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| 2. |
- Houltz, Birgitta, 1952, et al.
(författare)
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Left ventricular diastolic function and right atrial size are important rhythm outcome predictors after intraoperative ablation for atrial fibrillation.
- 2010
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Ingår i: Echocardiography (Mount Kisco, N.Y.). - : Wiley. - 1540-8175 .- 0742-2822. ; 27:8, s. 961-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Left ventricular (LV) diastolic function and right atrial (RA) size are not routinely included in preoperative echocardiographic examination in patients undergoing cardiac surgery with concomitant ablation for atrial fibrillation (AF). OBJECTIVE: To investigate the role of echocardiographic variables including LV diastolic function and RA area in long-term rhythm outcome prediction, in patients with documented AF undergoing intraoperative ablation concomitant to coronary artery bypass grafting (CABG). METHODS: Thirty-five consecutive patients, scheduled for CABG, and with a history of paroxysmal or permanent AF for 8.5 ± 11.3 years (mean ± SD) (median 5.8 years), were included in this prospective study. Echocardiography was performed prior to and 2.3 ± 0.4 years after the surgical procedure. RESULTS: Both LA and RA areas, LV diastolic function, paroxysmal AF, and sinus rhythm (SR) preoperatively were associated with SR at long-term follow-up. In the multivariate analysis, RA area (P = 0.004), and decreased LV diastolic function preoperatively, measured as the maximal LV long-axis relaxation velocity (P = 0.02), predicted SR at follow-up. CONCLUSIONS: RA size and LV diastolic function may be important variables in prediction of long-term rhythm outcome after intraoperative ablation for AF.
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| 3. |
- Johansson, Birgitta, 1957, et al.
(författare)
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Cardiac function in relation to rhythm outcome after intraoperative epicardial left atrial cryoablation.
- 2011
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Ingår i: Scandinavian cardiovascular journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 45:6, s. 327-35
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objectives. To assess the effects of intraoperative left atrial epicardial cryoablation on rhythm and atrial and ventricular function. Design. Thirty five patients with coronary artery disease and documented atrial fibrillation underwent coronary artery bypass surgery and concomitant cryoablation. An age and gender matched control group of 35 patients with atrial fibrillation underwent bypass surgery alone. Echocardiography was performed 9 ? 32 days before and 22 ? 6 months after surgery. Results. The proportion of patients in sinus rhythm at follow-up was 63% and 34% (p = 0.04) in the cryoablation and control groups, respectively. In patients with sinus rhythm both before surgery and at follow-up, the left atrial area increased (p = 0.002) and the mitral annular excursion during atrial contraction decreased (p = 0.01) after cryoablation. The mitral flow velocity during atrial systole decreased after cryoablation (p = 0.002). The LV diameter increased (p = 0.03) and the left ventricular ejection fraction (LVEF) decreased (p = 0.03) in cryoablated but not in control patients. Continued deterioration was seen in patients with atrial fibrillation both pre- and postoperatively. Conclusions. At long-term follow-up, a significantly higher proportion of patients was in sinus rhythm in the cryoablation than in the control group. The atrial and ventricular function had decreased at follow-up two years after surgery. This decrease was small and occurred within or close to the reference values in patients with sinus rhythm at follow-up, while patients remaining in atrial fibrillation showed a significant continued deterioration. Some subgroups were small, and the findings, although statistically significant, should be interpreted with caution.
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| 4. |
- Johansson, Birgitta, 1957, et al.
(författare)
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Mindfulness-Based Stress Reduction (MBSR) Delivered Live on the Internet to Individuals Suffering from Mental Fatigue After an Acquired Brain Injury
- 2015
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Ingår i: Mindfulness. - : Springer Science and Business Media LLC. - 1868-8527 .- 1868-8535. ; 6:6, s. 1356-1365
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Tidskriftsartikel (refereegranskat)abstract
- An acquired brain injury often leads to long-lasting mental fatigue, which can have a considerable effect on work and social interactions. Fortunately, the Mindfulness-Based Stress Reduction (MBSR) program has been found to alleviate mental fatigue. The purpose of this feasibility study was to evaluate the success of an interactive MBSR program delivered live online to individuals who have experienced a traumatic brain injury or stroke. We included the following three groups in our study: an Internet group, a face-to-face MBSR group, and an active control group who took weekly walks in natural environments. Thirty-four participants completed the study, and all were suffering from long-lasting mental fatigue after either a traumatic brain injury (16 participants) or a stroke (18 participants). However, seven did not accept to attend an Internet MBSR, and Internet was the only choice for others. We found that, according to the Mental Fatigue Scale (MFS), the program leads to significantly reduced mental fatigue in the Internet group compared with the face-to-face and the control group. Individuals in the MBSR groups also exhibited an improved ability to process two temporally close targets (attentional blink task), while this was not detected in the control group. In conclusion, we believe that it is possible for individuals suffering from mental fatigue after an acquired brain injury to obtain positive results through enrollment in a live, interactive, online MBSR program. This is promising, as the Internet is accessible to many individuals, irrespective of where they live. Further randomized control studies comparing are warranted.
