| 1. |
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| 2. |
- Ekelund, Mikael, et al.
(författare)
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Effects of total parenteral nutrition on rat enteric nervous system, intestinal morphology, and motility.
- 2005
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Ingår i: Journal of Surgical Research. - : Elsevier BV. - 1095-8673 .- 0022-4804. ; 124:2, s. 187-193
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Tidskriftsartikel (refereegranskat)abstract
- Total parenteral nutrition (TPN) is often crucial for patients not being able to feed enterally or having intestinal absorptive deficits. Enteral nutrition is, however, frequently regarded vital for maintaining functional and structural intestinal integrity. The aim of this study was to investigate possible effects of TPN on rat distal small intestine compared to enterally fed identically housed controls, regarding the enteric nervous system (ENS), motility in vitro, and morphology. This study shows that motor responses evoked by electrical stimulation or exposure to vasoactive intestinal peptide (VIP), pituitary adenylate cyclase activating peptide-27 (PACAP-27), and nitric oxide (NO) donor were unchanged. By using immunohistochemistry, the numbers of submucous (P < 0.05) and myenteric (P < 0.05) nerve cells were found to increase, expressed as numbers per unit length. The percentage of neurons expressing VIP, PACAP-27, NO-synthase, and galanin remained unchanged, however. By in situ hybridization the number of submucous neurons expressing neuropeptide Y-mRNA was found to decrease (P < 0.05); the other populations were unaltered. Morphometry revealed an increased submucosal thickness (P < 0.05), while intestinal circumference markedly decreased (P < 0.0001) in TPN-treated rats. In conclusion, TPN treatment resulted in reduced intestinal circumference leading to condensation of enteric neurons. No marked changes in neurotransmitter expression of the enteric neurons or in motor activity were noted.
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| 3. |
- Ekelund, Mikael, et al.
(författare)
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Total Parenteral Nutrition Causes Circumferential Intestinal Atrophy, Remodeling of the Intestinal Wall, and Redistribution of Eosinophils in the Rat Gastrointestinal Tract.
- 2007
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Ingår i: Digestive Diseases and Sciences. - : Springer Science and Business Media LLC. - 1573-2568 .- 0163-2116. ; 52:8, s. 1833-1839
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Tidskriftsartikel (refereegranskat)abstract
- Total parenteral nutrition (TPN) is held to cause intestinal atrophy and weaken mechanical and immunological barriers. To monitor the degree of atrophy caused by TPN, female Sprague-Dawley rats were, for 8 days, maintained on TPN (n = 6) and compared to identically housed controls given food and water ad libitum (n = 6). Specimens from jejunum, ileum, and colon were taken for histology and morphometric analysis. Topographic distribution and presence of eosinophils, by eosinophil peroxidase (EPO) staining, were examined in the gastric fundus, jejunum, ileum, and colon. Atrophy in terms of a markedly reduced circumference was noted throughout the intestinal tract in all rats subjected to TPN. The width of jejunal and ileal villi was narrowed and the length of jejunal villi was decreased. Furthermore, submucosal thickness in the jejunum and ileum increased. The height of ileal enterocytes remained unaltered. The number of goblet cells decreased in jejunal but not in ileal villi. The Paneth cells, suggested to play important roles in innate defense, increased in size. In the gastric fundus a marked increase in eosinophils was revealed predominantly in the mucosa and submucosa. The number and distribution of jejunal and ileal eosinophils were identical to those of controls. In colon from TPN rats, a redistribution of eosinophils was noted, causing a "band-like" accumulation of eosinophils in the basal portion of the mucosa. In conclusion, TPN causes gut atrophy and an increase in Paneth cell size. Eosinophils increase in number in the gastric fundus and a topographic redistribution occurs in the colon.
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| 4. |
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| 5. |
- Antonsson, Tobias, et al.
(författare)
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Differences in Health-Related Quality of Life After Gastric Bypass Surgery : a Cross-Sectional Study
- 2021
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 31:7, s. 3194-3202
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Tidskriftsartikel (refereegranskat)abstract
- Background: Gastric bypass (GBP) is a surgical method with good evidence of sustainable weight loss, reduced obesity-related comorbidities, and improved health-related quality of life (HRQoL). However, long-term data post-GBP is scarce on HRQoL related to other factors than weight loss, such as impact of socio-economic, age, and gender. Aim: To investigate long-term HRQoL in GBP patients. Methods: The study was conducted as a cross-sectional study covering 3 to 9 years post-GBP measuring HRQoL using RAND-36. Association to weight loss, time since surgery, gender, educational level, occupation, and age was analyzed. The participants were included on the basis that they had received a GBP that was performed by Region Skåne, the southernmost administrative healthcare region in Sweden. Recruitment to the study was by mail invitation for an online survey. Results: Of the total population of 5310 persons receiving the questionnaire, 1339 of the 1372 responders fulfilled the inclusion criteria. Those with low educational level, unemployed, persons on sick leave or disability support, and those with less weight loss reported the lowest HRQoL. The longer time since surgery, the lower the HRQoL. Conclusion: Less weight loss, longer time since GBP, lower educational level, and lower degree of employment all affect HRQoL negatively after GBP surgery. Graphical abstract: [Figure not available: see fulltext.]
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| 6. |
- Arvidsson, A, et al.
(författare)
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Water with Food Intake Does Not Influence Caloric Intake After Gastric Bypass (GBP): a Cross-Over Trial.
- 2015
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 25:2, s. 249-253
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Tidskriftsartikel (refereegranskat)abstract
- Bariatric patients seeking information meet very different recommendations on postoperative diet and eating behaviour. A reason for variability may be lack of hard evidence. A national survey on current dietary advice was conducted to serve as background for the present study on how drinking during a meal influenced caloric consumption.
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| 7. |
- Banke, Elin, et al.
(författare)
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Superantigen activates the gp130 receptor on adipocytes resulting in altered adipocyte metabolism.
- 2014
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Ingår i: Metabolism, Clinical and Experimental. - : Elsevier BV. - 1532-8600. ; 63:6, s. 831-840
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Tidskriftsartikel (refereegranskat)abstract
- The bacteria Staphylococcus aureus is part of the normal bacterial flora and produces a repertoire of enterotoxins which can cause food poisoning and toxic shock and might contribute to the pathogenesis of inflammatory diseases. These enterotoxins directly cross-link the T cell receptor with MHC class II, activating large amounts of T cells and are therefore called superantigens. It was recently discovered that the superantigen SEA binds to the cytokine receptor gp130. As obesity and type 2 diabetes are highly associated with inflammation of the adipose tissue and gp130 has been shown to play an important role in adipocytes, we wanted to investigate the effect of SEA on adipocyte signaling and function.
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| 8. |
- Carlsson, Marcus, et al.
