| 1. |
- Olsson, Anders, et al.
(författare)
-
Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair
- 2017
-
Ingår i: Surgery. - : Elsevier. - 0039-6060 .- 1532-7361. ; 161:2, s. 509-516
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic pain is common after inguinal hernia repair and has become one of the most important outcome measures for this procedure. The purpose of this study was to determine whether or not there is a relationship between specific postoperative complications and risk for chronic pain after open inguinal hernia repair.METHODS: A prospective cohort study was designed in which participants responded to the Inguinal Pain Questionnaire regarding postoperative groin pain 8 years after inguinal hernia repair. Responses to the questionnaire were matched with data from a previous study regarding reported postoperative complications after open inguinal hernia repair. Participants were recruited originally from the Swedish Hernia Register. Response rate was 82.4% (952/1,155). The primary outcome was chronic pain in the operated groin at follow-up. Grading of pain was performed using the Inguinal Pain Questionnaire.RESULTS: A total of 170 patients (17.9%) reported groin pain and 29 patients (3.0%) reported severe groin pain. The risk for developing chronic groin pain was greater in patients with severe pain in the preoperative or immediate postoperative period (odds ratio 2.09; 95% confidence interval 1.28-3.41). Risk for chronic pain decreased for every 1-year increase in age at the time of operation (odds ratio 0.99, 95% confidence interval 0.98-1.00).CONCLUSION: Both preoperative pain and pain in the immediate postoperative period are strong risk factors for chronic groin pain. Risk factor patterns should be considered before operative repair of presumed symptomatic inguinal hernias. The problem of postoperative pain must be addressed regarding both pre-emptive and postoperative analgesia.
|
|
| 2. |
|
|
| 3. |
- Cao, Yuli, et al.
(författare)
-
Cellular High-Energy Cavitation Trauma - Description of a Novel In Vitro Trauma Model in Three Different Cell Types
- 2016
-
Ingår i: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 7
-
Tidskriftsartikel (refereegranskat)abstract
- The mechanisms involved in traumatic brain injury have yet to be fully characterized. One mechanism that, especially in high-energy trauma, could be of importance is cavitation. Cavitation can be described as a process of vaporization, bubble generation, and bubble implosion as a result of a decrease and subsequent increase in pressure. Cavitation as an injury mechanism is difficult to visualize and model due to its short duration and limited spatial distribution. One strategy to analyze the cellular response of cavitation is to employ suitable in vitro models. The flyer-plate model is an in vitro high-energy trauma model that includes cavitation as a trauma mechanism. A copper fragment is accelerated by means of a laser, hits the bottom of a cell culture well causing cavitation, and shock waves inside the well and cell medium. We have found the flyer-plate model to be efficient, reproducible, and easy to control. In this study, we have used the model to analyze the cellular response to microcavitation in SH-SY5Y neuroblastoma, Caco-2, and C6 glioma cell lines. Mitotic activity in neuroblastoma and glioma was investigated with BrdU staining, and cell numbers were calculated using automated time-lapse imaging. We found variations between cell types and between different zones surrounding the lesion with these methods. It was also shown that the injured cell cultures released S-100B in a dose-dependent manner. Using gene expression microarray, a number of gene families of potential interest were found to be strongly, but differently regulated in neuroblastoma and glioma at 24 h post trauma. The data from the gene expression arrays may be used to identify new candidates for biomarkers in cavitation trauma. We conclude that our model is useful for studies of trauma in vitro and that it could be applied in future treatment studies.
|
|
| 4. |
- Célind, Jimmy, et al.
