1. |
- Célind, Jimmy, et al.
(författare)
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Secular trends of birthweight in boys from 1950 to 2010
- 2019
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Ingår i: Pediatrics and Neonatology. - : Elsevier BV. - 1875-9572. ; 60:5, s. 543-548
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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
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2. |
- Elfvin, Anders, 1971, et al.
(författare)
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Oxidative and nitrosative stress enzymes in relation to nitrotyrosine in Helicobacter pylori -infected humans
- 2014
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Ingår i: World Journal of Gastrointestinal Pathophysiology. - : Baishideng Publishing Group Inc.. - 2150-5330. ; 5:3, s. 373-379
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To compare a possible relation between Helico- bacter pylori (H. pylori) and the oxygen- and nitrogen radical system in humans. METHODS: Mechanisms for H. pylori to interfere with the oxygen and nitrogen radical system is of great im- portance for understanding of the H. pylori persistence and pathogenesis. Biopsies were obtained from the gastric wall of 21 individuals. Ongoing infection with H. pylori was detected using direct analyze from the biop- sies using campylobacter-like organism test (CLO-test) and/or by using 14C-urea breath test. The individuals were divided in a negative H. pylori and a positive H. pylori group. Expression in the gastric mucosa of induc- ible nitric oxide syntase (iNOS), nicotinamide adenine dinucleotide phosphate-oxidase (NADPH-oxidase) my- eloperoxidase (MPO), and nitrotyrosine were assessed by Western blotting. RESULTS: The individuals who undervent gastroscopy were divided in a H. pylori neg. [n = 13, m/f = 7/6, age(mean)=39]andaH.pylori pos.group[n=8,m/ f = 5/3, age (mean) = 53]. Using western blot analy- sis iNOS was detected as a 130 kDa band. The iNOS expression was upregulated in the antrum of H. pylori infected individuals in comparison to the controls, mean ± SD being 12.6 ± 2.4vs 8.3 ± 3.1,P < 0.01. There was a markedly upregulated expression of MPO in the antrum of H. pylori infected individuals in comparison to the control group without infection. In several of non- infected controls it was not possible to detect any MPO expression at all, whereas the expression was high in all the infected subjects, mean ± SD being 5.1 ± 3.4 vs 2.1 ± 1.9, P < 0.05. The NADPH-oxidase expression was analysed by detecting the NADPH-oxidase subunit p47-phox expression. P47-phox was detected as a 47 kDa band using Western blot, and showed a signifi- cantly higher expression of p47-phox in the antrum of the H. pylori infected individuals compared to the con- trols, mean ± SD being 3.1 ± 2.2vs 0.3 ± 0.2,P < 0.01. Regarding nitrotyrosine formation, Western blot did not show any significant increase or decrease compared to controls, 7.0 ± 0.9 vs 6.9 ± 1.1, not significant. CONCLUSION: iNOS, MPO and NADPH-oxidase was up-regulated among H. pylori infected. Regarding ni- trotyrosine no difference was found. This support an H. pylori related inhibition of radical formation.
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3. |
- Elfvin, Anders, 1971, et al.
(författare)
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Percutaneous implantation of gastric electrodes - a novel technique applied in animals and in patients
- 2007
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Ingår i: Neurogastroenterology and motility. - 1350-1925. ; 19:2, s. 103-9
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Tidskriftsartikel (refereegranskat)abstract
- Temporary electrodes implanted under general anaesthesia, or via an oral or percutaneous endoscopic gastrostomy route have been used for testing of gastric electrical stimulation (GES). We have developed a principle for percutaneous electrode implantation. Leads were constructed so that the tip could be anchored to the gastric submucosa under gastroscopic control. Acute experiments were performed in anaesthetized pigs. Three patients referred for nausea and/or vomiting and non-established indications for GES (chronic intestinal pseudo-obstruction, functional dyspepsia without gastroparesis) were evaluated. Electrode function was tested by recording and stimulation techniques. In the pigs, a slow-wave (SW) rhythm (3 min(-1)) was recorded with decrease in frequency at the end of the experiments. In the patients, implantation time from start of gastroscopy to end of electrode placement was 12-20 min. Electrode distance varied from 12 to 45 mm. Gastric electromyography showed a regular SW rhythm of about 3 min(-1). Antral pressure waves had intervals being multiples of the SW-to-SW time. With temporary GES for 7-9 days, weekly frequency of the referral symptoms decreased >80% in two patients and 33% in one patient. Temporary percutaneous gastric leads can easily be implanted and may be used for testing of GES and study of gastric electrophysiology.
