| 1. |
- Wennergren, Göran, 1947, et al.
(författare)
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Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases.
- 2001
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Ingår i: The European respiratory journal. - 0903-1936. ; 18:6, s. 1044-58
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Forskningsöversikt (refereegranskat)abstract
- Evidence from a large number of prospective case-control studies shows that respiratory syncytial virus (RSV) bronchiolitis in infancy is often associated with recurrent wheezing and asthma during subsequent years. However, wheezing tends to diminish and most studies show no significant increase in wheezing compared to controls by school age or adolescence. An unresolved question is whether severe RSV infection during infancy causes the respiratory sequelae or inherent abnormalities predispose an infant to develop severe respiratory infection and sequelae, i.e. RSV is associated with the development of pulmonary sequelae. Studies on long-term outcome of RSV bronchiolitis are reviewed from an evidence-based perspective. The majority of prospective placebo-controlled studies do not show any long-term beneficial effects of corticosteroid treatment, i.e. the risk of subsequent wheezing is not diminished by the treatment. The evidence for an increased risk of allergic sensitization after RSV bronchiolitis is not nearly as strong as the evidence for an increased risk of subsequent wheezing. In fact, most studies do not show any significant increase in atopy after RSV bronchiolitis. This suggests that the increased risk of wheezing after RSV is not linked to an increased risk of atopy. There are some indications that infants who develop severe RSV and subsequent wheezing may have aberrations that predate the RSV infection. To decide whether respiratory syncytial virus bronchiolitis causes, or is associated with the respiratory sequelae (or with subsequent allergy), it will be necessary to conduct prospective, randomized studies, where the cytokine profile prior to bronchiolitis onset is known. Such studies should preferably include some form of intervention against respiratory syncytial virus. A more complete understanding of the risk factors for severe respiratory syncytial virus infection and the role of respiratory syncytial virus infection in the initiation of asthma is needed as a basis for large-scale and cost-effective programmes to prevent respiratory syncytial virus-related morbidity.
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| 2. |
- Hansson Scherman, Marianne, 1944, et al.
(författare)
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Refusing to be ill: a longitudinal study of patients' experiences of asthma/allergy.
- 2002
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Ingår i: Disability and rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 24:6, s. 297-307
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this study was to search for a deeper understanding of the ways patients with asthma/allergy experience their illness situation. METHOD: Thirty patients with a history of airway symptoms on allergen exposure and a positive skin prick test were included in the study. They took part in open-ended interviews in their homes twice at an interval of eight years, according to the phenomenographic approach. RESULTS: Fourteen different categories of experience were identified: 'knowing for oneself, 'body related', 'environment related', 'psychosomatic', 'magic', 'fatalism', 'compliance with medication', 'alternative medicine', 'health care', 'provocation', 'avoidance', 'normalization', 'normification' and 'pursuing life'. The analysis also showed that these categories, to varying degrees, were an expression of a desire to retain an ordinary healthy identity and its value. The longitudinal results showed that with time the patients distanced themselves from the medical perspective and found their own ways of thinking and acting in relation to their ill health, which is seen as strengthening for the identity. CONCLUSIONS: The different, individual ways patients with asthma/allergy developed in relation to the illness situation have a preserving effect on the identity, which ought to be considered in patient education and rehabilitation.
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| 3. |
- Wennergren, Göran, 1947, et al.
(författare)
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Asthma hospitalizations continue to decrease in schoolchildren but hospitalization rates for wheezing illnesses remain high in young children.
- 2002
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Ingår i: Acta paediatrica (Oslo, Norway : 1992). - 0803-5253. ; 91:11, s. 1239-45
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Tidskriftsartikel (refereegranskat)abstract
- To analyse changes in hospitalization rates for asthma in children during recent years.In a population-based analysis, changes in asthma hospitalization rates were studied in children in Göteborg (Gothenburg), the second largest city in Sweden, during 1985-2000. The changes in different age groups have been correlated with the delivery of inhaled corticosteroids to the age groups.In the 5 to 18-y age group, there was a continuous, significant decrease in number of hospital days, admissions and individual patients admitted for asthma not only for the entire study period, 1985-2000, but also during the past 10-y period. The number of hospital days in the year 2000 was only 6% of the figure for 1985. An inverse correlation between delivery of inhaled corticosteroids and hospitalization for asthma was seen not only during 1985-1995, when use of inhaled corticosteroids became widespread (r(s) = -0.95, p = 0.007 for hospital days), but also when the entire period from 1985 to 2000 was analysed. Conversely, in the 0 to 1-y and 2 to 4-y age groups, there was no decrease in hospitalizations for wheezing illnesses or asthma-like symptoms during the past 10-y period, 1991-2000.During the period 1985-2000 the number of hospital days owing to asthma decreased by more than 90% in the 5 to 18-y age group. The marked decrease in asthma hospitalization rates among schoolchildren represents a great advance in paediatric respiratory medicine, which has been continuous during the past 10-y period. However, in young children admissions for wheezing have apparently not decreased.
