beta-blocker therapy before surgery and those who were not (control). Demographics and clinical outcomes were compared. Risk factors for 30-day mortality were evaluated using Poisson regression analysis.

    RESULTS: A total of 3187 patients were included, of whom 685 (21·5 per cent) used regular beta-blocker therapy before surgery. The overall 30-day mortality rate was significantly reduced in the beta-blocker group compared with controls: 3·1 (95 per cent c.i. 1·9 to 4·7) versus 8·6 (7·6 to 9·8) per cent respectively (P < 0·001). Beta-blocker therapy was the only modifiable protective factor identified in multivariable analysis of 30-day all-cause mortality (incidence rate ratio 0·31, 95 per cent c.i. 0·20 to 0·47; P < 0·001) and was associated with a significant reduction in death of cardiovascular, respiratory, sepsis and multiple organ failure origin.

    CONCLUSION: Preoperative beta-blocker therapy may be associated with a reduction in 30-day mortality following emergency colonic cancer surgery.

  • 39.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Matthiessen, Peter
    School of Medical Sciences, Örebro University, Örebro, Sweden; Division of Colorectal Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    The Relationship Between Severe Complications, Beta-Blocker Therapy and Long-Term Survival Following Emergency Surgery for Colon Cancer2019Inngår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, nr 10, s. 2527-2535Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Emergency surgery for colon cancer carries significant morbidity, and studies show more than doubled mortality when comparing elective to emergency surgery. The relationship between postoperative complications and survival has been outlined. Beta-blocker therapy has been linked to improved postoperative outcomes. This study aims to assess the impact of postoperative complications on long-term survival following emergency surgery for colon cancer and to determine whether beta-blockade can reduce complications.

    STUDY DESIGN: This cohort study utilized the prospective Swedish Colorectal Cancer Registry to identify adults undergoing emergency colon cancer surgery between 2011 and 2016. Prescription data for preoperative beta-blocker therapy were collected from the national drug registry. Cox regression was used to evaluate the effect of beta-blocker exposure and complications on 1-year mortality, and Poisson regression was used to evaluate beta-blocker exposure in patients with major complications.

    RESULTS: A total of 3139 patients were included with a mean age of 73.1 [12.4] of which 671 (21.4%) were prescribed beta-blockers prior to surgery. Major complications occurred in 375 (11.9%) patients. Those suffering major complications showed a threefold increase in 1-year mortality (adjusted HR = 3.29; 95% CI 2.75-3.94; p < 0.001). Beta-blocker use was linked to a 60% risk reduction in 1-year mortality (adjusted HR = 0.40; 95% CI 0.26-0.62; p < 0.001) but did not show a statistically significant association with reductions in major complications (adjusted IRR = 0.77; 95% CI 0.59-1.00; p = 0.055).

    CONCLUSION: The development of major complications after emergency colon cancer surgery is associated with increased mortality during one year after surgery. Beta-blocker therapy may protect against postoperative complications.

  • 40.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Matthiessen, Peter
    School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Fang, Xin
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Lindgren, Rickard
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes2020Inngår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, nr 1, s. 140-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.

    BACKGROUND: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking.

    METHODS: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model.

    RESULTS: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37-0.52, P < 0.001).

    CONCLUSIONS: Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.

  • 41.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Matthiessen, Peter
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Wallin, Göran
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Effects of beta-blocker therapy on mortality after elective colon cancer surgery: a Swedish nationwide cohort study2020Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 10, nr 7, artikkel-id e036164Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Colon cancer surgery remains associated with substantial postoperative morbidity and mortality despite advances in surgical techniques and care. The trauma of surgery triggers adrenergic hyperactivation which drives adverse stress responses. We hypothesised that outcome benefits are gained by reducing the effects of hyperadrenergic activity with beta-blocker therapy in patients undergoing colon cancer surgery. This study aims to test this hypothesis.

    DESIGN: Retrospective cohort study.

    SETTING AND PARTICIPANTS: This is a nationwide study which includes all adult patients undergoing elective colon cancer surgery in Sweden over 10 years. Patient data were collected from the Swedish Colorectal Cancer Registry. The national drugs registry was used to obtain information about beta-blocker use. Patients were subdivided into exposed and unexposed groups. The association between beta-blockade, short-term and long-term mortality was evaluated using Poisson regression, Kaplan-Meier curves and Cox regression.

