| 1. |
- Borregaard, Britt, et al.
(författare)
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Association between frailty and self-reported health following heart valve surgery
- 2020
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Ingår i: IJC Heart & Vasculature. - : ELSEVIER IRELAND LTD. - 2352-9067. ; 31
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Tidskriftsartikel (refereegranskat)abstract
- Background: Knowledge about the association between frailty and self-reported health among patients undergoing heart valve surgery remains sparse. Thus, the objectives were to I) describe changes in self-reported health at different time points according to frailty status, and to II) investigate the association between frailty status at discharge and poor self-reported health four weeks after discharge among patients undergoing heart valve surgery. Methods: In a prospective cohort study, consecutive patients undergoing heart valve surgery, including transapical/transaortic valve procedures were included. Frailty was measured using the Fried score, and self-reported health using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL-5 Dimensions 5-Levels Health Status Questionnaire (EQ-5D-5L). To investigate the association between frailty and self-reported health, multivariable logistic regression models were used. Analyses were adjusted for sex, age, surgical risk evaluation (EuroScore) and procedure and presented as odds ratios (OR) with 95% confidence intervals (CI). Results: Frailty was assessed at discharge in 288 patients (median age 71, 69% men); 51 patients (18%) were frail. In the multivariable analyses, frailty at discharge remained significantly associated with poor self-reported health at four weeks, OR (95% CI): EQ-5D-5L Index 3.38 (1.51-7.52), VAS 2.41 (1.13-5.14), and KCCQ 2.84 (1.35-5.97). Conclusion: Frailty is present at discharge in 18% of patients undergoing heart valve surgery, and being frail is associated with poor self-reported health at four weeks of follow-up. This supports a clinical need to address the unique risk of frail patients among heart valve teams broadly, and not only to measure frailty as a marker of operative risk. (C) 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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| 2. |
- Burzio, Cecilia, 1991, et al.
(författare)
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Removal of organic micropollutants from municipal wastewater by aerobic granular sludge and conventional activated sludge
- 2022
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Ingår i: Journal of Hazardous Materials. - : Elsevier BV. - 1873-3336 .- 0304-3894. ; 438
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Tidskriftsartikel (refereegranskat)abstract
- Removal performances of organic micropollutants by conventional activated sludge (CAS) and aerobic granular sludge (AGS) were investigated at a full-scale wastewater treatment plant. Lab-scale kinetic experiments were performed to assess the micropollutant transformation rates under oxic and anoxic conditions. Transformation rates were used to model the micropollutant removal in the full-scale processes. Metagenomic sequencing was used to compare the microbial communities and antimicrobial resistance genes of the CAS and AGS systems. Higher transformation ability was observed for CAS compared to AGS for most compounds, both at the full-scale plant and in the complementary batch experiments. Oxic conditions supported the transformation of several micropollutants with faster and/or comparable rates compared to anoxic conditions. The estimated transformation rates from batch experiments adequately predicted the removal for most micropollutants in the full-scale processes. While the compositions in microbial communities differed between AGS and CAS, the full-scale biological reactors shared similar resistome profiles. Even though granular biomass showed lower potential for micropollutant transformation, AGS systems had somewhat higher gene cluster diversity compared to CAS, which could be related to a higher functional diversity. Micropollutant exposure to biomass or mass transfer limitations, therefore played more important roles in the observed differences in OMP removal.
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| 3. |
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| 4. |
- Ekholm, Maria, et al.
