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  • Stattin, Pär, et al. (författare)
  • Surveillance and deferred treatment for localized prostate cancer : Population based study in the National Prostate Cancer Register of Sweden
  • 2008
  • Ingår i: Journal of Urology. - Baltimore : Williams and Wilkins. - 0022-5347 .- 1527-3792. ; 180:6, s. 2423-2430
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>PURPOSE: To what extent active surveillance and deferred treatment for localized risk prostate cancer are used is unclear. We assessed the use of surveillance and of deferred treatment in a population based, nationwide cohort in Sweden.</p> <p>MATERIALS AND METHODS: In the National Prostate Cancer Register of Sweden, with a 98% coverage vs the compulsory Swedish Cancer Registry, we identified 8,304 incident cases of prostate cancer in 1997 to 2002 with age younger than 70 years, clinical local stage T1 or 2, N0 or Nx, M0 or Mx and serum prostate specific antigen less than 20 ng/ml. Data were extracted from medical charts for 7,782 of these men (94%) at a median of 4 years after diagnosis.</p> <p>RESULTS: Primary treatment was surveillance for 2,065 men (26%), radical prostatectomy for 3,722 (48%), radiotherapy for 1,632 (21%) and hormonal treatment for 363 (5%). Men on surveillance had lower local tumor stage, grade and prostate specific antigen, and were older than those who received active primary treatment (p &lt;0.001). After a median surveillance of 4 years 711 men (34%) on surveillance had received deferred treatment, which was radical prostatectomy for 279 (39%), radiotherapy for 212 (30%) and hormonal treatment for 220 (30%).</p> <p>CONCLUSIONS: Surveillance was a common treatment for patients younger than 70 years with localized prostate cancer in Sweden in 1997 to 2002, 26% of men with localized prostate cancer started surveillance and after a median followup of 4 years, 66% of these men remained on surveillance.</p>
  • Hörer, Tal M., 1971-, et al. (författare)
  • Complications but not obesity or diabetes mellitus have impact on the intraperitoneal lactate/pyruvate ratio measured by microdialysis
  • 2010
  • Ingår i: Scandinavian Journal of Gastroenterology. - 1502-7708. ; 45:1, s. 115-121
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Objective</strong>: Studies have shown a higher risk of postoperative complications in diabetic and obese patients. An increased intraperitoneal lactate/pyruvate ratio as measured by microdialysis has been reported before postoperative complications have been discovered. It is not known whether diabetes or obesity have any influence on the intraperitoneal metabolism (lactate/pyruvate ratio, glucose, glycerol) in relation to major abdominal surgery. The aim of this study was to investigate the postoperative intraperitoneal and subcutaneous carbohydrate and fat metabolism as measured by microdialysis in obese and diabetic patients after major abdominal surgery without postoperative complications.</p><p><strong>Material and methods:</strong> Seven obese patients (body mass index &gt; 30 kg/m(2)) and six diabetic but non-obese patients were studied up to 48 h after major abdominal surgery and were compared with 31 non-diabetic, non-obese patients, all without complications. Microdialysis was performed to measure glucose, lactate, pyruvate and glycerol intraperitoneally and subcutaneously. The lactate/pyruvate ratio was calculated.</p><p><strong>Results:</strong> The lactate/pyruvate ratio did not differ between the groups. In the diabetic patients, glucose levels were higher intraperitoneally at both Days 1 and 2 compared to controls. Higher glycerol levels were found subcutaneously in obese patients at Day 2. CONCLUSIONS: The lactate/pyruvate ratio does not increase intraperitoneally after non-complicated major abdominal surgery in diabetic and obese patients. Obese patients have increased release of free fatty acids and glycerol subcutaneously, while diabetic patients show higher glucose levels intraperitoneally than controls.</p>
  • Sarve, Hamid, et al. (författare)
  • Quantification of bone remodeling in the proximity of implants
  • 2007
  • Ingår i: Proceedings of the 12th International Conference on Computer Analysis of Images and Patterns (CAIP07). - Berlin : Springer. - 978-3-540-74271-5 ; s. 253-260
  • Konferensbidrag (refereegranskat)abstract
    • <p>In histomorphometrical investigations of bone tissue modeling around screw-shaped implants, the manual measurements of bone area and bone-implant contact length around the implant are time consuming and subjective. In this paper we propose an automatic image analysis method for such measurements. We evaluate different discriminant analysis methods and compare the automatic method with the manual one. The results show that the principal difference between the two methods occurs in length estimation, whereas the area measurement does not differ significantly. A major factor behind the dissimilarities in the results is believed to be misclassification of staining artifacts by the automatic method.</p>
  • Friberg, Örjan, et al. (författare)
  • Incidence, microbiological findings, and clinical presentation of sternal wound infections after cardiac surgery with and without local gentamicin prophylaxis
  • 2007
