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- Nordin, Elise, 1985
(författare)
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Effects of FODMAPs and gluten on irritable bowel syndrome- from self-reported symptoms to molecular profiling
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Irritable bowel syndrome (IBS) is a complex disorder of gut-brain interactions. The diagnosis of IBS is based on subjective reporting of abdominal pain and altered bowel habits in the absence of any clinical alterations of the gut or other pathological conditions. Dietary regimens for symptom management include a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) diet and a gluten-free diet. However, scientific evidence supporting these dietary recommendations for managing IBS symptoms is weak: trials have been non-blinded and underpowered. While mechanistic understanding and objective markers of response remain scarce. Therefore, the aim of this thesis was to conduct a large double-blind study to investigate the effect of FODMAPs and gluten on symptomatic and molecular data including 16S rRNA analysis of the gut microbiota and metabolomics analyses, both at a group and subgroup (differential response) level. The resulting data served also to assess the accuracy of the Bristol Stool Form Scale (BSFS) used in IBS subtype diagnosis, and thus overcome the lack of objective evaluation of IBS symptoms. Trial data revealed that gluten caused no symptoms and FODMAPs triggered only modest symptoms of IBS, albeit with large inter-individual differences. Subjective reporting according to the BSFS conformed only modestly with stool water content in IBS, warranting caution towards IBS subtyping. FODMAPs increased saccharolytic microbial genera, phenolic-derived metabolites and 3-indolepropionate, but decreased bile acids. The genera Agathobacter, Anaerostipes, Fusicatenibacter, and Bifidobacterium correlated with increased plasma concentrations of phenolic-derived metabolites and 3-indolepropionate, i.e, metabolites related to decreased risk of incident type 2 diabetes and inflammation. Indeed, among FODMAP-related metabolites, only weak correlations to IBS symptoms were detected, as in the case of 3-indolepropionate to abdominal pain and interference with quality of life, warranting further investigation. Gluten displayed a modest effect on metabolites involved in lipid metabolism, including carnitine derivates, an acyl-CoA derivate, a medium-chain fatty acid, and an unknown lipid, but with no interpretable link to health. No molecular markers of a differential response were found, despite a comprehensive exploration with multiple analytical approaches. This could be explained by the absence of baseline variables, such as other omics layers or psychological factors, that could have determined the difference. In summary, the results indicate that gluten does not cause IBS symptoms. Moreover, the minor effect of FODMAPs on IBS symptoms must be weighed against their potential beneficial health effects. While the complexity of IBS likely explains the absence of molecular evidence for differential responses, such data analytical approach has potential where clear benefits of dietary interventions exist. Finally, the use of BSFS should include training for self-assessment, as a tool for subtyping IBS.
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- Elf, Marie, 1962-, et al.
(författare)
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The home as a place for rehabilitation-What is needed?
- 2020
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Ingår i: Architecture for Residential Care and Ageing Communities: Spaces for Dwelling and Healthcare. - New York, NY : Routledge, 2021. : Routledge. - 9780367358730 ; , s. 252-266, s. 252-266
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- This chapter aims to contribute to an understanding of the physical environment as an important part of the rehabilitation process for patients recovering from a stroke who rehabilitate at home. To further develop evidence-based care models for rehabilitation at home and incorporate person-environment dynamics, an understanding of how environmental factors relate to everyday life and recovering at home is crucial, especially for persons with long-term conditions, such as stroke survivors. Along with highlighting the challenges for the stroke survivors when rehabilitated at home, we discuss initiatives and intervention needed. We also present important theories that can be used in research in order to increase the knowledge of the person-environment interaction from a societal perspective vital to increase our knowledge of home and health dynamics in this context.
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- Nordin, Susanna, et al.