(författare)
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Heart filling exceeds emptying during late ventricular systole in patients with systolic heart failure and healthy subjects – a cardiac MRI study
- 2019
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Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 39:3, s. 192-200
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Tidskriftsartikel (refereegranskat)abstract
- Background: Total heart volume (THV) within the pericardium is not constant throughout the cardiac cycle and THV would intuitively be lowest at end systole. We have, however, observed a phase shift between ventricular outflow and atrial inflow which causes the minimum THV to occur before end systole. The aims were to explain the mechanism of the late-systolic net inflow to the heart and determine whether this net inflow is affected by increased cardiac output or systolic heart failure. Methods and Results: Healthy controls (n = 21) and patients with EF<35% (n = 14) underwent magnetic resonance imaging with flow measurements in vessels to and from the heart, and this was repeated in nine controls during 140 μgram kg−1 min−1 adenosine infusion. Minimum THV occurred 78 ± 6 ms before end of systolic ejection (8 ± 1% of the cardiac cycle) in controls. The late-systolic net inflow was 12·3 ± 1·1 ml or 6·0 ± 0·5% of total stroke volume (TSV). Cardiac output increased 66 ± 8% during adenosine but late-systolic net inflow to the heart did not change (P = 0·73). In patients with heart failure, late-systolic net inflow of the heart′s left side was lower (3·4 ± 0·5%) compared to healthy subjects (5·3 ± 0·6%, P = 0·03). Conclusions: Heart size increases before end systole due to a late-systolic net inflow which is unaffected by increased cardiac output. This may be explained by inertia of blood that flows into the atria generated by ventricular systole. The lower late-systolic net inflow in patients with systolic heart failure may be a measure of decreased ventricular filling due to decreased systolic function, thus linking systolic to diastolic dysfunction.
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| 9. |
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| 10. |
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| 11. |
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| 12. |
- Ekelund, Bo G., et al.
(författare)
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Comparing literary worlds : An analysis of the spaces of fictional universes in the work of two US prose fiction debut cohorts, 1940 and 1955
- 2005
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Ingår i: Poetics (Amsterdam. Print). - : Elsevier BV. - 0304-422X .- 1872-7514. ; 33:5-6, s. 343-368
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Tidskriftsartikel (refereegranskat)abstract
- This article presents a geometric data analysis (GDA) of the two “spaces of fictional universes” made up by the literary works of two cohorts of US prose fiction debut writers, 1940 and 1955. It is argued that the analysis reveals a common structure with significant variations that enable a comparison between two different states of a collective social imaginary, generated by 385 of the 560 authors included in the study. It is shown that the 1955 space is characterized by a greater contrast between agonistic and non-agonistic universes, and a firmer gendering of these oppositions. Other results include a confirmation of the generally accepted intuition that first novelists tend to reproduce features of their own social and geographical background in their works, but it is argued that different “site effects” enable a greater power to appropriate symbolically privileged spaces. The article concludes with a brief return to the individual authors, indicating the kind of research that the geometric data analysis makes possible.
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| 13. |
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| 14. |
- Ekelund, Bo G, et al.
(författare)
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The shape of the literary career: An analysis of publishing trajectories
- 2002
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Ingår i: Poetics. - 0304-422X. ; 30:5-6, s. 341-364
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Tidskriftsartikel (refereegranskat)abstract
- This article situates four literary careers in the US literary field using data from the 1940 cohort of debut writers. It uses prosopographical and bibliographical variables to illustrate how the data can be put to use. A discussion of literary trajectori
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| 15. |
- Ekelund, L, et al.
(författare)
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Imaging of Four-Corner Fusion (SLAC Arthrodesis) of the Wrist with 64-Slice Computed Tomography.
- 2007
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Ingår i: Acta Radiologica. - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 48:1, s. 76-79
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To find out whether it is possible to evaluate the healing of wrist arthrodesis, carried out with a metallic spider plate, by means of 64-slice computed tomography (CT). Material and Methods: 18 CT examinations were performed in 12 patients 2 weeks to 37 months following scapholunate advanced collapse (SLAC) arthrodesis fixed with a metallic plate. Ten patients also had plain films of the wrist. Radiation doses were estimated. Results: Plain films were difficult to evaluate due to overprojection of the spider plate. With 64-slice CT, however, it was possible to evaluate the healing process in all patients in spite of metallic artifacts. Radiation doses were low. Conclusion: The healing of SLAC arthrodesis of the wrist is difficult to evaluate with conventional radiography due to the metallic plate. By means of 64-slice CT, however, it was possible to “see under” the plate in all 12 patients.
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| 16. |
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| 17. |
- Ekelund, Mikael, et al.
(författare)
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Fetmakirurgi
- 2016
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Ingår i: Omvårdnad & Kirurgi. - 9789144088860 ; , s. 289-300
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Bokkapitel (refereegranskat)
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| 18. |
- Ekelund, Mikael, et al.
(författare)
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Gastroesophageal Reflux after Vertical Banded Gastroplasty is Alleviated by Conversion to Gastric Bypass.
- 2012
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 22:6, s. 851-854
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Conversion operations after vertical banded gastroplasty (VBG) are sometimes performed because of vomiting and/or acid regurgitation. Primary operation with gastric bypass (GBP) is known to reduce gastroesophageal reflux (GERD). Previous studies have not been designed to differentiate between the effects of the altered anatomy and of the ensuing weight loss. No series has reported data on acid reflux before and after conversion from VBG to GBP. METHODS: We invited eight VBG patients with current symptoms of GERD. All had intact staple lines as assessed by barium meal and gastroscopy. Acid reflux was quantified using 48-h Bravo capsule measurements. Conversion operations were performed creating an isolated 15-20-ml pouch; the previously banded part of gastric wall was excised. Gastrojejunostomy was made end to end with a 28-mm circular stapler. The study is based on five patients consenting to early postoperative endoscopy and pH measurement. RESULTS: All patients were women with a mean age of 49.5 years and BMI of 36.3. Time since VBG was 132.1 months. Time from conversion to second measurement was 46.6 days and BMI at that time 32.7. There was no mortality and no serious morbidity. All patients improved clinically and no patient had to go back on proton pump inhibition or antacids. Total time with pH < 4.0 was reduced from 18.4% to 3.3% (p < 0.05). DeMeester score was reduced from 58.1 to 15.9 (p < 0.05). CONCLUSIONS: The effect of converting VBG-operated patients to GBP results in a near-normalisation of acid reflux parameters and a discontinuation of proton pump inhibitor medication.
