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| 6. |
- Hillarp, Andreas, et al.
(författare)
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Effects of the oral, direct factor Xa inhibitor rivaroxaban on commonly used coagulation assays
- 2011
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Ingår i: JOURNAL OF THROMBOSIS AND HAEMOSTASIS. - : Blackwell Publishing. - 1538-7933 .- 1538-7836. ; 9:1, s. 133-139
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Rivaroxaban is an oral direct factor Xa inhibitor developed for prophylaxis and treatment of thromboembolic disorders. Laboratory monitoring is not necessary but the dose-dependent effects on common reagents and assay procedures are largely unknown. Objectives: To investigate the effect of rivaroxaban on commonly used coagulation assays. Materials and Methods: Rivaroxaban was added to plasma from healthy subjects in the concentration range 0-1000 mu g L-1 and analyzed using different reagents for activated partial thromboplastin time (APTT), prothrombin time (PT), antithrombin, fibrinogen and activated protein C (APC) resistance assays. Results: At an expected peak concentration of rivaroxaban in clinical use, the APTTs were almost invariably prolonged but at lower concentrations the effect was weak. The concentration needed to double the APTT varied between 389 +/- 106 and 617 +/- 149 mu g L-1 for different reagents. The PT assays showed a marked degree of difference. In general, the Quick PT type assays were more sensitive compared with the Owren type PT assays. The results from antithrombin assays were dependent on the type of reagent, with the Xa-based assay being sensitive for rivaroxaban with an estimated increase of 0.09 IU mL-1 per 100 mu g L-1 rivaroxaban. There were only minor effects on fibrinogen assays based on thrombin reagents. The APTT-based assay for APC resistance is affected in a dose-dependent manner whereas an assay based on the activation of coagulation at the prothrombinase level was unaffected. Conclusions: Different assays, and even different reagents within an assay group, display variable effects by therapeutic concentrations of rivaroxaban.
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| 9. |
- Isfahani, S. M. M., et al.
(författare)
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An ultra-low power multi-tunable triangle wave generator with frequency and amplitude control
- 2010
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Ingår i: ; , s. 236-239
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Konferensbidrag (refereegranskat)abstract
- ultra-low power adjustable triangle wave generator with a multi tunable amplitude and frequency is introduced in this paper. The proposed circuit consists of a Schmitt trigger and a current source. The overall nonlinearity of the TWG circuit is less than 2% in its current-to-frequency transfer characteristic. The tunable frequency and amplitude range are 10KHz to 40KHz and 0.1V-1.7V respectively. The topology is suitable for VLSI realization and can be used in the WINeR system.
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| 10. |
- Kazerouni, I. A., et al.
(författare)
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A 77 nW bioamplifier with a tunable bandwidth for neural recording systems
- 2010
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Ingår i: IEEE Asia-Pacific Conference on Circuits and Systems, Proceedings, APCCAS. - 9781424474561 ; , s. 36-39
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Konferensbidrag (refereegranskat)abstract
- In this paper a low-power low-noise amplifier for neural recording and biomedical applications is presented. The frequency band of the amplifier is tunable. It has a gain of 28.3 dB. The low and the high cut-off frequency can be adjusted from 24 mHz to 30.6 Hz and 4.5 kHz to 7.47 kHz, respectively. The circuit is designed in 0.18μm CMOS process, and it consumes only 77.8 nW at 1.8V supply voltage. The simulation results show a 14.3μV input-referred noise corresponding to 1.32 efficiency factor (NEF). It is a great improvement compared with recent presented works in terms on power consumption and NEF which is vital in neural recording applications.
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| 12. |
- Lövdahl, Susanna, et al.
(författare)
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A longitudinal study of family structure in Swedish persons with haemophilia
- 2014
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Ingår i: Haemophilia. - : Wiley. - 1351-8216 .- 1365-2516. ; 20:4, s. 493-499
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Tidskriftsartikel (refereegranskat)abstract
- Haemophilia is an X-linked inherited rare bleeding disorder affecting mainly men. The treatment consists of replacement therapy that has been associated with severe side effects, such as blood transmitted viral infections, but has markedly improved over the last decades. The aim of this study was to study family structure over time among Swedish persons with haemophilia (PWH), focusing on children, siblings and marital status. PWH A or B were identified from the haemophilia centres and the national Patient Registry. Each PWH was compared to five age- and gender-matched controls. The national Multi-Generation Registry was used to identify children and siblings. A total of 1365 children with a father suffering from haemophilia A or B and 1938 siblings of the PWH were identified. Having one or more children was significantly less common (P=0.003) for PWH than for controls. Significantly lower rates of having a child were also found for the subgroups of persons suffering from severe haemophilia and those infected with HIV (P<0.001). A higher proportion of PWH, with or without HIV and/or viral hepatitis had siblings compared to the controls (P<0.001). However, the mean number of siblings was significantly lower for persons with severe haemophilia (P=0.001). The number of marriages and divorces did not differ between PWH and controls. Our data indicate a negative impact of HIV and viral hepatitis on family structure for PWH despite the relatively good access to treatment in Sweden over the last few decades. This was particularly true for those with a severe form of haemophilia.
