| 1. |
- Eriksson, J., et al.
(författare)
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Metformin or SGLT2 inhibitor as 1st line treatment of type 2 diabetes? Design and interim results of the SMARTEST trial
- 2023
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier. - 0168-8227 .- 1872-8227. ; 197:Supl. 1
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Metformin is generally recommended as 1 st line medication in T2D. However, there is no compelling evidence of its superiority in preventing diabetes complications. SGLT2 inhibitors prevent cardiovascular mortality, heart failure and renal impairment in T2D patients at high cardiovascular risk.Aim: To assess whether an SGLT2 inhibitor is superior to metformin in preventing organ complications and premature death in early-stage T2D.Method: The SMARTEST study (SGLT2 inhibitor or Metformin As standaRd Treatment of Early Stage Type 2 diabetes) is a registry-based trial in primary care. Participants are included via on-site or video visits at 31 centers across Sweden; T2D <4 yr; drugnaïve (currently 31%) or montherapy; no cardiorenal diseases. Randomizaton 1:1, open label metformin (individualized dose) or dapagliflozin 10 mg/day. Diet, exercise and other medications are stipulated according to national guidelines. Patients are followed 2–6 yrs.Endpoints are collected using NDR and the national Patient Registry. The study will close when 844 primary endpoint events have occurred, giving 90% power to detect a HR of 0.8 for dapagliflozin vs metformin. Primary composite endpoint: time to death, myocardial infarction, stroke, heart failure or appearance/progression of microvascular complications (retinopathy, nephropathy, diabetic foot lesions). Other endpoints include: need for insulin therapy; blood pressure, BMI, HbA1c, PROM and health economy.Results: From late 2019 until May 2022 1100 patients are included. 38% are females, mean age is 60 years and HbA1c 46.5 mmol/mol (6.4%). So far, the primary endpoint event rate is 11/100 patient years (PY), whereas 7/100 PY was estimated from previous data. Nephropathy and foot-at-risk had high rates (6 and 3/100 PY) but MACE was rare (1/100 PY). The recruitment target is 2700 participants, expected by end 2023.Conclusion: Final results are expected in 2025 and can challenge or, equally important, reinforce the current metformin paradigm in early T2D. Event rates are higher than previously recognized for nephropathy and diabetic foot problems but lower for MACE.
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| 2. |
- Alfredsson, Joakim, 1962-, et al.
(författare)
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Randomized comparison of early supplemental oxygen versus ambient air in patients with confirmed myocardial infarction : Sex-related outcomes from DETO2X-AMI
- 2021
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Ingår i: American Heart Journal. - : Mosby Inc.. - 0002-8703 .- 1097-6744. ; 237, s. 13-24
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of this study is to investigate the impact of oxygen therapy on cardiovascular outcomes in relation to sex in patients with confirmed myocardial infarction (MI).Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction trial randomized 6,629 patients to oxygen at 6 L/min for 6-12 hours or ambient air. In the present subgroup analysis including 5,010 patients (1,388 women and 3,622 men) with confirmed MI, we report the effect of supplemental oxygen on the composite of all-cause death, rehospitalization with MI, or heart failure at long-term follow-up, stratified according to sex.Results: Event rate for the composite endpoint was 18.1% in women allocated to oxygen, compared to 21.4% in women allocated to ambient air (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.65-1.05). In men, the incidence was 13.6% in patients allocated to oxygen compared to 13.3% in patients allocated to ambient air (HR 1.03, 95% CI 0.86-1.23). No significant interaction in relation to sex was found (P=.16). Irrespective of allocated treatment, the composite endpoint occurred more often in women compared to men (19.7 vs 13.4%, HR 1.51; 95% CI, 1.30-1.75). After adjustment for age alone, there was no difference between the sexes (HR 1.06, 95% CI 0.91-1.24), which remained consistent after multivariate adjustment.Conclusion: Oxygen therapy in normoxemic MI patients did not significantly affect all-cause mortality or rehospitalization for MI or heart failure in women or men. The observed worse outcome in women was explained by differences in baseline characteristics, especially age
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| 4. |
- Girlanda, O., et al.
(författare)
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Defect sensitivity and strength of paperboard in out-of-plane tension and shear
- 2005
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Ingår i: Journal of Pulp and Paper Science (JPPS). - 0826-6220. ; 31:2, s. 100-104
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Tidskriftsartikel (refereegranskat)abstract
- This paper considers the effects of defects in the form of cracks on the failure properties in the thickness direction of multilayered board. The objective was to study how the peak stress value changes with various crack lengths under various load conditions. Specimens with manufactured cracks cut parallel to the machine-direction-cross-machine-direction plane were glued in the Arcan device and tested under pure tensile stress and mixed shear-tensile stress. The lower peak out-of-plane tensile stress measured in damaged samples indicates a defect sensitivity in multilayered board. The results for one type of board show that the loss in tensile strength is independent of the crack length. On the other hand, mixed shear and tensile stress behaviour does not appear to be influenced by the presence of cracks.
