| 1. |
- Owe-Larsson, Björn, et al.
(författare)
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Increased plasma levels of thioredoxin-1 in patients with first episode psychosis and long-term schizophrenia.
- 2011
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Ingår i: Progress in neuro-psychopharmacology & biological psychiatry. - : Elsevier BV. - 1878-4216 .- 0278-5846. ; 35:4, s. 1117-21
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Tidskriftsartikel (refereegranskat)abstract
- Excessive level of radicals and/or dysfunctional antioxidant response, oxidative stress, is implicated in the pathogenesis of schizophrenia. A condition of oxidative stress has been detected in the brain, peripheral tissues and fluids including plasma. Plasma thioredoxin-1 (Trx1) is well characterized and a putative marker for oxidative stress and recently shown to be increased in plasma at the onset of schizophrenia. The present study aimed to explore whether Trx1 can be used as a marker to identify schizophrenic patients at the time-point when patients have their first episode of psychosis as compared to patients with long-term schizophrenia and mentally healthy patients, respectively. Plasma samples obtained from 18 patients at first episode of psychosis, from 49 long-term schizophrenic patients and from 20 mentally healthy controls (admitted with minor physical injury to the general ward) where analyzed by ELISA for Trx1. The patients with first episode of psychosis were diagnosed at least 6months later and shown to constitute various psychotic syndromes, including schizophrenia, or affective disorder. The concentration of Trx1 in the patients with first episode of psychosis was 1.5±1.0ng/ml and 0.8±0.6ng/ml in controls. In the long-term schizophrenic patients the plasma concentration was 1.5±0.7. The differences between the groups of acute psychotic or long-term schizophrenia patients to controls were significant (p<0.016 and p<0.001, respectively). Our data indicate that Trx1 may not be used as an early marker to identify schizophrenic patients in a mixed population of first episode psychotic patients. Further, Trx1 did not discriminate with reliable accuracy patients with psychotic disorder from mentally healthy controls on an individual basis due to overlap in levels of Trx1. However, our observations show that psychotic patients in general are in a significant long-term condition of oxidative stress, with possible implications for the profound morbidity and mortality found in this patient population.
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| 2. |
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| 3. |
- Brorsson, Camilla, et al.
(författare)
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Liver resection is not associated with decreased cortisol levels.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Adrenal hormones are synthesized from cholesterol, produced and stored in the liver. Liver failure has been reported to be associated with adrenal insufficiency. A possible mechanism could be a limited supply of substrate for cortisol synthesis. The aims of this study was to evaluate the occurrence of total serum cortisol <200 nmol/L after major liver resection (≥ 30%) and other major surgery (hemicolectomy) and to assess associations between cholesterol and cortisol levels after liver resection.Methods: Prospective, observational study. 40 patients were included (major liver resection n=15, hemicolectomy n=25). Serum and salivary cortisol were followed from morning before surgery up to five days postoperatively. Sulphated dehydroepiandrosterone (DHEAS) and lipids (cholesterol, low density lipoproteins, high density lipoproteins and triglycerides) were obtained in liver resection patients.Results: 8/25 (32%, hemicolectomy patients), and 3/15 (20%, liver resection patients) had serum cortisol <200 nmol/L. Neither hemicolectomy nor liver resection was significantly associated with serum cortisol <200 nmol/L, p=0.49. Serum cortisol <200 nmol/L was not significantly associated with lipids below normal limits, (cholesterol; p=1.0 day 1, p=0.46 day 4, LDL; p=0.56 day 1, p=1.0 day 4, and HDL; p=0.27 day 1, p=1.0 day 4). Serum and salivary cortisol correlated significantly (rs=0.83, p<0.0001, hemicolectomy, rs=0.80, p<0.0001, liver resection).Conclusion: Serum cortisol levels <200 nmol/L was found in 32% (hemicolectomy) and 20% (liver resection) postoperatively. Compared to after hemicolectomy, serum cortisol <200 nmol/L was not significantly more common after liver resection. Lipids below normal limits were not associated with serum cortisol <200 nmol/L after liver resection.
