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| 2. |
- Olivecrona, Magnus, 1959-, et al.
(författare)
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Transportation
- 2020. - 2
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Ingår i: Management of Severe Traumatic Brain Injury. - : Springer. - 9783030393830 - 9783030393823 ; , s. 83-88
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Bokkapitel (refereegranskat)
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| 3. |
- Olivecrona, Magnus, et al.
(författare)
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Use of the CRASH study prognosis calculator in patients with severe traumatic brain injury treated with an intracranial pressure-targeted therapy
- 2013
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Ingår i: Journal of clinical neuroscience. - : Elsevier BV. - 0967-5868 .- 1532-2653. ; 20:7, s. 996-1001
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Tidskriftsartikel (refereegranskat)abstract
- Based on the Corticosteroid Randomisation after Significant Head Injury (CRASH) trial database, a prognosis calculator has been developed for the prediction of outcome in an individual patient with a head injury. In 47 patients with severe traumatic brain injury (sTBI) prospectively treated using an intracranial pressure (ICP) targeted therapy, the individual prognosis for mortality at 14 days and unfavourable outcome at 6 months was calculated and compared with the actual outcome. An overestimation of the risk of mortality and unfavourable outcome was found. The mean risk for mortality and unfavourable outcome were estimated to be 44.6 +/- 32.5% (95% confidence interval [CI], 35.1-54.2%) and 69.3 +/- 23.7% (95% CI, 62.3-76.2%). The actual outcome was 4.3% and 42.6% respectively. The absolute risk reduction (ARR) for mortality was 33.1% and for unfavourable outcome 29.8%. A logistic fit for outcome at 6 months shows a statistically significant difference (p < 0.01). A receiver operating characteristic (ROC) curve analysis shows an area under the curve (AUC) of 0.691. The CRASH prognosis calculator overestimates the risk of mortality and unfavourable outcome in patients with sTBI treated with an ICP-targeted therapy based on the Lund concept. We do not advocate the use of the calculator for treatment decisions in individual patients. We further conclude that patients with blunt sTBI admitted within 8 hours of trauma should be treated regardless of their clinical status as long as the initial cerebral perfusion pressure is > 10 mmHg.
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| 4. |
- Olivecrona, Magnus, 1959-, et al.
(författare)
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Validation of the Canadian Assessment of Tomography for Childhood Head Injury, the CATCH-rule
- 2018
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Ingår i: Journal of Neurotrauma. - : Mary Ann Liebert. - 0897-7151 .- 1557-9042. ; 35:16, s. A248-A248
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Head trauma in children is a common cause for a visit to the A&E. Among the many children it is important to identify those at risk for developing a clinical important head injury (CITBI). The most important way of identifying the children at risk is to perform a CT scan of the head. There are reports indicating an induction of 1 cancer in children on 1000 – 5000 CT examinations. It is thus important to minimise the use of CT. In 2010 Osmond and co-workers introduced the Canadian Assessment of Tomography for Childhood Head injury: the CATCH rule (CATCH-R), with the aim of identifying those at most risk and to reduce the use of CT. The aim of this study is to validate the CATCH-R, using a large cohort of children.Material Methods: The study is a cohort study based on the data set from: ‘‘Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study’’(Kuppermanns et al 2009). It includes data from more than 43000 children. The cohort was identified using the basal criteria in the CATCH-R, i.e. children with a GCS of 13 – 15. The CATCH-R was then used to identify children who should perform a CT.Results: We identified 37277 children with a GCS of 13 – 15 of which 7774 fulfilled the criteria for MHI according to the CATCH-R. Of these 2699 had one or more risk factors, i.e. should perform a CT scan. In the CT group 117 children had a CITBI and in the non-CT group (n=5075) we identified 36 children with CITBI. At the division MHI and no-MHI according to the CATCH-R the NPV is 99.2 % (CI 99.1 – 99.2 %), and specificity 79.3% (CI 78.9 – 79.7). At the division MHI with risk factor/s and MHI without risk factor/s the NPV is 99.3% (CI 99.1 – 99.5 %), and specificity 66.1 % (CI 65.0 – 67.2 %).Conclusion: It seems that using the CATCH-R the risk of not detecting a child with a CITBI is very small.
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| 5. |
- Olivecrona, Thomas, et al.
