1. |
- Hellström, Lennart, 1945-, et al.
(författare)
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Cadmium exposure pathways in a population living near a battery plant
- 2007
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Ingår i: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 373:2-3, s. 447-455
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The objectives of the present study were to assess the relative impact of different pathways of environmental cadmium (Cd) exposure and to evaluate the contribution from locally produced vegetables and root crops to the total dietary intake of Cd. Methods: Cadmium in urine was determined for 492 individuals living near a closed down battery factory in Sweden. For each individual we created an environmental exposure-index based on Cd emissions to ambient air and number of years living at various distances from the plant. This information as well as dietary data were collected via questionnaires. Samples of soil, carrots and/or potatoes were collected from 37 gardens and analysed for Cd concentration. Results: Eating homegrown vegetables/potatoes, environmental Cd-exposure-index, female gender, age above 30 years and smoking more than one pack of cigarettes daily for at least 10 years were found to be significantly associated with increased urine concentrations of Cd (UCd > 1.0 nmol/mmol creatinine). We found a statistically significant relation between Cd in urine and environmental Cd-exposure-index in persons eating homegrown vegetables/potatoes regularly. Cd concentrations in homegrown carrots, potatoes and in garden soil were highest in the area closest to the factory. Daily consumption of potatoes and vegetables cultivated in the vicinity of the closed battery factory was estimated to increase Cd intake by 18-38%. Conclusion: The present study shows that consumption of locally grown vegetables and root crops was an important exposure pathway, in subjects living near a nickel-cadmium battery plant, whereas direct exposure via ambient air was less important. © 2006 Elsevier B.V. All rights reserved.
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2. |
- Lexne, Erik
(författare)
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Psychiatric aspects on acute abdominal pain
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Psychiatric comorbidity is estimated to occur in up to 40% of all patients with somatic disorders, and it can have an influence on patient morbidity and mortality. Approximately 20% of patients who seek care for abdominal pain receive the diagnosis nonspecific abdominal pain, and later develop chronic abdominal pain. This condition and other abdominal conditions without organic explanation are sometimes called diseases of gut-braininteraction, and psychosocial factors (personality, psychiatric conditions, etc.) have been suggested to play an important role. Organic dyspepsia (which in this thesis is limited to pepticulcer, gastritis and gastro-esophageal reflux disease, or GERD) has previously been reported to be associated with personality traits and psychiatric conditions. Despite these known associations, few studies have specifically investigated psychiatric comorbidity in patients with acute abdominal conditions.The aim of this thesis is to investigate the prevalence of psychiatric comorbidity in patients with acute abdominal pain conditions in the emergency setting and to evaluate the possible longterm psychiatric problems of these patients.Methods: Consecutive patients with who came to emergency care with acute abdominal pain conditions were divided into three diagnostic groups: acid-dependent organic dyspepsia (pepticulcer, gastritis and GERD), specific abdominal diagnoses, and non-specific abdominal pain.These groups were evaluated for personality traits, psychiatric symptoms, and self-rated health.A follow-up study explored prescription of antidepressant and anxiolytic (anti-anxiety) medications in this patients 10–15 years after the initial visit to emergency care.Results: Among the various diagnostic groups, patients with acid-dependent organic dyspepsia had significantly more anxiety-related personality traits, less mature characters, significantly more psychiatric symptoms, and poorer self-rated health. Patients with nonspecific abdominal pain also had more personality traits associated with anxiety, although to a lesser extent. Personality factors were significantly associated with poor self-rated health. The long-term follow-up showed that patients with organic dyspepsia and non-specific abdominal pain were prescribed antidepressants and anxiolytic drugs statistically more often than patients with specific abdominal diagnoses.Conclusion: Patients with abdominal pain who seek emergency care have enhanced psychiatric comorbidity, more anxiety-related personality traits, and poorer perceived health.This trend is particularly evident in patients with a diagnosis of acid-dependent organicdyspepsia, and to a lesser degree, patients with a diagnosis of non-specific abdominal pain.These factors also predict future prescription of depression and anxiety medications. These results suggest that patients who come to emergency care with acute abdominal pain could potentially benefit from psychiatric consultation.
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3. |
- Moen, Vibeke, et al.
(författare)
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Feto-maternal osmotic balance at term. A prospective observational study
- 2018
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Ingår i: Journal of Perinatal Medicine. - : WALTER DE GRUYTER GMBH. - 0300-5577 .- 1619-3997. ; 46:2, s. 183-189
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We performed the present study to investigate the feto-maternal osmotic relationship at term with the hypothesis that, in contrast to the literature, maternal plasma osmolality is lower than fetal levels. In a previous study, we found that maternal plasma sodium at delivery was consistently lower than the sodium in the umbilical artery. Our aim was to corroborate these results with analysis of osmolality. Methods: Blood was sampled from 30 women immediately before cesarean section and from the umbilical artery and vein before cord clamping and osmolality, sodium and albumin were analyzed. Results: Maternal osmolality was (mean; 95% confidence interval) 287.0 (285.8-288.2) mOsmkg/kg, arterial cord osmolality was 289.4 (287.9-291.0) mOsm/kg and venous cord osmolality was 287.3 (286.0-288.5) mOsm/kg. The paired difference between maternal and umbilical arterial osmolality was mean (SD) -2.4 (3.3) mOsm/kg (P amp;lt; 0.001), between maternal and umbilical vein -0.3 (3.0) mOsm/kg (P = 0.63) and between umbilical artery and vein -2.1 (2.8) mOsm/kg (P amp;lt; 0.001). Conclusion: Maternal osmolality was significantly lower than arterial cord osmolality confirming our previous results. The feto-maternal osmotic gradient favors water transport from the mother to the fetus and may increase the fetal risk of water intoxication when the mother ingests or is administered large volumes of electrolyte free solutions.
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4. |
- Moen, Vibeke, et al.
(författare)
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Hyponatraemia reversibly affects human myometrial contractility. An in vitro pilot study
- 2020
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background In a previous study we found a significant correlation between dystocia and hyponatraemia that developed during labour. The present study examined a possible causal relationship. In vitro studies often use area under the curve (AUC) determined by frequency and force of contractions as a measure of myometrial contractility. However, a phase portrait plot of isometric contraction, obtained by plotting the first derivate of contraction against force of contraction, could indicate that bi-or multiphasic contractions might be less effective compared to the smooth contractions. Material and methods Myometrial biopsies were obtained from 17 women undergoing elective caesarean section at term. Each biopsy was divided into 8 strips and mounted isometrically in a force transducer. Seven biopsies were used in the first part of the study when half of the strips were immersed in the hyponatraemic study solution S containing Na+ 120 mmol/L and observed for 1 hour, followed by 1 hour in normonatraemic control solution C containing Na+ 136 mmol/L, then again in S for 1 hour, and finally 1 hour in C. The other half of the strips were studied in reverse order, C-S-C-S. The remaining ten biopsies were included in the second part of the study. Response to increasing doses of oxytocin (OT) in solutions S and C was studied. In the first part of the study we calculated AUC, and created phase portrait plots of two different contractions from the same strip, one smooth and one biphasic. In both parts of the study we registered frequency and force of contractions, and described appearance of the contractions. Results First part of the study: Mean (median) contractions per hour in C: 8.7 (7.6), in S 14,3 (13). Mean (SD) difference between groups 5.6 (4.2), p = 0.018. Force of contractions in C: 11.8 (10.2) mN, in S: 10.8 (9.2) mN, p = 0.09, AUC increased in S; p = 0.018. Bi-/multiphasic contractions increased from 8% in C to 18% in S, p = 0.001. All changes were reversible in C. Second part of the study: Frequency after OT 1.65 x 10-(9) M in C:3.4 (2.9), in S: 3.8 (3.2), difference between groups: p = 0.48. After OT 1.65 x 10-(7) M in C: 7.8 (8.9), increase from previous OT administration: p = 0.09, in S: 8.7 (9.0), p = 0.04, difference between groups, p = 0.32. Only at the highest dose of OT dose was there an increase in force of contraction in S, p = 0.05, difference between groups, p = 0.33. Initial response to OT was more frequently bi/multiphasic in S, reaching significance at the highest dose of OT(1.65 x 10-(7) M), p = 0.015. when almost all contractions were bi/multiphasic. Conclusion Hyponatraemia reversibly increased frequency of contractions and appearance of bi-or multiphasic contractions, that could reduce myometrial contractility. This could explain the correlation of hyponatraemia and instrumental delivery previously observed. Contractions in the hyponatraemic solution more frequently showed initial multiphasic contractions when OT was added in increasing doses. Longer lasting labours carry the risk both of hyponatraemia and OT administration, and their negative interaction could be significant. Further studies should address this possibility.
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5. |
- Nayeri, Fariba, 1958-, et al.
(författare)
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Hepatocyte Growth Factor Levels in Cerebrospinal Fluid : A Comparison between Acute Bacterial and Nonbacterial Meningitis
- 2000
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Ingår i: Journal of Infectious Diseases. - : Oxford University Press (OUP). - 0022-1899 .- 1537-6613. ; 181:6, s. 2092-2094
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Tidskriftsartikel (refereegranskat)abstract
- The organotrophic functions of the hepatocyte growth factor (HGF) have been the subject of several studies. In the more recent studies, this function has been reported in the brain. In the present study, we have measured the levels of HGF in cerebrospinal fluid (CSF) and sera from 78 patients divided into 6 different groups according to central nervous system (CNS) infection and control. Quantitative measurements of HGF in the CSF and serum were performed by an enzyme-linked immunosorbent assay. Elevated values of CSF HGF were found in the patients with acute bacterial/probable bacterial meningitis (P < .001), compared with nonbacterial CNS infections and facial palsy, as well as with a control group without signs of CNS involvement. The values of CSF HGF were not correlated to blood-brain-barrier disruption in the groups. These observations might indicate an intrathecal production of HGF in acute bacterial/probable bacterial meningitis.