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4. |
- Elfvin, Anders, 1971, et al.
(författare)
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Quantitative measurement of nitric oxide and hydrogen peroxide in Helicobacter pylori-infected Mongolian gerbils in vivo
- 2007
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 42:10, s. 1175-1181
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Peroxynitrite formation, as reflected by nitrotyrosine expression, is low in Helicobacter pylori-infected Mongolian gerbils despite pronounced expression of radical-forming enzymes. The aim of the present study was to investigate in vivo whether H. pylori inhibits either one or both of the nitro- and oxyradical formation pathways. Material and methods. Male Mongolian gerbils were infected with two different H. pylori strains, TN2GF4 and SS1. Six months after inoculation, direct measurement of NO and H(2)O(2) was performed in vivo using electrochemical microsensors positioned in close proximity to the gastric mucosa. Results. In the TN2GF4-infected animals the level of NO was significantly lower than that in controls. No significant difference in NO levels was detected between the SS1-infected group and the controls. H(2)O(2) was significantly increased in the SS1 animals compared with that in controls after 6 months. The H(2)O(2) level in the TN2GF4 group did not differ from that in controls. Conclusions. The results indicate that H. pylori infection is associated with strain-dependent functional inhibition of both the NO and oxyradical formation pathways in the gastric mucosa.
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5. |
- Hallersund, Peter, 1975, et al.
(författare)
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Angiotensin II receptor expression and relation to Helicobacter pylori-infection in the stomach of the Mongolian gerbil.
- 2010
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Ingår i: BMC gastroenterology. - 1471-230X. ; 10:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The role of the renin-angiotensin system in gastric physiology and disease has as yet been sparsely explored. The first aim of the study was to investigate the baseline presence and location of angiotensin II receptors (AT1R and AT2R) in the stomach of the Mongolian gerbil. A second aim was to elucidate whether the presence of H. pylori infection is associated with changes in the expression of these receptors. METHODS: H. pylori-negative and H. pylori-infected (strain SS1 or TN2GF4) male Mongolian gerbils were investigated. The stomachs were examined at six or 12 months after inoculation by the use of immunohistochemistry, western blot and microscopic morphometry. RESULTS: AT1R and AT2R were located in a variety of cells in the gerbil gastric wall, including a subpopulation of endocrine cells in the antral mucosa and inflammatory cells infiltrating H. pylori-infected stomachs. Gerbils infected with the SS1 strain showed a significantly increased antral AT1R protein expression and an increased number of infiltrating polymorphonuclear leucocytes (PMNs) at 12 months. The AT1R protein expression correlated with the number of PMNs and the antral expression of myeloperoxidase. CONCLUSIONS: Angiotensin II receptors are present in a variety of cells in the gastric wall of the Mongolian gerbil. The results indicate an influence dependent on the H. pylori strain on the gastric AT1R expression and a relationship between gastric AT1R expression and mucosal PMNs infiltration.
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6. |
- Hellström, Ann, 1959, et al.
(författare)
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Effect of Enteral Lipid Supplement on Severe Retinopathy of Prematurity A Randomized Clinical Trial
- 2021
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Ingår i: JAMA Pediatrics. - : American Medical Association (AMA). - 2168-6203 .- 2168-6211. ; 175:4, s. 359-367
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Lack of arachidonic acid (AA) and docosahexaenoic acid (DHA) after extremely preterm birth may contribute to preterm morbidity, including retinopathy of prematurity (ROP). OBJECTIVE To determine whether enteral supplementation with fatty acids from birth to 40 weeks' postmenstrual age reduces ROP in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS The Mega Donna Mega trial, a randomized clinical trial, was a multicenter study performed at 3 university hospitals in Sweden from December 15, 2016, to December 15, 2019. The screening pediatric ophthalmologists were masked to patient groupings. A total of 209 infants born at less than 27 weeks' gestation were tested for eligibility, and 206 infants were included. Efficacy analyses were performed on as-randomized groups on the intention-to-treat population and on the per-protocol population using as-treated groups. Statistical analyses were performed from February to April 2020. INTERVENTIONS Infants received either supplementation with an enteral oil providing AA (100mg/kg/d) and DHA (50mg/kg/d) (AA:DHA group) or no supplementation within 3 days after birth until 40 weeks' postmenstrual age. MAIN OUTCOMES AND MEASURES The primary outcomewas severe ROP (stage 3 and/or type 1). The secondary outcomes were AA and DHA serum levels and rates of other complications of preterm birth. RESULTS A total of 101 infants (58 boys [57.4%]; mean [SD] gestational age, 25.5 [1.5] weeks) were included in the AA:DHA group, and 105 infants (59 boys [56.2%]; mean [SD] gestational age, 25.5 [1.4] weeks) were included in the control group. Treatment with AA and DHA reduced severe ROP