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- Esmaily, Sorosh, et al.
(författare)
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Patient Outcomes after Heart Transplantation in Sweden between 1988 and 2017: Continuous Improvement in Survival.
- 2020
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Ingår i: The Journal of heart and lung transplantation. 39 (4), S284. - : Elsevier BV. - 1557-3117 .- 1053-2498.
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Konferensbidrag (refereegranskat)abstract
- To investigate the survival of heart transplant (HTx) recipients during different time periods in Sweden. We hypothesized that the survival for HTx recipients has improved following advancements in the management of these patients.Data was obtained through the database of the organ exchange organization Scandiatransplant. All patients who underwent HTx in Sweden between Jan 1988 and Dec 2017 were included. Patients were divided into five cohorts of six-year periods each.A total of 1137 HTx recipients were included. Main causes of transplantation were dilated cardiomyopathy (44 %) and ischemic heart disease (18 %). Retransplantation constituted a small portion of the overall total (2 %). The cohorts were similar in terms of age and gender, while later cohorts had higher BMI, lower GFR and longer ischemia time (Tab. 1). The later cohorts received organs from older donors (Tab. 1). The amount of heart transplantations performed in Sweden has increased with time (Tab. 1). Log-rank test comparing the survival curves was able to show improved survival during later eras (Fig. 1).Survival among HTx recipients has significantly improved in Sweden over time, despite less favorable recipients and donor characteristics. This was related to both reduced postoperative mortality and also improved long-time survival.
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- Fine, Kimberly L., et al.
(författare)
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Association Between Early Prescribed Opioid Initiation and Risk of Suicidal Behavior
- 2020
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Prescription opioid use has been linked to increased risk of suicidal behavior in adults. However, little research exists examining the role of prescription opioid use on risk of suicidal behavior in children and adolescents. This population is at high risk for suicidal behavior, as suicide is the second leading cause of death for people ages 10 to 34. Using healthcare data from Swedish population registers, we aimed to characterize the extent to which exposure to opioids at a young age leads to an increased risk of new onset suicidal behavior, for those with no history of suicidal behavior. Compared to demographically matched non-recipients, young people who initiated prescription opioids had just under three times the rate of subsequent suicidal behavior (HR = 2.64, 95% CI, 2.47-2.81). Compared to their unexposed siblings, young people who initiated prescription opioids had roughly two times the rate of subsequent suicidal behavior (HR = 1.83, 95% CI, 1.67-2.01). Finally, compared to young people initiating prescription NSAIDs, young people who initiated prescription opioids had only 19% relatively greater rates of suicidal behavior (HR, 1.19, 95% CI, 1.11-1.27). These results suggest the association between prescription opioids and suicidal behavior may be driven by the underlying pain indication.
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- Nilsson, J., et al.
(författare)
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Non-Ischemic Heart Preservation versus Static Cold Storage in Human Heart Transplantation
- 2020
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Ingår i: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. - : Elsevier BV. - 1557-3117. ; 39:4, s. 135-135
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Konferensbidrag (refereegranskat)abstract
- PURPOSE: Pre-clinical studies have shown that ex vivo non-ischemic heart preservation (NIHP) method can be safely used for 24 hours. This state-of-the-art method has never been applied on humans. The primary objective of the study was to evaluate the efficacy and safety of the NIHP method on early and late human heart allograft function compared with static cold storage (SCS). METHODS: We performed a prospective, open-label, non-randomised phase II study. All adult recipients listed for heart transplantation were included, unless they met any exclusion criteria. The primary endpoint was a composite of survival free of severe primary graft dysfunction, free of ECMO use within 7 days, and free of acute cellular rejection ≥2R within 180 days. Secondary endpoints were I/R-tissue injury, immediate graft function, and adverse event. Of the 37 eligible patients, nine were assigned to the NIHP method and 28 to SCS. RESULTS: The median age was 51 years (interquartile range (IQR), 37-58) for the donors and 56 years (IQR, 46 - 63) for the recipients. The median preservation time was significant longer for the NIHP group, 251 min (IQR, 219-269) compared with the SCS group, 199 min (IQR, 164 - 227), P=0.008. Over the first three months, all of the patients assigned to the NIHP group achieved event-free survival, compared with 21 (75%) of those assigned to the SCS group (Kaplan-Meier estimate of event free survival 75% (95% CI 55-87%); P=0.124). CK-MB assessed 6±2 h after ending perfusion was 77 (IQR, 54-101) ng/mL for the NIHP group compared with 137 (IQR, 73-196) ng/mL for the SCS group, P=0.030. Four (16%) death within six months after transplantation and three (12%) cardiac-related adverse events were reported in the SCS group compared with no deaths or cardiac-related adverse events in the NIHP group. CONCLUSION: This first-in-human study shows the NIHP method's feasibility and safety for use in the clinic of heart transplantation.
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- Brenner, P., et al.