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| 19. |
- Ekelund, Mikael
(författare)
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Intestinal Bypass and Total Parenteral Nutrition: Changes in Gut Function and Morphology
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abolition of enteral nutrition is sometimes required in severe illness. The primary aim of the present work has been to elucidate possible changes in intestinal morphology and motor function in absence of enteral nutrition. Total absence of enteral nutrition in an isolated intestinal segment was created by bypassing the distal ileum in a rat model. Intestinal bypass causes marked circumferential atrophy, a decrease in VIP, PACAP and NPY-containing nerve cells while NOS-containing nerve cells increase in number. Furthermore, loss of enteric neurons occurs. In vitro, longitudinal smooth muscle motor response changes from cholinergic contraction and nitrergic relaxation to a non-cholinergic and non-nitrergic motor response. One-week bypassed intestine becomes temporarily supersensitive to the relaxationinducing transmitters VIP, PACAP-27 and NO. The relaxatory response returns to normal after four weeks bypass. The selectivity of the receptors, by which PACAP and VIP mediate relaxation, change after bypass. In another model for intestinal adaptation, rats were set on total parenteral nutrition (TPN). TPN results in circumferential atrophy in the jejunum, ileum and colon. Morphological atrophic changes are more pronounced in the jejunum. With the exception of a decrease in the number of submucous neurons expressing NPY-mRNA, the rest of the neuronal subpopulations studied remain unaffected. Longitudinal smooth muscle response remains unaltered to electrical field stimulation and addition of VIP, PACAP or NO-donor. Jejunal goblet cells decrease in number and ileal Paneth cells increase in size. Eosinophils increase in number in the stomach, most evident in the mucosa and submucosa. In the colon, eosinophils take a more basal position within the mucosa, interpreted as eosinophils taking a ?passive position? in response to the lack of enteral stimuli. In conclusion: Absence of enteral stimuli causes a wide range of intestinal atrophic and functional changes.
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| 20. |
- Ekelund, Maria, et al.
(författare)
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Long-term performance of poly(vinyl chloride) cables, Part 2 : Migration of plasticizer
- 2008
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Ingår i: Polymer degradation and stability. - : Elsevier BV. - 0141-3910 .- 1873-2321. ; 93:9, s. 1704-1710
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Tidskriftsartikel (refereegranskat)abstract
- Cable samples with plasticized poly(vinyl chloride) insulations were aged in air at temperatures between 80 and 155 degrees C. The concentrations of the plasticizer (di-(2-ethylhexyl) phthalate, DEHP) in the insulations of the aged cables were determined by extraction of samples in tetrahydrofuran followed by analysis of the extract by liquid chromatography. The plasticizer concentration data for different ageing times were analysed by numerical methods, fitting Fick's second law with a concentration-dependent diffusivity. The analysis showed that the transport of the plasticizer to the surrounding air phase was controlled by diffusion at 120 and 155 degrees C with an activation energy of 89 kJ mol(-1). The evaporation of the plasticizer from the outer boundary was rate controlling at lower temperatures (<= 100 degrees C), The rate of evaporation was initially constant and independent of the plasticizer concentration at both 80 and 100 degrees C. The activation energy for the initial DEHP loss rate from PVC at these temperatures was the same as that obtained for evaporation of pure DEHP on a glass plate at 60-100 degrees C measured by thermogravimetry, 98 2 kJ mol-1. Furthermore, the evaporation rate of pure DEHP on a glass plate was also of the same order of magnitude as the rate of plasticizer loss from the cable insulation. Extrapolation of the plasticizer loss rate data (from the cable at 80 degrees C and from pure liquid DEHP at temperatures between 60 and 100 IQ to 25 degrees C predicted a maximum loss of plasticizer of 1% over 25 years. This is in accordance with earlier presented data and with the data presented in this report.
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| 21. |
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| 22. |
- Ekelund, Mikael, et al.
(författare)
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Perforated peptic duodenal ulcer in a paraesophageal hernia--a case report of a rare surgical emergency
- 2006
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Ingår i: BMC Surgery. - : Springer Science and Business Media LLC. - 1471-2482. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Paraesophageal hernias are quite common and sometimes feared due to the risk of incarceration and strangulation of any herniated organ. The hereby reported combination of an incarcerated paraesophageal hernia containing a perforated peptic ulcer is extremely rare. CASE PRESENTATION: An elderly man with multiple medical conditions was admitted due to severe upper abdominal pain. The patient was found to have a paraesophageal hernia and underwent a laparotomy. In the hernia, a perforated benign peptic duodenal ulcer was found. The duodenal defect was over-sewn, the hernial defect was closed and the former hernial cavity was drained by a right-sided chest tube. The patient was discharged one month after surgery and was found to do well at follow-up one month after discharge. CONCLUSION: This is the first report of a patient surviving the extremely rare and life-threatening combination of a perforated peptic duodenal ulcer in a paraesophageal hernia.
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| 23. |
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| 24. |
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| 25. |
- Ekelund, Ulf, et al.
(författare)
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Effects of selective ETB-receptor stimulation on arterial, venous and capillary functions in cat skeletal muscle
- 1994
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Ingår i: British Journal of Pharmacology. - 1476-5381. ; 112:3, s. 887-894
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Tidskriftsartikel (refereegranskat)abstract
- 1. This paper describes, in quantitative terms, the in vivo effects of two selective ETB-receptor agonists (IRL 1620 and BQ 3020) on vascular resistance (tone) in the following consecutive sections of the vascular bed of sympathectomized cat skeletal muscle: large-bore arterial resistance vessels (> 25 microns), small arterioles (< 25 microns) and the veins. The effects on capillary pressure transcapillary fluid exchange were also recorded. 2. Both IRL 1620 and BQ 3020, infused i.a. to the muscle preparation, evoked an initial transient dilator response followed by a moderate dose-dependent constrictor response, both being preferentially confined to the small arterioles. The dilator response was associated with a transient increase, and the constrictor response with a sustained decrease, in capillary pressure, the latter causing net transcapillary fluid absorption. The capillary filtration coefficient decreased during the constrictor response, indicating constriction of terminal arterioles/precapillary sphincters. 3. The vascular responses to the ETB-receptor agonists were unaffected by blockade of endothelium-derived nitric oxide (NG-nitro-L-arginine methyl ester) and by selective ETA-receptor blockade (FR139317). However, blockade of prostacyclin production with indomethacin decreased the amplitude of the dilator response, and decreased the time required to reach a steady-state vasoconstrictor response to the ETB-receptor agonists. 4. The effect of ETB-receptor stimulation on vascular tone was also evaluated in vitro on the cat femoral artery and vein. IRL 1620 had no effect on the femoral artery but caused a weak dose-dependent relaxation in the femoral vein. This large vein relaxation response seemed to be mediated by endothelium-derived nitric oxide and not by prostacyclin.(ABSTRACT TRUNCATED AT 250 WORDS)
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| 26. |
- Ekelund, Ulf, et al.
