| 51. |
- Rosenmuller, Mats H., 1968-, et al.
(författare)
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Expertise-based randomized clinical trial of laparoscopic versus small-incision open cholecystectomy
- 2013
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 100:7, s. 886-894
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several randomized clinical trials have compared laparoscopic cholecystectomy (LC) and small-incision open cholecystectomy (SIOC). Most have had wide exclusion criteria and none was expertise-based. The aim of this expertise-based randomized trial was to compare healthcare costs, quality of life (QoL), pain and clinical outcomes after LC and SIOC. Methods: Patients scheduled for cholecystectomy were randomized to treatment by one of two teams of surgeons with a preference for either LC or SIOC. Each team performed their specific method (SIOC or LC) as a first-choice operation, but converted to open cholecystectomy and common bile duct exploration when necessary. Intraoperative cholangiography was carried out routinely. The intention was to include all patients undergoing cholecystectomy, including emergency operations and procedures involving surgical training for residents. Results: Some 74.9 per cent of all patients undergoing cholecystectomy were included. Of 355 patients randomized, 333 were analysed. Self-estimated QoL scores in 258 patients, analysed by the area under the curve method, were significantly lower in the SIOC group at 1 month after surgery: median 2326 (95 per cent confidence interval 2187 to 2391) compared with 2411 (2334 to 2502) for the LC group (P = 0.030). The mean(s.d.) duration of operation was shorter for SIOC: 97(41) versus 120(48) min (P < 0.001). There were no significant differences between the groups in conversion rate, pain, complications, length of hospital stay or readmissions. Conclusion: SIOC had comparable surgical results but slightly worse short-term QoL compared with LC. Registration number: NCT00370344 (http://www.clinicaltrials.gov).
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| 52. |
- Saaf, M, et al.
(författare)
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Growth hormone treatment of osteoporotic postmenopausal women - a one-year placebo-controlled study
- 1999
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Ingår i: European journal of endocrinology. - : Oxford University Press (OUP). - 0804-4643 .- 1479-683X. ; 140:5, s. 390-399
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study the effect of 12 months of growth hormone (GH) treatment on bone markers, bone mineral density (BMD), lean body mass (LBM) and body fat mass (BF) in postmenopausal osteoporotic women. DESIGN: Sixteen patients were randomised to a double-blind randomised placebo-controlled one-year study with daily s.c. injections of GH or placebo. After the first year 14 patients (8 placebo treated, 6 GH treated) were recruited to GH treatment during the second year. All patients were also supplemented with 0.5 g calcium per oral. METHODS: Bone mineral density and body composition were assessed by dual energy X-ray absorptiometry. Biochemical bone markers were analysed by RIA or HPLC techniques. Diurnal GH profiles were performed with continuous venous blood sampling. RESULTS: Sixteen patients started in the placebo-controlled study. In all, twelve patients completed one year and only four patients completed two years of GH treatment. At baseline 3 patients had serum insulin-like growth factor-I (S-IGF-I) levels below -2 S.D. for age. Maximal diurnal GH levels tended to correlate negatively with S-IGF-I (P=0.076). S-IGF-I was unrelated to BMD. Serum IGF-binding protein-1 (S-IGFBP-1) correlated negatively with femoral neck BMD (r=-0.61, P=0.012). The intended GH dose of 0.05U/kg/day or a maximum of 3U/day s.c. was reduced to 0.024+/-0.004U/kg/day, equal to 0.5-2.7U/day due to frequent side effects, and four patients were excluded. After one year of GH treatment BF increased slightly, LBM and BMD in total body and lumbar spine were unchanged but femoral neck BMD had decreased 3.4+/-1.6% (P<0.05). The mean S-IGF-I increase was 32% (range -38-138%). Mean levels of the bone formation markers S-osteocalcin and S-procollagen type I propeptide increased maximally by 88 and 36% respectively after 9-12 months while the bone resorption markers were unchanged. In the placebo-treated group there were no significant alterations. CONCLUSIONS: The effects on S-IGF-I, bone markers and LBM were small although GH-related side effects were common. The reason for this apparent partial resistance to the anabolic effects of GH is not clear but nutritional deficits may be involved. Assessment of the effects of GH on bone mass and fracture rate requires longer study periods than one year.
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| 53. |
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| 54. |
- Skrifvars, M. B., et al.
(författare)
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Do patient characteristics or factors at resuscitation influence long-term outcome in patients surviving to be discharged following in-hospital cardiac arrest?
- 2007
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Ingår i: J Intern Med. - : Wiley. - 0954-6820 .- 1365-2796. ; 262:4, s. 488-95
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. Few studies have focused on factors influencing long-term outcome following in-hospital cardiac arrest. The present study assesses whether long-term outcome is influenced by difference in patient factors or factors at resuscitation. Methods. An analysis of cardiac arrest data collected from one Swedish tertiary hospital and from five Finnish secondary hospitals supplemented with data on 1 year survival. Multiple logistic regression analysis was used to identify factors associated with survival at 12 months. Results. A total of 441 patients survived to hospital discharge following in-hospital cardiac arrest and 359 (80%) were alive at 12 months. Factors independently associated with survival [odds ratio (OR) >1 indicates increased survival and <1 decreased survival] at 12 months were; age [OR 0.95, 95% confidence interval (CI) 0.93-0.98], renal disease (OR 0.3, CI 0.1-0.9), good functional status at discharge (OR 4.9, CI 1.3-18.9), arrest occurring at (compared with arrests on general wards) emergency wards (OR 4.7, CI 1.4-15.3), cardiac care unit (OR 2.8, CI 1.2-6.4), intensive care unit (OR 2.4, CI 1.1-5.7), ward for thoracic surgery (OR 10.2, CI 2.6-40.1) and unit for interventional radiology (OR 13.3, CI 3.4-52.0). There was no difference in initial rhythm, delay to defibrillation or delay to return of spontaneous circulation between survivors and nonsurvivors. Conclusion. Several patient factors, mainly age, functional status and co-morbid disease, influence long-term survival following cardiac arrest in hospital. The location where the arrest occurred also influences survival, but initial rhythm, delay to defibrillation and to return of spontaneous circulation do not.
