| 1. |
- Klarin, Bengt, et al.
(författare)
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Susceptibility to antibiotics in isolates of Lactobacillus plantarum RAPD-type Lp299v, harvested from antibiotic treated, critically ill patients after administration of probiotics.
- 2019
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Ingår i: MicrobiologyOpen. - : John Wiley & Sons. - 2045-8827. ; 8:2
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Tidskriftsartikel (refereegranskat)abstract
- Recultured Lactobacillus plantarum 299v-like strains were tested regarding antibiotic susceptibility, and no decrease was detected. Antibiotics are frequently used to treat patients in intensive care units (ICUs) and are associated with a significant risk of selection of resistant bacterial strains. In particular, it is possible that genetic transfer of antibiotic resistance to the resident gastrointestinal flora, as well as to administered probiotics, may be increased in the ICU setting. The aim of the present investigation was to detect possible changes in antimicrobial susceptibility in reisolates of the probiotic strain Lactobacillus plantarum 299v (Lp299v) given to antibiotic treated, critically ill patients. Lp299v-like strains were identified in cultures of biopsies and fecal samples from 32 patients given the probiotic strain enterally in two previous ICU studies. The patients received a variety of antibiotics. Isolates with the same genomic RAPD profile (RAPD-type) as Lp299v were obtained to enable monitoring of antibiotic susceptibility by E-tests. Forty-two isolates, collected throughout the course of illness, were tested against 22 different antibiotics. No obvious decrease in susceptibility was found for 21 of the tested antibiotics. There was a tendency toward decreased susceptibility to ampicillin. The stable antibiotic susceptibility profiles of the Lp299v-like isolates studied here suggests this probiotic is less likely to acquire resistance when administered to critically ill patients treated with broad-spectrum antibiotics.
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| 2. |
- Arnell, Magnus, et al.
(författare)
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Modellering av avloppsreningsverk för multikriteriebedömning av prestanda och miljöpåverkan
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Genom att använda detaljerade dynamiska modeller och kombinera resultat från årslånga simuleringar av ARV (såväl vatten- som slamlinjer) med livscykelanalys kan olika driftstrategier utvecklas och utvärderas utifrån en bred uppsättning hållbarhetskriterier fö att maximera resursutvinning och energieffektivitet samtidigt som vattenkvalitén bibehålls och driftskostnaderna kontrolleras. Metodiken har tillämpats vid en omfattande fallstudie av Käppalaverket.
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| 3. |
- ARNELL, MAGNUS
(författare)
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Performance Assessment of Wastewater Treatment Plants : Multi-Objective Analysis Using Plant-Wide Models
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As the knowledge about anthropogenic impacts of climate change has grown, the awareness of the contributions from treatment of wastewater has widened the scope for wastewater treatment plants (WWTPs). Not only shall ever stricter effluent constraints be met, but also energy efficiency be increased, greenhouse gases mitigated and resources recovered. All under a constant pressure on costs. The main objective of this research has been to develop a plant-wide modelling tool to evaluate the performance of operational strategies for multiple objectives at the plant and for off-site environmental impact. The plant-wide model platform Benchmark Simulation Model no. 2 (BSM2) has been modified to improve the evaluation of energy efficiency and include greenhouse gas emissions. Furthermore, the plant-wide process model has been coupled to a life cycle analysis (LCA) model for evaluation of global environmental impact. For energy evaluation, a dynamic aeration system model has been adapted and implemented. The aeration model includes oxygen transfer efficiency, dynamic pressure in the distribution system and non-linear behaviour of blower performance. To allow for modelling of energy recovery via anaerobic co-digestion the digestion model of BSM2 was updated with a flexible co-digestion model allowing for dynamic co-substrate feeds. A feasible procedure for substrate characterisation was proposed. Emissions of the greenhouse gases CO2, CH4 and N2O were considered. The bioprocess model in BSM2 was updated with two-step nitrification, four-step denitrification and nitrifier denitrification to capture N2O production. Fugitive emissions of the three gases were included from digestion, cogeneration and sludge storage. The models were tested in case studies for the three areas of development: aeration, co-digestion and greenhouse gas production. They failed to reject the hypothesis that dynamic process models are required to assess the highly variable operations of wastewater treatment plants. All parts were combined in a case study of the Käppala WWTP in Lidingö, Sweden, for comparison of operational strategies and evaluation of stricter effluent constraints. The averaged model outputs were exported to an LCA model to include off-site production of input goods and impact of discharged residues and wastes. The results reveal trade-offs between water quality, energy efficiency, greenhouse gas emissions and abiotic depletion of elemental and fossil resources. The developed tool is generally applicable for WWTPs and the simulation results from this type of combined models create a good basis for decision support.