(författare)
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Effects of the combined ETA and ETB receptor antagonist PD145065 on arteries, arterioles, and veins in the cat hindlimb
- 1995
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Ingår i: Journal of Cardiovascular Pharmacology. - 1533-4023. ; 26:Suppl. 3, s. 211-213
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe in quantitative terms the effects of ETA and ETB receptor blockade on vascular tone (resistance) in large-bore arterial resistance vessels (> 25 microns), small arterioles (< 25 microns), and veins in the cat gastrocnemius muscle in vivo. In the muscle vascular bed, the combined ETA and ETB receptor antagonist PD145065 (1 mg/kg/min, intra-arterially) abolished the biphasic vascular responses (dilatation followed by constriction) to both ET-1 (0.4 microgram/kg/min, intra-arterially) and to the selective ETB receptor agonist IRL1620 (3.2 micrograms/kg/min, intra-arterially). In the cat femoral artery and vein in vitro, PD145065 competitively inhibited the contractile responses to both ET-1 and IRL1620. The contractile response to the latter agonist could be evoked only after long-term incubation of the vessels (37 degrees C for 5 days). These results indicate that PD145065 is a potent antagonist at both ETA and ETB receptors in vivo and in vitro. Therefore, this antagonist may prove useful for elucidating the possible physiologic and/or pathophysiologic roles of the endothelins. For example, it was shown that PD145065 had no effect on vascular tone in the resting state, indicating no role for the endothelins in the regulation of basal vascular tone in cat skeletal muscle.
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| 27. |
- Ekelund Ugge, Gustaf Magnus Oskar, 1990-
(författare)
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Transcriptional biomarkers of toxicity – powerful tools or random noise? : An applied perspective from studies on bivalves
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aquatic organisms are constantly at risk of being exposed to potentially harmful chemical compounds of natural or anthropogenic origin. Biological life can for instance respond to chemical stressors by changes in gene expression, and thus, certain gene transcripts can potentially function as biomarkers, i.e. early warnings, of toxicity and chemical stress. A major challenge for biomarker application is the extrapolation of transcriptional data to potential effects at the organism level or above. Importantly, successful biomarker use also requires basal understanding of how to distinguish actual responses from background noise. The aim of this thesis is, based on response magnitude and variation, to evaluate the biomarker potential in a set of putative transcriptional biomarkers of general toxicity and chemical stress.Specifically, I addressed a selection of six transcripts involved in cytoprotection and oxidative stress: catalase (cat), glutathione-S-transferase (gst), heat shock proteins 70 and 90 (hsp70, hsp90), metallothionein (mt) and superoxide dismutase (sod). Moreover, I used metal exposures to serve as a proxy for general chemical stress, and due to their ecological relevance and nature as sedentary filter-feeders, I used bivalves as study organisms.In a series of experiments, I tested transcriptional responses in the freshwater duck mussel, Anodonta anatina, exposed to copper or an industrial wastewater effluent, to address response robustness and sensitivity, and potential controlled (e.g. exposure concentration) and random (e.g. gravidness) sources of variation. In addition, I performed a systematic review and meta-analysis on transcriptional responses in metal exposed bivalves to (1) evaluate what responses to expect from arbitrary metal exposures, (2) assess the influence from metal concentration (expressed as toxic unit), exposure time and analyzed tissue, and (3) address potential impacts from publication bias in the scientific literature.Response magnitudes were generally small in relationship to the observed variation, both for A. anatina and bivalves in general. The expected response to an arbitrary metal exposure would generally be close to zero, based on both experimental observations and on the estimated impact from publication bias. Although many of the transcripts demonstrated concentration-response relationships, large background noise might in practice obscure the small responses even at relatively high exposures. As demonstrated in A. anatina under copper exposure, this can be the case already for single species under high resolution exposures to single pollutants. As demonstrated by the meta-regression, this problem can only be expected to increase further upon extrapolation between different species and exposure scenarios, due to increasing heterogeneity and random variation. Similar patterns can also be expected for time-dependent response variation, although the meta-regression revealed a general trend of slightly increasing response magnitude with increasing exposure times.In A. anatina, gravidness was identified as a source of random variability that can potentially affect the baseline of most assessed biomarkers, particularly when quantified in gills. Response magnitudes and variability in this species were generally similar for selected transcripts as for two biochemical biomarkers included for comparison (AChE, GST), suggesting that the transcripts might not capture early warnings more efficiently than other molecular endpoints that are more toxicologically relevant. Overall, high concentrations and long exposure durations presumably increase the likelihood of a detectable transcriptional response, but not to an extent that justifies universal application as biomarkers of general toxicity and chemical stress. Consequently, without a strictly defined and validated application, this approach on its own appears unlikely to be successful for future environmental risk assessment and monitoring. Ultimately, efficient use of transcriptional biomarkers might require additional implementation of complementary approaches offered by current molecular techniques.
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| 28. |
- Frederiksen, Sven G, et al.
(författare)
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Mesenteric Torsion as a Cause of Late Abdominal Pain after Gastric Bypass Surgery.
- 2016
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 26:4, s. 896-899
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Tidskriftsartikel (refereegranskat)abstract
- Gastric bypass (GBP) has been the most common surgical way to treat obesity and its comorbidities. Late abdominal pain may occur by gastro-jejunal ulcers, gallstones, internal herniation or, rarely, intussusception. In an area with more than 1000 GBPs performed yearly, three patients with primary small bowel volvulus causing abdominal pain and requiring emergency or semi-urgent surgery were identified. Patients' histories, radiology, and surgery performed are presented. Weight loss followed by mesenteric narrowing of the root and thus relative elongation may make rotation of the small bowel mesentery possible. Such a torsion might be an overlooked differential diagnosis in obscure abdominal pain after GBP.
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| 29. |
- Hagelsteen, Kristine, et al.
(författare)
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Faster acquisition of laparoscopic skills in virtual reality with haptic feedback and 3D vision
- 2017
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Ingår i: Minimally Invasive Therapy and Allied Technologies. - : Informa UK Limited. - 1364-5706 .- 1365-2931. ; 26:5, s. 269-277
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The study investigated whether 3D vision and haptic feedback in combination in a virtual reality environment leads to more efficient learning of laparoscopic skills in novices.MATERIAL AND METHODS: Twenty novices were allocated to two groups. All completed a training course in the LapSim(®) virtual reality trainer consisting of four tasks: 'instrument navigation', 'grasping', 'fine dissection' and 'suturing'. The study group performed with haptic feedback and 3D vision and the control group without. Before and after the LapSim(®) course, the participants' metrics were recorded when tying a laparoscopic knot in the 2D video box trainer Simball(®) Box.RESULTS: The study group completed the training course in 146 (100-291) minutes compared to 215 (175-489) minutes in the control group (p = .002). The number of attempts to reach proficiency was significantly lower. The study group had significantly faster learning of skills in three out of four individual tasks; instrument navigation, grasping and suturing. Using the Simball(®) Box, no difference in laparoscopic knot tying after the LapSim(®) course was noted when comparing the groups.CONCLUSIONS: Laparoscopic training in virtual reality with 3D vision and haptic feedback made training more time efficient and did not negatively affect later video box-performance in 2D. [Formula: see text].
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| 30. |
- Hagelsteen, Kristine, et al.