(författare)
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The importance of the physical environment to support individualised care
- 2018
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Ingår i: Individualized Care: Theory, Measurement, Research and Practice. - Cham : Springer International Publishing. - 9783319898995 - 9783319898988 ; , s. 207-215
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- The physical environment is an important part of individualised care. Creating care environments tailored towards the individual person’s needs is essential for high-quality care and is increasingly recognised as being associated with improved health and well-being among older people. Today, care should be holistic and view the person behind the disease, taking that person’s perspective and treating the patient as a unique individual. Despite the emerging focus on individualised care approaches, the physical environment is still not considered as an integral part of care, and relatively little attention has been paid to environmental aspects. However, the physical environment has a great potential to facilitate or restrict care processes in a broad range of care settings, not least in residential care facilities for older people. The present chapter focuses on ways to support the individual in terms of the physical environment.
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- Bondesson, Johan, 1991
(författare)
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Geometric Modeling of Thoracic Aortic Surface Morphology - Implications for Pathophysiology and Clinical Interventions
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Vascular disease risk factors such as hypertension, hyperlipidemia and old age are all results of modern-day lifestyle, and these diseases are getting more and more common. One treatment option for vascular diseases such as aneurysms and dissections is endovascular aortic repair introduced in the early 1990s. This treatment uses tubular fabric covered metallic structures (endografts) that are implanted using a minimally invasive approach and placed to serve as an articial vessel in a damaged portion of the vasculature. To ensure that the interventions are successful, the endograft must be placed in the correct location, and designed to sustain the hostile biological, chemical, and mechanical conditions in the body for many years. This is an interaction that goes both ways, and keeping in mind that the endograft is a foreign object placed in the sensitive vascular system, it is also important that it does not disrupt the native conditions more than necessary. This thesis presents a segmentation and quantication methodology to accurately describe the complex morphology and motion of diseased blood vessels in vivo through a natural and intuitive description of their luminal surfaces. After methodology validation, a series of important clinical applications are performed, all based on non-invasive imaging. Firstly, it is shown that explicit surface curvature quantication is necessary when compared to relying solely on centerline curvature and estimation methods. Secondly, it is shown that endograft malapposition severity can be predicted from preoperative geometric analysis of thoracic aortic surfaces. Thirdly, a multiaxial dynamics analysis of cardiac induced thoracic aortic surface motion shows how thoracic endovascular aortic repair affects the deformations of the dierent portions of the thoracic aorta. Fourthly, the helical propagation pattern of type B aortic dissection is determined, and two distinct modes of chirality are revealed, i.e., achiral and right-handed chiral groups. Finally, the effects of thoracic endovascular aortic repair on helical and cross-sectional morphology of type B dissections are investigated revealing how acuity and chirality affects the alteration due to intraluminal lining with endografts. Thus, the work presented in this thesis contributes by adding knowledge about pathology and pathophysiology through better geometric description of surface conditions of diseased thoracic aortas. This gives clinicians insights to use in their treatment planning and provides more nuanced boundary conditions for endograft manufacturers. Comprehensive knowledge about diseases, better treatment planning, and better devices are all crucial in order to improve the outcomes of performed interventions and ultimately the quality of life for the treated patients.
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- Lundh, Torbjörn, 1965, et al.
(författare)
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REMOVABLE STENT AND METHOD OF PRODUCTION
- 2012
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Patent (övrigt vetenskapligt/konstnärligt)abstract
- A removable porous stent is disclosed, which can be placed in tubular structures. It can be placed at locations, which are unsuitable for permanent stents, like across important branches in the vasculature preferably in combination with anticoagulation. The walls of the stent are freely permeable for the blood flow. A temporary stent can be used during treatment of dissections with involvement of side branches. The dissected membrane is relocated to its original place and held in place by the stent until the healing process has reattached the membrane. At this point the stent will be removed. The removable stent can also be used as a carrier of chemotherapy and/or radiation to be placed in tubular structures for local treatment of cancer. The time for treatment is controlled and finished at removal. This approach will give the possibility to increase dosages and reduce side effects. The stent is formed by at least one continuous thread arranged in interconnected loops and having a reversible bind-off at one end of the tubular body, mechanically securing each loop at said end of the tubular body apart from a single releasable loop. This loop is preferably extended beyond the tubular structure of the stent enabling an initiation of the removal at a distance from the treatment site.
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