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| 13. |
- Lövdahl, Susanna, et al.
(författare)
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Hypertension and cardiovascular diseases in Swedish persons with haemophilia - A longitudinal registry study
- 2019
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Ingår i: Thrombosis Research. - : Elsevier BV. - 0049-3848 .- 1879-2472. ; 181, s. 106-111
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Data on the prevalence of hypertension and cardiovascular diseases (CVD) among persons with haemophilia (PWH) vary. Sweden has a long tradition of maintaining population-based data registries, and there is extensive follow-up of haemophilia patients due to the use of prophylaxis over decades. We evaluated the prevalence of these diseases among Swedish PWH compared to matched controls using a longitudinal study design. Methods: Data were obtained from the National Patient Registry and linked to records of persons with haemophilia enrolled in the haemophilia centres. For each subject, five gender and age matched controls were identified. Results: We identified 193 (19.7%) diagnoses of hypertension in PWH born in 1978 or earlier over >= 30 years compared with 550 (11.2%) among controls. The median ages and interquartile ranges were 60.0 (42.8, 69.9) and 57.2 (42.6, 70.6) years. The hazard rate (HR) for hypertension, PWH vs. controls, was 2.1, 95% CI: [1.8; 2.5], p < 0.001. The findings were similar in subgroup analyses of patients with non-severe and severe haemophilia with or without HIV and/or viral hepatitis. Angina pectoris was diagnosed in 69 (4.8%) of patients censored at age 75 compared with 311 (4.3%) in controls, and myocardial ischemia in 84 (5.9%) compared with 442 (6.2%). As a cause of death, the HR for myocardial ischemia, comparing PWH and controls, was 0.58, 95% CI: [0.42, 0.80], p = 0.001. Conclusion: Our data support an increased prevalence of hypertension among persons with haemophilia. The prevalence of CVD seems to be similar to that of controls, but with lower mortality.
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| 14. |
- Matindoust, S., et al.
(författare)
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Food quality and safety monitoring using gas sensor array in intelligent packaging
- 2016
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Ingår i: Sensor Review. - : Emerald Group Publishing Limited. - 0260-2288 .- 1758-6828. ; 36:2, s. 169-183
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Tidskriftsartikel (refereegranskat)abstract
- Purpose - This paper aims to study different possibilities for implementing easy-to-use and cost-effective micro-systems to detect and trace expelled gases from rotten food. The paper covers various radio-frequency identification (RFID) technologies and gas sensors as the two promoting feasibilities for the tracing of packaged food. Monitoring and maintaining quality and safety of food in transport and storage from producer to consumer are the most important concerns in food industry. Many toxin gases, even in parts per billion ranges, are produced from corrupted and rotten food and can endanger the consumers' health. To overcome the issues, intelligent traceability of food products, specifically the packaged ones, in terms of temperature, humidity, atmospheric conditions, etc., has been paid attention to by many researchers. Design/methodology/approach - Food poisoning is a serious problem that affects thousands of people every year. Poisoning food must be recognized early to prevent a serious health problem. Contaminated food is usually detectable by odor. A small gas sensors and low-cost tailored to the type of food packaging and a communication device for transmitting alarm output to the consumer are key factors in achieving intelligent packaging. Findings - Conducting polymer composite, intrinsically conducting polymer and metal oxide conductivity gas sensors, metal- oxide-semiconductor field-effect transistor (MOSFET) gas sensors offer excellent discrimination and lead the way for a new generation of "smart sensors" which will mould the future commercial markets for gas sensors. Originality/value - Small size, low power consumption, short response time, wide operating temperature, high efficiency and small area are most important features of introduced system for using in package food.
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| 19. |
- Osooli, M, et al.
(författare)
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Comparative burden of arthropathy in mild haemophilia : a register-based study in Sweden
- 2017
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Ingår i: Haemophilia. - : Wiley. - 1351-8216. ; 23:2, s. E79-E86
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Mild haemophilia is a congenital bleeding disorder affecting males. The burden of arthropathy in mild haemophilia has not been comprehensively described.AIM: The aim of this study was to compare the incidence, age at diagnosis and surgery for arthropathy and related hospitalizations between people with mild haemophilia and the general population in Sweden.METHODS: This was a register-based cohort study. Eligible participants were those with mild haemophilia born between 1941 and 2008 and a randomly selected, birthdate and sex-matched comparison group from the general population. Follow-up was from birth (or earliest 1984) until death, emigration or end of the study in 2008. Data on arthropathy were obtained from a national patient register. Negative binomial and competing risk regression and Kaplan-Meier estimate curves were used in the analysis.RESULTS: Overall, 315 people with haemophilia and 1529 people in the comparison group were included. Participants with haemophilia born between 1984 and 2008 had a ninefold (95% CI: 3.3-27.2) and 16-fold (95% CI: 6.7-36.5) increased incidence of arthropathy-related hospital admission and arthropathy diagnosis respectively. None in this cohort underwent surgery. Among participants with haemophilia born prior to 1984, the rates of arthropathy diagnosis and surgery of the index joints (knee, elbow, ankle) were increased twofold (95% CI: 1.0-3.2) and fivefold (95% CI: 1.7-17.8) respectively.CONCLUSION: Our data suggested a higher burden of arthropathy among individuals with mild haemophilia compared to the general population. Further research should investigate the need for targeted joint screening programmes among individuals with mild haemophilia.
