| 1. |
- Antoni, Gunnar, et al.
(författare)
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In Vivo Visualization of Amyloid Deposits in the Heart with C-11-PIB and PET
- 2013
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Ingår i: Journal of Nuclear Medicine. - : Society of Nuclear Medicine. - 0161-5505 .- 1535-5667 .- 2159-662X. ; 54:2, s. 213-220
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac amyloidosis is a differential diagnosis in heart failure and is associated with high mortality. There is currently no noninvasive imaging test available for specific diagnosis. N-[methyl-C-11]2-(4'-methylamino-phenyl)-6-hydroxybenzothiazole (C-11-PIB) PET is used in the evaluation of brain amyloidosis. We evaluated the potential use of C-11-PIB PET in systemic amyloidosis affecting the heart. Methods: Patients (n = 10) diagnosed with systemic amyloidosis-including heart involvement of either monoclonal immunoglobulin light-chain (AL) or transthyretin (ATTR) type- and healthy volunteers (n = 5) were investigated with PET/CT using C-11-PIB to study cardiac amyloid deposits and with C-11-acetate to measure myocardial blood flow to study the impact of global and regional perfusion on PIB retention. Results: Myocardial C-11-PIB uptake was visually evident in all patients 15-25 min after injection and was not seen in any volunteer. A significant difference in C-11-PIB retention in the heart between patients and healthy controls was found. The data indicate that myocardial amyloid deposits in patients diagnosed with systemic amyloidosis could be visualized with C-11-PIB. No correlation between C-11-PIB retention index and myocardial blood flow as measured with C-11-acetate was found on the global level, whereas a positive correlation on the segmental level was seen in a single patient. Conclusion: C-11-PIB and PET could be a method to study systemic amyloidosis of type AL and ATTR affecting the heart and should be investigated further both as a diagnostic tool and as a noninvasive method for treatment follow-up.
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| 2. |
- Beiron, Jens, 1959-, et al.
(författare)
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Drifterfarenheter från ett superisolerat flerbostadshus : Kv SEGLET, Karlstad
- 2010
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Seglet är ett 12-vånings punkthus med 44 lägenheter beläget i Karlstad. Byggherre är Karlstads Bostads AB. Huset är byggt med mycket höga ambitioner när det gäller kvalitet och resurshushållning och togs i drift i börjanav 2007.Denna rapport redovisar klimatskalets egenskaper och funktion samt utformningen av installationssystemen för värme, ventilation och tappvatten.Rapporten beskriver också drifterfarenheterna från de första årens drift samt de förbättringsåtgärder som utförts.Seglets lösningar visar att energieffektivisering och inneklimat kan gå hand ihand. Konceptet med en enkel förvärmning av tilluften löser två problem. Dels kan tilluften tillföras lägenheten utan risk för drag och dels saknar det FTX-systemets nackdelar med utökat servicebehov för filterbyten och ökad elanvändning för tilluftsfläkten. Det välisolerade och täta klimatskalet ger en komfortabel inomhusmiljö. Den befarade risken med höga rumstemperaturer sommartid har inte besannats. Tack vare genomtänkta fönsterplaceringar med solskyddsglas där så är befogat samt goda möjligheter till effektiv vädring har lägenheterna samma temperaturnivå sommartid som motsvarande lägenheter i normalisolerade byggnader. Byggnaden är mycket resurseffektiv med låga förbrukningstal på både energi och vatten. Då största delen av värmebehovet täcks med fjärrvärme står sig byggnaden mycket väl i en jämförande miljöbedömning.Nyckeltal för klimatskal och energianvändningMedelvärde för klimatskalets värmeisolering, Um, W/m2,K ca 0,21Luftläckage, läckflöde vid provtryckning till 50 Pa, l/s,m2Aomg 0,13Specifik energianvändning, kWh/m2,år 58
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| 3. |
- Celik, Haris
(författare)
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On the Performance of Dynamic TDD in Ultra-Dense Wireless Access Networks
- 2017
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The appetite for wireless high-data rate services is expected to continue for many years to come and drive the need for more capacity. Ultra-dense networks (UDNs) represent a paradigm shift where each base station (BS) serves only a few user equipments (UEs). By most accounts, most of the traffic will be generated indoor and operate in time-division duplex (TDD). This thesis considers dynamic TDD which has shown to perform well indoor for fluctuating traffic where the shorter communication range enables similar transmit powers to be used in uplink and downlink, but also generates potentially more harmful same-entity interference. Because of the sheer number of cells in UDN, the interference management needs to be both effective and scalable. In the first part of the thesis, we compare static TDD with non-cooperative dynamic TDD and show