compared with the standard of care (16 of 101 [15.8%] in the AA:DHA group vs 35 of 105 [33.3%] in the control group; adjusted relative risk, 0.50 [95% CI, 0.28-0.91]; P =.02). The AA:DHA group had significantly higher fractions of AA and DHA in serum phospholipids compared with controls (overall mean difference in AA:DHA group, 0.82 mol% [95% CI, 0.46-1.18 mol%]; P <.001; overall mean difference in control group, 0.13 mol% [95% CI, 0.01-0.24 mol%]; P =.03). There were no significant differences between the AA:DHA group and the control group in the rates of bronchopulmonary dysplasia (48 of 101 [47.5%] vs 48 of 105 [45.7%]) and of any grade of intraventricular hemorrhage (43 of 101 [42.6%] vs 42 of 105 [40.0%]). In the AA:DHA group and control group, respectively, sepsis occurred in 42 of 101 infants (41.6%) and 53 of 105 infants (50.5%), serious adverse events occurred in 26 of 101 infants (25.7%) and 26 of 105 infants (24.8%), and 16 of 101 infants (15.8%) and 13 of 106 infants (12.3%) died. CONCLUSIONS AND RELEVANCE This study found that, compared with standard of care, enteral AA:DHA supplementation lowered the risk of severe ROP by 50% and showed overall higher serum levels of both AA and DHA. Enteral lipid supplementation with AA:DHA is a novel preventive strategy to decrease severe ROP in extremely preterm infants.
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7. |
- Ahle, Margareta, 1966-, et al.
(författare)
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Maternal, fetal and perinatal factors associated with necrotizing enterocolitis in Sweden. A national case-control study
- 2018
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Ingår i: Plos One. - San Francisco, United States : Public Library of Science (PLoS). - 1932-6203. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective To analyze associations of maternal, fetal, gestational, and perinatal factors with necrotizing enterocolitis in a matched case-control study based on routinely collected, nationwide register data. Study design All infants born in 1987 through 2009 with a diagnosis of necrotizing enterocolitis in any of the Swedish national health care registers were identified. For each case up to 6 controls, matched for birth year and gestational age, were selected. The resulting study population consisted of 720 cases and 3,567 controls. Information on socioeconomic data about the mother, maternal morbidity, pregnancy related diagnoses, perinatal diagnoses of the infant, and procedures in the perinatal period, was obtained for all cases and controls and analyzed with univariable and multivariable logistic regressions for the whole study population as well as for subgroups according to gestational age. Results In the study population as a whole, we found independent positive associations with necrotizing enterocolitis for isoimmunization, fetal distress, cesarean section, neonatal bacterial infection including sepsis, erythrocyte transfusion, persistent ductus arteriosus, cardiac malformation, gastrointestinal malformation, and chromosomal abnormality. Negative associations were found for maternal weight, preeclampsia, maternal urinary infection, premature rupture of the membranes, and birthweight. Different patterns of associations were seen in the subgroups of different gestational age. Conclusion With some interesting exceptions, especially in negative associations, the results of this large, population based study, are in keeping with earlier studies. Although restrained by the limitations of register data, the findings mirror conceivable pathophysiological processes and underline that NEC is a multifactorial disease. © 2018 Ahle et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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8. |
- Alikhani, Vesta Seyed, 1982, et al.
(författare)
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Stabilisation and resuscitation with intact cord circulation is feasible using a wide variety of approaches; a scoping review
- 2023
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Ingår i: Acta Paediatrica. - 0803-5253. ; 112:12, s. 2468-2477
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Tidskriftsartikel (refereegranskat)abstract
- AimThis scoping review identified studies on approaches to intact cord resuscitation and/or stabilisation (ICR/S) for neonates delivered by Caesarean section (C-section).MethodsA systematic literature search was carried out using the PubMed, Web of Science, Scopus, Cochrane and CINAHL databases to identify papers published in English from inception to 14 November 2022.ResultsWe assessed 2613 studies and included 18 from 10 countries, covering 1-125 C-sections: the United States, the United Kingdom, Australia, India, Italy, China, France, The Netherlands, New Zealand and Taiwan. The papers were published from 2014 to 2023, and the majority were randomised controlled trials and observational studies. Different platforms, equipment and staff positions in relation to the operating table were described. Options for resuscitation and stabilisation included different bedding and trolley approaches, and maintaining aseptic conditions was mainly addressed by the neonatal team scrubbing in. Hypothermia was prevented by using warm surfaces, polythene bags and radiant heaters. Equipment was kept easily accessible by mounting it on a trolley or a separate mobile pole.ConclusionWe could not reach definitive conclusions on the optimal method for performing ICR/S during a C-section, due to study variations. However, a number of equipment and management options appeared to be feasible approaches.
