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| 2. |
- Ekerstad, Niklas, et al.
(författare)
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Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acute myocardial infarction
- 2022
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Ingår i: European Heart Journal. - : Oxford University Press. - 2048-8726 .- 2048-8734. ; 11:2, s. 89-98
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Data on the prognostic value of frailty to guide clinical decision-making for patients with myocardial infarction (MI) are scarce. To analyse the association between frailty classification, treatment patterns, in-hospital outcomes, and 6-month mortality in a large population of patients with MI.Methods and results: An observational, multicentre study with a retrospective analysis of prospectively collected data using the SWEDEHEART registry. In total, 3381 MI patients with a level of frailty assessed using the Clinical Frailty Scale (CFS-9) were included. Of these patients, 2509 (74.2%) were classified as non-vulnerable non-frail (CFS 1–3), 446 (13.2%) were vulnerable non-frail (CFS 4), and 426 (12.6%) were frail (CFS 5–9). Frailty and non-frail vulnerability were associated with worse in-hospital outcomes compared with non-frailty, i.e. higher rates of mortality (13.4% vs. 4.0% vs. 1.8%), cardiogenic shock (4.7% vs. 2.5% vs. 1.9%), and major bleeding (4.5% vs. 2.7% vs. 1.1%) (allP < 0.001), and less frequent use of evidence-based therapies. In Cox regression analyses, frailty was strongly and independently associated with 6-month mortality compared with non-frailty, after adjustment for age, sex, the GRACE risk score components, and other potential risk factors [hazard ratio (HR) 3.32, 95% confidence interval (CI) 2.30–4.79]. A similar pattern was seen for vulnerable non-frail patients (fully adjusted HR 2.07, 95% CI1.41–3.02).Conclusion: Frailty assessed with the CFS was independently and strongly associated with all-cause 6-month mortality, also after comprehensive adjustment for baseline differences in other risk factors. Similarly, non-frail vulnerability was independently associated with higher mortality compared with those with preserved functional ability.
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| 4. |
- Hellström, Kristina, et al.
(författare)
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Corrosion behavior of a Mo(Si, Al)2 composite at 1700°C in 95% N2 + 5% H2
- 2019
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Ingår i: Journal of the European Ceramic Society. - : Elsevier Ltd. - 0955-2219 .- 1873-619X. ; 39:16, s. 5197-5203
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Tidskriftsartikel (refereegranskat)abstract
- A Mo(Si, Al)2 based composite was pre-oxidized to establish an alumina scale on the material surface. Thereafter, the corrosion behavior of the composite was examined at 1700 °C for up to 24 h in 95% N2 + 5% H2. The weight change was followed by recording the material weight before and after exposure. The crystalline corrosion products were analyzed with X-ray diffraction (XRD) and the microstructure of the cross sectioned material was characterized using scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy (EDS). It was shown that AlN and Al5O6N layers developed on top of the pre-oxidized alumina layer and alumina threads develop out from the specimen surface. The accompanied aluminum consumption converts the substrate Mo(Si,Al)2 into Mo5Si3 immediately below the alumina scale to the extent that the Mo5Si3 becomes porous underneath the alumina scale. Corrosion mechanisms are discussed with the support of thermodynamic calculations.
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| 5. |
- Hellström, Monica, et al.
(författare)
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Innocent left ventricular outflow tract membrane.
- 2011
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 15:150(2), s. e65-e66
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Tidskriftsartikel (refereegranskat)abstract
- Innocent left ventricular outflow tract membranes are rare finding, and may have no significant haemodynamic effect. Thanks to the high resolution of the recent echocardiographs these membranes can be seen in detail. Various shapes and forms of such membranes need to be adequately studied and documented.