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| 5. |
- Johansson, Birgitta, 1960, et al.
(författare)
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Short-term sinus rhythm predicts long-term sinus rhythm and clinical improvement after intraoperative ablation of atrial fibrillation.
- 2008
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Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 10:5, s. 610-7
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Our aim was to compare the long-term effects on rhythm and quality of life (QoL) after left atrial epicardial radiofrequency (RF) ablation vs. no ablation in patients undergoing cardiac surgery. METHODS AND RESULTS: Thirty-nine patients with ECG documented atrial fibrillation (AF) scheduled for coronary artery bypass grafting (CABG) with or without concomitant valve surgery were consecutively elected for epicardial RF ablation. Thirty-nine age- and gender-matched patients scheduled for CABG with or without concomitant valve surgery only and with documented AF served as controls. The follow-up after ablation was 32 +/- 11 months. The percentage of patients in sinus rhythm (SR) at long-term follow-up was 62 vs. 33% (P = 0.03) after ablation and no ablation, respectively. SR at 3 months was highly predictive of that at 32 months (sensitivity 95%, positive predictive value 86%). Long-term SR was associated with better QoL, fewer symptoms, higher ejection fraction, and smaller left and right atria than AF. CONCLUSION: SR at 3 months was highly predictive of long-term SR that was associated with clinical improvement when compared with patients still in AF. AF at 3 months did not preclude a later stabilization to SR.
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| 6. |
- Kanter-Smoler, Gunilla, et al.
(författare)
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Novel findings in Swedish patients with MYH-associated polyposis: mutation detection and clinical characterization
- 2006
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Ingår i: Clin Gastroenterol Hepatol. - : Elsevier BV. - 1542-3565. ; 4:4, s. 499-506
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Biallelic mutations in the base-excision repair gene MYH have recently been associated with recessive inheritance of multiple colorectal adenomas. An investigation and characterization of MYH mutations in Swedish patients were therefore carried out. METHODS: A set of 15 unrelated adenomatous polyposis coli (APC)-mutation negative patients from the Swedish Polyposis Registry was screened for germline mutations in the MYH gene. The patients were clinically characterized and compared with 43 APC-mutation positive probands diagnosed during the same period. RESULTS: Disease-causing biallelic MYH mutations were identified in 6 patients (40%). The mean age at diagnosis was 47.8 years versus 34.1 years in APC-mutation positive patients (P = .015). Colorectal cancer at diagnosis of polyposis was present in 67% (4/6) of the patients, and all were right-sided, compared with only 19% versus 12.5% right-sided cancer in APC-mutation positive patients. Upper gastrointestinal manifestations were diagnosed in 1 of 5 compared with 23 of 27 in APC-mutation positive patients (odds ratio, 23; 95% confidence interval, 2-263; P = .0086). One family exhibited apparent dominant inheritance of colorectal adenomatous polyposis. Two new pathogenic mutations, MYH p.G175E and p.P391L, were identified. The mutations are argued to introduce profound changes in substrate-recognizing domains of the protein. CONCLUSIONS: Biallelic MYH mutations, including 2 novel mutations, were found in a substantial number of the patients with multiple colorectal adenomas who were negative for APC-mutation. The examined MYH-mutation positive patients were found to have higher risks of colorectal cancer at diagnosis, right-sided location of cancers, and a significantly lower incidence of upper gastrointestinal manifestations, compared with APC-mutation positive patients.
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| 7. |
- Karlsson, Diana, et al.
(författare)
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Modeling the regulation of the competence-evoking quorum sensing network in Streptococcus pneumoniae
- 2007
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Ingår i: Biosystems (Amsterdam. Print). - : Elsevier. - 0303-2647 .- 1872-8324. ; 90:1, s. 211-223
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Tidskriftsartikel (refereegranskat)abstract
- Competence for genetic transformation seems to play a fundamental role in the biology of Streptococcus pneumoniae and is believed to account for serotype switching, evolution of virulence factors, and rapid emergence of antibiotic resistance. The initiation of competence is regulated by the quorum sensing system referred as the ComABCDE pathway. Experimental studies reveal that competence is down-regulated a short time after its induction and several hypotheses about the mechanism(s) responsible for this shut-down have been presented. Possibly, a ComX-dependent gene product, such as a repressor or a phosphatase, is involved. To better understand the down-regulation of the competence-evoking system in S. pneumoniae, a mathematical model was set up. By analyzing the model, we suggest that shut-down of competence possibly occurs at the transcriptional level on the comCDE operon. As a result of introducing a putative comX-dependent repressor, which inhibits expression of comCDE and comX, in the mathematical model, competence is demonstrated to appear in waves. This is supported by experimental studies showing the appearance of successive competence cycles in pneumococcal batch cultures.