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9. |
- Andersson, Stina, 1977, et al.
(författare)
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A slow caloric satiety drinking test in patients with temporary and permanent gastric electrical stimulation.
- 2010
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Ingår i: European journal of gastroenterology & hepatology. - 0954-691X. ; 22:8, s. 926-932
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Improvement of gastric accommodation has been proposed as a potential explanation for the positive effect of gastric electrical stimulation (GES) on nausea/vomiting. A drinking test has been suggested as a noninvasive measure of gastric accommodation capacity. METHODS: Eight patients with therapy refractory nausea and vomiting and nonapproved diagnosis for GES (chronic intestinal pseudo-obstruction (CIP, n=1), functional dyspepsia (FD, n=3), postsurgical gastroparesis (PSGP, n=4) underwent temporary percutaneous GES for 10-14 days, randomized to stimulation ON or OFF, respectively. 19 patients [CIP (n=1), diabetic gastroparesis (n=5), FD (n=5), idiopathic gastroparesis (n=4), PSGP (n=4)] received permanent GES (Enterra, Medtronic) (follow-up at baseline, 6 and 12 months). At the end of each stimulation period a slow caloric satiety drinking test was performed (Nutridrink 1.5 kcal/ml, 15 ml/min). RESULTS: Healthy volunteers had higher drinking capacity compared to patients at baseline (1630+/-496 kcal vs. 887+/-412; P<0.001) and less composite symptom score (128+/-51 vs. 235+/-83; P<0.001). With temporary percutaneous GES, there was no significant change in drinking capacity during stimulation ON versus OFF (746+/-383 vs. 734+/-427 kcal) and symptom severity at the drinking test was unchanged. For patients having permanent GES there was no significant difference at 6 months (876+/-277 kcal) versus baseline, and no difference between symptomatic responders and nonresponders in change in drinking capacity (P=0.7). CONCLUSION: GES had no effect on proximal gastric function as evaluated by the slow caloric satiety drinking test. This seems to be the case for patients with approved as well as nonapproved indications for GES, and irrespective of the symptomatic response.
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10. |
- Andersson, S., et al.
(författare)
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Gastric electrical stimulation for intractable vomiting in patients with chronic intestinal pseudoobstruction
- 2006
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Ingår i: Neurogastroenterology and motility. - : Wiley. - 1350-1925 .- 1365-2982. ; 18:9, s. 823-30
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Tidskriftsartikel (refereegranskat)abstract
- Gastric electrical stimulation (GES) is effective for medically refractory nausea and vomiting in patients with idiopathic or diabetic gastroparesis (DGP). We studied whether GES has similar effects in chronic intestinal pseudoobstruction (CIP). Patients referred for chronic small bowel (SB) motor dysfunction requiring parenteral nutrition and having a weekly vomiting frequency (WVF) >/=7 refractory to prokinetics and antiemetics were included. Patients were implanted for high-frequency GES 12 stimuli min(-1), laparoscopy being the first-line implantation procedure. Results were compared with those obtained in 11 DGP patients. Three patients with familial CIP and one patient with postsurgical CIP fulfilled the criteria. Gastric emptying was delayed in two and was normal in two patients. SB transit time was markedly delayed. Laparoscopy was used in three patients, one patient required laparotomy. During GES, WVF decreased from 24 (mean) before GES to 6.9 at 12 months and 7.5 at last visit. Vomiting reduction was 50-90% at last visit. For the DGP patients, WVF decreased from 23 before GES to 3.5 at 12 months and 3.5 (P < 0.01) at last visit. In patients with CIP and medically refractory vomiting, GES seems to have an anti-vomiting effect comparable to that seen in patients with severe DGP. GES should be considered as a therapeutic option for these patients.
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13. |
- Challis, Pontus, et al.
(författare)
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Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)
- 2024
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Ingår i: Archives of Disease in Childhood-Fetal and Neonatal Edition. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109, s. 87-93
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.Design Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage >= II) were validated against hospital records.Patients All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.Main outcome measures NEC incidence.Results The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).Conclusions The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.
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14. |
- Challis, Pontus, et al.
