| 1. |
- Vouzouneraki, Konstantina, et al.
(författare)
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Temporal relationship of sleep apnea and acromegaly: a nationwide study
- 2018
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Ingår i: Endocrine. - : Springer Science and Business Media LLC. - 1355-008X .- 1559-0100. ; 62:2, s. 456-463
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Tidskriftsartikel (refereegranskat)abstract
- PurposePatients with acromegaly have an increased risk of sleep apnea, but reported prevalence rates vary largely. Here we aimed to evaluate the sleep apnea prevalence in a large national cohort of patients with acromegaly, to examine possible risk factors, and to assess the proportion of patients diagnosed with sleep apnea prior to acromegaly diagnosis.MethodsCross-sectional multicenter study of 259 Swedish patients with acromegaly. At patients' follow-up visits at the endocrine outpatient clinics of all seven university hospitals in Sweden, questionnaires were completed to assess previous sleep apnea diagnosis and treatment, cardiovascular diseases, smoking habits, anthropometric data, and S-IGF-1 levels. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale. Patients suspected to have undiagnosed sleep apnea were referred for sleep apnea investigations.ResultsOf the 259 participants, 75 (29%) were diagnosed with sleep apnea before the study start. In 43 (57%) of these patients, sleep apnea had been diagnosed before the diagnosis of acromegaly. After clinical assessment and sleep studies, sleep apnea was diagnosed in an additional 20 patients, yielding a total sleep apnea prevalence of 37%. Higher sleep apnea risk was associated with higher BMI, waist circumference, and index finger circumference. Sleep apnea was more frequent among patients with S-IGF-1 levels in the highest quartile.ConclusionSleep apnea is common among patients with acromegaly, and is often diagnosed prior to their acromegaly diagnosis. These results support early screening for sleep apnea in patients with acromegaly and awareness for acromegaly in patients with sleep apnea.
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| 2. |
- Ekholm, Jennifer, et al.
(författare)
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Full-scale aerobic granular sludge for municipal wastewater treatment – granule formation, microbial succession, and process performance
- 2022
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Ingår i: Environmental Science: Water Research & Technology. - 2053-1419. ; :8, s. 3138-3154
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Tidskriftsartikel (refereegranskat)abstract
- Aerobic granular sludge (AGS) plants have gained growing interest and application due to their low energy demand, small footprint, and low operational costs. However, the fulfilment of strict discharge limits for nitrogen and phosphorus, vast seasonal temperature variations, and large peaks in influent flows may pose challenges to the implementation of AGS. Moreover, the knowledge about microbial community assembly and process performance under varying environmental conditions in full-scale reactors is still limited. In this study, the first implementation of the AGS process in the Nordic countries was assessed. In two full-scale AGS reactors with different seeding sludges, the start-up was associated with rapid changes in microbial community composition in both, but only successful granulation in one. As a consequence, the non-granulated reactor was eventually reseeded with biomass from the better granulated reactor. This resulted in a convergence of the microbial communities in the two reactors with the maintenance of stable sludge concentrations (6–8 g L−1) with large granules (50–80% with diameter >2 mm) and fast settling of biomass (SVI30/SVI10 of 0.9–1). Immigration from the influent wastewater was a minor factor affecting the microbial community once the granules had formed, while the seasonal variations in environmental factors were identified as important. Key guilds of AOB (Nitrosomonas), NOB (mainly Ca. Nitrotoga), PAOs (mainly Tetrasphaera), and GAOs (mainly Ca. Competibacter) varied considerably in abundance throughout the study period. After 15 months, stable organic matter, nitrogen, and phosphorus removal were attained with low effluent concentrations. During the start-up, the BOD7/N ratio, influent flow, and temperature were important factors influencing the performance of the AGS.
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| 3. |
- Ekholm, Jennifer, 1992, et al.