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| 4. |
- Buunen, Mark, et al.
(författare)
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Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial.
- 2009
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Ingår i: The lancet oncology. - 1474-5488 .- 1470-2045. ; 10:1, s. 44-52
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Laparoscopic surgery for colon cancer has been proven safe, but debate continues over whether the available long-term survival data justify implementation of laparoscopic techniques in surgery for colon cancer. The aim of the COlon cancer Laparoscopic or Open Resection (COLOR) trial was to compare 3-year disease-free survival and overall survival after laparoscopic and open resection of solitary colon cancer. METHODS: Between March 7, 1997, and March 6, 2003, patients recruited from 29 European hospitals with a solitary cancer of the right or left colon and a body-mass index up to 30 kg/m(2) were randomly assigned to either laparoscopic or open surgery as curative treatment in this non-inferiority randomised trial. Disease-free survival at 3 years after surgery was the primary outcome, with a prespecified non-inferiority boundary at 7% difference between groups. Secondary outcomes were short-term morbidity and mortality, number of positive resection margins, local recurrence, port-site or wound-site recurrence, and blood loss during surgery. Neither patients nor health-care providers were blinded to patient groupings. Analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT00387842. FINDINGS: During the recruitment period, 1248 patients were randomly assigned to either open surgery (n=621) or laparoscopic surgery (n=627). 172 were excluded after randomisation, mainly because of the presence of distant metastases or benign disease, leaving 1076 patients eligible for analysis (542 assigned open surgery and 534 assigned laparoscopic surgery). Median follow-up was 53 months (range 0.03-60). Positive resection margins, number of lymph nodes removed, and morbidity and mortality were similar in both groups. The combined 3-year disease-free survival for all stages was 74.2% (95% CI 70.4-78.0) in the laparoscopic group and 76.2% (72.6-79.8) in the open-surgery group (p=0.70 by log-rank test); the difference in disease-free survival after 3 years was 2.0% (95% CI -3.2 to 7.2). The hazard ratio (HR) for disease-free survival (open vs laparoscopic surgery) was 0.92 (95% CI 0.74-1.15). The combined 3-year overall survival for all stages was 81.8% (78.4-85.1) in the laparoscopic group and 84.2% (81.1-87.3) in the open-surgery group (p=0.45 by log-rank test); the difference in overall survival after 3 years was 2.4% (95% CI -2.1 to 7.0; HR 0.95 [0.74-1.22]). INTERPRETATION: Our trial could not rule out a difference in disease-free survival at 3 years in favour of open colectomy because the upper limit of the 95% CI for the difference just exceeded the predetermined non-inferiority boundary of 7%. However, the difference in disease-free survival between groups was small and, we believe, clinically acceptable, justifying the implementation of laparoscopic surgery into daily practice. Further studies should address whether laparoscopic surgery is superior to open surgery in this setting.
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| 5. |
- Currie, Andrew, et al.
(författare)
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The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection Results From an International Registry
- 2015
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 261:6, s. 1153-1159
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Tidskriftsartikel (refereegranskat)abstract
- Background: The ERAS (enhanced recovery after surgery) care has been shown in randomized clinical trials to improve outcome after colorectal surgery compared to traditional care. The impact of different levels of compliance and specific elements, particularly out with a trial setting, is poorly understood.Objective: This study evaluated the individual impact of specific patient factors and perioperative enhanced recovery protocol compliance on postoperative outcome after elective primary colorectal cancer resection.Methods: The international, multicenter ERAS registry data, collected between November 2008 and March 2013, was reviewed. Patient demographics, disease characteristics, and perioperative ERAS protocol compliance were assessed. Linear regression was undertaken for primary admission duration and logistic regression for the development of any postoperative complication.Findings: A total of 1509 colonic and 843 rectal resections were undertaken in 13 centers from 6 countries. Median length of stay for colorectal resections was 6 days, with readmissions in 216 (9.2%), complications in 948 (40%), and reoperation in 167 (7.1%) of 2352 patients. Laparoscopic surgery was associated with reduced complications [odds ratio (OR) = 0.68; P < 0.001] and length of stay (OR = 0.83, P < 0.001). Increasing ERAS compliance was correlated with fewer complications (OR = 0.69, P < 0.001) and shorter primary hospital admission (OR = 0.88, P < 0.001). Shorter hospital stay was associated with preoperative carbohydrate and fluid loading (OR = 0.89, P = 0.001), and totally intravenous anesthesia (OR= 0.86, P < 0.001); longer stay was associated with intraoperative epidural analgesia (OR = 1.07, P = 0.019). Reduced postoperative complications were associated with restrictive perioperative intravenous fluids (OR = 0.35, P < 0.001).Conclusions: This analysis has demonstrated that in a large, international cohort of patients, increasing compliance with an ERAS program and the use of laparoscopic surgery independently improve outcome.