(författare)
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Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)
- 2024
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Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109:1, s. 87-93
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.Design Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage >= II) were validated against hospital records.Patients All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.Main outcome measures NEC incidence.Results The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).Conclusions The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.
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15. |
- Challis, Pontus, et al.
(författare)
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Validation of the diagnosis of necrotising enterocolitis in a Swedish population-based observational study
- 2019
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 108:5, s. 835-841
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The definition of necrotising enterocolitis (NEC) is based on clinical and radiological signs that can be difficult to interpret. The aim of the present study was to validate the incidence of NEC in the Extremely Preterm Infants in Sweden Study (EXPRESS)Methods: The EXPRESS study consisted of all 707 infants born before 27 + 0 gestational weeks during the years 2004–2007 in Sweden. Of these infants, 38 were recorded as having NEC of Bell stage II or higher. Hospital records were obtained for these infants. Furthermore, to identify missed cases, all infants with a sudden reduction of enteral nutrition, in the EXPRESS study were identified (n = 71). Hospital records for these infants were obtained. Thus, 108 hospital records were obtained and scored independently by two neonatologists for NEC.Results: Of 38 NEC cases in the EXPRESS study, 26 were classified as NEC after validation. Four cases not recorded in the EXPRESS study were found. The incidence of NEC decreased from 6.3% to 4.3%.Conclusion: Validation of the incidence of NEC revealed over- and underestimation of NEC in the EXPRESS study despite carefully collected data. Similar problems may occur in other national data sets or quality registers.
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16. |
- Dencker, Anna, 1956, et al.
(författare)
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Neonatal outcomes associated with mode of subsequent birth after a previous caesarean section in a first pregnancy: A Swedish population-based register study between 1999 and 2015
- 2022
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Ingår i: BMJ Paediatrics Open. - : BMJ. - 2399-9772. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate neonatal outcomes within 28 days in the subsequent birth in women who gave birth to their first baby by caesarean section (CS). Design and setting National retrospective population-based register study. A cohort of 94 451 neonates who were born in Sweden between 1999 and 2015 as a second child to a mother who had her first birth by emergency or planned caesarean. Methods Data were retrieved from the national registers held by Statistics Sweden and the National Board of Health and Welfare. Logistic regression was used to calculate unadjusted and adjusted ORs (aOR) with 95% CIs for each outcome. Main outcome measures Neonatal infection, neonatal asphyxia/respiratory distress, neonatal hospital care and neonatal death within 28 days. Results Emergency CS and instrumental vaginal birth were associated with a doubled risk of neonatal infection (aOR 2.0) and planned CS with a decreased risk (aOR 0.7) compared with spontaneous vaginal birth. Compared with spontaneous vaginal birth, an increased risk of birth asphyxia and/or respiratory distress was identified with all other modes of birth (aOR 2.2-3.2). Emergency CS and instrumental vaginal birth, but not planned CS, were associated with neonatal hospital care (aOR 1.8 and 1.7) and an increased mortality rate during the neonatal period (aOR 2.9 and 3.2), compared with spontaneous vaginal birth. Conclusions In childbirth following a previous birth by CS, spontaneous vaginal birth appears to confer better neonatal outcomes within 28 days after birth overall than other modes of birth.
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17. |
- Elfvin, Anders, 1971, et al.
(författare)
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Gastric expression of inducible nitric oxide synthase and myeloperoxidase in relation to nitrotyrosine in Helicobacter pylori-infected Mongolian gerbils.
- 2006
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 41:9, s. 1013-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: For obscure reasons Helicobacter pylori infection of the gastric mucosa is maintained despite a pronounced host defence response. The present study elucidates possible H. pylori-related interference in the oxy- and nitro-radical formation pathways. MATERIAL AND METHODS: Male Mongolian gerbils were infected with two different H. pylori strains, TN2GF4 and SS1. At 3, 6, 12 or 18 months after inoculation, gastric expressions of myeloperoxidase (MPO), inducible nitric oxide synthase (iNOS) and nitrotyrosine were assessed by Western blotting. RESULTS: Expression of both iNOS and MPO was markedly up-regulated in the H. pylori-infected animals compared with non-infected controls. The TN2GF4-infected animals initially (at 3 and 6 months) demonstrated pronounced expression of both iNOS and MPO. The SSI-infected animals exhibited a slower onset with significantly increased iNOS after 12 and 18 months. Nitrotyrosine expression was slightly elevated in the infected groups at 3 and 6 months compared with that in the controls. Nitrotyrosine levels then decreased and were no longer significantly different from those of controls (TN2GF4-infected animals) or were lower (SS1-infected animals) than in the controls. CONCLUSIONS: The results indicate that peroxynitrite formation as reflected by nitrotyrosine expression is low or even inhibited in chronic H. pylori infection despite pronounced expression of enzymes representing both the oxy- and nitro-radical formation pathways. The results support the theory that H. pylori survival is related to functional inhibition of mucosal enzymatic NO and/or oxy-radical formation.