(författare)
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Full-scale aerobic granular sludge for municipal wastewater treatment - granule formation, microbial succession, and process performance
- 2022
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Ingår i: Environmental Science: Water Research and Technology. - : Royal Society of Chemistry (RSC). - 2053-1419 .- 2053-1400. ; 8:12, s. 3138-3154
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Tidskriftsartikel (refereegranskat)abstract
- Aerobic granular sludge (AGS) plants have gained growing interest and application due to their low energy demand, small footprint, and low operational costs. However, the fulfilment of strict discharge limits for nitrogen and phosphorus, vast seasonal temperature variations, and large peaks in influent flows may pose challenges to the implementation of AGS. Moreover, the knowledge about microbial community assembly and process performance under varying environmental conditions in full-scale reactors is still limited. In this study, the first implementation of the AGS process in the Nordic countries was assessed. In two full-scale AGS reactors with different seeding sludges, the start-up was associated with rapid changes in microbial community composition in both, but only successful granulation in one. As a consequence, the non-granulated reactor was eventually reseeded with biomass from the better granulated reactor. This resulted in a convergence of the microbial communities in the two reactors with the maintenance of stable sludge concentrations (6-8 g L-1) with large granules (50-80% with diameter >2 mm) and fast settling of biomass (SVI30/SVI10 of 0.9-1). Immigration from the influent wastewater was a minor factor affecting the microbial community once the granules had formed, while the seasonal variations in environmental factors were identified as important. Key guilds of AOB (Nitrosomonas), NOB (mainly Ca. Nitrotoga), PAOs (mainly Tetrasphaera), and GAOs (mainly Ca. Competibacter) varied considerably in abundance throughout the study period. After 15 months, stable organic matter, nitrogen, and phosphorus removal were attained with low effluent concentrations. During the start-up, the BOD7/N ratio, influent flow, and temperature were important factors influencing the performance of the AGS.
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| 4. |
- Ekholm, Jennifer, 1992, et al.
(författare)
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Microbiome structure and function in parallel full-scale aerobic granular sludge and activated sludge processes
- 2024
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Ingår i: Applied Microbiology and Biotechnology. - 1432-0614 .- 0175-7598. ; 108:1
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: Aerobic granular sludge (AGS) and conventional activated sludge (CAS) are two different biological wastewater treatment processes. AGS consists of self-immobilised microorganisms that are transformed into spherical biofilms, whereas CAS has floccular sludge of lower density. In this study, we investigated the treatment performance and microbiome dynamics of two full-scale AGS reactors and a parallel CAS system at a municipal WWTP in Sweden. Both systems produced low effluent concentrations, with some fluctuations in phosphate and nitrate mainly due to variations in organic substrate availability. The microbial diversity was slightly higher in the AGS, with different dynamics in the microbiome over time. Seasonal periodicity was observed in both sludge types, with a larger shift in the CAS microbiome compared to the AGS. Groups important for reactor function, such as ammonia-oxidising bacteria (AOB), nitrite-oxidising bacteria (NOB), polyphosphate-accumulating organisms (PAOs) and glycogen-accumulating organisms (GAOs), followed similar trends in both systems, with higher relative abundances of PAOs and GAOs in the AGS. However, microbial composition and dynamics differed between the two systems at the genus level. For instance, among PAOs, Tetrasphaera was more prevalent in the AGS, while Dechloromonas was more common in the CAS. Among NOB, Ca. Nitrotoga had a higher relative abundance in the AGS, while Nitrospira was the main nitrifier in the CAS. Furthermore, network analysis revealed the clustering of the various genera within the guilds to modules with different temporal patterns, suggesting functional redundancy in both AGS and CAS. Key points: • Microbial community succession in parallel full-scale aerobic granular sludge (AGS) and conventional activated sludge (CAS) processes. • Higher periodicity in microbial community structure in CAS compared to in AGS. • Similar functional groups between AGS and CAS but different composition and dynamics at genus level. Graphical abstract: (Figure presented.).
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| 5. |
- Fadl, Helena, 1965-, et al.
(författare)
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Changing diagnostic criteria for gestational diabetes in Sweden-a stepped wedge national cluster randomised controlled trial-the CDC4G study protocol
- 2019
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Ingår i: Bmc Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way. The aim of the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) in Sweden () is to evaluate the clinical and health economic impacts of changing diagnostic criteria for GDM in Sweden and to create a prospective cohort to compare the many long-term outcomes in mother and baby under the old and new diagnostic approaches. Methods This is a stepped wedge cluster randomised controlled trial, comparing pregnancy outcomes before and after the switch in GDM criteria across 11 centres in a randomised manner. The trial includes all pregnant women screened for GDM across the participating centres during January-December 2018, approximately two thirds of all pregnancies in Sweden in a year. Women with pre-existing diabetes will be excluded. Data will be collected through the national Swedish Pregnancy register and for follow up studies other health registers will be included. Discussion The stepped wedge RCT was chosen to be the best study design for evaluating the shift from old to new diagnostic criteria of GDM in Sweden. The national quality registers provide data on the whole pregnant population and gives a possibility for follow up studies of both mother and child. The health economic analysis from the study will give a solid evidence base for future changes in order to improve immediate pregnancy, as well as long term, outcomes for mother and child.