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| 22. |
- Osooli, Mehdi, et al.
(författare)
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Joint comorbidities among Swedish carriers of haemophilia: A register-based cohort study over 22 years
- 2019
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Ingår i: Haemophilia. - : Wiley. - 1351-8216 .- 1365-2516. ; 25:5, s. 845-850
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Tidskriftsartikel (refereegranskat)abstract
- Background A significant fraction of women with an impaired factor VIII or IX gene in the X chromosome, carriers of haemophilia, will have clotting factor activities corresponding to those seen in males with non-severe haemophilia, hence, experience an increased bleeding tendency. Data describing the long-term joint outcomes among carriers are limited. We compared the age at onset, frequency of joint-related diagnoses as well as joint surgery and related hospitalizations among carriers of haemophilia with sex- and birthdate-matched controls from the general population. Methods Carriers of haemophilia born 1941-2008 were identified through the haemophilia treatment centres' (HTCs) databases and the National Patient Register of Sweden. For each carrier, we included up to five individuals using the Swedish population register as comparisons. Data for the period 1987-2008 were obtained. Results Among 539 potential carriers identified, 213 had a known factor activity. Carriers with reduced factor activity and those with unknown factor activity had received their first joint-related diagnosis at a significantly earlier age than their comparisons. The same subgroups showed an overall 2.3- and 2.4-fold higher hazard for joint-related diagnoses compared with the general population. In addition, the hazards of joint-related outpatient hospitalization were 3.2-fold (95% CI: 1.2, 9.1) and 2.5-fold (95% CI: 1.6, 3.7). This was not observed for those with normal factor activity. Conclusion Carriers of haemophilia suffer a significant risk for joint comorbidities. This risk seems to correlate to the factor activity. Our findings underline the importance of regular clinical follow-up of carriers at HTCs.
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| 23. |
- Osooli, M, et al.
(författare)
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The association between health utility and joint status among people with severe haemophilia A : findings from the KAPPA register
- 2017
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Ingår i: Haemophilia. - : Wiley. - 1351-8216. ; 23:3, s. E180-E187
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: People with severe haemophilia A have reportedly impaired health related quality of life (utility) mainly due to recurrent bleeding, arthropathy and treatment burden.AIM: To estimate utilities and evaluate their potential correlates - most importantly the joint status - among people with severe haemophilia A.METHODS: In this cross-sectional study, eligible participants had severe haemophilia A, were aged ≥15, negative for factor VIII inhibitor and included in the KAPPA register of Denmark, Norway and Sweden. Data on demographics, treatment history, haemophilia joint health score, and EQ-5D utility were obtained from the register. We used box plots to present utilities and joint status and ordinary least squares regression to evaluate correlates of utilities. Participants were consecutively enrolled in the KAPPA register between April 2013 and June 2016.RESULTS: Overall, 173 participants with median age of 34 (interquartile range: 25-45) were included. Twelve (6.9%) participants were on episodic treatment while 161 (93.1%) were treated using prophylaxis. Concomitant diseases and positive inhibitor history were reported for 73 (43.2%) and 21 (12.1%) participants, respectively. The highest median utility (1.0) was observed among those aged <29 on prophylaxis and those aged 30-44 who had started prophylaxis by age 3. In the multi-variable regression, joint scores of 16-25 (Coef. -0.18, 95% CI: -0.30, -0.06), 26-35 (Coef. -0.21, 95% CI: -0.36, -0.06) and >35 (Coef. -0.37, 95% CI: -0.52, -0.23) were associated with lower utilities.CONCLUSION: Moderate to severe joint manifestations are associated with reduced utilities among persons with severe haemophilia A.
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| 26. |
- Berntorp, Erik, et al.
(författare)
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Treatment of haemophilia A and B and von Willebrand's disease : summary and conclusions of a systematic review as part of a Swedish health-technology assessment
- 2012
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Ingår i: Haemophilia. - : Wiley. - 1351-8216 .- 1365-2516. ; 18:2, s. 158-165
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Forskningsöversikt (refereegranskat)abstract
- In an ongoing health-technology assessment of haemophilia treatment in Sweden, performed by the governmental agency Dental and Pharmaceutical Benefits Agency (TLV; tandvårds-och läkemedelsförmånsverket), the Swedish Council on Health Technology Assessment (SBU; statens beredning för medicinsk utvärdering) was called upon to evaluate treatment of haemophilia A and B and von Willebrand's disease (VWD) with clotting factor concentrates. To evaluate the following questions: What are the short-term and long-term effects of different treatment strategies? What methods are available to treat haemophilia patients that have developed inhibitors against factor concentrates? Based on the questions addressed by the project, a systematic database search was conducted in PubMed, NHSEED, Cochrane Library, EMBASE and other relevant databases. The literature search covered all studies in the field published from 1985 up to the spring of 2010. In most instances, the scientific evidence is insufficient for the questions raised in the review. Concentrates of coagulation factors have good haemostatic effects on acute bleeding and surgical intervention in haemophilia A and B and VWD, but conclusions cannot be drawn about possible differences in the effects of different dosing strategies for acute bleeding and surgery. Prophylaxis initiated at a young age can prevent future joint damage in persons with haemophilia. The available treatment options for inhibitors have been insufficiently assessed. The economic consequences of various treatment regimens have been insufficiently analysed. Introduction of national and international registries is important.