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6. |
- Neumark, Thomas, 1954-, et al.
(författare)
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Evaluation of phenoxymethylpenicillin treatment of acute otitis media in children aged 2-16
- 2007
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 25:3, s. 166-171
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study the clinical recovery from acute otitis media (AOM) in children, 2-16 years of age, managed with or without treatment with phenoxymethylpenicillin (PcV).Design. An open, prospective randomized trial. Children aged between 2 and 16 years, presenting with one- or double-sided AOM (without perforation) with symptom duration of less than four days, were included. The children were randomized to PcV for five days or to no primary antibiotic treatment. A health score and compliance were registered on a daily basis for seven days. Setting. A total of 32 health centres and 72 GPs in south-east Sweden.Subjects. Children aged 2-16 presenting with earache. Main outcome measures. Recovery time, symptom duration, frequency of complications (up to three months) and consumption of healthcare services independent of treatment with or without antibiotics.Results. A total of 179 patients carried out the trial, 92 were randomized to PcV, 87 to no primary antibiotic treatment. The median recovery time was four days in both groups. Patients who received PcV had less pain (p <0.001) and used fewer analgesics. There were no significant differences in the number of middle-ear effusions or perforations at the final control after three months. Children randomized to PcV treatment consulted less (p <0.001) during the first seven days.Conclusions. Our investigation supports that PcV treatment of AOM does not affect the recovery time or complication rates. PcV provided some symptomatic benefit in the treatment of AOM in otherwise healthy children, aged 2-16 years.
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7. |
- Petersson, Ulla, 1947-
(författare)
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Screening for Cardiovascular Risk and Diabetes in Primary Health Care : The Söderåkra Risk Factor Screening Study
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Cardiovascular disease (CVD) has been the predominant cause of morbidity and mortality for many decades in Sweden. Preventive work in primary health care through individual approach and community-based programmes has shown some success. Still, we need better risk assessment tools and health strategies to lessen the burden of CVD in our population.Methods: This thesis is based on four studies that explore the cardiovascular risk factor pattern and its development to CVD morbidity and mortality in the middle-aged (40-59 years) population in Söderåkra, southern Sweden, 1989-2006. At a single physician consultation in 1989-1990 the participants provided information about lifestyle in a self-administered questionnaire, underwent a physical examination and received medical advice after a laboratory investigation. The laboratory tests consisted mainly of blood glucose, serum lipids and thyroid function tests. Blood samples were also frozen for later analyses. A telephone interview on self-reported lifestyle changes was conducted ten years later. In 2006, primary health care medical records were studied for incident diabetes and also for impaired glucose tolerance (IGT). Finally, national registers were studied for incident fatal or nonfatal cardiovascular disease until 2006. Cardiovascular risk assessments using three separate risk algorithms were applied on the population.Results: The participation rate was high with 90% attendance. The conclusion of this cross-sectional baseline analysis was that it is meaningful to check for a secondary cause of hyperlipidemia, hypothyroidism, in women with a cholesterol value above 7.0 mmol/L. After 10 years follow-up women reported significantly more lifestyle changes than men, odds ratio (OR) 1.56 (95% CI: 1.11- 2.18; p= 0.010). Men with a history of smoking or CVD at baseline and women with treated hypertension at baseline made successful lifestyle changes, OR 4.77 (95% CI: 2.18-10.5; p<0.001 and OR 1.84 (95% CI: 1.12-3.02; p= 0.016), respectively, than those without these characteristics. Until 2006, 38 participants had developed diabetes and four subjects IGT out of 664 participants, excluding 10 with diabetes at baseline. A low level of IGFBP-1 at baseline was associated with the development of type 2 diabetes/IGT, hazard ratio (HR) 3.54 (95% CI: 1.18-10.6, p=0.024). This was independent of abdominal obesity or inflammation (CRP). After excluding 16 participants with prevalent CVD at baseline, 71 first fatal or nonfatal CVD events in 689 men and women were registered. Several known risk factors and risk markers were applied on this population.Those that turned out to be significantly associated with development of incident CVD in univariate Cox´s regression proportional hazard analyses where used in three different risk assessment models: the consultation model, SCORE and the extensive model. A non-laboratory-based risk assessment model, including variables easily obtained during one consultation visit to a general practitioner (GP), predicted cardiovascular events as accurately, HR 2.72; (CI 95% 2.18-3.39, p<0.001), as the established SCORE algorithm, HR 2.73; (CI 95% 2.10-3.55, p<0.001), which requires laboratory testing. Furthermore, adding laboratory measurements covering lipids, inflammation and endothelial dysfunction, did not confer any additional value to the prediction of CVD risk, HR 2.72; (CI 95% 2.19-3.37, p<0.001). The c-statistics for the consultation model (0.794; CI 95% 0.762-0.823) was not significantly different from SCORE (0.767; CI 95% 0.733-0.798, p=0.12) or the extended model (0.806; CI 95% 0.774-0.835, p=0.55).Conclusions: Our study showed that it is worth searching for hypothyroidism, in women with a cholesterol value above 7 mmol/L. The study identified female gender, previous CVD, hypertension and smoking as predictors of positive lifestyle change during follow-up. A low level of IGFBP-1 predicted future diabetes/IGT in this population as did increased waist and CRP. Finally, data on nonlaboratory risk factors obtained during one GP visit predicted future cardiovascular risk as accurately as SCORE or a laboratory-based risk algorithm.
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8. |
- Semark, Birgitta, et al.
(författare)
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Factors influencing the prescription of drugs of different price levels
- 2013
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Ingår i: Pharmacoepidemiology and Drug Safety. - : Wiley-Blackwell. - 1053-8569 .- 1099-1557. ; 22:3, s. 286-293
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Socioeconomic factors have been suggested to influence the prescribing of newer and more expensive drugs. In the present study, individual and health care provider factors were studied in relation to the prevalence of differently priced drugs. Methods Register data for dispensed drugs were retrieved for 18486 individuals in a county council in Sweden. The prevalence of dispensed drugs was combined with data for the individuals gender, age, education, income, foreign background, and type of caregiver. For each of the diagnostic groups (chronic obstructive pulmonary disease [COPD], depression, diabetes, and osteoporosis), selected drugs were dichotomized into cost categories, lower and higher price levels. Univariate and multivariate logistic regressions were performed using cost category as the dependent variable and the individual and provider factors as independent variables. Results In all four diagnostic groups, differences were observed in the prescription of drugs of lower and higher price levels with regard to the different factors studied. Age and gender affected the prescription of drugs of lower and higher price levels more generally, except for gender in the osteoporosis group. Income, education, foreign background, and type of caregiver affected prescribing patterns but in different ways for the different diagnostic groups. Conclusions Certain individual and provider factors appear to influence the prescribing of drugs of different price levels. Because the average price for the cheaper drugs versus more costly drugs in each diagnostic group was between 19% and 69%, there is a risk that factors other than medical needs are influencing the choice of drug.
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9. |
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10. |
- Trzebiatowska-Krzynska, Aleksandra, 1964-, et al.
(författare)
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Afterload dependence of right ventricular myocardial deformation : A comparison between tetralogy of Fallot and atrially corrected transposition of the great arteries in adult patients
- 2018
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Ingår i: PLOS ONE. - San Francisco, CA, United States : Public Library of Science. - 1932-6203. ; 13:9
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrior studies suggested that myocardial deformation is superior to conventional measures for assessing ventricular function. This study aimed to evaluate right ventricular (RV) myocardial deformation in response to increased afterload. Patients with the RV in the systemic position were compared with patients with the RV in the sub-pulmonic position with normal or only slightly elevated systolic right ventricular pressure. Correlations between global longitudinal strain (GLS), radial strain, atrioventricular plane displacement (AVPD), and exercise capacity were evaluated.Methods44 patients with congenital heart defect were enrolled in the study. The control group consisted of seven healthy volunteers. All patients underwent cardiovascular magnetic resonance (CMR) and cardiopulmonary exercise testing. We assessed biventricular myocardial function using CMR based feature tracking and compared the results to anatomic volumes.ResultsStrain analysis and displacement measurements were feasible in all participants. RVGLS and RVAVPD were reduced in both study groups compared to the control group (p<0.001). Left ventricular (LV) radial strain was significantly lower in patients with a systemic RV than in those with a subpulmonic RV and lower than in controls (p<0.001). Both LVAVPD and RVAVPD were significantly depressed in patients compared to controls (p<0.05). RVAVPD was more depressed in patients with a high systolic RV pressure than in those with normal RV pressure (p<0.001). RVAVPD did not correlate with exercise capacity in either study group. Exercise capacity in both patient groups was depressed to levels reported in previous studies, and did not correlate with RVGLS.ConclusionsBoth study groups had abnormal myocardial deformation and increased RV volumes. RVGLS in patients was lower than in controls, confirming the effect of increased afterload on myocardial performance.