(författare)
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Performance and perception of haptic feedback in a laparoscopic 3D virtual reality simulator
- 2019
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Ingår i: Minimally Invasive Therapy and Allied Technologies. - : Informa UK Limited. - 1364-5706 .- 1365-2931. ; 28:5, s. 309-316
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Tidskriftsartikel (refereegranskat)abstract
- Background: The benefit of haptic feedback in laparoscopic virtual reality simulators (VRS) is ambiguous. A previous study found 32% faster acquisition of skills with the combination of 3 D and haptic feedback compared to 2 D only. This study aimed to validate perception and effect on performance of haptic feedback by experienced surgeons in the previously tested VRS. Material and methods: A randomized single blinded cross-over study with laparoscopists (>100 laparoscopic procedures) was conducted in a VRS with 3 D imaging. One group started with haptic feedback, and the other group without. After performing the suturing task with haptics either enabled or disabled, the groups crossed over to the opposite setting. Face validity was assessed through questionnaires. Metrics were obtained from the VRS. Results: The haptics for ‘handling the needle’, ‘needle through tissue’ and ‘tying the knot’ was scored as completely realistic by 3/22, 1/22 and 2/22 respectively. Comparing the metrics for maximum stretch damage between the groups revealed a significantly lower score when a group performed with haptics enabled p =.027 (haptic first group) and p <.001(haptic last group). Conclusion: Haptic feedback in VRS has limited fidelity according to the tested laparoscopic surgeons. In spite of this, significantly less stretch damage was caused with haptics enabled.
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| 31. |
- Hagelsteen, Kristine, et al.
(författare)
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Simball Box for Laparoscopic Training With Advanced 4D Motion Analysis of Skills.
- 2016
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Ingår i: Surgical Innovation. - : SAGE Publications. - 1553-3506 .- 1553-3514. ; 23:3, s. 309-316
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Tidskriftsartikel (refereegranskat)abstract
- Laparoscopic skills training and evaluation outside the operating room is important for all surgeons learning new skills. To study feasibility, a video box trainer tracking 4-dimensional (4D) metrics was evaluated as a laparoscopic training tool.
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| 32. |
- Hedström, Jonas, et al.
(författare)
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Cholecystectomy After Previous Bariatric Surgery with Special Focus on Pregnant Patients—Results from Two Large Nationwide Registries
- 2020
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 30:5, s. 1874-1880
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Tidskriftsartikel (refereegranskat)abstract
- Background: Biliary complications during pregnancy is an important issue. The aim of this study was to examine if there is an increased risk to perform cholecystectomy during pregnancy in patients with previous bariatric surgery in comparison to other females subjected to cholecystectomy. Methods: The Nationwide Swedish Registry for Gallstone Surgery (GallRiks) and the Scandinavian Obesity Surgery Registry (SOReg) were combined. Female patients 18–45 years old were included. The study group was patients with a history of bariatric surgery whom were pregnant at the time of cholecystectomy. This group was compared with pregnant patients without previous bariatric surgery and non-pregnant with and without previous bariatric surgery. Results: In total, 21,314 patients were included and 292 underwent surgery during pregnancy. From 1282 patients identified in both registers, 16 patients were pregnant at the time of cholecystectomy. Acute cholecystectomy was performed in 5922 (28%) non-pregnant and 199 (68%) pregnant (p < 0.001), including 11/16 (69%) pregnant with previous bariatric surgery. When comparing all pregnant patients, those with previous bariatric surgery had longer operative time (p = 0.031) and length of stay (p = 0.043), but no differences were seen when only comparing patients with an acute indication for surgery. There was no difference in complications comparing pregnant patients with previous bariatric surgery with non-pregnant, both with and without previous bariatric surgery. Conclusions: Cholecystectomy during pregnancy in patients with previous bariatric surgery seems to be safe. The increased risk seen in the non-pregnant group after previous bariatric surgery is not seen in pregnancy, possibly due to an optimization of the circumstances at surgery.
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| 33. |
- Henriksson, Emma, et al.
(författare)
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SIK2 regulates CRTCs, HDAC4 and glucose uptake in adipocytes
- 2015
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Ingår i: Journal of Cell Science. - : The Company of Biologists. - 0021-9533 .- 1477-9137. ; 128:3, s. 472-486
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Tidskriftsartikel (refereegranskat)abstract
- Salt-inducible kinase 2 (SIK2) is an AMP-activated protein kinase (AMPK) related kinase abundantly expressed in adipose tissue. Our aim was to identify molecular targets and functions of SIK2 in adipocytes, and to address the role of PKA-mediated phosphorylation of SIK2 on Ser358. Modulation of SIK2 in adipocytes resulted in altered phosphorylation of CREB-regulated transcription co-activator 2 (CRTC2), CRTC3 and class IIa histone deacetylase 4 (HDAC4). Furthermore, CRTC2, CRTC3, HDAC4 and protein phosphatase 2A (PP2A) interacted with SIK2, and the binding of CRTCs and PP2A to wild-type but not Ser358Ala SIK2, was reduced by cAMP elevation. Silencing of SIK2 resulted in reduced GLUT4 (also known as SLC2A4) protein levels, whereas cells treated with CRTC2 or HDAC4 siRNA displayed increased levels of GLUT4. Overexpression or pharmacological inhibition of SIK2 resulted in increased and decreased glucose uptake, respectively. We also describe a SIK2-CRTC2-HDAC4 pathway and its regulation in human adipocytes, strengthening the physiological relevance of our findings. Collectively, we demonstrate that SIK2 acts directly on CRTC2, CRTC3 and HDAC4, and that the cAMP-PKA pathway reduces the interaction of SIK2 with CRTCs and PP2A. Downstream, SIK2 increases GLUT4 levels and glucose uptake in adipocytes.
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| 34. |
- Jacobsen, Hedin, et al.
(författare)
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Tensile Strength After Closure of Mesenteric Gaps in Laparoscopic Gastric Bypass: Three Techniques Tested in a Porcine Model.
- 2013
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Ingår i: Obesity surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 23:3, s. 320-324
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Internal hernias occur frequently after laparoscopic gastric bypass. We have found no data on the relative strength of the various techniques available for closing these defects. The present study was performed to obtain such data to form a theoretical basis for clinical studies. METHODS: Six piglets were operated laparoscopically and four loops of small bowel created in each. These mesenteric gaps were closed over a distance of 40mm using (1) running 2-0 Ethibond® suture, (2) Endo Hernia stapler, (3) fibrin glue (Tisseel®) and (4) controls, where the mesenteric surfaces were rubbed with a sponge and approximated without further intervention. After 6weeks, the different segments of the mesentery were excised. The tensile strength was measured using continuously increased traction until the closure ruptured. The ordinary mesentery served as the control. The breaking tension and total amount of energy transferred to the tissue were registered. RESULTS: Control areas with rubbed areas developed no adhesions. Suture and staple lines contracted by 30% in length, whereas the fibrin glued lines were even shorter. Median tensile strength was greatest for the sutured lines (14,293mN) and stapled lines (10,798mN). Fibrin glued lines were significantly weaker (6,780mN, p=0.013 and p=0.026), but as strong as ordinary mesentery (4,165mN). CONCLUSIONS: If ongoing controlled randomized trials show closure to be beneficial, further studies should include staples as one of the options for the closure of mesenteric defects. The role of fibrin glue needs to be further investigated.
