| 1. |
|
|
| 2. |
- Clausen, Fredrik, et al.
(författare)
-
Oxygen free radical-dependent activation of extracellular signal-regulated kinase mediates apoptosis-like cell death after traumatic brain injury
- 2004
-
Ingår i: Journal of Neurotrauma. ; 21:9, s. 1168-1182
-
Tidskriftsartikel (refereegranskat)abstract
- Mitogen-activated protein kinase (MAPK) cascades are membrane-to-nucleus signaling modules that recently have been implicated as mediators of cellular injury. In this study, we investigated the involvement of the MAP kinase p44/p42 (extracellular signal-regulated kinase [ERK1/2]) in traumatic brain injury (TBI) in rats. There was a strong increase in activated, phosphorylated ERK 1/2 (p-ERK 1/2) protein at 10 min up to 24 h after the injury. Expression of p-ERK occurred in cells identified as neurons, astrocytes, and microglia. Most of the cells expressing p-ERK were TUNEL positive at later time points. Treatment with the MEK inhibitor U0126 or the free radical scavenger S-PBN, both with neuroprotective properties in TBI, attenuated the early activation of ERK and resulted in less activation of caspase-3 and subsequent DNA fragmentation. Post-treatment with U0126 resulted in a significant decrease (-60%) in cortical cavity size and cortical atrophy at 2 weeks after trauma. Overall, the results suggest that ERK activation is initiated by increased oxygen radical activity and that overactivation of ERK sets off secondary cell death mechanisms in TBI. Clinical studies are warranted to evaluate the concept of MEK inhibition in head-injured patients.
|
|
| 3. |
- Kultanen, Hanna, et al.
(författare)
-
Antithrombotic agent usage before ictus in aneurysmal subarachnoid hemorrhage : relation to hemorrhage severity, clinical course, and outcome
- 2023
-
Ingår i: Acta Neurochirurgica. - : Springer. - 0001-6268 .- 0942-0940. ; 165:5, s. 1241-1250
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe number of patients with aneurysmal subarachnoid hemorrhage (aSAH) who are on antithrombotic agents before ictus is rising. However, their effect on early brain injury and disease development remains unclear. The primary aim of this study was to determine if antithrombotic agents (antiplatelets and anticoagulants) were associated with a worse initial hemorrhage severity, rebleeding rate, clinical course, and functional recovery after aSAH.MethodsIn this observational study, those 888 patients with aSAH, treated at the neurosurgical department, Uppsala University Hospital, between 2008 and 2018 were included. Demographic, clinical, radiological (Fisher and Hijdra score), and outcome (Extended Glasgow Outcome Scale one year post-ictus) variables were assessed.ResultsOut of 888 aSAH patients, 14% were treated with antithrombotic agents before ictus. Seventy-five percent of these were on single therapy of antiplatelets, 23% on single therapy of anticoagulants, and 3% on a combination of antithrombotic agents. Those with antithrombotic agents pre-ictus were significantly older and exhibited more co-morbidities and a worse coagulation status according to lab tests. Antithrombotic agents, both as one group and as subtypes (antiplatelets and anticoagulants), were not associated with hemorrhage severity (Hijdra score/Fisher) nor rebleeding rate. The clinical course did not differ in terms of delayed ischemic neurological deficits or last-tier treatment with thiopental and decompressive craniectomy. These patients experienced a higher mortality and lower rate of favorable outcome in univariate analyses, but this did not hold true in multiple logistic regression analyses after adjustment for age and co-morbidities.ConclusionsAfter adjustment for age and co-morbidities, antithrombotic agents before aSAH ictus were not associated with worse hemorrhage severity, rebleeding rate, clinical course, or long-term functional recovery.
|
|
| 4. |
- Lewen, Hanna, et al.
(författare)
-
Documented assessments and treatments of patients seeking emergency care because of pain
- 2010
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 24:4, s. 764-771
-
Tidskriftsartikel (refereegranskat)abstract
- Study rationale: Pain is one of the most frequent symptoms for which people seek emergency care. Studies show that pain management in emergency clinics is insufficient. No previous studies regarding pain documentation at emergency clinics in the Nordic countries have been undertaken. Objectives: The main purpose was to investigate the extent to which pain assessment, pain treatment and pain relief were documented in patient records. Design: Patient records were reviewed using a study-specific protocol. Setting: Emergency unit at a Swedish university hospital. Participants: A total of 698 patient records randomly selected were reviewed using a study-specific protocol. According to Swedish law and the university hospital's quality and safety guidelines, there should be a note in each patient record regarding whether or not the patient was in pain on arrival. The guideline stresses the importance of using patient self-assessment by a visual analogue scale (VAS). Results: In 361/698 (52%) records, there was a note by a doctor or a nurse as to whether or not the patient had been experiencing pain on arrival. In 319 of these 361 records 88%), a full pain assessment had been documented. In 15/319 (5%) cases, the pain assessment included patient VAS assessment. In 54/319 (17%) patient records, a note regarding pain treatment was found. Significantly more notes regarding pain treatment were found in the records with an initial documented pain assessment, when compared with the records without any such assessment (p < 0.01). In the 54 records with notes regarding pain treatment, 10 (19%) included documentation regarding the effect of the treatment. Conclusions: The results show an alarming lack of documentation regarding pain assessments, pain treatments and follow-ups. This is in marked contrast to Swedish law, which clearly stipulates the responsibility of health care staff to document information relevant to providing safe care. Prompt action to improve pain documentation is warranted.
|
|