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| 4. |
- Karlsson, Anne-Li, et al.
(författare)
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Bet v 1 homologues in strawberry identified as IgE-binding proteins and presumptive allergens
- 2004
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Ingår i: Allergy. - : Wiley. - 1398-9995 .- 0105-4538. ; 59:12, s. 1277-1284
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Tidskriftsartikel (refereegranskat)abstract
- Background: No strawberry allergen has so far been identified and characterized. Methods: Serum samples were collected from patients with a suggestive case history of adverse reactions to strawberry and other fruits. Extracts from fresh and frozen strawberries were analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), Western blotting and mass spectrometry. Patient blood samples were analysed for inhibition of IgE binding and basophil degranulation. Results: Several IgE-binding proteins could be detected. In more than half of the patient sera, a 20/18-kDa doublet band was observed in Western blotting. These two bands were excised and analysed by mass spectrometry showing the presence of proteins belonging to the Bet v 1 family of allergens. Inhibition of the IgE binding to the 20/18-kDa doublet was obtained by addition of two recombinantly expressed allergens belonging to the Bet v 1 family (Bet v 1 and Mal d 1) and strawberry protein extract. In a cell-based assay of patient blood samples, basophil degranulation could be induced by strawberry protein extract and by Bet v 1 and Mal d 1. Conclusions: We conclude that strawberry homologues to Bet v 1 may be allergens of importance for adverse reactions to strawberry.
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| 5. |
- Steen, Stig, et al.
(författare)
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Transplantation of lungs from a non-heart-beating donor
- 2001
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Ingår i: The Lancet. - 1474-547X. ; 357:9259, s. 825-829
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In animals, we have previously done successful lung transplantations using organs from non-heart-beating donors. We have also developed an ex-vivo system of assessing the function of such organs before transplantation. The next stage was to try the technique in human beings. Bearing in mind the sensitive ethical issues involved, our first aim was to find out what procedures would be acceptable, and to use the results to guide a clinical lung transplantation from a non-heart-beating donor. METHODS: The ethical acceptability of the study was gauged from the results of a broad information programme directed at the general public in Sweden, and from discussions with professionals including doctors, nurses, hospital chaplains, and judges. The donor was a patient dying of acute myocardial infarction in a cardiac intensive-care unit after failed cardiopulmonary resuscitation. The next of kin gave permission to cool the lungs within the intact body, and intrapleural cooling was started 65 min after death. Blood samples were sent for virological testing and cross matching. The next of kin then had time to be alone with the deceased. After 3 h, the body was transported to the operating theatre and the heart-lung block removed. The lungs were assessed ex vivo, and the body was transported to the pathology department for necropsy. RESULTS: No contraindications to transplantation were found, and the right lung was transplanted successfully into a 54-year-old woman with chronic obstructive pulmonary disease. The donor lung showed excellent function only 5 min after reperfusion and ventilation, and during the first 5 months of follow-up, the function of the transplanted lung has been good. INTERPRETATION: About half the deaths in Sweden are caused by cardiac and cerebrovascular disease. This group could be a potential source of lung donors. When all hospitals and ambulance personnel in Sweden have received training in non-heart-beating lung donation, we hope that there will be enough donor lungs of good quality for all patients needing a lung transplant.
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| 6. |
- De Robertis, Edoardo
(författare)
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Tools for protective lung ventilation. The elastic pressure-volume curve and aspiration of dead space
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ventilator-induced lung injury (VILI) may contribute to morbidity and mortality of acute lung injury (ALI). Lung protective ventilation (LPV), that reduces VILI, may involve low tidal volume (Vt). Particularly low Vt is possible if dead space ventilation is reduced e.g. by aspiration of dead space gas (ASPIDS). ASPIDS implies that gas rich in CO2 during expiration is aspirated through a separate channel from the tracheal tube and replaced by fresh gas injected in the inspiratory line. The elastic pressure volume (Pel/V) curve of the respiratory system is recommended as a guideline to set the ventilator so as to reduce VILI. The Vt should be confined to the linear segment of the Pel/V curve, to avoid lung collapse below this zone, and hyperinflation above it. However, the understanding of physiological phenomena behind the Pel/V curve is limited. The objectives were to increase our comprehension of the Pel/V curve, to enhance its potential clinical usefulness, and to develop and test ASPIDS, in an approach aiming at LPV. A computer controlled Servo Ventilator 900 C allowed accurate recording of the Pel/V curve and control of the ASPIDS system. ASPIDS allowed isocapnic ventilation of pigs and humans with low Vt, and higher PEEP levels in ALI patients. In pigs and humans recruitment was shown to start below the lower inflection point and to continue far above it. Pel/V curves recorded from different PEEP levels allowed evaluation of lung collapse and guidance in setting PEEP. New concepts will hopefully increase the feasibility of LPV.