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| 35. |
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| 36. |
- Klintman, Mikael, et al.
(författare)
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Maten märks: förutsättningar för konsumentmakt
- 2008
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Bok (populärvet., debatt m.m.)abstract
- Många människor anser sig numera ha större makt i rollen som konsumenter än som medborgare som röstar i partival. Som konsumenter kan vi idag ta ställning till en rad olika anspråk som görs på produkter och tjänster. Hur ser vi konsumenter på livsmedel som genom olika märken påstås ha unika egenskaper i produktionsledet: för miljön, för konsumentens hälsa, för arbetsförhållanden för fabriks- och jordbruksarbetarna, för djurens väl och ve, eller för det egna produktionslandets välstånd? Förekommer motsättningar och konkurrens mellan olika miljö- och varumärken? Vilka aktörer har makt att vara med och bestämma om vad som ska räknas som miljövänligt, socialt rättvis eller djurvänlig produktion? Går det – om det är önskvärt – att göra den gröna och etiska konsumtionens informationsredskap mer “demokratiska”? Finns det viktiga egenskaper hos varor och produktion som måste falla utanför konsumentmakten? Dessa frågor, som alla behandlas i boken, knyter an till frågan om vilka förutsättningar konsumenter egentligen har att fatta fria och politiska beslut som även går bortom var och ens egennytta. I den allmänna samhällsdebatten ses konsumenters makt av allt fler aktörer som en central förutsättning för att miljöproblem och andra samhällsproblem ska kunna lösas. Därmed blir en ökad kunskap om konsumentmaktens förutsättningar extra betydelsefull. Boken riktar sig till studenter, forskare, myndigheter och till alla andra med intresse för samhällsvetenskap och humaniora med inrikning på konsument- och livsmedelsfrågor, samt andra livsmedelsrelaterade vetenskaper. Mikael Klintman är docent och universitetslektor vid Forskningspolitiska institutet, Lunds universitet. Magnus Boström är docent, lektor och forskare vid institutionen för livsvetenskaper, Södertörns Högskola. Lena Ekelund är fil dr i nationalekonomi och docent i trägårdsvetenskap med ekonomisk inriktning vid Sveriges lantbruksuniversitet i Alnarp. Anna-Lisa Lindén är professor vid sociologiska institutionen, Lunds universitet.
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| 37. |
- Kopietz, Franziska, et al.
(författare)
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AMPK activation by A-769662 and 991 does not affect catecholamine-induced lipolysis in human adipocytes
- 2018
-
Ingår i: American Journal of Physiology - Endocrinology and Metabolism. - : American Physiological Society. - 1522-1555 .- 0193-1849. ; 315:5, s. 1075-1085
-
Tidskriftsartikel (refereegranskat)abstract
- Activation of AMP-activated protein kinase (AMPK) is considered an attractive strategy for the treatment of type 2 diabetes. Favorable metabolic effects of AMPK activation are mainly observed in skeletal muscle and liver tissue whereas the effects in human adipose tissue are only poorly understood. Previous studies, which largely employed the AMPK activator 5-aminoimidazole-4-carboxamide-1-D-ribofuranoside (AICAR), suggest an anti-lipolytic role of AMPK in adipocytes. The aim of this work was to re-investigate the role of AMPK in the regulation of lipolysis, using the novel allosteric small-molecule AMPK activators A-769662 and 991, with a focus on human adipocytes. For this purpose, human primary subcutaneous adipocytes were treated with A-769662, 991 or AICAR, as a control, before being stimulated with isoproterenol. AMPK activity status, glycerol release and the phosphorylation of hormone-sensitive lipase (HSL), a key regulator of lipolysis, was then monitored. Our results show that both A-769662 and 991 activated AMPK to a level which was similar to, or greater than that induced by AICAR. In contrast to AICAR, which as expected was anti-lipolytic, neither A-769662 nor 991 affected lipolysis in human adipocytes, although 991 treatment lead to altered HSL phosphorylation. Furthermore, we suggest that HSL Ser660 is an important regulator of lipolytic activity in human adipocytes. These data suggest that the anti-lipolytic effect observed with AICAR in previous studies is, at least to some extent, AMPK-independent.
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| 38. |
- Lindqvist, Andreas, et al.
(författare)
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Gastric bypass improves ss-cell function and increases β-cell mass in a porcine model.
- 2014
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Ingår i: Diabetes. - : American Diabetes Association. - 1939-327X .- 0012-1797. ; 63:5, s. 1665-1671
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Tidskriftsartikel (refereegranskat)abstract
- The most frequently used, and effective, treatment for morbid obesity is Roux-en-Y gastric bypass surgery (RYGB), which results in rapid remission of T2D in most cases. To what extent this is accounted for by weight loss or other factors remains elusive. To gain insight into these mechanisms, we investigated the effects of RYGB on ß-cell function and ß-cell mass in the pig, a species highly reminiscent of the human. RYGB was performed using linear staplers during open surgery. Sham-operated pigs were used as controls. Both groups were fed a low calorie diet for 3 weeks after surgery. Intravenous glucose-tolerance tests were performed 2 weeks after surgery. Body weight in RYGB-pigs and sham-operated, pair-fed control pigs developed similarly. RYGB-pigs displayed improved glycaemic control, which was attributed to increases in ß-cell mass, islet number and number of extra-islet ß-cells. Pancreatic expression of insulin and glucagon was elevated, and cells expressing the GLP-1-receptor were more abundant in RYGB-pigs. Our data from a pig model of RYGB emphasize the key role of improved ß-cell function and ß-cell mass to explain the improved glucose tolerance after RYGB as food intake and body weight remained identical.
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| 39. |
- Lindqvist, Andreas, et al.
(författare)
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Gastric bypass in the pig increases GIP levels and decreases active GLP-1 levels
- 2017
-
Ingår i: Peptides. - : Elsevier BV. - 0196-9781. ; 90, s. 78-82
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Tidskriftsartikel (refereegranskat)abstract
- Gastric bypass surgery results in remission of type 2 diabetes in the majority of patients. The incretin hormones glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) have been implicated in the observed remission. Most knowledge so far has been generated in obese subjects. To isolate the surgical effects of gastric bypass on metabolism and hormone responses from the confounding influence of obesity, T2D, or food intake, we performed gastric bypass in lean pigs, using sham-operated and pair-fed pigs as controls. Thus, pigs were subjected to Roux-en-Y gastric bypass (RYGB) or sham surgery and oral glucose tolerance tests (OGTT). RYGB pigs and sham pigs exhibited similar basal and 120-min glucose levels in response to the OGTT. However, RYGB pigs had approximately 1.6-fold higher 30-min glucose (p < 0.01). Early insulin release (EIR) was enhanced approximately 3.5-fold in the RYGB pigs (p < 0.01). Furthermore, GIP release, both acute and sustained release (p < 0.001 and p < 0.01, respectively), was increased approximately 2.5-fold and 1.4-fold, respectively, in RYGB pigs. Although total GLP-1 release increased approximately 2.1-fold after RYGB (p < 0.001), active GLP-1 was 33% lower (p < 0.01). Interestingly basal DPP4-activity was approximately 3.2-fold higher in RYGB pigs (p < 0.001). In conclusion, RYGB in lean pigs increases the response of GIP, total GLP-1, and insulin, but reduces levels of active GLP-1 in response to an oral glucose load. These data challenge the role of active GLP-1 as a contributor to remission from diabetes after RYGB.
