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- Bergquist, Maria
(författare)
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Glucocorticoid receptors in severe inflammation : Experimental and clinical studies
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Septic shock is one of the most common causes of mortality in intensive care, in spite of antibiotic treatment. Glucocorticoid treatment can be used to blunt an overwhelming immune response in severe inflammation. The varying effects of glucocorticoid treatment in sepsis are poorly understood, with consequences for the clinical guidelines for treatment. Glucocorticoids are potent anti-inflammatory mediators which exert their effects through the glucocorticoid receptor (GR). Deeper understanding about the mechanisms of GR signalling may help to guide and improve glucocorticoid treatment. The aim of this thesis was to analyse GR expression and binding capacity in experimental and human septic shock and severe inflammation with cellular specificity using flow cytometry. In the late phase of a murine sepsis model, we observed decreased GR expression in leukocytes. In a murine model of early endotoxic shock, we observed decreased GR binding capacity in spite of an increased expression, in neutrophils. Glucocorticoid treatment was beneficial only when administered early in both models. Compared to healthy subjects, GR expression was increased in leukocytes from patients during the initial sepsis phase, while GR binding capacity was only increased in lymphocytes and monocytes. In contrast, neutrophils and other leukocyte subsets displayed decreased GR binding capacity. Neutrophil numbers were increased in all patients with sepsis compared to healthy subjects. We also studied patients with burn injury after admission before any infectious event had likely occurred, and on day 7 post admission, when several of the patients had been diagnosed with sepsis. GR expression and binding capacity was increased in leukocytes on admission as compared to healthy subjects, and patients diagnosed with sepsis on day 7 had a further increased GR expression in T lymphocytes. GR binding capacity was decreased in proportion to the extent of the burn injury on day 14 post admission. In conclusion, sepsis and severe inflammation have significant impact on the expression and function of GR, likely to influence the efficiency of glucocorticoid treatment. In addition, glucocorticoid treatment is beneficial only when given early in these models of experimental sepsis.
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| 2. |
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| 3. |
- Ringdal, Mona, 1955, et al.
(författare)
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Early mobilization in ICU
- 2017
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Ingår i: EfCCNa conference in Belfast, Irland, Oral paper, February, 2017.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Rylander, Christian, 1960
(författare)
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FRC in acute lung injury. Experimental and clinical studies
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Respiratory failure due to acute lung injury (ALI) of diffuse inflammatory origin is a major cause of respiratory failure treated in intensive care units. In ALI, FRC is reduced by various mechanisms associated with hypoxemia and consolidation of the lung. Increasing FRC by use of positive-pressure ventilation without causing side effects from raised pressure and volume in the lungs is critical when managing patients with ALI. The overall aim of this thesis was to elucidate the pathophysiology of acute lung injury using inert gas methods and CT analysis to assess lung volumes. Three experimental studies involving 32 anaesthetised pigs and one clinical study involving 20 healthy subjects and 25 mechanically ventilated patients with ALI were undertaken. Gas volume, tissue volume and the mechanical properties of the lung were measured using computed tomography (CT), inert gas dilution techniques and the inspiratory occlusion technique, respectively. CT analysis was used as a reference method for quantifying lung perturbations and as a tool to detect regional conditions within the lung. In summary, the early phase of experimental ALI was characterised by rapidly appearing consolidation and loss of aeration that were established within one hour, and the degree of consolidation was reflected in reduced arterial oxygenation. Despite significant loss of aeration, the dimensions of the injured lung were preserved or even slightly increased. The tidal volume was redistributed from basal dependent to apical lung regions but neither overall nor regional gas trapping could be demonstrated. The evolution of lung injury was accompanied by reduced FRC as well as increased resistance and reduced compliance of the respiratory system. FRC appeared to be the more sensitive indicator of the effects of changed PEEP. Further evolution of the lung injury after one hour was not affected by changes in PEEP of limited duration. The expiratory time constant was shortened in injured dependent lung regions and limiting the expiratory time did not provoke gas trapping. In contrast to the findings in early experimental ALI, sedated patients with established ARDS showed evidence of considerable gas trapping while mechanically ventilated. The study findings imply that alveolar flooding is a more important contributor than alveolar collapse to loss of aeration and lung consolidation in early experimental ALI. FRC monitoring as an adjunct to monitoring of arterial oxygenation may be of clinical value when judging the progress of ALI and the effects of changed PEEP. Furthermore, airflow obstruction and gas trapping are not prominent features of injury to dependent lung regions in early ALI. In the patients, however, mechanical heterogeneity of the injured lung with maldistribution of ventilation and gas trapping, possibly due to airway closure and/or obstruction, mandates for further confirmative studies. Future development of CT systems with increased resolution will be of value when investigating regional properties of the lung and structural correlates to the loss of aeration and consolidation seen in ALI.
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| 5. |
- Rylander, Lars, et al.