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11. |
- Wanby, Pär, et al.
(författare)
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Asymmetric dimethylarginine (ADMA) as a risk marker for stroke and TIA in a Swedish population
- 2006
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Ingår i: Atherosclerosis. - : Elsevier BV. - 0021-9150 .- 1879-1484. ; 185:2, s. 271-277
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Tidskriftsartikel (refereegranskat)abstract
- Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, has been shown to be involved in the pathogenesis of atherosclerosis. The present study was initiated to investigate the role of ADMA as a risk marker of acute cerebrovascular disease (CVD). We examined 363 CVD patients and 48 controls. The ADMA concentration (mean ± S.D., μmol/L) in controls was 0.50 ± 0.06. Compared to controls, increased concentrations of ADMA were observed in cardio-embolic infarction (0.55 ± 0.08; p < 0.001; n = 71), and TIA (0.54 ± 0.05; p < 0.001; n = 31), but not in non-cardio-embolic infarction (0.51 ± 0.07; p = 0.56; n = 239) and haemorrhagic stroke (0.51 ± 0.11; p = 0.77; n = 22). In multivariate logistic regression models, CVD increased across quartiles of ADMA in all subgroups, but this association was only significant in the TIA group (odds ratio for highest versus lowest quartile 13.1; 95% CI: 2.9–58.6; p trend 0.001) A decreased arginine/ADMA ratio was significantly associated with CVD in the entire study population (p < 0.01). Our results indicate that ADMA is a weak independent marker for acute stroke and a strong marker for TIA and that relative arginine deficiency, measured as the l-arginine/ADMA ratio, is present in acute CVD.
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12. |
- Abednazari, Hossein, 1959-, et al.
(författare)
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Hepatocyte growth factor is a better indicator of therapeutic response than C-reactive protein within the first day of treatment in pneumonia
- 2006
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Ingår i: Chemotherapy. - : S. Karger AG. - 0009-3157 .- 1421-9794. ; 52:5, s. 260-263
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Tidskriftsartikel (refereegranskat)abstract
- Acute bacterial infectious diseases are mostly treated empirically at admission before the culture results are available. According to the risk for serious complications in the case of therapeutic failure, it is important to evaluate the therapy results and change to a more appropriate antibiotic regime as soon as possible. In the present study, 40 patients with X-ray-verified community-acquired pneumonia were examined and blood specimens were collected before and within 24 h of treatment. Body temperature, C-reactive protein (CRP) and hepatocyte growth factor (HGF) were investigated. Thirty-two patients received an appropriate initial antibiotic therapy regarding clinical outcome, but in 8 patients the treatment was changed because of therapy failure. Changes of HGF levels after 18–24 h of treatment could predict the therapeutic results accurately in 38 of 40 cases (sensitivity 100%, specificity 94%, positive likelihood ratio 16.0). HGF was significantly better to predict therapy outcome than CRP (p < 0.0001).
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13. |
- Abednazari, Hossin, et al.
(författare)
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Hepatocyte growth factor is a reliable marker for efficient anti-bacterial therapy within the first day of treatment
- 2014
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Ingår i: Advances in Bioscience and Biotechnology. - : Scientific Research Publishing. - 2156-8456 .- 2156-8502. ; 5:10, s. 823-830
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Tidskriftsartikel (refereegranskat)abstract
- Rapid diagnosis and choice of appropriate antibiotic treatment might be life-saving in serious infectious diseases. Still the available markers that can evaluate and monitor the diagnosis and treatment are few. Hepatocyte growth factor (HGF) has been studied as a potent regenerative factor produced and released during injuries such as infectious diseases. Monitoring of HGF levels might predict therapy results better than C-reactive protein (CRP) within the first day of treatment in pneumonia. For further investigation of previous observations we aimed to study HGF as a first-day marker in over-representing infectious diseases in comparison to procalcitonin (PCT), CRP and body temperature. Fifty-one patients with community acquired infectious diseases were included consequently at admittance and the serum samples were collected before and within 18 - 24 hours of treatment. HGF levels decreased significantly in case of efficient antibiotic therapy and HGF was shown to be better than PCT, CRP and body temperature to evaluate treatment. In patients with pneumonia, monitoring of HGF was most reasonable. HGF might be used as a therapeutic marker within the first day of empiric antibiotic treatment during infection.
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14. |
- Afrell, Maria, et al.
(författare)
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Improving the interaction between the physiotherapist and the patient with long-lasting pain
- 2014
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: To investigate whether it would be possible to improve the understanding and communication between physiotherapists and patients with long-lasting pain by, in a systematic way, approaching their condition from a bodily existential perspective.Method: 31 physiotherapists answered written open questions about what happened when they in 90 encounters used key questions about living with pain together with a tentative frame for interpreting the answers - typologies of approaches to living with long-lasting pain. In the analysis, we combined qualitative content analysis with the counting of the numbers of codes.Results: According to the physiotherapists, patients were positive to answering the key questions, which also evoked emotional responses and reflection. The relation between the physiotherapists and their patients improved. The typologies helped the physiotherapists understand their patients better, as well as in assessing the patients’ problems and choosing treatment. In all, positive experience clearly dominated. Conclusion: When used by physiotherapists with an interest in patients with longlasting pain, the key questions and typologies seem to enrich the clinical interaction in many cases. To try the generalisability of our findings, we regard it an interesting possibility to conduct a larger, quantitative questionnaire study based on the experiences and results of the present one.
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15. |
- Ahlander, Britt-Marie, 1954-, et al.
(författare)
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An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion
- 2017
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Ingår i: Clinical Physiology and Functional Imaging. - : Blackwell Publishing. - 1475-0961 .- 1475-097X. ; 37:1, s. 52-61
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo-echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference.METHODS: Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study.RESULTS: Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI).CONCLUSION: GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.
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16. |
- Almroth, Gabriel, et al.
(författare)
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Fibroblast Growth Factor 23, Hepatocyte Growth Factor, Interleukin-6, High-Sensitivity C-Reactive Protein and Soluble Urokinase Plasminogen Activator Receptor. Inflammation Markers in Chronic Haemodialysis Patients?
- 2013
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Ingår i: Scandinavian Journal of Immunology. - : Wiley-Blackwell. - 0300-9475 .- 1365-3083. ; 78:3, s. 285-290
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Tidskriftsartikel (refereegranskat)abstract
- Sera from 84 haemodialysis (HD) patients and 68 healthy blood donors were analysed with commercially available ELISA techniques for fibroblast growth factor 23 (FGF-23), hepatocyte growth factor (HGF), interleukin-6 (Il-6), high-sensitivity C-reactive protein (hs-CRP) and soluble urokinase plasminogen activator receptor (suPAR), to find a possible correlation of FGF-23 and HGF with the earlier recognized inflammatory markers Il-6 and hs-CRP or suPAR. All patients studied had significantly elevated levels of FGF-23, HGF, hs-CRP and suPAR as compared to the controls. Il-6 and hs-CRP correlated for patients (R=0.6) as well as for patients and controls altogether. Ln (natural logarithm) of HGF correlated weakly with Ln Il-6 and Ln CRP (R 0.28-0.37). Ln FGF-23 correlated only with Ln HGF (r=-0.25) in controls. Ln HGF correlated with ln suPAR (r=0.6) in both patients and controls. Although elevated as compared to controls, we found no correlation of FGF-23 with the recognized inflammatory markers Il-6, hs-CRP, nor HGF or the new marker suPAR in HD patients. Ln HGF correlated with Ln Il-6, Ln CRP and Ln suPAR. Although probably involved in vessel disease, FGF-23 and HGF may play other roles than acting in inflammatory vessel disease in HD patients. Further studies are necessary to evaluate the role of these immunological markers in chronic haemodialysis patients with atherosclerosis.
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17. |
- Almroth, Gabriel, et al.
(författare)
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Sclerostin, TNF-alpha and Interleukin-18 Correlate and are Together with Klotho Related to Other Growth Factors and Cytokines in Haemodialysis Patients
- 2016
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Ingår i: Scandinavian Journal of Immunology. - : Wiley-Blackwell. - 0300-9475 .- 1365-3083. ; 83:1, s. 58-63
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Tidskriftsartikel (refereegranskat)abstract
- Patients with chronic renal failure are known to have renal osteodystrophy (bone disease) and increased calcification of vessels. A new marker of bone disease, sclerostin, the two pro-inflammatory cytokines tumour necrosis factor-alpha (TNF-alpha) and interleukin-18 (IL-18), and the fibroblast growth factor-23 (FGF-23) receptor-associated marker Klotho were tested in 84 haemodialysis (HD) patients and in healthy controls. The patients had significantly higher levels of the three former markers than of the controls while Klotho was significantly higher in the controls. Low level, but significant, correlations were observed in the patient group when the levels of these four markers were compared to each other and to those of 5 cytokines and growth factors tested earlier; high-sensitive CRP (hsCRP), interleukin-6 (IL-6), hepatocyte growth factor (HGF), fibroblast growth factor-23 (FGF-23) and soluble urokinase plasminogen activator (suPAR). Ln sclerostin correlated positively to Ln hsTNF-alpha, Ln HGF and Ln suPAR. Ln hsTNF-alpha correlated positively to Ln sclerostin, Ln hsCRP, Ln IL-6, Ln FGF-23, Ln suPAR and Ln IL-18. Ln IL-18 correlated positively to Ln suPAR and Ln TNF-alpha. Ln Klotho correlated negatively to Ln hsCRP but did not correlate to Ln FGF-23. The markers studied here may be involved in the calcification of vessels seen in HD patients due to a combination of inflammation and bone disease. The mechanisms are still not fully known but may be of importance for future therapeutic possibilities in this group of patients.