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| 6. |
- Hellström, Pia, 1960-
(författare)
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Fenton Pre-treatment of a Birch Kraft Pulp for MFC preparation
- 2015
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The potential to use acidic hydrogen peroxide in the presence of ferrous ions (Fenton’s reagent) as a pre-treatment when producing microfibrillar cellulose (MFC) from a fully bleached birch (Betula verucosa) kraft pulp was investigated and the properties of the produced MFC was compared to the properties of a MFC produced with enzymatic pre-treatment with a monocomponent endoglucanase (FiberCare® R). The mechanical treatment to MFC was performed in a laboratory colloid mill or in a pilot high-pressure homogeniser and the pre-treated pulps as well as the produced MFCs were chemically and morphologically characterised. Additionally, the MFCs produced in the colloid mill were evaluated as strength enhancers in test sheets representing the middle ply of paperboard.From the chemical characterisation, it was concluded that the Fenton pre-treatment caused a decrease in the degree of polymerisation (DP) and an increase in both carboxyl- and carbonyl groups. The increase in carbonyl groups could not be explained by the formation of new reducing end groups due to depolymerisation which indicates that carbonyl groups are introduced along the cellulose chain. The enzymatic pre-treatment as performed in this study caused less impact on the cellulosic material, i.e. resulted in a pulp with a higher DP and a much lower amount of carbonyl- and carboxylic groups compared with the Fenton pre-treated pulps. In the subsequent mechanical treatment in a colloid mill, the Fenton pre-treated pulps were easier to process mechanically i.e. reached a higher specific surface area and a higher surface charge at a given mechanical treatment time compared to enzymatic pre-treated pulps and pulps not subjected to any pre-treatment. These findings were confirmed when MFCs were produced by homogenisation at high pressure in multiple passes; the birch kraft pulp was either pre-treated with Fenton’s reagent or the combined mechanic and enzymatic pre-treatment methodology used at the Centre Technique du Papier (CTP, France). By size fractionation, rheological measurements and scanning electron microscopy, it was revealed that Fenton pre-treatment resulted in MFC suspension containing a significantly higher proportion of small sized material (< 0.2 mm).When the MFCs were evaluated as strength enhancers in test sheets produced from a furnish consisting of a spruce (Picea abies) chemithermomechanical pulp, MFC and a retention system containing cationic starch and an anionic silica sol, Fenton pre-treated MFCs increased the strength properties more than the enzymatic pre-treated MFCs. Addition of 5 wt% Fenton pre-treated MFC resulted in an increase in z-directional strength of about 50%, an increase in tensile stiffness index of about 25% and an increase in tensile index of 35% compared to test sheets prepared without MFC addition.
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| 7. |
- Hodgson, S., et al.
(författare)
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Bone mineral density changes in relation to environmental PCB exposure
- 2008
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Ingår i: Journal of Environmental Health Perspectives. - : Environmental Health Perspectives. - 0091-6765 .- 1552-9924. ; 116:9, s. 1162-1166
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bone toxicity has been linked to organochlorine exposure following a few notable poisoning incidents, but epidemiologic studies in populations with environmental organochlorine exposure have yielded inconsistent results. Objectives: The aim of this study was to investigate whether organochlorine exposure was associated with bone mineral density (BMD) in a population 60-81 years of age (154 males, 167 females) living near the Baltic coast, close to a river contaminated by polychlorinated biphenyls (PCBs). Methods: We measured forearm BMD in participants using dual energy X-ray absorptiometry, and we assessed low BMD using age- and sex-standardized Z-scores. We analyzed blood samples for five dioxin-like PCBs, the three most abundant non-dioxin-like PCBs, and p,p'-dichlorophenyldichloroethylene (p,p'-DDE). Results: In males, dioxin-like chlorobiphenyl (CB)-118 was negatively associated with BMD, the odds ratio for low BMD (Z-score less than -1) was 1.06 (95% confidence interval, 1.01-1.12) per 10 pg/mL CB-118. The sum of the three most abundant non-dioxin-like PCBs was positively associated with BMD, but not with a decreased risk of low BMD. In females, CB-118 was positively associated with BMD, but this congener did not influence the risk of low BMD in women. Conclusions: Environmental organochlorine exposures experienced by this population sample since the 1930s in Sweden may have been sufficient to result in sex-specific changes in BMD.
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| 8. |
- Hyttel-Sorensen, Simon, et al.
(författare)
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A phase II randomized clinical trial on cerebral near-infrared spectroscopy plus a treatment guideline versus treatment as usual for extremely preterm infants during the first three days of life (SafeBoosC) : study protocol for a randomized controlled trial
- 2013
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 14, s. 120-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Every year in Europe about 25,000 infants are born extremely preterm. These infants have a 20% mortality rate, and 25% of survivors have severe long-term cerebral impairment. Preventative measures are key to reduce mortality and morbidity in an extremely preterm population. The primary objective of the SafeBoosC phase II trial is to examine if it is possible to stabilize the cerebral oxygenation of extremely preterm infants during the first 72 hours of life through the application of cerebral near-infrared spectroscopy (NIRS) oximetry and implementation of an clinical treatment guideline based on intervention thresholds of cerebral regional tissue saturation rStO(2). Methods/Design: SafeBoosC is a randomized, blinded, multinational, phase II clinical trial. The inclusion criteria are: neonates born more than 12 weeks preterm; decision to conduct full life support; parental informed consent; and possibility to place the cerebral NIRS oximeter within 3 hours after birth. The infants will be randomized into one of two groups. Both groups will have a cerebral oximeter monitoring device placed within three hours of birth. In the experimental group, the cerebral oxygenation reading will supplement the standard treatment using a predefined treatment guideline. In the control group, the cerebral oxygenation reading will not be visible and the infant will be treated according to the local standards. The primary outcome is the multiplication of the duration and magnitude of rStO(2) values outside the target ranges of 55% to 85%, that is, the 'burden of hypoxia and hyperoxia' expressed in '%hours'. To detect a 50% difference between the experimental and control group in %hours, 166 infants in total must be randomized. Secondary outcomes are mortality at term date, cerebral ultrasound score, and interburst intervals on an amplitude-integrated electroencephalogram at 64 hours of life and explorative outcomes include neurodevelopmental outcome at 2 years corrected age, magnetic resonance imaging at term, blood biomarkers at 6 and 64 hours after birth, and adverse events. Discussion: Cerebral oximetry guided interventions have the potential to improve neurodevelopmental outcome in extremely preterm infants. It is a logical first step to test if it is possible to reduce the burden of hypoxia and hyperoxia.