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| 27. |
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| 29. |
- Hillarp, Andreas, et al.
(författare)
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Effects of the oral, direct factor Xa inhibitor apixaban on routine coagulation assays and anti-FXa assays
- 2014
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Ingår i: Journal of Thrombosis and Haemostasis. - : Elsevier BV. - 1538-7933 .- 1538-7836. ; 12:9, s. 1545-1553
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionApixaban is an oral direct factorXa inhibitor developed for the prophylaxis and treatment of thromboembolic disorders. Laboratory monitoring is not necessary, but the effects on common coagulation reagents and assays constitute clinically valuable information. ObjectivesTo investigate the effects of apixaban on commonly used coagulation methods, and to evaluate anti-FXa assays for specific determination of the drug concentration. Materials and MethodsApixaban was added to plasma from healthy subjects in the concentration range 0-1000gL(-1), and analyses were performed with different reagents for activated partial thromboplastin time (APTT), prothrombin time (PT), antithrombin, proteinC, and proteinS. A lupus anticoagulant assay and an APTT assay with varying phospholipid concentrations were used to study the phospholipid dependence. ResultsIn general, apixaban showed fewer effects invitro than have been shown for rivaroxaban, another direct FXa inhibitor. The concentration needed to double the APTT varied between 2200 and 4700gL(-1), and the concentration needed to double the PT varied between 700 and 3900gL(-1). The effects on antithrombin, proteinC and proteinS assays were dependent on the type of reagent. Apixaban did not cause false-positive lupus anticoagulant results. Chromogenic anti-FXa assays showed linear dose-response curves with apixaban. ConclusionsTherapeutic concentrations of apixaban variably affect different assay groups, and even different reagents within an assay group. The effects were much smaller than with rivaroxaban. The use of APTT and/or PT assays to screen the anticoagulant activity of apixaban cannot be recommended. A chromogenic anti-FXa assay can be used for reliable measurements of apixaban concentration.
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| 30. |
- Kianpour, I., et al.
(författare)
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A subthreshold ultra low power 22fJ/conversion flash ADC for RFID sensing applications
- 2011
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Ingår i: 2011 19th Iranian Conference on Electrical Engineering (ICEE). - 9781457707308 - 9789644634284 ; , s. 1-4
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In this paper an ultra low power Flash ADC for RFID application is presented. Several techniques are used to further reduce the power consumption and relatively elevate the speed of the ADC. These techniques include a low power Track-and-Latch comparator with no static current, large resisters in the resister string, an optimum encoder with only 2 stages using subthreshold design with the aid of low supply voltage of 0.7v for resister string and 0.5v for all logic blocks. In this ADC by absolute approximation the occupied area is equal with area of 16 resisters in the string. The circuit designed in 0.18μm CMOS technology and simulations show that the 4-bit ADC consumes almost 14.5μW at 40MS/s and 93.8nW at 0.1MS/s; however, it minimally dissipates only 22fJ per each conversion step. The results show that the proposed ADC could seriously compete with other low power ADCs in RFID sensing applications such as SAR ADCs.
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| 31. |
- Kihlberg, Kristina, et al.
(författare)
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Factor IX antibodies and tolerance in hemophilia B in the Nordic countries - The impact of F9 variants and complications
- 2022
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Ingår i: Thrombosis Research. - : Elsevier BV. - 0049-3848 .- 1879-2472. ; 217, s. 22-32
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The development of inhibitory antibodies (inhibitors) in persons with hemophilia B (PwHB) causes significant morbidity. Data on the impact of the F9 variant and immune tolerance induction (ITI) outcome are limited.The aim of this study was to investigate the presence of neutralizing and non-neutralizing antibodies (NNA) in severe hemophilia B (HB) and to evaluate ITI outcome and complications in relation to the pathogenic F9 variant.Materials and methods: Persons with severe HB in the Nordic countries were enrolled and information on F9 variants, inhibitors, ITI and complications were collected. Analyses of anti-FIX antibodies with a fluorescence -immunoassay (xFLI) and an ELISA method were conducted.Results: Seventy-nine PwHB were enrolled. Null variants were seen in 33 (42 %) PwHB and 12 (15 %) had a current or former inhibitor. Eleven (92 %) of the inhibitor patients had experienced allergic manifestations and three (25 %) nephrotic syndrome. Of 10 PwHB with at least one ITI attempt, eight (80 %) were considered tolerant at enrolment. Immunosuppression was included in seven of eight successful or partially successful at-tempts. Five PwHB had at least one ITI failure before a successful or partially successful ITI. No NNA could be identified.Conclusion: A high proportion of severe F9 gene defects among persons with severe HB in the Nordic countries may explain the observed relatively high prevalence of inhibitors. ITI success was independent of the F9 variant and attained despite allergic manifestations and previous ITI failures. Inclusion of immunosuppression tenta-tively enhances the chances of ITI success. No NNA were observed.