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18. |
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19. |
- Aneq Åström, Meriam, et al.
(författare)
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Evaluation of Right and Left Ventricular Function Using Speckle Tracking Echocardiography in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy and Their First Degree Relatives
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Introduction and aim: The identification of right ventricular abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) in early stages is still difficult. The aim of this study was to investigate if longitudinal strain based on speckle tracking can detect subtle right (RV) or left ventricular (LV) dysfunction as an early sign of ARVC. Methods and results: Seventeen male patients, fulfilling Task force criteria for ARVC, 49 (32-70) years old, nineteen male first degree relatives 29 (19-73) y.o. and twenty-two healthy male volunteers 36 (24-66) y.o participated in the study. Twelve-lead and signal-averaged electrocardiograms were recorded. All subjects underwent echocardiography. LV and RV diameters, peak systolic velocity from tissue Doppler and longitudinal strain based on speckle tracking were measured from the basal and mid segments in both ventricles. RV longitudinal strain measurement was successful in first degree relatives and controls (95 resp. 86%) but less feasible in patients (59%). Results were not systematically different between first degree relatives and controls. Using discriminant analysis, we then developed an index based on echocardiographic parameters. All normal controls had an index Conclusion: Longitudinal strain of LV and RV segments was significantly lower in patients than in relatives and controls. An index was developed incorporating dimensional and functional echocardiographic parameters. In combination with genetic testing this index might help to detect early phenotype expression in mutation carriers.
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20. |
- Ashman Kröönström, Linda, 1982, et al.
(författare)
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Exercise capacity, physical activity, and health-related quality of life in adults with CHD
- 2020
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Ingår i: Cardiology in the Young. - 1047-9511 .- 1467-1107. ; 30:5, s. 668-673
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to assess exercise capacity, physical activity, and health-related quality of life within a broad and unselected group of adults with CHD.Design: From April 2009 to February 2014, 1310 patients were assessed for suitability to participate in this single-centre cross-sectional study. Seven hundred and forty-seven (57%) patients were included, performed a submaximal bicycle test, and answered questionnaires regarding physical activity and health-related quality of life. Exercise capacity, physical activity, and health-related quality of life were compared with reference values and correlations were studied.Results: The exercise capacities of men and women with CHD were 58.7 and 66.3%, respectively, of reference values. Approximately, 20-25% of the patients did not achieve the recommended amount of physical activity. In addition, men scored significantly less points on 7 out of 10 scales of health-related quality of life and women in 6 out of 10 scales, compared with reference values. The strongest correlation was between exercise capacity and the Short Form-36 (physical function).Conclusions: Exercise capacity was impaired in all adults with CHD, including those with less complicated CHD. One-quarter of the patients did not achieve the recommended levels of physical activity. Exercise tests followed by individualised exercise prescriptions may be offered to all patients with CHD aiming to increase exercise capacity, levels of physical activity, improve health-related quality of life, and reduce the risk of acquired life-style diseases.
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21. |
- Axelsson Olsson, Diana, et al.
(författare)
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Acanthamoeba-Campylobacter coculture as a novel method for enrichment of Campylobacter species
- 2007
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Ingår i: Applied and Environmental Microbiology. - 0099-2240 .- 1098-5336. ; 73:21, s. 6864-6869
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Tidskriftsartikel (refereegranskat)abstract
- In this study, we present a novel method to isolate and enrich low concentrations of Campylobacter pathogens. This method, Acanthamoeba-Campylobacter coculture (ACC), is based on the intracellular survival and multiplication of Campylobacter species in the free-living protozoan Acanthamoeba polyphaga. Four of the Campylobacter species relevant to humans and livestock, Campylobacter jejuni, C. coli, C. lari, and C. hyointestinalis, were effectively enriched by the coculture method, with growth rates comparable to those observed in other Campylobacter enrichment media. Studying six strains of C. jejuni isolated from different sources, we found that all of the strains could be enriched from an inoculum of fewer than 10 bacteria. The sensitivity of the ACC method was not negatively affected by the use of Campylobacter-selective antibiotics in the culture medium, but these were effective in suppressing the growth of seven different bacterial species added at a concentration of 10(4) CFU/ml of each species as deliberate contamination. The ACC method has advantages over other enrichment methods as it is not dependent on a microaerobic milieu and does not require the use of blood or other oxygen-quenching agents. Our study found the ACC method to be a promising tool for the enrichment of Campylobacter species, particularly from water samples with low bacterial concentrations.
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22. |
- Brudin, Lars, et al.
(författare)
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Comparison of two commonly used reference materials for exercise bicycle tests with a Swedish clinical database of patients with normal outcome
- 2014
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Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 34:4, s. 297-307
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reference values for working capacity, blood pressure, heart rate, perceived exertion, etc. during bicycle exercise tests have been sought after for many years. This is because earlier commonly used reference values for physical work capacity have been either too low or too high when compared to the clinical experience of several Swedish departments of clinical physiology. The aim of the study was to compare two commonly used reference materials with normal outcomes from a clinical database. Methods: Data from a clinical database of standardized exercise tests in Kalmar, Sweden, between 2004 and 2012, and having been judged as normal, were divided into 5-year categories of 5-10 to 75-80 years of age covering people from 7 to 80 years of age. Results: Maximal working capacity (W-max), maximal heart rate, maximal systolic blood pressure and maximal perceived exertion are presented for each of the 15 age categories. Regression equations are also presented for each sex with age and height as independent predictors. Quantitative comparisons of W-max are calculated for the three materials and possible explanations discussed. Conclusions: Values of W-max lie between the two reference materials most commonly used in Sweden. In addition, the present material covers subjects aged 7-19 years.
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23. |
- Carlén, Anna, et al.
(författare)
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Exercise systolic blood pressure response during cycle ergometry is associated with future hypertension in normotensive individuals
- 2024
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Ingår i: European Journal of Preventive Cardiology. - : OXFORD UNIV PRESS. - 2047-4873 .- 2047-4881.
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Tidskriftsartikel (refereegranskat)abstract
- Aims We aimed to investigate the association between the exercise systolic blood pressure (SBP) response and future hypertension (HTN) in normotensive individuals referred for cycle ergometry, with special regard to reference exercise SBP values and exercise capacity.Methods and results In this longitudinal cohort study, data from 14 428 exercise tests were cross-linked with Swedish national registries on diagnoses and medications. We excluded individuals with a baseline diagnosis of cardiovascular disease or HTN. The peak exercise SBP (SBPpeak) was recorded and compared with the upper limit of normal (ULN) derived from SBP(pea)k reference equations incorporating age, sex, resting SBP, and exercise capacity. To evaluate the impact of exercise capacity, three SBP to work rate slopes (SBP/W-slopes) were calculated, relative to either supine or seated SBP at rest or to the first exercise SBP. Adjusted hazard ratios [HRadjusted (95% confidence interval, CI)] for incident HTN during follow-up, in relation to SBP response metrics, were calculated. We included 3895 normotensive individuals (49 +/- 14 years, 45% females) with maximal cycle ergometer tests. During follow-up (median 7.5 years), 22% developed HTN. Higher SBP(peak )and SBPpeak > ULN were associated with incident HTN [HRadjusted 1.19 (1.14-1.23) per 10 mmHg, and 1.95 (1.54-2.47), respectively]. All three SBP/W-slopes were positively associated with incident HTN, particularly the SBP/W-slope calculated as supine-to-peak SBP [HRadjusted 1.25 (1.19-1.31) per 1 mmHg/10 W].Conclusion Both SBPpeak > ULN based on reference values and high SBP/W-slopes were associated with incident HTN in normotensive individuals and should be considered in the evaluation of the cycle ergometry SBP response.Lay summary We examined the systolic blood pressure (SBP) response during maximal bicycle exercise testing in individuals without hypertension (HTN) or established cardiovascular disease and found that:center dot When applying reference values for peak SBP during cycling exercise, accounting for age, sex, resting blood pressure (BP), and exercise capacity, exceeding the upper limit of normal was associated with twice as high relative risk of future HTN, compared with having a peak SBP within normal limits.center dot A steep increase in exercise SBP in relation to the increase in work rate was also associated with future HTN but did not always coincide with elevated peak SBP.
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24. |
- Carlsson, Hanna, et al.