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| 8. |
- Sylvan, Sandra Eketorp, et al.
(författare)
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First-line therapy in chronic lymphocytic leukemia : a Swedish nation-wide real-world study on 1053 consecutive patients treated between 2007 and 2013
- 2019
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Ingår i: Haematologica. - : FERRATA STORTI FOUNDATION. - 0390-6078 .- 1592-8721. ; 104:4, s. 797-805
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate long-term outcome following first-line therapy in consecutive chronic lymphocytic leukemia (CLL) patients in a well-defined geographic area: Sweden. All patients diagnosed with CLL (2007-2013) (n=3672) were identified from national registries, screening of patient files identified all (100%) treated first line (n=1053) and for those, an in-depth analysis was performed. End points were overall response rate, progression-free survival (PFS), overall survival (OS), and safety. Median age was 71 years; 53% had Rai stage III-IV and 97% had performance status grade 0-2. Fluorescence in situ hybridization (FISH) was performed in 57% of patients: 15% had del(17p). Chlorambucil + prednisone was used in 39% (5% also received rituximab). Fludarabine+cyclophosphamide+rituximab or fludarabine+cyclophosphamide was used in 43% and bendamustine + rituximab in 6%. Overall response rate was 64%; chlorambucil 43%, fludarabine+cyclophosphamide+rituximab 84%, fludarabine+cyclophosphamide 75% and bendamustine + rituximab 75%. Median PFS and OS was 24 and 58 months, respectively, both were significantly associated (multivariate analysis) with type of treatment, del(17p), performance status, gender, age and geographical region (OS only). Chlorambucil-treated patients had a median PFS and OS of only 9 and 33 months, respectively. Chlorambucil usage declined gradually throughout the study period, but one-third of patients still received chlorambucil + rituximab in 2013. Infections >= grade III were significantly associated with treatment; chlorambucil 19% versus fludarabine+cyclophosphamide+rituximab 30%. Richter transformation occurred in 5.5% of the patients, equally distributed across therapies. This is the largest retrospective, real-world cohort of consecutive first-line treated CLL patients with a complete follow up. In elderly patients, an unmet need for more effective, well-tolerated therapies was identified.
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| 9. |
- Thang, ND, et al.
(författare)
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ECG signs of acute myocardial ischemiain the prehospital setting of a suspected acute coronary syndrome and its association with outcomes
- 2014
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Ingår i: American Journal of Emergency Medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 32:6, s. 601-605
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aims of this study were (a) to determine the prehospital prevalence of electrocardiographic (ECG) signs of acute myocardial ischemia in patients with suspected acute coronary syndrome and (b) to describe the relationships between the various ECG patterns and the diagnosis of acute myocardial infarction (AMI) and outcomes. METHODS: Prospective cohort study using data from an interventional trial in acute chest pain patients transported by the emergency medical services. These patients were classified into 3 groups: patients with ECG showing signs of acute myocardial ischemia, patients with ECG showing other abnormal changes (bundle-branch block, pacemaker rhythm, Q-wave or T-wave inversion) and patients without significant pathologic findings. All P values are age-adjusted. RESULTS: Among 1546 patients, 312 (20%) had ECG signs of acute myocardial ischemia. Of them, 57% had a final diagnosis of AMI versus 26% of those with other abnormal ECGs and 12% of those with ECG without significant pathologic findings (P<.0001). In all, 53% of all AMI cases involved patients without ECG signs of acute myocardial ischemia. Although ECG signs of acute myocardial ischemia predicted heart failure and ventricular tachyarrhythmias both prior to and after hospital admission, there was no significant difference in 30-day mortality between the 3 patient groups (4.3%, 3.7%, and 1.2%, respectively, P=.11). CONCLUSION: Among patients with a clinical suspicion of AMI in the prehospital setting, the prevalence of ECG signs suggesting AMI was low, as was the ability to identify AMI patients using ECG findings only. We therefore need better instruments in the prehospital triage of patients with acute chest pain.
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