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| 6. |
- Persson, Britt C., et al.
(författare)
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The ms2io6A37 modification of tRNA in Salmonella typhimurium regulates growth on citric acid cycle intermediates
- 1998
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Ingår i: Journal of Bacteriology. - 0021-9193. ; 180:12, s. 3144-3151
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Tidskriftsartikel (refereegranskat)abstract
- The modified nucleoside 2-methylthio-N-6-isopentenyl adenosine (ms(2)i(6)A) is present in position 37 (adjacent to and 3' of the anticodon) of tRNAs that read codons beginning with U except tRNA(I,V)(Ser) in Escherichia coli, In Salmonella typhimurium , 2-methylthio-N-6-(cis-hydroxy)isopentenyl adenosine (ms(2)io(6)A; also referred to as 2-methylthio cis-ribozeatin) is found in tRNA, most likely in the species that have ms(2)i(6)A in E. coli. Mutants (miaE) of S. typhimurium in which ms(2)i(6)A hydroxylation is blocked are unable to grow aerobically on the dicarboxylic acids of the citric acid cycle. Such mutants have normal uptake of dicarboxylic acids and functional enzymes of the citric acid cycle and the aerobic respiratory chain. The ability of S. typhimurium Bo grow ore succinate, fumarate, and malate is dependent on the state of modification in position 37 of those tRNAs normally having ms(2)io(6)A37 and is not due to a second cellular function of tRNA (ms(2)io(6)A37)hydroxylase, the miaE gene product. We suggest that S. typhimurium senses the hydroxylation status of the isopentenyl group of the tRNA and will grow on succinate, fumarate, or malate only if the isopentenyl group is hydroxylated.
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| 7. |
- Robba, Chiara, et al.
(författare)
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Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients : a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial
- 2022
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 48:8, s. 1024-1038
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods: Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results: A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (VT) was 7 (Interquartile range, IQR = 6.2–8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5–9) cmH20, plateau pressure was 20 cmH20 (IQR = 17–23), driving pressure was 12 cmH20 (IQR = 10–15), mechanical power 16.2 J/min (IQR = 12.1–21.8), ventilatory ratio was 1.27 (IQR = 1.04–1.6), and respiratory rate was 17 breaths/minute (IQR = 14–20). Median partial pressure of oxygen was 87 mmHg (IQR = 75–105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36–45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003–1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001–1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions: Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.
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| 8. |
- Schönning, A., et al.
(författare)
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Venous thrombosis in children and adolescents with Hodgkin lymphoma in Sweden
- 2017
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Ingår i: Thrombosis Research. - : Elsevier BV. - 0049-3848 .- 1879-2472. ; 152, s. 64-68
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Pediatric patients with Hodgkin lymphoma (HL) have several risk factors for venous thromboembolism (VTE). Although these patients are occasionally treated with thromboprophylaxis, no guidelines are implemented in Sweden. Scarce data from adult patients indicate an increased risk of VTE, but pediatric data is largely missing. Given the favorable overall survival of HL, there should reasonably be more focus on preventing complications. Materials and methods We conducted a retrospective cohort study, including all patients registered in the Childhood Cancer Registry under the age of 18 years diagnosed with HL between January 2005 and December 2015 in Sweden. Results Data was retrieved from the medical records of all 163 patients (100%) at six Swedish pediatric cancer centers. The incidence of VTE was 7.7% (symptomatic VTE 3.9%). The median follow-up was 3.4 years (range 0.3–10.5). Only five patients (3.1%) were treated with thromboprophylaxis. All VTE events occurred in the older age category (11–17 years) and all but one (92.7%) had a mediastinal mass. While the VTE did not significantly affect the treatment of HL, it caused increased morbidity and 2/12 developed a post-thrombotic syndrome. No significant risk factors for VTE were identified. Conclusions VTE is a relatively common complication of HL and its treatment, causing increased acute and long-term morbidity. However, due to limited number of events we could not demonstrate risk-factors for VTE that would identify patients who might benefit from thromboprophylaxis.
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