(författare)
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Cell-Mediated Proteomics, and Serological and Mucosal Humoral Immune Responses after Seasonal Influenza Immunization: Characterization of Serological Responders and Non-Responders
- 2024
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Ingår i: Vaccines. - : MDPI. - 2076-393X. ; 12:3
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Tidskriftsartikel (refereegranskat)abstract
- Immunization against influenza through vaccination is the most effective method with which to prevent infection. To assess protection after immunization, analysing humoral response with a hemagglutinin inhibition assay is the gold standard, but cell-mediated immune response has been shown to better correlate with protection in the elderly. Our aim was to explore the influenza-specific cell-mediated and mucosal humoral responses in serologically defined responders and non-responders. We analysed sera for total immunoglobulins (Ig) A, G, and M and nasal swab samples for influenza-specific IgA. Peripheral blood mononuclear cells were stimulated with trivalent influenza vaccine VaxiGripTetra, and supernatants were analysed for influenza-specific responses with the Olink Immune-Oncology panel using a proximity extension assay. We included 73 individuals, of which 69 completed the study with follow-up sampling at one and six months post-vaccination. Of the 73, 51 (70%) were found to be serological responders and 22 (30%) were non-responders. We did not find any significant differences in sex or mucosal humoral response between responders and non-responders; however, a higher IFN gamma/IL-10 ratio in individuals <= 65 years of age indicates an enhanced cell-mediated immune response in this age group. Characteristics of the non-responders were found to be higher levels of IgM, Granzyme B and Interleukin 12, and lower levels of C-X-C motif chemokine 13 compared with those of the responders. In conclusion, our results did not show any correlation between serological response and age. Furthermore, the majority of influenza-specific cell-mediated immune markers did not differ between responders and non-responders; the immune marker profile of the non-responders and its contribution to protection is of interest but needs to be further explored.
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25. |
- Carlsson, Hanna, et al.
(författare)
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Complement activation in individuals with previous subclinical Lyme borreliosis and patients with previous Lyme neuroborreliosis
- 2020
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Ingår i: European Journal of Clinical Microbiology and Infectious Diseases. - : Springer. - 0934-9723 .- 1435-4373. ; 39:5, s. 855-862
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Tidskriftsartikel (refereegranskat)abstract
- Lyme borreliosis (LB) is caused by Borrelia burgdorferi and infection may lead to not only a large variety of clinical manifestations but also a subclinical outcome. The aim of the present study was to investigate if there is a constitutional difference in complement activation between individuals with previous subclinical Lyme borreliosis (SB) and patients previously diagnosed with Lyme neuroborreliosis (LNB).Lepirudin plasma for activation studies was collected from 60 SB individuals and from 22 patients pre-diagnosed with LNB. The plasma was incubated with live Borrelia spirochetes of two strains (complement sensitive B. garinii Lu59 and complement resistant B. afzelii ACA1).Complement factor C3 was measured in non-activated lepirudin plasma with immune-nephelometry and C3a and sC5b-9 generated during complement activation were measured by enzyme-linked immunosorbent assay.We found that the complement sensitive Lu59 induced higher complement activation than the complement resistant ACA1 when measuring activation products C3a and sC5b-9 in SB and LNB patients, p < 0.0001. No significant difference was found between SB and LNB patients in systemic levels of C3. Furthermore, SB individuals generated a higher activation of C3 cleavage to C3a (C3a/C3 ratio) than LNB patients after activation with ACA1, p < 0.001, but no significant differences were found in response to Lu59. In conclusion, Lu59 induced higher complement activation than ACA1 and individuals with previous SB showed increased generation of C3a compared with patients with previous LNB. In our study population, this mechanism could lead to less elimination of spirochetes in LNB patients and thereby be a factor contributing to the clinical outcome.
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26. |
- Carlsson, Hanna, et al.
(författare)
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Subclinical Lyme borreliosis is common in south-eastern Sweden and may be distinguished from Lyme neuroborreliosis by sex, age and specific immune marker patterns
- 2018
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Ingår i: Ticks and Tick-borne Diseases. - : ELSEVIER GMBH, URBAN & FISCHER VERLAG. - 1877-959X .- 1877-9603. ; 9:3, s. 742-748
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Tidskriftsartikel (refereegranskat)abstract
- Background: Determinants of a subclinical course of Lyme borreliosis (LB) remain largely unknown. The aim of this study was to assess the extent, sex and age profiles of subclinical Borrelia seroconversion in a LB endemic area in Sweden and to map blood cellular Borrelia-specific immune marker patterns in individuals with a previous subclinical LB course compared with patients previously diagnosed with Lyme neuroborreliosis (LNB). Methods: A large group of 1113 healthy blood donors was screened for multiple IgG anti-Borrelia antibodies and asked to complete a health inquiry regarding previous LB. A group of subjects with anti-Borrelia-specific IgG antibodies but no previous history of LB (subclinical LB, n = 60) was identified together with 22 cases of previous LNB. Whole Borrelia spirochetes, strains B. afzelii ACA1 and B. garinii Ip90, were used for ex vivo whole blood stimulations, whereas outer surface protein enriched fractions of the same strains were used for stimulation of peripheral blood mononuclear cells (PBMCs). An extensive panel of immune markers was analysed in the supernatants after stimulation using multiplex bead arrays, and Borrelia-specific secretion was determined by subtracting the spontaneous secretion. Results: A total of 125/1113 blood donors reported previous clinical LB. In contrast, 66 donors denied previous LB but showed multiple IgG anti-Borrelia antibodies; these were defined as subclinical subjects, of whom 60 were available for further studies. The subclinical subjects consisted of significantly more men and had a younger age compared with the LNB patients (p amp;lt;= 0.01). Discriminant analysis revealed a distinct pattern of sex, age and PBMC B. garinii-specific levels of IL-10, IL-17A and CCL20 discriminating subclinical subjects from LNB patients. Conclusions: This study confirms that subclinical Borrelia seroconversion is common in south-eastern Sweden. The findings further suggest that male sex, younger age together with B. gariniii induced levels of IL-10, IL-17A and CCL20 may be associated with a subclinical course.
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27. |
- Carlsson, Martin, et al.
(författare)
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Directly measured free 25-hydroxy vitamin D levels show no evidence of vitamin D deficiency in young Swedish women with anorexia nervosa
- 2018
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Ingår i: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 23:2, s. 247-254
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Anorexia nervosa (AN) is an eating disorder characterized by low fat mass complicated by osteoporosis. The role of circulating vitamin D in the development of bone loss in AN is unclear. Fat mass is known to be inversely associated with vitamin D levels measured as serum levels of total, protein-bound 25-hydroxyvitamin D, but the importance of directly measured, free levels of 25(OH)D has not been determined in AN. The aim of this study was to investigate vitamin D status, as assessed by serum concentrations of total and free serum 25(OH)D in patients with AN and healthy controls. Methods In female AN patients (n = 20), and healthy female controls (n = 78), total 25(OH)D was measured by LC-MS/MS, and free 25(OH)D with ELISA. In patients with AN bone mineral density (BMD) was determined with DEXA. Results There were no differences between patients and controls in total or free S-25(OH)D levels (80 +/- 31 vs 72 +/- 18 nmol/L, and 6.5 +/- 2.5 vs 5.6 +/- 1.8 pg/ml, respectively), and no association to BMD was found. In the entire group of patients and controls, both vitamin D parameters correlated with BMI, leptin, and PTH. Conclusions The current study did not demonstrate a vitamin D deficiency in patients with AN and our data does not support vitamin D deficiency as a contributing factor to bone loss in AN. Instead, we observed a trend toward higher vitamin D levels in AN subjects compared to controls. Measurement of free vitamin D levels did not contribute to additional information.
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28. |
- Carlsson, Martin, et al.
(författare)
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Erythrocyte fatty acid composition does not influence levels of free, bioavailable, and total 25-hydroxy vitamin D
- 2017
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Taylor & Francis. - 0036-5513 .- 1502-7686. ; 77:1, s. 45-52
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Tidskriftsartikel (refereegranskat)abstract
- In vitro, mono- and polyunsaturated fatty acids (FAs) may decrease the binding affinity of vitamin D metabolites for vitamin D-binding protein, which in turn may influence their bioavailability. FAs incorporated as phospholipids in erythrocyte (ery-) cell membranes reflect dietary intake. The purpose of this study was to investigate ery-FA composition in relation to markers for vitamin D. In healthy females (age 22.6 +/- 2.0 years) total 25(OH)D was measured by LC-MS/MS (n=78), free 25(OH)D with ELISA (n=64 of 78), and bioavailable 25(OH)D was calculated. Analysis of ery-FA composition was by gas chromatography (n=56 of 78). A strong correlation between total 25(OH)D and free 25(OH)D was seen (r=.66, p<.001), and between total-25(OH)D and bioavailable 25(OH)D (r=.68, p<.001). No correlations between 25(OH)D fractions and specific fatty acids were found, and in particular, no associations with mono- and poly-unsaturated FA compositions. All 25(OH)D fractions were correlated with leptin (total 25(OH)D (r=-.33, p<.003); bioavailable 25(OH)D (r=-.47, p<.001); free 25(OH)D (r=-.44, p<.001). Associations were found between PTH and total 25(OH)D (r=-.35, p=.002) and weaker between bioavailable 25(OH)D (r=-.35, p=.040) and free 25(OH)D (r=-.28, p=.079). All fractions of 25(OH)D appear to correlate in a similar way to PTH, BMI and body fat (leptin). No association was found between ery-FA composition and free/bioavailable 25(OH)D. It is unlikely that FAs are a strong uncoupling factor of DBP-bound 25(OH)D.
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29. |
- Carlsson, Martin, et al.