(författare)
-
Secular trends of birthweight in boys from 1950 to 2010
- 2019
-
Ingår i: Pediatrics and Neonatology. - : Elsevier BV. - 1875-9572. ; 60:5, s. 543-548
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Birthweight is an indicator of fetal development and intrauterine conditions and is associated with future health outcomes. Secular birthweight trends prior to the 1970s are mostly unknown. Our aim was to explore secular birthweight trends in Swedish boys from 1950 to 2010. Methods: We have collected detailed growth data including birthweight from archived School Health Care records for children born in Gothenburg from 1946 and onwards and established a unique population-based cohort, the Body Mass Index Epidemiology Study (BEST). The birthweight cohort spans six decades (1950–2010) and includes 46,548 boys. Results: The mean birthweight of the complete study cohort was 3580 ± 562 g. Linear regression analysis of the entire period revealed a minimal negative secular trend for birthweight (BETA = −0.4 g/year; p < 0.01). However, three distinct trends appeared during sub-periods: a decrease 1950–80, an increase 1980–2000 and another decrease 2000–2010. Conclusion: We demonstrate that birthweight in boys has undergone periodic decreases and subsequent increases, but the overall trend from the 1950s to the present is stable. © 2019
|
|
| 5. |
- Heinius, Göran, et al.
(författare)
-
Effects of Different Fluid Regimes and Desmopressin on Uncontrolled Hemorrhage During Hypothermia in the Rat
- 2012
-
Ingår i: Therapeutic Hypothermia and Temperature Management. - : Mary Ann Liebert. - 2153-7658 .- 2153-7933. ; 2:2, s. 53-60
-
Tidskriftsartikel (refereegranskat)abstract
- Resuscitation with large volumes of crystalloids during traumatic hemorrhagic shock might increase the mortality by inducing rebleeding. However, few studies have addressed this problem during hypothermic conditions. Sixty-eight Sprague-Dawley rats were exposed to a standardized femoral artery injury and resuscitated with low (LRe), medium (MRe), or high (HRe) intensity using lactated Ringer's solution after being cooled to 30°C. An additional MRe group was also given desmopressin since this drug might reverse hypothermic-induced impairment of the primary hemostasis. The rats were rewarmed after 90 minutes and observed for 3 hours. The incidence, on-set time, duration, and volume of bleedings and hemodynamic changes were recorded. Rebleedings occurred in 60% of all animals and were more voluminous in the HRe group than in the LRe group (p=0.01). The total rebleeding volume per animal increased with the rate of fluid administration (r=0.50, p=0.01) and the duration of each rebleeding episode was longer in the HRe group than in the LRe group (p<0.001). However, the mortality tended to be higher in the LRe group (LRe=6/15, MRe=1/15, HRe=2/15, p=0.07). Desmopressin did not change the bled volume or the mortality. Overall, the mortality increased if rebleeding occurred (10/35 rebleeders died vs. 1/25 nonrebleeders, p=0.015). Liberal fluid administration increased the rebleeding volume while a trend toward higher mortality was seen with the restrictive fluid program. Desmopressin had no effect on the studied parameters.
|
|
| 6. |
- Heinius, Goran, et al.
(författare)
-
HYPOTHERMIA INCREASES REBLEEDING DURING UNCONTROLLED HEMORRHAGE IN THE RAT
- 2011
-
Ingår i: Shock. - : Biomedical Press. - 1073-2322 .- 1540-0514. ; 36:1, s. 60-66
-
Tidskriftsartikel (refereegranskat)abstract
- Trauma registers show that hypothermia (HT) is an independent risk factor for death during hemorrhagic shock, although experimental animal studies indicate that HT may be beneficial during these conditions. However, the animal models were not designed to detect the expected increase in bleeding caused by HT. In a new model for uncontrolled bleeding, 40 Sprague-Dawley rats were exposed to a standardized femoral artery injury and randomized to either normothermia or HT. Ketamine/midazolam was used to minimize hemodynamic changes due to the anesthesia. The hypothermic rats were cooled to 30 degrees C and rewarmed again at 90 min. The study period was 3 h. The incidence, onset time, duration, and volume of bleedings as well as hemodynamic and metabolic changes were recorded. There was no difference between groups with respect to the initial bleeding. Rebleedings occurred among 60% of the animals in both groups. Hypothermic rebleeders had more, larger, and longer rebleedings, resulting in a total rebleeding volume amounting to 41% of their estimated blood volume. The corresponding figure for the normothermic rebleeders was 3% (P less than 0.001). Total rebleeding volume was significantly larger in the hypothermic group, even at body temperatures greater than 35 degrees C. We conclude that the risk of rebleeding from a femoral injury is greater in the presence of cooling and HT. The larger rebleeding volumes seen even at body temperatures greater than 35 degrees C indicate that factors other than temperature-induced coagulopathy also contributed to the increased hemorrhage.
|
|
| 7. |
- Ivarson, Josefine, et al.