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18. |
- Elfvin, Anders, 1971
(författare)
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Helicobacter pylori associated effects on inflammatory radical formation and angiotensin II receptors in the stomach
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Helicobacter pylori infection of the stomach always results in mucosal inflammation and a marked systemic immune response. Despite the profound host defence reactions the bacterium avoids elimination and persists in the mucosa. This results in chronic inflammation and an increased risk for peptic ulcers and adenocarcinoma. Still a majority of infected individuals never develop any symptomatic disease. Previous results from our laboratory indicate that H. pylori reduces the power of host defence by restricting gastric NO production by pathogen-derived competitive iNOS inhibitors. It was considered of interest to further investigate not only the H. pylori associated inhibition of nitro-radical formation, but also interactions with the oxy-radical formation in gastric carcinogenesis. Furthermore, because the renin angiotensin system (RAS) recently was ascribed immunomodulatory actions, it was considered of interest to also explore if H. pylori influences the presence and location of this regulatory system in the gastric mucosa. The H. pylori infected Mongolian gerbil was used as the experimental model and was followed up to 18 months after infection. A first aim of this thesis was to by use of histopathology validate the model?s suitability for studies of H. pylori (strains SS1 and TN2GF4) induced gastric mucosal pathology. The results indicate that the H. pylori infected Mongolian gerbil cannot be confirmed as being a cancer model, but it is suitable for studies of acute and chronic mucosal inflammation. The Mongolian gerbil model was then used to elucidate H. pylori strain dependency on the expression of the oxy- and nitro-radical forming enzymes, and to investigate whether H. pylori infection results in inhibition of either or both of the nitro- and oxy-radical formation. Western blotting was used to assess iNOS and MPO expressions as representatives for nitro- and oxy radicalforming pathways, respectively. Radical formation was assessed as presence of nitrotyrosine or by use of NO or H2O2 sensitive microelectrodes. The results confirm that H. pylori infection in Mongolian gerbils despite an up-regulation of nitro- and oxy-radical forming enzymes results in inhibition of radical formation. Response patterns differed over time in relation to the H. pylori strain under study. The results were confirmed in human gastric specimens using similar western blot assessing expression of nitro-and oxy-radical forming enzymes as well as nitrotyrosine. Finally, gene transcripts and immunoreactivity to the angiotensin II receptors AT1R and AT2R were found present in the antral wall of the Mongolian gerbil. The investigation indicated a possible H. pylori strain dependent influence on the AT1R expression. The present studies on experimentally infected Mongolian gerbils and asymptomatic human tissues support strongly that H. pylori avoids to be eliminated from the gastric mucosa by interfering with the nitro- and oxy-radical formation. In addition the investigations also suggest the presence of a H. pylori strain dependent influence on the AT1R expression constituting a novel immunomodulatory principle.
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19. |
- Elfvin, Anders, 1971, et al.
(författare)
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Helicobacter pylori induces gastritis and intestinal metaplasia but no gastric adenocarcinoma in Mongolian gerbils.
- 2005
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 40:11, s. 1313-20
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The Mongolian gerbil is considered as the model of choice when studying adenocarcinoma related to Helicobacter pylori infection. The purpose of this study was to compare two different H. pylori strains and elucidate whether adenocarcinomas developed in gerbils. MATERIAL AND METHODS: Male gerbils were separated into three groups: one control and two groups infected with two different strains of H. pylori, TN2GF4 and SS1. At 3, 6, 12 or 18 months after inoculation 5 animals from each group were sacrificed. The stomach was used for culture, and for histology. RESULTS: Inflammation was seen after 3 months in all the infected animals. In the controls no pathology was found at any time. Intestinal metaplasia was found in both the infected groups. Glands buried in the submucusal layer, changes that might be misinterpreted as adenocarcinoma, were found in 10% of the SS1 and in 65% of the TN2GF4 animals. Adenocarcinoma was not found in any of the gerbils. CONCLUSIONS: All studies claiming to have found H. pylori-induced adenocarcinomas in gerbils describe atypical glands penetrating into the muscularis propria and interpret these as invasive growths due to cancer. An alternative interpretation is that the deranged glandular structures grow in and below the submucosa. It is suggested that atypical glands in the muscularis layer are not enough as a diagnostic criterion for gastric adenocarcinoma. It is concluded that adenocarcinoma has not yet been shown convincingly to develop in Mongolian gerbils infected with H. pylori. Nevertheless, it is a model well suited for studying gastritis, gastric ulcer and premalignant changes such as metaplasia.