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| 7. |
- Andersson, Eva, 1955, et al.
(författare)
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Adult-onset asthma and wheeze among irritant-exposed bleachery workers.
- 2003
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Ingår i: American journal of industrial medicine. - : Wiley. - 0271-3586. ; 43:5, s. 532-538
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Tidskriftsartikel (refereegranskat)abstract
- Background Whether new-onset asthma is associated with irritant exposure is unclear. The aim was to investigate if occupational exposure to irritant gases, especially repeated peak exposure (gassings), increased the risk of obstructive airways disease. Methods Data on airway symptoms and exposure among bleachery (n=101) and paper department workers (n=314) were collected by a questionnaire. Incidence rates and hazard ratios (HR) (Cox regression) were calculated. Non-responders were interviewed by telephone. Results The incidence rate for adult-onset physician-diagnosed asthma among bleachery workers reporting gassings giving rise to respiratory symptoms was 7.6/103 person-years and for those without gassings 2.2/103 person-years, compared to 1.0/103 person-years for paper workers. In a Cox regression model for asthma (n=12), stratified for sex, HR for gassings were 5.6 (95% confidence intervals (CI) 1.6–20), for hay fever 3.0 (95% CI 0.8–11), and for ever smoking 0.7 (95% CI 0.2–2.4). The same model for adult-onset wheeze gave HR of 5.2 (95% CI 2.2–12), 1.7 (95% CI 0.6–5.4), and 1.1 (95% CI 0.5–2.7), respectively. Conclusions Repeated peak exposure to irritant gases, here studied as gassings in the pulp industry, increased the risk for both adult-onset asthma and wheeze.
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| 8. |
- Holst, Holger
(författare)
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New Methods for Automated Interpretation of Electrocardiograms and Lung Scintigrams
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The principal purposes of the studies reported in this thesis were to develop new methods to make computerised decision support systems in medicine both more reliable and fully automated. These aims were pursued in the belief that the solution to these problems will lead to an increased clinical use of such systems resulting in benefit to both patient and physician. In the first two studies, methods to produce measures of confidence for the advice presented by the computer were developed. Although the studies were evaluated by the use of ECGs, the methods developed are generally applicable to other data sources. In the third and fourth studies, a fully automated method for the interpretation of lung scintigrams was developed and thereafter evaluated using patient images from a hospital separate from where it was developed. All the studies reported upon were based on the use of artificial neural networks, and supplemented with software for confidence measure calculations or image processing. The results showed that the methods developed in the first two studies could indicate whether the computer considered a tested ECG to be unusual as well as indicate if it considered the sample to be difficult or easy to interpret. Study three showed that it was possible to develop a fully automated method for image analysis with a performance similar to methods requiring manual assistance by physicians. The fourth study showed that the performance of this automated method was similar to that of experienced physicians when tested on images originating from a different hospital.
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| 9. |
- Wennergren, Göran, 1947
(författare)
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Effekt av passiv och aktiv tobaksrökning vid astma
- 2002
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Ingår i: Hur kan vi minska allergi- och astmabesvär för barn och unga? Anpassning och behandling. Kunskapsunderlag till Barnallergiåret 2003. - Stockholm : Astma- och Allergiförbundet. - 919726847X ; , s. 19-24
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Saetrum Opgaard, Ole, et al.
(författare)
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Endocardial expression and functional characterization of endothelin-1
- 2001
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Ingår i: Molecular and Cellular Biochemistry. - 0300-8177. ; 224:1-2, s. 151-158
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Tidskriftsartikel (refereegranskat)abstract
- Endothelin-1 (ET-1), a 21 amino acid peptide exerts a wide range of biological activities including vasoconstriction, mitogenesis and inotropic effects on the heart. In this study, we examined whether endocardial endothelial cells express ET-1 and evaluated its functional properties. Using immunofluorescence localization method, we demonstrated cytoplasmic staining of ET-1 in the human endocardial endothelial cells from the right atrium and left ventricle. Employing reverse transcriptase polymerase chain reaction (RT-PCR) expression of ET-1 mRNA and its receptors ET(A) and ET(B) mRNAs were found in human myocardial as well as in endocardial endothelial cells. Biological activity of endocardial endothelial cells derived ET-1 was established as the conditioned media obtained from cultured porcine endocardial endothelial cells induced a slowly developing, strong and long-lasting contraction of circular rat aortic segments, with similar characteristics to that obtained with exogenous ET-1. Furthermore, the selective endothelin-A receptor antagonist, FR 139317, blocked the conditioned media induced contractions. Our results suggest that endocardial endothelial cells express and release biologically active ET-1 which could play a pivotal role in the regulation of myocardial contractility as well as a circulatory peptide may further act in other peripheral target organs.
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