| 1. |
- Attia, Shady, et al.
(författare)
-
Overheating calculation methods, criteria, and indicators in European regulation for residential buildings
- 2023
-
Ingår i: Energy and Buildings. - : Elsevier. - 0378-7788 .- 1872-6178. ; 292
-
Tidskriftsartikel (refereegranskat)abstract
- With the ongoing significance of overheating calculations in the residential building sector, building codes such as the European Energy Performance of Building Directive (EPBD) are essential for harmonizing the indicators and performance thresholds. This paper investigates Europe's overheating calculation methods, indicators, and thresholds and evaluates their ability to address climate change and heat events. e study aims to identify the suitability of existing overheating calculation methods and propose recommendations for the EPBD. The study results provide a cross-sectional overview of twenty-six European countries. The most influential overheating calculation criteria are listed the best approaches are ranked. The paper provides a thorough comparative assessment and recommendations to align current calculations with climate-sensitive metrics. The results suggest a framework and key performance indicators that are comfort-based, multi-zonal, and time-integrated to calculate overheating and modify the EU's next building energy efficiency regulations. The results can help policymakers and building professionals to develop the next overheating calculation framework and approach for the future development of climate-proof and resilient residential buildings.
|
|
| 2. |
- Kilpeläinen, Tuomas O, et al.
(författare)
-
Genome-wide meta-analysis uncovers novel loci influencing circulating leptin levels
- 2016
-
Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 7
-
Tidskriftsartikel (refereegranskat)abstract
- Leptin is an adipocyte-secreted hormone, the circulating levels of which correlate closely with overall adiposity. Although rare mutations in the leptin (LEP) gene are well known to cause leptin deficiency and severe obesity, no common loci regulating circulating leptin levels have been uncovered. Therefore, we performed a genome-wide association study (GWAS) of circulating leptin levels from 32,161 individuals and followed up loci reaching P<10(-6) in 19,979 additional individuals. We identify five loci robustly associated (P<5 × 10(-8)) with leptin levels in/near LEP, SLC32A1, GCKR, CCNL1 and FTO. Although the association of the FTO obesity locus with leptin levels is abolished by adjustment for BMI, associations of the four other loci are independent of adiposity. The GCKR locus was found associated with multiple metabolic traits in previous GWAS and the CCNL1 locus with birth weight. Knockdown experiments in mouse adipose tissue explants show convincing evidence for adipogenin, a regulator of adipocyte differentiation, as the novel causal gene in the SLC32A1 locus influencing leptin levels. Our findings provide novel insights into the regulation of leptin production by adipose tissue and open new avenues for examining the influence of variation in leptin levels on adiposity and metabolic health.
|
|
| 3. |
- Levin, Anna, et al.
(författare)
-
The changing landscape of surgery for Crohns disease
- 2020
-
Ingår i: SEMINARS IN COLON AND RECTAL SURGERY. - : W B SAUNDERS CO-ELSEVIER INC. - 1043-1489. ; 31:2
-
Tidskriftsartikel (refereegranskat)abstract
- The incidence of Crohns disease is increasing world-wide and the disease location and behavior is changing towards more colonic as well as inflammatory behavior. As previous data have spoken towards ileal disease and structuring and penetrating disease to be the indications most in need of surgery, one could expect the surgical load to decrease. As these changes are relative, the absolute numbers of surgical interventions are less affected. There are also data showing an increasing complexity among patients at time of surgery. Finally, a new role for surgery as initial therapy to induce remission instead of biologic therapy in ileal or ileocaecal disease has been suggested. In order to improve the care for patients with Crohns disease in general, and the peri-operative phase in particular, the use of multidisciplinary team discussions is essential. In conclusion, the role of surgery is changing. Fewer patients need surgery, but when they do they have more complex disease. In the future, ileocaecal resection may be used increasingly as initial therapy to induce remission in a true top-down approach. (C) 2020 Elsevier Inc. All rights reserved.
|
|
| 4. |
- Risto, Anton, et al.