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20. |
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21. |
- Elfvin, Anders, 1971, et al.
(författare)
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Temporary percutaneous and permanent gastric electrical stimulation in children younger than 3 years with chronic vomiting.
- 2011
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Ingår i: Journal of pediatric surgery. - : Elsevier BV. - 1531-5037 .- 0022-3468. ; 46:4, s. 655-61
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate whether young children with drug-refractory nausea and vomiting can be treated with gastric electrical stimulation (GES) in a similar way as adults and to evaluate whether temporary percutaneous gastric electrical stimulation (TPGES) can be used in the pediatric population to select the patients who are responders to GES treatment. We report the clinical results in 3 children between 2 and 3 years of age. To the best of our knowledge, these are the youngest patients treated with GES.
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22. |
- Englund-Ögge, Linda, et al.
(författare)
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Glycemic control assessed by continuous glucose monitoring during pregnancy in women with type 1 diabetes and its association with preeclampsia, an observational Swedish cohort study
- 2024
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Ingår i: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA. - 0001-6349 .- 1600-0412. ; 103:7, s. 1426-1436
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionWomen with type 1 diabetes have an increased risk of preeclampsia (PE), but it is not fully understood if degree of glycemic control is associated with this risk. The aim of this study was to assess glycemic control during pregnancy analyzed by continuous glucose monitoring (CGM) in women with and without PE and to investigate if glycemic control is associated with increased risk of PE.Material and MethodsA total of 120 pregnant Swedish women with type 1 diabetes using CGM were included. Background factors and pregnancy outcomes were collected from medical records. CGM data were collected via the internet-based platform Diasend. Mean glucose, standard deviation of mean glucose, percentage of time in target, time below target, and time above target were presented for each trimester in women who did or did not develop PE. Associations between CGM-derived metrics and PE were analyzed with logistic regression and adjusted for confounders.ResultsTwenty-two women (18.3%) developed PE. There were no significant differences in maternal characteristics between women with and without PE. Glycemic control improved in each trimester but was suboptimal in both groups. Time in target increased from 59% in the non-PE group and 54% in the PE group in the first trimester to 65% in both groups in the third trimester. There were no significant associations between glycemic control and PE after adjustment for confounders.ConclusionsDegree of glycemic control during pregnancy assessed by CGM was not associated with development of PE in women with type 1 diabetes. However, more research is needed to understand the role of glycemic control in relation to development of PE. This study showed that women with diabetes improved their glycemic control during pregnancy; however, there were no significant differences in glycemic control in women developing preeclampsia compared to women who did not develop preeclampsia. Larger studies are needed.image
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23. |
- Farooqi, Aijaz, et al.
(författare)
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One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019
- 2024
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Ingår i: Archives of Disease in Childhood-Fetal and Neonatal Edition. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109:1, s. 10-17
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo explore associations between perinatal activity and survival in infants born at 22 and 23 weeks of gestation in Sweden. Design/SettingData on all births at 22 and 23 weeks' gestational age (GA) were prospectively collected in 2004-2007 (T1) or obtained from national registers in 2014-2016 (T2) and 2017-2019 (T3). Infants were assigned perinatal activity scores based on 3 key obstetric and 4 neonatal interventions. Main outcomeOne-year survival and survival without major neonatal morbidities (MNM): intraventricular haemorrhage grade 3-4, cystic periventricular leucomalacia, surgical necrotising enterocolitis, retinopathy of prematurity stage 3-5 or severe bronchopulmonary dysplasia. The association of GA-specific perinatal activity score and 1-year survival was also determined. Results977 infants (567 live births and 410 stillbirths) were included: 323 born in T1, 347 in T2 and 307 in T3. Among live-born infants, survival at 22 weeks was 5/49 (10%) in T1 and rose significantly to 29/74 (39%) in T2 and 31/80 (39%) in T3. Survival was not significantly different between epochs at 23 weeks (53%, 61% and 67%). Among survivors, the proportions without MNM in T1, T2 and T3 were 20%, 17% and 19% for 22 weeks and 17%, 25% and 25% for 23 weeks' infants (p>0.05 for all comparisons). Each 5-point increment in GA-specific perinatal activity score increased the odds for survival in first 12 hours of life (adjusted OR (aOR) 1.4; 95% CI 1.3 to 1.6) in addition to 1-year survival (aOR 1.2; 95% CI 1.1 to 1.3), and among live-born infants it was associated with increased survival without MNM (aOR 1.3; 95% CI 1.1 to 1.4). ConclusionIncreased perinatal activity was associated with reduced mortality and increased chances of survival without MNM in infants born at 22 and 23 weeks of GA.