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| 4. |
- Brorson, Håkan, et al.
(författare)
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Lymfödem
- 2016. - 4
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Ingår i: Kirurgi. - 9789144099842 ; , s. 645-653
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Bokkapitel (refereegranskat)abstract
- Lymfsystemets anatomi och fysiologi. Orsaker till svullnad. Utredning av ödem. Etiologi. Komplikationer vid lymfödem. Behandling och resultat.
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| 5. |
- Carling, Malin S, et al.
(författare)
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Preoperative plasma fibrinogen concentration, factor XIII activity, perioperative bleeding, and transfusions in elective orthopaedic surgery: A prospective observational study
- 2016
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Ingår i: Thrombosis Research. - : Elsevier BV. - 0049-3848. ; 139, s. 142-147
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Tidskriftsartikel (refereegranskat)abstract
- Background: Major orthopaedic surgery involves a calculated risk of bleeding. In other groups of surgical patients, low preoperative plasma fibrinogen concentration and factor XIII (FXIII) activity have been associated with an elevated risk of bleeding. In the present study we investigated the association between preoperative fibrinogen plasma concentration and FXIII activity on bleeding and transfusion requirements in patients undergoing a spinal fusion procedure or hip or knee arthroplasty. Methods: Two hundred and forty-five adult patients undergoing spine fusion surgery (n = 52), total unilateral primary hip arthroplasty (n=114), or total knee arthroplasty (n=79) were included in a prospective observational study. Blood samples were collected <24 h before surgery and analysed for fibrinogen concentration and FXIII activity. Intraoperative and postoperative bleeding volume and transfusion requirements were recorded. Results: Spinal fusion surgery patients with a low preoperative fibrinogen concentration (<= 2.5 g/L) had a greater total perioperative median bleeding volume than patients with fibrinogen > 2.5 g/L (2430 (400-6560) mL vs. 1390 (400-7420) mL, p = 0.029). No significant association between low fibrinogen levels and perioperative bleeding volume was observed for arthroplasty patients. There was no association between low fibrinogen levels and transfusion requirements in any of the groups. Low FXIII activity was not significantly associated with bleeding volume and transfusion requirements in any group. Conclusion: Measurement of preoperative fibrinogen plasma concentration can identify spinal fusion patients with an increased risk of excessive perioperative bleeding. Measurement of FXIII activity cannot identify orthopaedic patients with elevated risk of bleeding.
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| 6. |
- Carling, Malin S, et al.
(författare)
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Transfusions and blood loss in total hip and knee arthroplasty: a prospective observational study
- 2015
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Ingår i: Journal of Orthopaedic Surgery and Research. - : Springer Science and Business Media LLC. - 1749-799X. ; 10:48
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a high prevalence of blood product transfusions in orthopedic surgery. The reported prevalence of red blood cell transfusions in unselected patients undergoing hip or knee replacement varies between 21% and 70%. We determined current blood loss and transfusion prevalence in total hip and knee arthroplasty when tranexamic acid was used as a routine prophylaxis, and further investigated potential predictors for excessive blood loss and transfusion requirement. Methods/materials: In total, 193 consecutive patients undergoing unilateral hip (n = 114) or knee arthroplasty (n = 79) were included in a prospective observational study. Estimated perioperative blood loss was calculated and transfusions of allogeneic blood products registered and related to patient characteristics and perioperative variables. Results: Overall transfusion rate was 16% (18% in hip patients and 11% in knee patients, p = 0.19). Median estimated blood loss was significantly higher in hip patients (984 vs 789 mL, p < 0.001). Preoperative hemoglobin concentration was the only independent predictor of red blood cell transfusion in hip patients while low hemoglobin concentration, body mass index, and operation time were independent predictors for red blood cell transfusion in knee patients. Conclusions: The prevalence of red blood cell transfusion was lower than previously reported in unselected total hip or knee arthroplasty patients. Routine use of tranexamic acid may have contributed. Low preoperative hemoglobin levels, low body mass index, and long operation increase the risk for red blood cell transfusion.