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| 55. |
- Skrifvars, M. B., et al.
(författare)
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Variability in survival after in-hospital cardiac arrest depending on the hospital level of care
- 2007
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 73:1, s. 73-81
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Survival after in-hospital cardiac arrest (IHCA) differs considerably between hospitals. This study tries to determine whether this difference is due to patient selection because of the hospital level of care or to effective resuscitation management. METHODS: Prospectively collected data on management of in-hospital cardiac arrests from Sahlgrenska Hospital, a tertiary hospital in Gothenburg, Sweden (cohort one) and from five Finnish secondary hospitals (cohort two). A multiple logistic regression model was created for predicting survival to hospital discharge. RESULTS: A total of 954 cases from Sahlgrenska Hospital and 624 patients from the hospitals in Finland were included. The delay to defibrillation was longer at Sahlgrenska than at the five Finnish secondary hospitals (p=0.045). Significant predictors of survival were: (1) age below median (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.5-2.8); (2) no diabetes (OR 1.9, CI 1.2-2.9); (3) arrests occurring during office hours (OR 1.5, CI 1.1-2.2); (4) witnessed cardiac arrest (OR 6.3, CI 2.6-15.3); (5) ventricular fibrillation or ventricular tachycardia as the initial rhythm (OR 4.9, CI 3.5-6.7); (6) location of the arrest (compared to arrests in general wards, GW): thoracic surgery and heart transplantation ward (OR 2.9, CI 1.5-5.9), interventional radiology (OR 4.8, CI 1.9-12.0) and other in-hospital locations (3.0, CI 1.6-5.7) and (7) hospital (compared to arrests at Sahlgrenska Hospital); arrests at Etela-Karjala Central Hospital [CH] (OR 0.3, CI 0.1-0.7), Paijat-Hame CH (OR 0.3, CI 0.1-0.8) and Seinajoki CH (OR 0.4, CI 0.3-0.7). CONCLUSION: The comparison of survival following IHCA between different hospitals is difficult, there seems to be undefined factors greatly associated with outcome. A great variability in survival within different hospital areas probably because of differences in patient selection, patient surveillance and resuscitation management was also noted. A locally implemented strong in-hospital chain of survival is probably the only way to improve outcome following IHCA.
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| 56. |
- Thorén, Emil, et al.
(författare)
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MEMOS 3D modelling of ELM-induced transient melt damage on an inclined tungsten surface in the ASDEX Upgrade outer divertor
- 2018
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Ingår i: Nuclear Materials and Energy. - : ELSEVIER SCIENCE BV. - 2352-1791. ; 17, s. 194-199
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Tidskriftsartikel (refereegranskat)abstract
- The first MEMOS 3D simulations of liquid metal motion on an inclined bulk tungsten sample transiently molten by edge-localized modes (ELMs) are reported. The exposures took place at the outer ASDEX-Upgrade divertor with the tungsten surface tangent intersecting the magnetic field at similar to 18 degrees. Simulations confirm that the observed poloidal melt motion is caused by the volumetric J x B force with J the bulk replacement current triggered by thermionic emission. The final erosion profile and total melt build up are reproduced by employing the escaping thermionic current dependence on the incident heat flux derived from dedicated particle-in-cell simulations. Modelling reveals that melt dynamics is governed by the volumetric Lorentz force, capillary flows due to thermal surface tension gradients and viscous deceleration. The effect of the evolving surface deformation, that locally alters the field-line inclination modifying the absorbed power flux and the escaping thermionic current, in the final surface morphology is demonstrated to be significant.
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| 57. |
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| 58. |
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| 59. |
- Thorén, Per-Anders, et al.
(författare)
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Modeling and Measuring Viscoelasticity with Dynamic Atomic Force Microscopy
- 2018
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Ingår i: Physical Review Applied. - : AMER PHYSICAL SOC. - 2331-7019. ; 10:2
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Tidskriftsartikel (refereegranskat)abstract
- The interaction between a rapidly oscillating atomic-force-microscope tip and a soft-material surface is described with use of both elastic and viscous forces in a moving-surface model. We present the simplest form of this model, motivating our derivation with the models ability to capture the impact dynamics of the tip and sample with an interaction consisting of two components: interfacial or surface force, and bulk or volumetric force. Analytic solutions to the piecewise linear model identify characteristic time constants, providing a physical explanation for the hysteresis observed in the measured dynamic-force-quadrature curves. Numerical simulation is used to fit the model to experimental data, and excellent agreement is found with a variety of different samples. The model parameters form a dimensionless impact-rheology factor, giving a quantitative physical number to characterize a viscoelastic surface that does not depend on the tip shape or cantilever frequency.
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| 60. |
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