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| 6. |
- Edelbring, Samuel, 1969-, et al.
(författare)
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Virtual Patients in clinical education from a phenomenological perspective
- 2009
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Konferensbidrag (refereegranskat)abstract
- Background: Although Virtual Patients (VPs) are more commonly used today there is no clear-cut picture of the nature of VPs as a learning tool. This means that educators hesitate in further curricular integration of VPs. Students and educators need examples of how this innovation can support student learning in practice.Summary of work: We have analysed the use of VPs in a clinical rotation of medical students of rheumatology lasting 2-4 weeks. The phenomenological approach was used in order to maximise the student perspective. Focus lied with the character of VP learning and the immediate framework supporting meaningful learning with VPs at the clinic. We interviewed31 students followed by a phenomenological analysis of the transcriptions. This resulted inincreased knowledge of the value of VPs in this setting.Summary of results: VPs as a learning tool play a role of enhancing the value of other learning activities at the clinic. The immediate framework affects the way that students approach VPs. When students work in pairs, reflection and argumentation strengthen the learning experience.Conclusions: The study approach provided a way to characterise learning with VPs as enhancing the value of clinical education.Take-home messages: Phenomenological research interviews provide a way of discovering the value of innovations in medical education.
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| 7. |
- Eriksson-Aras, Karin
(författare)
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Ljudrum : En studie av ljud och lyssnande som kulturell praktik
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of the thesis is to investigate how sound creates distinct, cognitive and spatial entities, sound spaces, and to find out how sound spaces constitute forms of human interaction. A further aim is to establish concepts used when studying sound spaces, thus contributing to a Swedish terminology for describing and analysing sound and sound spaces. The analysis follows a hermeneutic spiral, alternating between inductive and deductive methodology, between the individual and the general. Conclusions are transferred from Istanbul to a broader level; to people in general.Forms of representation are developed by composing an exposition of pictures, maps, graphs, notes and links to acoustic files, alongside the written account. The study is based on well-established music and acoustic terminology. Terms that are used in the thesis are explained in information boxes. Altogether, this constitutes an attempt to build a comprehensive cultural analytical vocabulary to describe in text what a sound space sounds like.The study shows how sound has much to tell about the lived life in a large city, here represented by sound spaces in Istanbul. Sound is greatly significant in people’s lives. Sound spaces can be regarded as arenas for communication between people and are included in a world of sound containing interaction and crucial information.By investigating and bringing attention to spaces of sound that are shaped by their users in such places as urban environments, insights are won concerning the significance of everyday life in the city environment. With emphasis on the importance of sound, the interconnection between the subjective and the objective world of sounds is studied, contributing to enhance the understanding of how the world functions through sounds. The sound spaces of Istanbul are the sounds of a metropolis, which means that the study not only portrays and analyses sound spaces in general, but stresses metropolis sound spaces, and conditions for listening, being heard and communicating in large cities. The study contributes to bringing attention to and clarifying the knowledge that can be extracted by recognising the value of sound and listening in the research of cultural studies.
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| 8. |
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| 9. |
- Lundberg, Owe, et al.
