| 1. |
- Hasselqvist-Ax, Ingela, et al.
(författare)
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Dispatch of Firefighters and Police Officers in Out-of-Hospital Cardiac Arrest : A Nationwide Prospective Cohort Trial Using Propensity Score Analysis.
- 2017
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Ingår i: Journal of the American Heart Association. - 2047-9980. ; 6:10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Dispatch of basic life support-trained first responders equipped with automated external defibrillators in addition to advanced life support-trained emergency medical services personnel in out-of-hospital cardiac arrest (OHCA) has, in some minor cohort studies, been associated with improved survival. The aim of this study was to evaluate the association between basic life support plus advanced life support response and survival in OHCA at a national level.METHODS AND RESULTS: This prospective cohort study was conducted from January 1, 2012, to December 31, 2014. People who experienced OHCA in 9 Swedish counties covered by basic life support plus advanced life support response were compared with a propensity-matched contemporary control group of people who experienced OHCA in 12 counties where only emergency medical services was dispatched, providing advanced life support. Primary outcome was survival to 30 days. The analytic sample consisted of 2786 pairs (n=5572) derived from the total cohort of 7308 complete cases. The median time from emergency call to arrival of emergency medical services or first responder was 9 minutes in the intervention group versus 10 minutes in the controls (P<0.001). The proportion of patients admitted alive to the hospital after resuscitation was 31.4% (875/2786) in the intervention group versus 24.9% (694/2786) in the controls (conditional odds ratio, 1.40; 95% confidence interval, 1.24-1.57). Thirty-day survival was 9.5% (266/2786) in the intervention group versus 7.7% (214/2786) in the controls (conditional odds ratio, 1.27; 95% confidence interval, 1.05-1.54).CONCLUSIONS: In this nationwide interventional trial, using propensity score matching, dispatch of first responders in addition to emergency medical services in OHCA was associated with a moderate, but significant, increase in 30-day survival.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02184468.
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| 2. |
- Hambraeus, Mette, et al.
(författare)
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Functional outcome and health-related quality of life in patients with sacrococcygeal teratoma – a Swedish multicenter study
- 2019
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Ingår i: Journal of Pediatric Surgery. - : Elsevier BV. - 0022-3468 .- 1531-5037. ; 54:8, s. 1638-1643
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Tidskriftsartikel (refereegranskat)abstract
- Background/Purpose: The aims of this study were to evaluate bowel and urinary tract function, to identify predictors for dysfunctional outcome and to evaluate health-related quality-of life (QoL) in patients treated for sacrococcygeal teratomas (SCT). Methods: Medical records of patients with SCT born between 1985 and 2015 treated at three Swedish pediatric surgical centers were reviewed. Questionnaires regarding urinary tract function, bowel function and QoL were sent to patients and parents. Different QoL instruments were used for the different age groups. Results: Totally 85 patients were identified. Four patients died in the neonatal period. Forty-nine patients answered the questionnaires (60%). Median age at follow-up was 8.9 years (range 3.6–28.8). Bowel dysfunction was reported by 36% and urinary tract dysfunction by 46% of the patients. Univariate analysis revealed that urinary tract dysfunction correlated with gestational age (p = 0.018) and immature histology (p = 0.008), and bowel dysfunction correlated with gestational age (p = 0.016) and tumor size (p = 0.042). Low gestational age was an independent predictor for both urinary tract and bowel dysfunction. Good or very good QoL was reported by 56% of children aged 4–7 years, 90% of children aged 8–17 years and 67% of the adults. Conclusion: Although a considerable proportion of bowel and urinary tract dysfunction was found, the reported QoL was good in a majority of the patients with SCT. Low gestational age was found to be a predictor for bowel- and urinary tract dysfunction. Level of Evidence: Level III.
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| 3. |
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| 4. |
- Rutegård, Martin, 1982-, et al.
(författare)
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Chronic pain after open inguinal hernia repair : expertise-based randomized clinical trial of heavyweight or lightweight mesh.