(författare)
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Worldwide First Successful and Reproducable Long-Term Survival up to Half a Year : Completed Preclinical Study with Life-Supporting Orthotopic Pig-to-Baboon Cardiac Xenotransplantation (oXHTx) Fullfilling the ISHLT Prerequisite for Clinical Cardiac Xenotransplantation
- 2020
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Ingår i: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. - : Elsevier BV. - 1557-3117. ; 39:4, s. 12-12
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Konferensbidrag (refereegranskat)abstract
- PURPOSE: Major hurdles in oXHTx are the delayed xenograft rejection, the early perioperative cardiac xenograft dysfunction (PCXD) and the pig heart overgrowth, which were solved in this study with a costimulation blockade, a new non-ischemic cold preservation and a growth inhibition by anti-proliferative drugs. Aim was to achieve a 90-days-survival of minimal 60% (6 of 10 baboons) in this life-supporting orthotopic pig-to-baboon model (oXHTx), because this is the recommendation of the ISHLT to begin a clinical cardiac XT program. METHODS: We transplanted 8 GalKO/hCD46/hTM transgenic (tg) pig hearts orthotopically into baboons with using a basic immunosuppression consisting of ATG, rituximab, mycophenolate (MMF), cortisone and a costimulation blockade CD40mAb (high dose: 50 mg/kg). To prevent PCXD, we used instead of the crystalloid solution a new non-ischemic 8°C cold perfusion technique with oxygenated erythrocytes. Additional antihypertensive drugs and an mTOR inhibitor (temsirolimus) were applied to inhibit pig xenograft growth and hypertrophy. RESULTS: In comparison to our previous group with crystalloid cardioplegia (Längin et al. Nature. 2018;564:430-433) in this group with cold perfusion preservation (non-ischemic) no PCXD was found. One baboon died of a pancreatitis on day 14, another of sepsis on day 26. By using the antiproliferative therapy, 6 of 8 recipient baboons reached the end of study, were long-term surviving (4 were actively terminated after 90 days according to the guidelines of our government). With special permit two further experiments could be prolonged to half a year and the animals were terminated on day 182 and 195. All baboons lived under excellent physical conditions and no hyperacute rejection or DXR occurred. CONCLUSION: First time in a life-supporting oXHT of multi-tg pig hearts here was a consistent reproduceable long-term survival of 3 - 6 months achieved, which is a major progress after 25 years of research. This is an essential milestone and breakthrough and meets the prerequisite according to the ISHLT to begin a clinical phase I study with patients in terminal heart failure. This paves the way to clinical cardiac XT in the next 2 to 5 years.
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- Irestorm, Elin, et al.
(författare)
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Auditory hypersensitivity and attention in survivors of paediatric brain tumours
- 2020
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Konferensbidrag (refereegranskat)abstract
- Objective: Both auditory and visual hypersensitivity are clinical features of mental fatigue after acquired brain damage or in neurological disorders. Both types of hypersensitivity are also associated with attention deficits, especially in neurodevelopmental syndromes. The aim of this study was to examine auditory and visual hypersensitivity, and associations to attention, in a group of children and adolescents treated for paediatric brain tumours (PBTs).Participants and Methods: Included in the study were 34 survivors of PBTs, 8–18 years of age (M: 13.6, SD: 3.0). Eighteen participants were female and 16 were male. Mean time since diagnosis was 4.2 years (SD: 2.2). Auditory and visual hypersensitivity were assessed using two items from the questionnaire Mental Fatigue Scale (MFS), scored on a 7-point Likert scale from 0 – 3. Scores above 1 indicate hypersensitivity. Attention was assessed using Conners Continuous Performance Test 3 (detectability, commissions, variability), and T-scores above 60 were considered impaired. Spearman correlations were conducted between the performance-based and self-report measures.Results: Results from the MFS revealed that 53% of the survivors experienced auditory and 18% visual hypersensitivity as a sequela. Regarding attention, elevated scores were more common for detectability (18%) and variability (21%) than commissions (8%). Visual hypersensitivity was not significantly associated with any of the attention measures, whereas auditory hypersensitivity was significantly associated with detectability (r=.42, p=0.013) and variability (r=.57, p<0.001).Conclusions: These results suggest that auditory hypersensitivity is common after treatment for PBT, and that it is associated with decreased attention. This relationship should be taken into consideration when assessing survivors of PBTs.
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| 8. |
- Kylén, Erik, et al.
(författare)
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Development of an Animated Video for Pre- and Postoperative Learning for Osteoarthritis Patients
- 2020
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Ingår i: Education and New Developments 2020. - Lisboa, Portugal. - 9789895481521 ; , s. 428-432
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Osteoarthritis (OA) is a condition in the joint that is developing for a long time and hit first and mainlyarticular cartilage, and it is a long-term chronic disease characterized by deterioration. In the final stage itis affected all the tissues of the joints such as bones, ligaments, arthritis, joint fluid and muscles, whichresults in bones rubbing together and creating stiffness, pain, and impaired movement. This disease canaffect the joints in the knees, hands, feet, spine and shoulder. OA is the single most common cause ofdisability in older adults worldwide. Patients need to receive detailed information about the disability,learn about their disease, its treatment and how to follow recommendations both before and after thesurgery. As hospital stays are shortening the need of information is increasing, as the patients need toprepare themselves at home before the operation, as well as take care of their rehabilitation when they arecoming home, discharged from hospital. In this paper we present a case study about the development of aweb-based animated video that was developed to support the learning for patients with OA, using adesign science research approach. DSR is an iterative process that include three iterative research cycles.The relevance cycle provided the requirements for the application from the very beginning. The relevancecycle, the rigor cycle and the design cycle were conducted iteratively, and have generated designalternatives that have been evaluated in discussions with OA surgery physicians, as representatives fromthe application domain.
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