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| 32. |
- Kihlberg, Kristina, et al.
(författare)
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No difference in quality of life between persons with severe haemophilia A and B
- 2023
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Ingår i: Haemophilia. - : Wiley. - 1351-8216 .- 1365-2516. ; 29:4, s. 987-996
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionGood health-related quality of life (HRQoL) is an important goal in the treatment of persons with haemophilia B (PwHB). Studies focusing on this population are limited, however, and data are insufficient. AimTo assess the HRQoL in PwHB and to compare this to data on persons with haemophilia A (PwHA), as well as to evaluate the impact of joint health on HRQoL and to identify areas of insufficient care. MethodsThe B-NORD study enrolled persons with severe haemophilia B and matched controls with haemophilia A. HRQoL was assessed using the EQ-5D-3L questionnaire and joint health using Haemophilia Joint Health Score 2.1 (HJHS). ResultsThe EQ-5D-3L was completed by 63 PwHB and 63 PwHA. Mobility problems were reported by 46% of PwHB and 44% of PwHA, pain/discomfort by 62% and 56%, and anxiety/depression by 33% and 17%, respectively. No significant difference was observed between PwHA and PwHB in EQ-5D profiles, level sum score, EQ-5D index (PwHB mean .80, PwHA mean .83, p = .24), or EQ VAS score (PwHB: mean 70, PwHA: mean 77, p = .061). Linear regression adjusted for age demonstrated that an increase in HJHS score was associated with a significant decrease in both EQ-5D index (B -.003, R-2 .22) and EQ VAS score (B -.37, R-2 .17). ConclusionDespite the majority of patients being treated with prophylaxis, impaired HRQoL was reported in both PwHB and PwHA. No differences in HRQoL were found between the two groups. Impaired joint health had a significant negative impact on HRQoL.
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| 33. |
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| 34. |
- Lindahl, Tomas, et al.
(författare)
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Effects of the oral, direct thrombin inhibitor dabigatran on five common coagulation assays
- 2011
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Ingår i: Thrombosis and Haemostasis. - : F K Schattauer Verlagsgesellschaft MBH. - 0340-6245 .- 2567-689X. ; 105:2, s. 371-378
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Tidskriftsartikel (refereegranskat)abstract
- Dabigatran is an oral, reversible thrombin inhibitor that has shown promising results in large clinical trials. Laboratory monitoring is not needed but the effects on common coagulation assays are incompletely known. Dabigatran was added to plasma from healthy subjects in the concentration range 0-1,000 μg/l and analysed using several reagents for activated thromboplastin time (APTT), prothrombin time (PT), fibrinogen, antithrombin, and activated protein C resistance. Typical trough concentrations are about 50 μg/l, peak concentrations 100-300 μg/l. At 100 μg/l all APTT-results were prolonged. The concentration required to double APTT ranged between 227 and 286 μg/l, the responses for all five reagents were similar. PT-reagents were much less affected with almost no samples above INR 1.2 at 100 μg/l. The effect was sample dilution dependent with PT Quick type more sensitive than PT Owren type methods. If a patient on dabigatran has prolonged APTT, >90 seconds, and Quick PT INR>2 or Owren PT INR>1.5 over-dosing or accumulation of dabigatran should be considered. Two of four fibrinogen reagents underestimated the fibrinogen concentration considerably at expected peak concentration. Methods based on inhibition of thrombin over-estimated the antithrombin concentration, but not Xa-based. The APC-resistance methods over-estimated the APC-ratio, which may lead to miss-classification of factor V Leiden patients as being normal. Different coagulation assays, and even different reagents within an assay group, display variable effects at therapeutic concentrations of dabigatran. Some of these assay variations are of clinical importance, thus knowledge is needed for a correct interpretation of results.
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| 35. |
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| 36. |
- Lövdahl, Susanna, et al.
(författare)
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Incidence, mortality rates and causes of deaths in haemophilia patients in Sweden.