    PRIMARY AND SECONDARY OUTCOMES: Primary outcome of interest was 1-year all-cause mortality. Secondary outcomes included 90-day all-cause and 5-year cancer-specific mortality.

    RESULTS: The study included 22 337 patients of whom 36.1% were prescribed preoperative beta-blockers. Survival was higher in patients on beta-blockers up to 1 year after surgery despite this group being significantly older and of higher comorbidity. Regression analysis demonstrated significant reductions in 90-day deaths (IRR 0.29, 95% CI 0.24 to 0.35, p<0.001) and a 43% risk reduction in 1-year all-cause mortality (adjusted HR 0.57, 95% CI 0.52 to 0.63, p<0.001) in beta-blocked patients. In addition, cancer-specific mortality up to 5 years after surgery was reduced in beta-blocked patients (adjusted HR 0.80, 95% CI 0.73 to 0.88, p<0.001).

    CONCLUSION: Preoperative beta-blockade is associated with significant reductions in postoperative short-term and long-term mortality following elective colon cancer surgery. Its potential prophylactic effect warrants further interventional studies to determine whether beta-blockade can be used as a way of improving outcomes for this patient group.

  • 42.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Matthiessen, Peter
    School of Medical Science, Örebro University, Örebro, sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Wallin, Göran
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    The Effects of Beta-Blocker Therapy on Mortality After Elective Colon Cancer SurgeryManuskript (preprint) (Annet vitenskapelig)
  • 43.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Mohammad Ismail, Ahmad
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Borg, Tomas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Forssten, Maximilian Peter
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Wretenberg, Per
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery2022Inngår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 48, nr 2, s. 743-751Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery.

    METHODS: This is a retrospective nationwide observational cohort study. All adults [Formula: see text] 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality.

    RESULTS: 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26-0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure.

    CONCLUSIONS: Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

  • 44.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Phelan, Herb A
    Univ of Texas Southwestern Medical Center, Parkland Memorial Hospital, Dallas, USA.
    Dogan, Sinan
    Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Cook, Allyson C.
    UT-Southwestern Medical Center. Parkland Memorial Hospital, Dallas, USA.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden; Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Predicting In-Hospital and 1-Year Mortality in Geriatric Trauma Patients Using Geriatric Trauma Outcome Score2017Inngår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 224, nr 3, s. 264-269Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The Geriatric Trauma Outcome Score, GTOS (= [age] + [Injury Severity Score (ISS)x2.5] + 22 [if packed red blood cells (PRBC) transfused ≤24hrs of admission]), was developed and validated as a prognostic indicator for in-hospital mortality in elderly trauma patients. However, GTOS neither provides information regarding post-discharge outcomes, nor discriminates between patients dying with and without care restrictions. Isolating the latter, GTOS prediction performance was examined during admission and 1-year post-discharge in a mature European trauma registry.

    Study Design: All trauma admissions ≥65years in a university hospital during 2007-2011 were considered. Data regarding age, ISS, PRBC transfusion ≤24hrs, therapy restrictions, discharge disposition and mortality were collected. In-hospital deaths with therapy restrictions and patients discharged to hospice were excluded. GTOS was the sole predictor in a logistic regression model estimating mortality probabilities. Performance of the model was assessed by misclassification rate, Brier score and area under the curve (AUC).

    Results: The study population was 1080 subjects with a median age of 75 years, mean ISS of 10 and PRBC transfused in 8.2%). In-hospital mortality was 14.9% and 7.7% after exclusions. Misclassification rate fell from 14% to 6.5%, Brier score from 0.09 to 0.05. AUC increased from 0.87 to 0.88. Equivalent values for the original GTOS sample were 9.8%, 0.07, and 0.87. One-year mortality follow-up showed a misclassification rate of 17.6%, and Brier score of 0.13.

    Conclusion: Excluding patients with care restrictions and discharged to hospice improved GTOS performance for in-hospital mortality prediction. GTOS is not adept at predicting 1-year mortality.