  • Ingår i: European Journal of Clinical Microbiology and Infectious Diseases. - Berlin : Springer. - 0934-9723 .- 1435-4373. ; 26:2, s. 91-97
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Sternal wound infection (SWI) is a serious complication after cardiac surgery. In a previous randomized controlled trial, the addition of local collagen-gentamicin in the sternal wound before wound closure was found to significantly reduce the incidence of postoperative wound infections compared with the routine intravenous prophylaxis of isoxazolyl-penicillin only. The aims of the present study were to analyse the microbiological findings of the SWIs from the previous trial as well as to correlate these findings with the clinical presentation of SWI. Differences in clinical presentation of SWIs, depending on the causative agent, could be identified. Most infections had a late, insidious onset, and the majority of these were caused by staphylococci, predominantly coagulase-negative staphylococci. The clinically most fulminant infections were caused by gram-negative bacteria and presented early after surgery. Local administration of gentamicin reduced the incidence of SWIs caused by all major, clinically important bacterial species. Propionibacterium acnes was identified as a possible cause of SWI and may be linked to instability in the sternal fixation. There was no indication of an increase in the occurrence of gentamicin-resistant bacterial isolates in the treatment group. Furthermore, the addition of local collagen-gentamicin reduced the incidence of SWIs caused by methicillin-resistant coagulase-negative staphylococci. This technique warrants further evaluation as an alternative to prophylactic vancomycin in settings with a high prevalence of methicillin-resistant Staphylococcus aureus.</p>
  • Landgren, Ola, et al. (författare)
  • Personal and family history of autoimmune diabetes mellitus and susceptibility to young-adult-onset Hodgkin lymphoma
  • 2006
  • Ingår i: International Journal of Cancer. - 0020-7136 .- 1097-0215. ; 118:2, s. 449-452
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Young-adult-onset (15-44 years of age) Hodgkin lymphoma (HL) is believed to arise as a consequence of late primary infection in susceptible individuals. The properties of this susceptibility remain little understood. We have previously reported an increased occurrence of HL in patients with rheumatoid arthritis and among their offspring, suggesting that susceptibility to autoimmunity might be of importance also in the pathogenesis of HL. To explore this hypothesis, we assessed the association of personal and family history of diabetes mellitus, with risk of subsequent HL in a population-based case-control study, including as cases all individuals diagnosed with HL above 15 years of age 1964-1999 (n = 6,873) in Sweden, and matched population controls (n = 12,565). First-degree relatives of cases and controls were identified through linkage with the Multi-generation Register. We identified discharges listing diabetes mellitus through linkage with the Inpatient Register (1964-2000). We used odds ratios (OR) as measures of relative risk. Cases with young-adult-onset HL were less likely to have a personal (OR =0.5, 95% CI 0.2-1.1) or family (OR =0.7, 95% CI 0.6-0.8) history of diabetes mellitus. In contrast, HL diagnosed at older ages was neither associated with a personal (OR =1.0) nor family (OR =1.0) history of diabetes mellitus. These findings suggests that characteristics of the immune system associated with conditions such as diabetes mellitus type I are of importance in the pathogenesis of young-adult-onset HL.</p> <p>Copyright 2005 Wiley-Liss, Inc.</p>
  • Ge, Chenjie, et al. (författare)
  • Enlarged Training Dataset by Pairwise GANs for Molecular-Based Brain Tumor Classification
  • 2020
  • Ingår i: IEEE Access. - 2169-3536. ; 8:1, s. 22560-22570
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper addresses issues of brain tumor subtype classification using Magnetic Resonance Images (MRIs) from different scanner modalities like T1 weighted, T1 weighted with contrast-enhanced, T2 weighted and FLAIR images. Currently most available glioma datasets are relatively moderate in size, and often accompanied with incomplete MRIs in different modalities. To tackle the commonly encountered problems of insufficiently large brain tumor datasets and incomplete modality of image for deep learning, we propose to add augmented brain MR images to enlarge the training dataset by employing a pairwise Generative Adversarial Network (GAN) model. The pairwise GAN is able to generate synthetic MRIs across different modalities. To achieve the patient-level diagnostic result, we propose a post-processing strategy to combine the slice-level glioma subtype classification results by majority voting. A two-stage course-to-fine training strategy is proposed to learn the glioma feature using GAN-augmented MRIs followed by real MRIs. To evaluate the effectiveness of the proposed scheme, experiments have been conducted on a brain tumor dataset for classifying glioma molecular subtypes: isocitrate dehydrogenase 1 (IDH1) mutation and IDH1 wild-type. Our results on the dataset have shown good performance (with test accuracy 88.82%). Comparisons with several state-of-the-art methods are also included.