(författare)
-
Call the On-Call : a study of student learning on an interprofessional training ward
- 2021
-
Ingår i: Journal of Interprofessional Care. - : Informa UK Limited. - 1356-1820 .- 1469-9567. ; 35:2, s. 275-283
-
Tidskriftsartikel (refereegranskat)abstract
- Interprofessional training wards are designed to train students’ team and communication competences. Such wards are generally highly valued clinical placements by undergraduate students; however, evidence in the literature suggests that medical students experience a lack of profession-specific tasks on these wards. Moreover, students lack structured training in the complexities of everyday communication where different health professions rarely are present together in stable teams. This paper reviews one strategy to train students in interprofessional communication while letting students perform profession-specific tasks. A qualitative study with ethnographically-collected data was conducted among three interprofessional student teams over three two-week periods, mixing field observations (75 h), interviews (n = 16), and field notes (45 pages). The findings show that students gained insights into new aspects of their professional roles and an appreciation of clear and open interprofessional communication over the telephone. Learning was facilitated through being confronted with new situations and discussing these experiences with each other over time. Call the On-Call as a pedagogic activity provided not just medical students, but also nursing students with new types of profession-specific tasks on the interprofessional training ward.
|
|
| 8. |
- Mahdavi, Jafar, et al.
(författare)
-
Helicobacter pylori SabA adhesin in persistent infection and chronic inflammation
- 2002
-
Ingår i: Science. - : American Association for the Advancement of Science. - 0036-8075 .- 1095-9203. ; 297:5581, s. 573-578
-
Tidskriftsartikel (refereegranskat)abstract
- Helicobacter pylori adherence in the human gastric mucosa involves specific bacterial adhesins and cognate host receptors. Here, we identify sialyl-dimeric-Lewis x glycosphingolipid as a receptor for H. pylori and show that H. pylori infection induced formation of sialyl-Lewis x antigens in gastric epithelium in humans and in a Rhesus monkey. The corresponding sialic acid-binding adhesin (SabA) was isolated with the "retagging" method, and the underlying sabA gene (JHP662/HP0725) was identified. The ability of many H. pylori strains to adhere to sialylated glycoconjugates expressed during chronic inflammation might thus contribute to virulence and the extraordinary chronicity of H. pylori infection.
|
|
| 9. |
- Olsson, Anders, et al.
(författare)
-
The Short-Form Inguinal Pain Questionnaire (sf-IPQ) : An Instrument for Rating Groin Pain After Inguinal Hernia Surgery in Daily Clinical Practice
- 2019
-
Ingår i: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 43:3, s. 806-811
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The Inguinal Pain Questionnaire (IPQ) is a standardised and validated instrument for assessing persisting pain after groin hernia surgery. The IPQ is often perceived as being too extensive for routine use. The aim of this study was to develop and evaluate a condensed version of the IPQ in order to facilitate its use in daily clinical practice.Methods: The condensed form, i.e. Short-Form Inguinal Pain Questionnaire (sf-IPQ), comprises two main items taken from the IPQ. Four hundred patients were recruited from the Swedish Hernia Register and were sent the IPQ, sf-IPQ and the Short-Form McGill Pain Questionnaire (SF-MPQ) three years after hernia repair. Ratings from the IPQ and the sf-IPQ were converted to a 12-point scale. The reported scores for the two shared items in the IPQ and sf-IPQ were compared using the Intraclass Correlation Coefficient (ICC), Cohen’s kappa and McNemar’s test.Results: After two reminders, the response rate was 69.8% (n = 279/400). The ICC for the IPQ and sf-IPQ scores was 0.78 (95% confidence interval 0.73–0.82, p < 0.001). Cohen’s kappa was 0.66 (95% confidence interval 0.55–0.77, p < 0.001). The sf-IPQ systematically indicated a higher pain score than the IPQ (p = 0.013).Conclusions: Despite the systematic difference in level of pain scored, correlation, consistency and agreement were seen between the IPQ and sf-IPQ. The forms appear to be interchangeable, though the sf-IPQ may be a more sensitive instrument. The condensed structure of the sf-IPQ is more user-friendly and shows promise as a useful tool in daily clinical practice.