that flexible time resource allocation is preferred for indoor UDNs. However, since it only provides a lower bound on performance, additional interference coordination is required. Unfortunately, existing schemes often consider either too few, too many, or simply the wrong interferers. We introduce a scheduling model that relates BS-to-BS interferences measured offline to individual BS activation probability taking into account traffic and propagation environment. Results show that the proposed scheme performs well when interference is high, and optimally when interference is low. In the second part, we introduce cooperation to utilize the otherwise idle BSs and mitigate same- and other entity interference. Zero forcing (ZF) is employed in the downlink where not only downlink UEs but also uplink BSs are included in the precoding. Since downlink BSs do not know the information to be sent by uplink UEs beforehand, dummy symbols with zero power are transmitted. It shown that both uplink and downlink performance improves at low and medium load. Furthermore, it is possible to trade performance in the two directions at high load.
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| 4. |
- Erlinge, D., et al.
(författare)
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Bivalirudin versus Heparin Monotherapy in Myocardial Infarction
- 2017
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Ingår i: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 377:12, s. 1132-1142
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Tidskriftsartikel (refereegranskat)abstract
- Background The comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors. Methods In this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y12 inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors. The patients were randomly assigned to receive bivalirudin or heparin during PCI, which was performed predominantly with the use of radial-artery access. The primary end point was a composite of death from any cause, myocardial infarction, or major bleeding during 180 days of follow-up. Results A total of 6006 patients (3005 with STEMI and 3001 with NSTEMI) were enrolled in the trial. At 180 days, a primary end-point event had occurred in 12.3% of the patients (369 of 3004) in the bivalirudin group and in 12.8% (383 of 3002) in the heparin group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.10; P=0.54). The results were consistent between patients with STEMI and those with NSTEMI and across other major subgroups. Myocardial infarction occurred in 2.0% of the patients in the bivalirudin group and in 2.4% in the heparin group (hazard ratio, 0.84; 95% CI, 0.60 to 1.19; P=0.33), major bleeding in 8.6% and 8.6%, respectively (hazard ratio, 1.00; 95% CI, 0.84 to 1.19; P=0.98), definite stent thrombosis in 0.4% and 0.7%, respectively (hazard ratio, 0.54; 95% CI, 0.27 to 1.10; P=0.09), and death in 2.9% and 2.8%, respectively (hazard ratio, 1.05; 95% CI, 0.78 to 1.41; P=0.76). Conclusions Among patients undergoing PCI for myocardial infarction, the rate of the composite of death from any cause, myocardial infarction, or major bleeding was not lower among those who received bivalirudin than among those who received heparin monotherapy. (Funded by the Swedish Heart-Lung Foundation and others; VALIDATE-SWEDEHEART ClinicalTrialsRegister.eu number, 2012-005260-10 ; ClinicalTrials.gov number, NCT02311231 .).
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| 5. |
- Fridh, Jens, et al.
(författare)
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DYNAMIC FEATURES OF PARTIAL ADMISSION : OUTCOMES FROM ROTATING MEASUREMENTS
- 2007
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Ingår i: Euroturbo 7. - Athens : Local Conference Organising Committee. ; , s. 451-462
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Konferensbidrag (refereegranskat)abstract
- A system for rotating measurements has been designed and commissioned for a two-stage axial turbine of impulse design. Relative total pressure and strain gauge measurements in the rotating frame of reference have been performed during partial admission tests in this turbine. The overall project objectives are to determine unsteady aerodynamic losses related to admission sector-ends and rotor forcing functions. Some outcomes are presented and discussed herein. The unsteadiness in the measured relative total pressure is observed to be largest downstream of the suction side of the partial admission blockage where the high momentum fluid vividly interacts with the rotor. Strain gauge results show a high strain peak downstream of the suction side of the blockage. When reducing the shaft speed at constant pressure ratio, the dip in relative total pressure and the peak in tensile strain, that occur when a blade enters the blocked region, are shifted in the counter rotational direction. This is believed to reflect earlier emptying of the rotor blade channel. Furthermore, an increase of the flow capacity coefficient with a decrease of admission degree has been observed.