  • 45.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Division of Trauma and Acute Care Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Riddez, Louis
    Department of Surgery, Division of Trauma and Acute Care Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Mohseni, Shahin
    Department of Surgery, Division of Trauma and Acute Care Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Surgery, Division of Trauma and Acute Care Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Digital rectal examination for initial assessment of the multi-injured patient: Can we depend on it?2016Inngår i: Annals of Medicine and Surgery, E-ISSN 2049-0801, Vol. 9, s. 77-81Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Digital rectal examination (DRE) is part of the assessment of trauma patients as recommended by ATLS (R). The theory behind is to aid early diagnosis of potential lower intestinal, urethral and spinal cord injuries. Previous studies suggest that test characteristics of DRE are far from reliable. This study examines the correlation between DRE findings and diagnosis and whether DRE findings affect subsequent management.

    Materials and methods: Patients with ICD-10 codes for spinal cord, urethral and lower intestinal injuries were identified from the trauma registry at an urban university hospital between 2007 and 2011. A retrospective review of electronic medical records was carried out to analyse DRE findings and subsequent management.

    Results: 253 patients met the inclusion criteria with a mean age of 44 +/- 20 years and mean ISS of 26 +/- 16. 160 patients had detailed DRE documentation with abnormal findings in 48%. Sensitivity rate was 0.47. Correlational analysis between examination findings and diagnosis gave a kappa of 0.12. Subsequent management was not altered in any case due to DRE findings.

    Conclusion: DRE in trauma settings has low sensitivity and does not change subsequent management. Excluding or postponing this examination should therefore be considered. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  • 46.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Sarani, Babak
    Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, USA.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    The Association of Intracranial Pressure Monitoring and Mortality: A Propensity Score-Matched Cohort of Isolated Severe Blunt Traumatic Brain Injury2019Inngår i: Journal of Emergencies, Trauma and Shock, ISSN 0974-2700, E-ISSN 0974-519X, Vol. 12, nr 1, s. 18-22Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Intracranial pressure (ICP) monitoring in traumatic brain injury (TBI) is common. Yet, its efficacy varies between studies, and the actual effect on the outcome is debated. This study investigates the association of ICP monitoring and clinical outcome in patients with an isolated severe blunt TBI.

    Patients and Methods: Patients were recruited from the American College of Surgeons-Trauma Quality Improvement Program database during 2014. Inclusion criteria were limited to adult patients (>= 18 years) who had a sustained isolated severe intracranial injury (Abbreviated Injury Scale [AIS] head of >= 3 and Glasgow Coma Scale [GCS] of <= 8) following blunt trauma to the head. Patients with AIS score >0 for any extracranial body area were excluded. Patients' demographics, injury characteristics, interventions, and outcomes were collected for analysis. Patients receiving ICP monitoring were matched in a 1:1 ratio with controls who were not ICP monitored using propensity score matching.

    Results: A total of 3289 patients met inclusion criteria. Of these, 601 (18.3%) were ICP monitored. After propensity score matching, 557 pairs were available for analysis with a mean age of 44 (standard deviation 18) years and 80.2% of them were male. Median GCS on admission was 4[3,7], and a third of patients required neurosurgical intervention. There were no statistical differences in any variables included in the analysis between the ICP-monitored group and their matched counterparts. ICP-monitored patients required significantly longer intensive care unit and hospital length of stay and had an increased mortality risk with odds ratio of 1.6 (95% confidence interval: 1.1-2.5, P = 0.038).

    Conclusion: ICP monitoring is associated with increased in-hospital mortality in patients with an isolated severe TBI. Further investigation into which patients may benefit from this intervention is required.

  • 47.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
    Corrigendum to "Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?": [Injury 48 (2017) 101–105]2017Inngår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, nr 11, s. 2612-2612Artikkel i tidsskrift (Fagfellevurdert)
  • 48.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?2017Inngår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, nr 1, s. 101-105Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Depressive symptoms occur in approximately half of trauma patients, negatively impacting on functional outcome and quality of life following severe head injury. Pontine noradrenaline has been shown to increase upon trauma and associated beta-adrenergic receptor activation appears to consolidate memory formation of traumatic events. Blocking adrenergic activity reduces physiological stress responses during recall of traumatic memories and impairs memory, implying a potential therapeutic role of beta-blockers. This study examines the effect of pre-admission beta-blockade on post-traumatic depression.