- 2013
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Ingår i: Haemophilia. - : Wiley. - 1351-8216. ; 19:3, s. 362-369
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Tidskriftsartikel (refereegranskat)abstract
- Sweden has been a pioneer in the treatment of haemophilia, with the first concentrate available in the 1950s. Treatment has improved over the years to its current state-of-the art. The aim of the current study was to evaluate the long-term outcome of haemophilia in terms of incidence, morbidity and mortality. Patients diagnosed with haemophilia A or B registered at the national haemophilia centres and/or the Patient Registry and born before 2009 and alive in 1968 were enrolled and linked to the Cause of Death-, Migration- and Medical Birth registries. Five age- and sex-matched controls were selected for each patient. A total of 1431 patients with haemophilia A or B were compared with 7150 controls. The 3-year moving average incidence rate per 100 000 population varied between 21 and 36. The hazard ratio for all-cause mortality compared with controls was 2.2, 95% CI: [1.8; 2.7], P < 0.001 for the entire group of patients and 1.7, 95% CI: [1.3; 2.2], P < 0.001 when patients with HIV and/or viral hepatitis were excluded. The corresponding figures for the severe haemophilia subgroup were 6.6, 95% CI: [4.5; 10.0], P < 0.001 and 8.2, 95% CI [3.2; 20.8], P < 0.001 respectively. The most common causes of death were related to malignancies and the haemostatic defect. People with haemophilia were 57% less likely to die from ischaemic heart disease than controls. People with haemophilia in Sweden demonstrate higher mortality over time, independent of HIV and viral hepatitis, despite relatively advantageous access to clotting factor concentrates.
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| 37. |
- Lövdahl, Susanna, et al.
(författare)
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Malignancies in Swedish persons with haemophilia : a longitudinal registry study
- 2016
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Ingår i: Blood Coagulation and Fibrinolysis. - 0957-5235 .- 1473-5733. ; 27:6, s. 631-636
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to investigate, over time, the incidence of and mortality due to malignant diseases among persons with haemophilia, compared to matched controls. Persons with haemophilia A or B were enrolled via registries at each haemophilia centre, as well as from the National Patient Registry, and were compared to five sex and age-matched controls per patient. Data from the national Cancer Registry were linked to the study participants. A total of 1431 persons with haemophilia and 7150 matched controls were enrolled. Between the years 1972 and 2008, 164 malignancies were reported. The most common type of cancer among patients was prostate cancer, followed by haematologic malignancies, including lymphoma and leukaemia, which were significantly more frequent in patients [ n=35 (2.4%) vs. n=60 (0.8%); P < 0.001]. Malignancies in bladder and other urinary organs were also significantly different [ n=21 (1.5%) vs. n=46 (0.6%); P < 0.01]. The overall incidence rate ratio of malignancies per 1000 person-years compared to the controls was 1.3 [95% confidence interval (CI) 1.1, 1.6]. In subgroup analysis, the corresponding incidence rate ratios per 1000 person-years for persons with severe haemophilia was 1.7 (95% CI 0.9, 3.1) and that for mild/moderate haemophilia 1.1 (95% CI 0.8, 1.5). Swedish persons with haemophilia had a significantly higher incidence of malignant diseases than controls. These were primarily haematologic malignancies and cancer in urinary organs, and the difference independent of any co-infections with HIV and/or viral hepatitis. The findings indicate the importance of further studies and close follow-up of malignancies in persons with haemophilia.
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| 38. |
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| 39. |
- Nilsaz, A. S., et al.
(författare)
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Low power 0.18 um CMOS ultra wideband inductor-less LNA design for UWB receiver
- 2010
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Ingår i: IEEE Asia-Pacific Conference on Circuits and Systems, Proceedings, APCCAS. - 9781424474561 ; , s. 855-858
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Konferensbidrag (refereegranskat)abstract
- This paper presents an inductor-less low-noise amplifier (LNA) design for ultra-wideband (UWB) receivers and microwave access covering the frequency range from 0.4 to 5.7 GHz using 0.18-μm CMOS. Simulation results show that the voltage gain reaches a peak of 18.94 dB in-band with an upper 3-dB frequency of 5.7 GHz. The IIP3 is about 3 dBm and the noise figure (NF) ranges from 3.15-3.86 dB over the band of interest. Input matching is better than -8.79dB and the LNA consumes 5.77mW at 1.8V supply voltage. A figure of merit is used to compare the proposed design with recently published wideband CMOS LNAs. The proposed design achieves a superior voltage gain and tolerable NF, with the additional advantage of removing the bulky inductors. It is shown that the designed LNA without on-chip inductors achieves comparable performances with inductor-based designs.
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| 40. |
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| 41. |
- Radulovic, Vladimir, 1969, et al.
(författare)
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Heparin and Protamine Titration Does Not Improve Haemostasis after Cardiac Surgery: A Prospective Randomized Study
- 2015
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 10:7
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Tidskriftsartikel (refereegranskat)abstract
- Background Bleeding complications are common in cardiac surgery. Perioperative handling of heparin and protamine may influence the haemostasis. We hypothesized that heparin and protamine dosing based on individual titration curves would improve haemostasis in comparison to standard dosing. Sixty patients scheduled for first time elective coronary artery bypass grafting or valve surgery were included in a prospective randomized study. The patients were randomized to heparin and protamine dosing with Hepcon HMS Plus device or to standard weight and activated clotting time (ACT) based dosing. Blood samples were collected before and 10 minutes, 2 hours and 4 hours after cardiopulmonary bypass. Primary endpoint was endogenous thrombin potential in plasma 2 hours after surgery as assessed by calibrated automated thrombography. Secondary endpoints included total heparin and protamine doses, whole blood clot formation (thromboelastometry) and post-operative bleeding volume and transfusions. Heparin effect was assessed by measuring anti-Xa activity. Endogenous thrombin potential and clot formation deteriorated in both groups after surgery without statistically significant intergroup difference. There were no significant differences between the groups in total heparin and protamine doses, heparin effect, or postoperative bleeding and transfusions at any time point. Significant inverse correlations between anti-Xa activity and endogenous thrombin potential were observed 10 min (r = -0.43, p = 0.001), 2 hours (r = -0.66, p<0.001) and 4 hours after surgery (r = -0.58, p<0.001). In conclusion, the results suggest that perioperative heparin and protamine dosing based on individual titration curves does not improve haemostasis after cardiac surgery. Postoperative thrombin generation capacity correlates to residual heparin effect.