  • Bin Kaderi, Mohamed Arifin, 1978- (författare)
  • Assessment of Novel Molecular Prognostic Markers in Chronic Lymphocytic Leukemia
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The clinical course of chronic lymphocytic leukemia (CLL) is highly heterogeneous, which has prompted<sup> </sup>the search for biomarkers that can predict prognosis in this disease. The IGHV gene mutation status and certain genomic aberrations have been identified as reliable prognostic markers of clinical outcome for this disorder. However, the search for more feasible prognostic markers in CLL is still being pursued. Recently, certain single nucleotide polymorphisms (SNPs) in the <em>GNAS1</em>, <em>BCL2</em> and <em>MDM2</em> genes and the RNA expression levels of the <em>LPL</em>, <em>ZAP70</em>, <em>TCL1, CLLU1 </em>and <em>MCL1</em> genes were suggested as novel prognostic markers in CLL.</p> <p>In papers I-III, we performed genotyping analyses of the <em>GNAS1</em> T393C, <em>BCL2</em> -938C&gt;A and <em>MDM2</em> SNP309 polymorphisms in 268-418 CLL patients and related the genotypes with clinical data. Association studies between the polymorphisms and established prognostic markers (i.e. IGHV mutation status, genomic aberrations, CD38 expression) were also performed. Our studies did not find any significant relationship between these SNPs with either clinical outcome or other known prognostic markers in CLL.</p> <p>In paper IV, we measured the RNA expression levels of <em>LPL</em>, <em>ZAP70</em>, <em>TCL1,</em> <em>CLLU1</em> and <em>MCL1</em> in 252 CLL cases and correlated these levels with clinical outcome. Here, we verified that high expression of all these RNA-based markers, except <em>MCL1</em>, were associated with an unfavourable prognosis. We also confirmed a close relationship between IGHV mutation status and the RNA-based markers, especially for <em>LPL</em> and <em>CLLU1</em> expression. Among the RNA-based markers, multivariate analysis revealed <em>LPL</em> expression as the strongest independent prognostic marker for overall survival and time to treatment. Furthermore, the RNA-based markers could add further prognostic information to established markers in subgroups of patients, with <em>LPL</em> expression status giving the most significant results.</p> <p>In summary, data from papers I-III could not verify the <em>GNAS1</em> T393C, <em>BCL2</em> -938C&gt;A and <em>MDM2 </em>SNP309 polymorphisms as prognostic markers in CLL. Future SNP markers must hence be confirmed in large, independent cohorts before being proposed as prognostic marker in CLL. In paper IV, we conclude that <em>LPL</em> expression appears to be the strongest among the RNA-based markers for CLL prognostication. Further efforts to standardize <em>LPL</em> quantification are required before it can be applied in the clinical laboratory to predict clinical outcome in this disease.<em></em></p>
  • de León, Alex, 1978- (författare)
  • Effects of anesthesia on esophageal sphincters in obese patients
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of this thesis was to evaluate the UES, LES, esophageal (E) and barrier (Br) pressures (P) using high resolution solid state manometry (HRSM). Comparisons were made between obese and nonobese patients, before and during anesthesia induction, and in obese patients in different body positions and during different respiratory maneuvers.</p> <p><strong>Methods:</strong> The effects of low-dose propofol (0.3 mg/kg iv) were studied in 10 young (ages 18–30 years) and 10 elderly volunteers (ages 60–87 years). The effects of anesthesia induction with remifentanil, propofol and rocuronium were studied in 14 obese patients (BMI &gt;35 kg/m2) and compared with effects in 14 non-obese patients. The effects of different body positions on esophageal sphincters were evaluated in 17 obese patients before and during anesthesia. The effects of different respiratory maneuvers on pressures in the esophagus and esophageal sphincters were studied before and during anesthesia in 17 obese patients. HRSM was used in all studies.</p> <p><strong>Results:</strong> The low propofol dose did not infl uence LES pressures in either young or elderly volunteers. Anesthesia induction with Remifentanil and Propofol decreased pressures in the esophageal sphincters and the BrP in both obese and non-obese patients. The pressures were signifi cantly lower in obese patients. The BrP remained positive in both obese and non-obese individuals. The LES pressure increased in the Trendelenburg position before but not during anesthesia. During spontaneous breathing the LES pressure was signifi cantly lower during end-expiration compared to end-inspiration. The LES pressure increased during the Valsalva maneuver and forced inspiration. With the patients in supine position the EP was positive during normal spontaneous breathing and during mechanical ventilation but was negative during forced inspiration. The EP increased signifi cantly during PEEP.