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| 7. |
- Hansson, Emma C., 1985, et al.
(författare)
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Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel : a nationwide study
- 2016
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 37:2, s. 189-197
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Tidskriftsartikel (refereegranskat)abstract
- AIMS:Excessive bleeding impairs outcome after coronary artery bypass grafting (CABG). Current guidelines recommend withdrawal of clopidogrel and ticagrelor 5 days (120 h) before elective surgery. Shorter discontinuation would reduce the risk of thrombotic events and save hospital resources, but may increase the risk of bleeding. We investigated whether a shorter discontinuation time before surgery increased the incidence of CABG-related major bleeding complications and compared ticagrelor- and clopidogrel-treated patients.METHODS AND RESULTS:All acute coronary syndrome patients in Sweden on dual antiplatelet therapy with aspirin and ticagrelor (n = 1266) or clopidogrel (n = 978) who underwent CABG during 2012-13 were included in a retrospective observational study. The incidence of major bleeding complications according to the Bleeding Academic Research Consortium-CABG definition was 38 and 31%, respectively, when ticagrelor/clopidogrel was discontinued <24 h before surgery. Within the ticagrelor group, there was no significant difference between discontinuation 72-120 or >120 h before surgery [odds ratio (OR) 0.93 (95% confidence interval, CI, 0.53-1.64), P = 0.80]. In contrast, clopidogrel-treated patients had a higher incidence when discontinued 72-120 vs. >120 h before surgery (OR 1.71 (95% CI 1.04-2.79), P = 0.033). The overall incidence of major bleeding complications was lower with ticagrelor [12.9 vs. 17.6%, adjusted OR 0.72 (95% CI 0.56-0.92), P = 0.012].CONCLUSION:The incidence of CABG-related major bleeding was high when ticagrelor/clopidogrel was discontinued <24 h before surgery. Discontinuation 3 days before surgery, as opposed to 5 days, did not increase the incidence of major bleeding complications with ticagrelor, but increased the risk with clopidogrel. The overall risk of major CABG-related bleeding complications was lower with ticagrelor than with clopidogrel.
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| 8. |
- Håkansson, Åsa, et al.
(författare)
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Immunological alteration and changes of gut microbiota after dextran sulfate sodium (DSS) administration in mice
- 2015
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Ingår i: Clinical and Experimental Medicine. - : Springer Science and Business Media LLC. - 1591-9528. ; 15:1, s. 107-120
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Tidskriftsartikel (refereegranskat)abstract
- Ulcerative colitis (UC) is characterized bychronic inflammation of the colonic mucosa. Administrationof dextran sulfate sodium (DSS) to animals is a frequentlyused model to mimic human colitis. Deregulationof the immune response to the enteric microflora orpathogens as well as increased intestinal permeability havebeen proposed as disease-driving mechanisms. To enlargethe understanding of the pathogenesis, we have studied theeffect of DSS on the immune system and gut microbiota inmice. Intestinal inflammation was verified through histologicalevaluation and myeloperoxidase activity. Immunologicalchanges were assessed by flow cytometry inspleen, Peyer0s patches and mesenteric lymph nodes andthrough multiplex cytokine profiling. In addition, quantificationof the total amount of bacteria on colonic mucosaas well as the total amount of lactobacilli, Akkermansia,Desulfovibrio and Enterobacteriaceae was performed bythe use of quantitative PCR. Diversity and communitystructure were analysed by terminal restriction fragmentlength polymorphism (T-RFLP) patterns, and principalcomponent analysis was utilized on immunological andT-RFLP patterns. DSS-induced colitis show clinical andhistological similarities to UC. The composition of thecolonic microflora was profoundly changed and correlatedwith several alterations of the immune system. The resultsdemonstrate a relationship between multiple immunologicalchanges and alterations of the gut microbiota after DSSadministration. These data highlight and improve the definitionof the immunological basis of the disease andsuggest a role for dysregulation of the gut microbiota in thepathogenesis of colitis.
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| 9. |
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| 10. |
- Polistena, Andrea, et al.
(författare)
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Surgical treatment of secondary hyperparathyroidism in elderly patients : an institutional experience
- 2017
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Ingår i: Aging clinical and experimental research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 29:suppl. 1, s. 23-28
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Tidskriftsartikel (refereegranskat)abstract
- Background: Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. Aim: The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Methods: Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. Results: In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. Discussion: Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. Conclusions: Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.
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