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| 42. |
- Radulovic, Vladimir, 1969, et al.
(författare)
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Sustained heparin effect contributes to reduced plasma thrombin generation capacity early after cardiac surgery.
- 2012
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Ingår i: Thrombosis research. - : Elsevier BV. - 1879-2472 .- 0049-3848. ; 130:5, s. 769-774
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Thrombin is a key component in the coagulation cascade, and impaired thrombin generation has been linked to increased bleeding after surgical procedures. The aim was to evaluate postoperative thrombin generation capacity in plasma after cardiac surgery, and its potential associations to activity of individual coagulation factors and heparin. MATERIAL AND METHODS: Forty-eight coronary artery bypass grafting patients were included in a prospective observational cohort study. Thrombin generation capacity was analysed in plasma with calibrated automated thrombogram with tissue factor as activator before (baseline), and 2h and 24h after surgery. In addition, plasma activity of coagulation factors II, V, VII, VIII, IX, X, XI, XIII, were determined. Heparin effect was assessed by anti-Xa activity, APTT and thrombin time. RESULTS: Thrombin generation was markedly reduced 2h after surgery compared to baseline. Peak levels decreased with median 74% (interquartile range 52-90), p<0.001, and endogenous thrombin generation potential decreased with 65% (43-86), p<0.001. Postoperative changes in endogenous thrombin generation potential correlated inversely to changes in anti-Xa activity (r=-0.51, p=0.010) and to changes in thrombin time (r=-0.51, p=0.009), but there were no correlations to changes in individual coagulation factor activity. CONCLUSIONS: A marked reduction in thrombin generation potential was observed in the early postoperative phase after cardiac surgery. The decrease was independent of reductions in individual coagulation factor activity but correlated to heparin effects. The results indicate that a sustained heparin effect contributes to the postoperative reduction in thrombin generation capacity.
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| 43. |
- Sarmiento, David M., et al.
(författare)
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Low power tunable CMOS I-UWB transmitter design
- 2007
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Ingår i: 2007 Norchip. - 9781424415168 ; , s. 116-119
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Konferensbidrag (refereegranskat)abstract
- In this paper an on-chip tunable Impulse-Ultra Wide Band Transmitter is presented. It is capable of modifjing the power emission to comply with the FCC regulations at different pulse rates up to 300 NMz using two external controls. The maximum power consumption is 1.2 mW and 142 mu W at 300 NMz and 10 AM PRF respectively with a leakage current of 100 nA. The prototype has been designed in 0.18 UMC technology and placed in a QFN lead-less package.
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| 44. |
- Sarmiento M., David, et al.
(författare)
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A 9.2pJ/pulse UWB-IR transmitter with tunable amplitude for wireless sensor tags in 0.18um CMOS
- 2010
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Konferensbidrag (refereegranskat)abstract
- This paper presents a transmitter design for Ultra Wideband Impulse Radio (UWB-IR) communications. The design is targeted towards the implementation of passive Wireless Sensor Tags (WST) where micro-power consumption is required. The transmitter has been implemented in UMC 0.18μm CMOS and placed inside a QFN lead-less package. It complies with the FCC regulations for Pulse Rate Frequencies (PRF) up to 10MHz using OOK modulation. It is capable of adjusting the Power Spectral Emissions (PSE) modifying the transmitted pulse amplitude to always achieve the best BER/Power performance depending on the application demands. The power emission tunability has been validated implementing a complete communication link using a low sensitivity non-coherent energy receiver. Measurements show a maximum power consumption of 92uW@10MHz PRF having a maximum energy/pulse of 9.2 pJ.
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| 45. |
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| 46. |
- Steen Carlsson, K, et al.
(författare)
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People with Haemophilia and Female Carriers in Sweden have a Higher Risk of Developing Anxiety, Depression and Pain Based on Treatment Patterns as Compared to Matched Controls: Data from a Registry Study over a Period of 11 Years
- 2019
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Ingår i: ISTH 2019 abstract OC 32.3.