(författare)
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Highly reproducible results of breast cancer biomarkers when analysed in accordance with national guidelines - a Swedish survey with central re-assessment
- 2015
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Ingår i: Acta Oncologica. - : TAYLOR and FRANCIS LTD. - 0284-186X .- 1651-226X. ; 54:7, s. 1040-1048
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Tidskriftsartikel (refereegranskat)abstract
- Background. Biomarkers are crucial for decisions regarding adjuvant therapy in primary breast cancer, and their correct assessment is therefore of the utmost importance. Aims. To investigate the concordance between Swedish pathology departments and a reference laboratory, for routine analysis of oestrogen receptor (ER), progesterone receptor (PR), Ki67, and human epidermal growth factor receptor 2 (HER2), alone, and in combination (St Gallen subtypes). Methods. This survey included 27 of the 28 pathology laboratories in Sweden, covering 98% of cases of primary breast cancer surgery in Sweden. Paraffin-embedded tumour blocks (n = 270) were collected and sent to the central reference laboratory, together with the originally stained slides, for re-analysis. The primary evaluations were previously performed according to national Swedish guidelines, without any knowledge of the subsequent central assessment. Results. The agreement for ER, PR, and Ki67 was 99% [kappa value (kappa) = 0.95], 95% (kappa = 0.85), and 85% (kappa = 0.70), respectively. The agreement for HER2 (0/1 + vs. 2+/3+) was 85% (kappa = 0.64), but when equivocal tumours were further analysed with in situ hybridisation, only one discrepancy was observed. Discrepancies between results for ER and PR seem to be explained by analytical differences, whereas the interpretation of staining seems to be more critical for Ki67 and HER2 immunohistochemistry. The agreement between the results from the Swedish laboratories and the reference laboratory, based on the St Gallen subtypes, was 88% (kappa = 0.81). Conclusions. When applying national guidelines, highly reproducible results were obtained in routine assessment of breast cancer biomarkers, and the results of this study confirm the clinical utility of these markers for decisions regarding the treatment of primary breast cancer.
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| 5. |
- Ekholm, Maria, et al.
(författare)
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Two Years of Adjuvant Tamoxifen Provides a Survival Benefit Compared With No Systemic Treatment in Premenopausal Patients With Primary Breast Cancer: Long-Term Follow-Up (> 25 years) of the Phase III SBII:2pre Trial
- 2016
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Ingår i: Journal of Clinical Oncology. - : AMER SOC CLINICAL ONCOLOGY. - 0732-183X .- 1527-7755. ; 34:19, s. 2232-
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this study was to evaluate the long-term effect of 2 years of adjuvant tamoxifen compared with no systemic treatment (control) in premenopausal patients with breast cancer over different time periods through long-term (amp;gt; 25 years) follow-up. Patients and Methods Premenopausal patients with primary breast cancer (N = 564) were randomly assigned to 2 years of tamoxifen (n = 276) or no systemic treatment (n = 288). Data regarding date and cause of death were obtained from the Swedish Cause of Death Register. End points were cumulative mortality (CM) and cumulative breast cancer-related mortality (CBCM). The median follow-up for the 250 patients still alive in April 2014 was 26.3 years (range, 22.7 to 29.7 years). Results In patients with estrogen receptor-positive tumors (n = 362), tamoxifen was associated with a marginal reduction in CM (hazard ratio [HR], 0.77; 95% CI, 0.58 to 1.03; P = .075) and a significant reduction in CBCM (HR, 0.73; 95% CI, 0.53 to 0.99; P = .046). The effect seemed to vary over time (CM years 0 to 5: HR, 1.05; 95% CI, 0.64 to 1.73; years amp;gt;5 to 15: HR, 0.58; 95% CI, 0.37 to 0.91; and after 15 years: HR, 0.82; 95% CI, 0.48 to 1.42; CBCM years 0 to 5: HR, 1.09; 95% CI, 0.65 to 1.82; years amp;gt;5 to 15: HR, 0.53; 95% CI, 0.33 to 0.86; and after 15 years: HR, 0.72; 95% CI, 0.36 to 1.44). Conclusion Two years of adjuvant tamoxifen resulted in a long-term survival benefit in premenopausal patients with estrogen receptor-positive primary breast cancer. (C) 2016 by American Society of Clinical Oncology. Creative Commons Attribution Non-Commercial No Derivatives 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/
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| 6. |
- Ekholm, Therese
(författare)
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Animals and Humans : Human-animal interaction in northern Sweden during the late glacial and postglacial time
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- When the last remnant of the Weichsel glacier melted in northern Sweden, around 7000 BC, pioneer settlers entered virgin land, following their prey, which in turn followed the vegetation dispersion. Some of the settlers derived from the east and the northeast and spread from the Russian taiga, through Finland and into northern Sweden, the study area for this thesis. Some of the settlers derived from southwest Europe and spread through Denmark, into south Sweden and northwards. These two main flows of people moved in small groups over large areas, close to the ice margin and shared a lithic technology, but with some differences. These differences can be traced in the debris at archaeological sites, along with calcined animal bones. This thesis focuses on the calcined bones and the seemingly most important prey for the southern and eastern settlers respectively, and the changes that occurred during the time frame of 9000-4000 BC. This has been done by identifying Mesolithic sites with calcined bones, selecting bone samples from the assemblages, determining species and radiocarbon dating the samples. The species in focus are reindeer (Rangifer tarandus), elk (Alces alces), beaver (Castor fiber) and seal (Phoca sp.), mainly ringed seal (Phoca hispida), which are the largest and most common species found at the sites. To support the results, previously radiocarbon-dated calcined-bone samples and charcoal samples, found in connection with species-determined bones, are included. This study shows that the people moving in from the Russian taiga in the east hunted terrestrial mammals (reindeers and elks) in the beginning. They continued doing so, even when they reached the coast of the Baltic Sea, where the ringed seal lived at the time. Not until several thousands of years later were the first seal bones left at Mesolithic sites in northernmost Norrland. The people moving in from the south, on the other hand, hunted both terrestrial mammals and seal. Using an additional set of dates from an expanded area in Sweden, together with southern Norway, it is shown that around the 8.2 k BP cold event (6200 BC), the inland settlers changed their prey from a high-ranked prey to a low-ranked prey owing to population growth and climate change.