- 2021
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Ingår i: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 108:2, s. 138-144
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is a shortage of high-quality studies regarding choice of mesh in open anterior inguinal hernia repair in relation to long-term chronic pain. The authors hypothesized that heavyweight compared with lightweight mesh causes increased postoperative pain.METHODS: An RCT was undertaken between 2007 and 2009 at two sites in Sweden. Men aged 25 years or older with an inguinal hernia evaluated in the outpatient clinic were randomized in an unblinded fashion to heavyweight or lightweight mesh for open anterior inguinal hernia repair. Data on pain affecting daily activities, as measured by the Short-Form Inguinal Pain Questionnaire 9-12 years after surgery, were collected as the primary outcome. Differences between groups were evaluated by generalized odds and numbers needed to treat.RESULTS: A total of 412 patients were randomized; 363 were analysed with 320 questionnaires sent out. A total of 271 questionnaires (84.7 per cent) were returned; of these, 121 and 150 patients were in the heavyweight and lightweight mesh groups respectively. Pain affecting daily activities was more pronounced in patients randomized to heavyweight versus lightweight mesh (generalized odds 1.33, 95 per cent c.i. 1.10 to 1.61). This translated into a number needed to treat of 7.06 (95 per cent c.i. 4.28 to 21.44). Two reoperations for recurrence were noted in the heavyweight mesh group, and one in the lightweight mesh group.CONCLUSION: A large-pore lightweight mesh causes significantly less pain affecting daily activities a decade after open anterior inguinal hernia repair. Registration number: NCT00451893 (http://www.clinicaltrials.gov).
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| 5. |
- Svensson, Jennie, 1987-
(författare)
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The Submerged Entry Nozzle : A Study of how to Reduce Decarburization and Clogging
- 2014
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During continuous casting the submerged entry nozzle (SEN) is one of the critical points. This since sequence casting is favourable, clogging of the SEN results in fever sequences or aborted castings. In this study the preheating of SEN has been evaluated at different steel plants. This since it earlier has been found, preheating resulted in decarburisation of the refractory base material (RBM) which in turn resulted in clogging of the SEN. During the industrial preheating trials it was found that decarburisation of the SEN is possible.The decarburisation results in a higher oxygen potential near the SEN wall. This in turn makes it possible for aluminum in the molten steel to form alumina particles. For low carbon aluminum killed steel grades, accretion of alumina clusters on the SEN internal wall result in clogging which hinder or reduces the steel flow through the SEN. For this reason, laboratory trials were performed to establish the formation of a liquid phase. Thus simulating the formation of liquid inclusions when alumina clusters attaches to the SEN wall, and which can be washed away by the steel flow. Formation of a liquid phase was indicated at the temperatures 1550-1600°C, and plasma coated nozzles were tried in pilot plant trials. The coating contained of 5-9 pct, 99.9 pct pure, calcium titanate (CaTiO3) mixed with yttria stabilized zirconia (YSZ).
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| 6. |
- Svensson, Magnus, et al.
(författare)
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Validating microscopic colitis (MC) in Swedish pathology registers
- 2018
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis. - 0036-5521 .- 1502-7708.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Microscopic colitis (MC), encompassing collagenous colitis (CC) and lymphocytic colitis (LC), is a diagnosis which relies on histopathologic criteria. This report examines the validity of having a diagnosis of MC in Swedish pathology registers.METHODS: We reviewed patient charts from 215 randomly selected individuals from 15 pathology departments in five healthcare regions in Sweden with a relevant histopathology code for MC on colon biopsies. Information on clinical symptoms and laboratory data were obtained from medical chart review. We obtained sufficient data on 211 individuals for calculating positive predictive values (PPVs) for MC.RESULTS: In total, 200/211 patients with a histopathology diagnosis of MC were confirmed as also having a clinical diagnosis of MC after chart review, yielding a PPV of 95% (95%CI =91-97%). The PPV for CC was 95% (95%CI =87-98%) and 85% for LC (95%CI =78-90%). The median age at biopsy was 67 years (range 17-90 years), and 72% (n = 154) were women. The most common symptoms in patients with MC histopathology were diarrhea (96% of patients), weight loss (24%) and abdominal pain (13%). Four percent (4/111) of patients with available data on stool culture were positive for gastrointestinal pathogens (none had Clostridium difficile). In 81 patients with available celiac serology, five (6%) were positive. Twenty-six percent of all patients had at least one other autoimmune disease, the most frequent being hypothyroidism (8%) and celiac disease (6%).CONCLUSIONS: This study found a high validity for MC as recorded in Swedish pathology registers.