(författare)
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Regulation of lipoprotein lipase
- 1993
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Ingår i: Biochemical Society Transactions. - 0300-5127 .- 1470-8752. ; 21:2, s. 509-513
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Tidskriftsartikel (refereegranskat)
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| 6. |
- Rodling Wahlström, Marie, et al.
(författare)
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Effects of prostacyclin on the early inflammatory response in patients with traumatic brain injury : a randomised clinical study
- 2014
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Ingår i: SpringerPlus. - : Springer. - 2193-1801. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE AND DESIGN: A prospective, randomised, double-blinded, clinical trial was performed at a level 1 trauma centre to determine if a prostacyclin analogue, epoprostenol (Flolan®), could attenuate systemic inflammatory response in patients with severe traumatic brain injury (TBI).SUBJECTS: 46 patients with severe TBI, randomised to epoprostenol (n = 23) or placebo (n = 23).TREATMENT: Epoprostenol, 0.5 ng · kg(-1) · min(-1), or placebo (saline) was given intravenously for 72 hours and then tapered off over the next 24 hours.METHODS: Interleukin-6 (IL-6), interleukin-8 (IL-8), soluble intracellular adhesion molecule-1 (sICAM-1), C-reactive protein (CRP), and asymmetric dimethylarginine (ADMA) levels were measured over five days. Measurements were made at 24 h intervals ≤24 h after TBI to 97-120 h after TBI.RESULTS: A significantly lower CRP level was detected in the epoprostenol group compared to the placebo group within 73-96 h (p = 0.04) and within 97-120 h (p = 0.008) after trauma. IL-6 within 73-96 h after TBI was significantly lower in the epoprostenol group compared to the placebo group (p = 0.04). ADMA was significantly increased within 49-72 h and remained elevated, but there was no effect of epoprostenol on ADMA levels. No significant differences between the epoprostenol and placebo groups were detected for IL-8 or sICAM-1.CONCLUSIONS: Administration of the prostacyclin analogue epoprostenol significantly decreased CRP and, to some extent, IL-6 levels in patients with severe TBI compared to placebo. These findings indicate an interesting option for treatment of TBI and warrants future larger studies.TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT01363583.
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| 7. |
- Rodling Wahlström, Marie, 1960-, et al.
(författare)
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Subarachnoid haemorrhage induces a long-lasting increase of asymmetric dimethylarginine, ADMA, in serum
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background and Purpose: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase (NOS), inhibiting nitric oxide (NO) production and thus induces vasoconstriction and endothelial dysfunction. ADMA might therefore be involved in the cerebral vasospasm and cardiovascular complications observed after subarachnoid haemorrhage (SAH). The aim of this study was to evaluate whether ADMA was increased in subjects during the acute phase (first week) and non-acute phase (three months later) after SAH.Methods: Prospective clinical study of 20 subjects with SAH. ADMA in serum (ADMA/s) at admission was compared to sex and age matched controls. ADMA/s and ADMA in cerebrospinal fluid (ADMA/csf, from subjects with ventriculostomy) were determined by HPLC-based separation and detection.Results: There was no significant difference in ADMA/s the day after SAH (day 2) between SAH subjects and controls (0.22±0.10 vs. 0.25±0.12 µmol/L). ADMA/s increased by 68% during the first week after SAH (day 2; 0.22±0.10 vs. day 7; 0.37±0.34 µmol/L, p<0.05) and remained elevated at a three-month follow-up (0.36±0.10 µmol/L). ADMA/csf was significantly lower than ADMA/s throughout the study period.Conclusion; ADMA/s in SAH subjects increased significantly during the first week after SAH and remained elevated at a three-month follow-up. This might indicate that reduction of the available NO is involved in long-term effects after SAH.
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| 8. |
- Rodling Wahlström, Marie, et al.