    Methods: All adult trauma patients (>= 18 years) with severe, isolated traumatic brain injury (intracranial Abbreviated Injury Scale score (AIS) >= 3 and extracranial AIS <3) were recruited from the trauma registry of an urban university hospital between 2007 and 2011. Exclusion criteria were in-hospital deaths and prescription of antidepressants up to one year prior to admission. Pre- and post-admission beta-blocker and antidepressant therapy data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. Patients with and without pre-admission beta-blockers were matched 1: 1 by age, gender, Glasgow Coma Scale, Injury Severity Score and head AIS. Analysis was carried out using McNemar's and Student's t-test for categorical and continuous data, respectively.

    Results: A total of 545 patients met the study criteria. Of these, 15% (n = 80) were prescribed beta-blockers. After propensity matching, 80 matched pairs were analyzed. 33% (n = 26) of non beta-blocked patients developed post-traumatic depression, compared to only 18% (n = 14) in the beta-blocked group (p = 0.04). There were no significant differences in ICU (mean days: 5.8 (SD 10.5) vs. 5.6 (SD 7.2), p = 0.85) or hospital length of stay (mean days: 21 (SD 21) vs. 21 (SD 20), p = 0.94) between cohorts.

    Conclusion: beta-blockade appears to act prophylactically and significantly reduces the risk of posttraumatic depression in patients suffering from isolated severe traumatic brain injuries. Further prospective randomized studies are warranted to validate this finding.

  • 49.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden ; .
    Thelin, Eric Peter
    Department of Clinical Neuroscience, Karolinska Institutet Solna, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Bellander, Bo Michael
    Department of Clinical Neuroscience, Karolinska Institutet Solna, Stockholm, Sweden.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Talving, Peep
    Department of Surgery, Tartu University Hospital, Tartu, Estonia.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden.
    β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study2017Inngår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 43, nr 6, s. 783-789Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.

    METHODS: Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to β-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted β-blocked cases and were matched to non β-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of β-blockers on GOS.

    RESULTS: 362 patients met the inclusion criteria with 21% receiving β-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the β-blocked cases (18.0 vs. 26.8 days, p < 0.01). The risk of poor long-term functional outcome was more than doubled in non-β-blocked controls (OR 2.44, 95% CI 1.01-6.03, p = 0.03).

    CONCLUSION: Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.

  • 50.
    Ahlberg, Emelie
    et al.
    Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Al-Kaabawi, Ahmed
    Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Thune, Rebecka
    Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Simpson, Melanie Rae
    Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
    Pedersen, Sindre Andre
    Library Section for Research Support, Data and Analysis, NTNU University Library, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
    Cione, Erika
    Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Cosenza, Italy.
    Jenmalm, Maria Christina
    Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Tingö, Lina
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Nutrition-Gut-Brain Interactions Research Centre, School of Medical Sciences, Örebro University, Örebro, Sweden; Food and Health Programme, Örebro University, Örebro, Sweden.
    Breast milk microRNAs: Potential players in oral tolerance development2023Inngår i: Frontiers in Immunology, E-ISSN 1664-3224, Vol. 14, artikkel-id 1154211Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Breast milk is an essential source of nutrition and hydration for the infant. In addition, this highly complex biological fluid contains numerous immunologically active factors such as microorganisms, immunoglobulins, cytokines and microRNAs (miRNAs). Here, we set out to predict the function of the top 10 expressed miRNAs in human breast milk, focusing on their relevance in oral tolerance development and allergy prevention in the infant. The top expressed miRNAs in human breast milk were identified on basis of previous peer-reviewed studies gathered from a recent systematic review and an updated literature search. The miRNAs with the highest expression levels in each study were used to identify the 10 most common miRNAs or miRNA families across studies and these were selected for subsequent target prediction. The predictions were performed using TargetScan in combination with the Database for Annotation, Visualization and Integrated Discovery. The ten top expressed miRNAs were: let-7-5p family, miR-148a-3p, miR-30-5p family, miR-200a-3p + miR-141-3p, miR-22-3p, miR-181-5p family, miR-146b-5p, miR-378a-3p, miR-29-3p family, miR-200b/c-3p and miR-429-3p. The target prediction identified 3,588 potential target genes and 127 Kyoto Encyclopedia of Genes and Genomes pathways; several connected to the immune system, including TGF-b and T cell receptor signaling and T-helper cell differentiation. This review highlights the role of breast milk miRNAs and their potential contribution to infant immune maturation. Indeed, breast milk miRNAs seem to be involved in several pathways that influence oral tolerance development.

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