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| 7. |
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| 8. |
- Ekholm, Tobias, et al.
(författare)
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Total curvatures of holonomic links
- 2000
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Ingår i: JOURNAL OF KNOT THEORY AND ITS RAMIFICATIONS. - 0218-2165. ; 9:7, s. 893-906
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Tidskriftsartikel (refereegranskat)abstract
- A differential geometric characterization of the braid-index of a link is found. After multiplication by 2 pi, it equals the infimum of the sum of total curvature and total absolute torsion over holonomic representatives of the link.
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| 9. |
- Engström, Terese, et al.
(författare)
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Hormone receptor mRNA and protein levels as predictors of premenopausal tamoxifen benefit
- 2024
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Ingår i: Acta Oncologica. - 0284-186X. ; 63, s. 125-136
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Tamoxifen remains an important adjuvant treatment in premenopausal patients with hormone receptor-positive breast cancer. Thus, determination of hormone receptors is important. Here, we compare cytosol-based methods, immunohistochemistry (IHC), and gene expression (GEX) analysis for determining hormone receptor status in premenopausal breast cancer patients from a randomised tamoxifen trial, to evaluate their performance in identifying patients that benefit from tamoxifen. Patients and Methods: Premenopausal patients (n=564) were randomised to 2 years of tamoxifen or no systemic treatment. Estrogen receptor (ER) and progesterone receptor (PR) status by protein expression measured by cytosol-based methods and IHC, and mRNA by GEX analysis were compared in 313 patients with available data from all methods. Kaplan Meier estimates and Cox regression were used to evaluate the treatment-predictive value for recurrence-free interval (RFi) and overall survival (OS). Median follow-up for event-free patients was 26 (RFi) and 33 (OS) years. Results: The mRNA data of ESR1 and PGR distributed bimodally, patterns confirmed in an independent cohort. Kappa-values between all methods were 0.76 and 0.79 for ER and PR, respectively. Tamoxifen improved RFi in patients with ER-positive (ER+) or PR-positive (PR+) tumours (Hazard Ratio [HR] and 95% confidence interval [CI]), cytosol-ER+ 0.53 [0.36–0.79]; IHC-ER+ 0.55 [0.38–0.79]; GEX-ER+ 0.54 [0.37–0.77]; cytosol-PR+ 0.49 [0.34–0.72]; IHC-PR+ 0.58 [0.40–0.85]; GEX-PR+ 0.55 [0.38–0.80]). Results were similar for OS. Interpretation: These methods can all identify patients that benefit from 2 years of tamoxifen with equal performance, indicating that GEX data might be used to guide adjuvant tamoxifen therapy.
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| 10. |
- Hedman, Kristina, et al.
(författare)
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Orimlig ökning av adhd-diagnoser
- 2024
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Ingår i: Svenska dagbladet. - 1101-2412.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Sveriges neuropsykologers förening: Ökningen av adhd-diagnoser är ett samhällsproblem som inte kan lösas enbart av vården, och lösningen finns knappast i en växande mängd av utredningar, diagnoser och medicinering.
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