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| 7. |
- Svensson, Pär-Johan
(författare)
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Molecular studies on Hirschsprung disease and 'Ondine's curse'
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is based on molecular studies of two diseases that arise from dysfunction of, defective migration or inappropriate apoptosis of neural crest derived cells: Hirschsprung disease (HSCR) and "Ondine's curse" (congenital central hypoventilation syndrome, CCHS). The neural crest (NC) is a condensation of pluripotent cells of ectodermal origin. Neural crest cells migrate during fetal life to form, among other tissues and cell types, the sympathetic part of the autonomic nervous system. Sympathetic neuroblasts invade the gastrointestinal canal in a cranial to caudal direction, cluster and differentiate to become the neuronal intestinal ganglia of Meissner and Auerbach. NC cells also form the cholinergic pathways in the ventral medulla. Patients with HSCR lack neuronal ganglia in the hindgut. This results in poor co-ordination of propulsion and a contracted distal segment with subsequent constipation or intestinal obstruction. The disease affects one in 5000 live births and males are more often affected than females. Familial occurrence and an increased risk for siblings indicate a genetic cause of HSCR. The studies on HSCR (Papers I-III) were based on 69 unrelated HSCR patients comprising 7 familial and 62 sporadic cases, accrued from the Stockholm region. Being a population-based study, there were no bias of ascertainment towards familial or long segment aganglionosis. Mutational screening was performed with single stranded conformation polymorphism analysis (SSCP) in candidate genes for NC development: the RET, endothelin receptor-B (EDNRB) and endothelin-3 (EDN-3) genes. Five germline mutations were detected in the RET gene: two frameshift and one missense mutation (C620R) typical for multiple endocrine neoplasia type 2A (MEN 2A) in familial cases; two missense mutations in sporadic cases. A girl with HSCR and MEN2A mutation developed medullary thyroid carcinoma at the age of 13 years (paper I). Six sporadic HSCR cases had one out of three different missense mutations in the EDNRB gene. Five of the mutations were inherited, one de novo. In all families with an inherited mutation, there were multiple cases of constipation in the family branch segregating the EDNRB mutation. These could constitute cases of subclinical Hirschsprung disease (paper II). An additional non-consanguineous family segregated two identical EDNRB mutations (G57S), as well as a RET mutation (R982C). The male proband, with short segment HSCR carries the RET and is heterozygous for the EDNRB mutation. The mother and sister both carry the RET mutation. The mother is heterozygous, the sister homozygous for the EDNRB mutation. The female carriers of both mutations were clinically unaffected. This suggests a possible additional sex-dependent modifying locus in this family (paper III). The original population-based cohort of 69 cases was expanded to 75 for the EDN-3 study described in paper IV. Among these 75 cases, a male patient with non-syndromic HSCR was found to carry a heterozygous frameshift mutation, predicted to result in haplo-insufficiency. The mutation is inherited from the mother, who has a history of moderate constipation (paper IV). "Ondine's curse" is a disease characterised by the absence of autonomous breathing due to dysfunction of neural crest derived cells in the ventral medulla. An association with HSCR is reported in 15-50% of "Ondine's curse" patients. 25 cases, four with associated HSCR, where nonselectively ascertained and screened for mutations in the RET, glial cell line-derived neurotrophic factor (GDNF), EDNRB, EDN-3 and EDN-1 genes. A missense mutation was detected in the RET gene in a patient with late onset "Ondine's curse" and hyperphagia. This mutation was inherited from the clinically unaffected father. A mutation was also detected in the EDN-1 gene 3'UTR domain, in a patient with classical isolated "Ondine's curse" (paper V).
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| 8. |
- Winberg, Johanna, et al.
(författare)
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Mutation Screening and Array Comparative Genomic Hybridization Using a 180K Oligonucleotide Array in VACTERL Association
- 2014
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:1, s. e85313-
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Tidskriftsartikel (refereegranskat)abstract
- In order to identify genetic causes of VACTERL association (V vertebral defects, A anorectal malformations, C cardiac defects, T tracheoesofageal fistula, E esophageal atresia, R renal anomalies, L limb deformities), we have collected DNA samples from 20 patients diagnosed with VACTERL or with a VACTERL-like phenotype as well as samples from 19 aborted fetal cases with VACTERL. To investigate the importance of gene dose alterations in the genetic etiology of VACTERL association we have performed a systematic analysis of this cohort using a 180K array comparative genomic hybridization (array-CGH) platform. In addition, to further clarify the significance of PCSK5, HOXD13 and CHD7 genes in the VACTERL phenotype, mutation screening has been performed. We identified pathogenic gene dose imbalances in two fetal cases; a hemizygous deletion of the FANCB gene and a (9;18)(p24;q12) unbalanced translocation. In addition, one pathogenic mutation in CHD7 was detected, while no apparent disease-causing mutations were found in HOXD13 or PCSK5. Our study shows that although large gene dose alterations do not seem to be a common cause in VACTERL association, array-CGH is still important in clinical diagnostics to identify disease cause in individual cases.
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