(författare)
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Evidence of Daytime Variation of Asymmetric Dimethylarginine: An Intervention Study with Rosiglitazon in Type 2 Diabetes
- 2011
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Ingår i: The Open Endocrinology Journal. - : Bentham Open. ; :5, s. 14-18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Asymmetric dimethylarginine (ADMA) has in some, but not all studies been associated with insulin resistance (IR). We wanted to challenge the hypothesis that plasma ADMA levels are associated with IR in an intervention study using an insulin sensitizing drug. Another aim of the study was to study daytime ADMA variation and if food intake influence ADMA concentration.Methods: Nine patients with diet treated type 2 diabetes were investigated with daytime profiles of ADMA (8 am-5 pm) before and during treatment with rosiglitazone for 8 weeks. A control group matched for age and sex underwent a similar investigation at baseline.Results: After treatment with rosiglitazone, ADMA (0.63- 0.64 mmol/L; p=0.26) and homocysteine (10.3 -10.6 mol/L; p=0.61) concentrations did not change. Postprandial (10 am – 5 pm) ADMA concentrations were 10% higher than fasting morning levels (p=0.006) and this difference was similar for controls and diabetes patients both pre and post treatment with rosiglitazone.Conclusions: Treatment with rosiglitazone aiming to improve insulin sensitivity did not affect ADMA concentration in type 2 diabetes patients. The ADMA daytime variation and the relation to food intake appear to be a novel finding and should be considered in future studies.
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30. |
- Carlsson, Martin, et al.
(författare)
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Older Swedish Adults with High Self-Perceived Health Show Optimal 25-Hydroxyvitamin D Levels Whereas Vitamin D Status Is Low in Patients with High Disease Burden
- 2016
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 8:11
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Tidskriftsartikel (refereegranskat)abstract
- Controversy pervades the definition of adequate and optimal vitamin D status. The Institutes of Medicine have recommended serum 25(OH) D levels above 50 nmol/L based upon evidence related to bone health, but some experts, including the Endocrine Society and International Osteoporosis Foundation, suggest a minimum serum 25(OH) D level of 75 nmol/L to reduce the risk of falls and fractures in older adults. In a cross-sectional study, we compared vitamin D status in people >= 75 years selected from four groups with a frailty phenotype, combined with a control group free from serious illness, and who considered themselves completely healthy. Only 13% of the 169 controls were vitamin D deficient (S-25(OH) D) < 50 nmol/L), in contrast with 49% of orthopedic patients with hip fractures (n = 133), 31% of stroke patients (n = 122), 39% of patients visiting the hospital's emergency department >= 4 times a year (n = 81), and 75% of homebound adult residents in long-term care nursing homes (n = 51). The mean vitamin D concentration of the healthy control group (74 nmol/L) was similar to a suggested optimal level based on physiological data and mortality studies, and much higher than that of many officially recommended cut-off levels for vitamin D deficiency (< 50 nmol/L). The present study provides a basis for planning and implementing public guidelines for the screening of vitamin D deficiency and vitamin D treatment for frail elderly patients.
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31. |
- CöSter, Maria C., et al.
(författare)
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Minimally important change, measurement error, and responsiveness for the Self-Reported Foot and Ankle Score
- 2017
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Ingår i: Acta Orthopaedica. - Abingdon : TAYLOR & FRANCIS LTD. - 1745-3674 .- 1745-3682. ; 88:3, s. 300-304
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Patient-reported outcome measures (PROMs) are increasingly used to evaluate results in orthopedic surgery. To enhance good responsiveness with a PROM, the minimally important change (MIC) should be established. MIC reflects the smallest measured change in score that is perceived as being relevant by the patients. We assessed MIC for the Self-reported Foot and Ankle Score (SEFAS) used in Swedish national registries. Patients and methods - Patients with forefoot disorders (n = 83) or hindfoot/ankle disorders (n = 80) completed the SEFAS before surgery and 6 months after surgery. At 6 months also, a patient global assessment (PGA) scaleas external criterionwas completed. Measurement error was expressed as the standard error of a single determination. MIC was calculated by (1) median change scores in improved patients on the PGA scale, and (2) the best cutoff point (BCP) and area under the curve (AUC) using analysis of receiver operating characteristic curves (ROCs). Results - The change in mean summary score was the same, 9 (SD 9), in patients with forefoot disorders and in patients with hindfoot/ankle disorders. MIC for SEFAS in the total sample was 5 score points (IQR: 2-8) and the measurement error was 2.4. BCP was 5 and AUC was 0.8 (95% CI: 0.7-0.9). Interpretation - As previously shown, SEFAS has good responsiveness. The score change in SEFAS 6 months after surgery should exceed 5 score points in both forefoot patients and hindfoot/ankle patients to be considered as being clinically relevant.
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32. |
- Cöster, Maria, et al.
(författare)
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Comparison of the Self-Reported Foot and Ankle Score (SEFAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS)
- 2014
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Ingår i: Foot & ankle international. - Thousand Oaks, CA : SAGE Publications (UK and US): 12 month Embargo. - 1071-1007 .- 1944-7876. ; 35:10, s. 1031-1036
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Self-reported Foot and Ankle Score (SEFAS) is a patient-reported outcome measure, while the American Orthopedic Foot and Ankle Society Score (AOFAS) is a clinician-based score, both used for evaluation of foot and ankle disorders. The purpose of this study was to compare the psychometric properties of these 2 scoring systems. Methods: A total of 95 patients with great toe disorders and 111 patients with ankle or hindfoot disorders completed the 2 scores before and after surgery. We evaluated time to complete the scores in seconds, correlations between scores with Spearmans correlation coefficient (r(s)), floor and ceiling effects by proportion of individuals who reached the minimum or maximum values, test-retest reliability and interobserver reliability by intraclass correlation coefficient (ICC), internal consistency by Cronbachs coefficient alpha (CA), and responsiveness by effect size (ES). Data are provided as correlation coefficients, means, and standard deviations. Results: SEFAS was completed 3 times faster than AOFAS. The scores correlated with an r(s) of .49 for great toe disorders and .67 for ankle/hindfoot disorders (both P less than .001). None of the scores had any floor or ceiling effect. SEFAS test-retest ICC values measured 1 week apart were .89 for great toe and .92 for ankle/hindfoot disorders, while the corresponding ICC values for AOFAS were .57 and .75. AOFAS interobserver reliability ICC values were .70 for great toe and .81 for ankle/hindfoot disorders. SEFAS CA values were .85 for great toe and .86 for ankle/hindfoot disorders, while the corresponding CA values for AOFAS were .15 and .42. SEFAS ES values were 1.15 for great toe and 1.39 for ankle/hindfoot disorders, while the corresponding ES values for AOFAS were 1.05 and 1.73. Conclusion: As SEFAS showed similar or better outcome in our tests and was completed 3 times faster than AOFAS, we recommend SEFAS for evaluation of patients with foot and ankle disorders.
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33. |
- Damgaard, Tobias, et al.
(författare)
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Estimated glomerular filtration rate as a tool for early identification of patients with insufficient exposure to beta-lactam antibiotics in intensive care units
- 2024
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Ingår i: Infectious Diseases. - : Taylor & Francis Group. - 2374-4235 .- 2374-4243. ; 56:6, s. 451-459
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Tidskriftsartikel (refereegranskat)abstract
- Background: Only about 50% of intensive care unit (ICU) patients reach a free trough concentration above MIC (100% fT > MIC) of beta-lactam antibiotics. Although dose adjustments based on therapeutic drug monitoring (TDM) could be beneficial, TDM is not widely available. We investigated serum creatinine-based estimated GFR (eGFR) as a rapid screening tool to identify ICU patients at risk of insufficient exposure. Method: Ninety-three adult patients admitted to four ICUs in southeast Sweden treated with piperacillin/tazobactam, meropenem, or cefotaxime were included. Beta-lactam trough concentrations were measured. The concentration target was set to 100% fT > MICECOFF (2, 4, and 16 mg/L based on calculated free levels for meropenem, cefotaxime, and piperacillin, respectively). eGFR was primarily determined via Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and compared to three other eGFR equations. Data was analysed using logistic regression and receiver operative characteristic (ROC) curves. Results: With intermittent standard dosing, insufficient exposure was common in patients with a relative eGFR >= 48mL/min/1.73m(2) [85%, (45/53)], particularly when treated with cefotaxime [96%, (24/25)]. This eGFR cut-off had a sensitivity of 92% and specificity of 82% (AUC 0.871, p < 0.001) in identifying insufficient exposure. In contrast, patients with eGFR <48mL/min/1.73m(2) had high target attainment [90%, (36/40)] with a wide variability in drug exposure. There was no difference between the four eGFR equations (AUC 0.866-0.872, cut-offs 44-51 ml/min/1.73m(2)). Conclusion: Serum creatinine-based eGFR is a simple and widely available surrogate marker with potential for early identification of ICU patients at risk of insufficient exposure to piperacillin, meropenem, and cefotaxime.
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34. |
- De Geer, Jakob, et al.
(författare)
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Large variation in blood flow between left ventricular segments, as detected by adenosine stress dynamic CT perfusion.
- 2015
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Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 35:4, s. 291-300
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Dynamic cardiac CT perfusion (CTP) is based on repeated imaging during the first-pass contrast agent inflow. It is a relatively new method that still needs validation.PURPOSE: To evaluate the variation in adenosine stress dynamic CTP blood flow as compared to (99m) Tc SPECT. Secondarily, to compare manual and automatic segmentation.METHODS: Seventeen patients with manifest coronary artery disease were included. Nine were excluded from evaluation for various reasons. All patients were examined with dynamic stress CTP and stress/rest SPECT. CTP blood flow was compared with SPECT on a per segment basis. Results for manual and automated AHA segmentation were compared.RESULTS: CTP showed a positive correlation with SPECT, with correlation coefficients of 0·38 and 0·41 for manual and automatic segmentation, respectively (P<0·0001). There was no significant difference between the correlation coefficients of the manual and automated segmentation procedures (P = 0·75). The average per individual global CTP blood flow value for normal segments varied by a factor of 1·9 (manual and automatic segmentation). For the whole patient group, the CTP blood flow value in normal segments varied by a factor of 2·9/2·7 (manual/automatic segmentation). Within each patient, the average per segment blood flow in normal segments varied by a factor of 1·3-2·0/1·2-2·1 (manual/automatic segmentation).CONCLUSION: A positive but rather weak correlation was found between CTP and (99m) Tc SPECT. Large variations in CTP blood flow suggest that a cut-off value for stress myocardial blood flow is inadequate to detect ischaemic segments. Dynamic CTP is hampered by a limited coverage.