(författare)
-
Colectomy reconstruction for ulcerative colitis in Sweden and England: a multicenter prospective comparison between ileorectal anastomosis and ileal pouch-anal anastomosis after colectomy in patients with ulcerative colitis. (CRUISE-study)
- 2023
-
Ingår i: BMC Surgery. - : BMC. - 1471-2482. ; 23:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere are no prospective trials comparing the two main reconstructive options after colectomy for Ulcerative colitis, ileal pouch anal anastomosis and ileorectal anastomosis. An attempt on a randomized controlled trial has been made but after receiving standardized information patients insisted on choosing operation themselves.MethodsAdult Ulcerative colitis patients subjected to colectomy eligible for both ileal pouch anastomosis and ileorectal anastomosis are asked to participate and after receiving standardized information the get to choose reconstructive method. Patients declining reconstruction or not considered eligible for both methods will be followed as controls. The CRUISE study is a prospective, non-randomized, multi-center, open-label, controlled trial on satisfaction, QoL, function, and complications between ileal pouch anal anastomosis and ileorectal anastomosis.DiscussionReconstruction after colectomy is a morbidity-associated as well as a resource-intensive activity with the sole purpose of enhancing function, QoL and patient satisfaction. The aim of this study is to provide the best possible information on the risks and benefits of each reconstructive treatment.
|
|
| 5. |
- Risto, Anton, et al.
(författare)
-
Long-term Follow-up, Patient Satisfaction, and Quality of Life for Patients With Kocks Continent Ileostomy
- 2021
-
Ingår i: Diseases of the Colon & Rectum. - : LIPPINCOTT WILLIAMS & WILKINS. - 0012-3706 .- 1530-0358. ; 64:4, s. 420-428
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Continent ileostomy is a solution for patients after proctocolectomy. OBJECTIVE: The aim of this study was to assess the long-term complications and failure rate alongside patient satisfaction, function, and quality of life for patients with a continent ileostomy. DESIGN: This was a retrospective, descriptive cross-sectional study. SETTINGS: All patients were operated in 1 center between 1980 and 2016. PATIENTS: A total of 85 patients received a de novo continent ileostomy in our institution. Sixty-nine patients (80%) had ulcerative colitis, 12 (14%) had Crohns disease, 2 had indeterminate colitis, and 1 each had familial adenomatous polyposis and anal atresia. MAIN OUTCOME MEASURES: Medical charts were reviewed for reoperations and pouchitis. The 36-Item Short Form, Short Health Scale, and a local continent ileostomy questionnaire were used to assess quality of life, function, and satisfaction. RESULTS: After a median follow-up of 24 years, 67 patients (79%) underwent a total of 237 reoperations, of which 15 were conversions to end ileostomies, that is, failures. Fifty patients (59%) underwent repeat laparotomies, excluding loop ileostomy closures. Nipple detachment was the most common cause for repeat laparotomy, and fistulation was the most common cause for pouch removal. IPAA before continent ileostomy was associated with an increased risk for failure. Crohns disease was not associated with an increased risk for reoperation or failure. Forty-three patients (84%) reported that they were satisfied. Seventy patients were available for questionnaires, and 50 patients (71%) answered. There was no difference in the 36-Item Short Form between the continent ileostomy population and an age-matched control population. LIMITATIONS: The retrospective, single-center design of the study alongside <100% response rate are to be considered limitations. CONCLUSIONS: Despite large numbers of complications, patients are generally satisfied with their continent ileostomies, and their quality of life is comparable to the general population. See Video Abstract at http://links.lww.com/DCR/B444.
|
|
| 6. |
- Risto, Anton, 1984-
(författare)
-
Reconstruction after Colectomy for Inflammatory Bowel Disease
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- After colectomy there are four options available. The least complicated and most common is to leave the end ileostomy and not go for any reconstructive surgery. Then there is the ileal pouch anal anastomosis (IPAA) in which the rectum is removed, but the anal canal and a small rectal “cuff” is preserved. The pouch is created from the distal ileum and anastomosed to the rectal cuff. In the ileorectal anastomosis (IRA) the rectum is spared, and the distal ileum is anastomosed to the top of the rectum. In the continent ileostomy (CI), also referred to as the Kock pouch, the fecal flow is let out through the abdominal wall, but a pouch and a nipple valve mechanism is created making the stoma continent which needs to be manually emptied. This thesis aims to investigate function, quality of life, satisfaction, complications, and aspects associated with the chance of having reconstructive surgery after colectomy for inflammatory bowel disease (IBD), i.e. ulcerative colitis (UC) or Crohn’s disease (CD).The first two papers focus on the continent ileostomy, the most uncommon of the options after colectomy. In Paper 1 all patients who have received a CI at our center were identified and medical charts were reviewed for complications and CI patency. Function and quality of life were