|
|
| 10. |
- Sondén, Anders
(författare)
-
Shock wave effects on the vascular endothelium
- 2002
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A shock wave is a pressure wave with high amplitude and a velocity above sound. Man is exposed to shock waves (SWs) in connection with trauma, e.g. explosions and high-energy missiles and medical treatments such as extracorporeal lithotripsy (ESWL). A major consequence of SWs is blood vessel injury. The ensuing detachment of endothelial cells (EC) and rupture of basal membranes partially explain the hemorrhages, thrombus formation and tissue edema, seen after SW exposure. Additional effects on endothelial cell functions are, however, conceivable in order to explain the panorama of injury, which might proceed to multiple organ failure. The flyer-plate technique is an established method to detonate explosives. This thesis describes how the flyer-plate technique was modified to expose cell monolayers to precise SWs, in ordinary cell culture wells. Mean peak amplitudes generated were 23 MPa or 104 MPa, depending on the experimental setting. Human umbilical vein endothelial cells (HUVECs) were used for cell experiments. To elucidate the mechanisms involved in SW injury we assessed the role of two suggested factors, viz. cavitation bubbles and reactive oxygen species (ROS). HUVECs exposed to SWs only, could not be distinguished from controls with regards to morphology or cell viability. Yet, a sub-lytic cell membrane injury was indicated. HUVEC cultures exposed to SWs plus cavitation (SWC) exhibited discrete endothelial lesions. Within the lesion area cell detachment, cell membrane damage and cell death was observed. A dose- response relationship between cavitation and cell injury was demonstrated. No protective effects of ROS scavengers were shown. To gain further insight into the pathophysiology of SW tissue injury we assessed the effects of SWs or SWC on the adhesion molecules P-selectin, E-selectin and ICAM-1 as well as cytoskeletal organization. A previous study had shown that H2O2 can induce reversible disassembly of tubulin and vimentin filaments. No significant effects of SWs per se, on the studied parameters, were observed. A sequential induction of P-selectin, E-selectin and ICAM-1 expression was shown in samples exposed to SWC. The induction of E-selectin and ICAM-1 was preceded by nuclear translocation of the NFkappaB subunit p65, implicating transcriptional regulation of this response. Destruction of actin, tubulin and vimentin filaments was seen in cells within the main lesion area. Cells peripheral to this area displayed disassembly of dense peripheral bands and formation of actin stress fibers, implying enhanced monolayer permeability in this region. Finally, we studied the cytoskeletal reorganization in relation to endothelial regeneration after SWC injury. It was shown that endothelial lesions, caused by SWC, exhibited impaired endothelial regeneration rate compared to mechanically produced lesions used as controls. This SW effect could be related to hampered cytoskeletal redistribution of tubulin- and actin filaments at the lesion border. In conclusion the flyer-plate technique can be used to expose cell monolayers to reproducible SWs. Our experimental model separates the effects of SWs from the effects of SWC. SWs per se caused cell membrane injury without affecting cell viability. Endothelial cell detachment and lytic cell injury, previously described in relation to explosions, high-energy missile trauma, laser angioplasty, ophthalmologic laser surgery and ESWL, was, however, linked to the generation of cavitation. Finally, SWC lesions were associated with a pro-inflammatory reaction as well as impaired endothelial regeneration rate, which may be attributed to changes in cytoskeletal functions.
|
|