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35. |
- Djukanovic, Ingrid, et al.
(författare)
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Health-related quality of life in patients before and after planned orthopedic surgery : a prospective follow-up study
- 2011
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Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier. - 1878-1241 .- 1878-1292. ; 15:4, s. 185-195
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere are increasing demands on health care for both results and quality. Treatment outcome from the patient’s perspective is essential but not often demanded. The aim of the study was to assess Health Related Quality of Life (HRQoL) prior to and one year after an elective orthopedic intervention.MethodsHRQoL was evaluated by the 5-dimensional scale of the EuroQoL (EQ5D) with two additional scales, EQVAS and PainVAS in 676 consecutive patients undergoing 120 different elective orthopedic interventions. Descriptive statistics were used.ResultsResults showed patients treated for arthrosis with total hip and knee replacement had the greatest improvement in HRQoL. Patients that underwent spinal, upper arm and arthroscopic knee surgery showed considerable improvement. All patients experienced pain relief one year after surgery. Changes in the three effect variables EQ5D, EQVAS and PainVAS correlated significantly with each other.ConclusionsThe study provides an overview of patient assessment of HRQoL before and after some of the most common elective orthopedic interventions. Knowledge obtained from patient groups should help improve and individualize care both from a nursing and surgical perspective.
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36. |
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37. |
- Ekman, A., et al.
(författare)
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Neuromuscular block and the electroencephalogram during sevoflurane anaesthesia
- 2007
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Ingår i: NeuroReport. - 0959-4965 .- 1473-558X. ; 18:17, s. 1817-1820
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Tidskriftsartikel (refereegranskat)abstract
- The effect of neuromuscular block on the anaesthetic depth of hypnosis is an elusive question. We simultaneously investigated the influence of neuromuscular block on the bispectral index, a measure of hypnosis during general anaesthesia, and on the electroencephalogram. Patients were anaesthetized with sevoflurane. Noxious tetanic electrical stimulation was applied on two occasions: before and after profound neuromuscular block achieved with rocuronium. Neuromuscular block significantly attenuated the effect from noxious stimulation on electroencephalogram power and synchrony in the γ band (P<0.05), and the corresponding effect on bispectral index (P<0.02). These findings are probably due to the reduced arousing afferent input from paralysed muscles, and not to changes in the frontal electromyogram.
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38. |
- Ekman, A., et al.
(författare)
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The effect of neuromuscular block and noxious stimulation on hypnosis monitoring during sevoflurane anesthesia
- 2007
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Ingår i: Anesthesia and Analgesia. - : Ovid Technologies (Wolters Kluwer Health). - 0003-2999 .- 1526-7598. ; 105:3, s. 688-695
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There are conflicting results on the influence of neuromuscular block (NMB) on the bispectral index (BIS). We investigated the influence of two degrees of NMB on BIS, Alaris auditory-evoked potential index (AAI), and the electromyogram (EMG) obtained with needle electrodes from the frontal and temporal muscles, immediately adjacent to the BIS-sensor. METHODS: Twenty patients were anesthetized with sevoflurane, titrated for 30 min to an end-tidal concentration of 1.2% (baseline). Rocuronium was infused to 50% (partial) and 95% (profound) depression of the first twitch in a train-of-four response, the order being randomly chosen. Noxious tetanic electrical stimulation was applied at four occasions: 1) at baseline (control measurement), 2 and 3) at each degree of NMB, and 4) after neostigmine reversal. BIS, AAI, and EMG were obtained 2 min before and 2 min after each noxious stimulation. RESULTS: Median BIS and AAI at baseline were 44 (39-50) and 15 (14-16), respectively. The two degrees of NMB did not affect BIS, AAI, and EMG before noxious stimulation. In contrast, profound NMB altered the BIS and AAI responses to noxious stimulation when compared with partial NMB, (BIS P = 0.01, AAI P < 0.01), after neostigmine reversal (BIS P < 0.01, AAI P = 0.01) and compared with baseline (BIS P = 0.08, AAI P = 0.02). No significant increase in EMG was found. CONCLUSION: BIS and AAI responses to noxious tetanic electrical stimulation are affected by the degree of NMB during sevoflurane anesthesia whereas NMB does not affect BIS or AAI in the absence of noxious stimulation.
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39. |
- Ellin, Fredrik, et al.
(författare)
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Impact of comorbidity on survival in peripheral T-cell lymphomas : A Swedish Lymphoma Registry study
- 2018
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Ingår i: Hematological Oncology. - : Wiley. - 0278-0232. ; 36:1, s. 159-165
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Tidskriftsartikel (refereegranskat)abstract
- Comorbidity impacts survival in B-cell lymphoma patients, but the influence in peripheral T-cell lymphomas (PTCLs) has been little studied. To investigate the impact of comorbidity on outcome in PTCL, we identified adult patients with newly diagnosed PTCL from 2000 to 2009 in the Swedish Lymphoma Registry. Data on comorbidity at diagnosis were retrospectively collected according to the Charlson Comorbidity Index (CCI). Comorbid conditions were present in 263 out of 694 (38%) patients. A CCI score of ≥2 was associated with inferior overall survival (OS) (hazard ratio [HR] 1.63, P < .001) and progression-free survival (HR 1.54, P < .001) in multivariate analysis. In patients undergoing front-line autologous stem cell transplantation (auto SCT), CCI >0 was associated with inferior OS (HR 2.40, P = .013). Chemotherapy regimens were classified as curative or low-intensity treatments. Among patients aged ≥75 years (n = 214), low-intensity and curative treatment groups had similar OS (HR 0.8, P = .6), also when adjusted for CCI. In summary, our results demonstrate CCI to be independently associated with survival in PTCLs. Even limited comorbidity impacted survival after front-line auto SCT, which needs to be considered in treatment decisions. Intensive anthracycline-based chemotherapy in elderly PTCL patients might be of limited benefit.
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40. |
- Elmberg, Viktor, et al.
(författare)
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Reference equations for breathlessness during incremental cycle exercise testing
- 2023
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Ingår i: ERJ Open Research. - : European Respiratory Society. - 2312-0541. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Exertional breathlessness is commonly assessed using incremental exercise testing (IET), but reference equations for breathlessness responses are lacking. We aimed to develop reference equations for breathlessness intensity during IET.METHODS: A retrospective, consecutive cohort study of adults undergoing IET was carried out in Sweden. Exclusion criteria included cardiac or respiratory disease, death or any of the aforementioned diagnoses within 1 year of the IET, morbid obesity, abnormally low exercise capacity, submaximal exertion or an abnormal exercise test. Probabilities for breathlessness intensity ratings (Borg CR10) during IET in relation to power output (%predWmax), age, sex, height and body mass were analysed using marginal ordinal logistic regression. Reference equations for males and females were derived to predict the upper limit of normal (ULN) and the probability of different Borg CR10 intensity ratings.RESULTS: 2581 participants (43% female) aged 18-90 years were included. Mean breathlessness intensity was similar between sexes at peak exertion (6.7±1.5 versus 6.4±1.5 Borg CR10 units) and throughout exercise in relation to %predWmax. Final reference equations included age, height and %predWmax for males, whereas height was not included for females. The models showed a close fit to observed breathlessness intensity ratings across %predWmax values. Models using absolute W did not show superior fit. Scripts are provided for calculating the probability for different breathlessness intensity ratings and the ULN by %predWmax throughout IET.CONCLUSION: We present the first reference equations for interpreting breathlessness intensity during incremental cycle exercise testing in males and females aged 18-90 years.
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41. |
- Emilsson, Kent, 1963-, et al.
(författare)
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The mode of left ventricular pumping : is there an outer contour change in addition to the atrioventricular plane displacement?
- 2001
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Ingår i: Clinical Physiology. - : Wiley. - 0144-5979 .- 1365-2281. ; 21:4, s. 437-446
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Tidskriftsartikel (refereegranskat)abstract
- The outer contour of the heart has in some studies been shown to be constant during the heart cycle and the epicardial apex almost stationary whilst the base of the ventricles moves towards apex during systole. The base of the left ventricle has been regarded as a cylinder with constant cross-sectional area with changes in height during the heart cycle, the latter corresponding to the amplitude of mitral annulus motion (MAM). In this echocardiographic study, including 20 healthy adults, the stroke volume calculated by the cylinder model was significantly lower than by a reference method (modified Simpson's rule). MAM explained 82% of the stroke volume and 18% must, therefore, be explained by an inward motion of the outer left ventricular wall. A mean outer diameter shortening of about 3% (about 2 mm) was calculated.
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42. |
- Engvall, Jan, et al.