(författare)
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Subarachnoid haemorrhage induces an inflammatory response followed by a delayed persisting increase in asymmetric dimethylarginine
- 2012
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa UK Limited. - 0036-5513 .- 1502-7686. ; 72:6, s. 484-489
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Tidskriftsartikel (refereegranskat)abstract
- Object: Subarachnoid haemorrhage (SAH) is associated with an inflammatory systemic response and cardiovascular complications. Asymmetric dimethyl arginine (ADMA), an endogenous inhibitor of nitric oxide synthase, mediates vasoconstriction and might contribute to cerebral vasoconstriction and cardiovascular complications after SAH. ADMA is also involved in inflammation and induces endothelial dysfunction.The aim of this study was to evaluate whether and how CRP (marker for systemic inflammation) and ADMA increased in patients during the acute phase (first week) after SAH. The ADMA level was also assessed in the patients in a non-acute phase (three months), and in healthy controls.Methods: Prospective study of 20 patients with aneurysmal SAH. ADMA and CRP were followed daily during the first week after SAH and a follow up sample for ADMA was obtained three months later. A single blood sample for ADMA was collected from age and sex matched healthy controls (n=40, 2 for each case).Results: CRP increased significantly from day 2; 16 (Confidence interval (CI) 10-23) mg/L to day 4; 84 (CI 47-120) mg/L, (p<0.01). ADMA increased significantly from day 2; 0.22 (CI 0.17-0.27) µmol/L, to day 7; 0.37 (CI 0.21-0.54) µmol/L, p<0.01. ADMA remained elevated at a three-month follow-up 0.36 (CI 0.31-0.42) µmol/L.ADMA in the first sample from the patients (day 1-3); 0.25 (CI 0.19-0.30) µmol/L, was not different from ADMA in matched healthy controls; 0.25 (CI 0.20-0.31), p>0.05.Conclusion: After SAH, CRP and ADMA in serum increased significantly during the first week and ADMA remained elevated three months later.
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| 9. |
- Savonen, Roger, et al.
(författare)
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The tissue distribution of lipoprotein lipase determines where chylomicrons bind
- 2015
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Ingår i: Journal of Lipid Research. - 0022-2275 .- 1539-7262. ; 56:3, s. 588-598
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Tidskriftsartikel (refereegranskat)abstract
- To determine the role of LPL for binding of lipoproteins to the vascular endothelium, and for the distribution of lipids from lipoproteins, four lines of induced mutant mice were used. Rat chylomicrons labeled in vivo with [C-14] oleic acid (primarily in TGs, providing a tracer for lipolysis) and [H-3]retinol (primarily in ester form, providing a tracer for the core lipids) were injected. TG label was cleared more rapidly than core label. There were no differences between the mouse lines in the rate at which core label was cleared. Two minutes after injection, about 5% of the core label, and hence chylomicron particles, were in the heart of WT mice. In mice that expressed LPL only in skeletal muscle, and had much reduced levels of LPL in the heart, binding of chylomicrons was reduced to 1%, whereas in mice that expressed LPL only in the heart, the binding was increased to over 10%. The same patterns of distribution were evident at 20 min when most of the label had been cleared. Thus, the amount of LPL expressed in muscle and heart governed both the binding of chylomicron particles and the assimilation of chylomicron lipids in the tissue.
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| 10. |
- Bader, Sam Er. 1979-, et al.
(författare)
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A Validation Study of Kwon's Prognostic Scoring System for Chronic Subdural Haematoma
- 2022
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 165, s. e365-e372
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Surgery for chronic subdural haematoma (CSDH) is one of the most frequent operations in neurosurgical practice. CSDH afflicts the elderly population most. In 2018, Kwon and co-workers published the Kwon Scoring System (KSS), whereby six clinical and radiological factors are used to facilitate, and promote quality in, surgical decision-making and counselling of relatives. The aim of this study is to validate the KSS.METHOD: Patients operated on for unilateral CSDH at Orebro University Hospital, Sweden, between 2013 and 2019 constituted the study population. General data and the six outcome predictors according to the KSS were extracted from the electronic patient records. The pre-operative mRS score and the post-operative six-month mRS score were assessed.RESULTS: We identified 133 patients (69.2% male) with a median age of 80.2 years (IQR 72.6-85.9). The median GCS at admission was 15; 57.1% had motor deficits and 36.81% were disoriented. For 39.1% of the patients, the prognosis was a favourable outcome (mRS 0-1) at six months. The median KSS score was 9; 63.9% of the patients scored ≥ 9, and 36 (42.4%) of these patients actually achieved a favourable outcome. This corresponds to a prediction model sensitivity of 0.667 and specificity of 0.424. A ROC curve analysis of the model yielded an AUC of 0.62441.CONCLUSION: In our material, the KSS did not predict outcome precisely enough to base treatment decisions or counselling of relatives on the scores obtained.
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