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| 9. |
- Hyttel-Sorensen, Simon, et al.
(författare)
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Clinical use of cerebral oximetry in extremely preterm infants is feasible
- 2013
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Ingår i: Danish Medical Journal. - 2245-1919. ; 60:1, s. A4533-
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The research programme Safeguarding the Brains of our smallest Children (SafeBoosC) aims to test the benefits and harms of cerebral near-infrared spectroscopy (NIRS) oximetry in infants born before 28 weeks of gestation. In a phase II trial, infants will be randomised to visible cerebral NIRS oximetry with pre-specified treatment guidelines compared to standard care with blinded NIRS-monitoring. The primary outcome is duration multiplied with the extent outside the normal range of regional tissue oxygen saturation of haemoglobin (rStO(2)) of 55 to 85% in percentage hours (burden). This study was a pilot of the Visible Oximetry Group. MATERIAL AND METHODS: This was an observational study including ten infants. RESULTS: The median gestational age was 26 weeks + three days, and the median start-up time was 133 minutes after delivery. The median recording time was 69.7 hours, mean rStO(2) was 64.2 +/- 4.5%, median burden of hyper- and hypoxia was 30.3% hours (range 2.8-112.3). Clinical staff responded to an out of range value 29 times - only once to values above 85%. In comparison, there were 83 periods of more than ten minutes with an rStO(2) below 55% and four episodes with an rStO(2) above 85%. These periods accounted for 72% of the total hypoxia burden. A total of 18 of the 29 interventions were adjustments of FiO(2) which in 13 of the 18 times resulted in an out-of-range SpO(2). Two infants suffered second-degree burns from the sensor. Five infants died. In all cases, this was unrelated to NIRS monitoring and treatment. CONCLUSION: The intervention of early cerebral NIRS monitoring proved feasible, but prolonged periods of hypoxia went untreated. Thus, a revision of the treatment guideline and an alarm system is required.
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| 10. |
- Mohlkert, Lilly -Ann, et al.
(författare)
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Preterm arteries in childhood : dimensions, intima-media thickness, and elasticity of the aorta, coronaries, and carotids in 6-y-old children born extremely preterm
- 2017
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Ingår i: Pediatric Research. - : NATURE PUBLISHING GROUP. - 0031-3998 .- 1530-0447. ; 81:2, s. 299-306
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Preterm birth increases risk for adult cardiovascular disease. We hypothesized that arteries in 6-y-old children born preterm are narrower, with thicker intima-media and stiffer than in peers born at term. METHODS: Children born extremely preterm (EXP, n = 176, birthweights: 348-1,161 g) and at term (CTRL, n = 174, birth weights: 2,430-4,315 g) were included. Using ultrasonography, we determined diameters of the coronaries (CA), common carotid arteries (CCA) and aorta, the carotid intima media thickness (CIMT), and the stiffness index of the CCA and aorta. RESULTS: Arteries were 5-10% narrower in EXP than in CTRL (P < 0.005) but after adjustment for body surface area, diameter differences diminished or disappeared. EXP-children born small for gestational age exhibited similar arterial dimensions as those born appropriate for date. The cIMT was 0.38 (SD = 0.04) mm and did not differ between groups. Carotid but not aortic stiffness was lower in EXP than in CTRL. CONCLUSION: In 6-y-old children born extremely preterm, conduit arteries are of similar or smaller size than in controls born at term, and they have no signs of accelerated intima media thickening or arterial stiffening. While these findings are reassuring for these children and their families, the causal pathways from preterm birth to adult cardiovascular disease remain unknown.
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