(författare)
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Tidstrender av PFAS-nivåer i serum hos gravida kvinnor
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Högfluorerade ämnen, eller per- och polyfluorerade alkylsyror (PFAS) är mycket stabila ämnen som pga av sina vatten- och fettavvisande egenskaper har många användningsområden. Syftet med den aktuella studien var att studera tidstrender av PFAS under perioden 1995-2014 hos gravida kvinnor.Studien inkluderade 1208 kvinnor i södra Sverige från vilka serumprover samlades in i tidig graviditet. I serumproverna analyserades koncentrationen av fyra olika PFAS, nämligen PFOS (perfluoroktansulfonat), PFOA (perfluoroktansyra), PFNA (perfluornonansyra) och PFHxS (perfluorhexasulfonat).De högsta koncentrationerna och den största minskningen (ca 9% per kalenderår) över tid observerades för PFOS där ca 33% av variationen förklarades av kalenderår. Även PFOA och PFHxS minskade (2,3-3,5% per kalenderår) under studieperioden medan PFNA ökade.Sammanfattningsvis visar studien klara minskningar över tiden av vissa PFAS, men ämnena har lång halveringstid i människa vilket innebär att halterna minskar långsamt och kommer att finnas kvar i kroppen under lång tid. Dessutom är ämnena stabila ute i naturen så människorna kommer fortsatt att exponeras för dem. Vidare är det så att vissa PFAS har förbjudits såsom PFOS vilket fått till följd att nya ämnen som PFNA vilka ersatt dessa ökade under studieperioden.
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| 6. |
- Silverplats, Jennie
(författare)
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In-hospital cardiac arrest and cardiopulmonary resuscitation in Sweden : Healthcare professionals’ competence and compliance with guidelines
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Competence in cardiopulmonary resuscitation (CPR) is the foundation for performing CPR in accordance with guidelines during in-hospital cardiac arrest (IHCA) events, which is crucial to patient survival. All IHCA events are to be reported to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR), but compliance is unclear. This may affect the interpretation of patient characteristics, IHCA care and outcomes.The aim of this thesis was to evaluate CPR competence and compliance with guidelines among in-hospital healthcare professionals (HCP), including evaluation of possible associated factors, patient characteristics, situational factors, and patient outcomes in the in-hospital setting.Methods: Data were collected through surveys among in-hospital HCPs during 2009 and 2013–2016. Further, data from the SRCR, the Swedish PeriOperative Register, and medical records were used to find all treated IHCA events at selected hospitals during 2018–2019. All witnessed IHCA events involving adult patients were evaluated regarding compliance with initial CPR guidelines.Results: The theoretical knowledge of CPR was poor and self-assessed abilities of performing CPR were low. Recent CPR training, working on a monitored ward, and being a nurse or physician were factors associated with higher knowledge and ratings of abilities. A majority of HCPs showed positive attitudes towards being required to perform CPR. However, attitudes in real-life IHCA situations signaled a possible perceived lack of resources. The case completeness of IHCA events in the SRCR was lacking. Most non-reported events occurred on monitored wards, with differences from reported events observed. Compliance with initial CPR guidelines was higher among HCPs on monitored wards versus non-monitored wards, but the place of arrest was not associated with patient outcome.Conclusion: The results underline the importance of frequent CPR training, especially on non-monitored wards, and of compliance with initial CPR guidelines. Non-reporting of IHCA events on monitored wards affects the interpretation of patient characteristics, IHCA care and outcomes. The procedures for reporting IHCA to the SRCR need to be well established. Reviews of patient medical records from monitored wards may improve case completeness in the SRCR.
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| 7. |
- Sjöblom, Ted, et al.
(författare)
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REEDS : Reference data and algorithms for research and development of smart ships
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish Transport Administration Research and Innovation fund for Maritime research funded the project "Reference data and algorithms to support research and development of smart ships". The project goes by the working name, and is communicated as, Reeds. It responds to a synthesis of a number of different needs identified in previous projects and studies. The background to the project is that in recent years the focus has been on developing algorithms to interpret and act on the physical environment around different types of craft. In order to be able to develop and evaluate these algorithms, it has become clear that open datasets and a fair benchmarking platform are required that allow various developers in industries and researchers to evaluate algorithms. In the road vehicle sector, Kitti, as of 2013, is the largest dataset used as a reference dataset. The dataset in this project contains sensor data from several data collection occasions within a maritime context, from high-precision sensors such as cameras, radar, lidar, and IMU. For marine applications, there has been no similar dataset with anywhere near the same amount of data and time synchronisation between sensors. The reference data and reference algorithms were available periodically during the project through an online service where researchers and developers could upload their algorithms to use the dataset.In addition to the dataset itself, Reeds adds additional strengths compared to other reference datasets:- New approach to comparing algorithms fairly, where new algorithms are always compared on a centralised hardware in a cloud service and re-evaluated when new data is added, i.e. an unbiased algorithm evaluation service.- Method that combines NTP and PTP time protocols for synchronisation between the sensors with microsecond accuracy- More types and more modern sensors that can be used at a higher level of abstraction and can thus be applied in more areas.- Sensor fusion of both onboard and land-side sensors- Identify areas of application for navigation and surveillance on land based on the algorithms developed during the project and the use of new sensor types not established in shipping.- The project built up a maritime reference data set that enables the creation of a digital description for the ship's surrounding environment and developed reference algorithms to demonstrate new navigation and monitoring methodology in the area of "enhanced navigation"."Enhanced navigation" is defined under the project as the use of new technology based on developments in digitisation and autonomous functions, where new navigation methods use sensors both on board and ashore to increase maritime safety and robustness. The project has built a web-based user interface referred to in the report as "Crowsnest" that handles these new sensors and visualises this data in a familiar interface similar to an overlay in ECDIS that is openly available for the public to build on. Which was used for the evaluation and concept development of new user interfaces based on feedback from pilots and VTS operators.By providing reference datasets and reference algorithms with demonstrations, researchers and companies now have the opportunity to develop algorithms for the intelligent and autonomous ships of the future.
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