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| 40. |
- Lindqvist, Andreas, et al.
(författare)
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The impact of Roux-en-Y gastric bypass surgery on normal metabolism in a porcine model
- 2017
-
Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 12:3
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Tidskriftsartikel (refereegranskat)abstract
- Background A growing body of literature on Roux-en-Y gastric bypass surgery (RYGB) has generated inconclusive results on the mechanism underlying the beneficial effects on weight loss and glycaemia, partially due to the problems of designing clinical studies with the appropriate controls. Moreover, RYGB is only performed in obese individuals, in whom metabolism is perturbed and not completely understood. In an attempt to isolate the effects of RYGB and its effects on normal metabolism, we investigated the effect of RYGB in lean pigs, using sham-operated pair-fed pigs as controls. Two weeks post-surgery, pigs were subjected to an intravenous glucose tolerance test (IVGTT) and circulating metabolites, hormones and lipids measured. Bile acid composition was profiled after extraction from blood, faeces and the gallbladder. A similar weight development in both groups of pigs validated our experimental model. Despite similar changes in fasting insulin, RYGB-pigs had lower fasting glucose levels. During an IVGTT RYGB-pigs had higher insulin and lower glucose levels. VLDL and IDL were lower in RYGB-than in sham-pigs. RYGB-pigs had increased levels of most amino acids, including branched-chain amino acids, but these were more efficiently suppressed by glucose. Levels of bile acids in the gallbladder were higher, whereas plasma and faecal bile acid levels were lower in RYGB-than in sham-pigs. In a lean model RYGB caused lower plasma lipid and bile acid levels, which were compensated for by increased plasma amino acids, suggesting a switch from lipid to protein metabolism during fasting in the immediate postoperative period.
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| 41. |
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| 42. |
- Möller Rydberg, Emilia, et al.
(författare)
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Fractures of the lateral malleolus - a retrospective before-and-after study of treatment and resource utilization following the implementation of a structured treatment algorithm
- 2022
-
Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background In 2015 a study of isolated lateral malleolar fractures (AO/OTA44-B1) treated at Sahlgrenska University hospital (SU) during two consecutive years revealed large-scale variation in the choice of treatment and planned follow-up. The study resulted in the development of a structured treatment algorithm (TA) for ankle fractures. We investigated the effects of this well-implemented TA on the classification, treatment and follow-up of lateral malleolar fractures. Methods The current study is an uncontrolled, non-randomized, retrospective before-and-after study comparing a group of AO/OTA44-B1 fractures treated at SU before the introduction of the TA for ankle fractures (1 April 2012 to 31 March 2014) with a group treated after the introduction of the TA (1 September 2017 to 31 August 2019). Results In all the studied parameters regarding treatment for AO/OTA44-B1 fractures, a statistically significant change was seen after the introduction of the TA. Surgical treatment reduced from 32% (95% CI 27.5 - 36.5) pre-TA to 10% (95% CI 6.9 - 13.1) post-TA, while the number of patients permitted full weight-bearing increased from 41% (95% CI 36.3 - 45.7) to 84% (95% CI 80.1 - 87.9). Conclusions A thoroughly implemented treatment algorithm can reduce the number of surgical treatments for stable ankle fractures. The current study demonstrates that a structured treatment algorithm can standardize the management of ankle fractures and make decisions less dependent on the surgeon's discretion.
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| 43. |
- Nergård, Bent J, et al.
(författare)
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Mucosal glucagon-like peptide-1 and gastric inhibitory polypeptide cell numbers in the super-obese human foregut after gastric bypass.
- 2015
-
Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 11:6, s. 1237-1246
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Tidskriftsartikel (refereegranskat)abstract
- Super-obesity, a body mass index>50 kg/m(2), is difficult to treat. Many studies have focused on the anatomic changes of the intestines; the physiologic background is not clearly identified. It is established that Roux-en-Y gastric bypass (RYGB) augments secretion of glucagon-like peptide-1 (GLP-1), peptide tyrosine tyrosine (PYY), and insulin, but other aspects of gut hormone cell function in the alimentary limb are unknown.
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| 44. |
- Norrman, Gustav, et al.
(författare)
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Non-operative management of blunt liver trauma: feasible and safe also in centres with a low trauma incidence.
- 2009
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Ingår i: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 11:1, s. 50-56
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Non-operative management (NOM) of blunt liver trauma is currently, if possible, the preferred treatment of choice. The present study evaluates the experience of blunt liver injury in adults in a Swedish university hospital. MATERIAL AND METHODS: Forty-six patients with blunt liver trauma were treated from January 1994 through to December 2004. Patient charts were reviewed retrospectively to examine injury severity score (ISS), liver injury grade, diagnostics, treatment and outcome. RESULTS: Thirty-five patients (76%) were initially treated non-operatively and 11 (24%) patients had immediate surgery. In four (11%) patients, NOM failed and the patients required surgery 8-72 h after admission. Patients failing non-operative care had a significantly lower systolic blood pressure on admission as compared with patients with successful NOM (P = 0.001). Patients immediately operated upon had higher ISS (P < 0.001) and were haemodynamically unstable to a greater extent (P < 0.001) as compared with patients initially considered for NOM. Operated patients had increased transfusion requirements (P < 0.001), longer total hospital stay (P = 0.011) and stay in the intensive care unit (ICU) unit (P < 0.001) as compared with NOM. One immediately operated and one failed NOM died (total mortality 4%). Seventeen patients in the NOM group were successfully treated without surgery despite the presence of at least one described risk factor. CONCLUSIONS: Most patients with blunt liver trauma can be treated without surgery, and non-operative management may be performed even in the presence of established risk factors.
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| 45. |
- Norrman, Gustav, et al.