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| 7. |
- Lif, Jan O., et al.
(författare)
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Applicability of Anisotropic Viscoelasticity of Paper at Small Deformations
- 1999
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Ingår i: Mechanics of time-dependant materials. - : Springer. - 1385-2000 .- 1573-2738. ; 2:3, s. 245-267
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Tidskriftsartikel (refereegranskat)abstract
- In this paper the applicability of two-dimensional phenomenlogical linear viscoelastic modelling aimed at printing applications is presented. An iterative algorithm is used to find model parameters evaluated from dynamic mechanical testing at stationary conditions. Experiments are performed in the time domain with different load stimuli in either displacement or force control. The experiments are compared to model predictions.The results show that only small deviations were found on model parameters from the algorithm used on either the loss or the storage properties of paper. This was illustrated by converting line spectra from storage compliances to loss compliances within the frequency domain. The harmonic properties were obtained at conditions with nonlinear material behaviour. Despite this, the two-dimensional linear viscoelastic model described well the behaviour of paper at different states of stress and strain at levels adequate for web-fed printing. The usefulness of the relation between retardances and relaxances was examined by comparing model predictions with different driving stimuli resulting in either creep or relaxation. The time-dependent transverse strain of machine-made paper due to either longitudinal stress relaxation or creep was demonstrated. Finally, extensions of the present model including inelastic material behaviour were discussed.
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| 8. |
- Mellin, Pelle, et al.
(författare)
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A proposed Swedish national standard and best practice for detection of Ar in PM hip material
- 2018
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Ingår i: Euro PM 2018 Congress and Exhibition. - : European Powder Metallurgy Association (EPMA). - 9781899072507
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Konferensbidrag (refereegranskat)abstract
- Ar in metal is present as gaseous voids which affect the material performance; most notably the mechanical properties. In agreement with literature findings, our investigation confirms this for 316L steel produced by PM HIP. Detecting the Ar is possible by microscopy, but more reliably with inert gas fusion followed by gas chromatography or mass spectrometry. The users of these techniques have accumulated experience over the years and consider them robust, especially in terms of distinguishing a presence or absence of Ar. Since consensus has emerged, a standard is now possible. We propose firstly a national standard. It may be used as a quality agreement between the purchaser and provider of the PM HIP service. The proposed standard considers the distinctiveness of PM HIP. For example that Ar tends to segregate in PM HIP cans. In fact, consensus has also been reached on how to reliably sample from PM HIP cans. © European Powder Metallurgy Association (EPMA).
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| 9. |
- Mukka, Sebastian, et al.
(författare)
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Study protocol: The DAICY trial-dual versus single-antibiotic impregnated cement in primary hemiarthro-plasty for femoral neck fracture-a register-based cluster-randomized crossover-controlled trial
- 2022
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 93, s. 794-800
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Older patients with a dis-placed femoral neck fracture (FNF) are often treated with a cemented primary hemiarthroplasty (HA). The DAICY trial investigates whether high-dose dual-impregnated antibiotic -loaded cement (DIAC) including gentamicin and clindamy-cin can reduce the risk of periprosthetic joint infection (PJI) in comparison with low-dose single-impregnated gentami-cin antibiotic-loaded cement (SIAC), in patients & GE; 60 years treated with a cemented HA for a displaced FNF. Study design - The trial is a national, multicenter, reg-ister-based, cluster-randomized, crossover trial. Patients & GE; 60 years with a non-pathological, displaced FNF (Type Garden 3-4/AO 31-B2 or B3) suitable for HA according to local guidelines are eligible for inclusion. Participating orthopedic departments will be randomized to start with either SIAC (control group) or DIAC treatment (intervention group) for 2 years. After 2 years, the study departments will then change to the other treatment arm for the remaining 2 years of the study. Approximately 7,000 patients will be included. The study is pragmatic in that the choice of implant brands, sur-gical approach and peri-and postoperative protocols follow the local routines of each participating department. All out-come variables will be retrieved after linkage of the studycohort to the following Swedish registers: the Fracture Reg-ister, the Arthroplasty Register, the National Patient Register and the Prescribed Drug Registry Outcome - The primary outcome will be periprosthetic joint infection of the index joint within 1 year after surgery. Secondary outcomes will be any reoperation on the index joint, mortality within 90 days and 1 year, resistance patterns of causative bacteria in cases of PJI, and health economics. Potential added value - This trial is designed to sup-port or refute the efficacy of DIAC used in patients with a dis-placed FNF, potentially reducing PJI and resource allocation. Start of the trial and estimated duration - The DAICY trial started recruiting patients in January 2022 and will continue recruiting for approximately 4 years. Complete follow-up expected in 5 years.
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