(författare)
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Moderately trained male football players, compared to sedentary male adults, exhibit anatomical but not functional cardiac remodelling, a cross-sectional study
- 2021
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Ingår i: Cardiovascular Ultrasound. - : BMC. - 1476-7120. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background Elite athletes have been the subject of great interest, but athletes at an intermediate level of physical activity have received less attention in respect to the presence of cardiac enlargement and/or hypertrophy. We hypothesized that playing football, often defined as demanding less endurance components than running or cycling, would still induce remodelling similar to sports with a dominating endurance component. Methods 23 male football players, age 25+/- 3.9 yrs. underwent exercise testing, 2D- and 3D- echocardiography and cardiac magnetic resonance (CMR). The results were compared with a control group of engineering students of similar age. The athletes exercised 12 h/week and the control subjects 1 h/week, p < 0.001. Results The football players achieved a significantly higher maximal load at the exercise test (380 W vs 300 W, p < 0.001) as well as higher calculated maximal oxygen consumption, (49.7 vs 37.4 mL x kg(- 1) x min(- 1), p < 0.001) compared to the sedentary group. All left ventricular (LV) volumes assessed by 3DEcho and CMR, as well as CMR left atrial (LA) volume were significantly higher in the athletes (3D-LVEDV 200 vs 154 mL, CMR-LVEDV 229 vs 185 mL, CMR-LA volume 100 vs 89 mL, p < 0.001, p = 0.002 and p = 0.009 respectively). LVEF and RVEF, LV strain by CMR or by echo did not differentiate athletes from sedentary participants. Right ventricular (RV) longitudinal strain, LA and right atrial (RA) strain by CMR all showed similar results in the two groups. Conclusion Moderately trained intermediate level football players showed anatomical but not functional cardiac remodelling compared to sedentary males.
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43. |
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44. |
- Fredriksson, Tobias, et al.
(författare)
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Diagnostic patterns of serum inflammatory protein markers in children with Lyme neuroborreliosis
- 2024
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Ingår i: Ticks and Tick-borne Diseases. - : Elsevier. - 1877-959X .- 1877-9603. ; 15:4
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Tidskriftsartikel (refereegranskat)abstract
- Definite diagnosis of Lyme neuroborreliosis (LNB) requires investigation of serum and cerebrospinal fluid (CSF). Thus, lumbar puncture is necessary, and requires administration of sedating drugs in children. This study aimed to investigate if a pattern of different inflammatory biomarkers in serum could contribute to the selection of children for lumbar puncture in suspected LNB. Patients were included from a cohort of children who was previously investigated for LNB including serum and CSF sampling during the years 2010-2014. The multiplex proximity extension assay (PEA) inflammation panel Target 96 (Olink Bioscience, Uppsala, Sweden) was used to examine 92 biomarkers in serum. Based on the presence of CSF pleocytosis and Borrelia-specific antibodies, patients were divided into a definite LNB group (n=61) and a non-LNB control group (n=58). Following PEA and statistical analysis with multivariate logistic regression, five biomarkers remained significant (p < 0.001), which were included in a calculation of protein index. The index biomarkers were CST5, IL-15RA, CXCL10, DNER and CX3CL1. A receiver operating characteristic curve was constructed from the index, which showed an 80 % sensitivity and 81 % specificity. Area under the curve was 0.889. We offer evidence that, with further refinements, patterns of serum biomarkers might help identify those children more or less likely to have LNB, perhaps ultimately decreasing the need for lumbar punctures.
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45. |
- Goransson, Ingrid, et al.
(författare)
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Hand function 5 years after treatment with collagenase Clostridium histolyticum injection for Dupuytrens disease
- 2021
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 46:9, s. 985-994
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to report hand function, disability and satisfaction and patients perception of functionally troublesome contractures 5 years after injection with collagenase Clostridium histolyticum and hand therapy for Dupuytrens disease. Data from 79 patients were collected before and at 3, 12 and 60 months after treatment. Hand function was significantly improved, and 70% achieved a functional range of motion in the treated hand. QuickDASH scores and range of motion were best at 3 months follow-up. At 60 months, mean total extension deficit was 48 degrees, which was 57% of the deficit before treatment. Thirty-seven patients (47%) had developed recurrent contractures in treated finger(s) meeting the criteria for new treatment. The threshold for functionally troublesome contractures was found to be 30 degrees-60 degrees in the finger joints. Treatment was experienced as painful, but few hand function problems occurred. Most patients would choose this treatment method again.
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46. |
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47. |
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48. |
- Gunningberg, Lena, et al.
(författare)
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Nurse Managers prerequisite for nursing development: a survey on pressure ulcers and contextual factors in hospital organizations
- 2010
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Ingår i: JOURNAL OF NURSING MANAGEMENT. - : Blackwell Publishing Ltd. - 0966-0429 .- 1365-2834. ; 18:6, s. 757-766
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Tidskriftsartikel (refereegranskat)abstract
- Aim To describe and compare pressure ulcer prevalence in two county councils and concurrently explore Nurse Managers perspective of contextual factors in a hospital organization. Background Despite good knowledge about risk factors and prevention of pressure ulcers, the prevalence of pressure ulcers remains high. Nurse Managers have a key role in implementing evidence-based practice. Methods The present study included five hospitals in two Swedish county councils: county council A (non-university setting) and county council B (university setting). A pressure ulcer prevalence study was conducted according to the methodology developed by the European Pressure Ulcer Advisory Panel. The Nurse Managers answered a (27-item) questionnaire on contextual factors. Results County council B had significantly less pressure ulcers grade (2-4) (7.7%) than county council A (11.3%). The Nurse Managers assessed only two out of the 27 general contextual items significantly differently. Some significant differences were observed in ward organization. Conclusions In county council B, the Nurse Managers seemed more aware of prevention strategies compared with Nurse Managers in county council A. The Nurse Managers should take more responsibility to develop the prerequisite for quality improvement in nursing. Implication for nursing management Nursing outcomes (e. g. pressure ulcers) should be incorporated into national quality registries for benchmarking and Nurse Managers competence in evidence-based practice and research methodology increased.
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49. |
- Gustafsson, Charlotte Eklund, et al.
(författare)
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Prognostic value of peak work rate indexed by left ventricular diameter
- 2023
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Ingår i: Scientific Reports. - : NATURE PORTFOLIO. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Left ventricular diameter (LVEDD) increases with systematic endurance training but also in various cardiac diseases. High exercise capacity associates with favorable outcomes. We hypothesized that peak work rate (W-peak) indexed to LVEDD would carry prognostic information and aimed to evaluate the association between W-peak/LVEDDrest and cardiovascular mortality. W-peak/LVEDDrest (W/mm) was calculated in patients with an echocardiographic examination within 3 months of a maximal cycle ergometer exercise test. Low W-peak/LVEDDrest was defined as a value below the sex- and age-specific 5th percentile among lower-risk subjects. The association with cardiovascular mortality was evaluated using Cox regression. In total, 3083 patients were included (8.0 [5.4-11.1] years of follow-up, 249 (8%) cardiovascular deaths). W-peak/LVEDDrest (W/mm) was associated with cardiovascular mortality (adjusted hazard ratio (HR) 0.28 [0.22-0.36]), similar to W-peak in % of predicted, with identical prognostic strength when adjusted for age and sex (C-statistics 0.87 for both). A combination of low W-peak/LVEDDrest and low W-peak was associated with a particularly poor prognosis (adjusted HR 6.4 [4.0-10.3]). W-peak/LVEDDrest was associated with cardiovascular mortality but did not provide incremental prognostic value to W-peak alone. The combination of a low W-peak/LVEDDrest and low W-peak was associated with a particularly poor prognosis.
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50. |
- Hedman, Kristofer, 1984-, et al.
(författare)
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Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry
- 2021
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 28:12, s. 1360-1369
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Tidskriftsartikel (refereegranskat)abstract
- Background: Guidelines recommend considering workload in interpretation of the systolic blood pressure (SBP) response to exercise, but reference values are lacking. Design: This was a retrospective, consecutive cohort study. Methods: From 12,976 subjects aged 18–85 years who performed a bicycle ergometer exercise test at one centre in Sweden during the years 2005–2016, we excluded those with prevalent cardiovascular disease, comorbidities, cardiac risk factors or medications. We extracted SBP, heart rate and workload (watt) from ≥ 3 time points from each test. The SBP/watt-slope and the SBP/watt-ratio at peak exercise were calculated. Age- and sex-specific mean values, standard deviations and 90th and 95th percentiles were determined. Reference equations for workload-indexed and peak SBP were derived using multiple linear regression analysis, including sex, age, workload, SBP at rest and anthropometric variables as predictors. Results: A final sample of 3839 healthy subjects (n = 1620 female) were included. While females had lower mean peak SBP than males (188 ± 24 vs 202 ± 22 mmHg, p < 0.001), workload-indexed SBP measures were markedly higher in females; SBP/watt-slope: 0.52 ± 0.21 versus 0.41 ± 0.15 mmHg/watt (p < 0.001); peak SBP/watt-ratio: 1.35 ± 0.34 versus 0.90 ± 0.21 mmHg/watt (p < 0.001). Age, sex, exercise capacity, resting SBP and height were significant predictors of the workload-indexed SBP parameters and were included in the reference equations. Conclusions: These novel reference values can aid clinicians and exercise physiologists in interpreting the SBP response to exercise and may provide a basis for future research on the prognostic impact of exercise SBP. In females, a markedly higher SBP in relation to workload could imply a greater peripheral vascular resistance during exercise than in males.
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