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| 6. |
- Granstam, Sven-Olof, et al.
(författare)
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Evaluation of patients with cardiac amyloidosis using echocardiography, ECG and right heart catheterization
- 2013
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Ingår i: Amyloid. - : Informa UK Limited. - 1350-6129 .- 1744-2818. ; 20:1, s. 27-33
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Tidskriftsartikel (refereegranskat)abstract
- Aims:To characterize patients with cardiac amyloidosis using echocardiography, electrocardiogram (ECG) and right heart catheterization (RHC).Methods and results:Fourteen patients with biopsy verified light chain or transthyretin cardiac amyloidosis were included. All patients had heart failure with markedly elevated NT-proBNP. Echocardiography demonstrated biventricular hypertrophy, left atrial enlargement and normal to slightly reduced left ventricular ejection fraction. Tissue Doppler septal e´ was low and median E/e´ was high. Within 6 months RHC was performed in eight of the patients. The restrictive filling pattern demonstrated by echocardiography corresponded well to median pulmonary wedge pressure (21 mmHg). Systolic pulmonary artery pressure (SPAP) was increased, whereas cardiac output and stroke volume were seen to be decreased with both methods. ECG demonstrated: low voltage (36%), abnormal R-progression (65%), ST-T abnormalities (71%) and high incidence of fibrillation (36%). In addition, a case report following the treatment of melphalan and dexamethasone is presented with improvement of hypertrophy, SPAP, left ventricular mass and e´.Conclusion: These findings should lead to a suspicion of cardiac amyloidosis and suggest further investigation.
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| 7. |
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| 8. |
- Harms, Hendrik J., et al.
(författare)
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Association of right ventricular myocardial blood flow with pulmonary pressures and outcome in cardiac amyloidosis
- 2023
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Ingår i: JACC Cardiovascular Imaging. - : Elsevier. - 1936-878X .- 1876-7591.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cardiac amyloidosis (CA) is a restrictive and infiltrative cardiomyopathy, characterized by increased biventricular filling pressures and low output. Symptoms are predominantly of right heart origin. The role of right ventricular (RV) myocardial blood flow (MBF) in CA has not been studied.Objectives: This study aimed to first associate RV MBF measured by using positron emission tomography (PET) with reference standards of RV pressures and then to explore its prognostic value in CA.Methods: Cardiac PET was performed at rest in 52 patients with CA and 9 healthy control subjects. MBF was quantified from the right and left ventricles by using 11C-acetate, 15O-water, or both (n = 25). RV pressure was measured invasively or by echocardiography. Associations between biventricular MBF toward symptoms, RV function, and outcome (death or acute heart failure) were studied in patients with CA.Results: MBF of the right ventricle (MBFRV) and the ratio of MBFRV and MBF of the left ventricle (MBFRV/LV) for the 2 tracers were significantly correlated (r > 0.92). MBFRV was directly correlated with RV systolic pressures with both tracers (P ≤ 0.005). MBFLV was inversely correlated with wall thickness (P < 0.0001). MBFRV/LV was significantly associated with N-terminal pro–B-type natriuretic peptide levels, New York Heart Association functional class, RV pressures, and RV systolic function (all; P < 0.001). Twenty-six cardiac events (25 deaths) occurred during follow-up (median 44 months). MBFRV/LV higher than 56% was associated with a diagnosis of pulmonary hypertension (AUC: 0.96 [95% CI: 0.91-1.00]; P < 0.0001); and predicted outcome with hazard ratio 9.0 (95% CI: 4.2-14.5), P < 0.0001).Conclusions: Measurements of MBFRV using PET are feasible, as confirmed with 2 different tracers. Imbalance between RV and LV myocardial perfusion is associated with increased RV load and adverse events in cardiac amyloidosis.