</p> <p><strong>Conclusion:</strong> High-resolution solid-state manometry is a valuable tool for studying esophageal function. Lower esophageal sphincter pressure and barrier pressure decreased during anesthesia induction and were signifi cantly lower in obese compared to non-obese patients. However, barrier pressure remained positive in all patients. When evaluating the risk for regurgitation, the lowest lower esophageal sphincter pressure and barrier pressure are found during end-expiration. PEEP during anesthesia increased esophageal pressures and may therefore decrease the risk for passive regurgitation.</p>
  • Löf, Lennart, et al. (författare)
  • ICU patients' recall of emotional reactions in the trajectory from falling critically ill to hospital discharge : follow-ups after 3 and 12 months
  • 2008
  • Ingår i: Intensive & Critical Care Nursing. - Edinburgh : Churchill Livingstone. - 0964-3397 .- 1532-4036. ; 24:2, s. 108-121
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Patients' memories of frightening ICU experiences may be a threat to later psychological recovery. The purpose of the study is to describe ICU patients' recall of their emotional reactions, from falling critically ill to hospital discharge; this at 3 and 12 months following discharge from the ICU. The study is qualitative and concerns eight ICU patients ventilated for more than 72h. The participants were interviewed twice and the data were subjected to qualitative content analysis. It emerged that the memories of emotions during the trajectory of critical illness were extensive, detailed and strong, and that unpleasant emotions were clearly stable over time. At 12 months as compared with 3 months, the unpleasant emotions were less intense and had less prominent; furthermore the ICU care was more greatly associated with a sense of security, and there was greater recall of caring doctors and nurses (though not of their names) as well as next of kin. CONCLUSIONS: The study generated knowledge not previously described about how ICU patients' recollection of their emotions during the trajectory of critical illness changes over time. This has implications regarding future study of patients' ICU memories and regarding patients' need for support in coping with such memories.</p>
  • Sandin, M., et al. (författare)
  • Effects of pain stimulation on bispectral index, heart rate and blood pressure at different minimal alveolar concentration values of sevoflurane
  • 2008
  • Ingår i: Acta Anaesthesiologica Scandinavica. - Copenhagen : Blackwell Munksgaard. - 0001-5172 .- 1399-6576. ; 52:3, s. 420-426
  • Tidskriftsartikel (övrigt vetenskapligt)abstract
    • <p><strong>Background: </strong>The aim of the present study was to examine the level of unconsciousness measured with bispectral index (BIS) at different minimal alveolar concentration (MAC) levels of sevoflurane, and to study the hemodynamic and BIS reactions during noxious stimulation with transcutaneous electrical nerve stimulation (TENS) and an ice water pain test (IWP).</p><p><strong>Methods: </strong>This study was approved by the Ethics Committee and was performed on 10 healthy, young volunteers (six males and four females), ASA physical status I. Anesthesia was induced and maintained with sevoflurane in an oxygen/air mixture. The volunteers were spontaneously breathing, but if necessary, ventilation was mechanically supported. TENS and IWP were performed at 1.0, 1.5 and 2.0 MAC of sevoflurane.</p><p><strong>Results: </strong>At 1.0 MAC, there was a significant increase in BIS during pain stimulation both with IWP (<em>P</em>&lt;0.03) and with TENS (<em>P</em>&lt;0.005), but at 1.5 MAC there were no changes. A marked variation in BIS was seen at 2.0 MAC, with periods of burst suppression and periods of high BIS values despite clinical signs of deep anesthesia. These marked variations in BIS were seen before, during and after pain stimulation. One volunteer (# 8) had a short episode of convulsions at 2.0 MAC.</p><p><strong>Conclusion: </strong>BIS, heart rate and blood pressure increased during pain stimulation at 1.0 MAC but not at 1.5 MAC of sevoflurane. There was a remarkable variation in BIS at 2.0 MAC of sevoflurane, with BIS values indicating wakefulness despite clinical signs of deep anesthesia. This BIS variation is probably caused by epileptogenic activity due to sevoflurane.</p>
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