(författare)
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Nonoperative Management of Blunt Splenic Trauma: Also Feasible and Safe in Centers with Low Trauma Incidence and in the Presence of Established Risk Factors
- 2009
-
Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1863-9941. ; 35:2, s. 102-107
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Tidskriftsartikel (refereegranskat)abstract
- Background: Treatment of blunt splenic trauma has undergone dramatic changes over the last few decades. Nonoperative management (NOM) is now the preferred treatment of choice, when possible. The outcome of NOM has been evaluated. This study evaluates the results following the management of blunt splenic injury in adults in a Swedish university hospital with a low blunt abdominal trauma incidence. Method: Fifty patients with blunt splenic trauma were treated at the Department of Surgery, Lund University Hospital from January 1994 to December 2003. One patient was excluded due to a diagnostic delay of > 24 h. Charts were reviewed retrospectively to examine demographics, injury Severity score (ISS), splenic injury grade, diagnostics, treatment and outcome measures. Results: Thirty-nine patients (80%) were initially treated nonoperatively (NOM), and ten (20%) patients underwent immediate surgery (operative management, OM). Only one (3%) patient failed NOM and required surgery nine days after admission (failure of NOM, FNOM). The patients in the OM group had higher ISS (p < 0.001), higher grade of splenic injury (p < 0.001), and were hemodynamically unstable to a greater extent (p < 0.001). This was accompanied by increased transfusion requirements (p < 0.001), longer stay in the ICU unit (p < 0.001) and higher costs (p = 0.001). Twenty-seven patients were successfully treated without surgery. No serious complication was found on routine radiological follow-up. Conclusion: Most patients in this study were managed conservatively with a low failure rate of NOM. NOM of blunt splenic trauma could thus be performed in a seemingly safe and effective manner, even in the presence of established risk factors. Routine follow-up with CT scan did not appear to add clinically relevant information affecting patient management.
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| 46. |
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| 47. |
- Pedersen, Hanne, et al.
(författare)
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Visuospatial ability is associated to 2D laparoscopic simulator performance amongst surgical residents
- 2023
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Ingår i: Surgery Open Science. - : Elsevier BV. - 2589-8450. ; 11, s. 56-61
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Tidskriftsartikel (refereegranskat)abstract
- Background: The technical skills of a surgeon influence surgical outcome. Testing technical aptitude at point of recruitment of surgical residents is only conducted in a few countries. This study investigated the impact of visuospatial ability (VSA), background factors, and manual dexterity on performance in two different laparoscopic surgical simulators amongst applicants and 1st year surgical residents. Method: Applicants from general surgery, pediatric surgery, and urology were included from seven hospitals in Sweden between 2017 and 2021. Some 73 applicants were invited and 50 completed. Participants filled out a background form, and were tested for manual dexterity, and visuospatial ability. Two laparoscopic simulators were used, one 2D video box trainer and one 3D Virtual Reality Simulator. Results: A significant association was found between the visuospatial ability test and 2D video box laparoscopic performance (95 % CI: 1.028–1.2, p-value <0.01). For every point on the visuospatial test the odds of accomplishing the task increased by 11 %. No association was found between VSA and performance in a laparoscopic VR simulator using 3D vision. No other background factors were associated with performance in the two laparoscopic simulators. Conclusion: Visuospatial ability in applicants to surgical residency positions is associated to performance in a 2D video box trainer. Knowledge of a resident's visuospatial ability can be used to tailor individualized laparoscopic training programs, and in the future might function as a selection tool concerning laparoscopic ability. Key message: Visuospatial ability differs greatly amongst applicants for surgical residency and is associated to laparoscopic simulator performance. Testing applicants' visuospatial ability could possibly be used to tailor individualized laparoscopic training programs or in the future as a selection tool concerning laparoscopic ability.
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| 48. |
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| 49. |
- Steingrimsson, Steinn, et al.
(författare)
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Electroencephalography-based neurofeedback as treatment for post-traumatic stress disorder: A systematic review and meta-analysis
- 2020
-
Ingår i: European psychiatry : the journal of the Association of European Psychiatrists. - : Royal College of Psychiatrists. - 1778-3585. ; 63:1
-
Forskningsöversikt (refereegranskat)abstract
- BACKGROUND.: Post-traumatic stress disorder (PTSD) is debilitating for patients and society. There are a number of treatment methods albeit not all patients respond to these and an interesting method using electroencephalography-based neurofeedback (EEG-NF) has become more prominent in recent years. This systematic review aimed to assess whether EEG-NF, compared with sham NF, other treatment, or no treatment, is effective for PTSD. Primary outcomes were self-harm, PTSD symptoms, level of functioning and health-related quality of life. METHODS.: Systematic literature searches for randomized controlled trials (RCTs) were conducted in six databases. Random effects meta-analysis was performed. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS.: Four RCTs were included (123 participants). Suicidal thoughts were significantly reduced after EEG-NF compared with a waiting list in a small study. PTSD symptoms were assessed in all studies with different instruments. Results were consistently in favor of EEG-NF with large effect sizes (standardized mean difference -2.30 (95% confidence interval: -4.37 to -0.24). One study reported significantly improved level of executive functioning and one study a reduction in use of psychotropic medication. Complications were scarcely reported. Certainty of evidence was assessed as very low for the four assessed outcomes. CONCLUSIONS.: Based on four RCTs, with several study limitations and imprecision, it is uncertain whether EEG-NF reduces suicidal thoughts, PTSD symptoms, medication use, or improves function. Although all studies showed promising results, further studies are needed to increase the certainty of evidence.
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| 50. |
- Säll, Johanna, et al.
(författare)
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Insulin induces Thr484 phosphorylation and stabilization of SIK2 in adipocytes
- 2019
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Ingår i: Cellular Signalling. - : Elsevier BV. - 1873-3913 .- 0898-6568. ; 55, s. 73-80
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Tidskriftsartikel (refereegranskat)abstract
- AIMS/HYPOTHESIS: Salt-inducible kinase 2 (SIK2) is downregulated in adipose tissue from obese or insulin-resistant individuals and inhibition of SIK isoforms results in reduced glucose uptake and insulin signalling in adipocytes. However, the regulation of SIK2 itself in response to insulin in adipocytes has not been studied in detail. The aim of our work was to investigate effects of insulin on various aspects of SIK2 function in adipocytes.METHODS: Primary adipocytes were isolated from human subcutaneous and rat epididymal adipose tissue. Insulin-induced phosphorylation of SIK2 and HDAC4 was analyzed using phosphospecific antibodies and changes in the catalytic activity of SIK2 with in vitro kinase assay. SIK2 protein levels were analyzed in primary adipocytes treated with the proteasome inhibitor MG132.RESULTS: We have identified a novel regulatory pathway of SIK2 in adipocytes, which involves insulin-induced phosphorylation at Thr484. This phosphorylation is impaired in individuals with a reduced insulin action. Insulin stimulation does not affect SIK2 catalytic activity or cellular activity towards HDAC4, but is associated with increased SIK2 protein levels in adipocytes.CONCLUSION/INTERPRETATION: Our data suggest that downregulation of SIK2 in the adipose tissue of insulin-resistant individuals can partially be caused by impaired insulin signalling, which might result in defects in SIK2 expression and function.
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