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| 9. |
- James, Stefan, 1964-, et al.
(författare)
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Bivalirudin Versus Heparin Monotherapy in ST-Segment-Elevation Myocardial Infarction
- 2021
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Ingår i: Circulation. Cardiovascular Interventions. - : Lippincott Williams & Wilkins. - 1941-7640 .- 1941-7632. ; 14:12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Bivalirudin was not superior to unfractionated heparin in patients with myocardial infarction (MI) treated with percutaneous coronary intervention and no planned use of GPI (glycoprotein IIb/IIIa inhibitors) in contemporary clinical practice of radial access and potent P2Y12-inhibitors in the VALIDATE-SWEDEHEART randomized clinical trial (Bivalirudin Versus Heparin in STEMI and NSTEMI Patients on Modern Antiplatelet Therapy-Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry).METHODS: In this prespecified separately powered subgroup analysis, we included patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with the primary composite end point of all-cause death, MI, or major bleeding event within 180 days.RESULTS: Among the 6006 patients enrolled in the trial, 3005 patients with ST-segment-elevation MI were randomized to receive bivalirudin or heparin. The mean age was 66.8 years. According to protocol recommendations, 87% were treated with potent oral P2Y12-inhibitors before start of angiography and radial access was used in 90%. GPI was used in 51 (3.4%) and 74 (4.9%) of patients randomized to receive bivalirudin and heparin, respectively. The primary end point occurred in 12.5% (187 of 1501) and 13.0% (196 of 1504; hazard ratio [HR], 0.95 [95% CI, 0.78-1.17], P=0.64) with consistent results in all major subgroups. All-cause death occurred in 3.9% versus 3.9% (HR, 1.00 [0.70-1.45], P=0.98), MI in 1.7% versus 2.2% (HR, 0.76 [0.45-1.28], P=0.30), major bleeding in 8.3% versus 8.0% (HR, 1.04 [0.81-1.33], P=0.78), and definite stent thrombosis in 0.5% versus 1.3% (HR, 0.42 [0.18-0.96], P=0.04).CONCLUSIONS: In patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with radial access and receiving current recommended treatments with potent P2Y12-inhibitors rate of the composite of all-cause death, MI, or major bleeding was not lower in those randomized to receive bivalirudin as compared with heparin.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02311231.
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| 10. |
- Mariusdottir, Elin, et al.
(författare)
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Hartmann’s procedure in rectal cancer surgery is often an intraoperative decision : a retrospective multicenter study
- 2024
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Ingår i: Langenbeck's Archives of Surgery. - 1435-2443. ; 409:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to investigate patient-related factors predicting the selection of rectal cancer patients to Hartmann’s procedure as well as to investigate how often, and on what grounds, anterior resection is intraoperatively changed to Hartmann’s procedure. Methods: Prospectively collected data from the Swedish Colorectal Cancer Registry regarding patients with rectal cancer operated upon from January 1 2007 to June 30 2017 in the county of Skåne were retrospectively reviewed. Data were expanded with further details from medical charts. A univariable analysis was performed to investigate variables associated with unplanned HP and significant variables included in a multivariable logistic regression analysis. Results: Altogether, 1141 patients who underwent Hartmann’s procedure (275 patients, 24%), anterior resection (491 patients, 43%), or abdominoperineal resection (375 patients, 33%) were included. Patients undergoing Hartmann’s procedure were significantly older and had more frequently comorbidity. The decision to perform Hartmann’s procedure was made preoperatively in 209 (76%) patients, most commonly because of a comorbidity (27%) or oncological reasons (25%). Patient preference was noted in 8% of cases. In 64 cases (23%), the decision was made intraoperatively, most often due to anastomotic difficulties (60%) and oncological reasons (22%). Anastomotic difficulties were most often reported due to technical difficulties, a low tumor or neoadjuvant radiotherapy. Male gender was a significant risk factor for undergoing unplanned Hartmann’s procedure. Conclusions: The decision to perform Hartmann’s procedure was frequently made intraoperatively. Hartmann’s procedure should be considered and discussed preoperatively in old and frail patients, especially in the presence of mid-rectal cancer and/or male gender, since these factors increase the risk of intraoperative anastomotic difficulties.
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