evaluated with the 36-item short form survey (SF-36), short health scale (SHS) and a local CI specific questionnaire for function and satisfaction. In Paper II, the Swedish national patient register (NPR) was used to identify all patients with an IBD diagnosis who had received a CI and data on diagnosis, demographics, reoperations, and excisions were obtained from the register. Paper III describes an ongoing prospective non-randomized, multi-center, open-label, controlled trial between IRA and IPAA in UC patients subjected to colectomy. The primary endpoint is satisfaction but Quality of Life (QoL), sexual function, bowel function and complications are also evaluated. In Paper IV, we investigated if the chance of getting reconstructed after colectomy was dependent on the IPAA volumes at the colectomy hospital using data from the national patient register. The hospitals were arranged in to four categories based on the average annual number of IPAA procedures: (0, 1-3, 4-7, >7 procedures per year). In Paper I we found that 59 % of CI patients needed repeat laparotomy after a median follow up of 24 years and nipple detachment was the most common cause of repeat laparotomy. Fifteen patients (18 %) had their CIs converted to end ileostomies and the most common cause for this was fistulas. Eighty-four per cent of CI patients reported satisfaction with their reconstruction. The national study in Paper II identified 727 IBD patients with CI and the median follow-up time was 27 years. During follow-up, 1484 reoperations were performed on 536 patients (74 %). Twenty-six per cent of the patients did not have any reoperations, 24 % had one reoperation, 20 % had two reoperations and the remaining 30 % had between three and 15 reoperations each. The CIs were identified to have been removed in 77 (11 %) patients. In Paper III we have so far included 47 patients in the intervention arms out of which 35 (74 %) have chosen IRA and 12 patients (26 %) have chosen IPAA. Another 44 (40 % of the whole group) patients have so far received an IPAA but were deemed non-eligible for both IRA and IPAA and were hence not eligible for the intervention arms. So far 18 patients (17 % of the whole group) have chosen an ileostomy. In Paper IV we first identified 4112 UC patients subjected to colectomy between 1997 and 2020. Out of these 4112 patients, 1932 (47 %) went through some kind of reconstruction, 964 (50 %) IRA, 927 (48 %) IPAA and 41 (2 %) CI. The proportion having restorative surgery was larger for patients subjected to colectomy at a high IPAA volume center (62 % vs 38 %) and the chance of getting an IPAA increased with each IPAA volume category (Hazard ratios (HR) were: 1; 1.49 95 % CI (1.25-1.78) ; 1.79 95 % CI (1.49-2.15) and 2.11 95 % CI (1.70-2.62) respectively)The IPAA volumes did not affect the chance of receiving an IRA or the risk of failure of reconstruction.
|
|
| 7. |
- Risto, Anton, et al.
(författare)
-
Reoperations and Long-term Survival of Kock’s Continent Ileostomy in Inflammatory Bowel Disease Patients: A Population Based National Cohort Study from Sweden
- 2023
-
Ingår i: Diseases of the Colon & Rectum. - : Wolters Kluwer. - 0012-3706 .- 1530-0358. ; 66:11, s. 1492-1499
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Kock’s continent ileostomy is an option after proctocolectomy for patients not suitable for ileal pouch anal anastomosis or ileorectal anastomosis. Ulcerative colitis is the most common indication for continent ileostomy.OBJECTIVE: The aim of this study was to evaluate the long-term outcome of continent ileostomy.DESIGN: Retrospective cohort register study.SETTINGS: Data were obtained from the Swedish National Patient Registry.PATIENTS: All patients with inflammatory bowel disease and a continent ileostomy were identified. Data on demographics, diagnosis, reoperations, and excisions of the continent ileostomy was obtained. Patients with inconsistent diagnostic coding were classified as inflammatory bowel disease-unclassified.MAIN OUTCOME MEASURES: The main outcome measures was number of reoperations, time to reoperations and time to excision of continent ileostomy.RESULTS: We identified 727 patients, 428 (59%) with ulcerative colitis, 45 (6%) with Crohn’s disease and 254 (35%) with inflammatory bowel disease-unclassified. After a median follow-up time of 27 (IQR, 21-31) years 191 (26%) patients had never had revisional surgery. Some 1,484 reoperations were performed on 536 (74%) patients, the median number of reoperations was 1 (IQR, 0-3) per patient. The continent ileostomy was excised in 77 (11%) patients. Reoperation within the first year after reconstruction was associated with higher rate of revisions (IRR, 2.90 p < 0.001) and shorter time to excision (HR 2.38 p < 0.001). Constructing the continent ileostomy after year 2000 was associated with increased revision and excision rates (IRR, 2.7 p < 0.001 and HR 2.74 p = 0.013). Inflammatory bowel disese-unclassified was associated with increased revisions (IRR, 1.3 p < 0.001) and the proportion of IBD-unclassified patients almost doubled from the 1980s (32%) to after 2000 (50%).LIMITATIONS: Retrospective design, data from register. No data on quality of life available.CONCLUSION: Continent ileostomy is associated with substantial need for revisional surgery, but most patients get to keep their reconstruction for a long time. See Video Abstract at https://links.lww.com/DCR/C122.
|
|
| 8. |
- Risto, Anton, et al.