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24. |
- Gudjónsdóttir, Margrét Johansson, et al.
(författare)
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Changes in incidence and etiology of early-onset neonatal infections 1997-2017 - a retrospective cohort study in western Sweden.
- 2019
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Ingår i: BMC pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- The objective of the study was to evaluate data on early-onset neonatal invasive infections in western Sweden for the period 1997-2017. To identify changes in incidence, etiology and mortality and compare to previous studies from the same area starting from 1975.Observational epidemiological, retrospective study on infants 0-6days of age with a positive culture in blood and/or cerebrospinal fluid between 1997 and 2017. A comparison was made of the incidence between 2008 and 2017 compared to 1997-2007. Changes in the incidence of infections due to Group B streptococci, Staphylococcus aureus and aerobic Gram-negative rods were assessed from 1975.The total incidence, including both recognized pathogens and commensals as causative agents, was 1.1/1000 live births. The incidence declined from 1.4/1000 LB in 1997-2007 to 0.9/1000 LB in 2008-2017 but the case-fatality rate remained unchanged, (8/119 vs 7/90), at 7%. Among the 209 patients identified during 1997-2017 with sepsis or meningitis the most common organisms were Group B streptococci (40%, 84/209), S. aureus (16%, 33/209) and E. coli (9%, 18/209). The incidence of Group B streptococci infections went from 0.9/1000 live births 1987-1996 to 0.45/1000 live births 1997-2017 and all cases were within 72h. The proportion of extremely preterm infants (<28weeks gestation) rose steadily during the study period but there was no rise in infections due to Gram-negative organisms. The spectrum of cultured organisms changed after 72h as commensal organisms started to emerge.There has been a decrease in the incidence of neonatal early-onset infections compared to previous studies in western Sweden. The incidence of GBS infections was not as low as in other reports. Further studies are needed to assess if screening-based intra partum antimicrobial prophylaxis instead of a risk factor-based approach for identifying candidates for intrapartum antimicrobial prophylaxis would be a better option for this study area.This study is one of the longest running follow-ups in the world, a follow-up of 43years of early-onset neonatal infections.The incidence of early-onset GBS infections is higher in Western Sweden compared to other local reports.No difference in the incidence of early-onset GBS depending on the definition of early-onset being within 72h or 7days of life.
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25. |
- Gudjónsdóttir, Margrét Johansson, et al.
(författare)
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Late-onset Neonatal Infections 1997 to 2017 Within a Cohort in Western Sweden-The Last 21 Years of a 43-Year Surveillance.
- 2021
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Ingår i: The Pediatric infectious disease journal. - 1532-0987. ; 40:4, s. 359-364
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Tidskriftsartikel (refereegranskat)abstract
- The objective of the study was to assess the epidemiology of late-onset (LO) neonatal invasive infections with surveillance covering 43 years, starting from 1975.Observational epidemiologic, retrospective study including a cohort of infants born in western Sweden in 1997-2017, who had a positive blood and cerebral spinal fluid culture between 3 and 120 days of age. A comparison was made of the incidence between 1997-2007 and 2008-2017. Data on LO infections during 3-27 days of life were assessed from 1975.A total of 473 cases of LO infections were registered in 437 patients. The incidence increased from 2.0 to 3.1/1000 live births (LB) between 1997-2007 and 2008-2017 (P<0.001). The increase in incidence was most pronounced among infants born <28 weeks gestation (from 255 to 398/1000 LB, P<0.001). The most frequent pathogens were Staphylococcus aureus (25%), coagulase-negative staphylococci (17%), and Escherichia coli (13%). Infections due to group B Streptococci rose from 0.16/1000 LB to 0.33 (P=0.03). During the whole surveillance period from 1975 to 2017, there were 579 cases between 3 and 27 days of life. Although the incidence increased in 2008-2017 to 1.9/1000 LB after first declining in 1997-2007, the case-fatality rate continued to decline from 27/284 (9.5%) between 1975 and 1996 to 6/182 (3.3%) in 2008 and 2017 (P=0.01).The incidence of LO neonatal invasive infections increased during the study period (1997-2017), but the case-fatality rate remained lower than in the previous surveillance period (1975-1996). Further surveillance and interventions with focus on prevention is critical to counteract the increasing incidence among high-risk infants.
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