(författare)
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Effect of pneumoperitoneum induced by carbon dioxide and air on tumor load in a rat model.
- 1998
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 22:5, s. 470-472
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Tidskriftsartikel (refereegranskat)abstract
- Laparoscopic surgery for malignant disease is highly controversial mainly due to the large number of abdominal wall metastases being reported. Previous experimental studies have particularly studied CO2 pneumoperitoneum and its effect on tumor development. The purpose of this study was to compare CO2- and air-induced pneumoperitoneum with regard to intraperitoneal tumor growth. Altogether 39 rats were injected intraperitoneally with 10(5) colonic tumor cells and randomly allocated into three groups: 13 rats had a pneumoperitoneum created with CO2, 13 with air, and 13 served as controls. Tumor development was determined semiquantitatively by a peritoneal cancer index scale after 12 days. CO2 and air pneumoperitoneum equally increased intraperitoneal tumor growth compared to controls. Pneumoperitoneum induced by CO2 and air seems to increase tumor load, but the mechanisms are not established. This finding supports the hypothesis that insufflation not only by causing tumor cell movements but in fact pneumoperitoneum per se and the used gas are involved in the development of abdominal wall metastases after laparoscopic surgery.
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| 10. |
- Lundberg, Owe, 1957-
(författare)
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Laparoscopy and tumour growth : a clinical and experimental study
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: Laparoscopic technique was quickly adopted in general surgery because of less pain, quicker recovery and shorter hospital stay. In the 1990´s several reports on port site metastases restrained the enthusiasm to use laparoscopic surgery in malignant diseases. The numerous reports on port site metastases initiated a debate whether laparoscopic surgery would increase the risk of tumour spread and growth. Personal experience of two patients who devloped port site metastases from an incidental gall bladder cancer (GBC) after laparoscopic cholecystectomy (LC), encouraged us to study the incidence of wound metastases from GBC after laparoscopic and open cholecystectomy (OC). Experimentally we examined whether pneumoperitoneum would increase the risk of tumour development. Several studies had demonstrated that minimally invasive procedures exert a less negative influence on the immune system and may have beneficial effects for cancer patients. We wanted to compare the long term survival after OC and LC and if the occurence of port site metastases had any impact on survival. Material and methods: A questionnaire was sent out to all major hospitals in Sweden requesting information obout the number of port site metastases encountered 1991-94. Data on all pateints with verfied GBC were obtained from the Swedish Oncological Centres. Data on all patients with GBC registered with surgical codes for cholecystectomy were collected from the National Board of Health and Welfare (EpC). The patient files were scrutinized and long term survival data was achieved (EpC). In the first experiment on Wistar Fu rats, adenocarcinoma cells were injected intraperitoneally in animals insufflated with air, CO2 and not insufflated controls. In the following studies, rats were similarly insufflated with air,CO2 and compared to not insufflated controls. Laser Doppler blood flow in the abdominal wall was concomitantly measured. To study the effect of reduced blood flow, one rectus muscle was clamped and the other not and laser Doppler Blood flow was measured in both rectus muscles. Adenocarcinoma cells were injected into the rectus muscles in all animals at the induction of pneumoperitoneum/clamping. Results: 14 of 55 patients developed wound metastases from GBC after LC and 12 of 187 after OC. Gallbladder perforation was overrepresented in patients with wound metastases. Improved survival was noted after LC in patients with T3 tumours. Experimentally, air and CO2 equally increased intraperitoneal tumour development, Insufflation with air,CO2 and clamping decreased blood flow in the abdominal wall and increased tumour growth at the same site. Conclusion: Despite a high rate of wound metastases, LC does not seem to worsen the prognosis of GBC and may even have a positive effect on survival. Perforation of the malignant gallbladder seems to be associated with an increased risk of metastatic formation. In the experimental setting, pneumoperitoneum seems to increase tumour development. Other features of laparoscopic surgery such as decreased blood flow in the abdominal wall may contribute to increased risk of tumour progress.
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