(författare)
-
Staging Pouch Surgery in Ulcerative Colitis in the Biological Era
- 2022
-
Ingår i: Clinics in Colon and Rectal Surgery. - : THIEME MEDICAL PUBL INC. - 1531-0043 .- 1530-9681. ; 35:01, s. 58-65
-
Tidskriftsartikel (refereegranskat)abstract
- Restorative proctocolectomy, or ileal pouch anal anastomosis, is considered the standard treatment for intractable ulcerative colitis. When the pelvic pouch was first introduced in 1978, a two-stage procedure with proctocolectomy, construction of the pelvic pouch, and a diverting loop with subsequent closure were suggested. Over the decades that the pelvic pouch has been around, some principal technical issues have been addressed to improve the method. In more recent days the laparoscopic approach has been additionally introduced. During the same time-period the medical arsenal has developed far more with the increasing use of immune modulators and the introduction of biologicals. Staging of restorative proctocolectomy with a pelvic pouch refers to how many sessions, or stages, the procedure should be divided into. The main goal with restorative proctocolectomy is a safe operation with optimal short- and long-term function. In this paper we aim to review the present knowledge and views on staging of the pouch procedure in ulcerative colitis, especially with consideration to the treatment with biologicals.
|
|
| 9. |
- Van Noije, Twan, et al.
(författare)
-
EC-Earth3-AerChem : A global climate model with interactive aerosols and atmospheric chemistry participating in CMIP6
- 2021
-
Ingår i: Geoscientific Model Development. - : Copernicus GmbH. - 1991-959X .- 1991-9603. ; 14:9, s. 5637-5668
-
Tidskriftsartikel (refereegranskat)abstract
- This paper documents the global climate model EC-Earth3-AerChem, one of the members of the EC-Earth3 family of models participating in the Coupled Model Intercomparison Project Phase 6 (CMIP6). EC-Earth3-AerChem has interactive aerosols and atmospheric chemistry and contributes to the Aerosols and Chemistry Model Intercomparison Project (AerChemMIP). In this paper, we give an overview of the model, describe in detail how it differs from the other EC-Earth3 configurations, and outline the new features compared with the previously documented version of the model (EC-Earth 2.4). We explain how the model was tuned and spun up under preindustrial conditions and characterize the model's general performance on the basis of a selection of coupled simulations conducted for CMIP6. The net energy imbalance at the top of the atmosphere in the preindustrial control simulation is on average -0.09 W m-2 with a standard deviation due to interannual variability of 0.25 W m-2, showing no significant drift. The global surface air temperature in the simulation is on average 14.08 ∼ C with an interannual standard deviation of 0.17 ∼ C, exhibiting a small drift of 0.015 ± 0.005 ∼ C per century. The model's effective equilibrium climate sensitivity is estimated at 3.9 ∼ C, and its transient climate response is estimated at 2.1 ∼ C. The CMIP6 historical simulation displays spurious interdecadal variability in Northern Hemisphere temperatures, resulting in a large spread across ensemble members and a tendency to underestimate observed annual surface temperature anomalies from the early 20th century onwards. The observed warming of the Southern Hemisphere is well reproduced by the model. Compared with the ECMWF (European Centre for Medium-Range Weather Forecasts) Reanalysis version 5 (ERA5), the surface air temperature climatology for 1995-2014 has an average bias of -0.86 ± 0.05 ∼ C with a standard deviation across ensemble members of 0.35 ∼ C in the Northern Hemisphere and 1.29 ± 0.02 ∼ C with a corresponding standard deviation of 0.05 ∼ C in the Southern Hemisphere. The Southern Hemisphere warm bias is largely caused by errors in shortwave cloud radiative effects over the Southern Ocean, a deficiency of many climate models. Changes in the emissions of near-term climate forcers (NTCFs) have significant effects on the global climate from the second half of the 20th century onwards. For the SSP3-7.0 Shared Socioeconomic Pathway, the model gives a global warming at the end of the 21st century (2091-2100) of 4.9 ∼ C above the preindustrial mean. A 0.5 ∼ C stronger warming is obtained for the AerChemMIP scenario with reduced emissions of NTCFs. With concurrent reductions of future methane concentrations, the warming is projected to be reduced by 0.5 ∼ C.
|
|