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Konferensbidrag (refereegranskat)abstract
- Background: People with haemophilia (PwH) have increased risk of bleeds associated with acute and chronic pain, and long-term disability. Anxiety and depression are other determinants negatively affecting quality of life in PwH. Despite the severity of these co-morbidities, they have not been extensively investigated and associations between them even less. Aims: The MIND study (NCT03276130) aims to identify patterns of prescribed pain, anti-depressive and anti-anxiety medication and management of pain, depression and anxiety in PwH in four Nordic countries, based on patient registry data (A) and surveys (B). Here we describe current and retrospective treatment patterns of prescribed medication (part A) in PwH in Sweden, explore associations with the PwH background and complication characteristics, and compare prescribed medication use between PwH and the general population. Methods: This 11-year (2007-2017) retrospective population-based registry study, uses international classification systems for diagnoses, surgeries and medications. The study population includes all ages and was identified by diagnosis of haemophilia A or B, or at least one prescription of any factor VIII, IX, or bypassing agent. For each study subject, five age and gender-matched controls were included. Results: Data were extracted for 1550 PwH. The study population is shown in figure 1. The probability of being prescribed with analgesics, neuroleptics and anti-depressants in PwH compared to controls are shown in Table 1. Conclusions : A substantially higher prescription of analgesics in Swedish PwH as compared to controls suggests a need for increased focus on pain management including improved bleed protection and prevention of, e.g. arthropathy. The increased prescription of neurolep-tics and anti- depressants demonstrates that anxiety and depression are overrepresented in PwH and underscores the importance of identifying and managing the broad PwH population including non- frequent health care users. A similar prescription pattern was seen in female carriers suggesting a need for high medical attention and further research to address knowledge gaps.
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| 47. |
- Ternström, Lisa, 1972, et al.
(författare)
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Plasma activity of individual coagulation factors, hemodilution and blood loss after cardiac surgery: a prospective observational study.
- 2010
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Ingår i: Thrombosis research. - : Elsevier BV. - 1879-2472 .- 0049-3848. ; 126:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Hemodilution and consumption of coagulation factors during cardiopulmonary bypass has been suggested to contribute to bleeding complications after cardiac surgery. The aim was to describe the activity of individual coagulation factors after CABG in relation to hemodilution and postoperative bleeding. MATERIALS AND METHODS: Plasma concentrations of fibrinogen and plasma activity of FII, FV, FVII, FVIII, FIX, FX, FXI and FXIII adjusted for hemodilution were analysed in 57 CABG patients before, and 2h and 24h after surgery. Postoperative bleeding was registered and correlations to coagulation factor activity were calculated. RESULTS: Adjusted plasma concentration of fibrinogen (-14+/-6%), and plasma activity of FII (-9+/-6%), FV (-13+/-8%), FX (-13+/-7%) and FXIII (-9+/-14%) were reduced two hours after surgery compared to baseline (all p<0.001). FVII (+3+/-12%, p=0.34) and FXI (+1+/-19%, p=0.50) were unchanged, while FVIII (+23+/-44%, p=0.006) and FIX (+23+/-17%, p<0.001) increased. Twenty-four hours after surgery fibrinogen (+45+/-27%), FVIII (+93+/-66%) and FIX (+33+/-26%) were all increased (all p<0.001), while FVII (-37+/-14%, p<0.001), FXI (-4+/-18%, p=0.02) and FXIII (-6+/-15%, p=0.004) were decreased. Median postoperative blood loss was 380 ml/12h. There were significant inverse correlations between postoperative blood loss and fibrinogen concentration 2h after surgery (r=-0.33, p=0.019) and between postoperative blood loss and pre- and postoperative FXIII activity (r=-0.34, p=0.009 and r=-0.41, p=0.003, respectively), but not between blood loss and any of the other factors. CONCLUSIONS: There is a marked dissociation in plasma activity of individual coagulation factors after CABG. Plasma concentration of fibrinogen and factor XIII activity correlates inversely to postoperative blood loss after CABG.
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| 48. |
- Westberg, Lars, 1973, et al.
(författare)
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Association between a dinucleotide repeat polymorphism of the estrogen receptor alpha gene and personality traits in women.
- 2003
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Ingår i: Molecular psychiatry. - : Springer Science and Business Media LLC. - 1359-4184 .- 1476-5578. ; 8:1, s. 118-22
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Tidskriftsartikel (refereegranskat)abstract
- Estrogens are known to play a key role in the regulation of various aspects of behavior. In order to study the potential contribution of genetic variation in the estrogen receptor (ER) alpha to specific personality traits, we investigated a repeat polymorphism in the ER alpha gene in 172 42-year-old women who had been assessed using the Karolinska Scales of Personality (KSP). Based on the hypothesis that there is a relationship between the length of a repeat polymorphism and gene function,(1) the alleles were divided into two groups: short and long. In order to elucidate the possible influence of the ER alpha gene on the different aspects of personality measured by means of the KSP, the possible association between this gene and four different factors ('neuroticism', 'psychoticism', 'non-conformity', and 'extraversion') was analysed. 'Neuroticism', 'psychoticism', and 'non-conformity' all appeared to be associated with the ER alpha gene. After correction for multiple comparisons by means of permutation analysis, the associations with the factor 'non-conformity'--including the subscales 'indirect aggression' and 'irritability'--and the factor 'psychoticism'--including the subscale 'suspicion'--remained significant. The results suggest that the studied dinucleotide repeat polymorphism of the ER alpha gene may contribute to specific components of personality.
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