| 1. |
- Murari, A., et al.
(författare)
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A control oriented strategy of disruption prediction to avoid the configuration collapse of tokamak reactors
- 2024
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Ingår i: Nature Communications. - 2041-1723 .- 2041-1723. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- The objective of thermonuclear fusion consists of producing electricity from the coalescence of light nuclei in high temperature plasmas. The most promising route to fusion envisages the confinement of such plasmas with magnetic fields, whose most studied configuration is the tokamak. Disruptions are catastrophic collapses affecting all tokamak devices and one of the main potential showstoppers on the route to a commercial reactor. In this work we report how, deploying innovative analysis methods on thousands of JET experiments covering the isotopic compositions from hydrogen to full tritium and including the major D-T campaign, the nature of the various forms of collapse is investigated in all phases of the discharges. An original approach to proximity detection has been developed, which allows determining both the probability of and the time interval remaining before an incoming disruption, with adaptive, from scratch, real time compatible techniques. The results indicate that physics based prediction and control tools can be developed, to deploy realistic strategies of disruption avoidance and prevention, meeting the requirements of the next generation of devices.
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| 6. |
- Ederle, Joerg, et al.
(författare)
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Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial
- 2010
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Ingår i: The Lancet. - 1474-547X. ; 375:9719, s. 985-997
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Tidskriftsartikel (refereegranskat)abstract
- Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. Findings The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4.0%) events of disabling stroke or death in the stenting group compared with 27 (3.2%) events in the endarterectomy group (hazard ratio [HR] 1.28, 95% CI 0.77-2.11). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5.2% in the endarterectomy group (72 vs 44 events; HR 1.69, 1.16-2.45, p=0.006), Risks of any stroke (65 vs 35 events; HR 1.92, 1.27-2.89) and all-cause death (19 vs seven events; HR 2.76, 1.16-6.56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0.0197). Interpretation Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery.
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| 7. |
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| 9. |
- Ham, C. J., et al.
(författare)
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Towards understanding reactor relevant tokamak pedestals
- 2021
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Ingår i: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 61:9
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Tidskriftsartikel (refereegranskat)abstract
- The physics of the tokamak pedestal is still not fully understood, for example there is no fully predictive model for the pedestal height and width. However, the pedestal is key in determining the fusion power for a given scenario. If we can improve our understanding of reactor relevant pedestals we will improve our confidence in designing potential fusion power plants. Work has been carried out as part of a collaboration on reactor relevant pedestal physics. We report some of the results in detail here and review some of the wider work which will be reported in full elsewhere. First, we attempt to use a gyrokinetic-based calculation to eliminate the pedestal top density as a model input for Europed/EPED pedestal predictions. We assume power balance at the top of the pedestal, that is, the heat flux crossing the separatrix must be equal to the heat source at the top of the pedestal and investigate the consequences of this assumption. Unfortunately, the transport assumptions of the EPED model mean that this method does not discriminate between different pairs of density and temperature profiles for a given pressure profile. Second, we investigate the effects of non flux surface density on the bootstrap current. Third, type I ELMs will not be tolerable for a reactor relevant regime due to the damage that they are expected to cause to plasma facing components. In recent years various methods of running tokamak plasmas without large ELMs have been developed. These include small and no ELM regimes, the use of resonant magnetic perturbations and the use of vertical kicks. We discuss the quiescent H-mode here. Finally we give a summary and directions for future work.
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| 10. |
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| 11. |
- Matic, L. P., et al.
(författare)
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Novel Multiomics Profiling of Human Carotid Atherosclerotic Plaques and Plasma Reveals Biliverdin Reductase B as a Marker of Intraplaque Hemorrhage
- 2018
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Ingår i: JACC: Basic to Translational Science. - : Elsevier BV. - 2452-302X. ; 3:4, s. 464-480
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Tidskriftsartikel (refereegranskat)abstract
- Clinical tools to identify individuals with unstable atherosclerotic lesions are required to improve prevention of myocardial infarction and ischemic stroke. Here, a systems-based analysis of atherosclerotic plaques and plasma from patients undergoing carotid endarterectomy for stroke prevention was used to identify molecular signatures with a causal relationship to disease. Local plasma collected in the lesion proximity following clamping prior to arteriotomy was profiled together with matched peripheral plasma. This translational workflow identified biliverdin reductase B as a novel marker of intraplaque hemorrhage and unstable carotid atherosclerosis, which should be investigated as a potential predictive biomarker for cardiovascular events in larger cohorts.
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| 12. |
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| 13. |
- Sorelius, Karl, et al.
(författare)
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The Microbiology of Infective Native Aortic Aneurysms in a Population-Based Setting
- 2022
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Ingår i: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 78, s. 112-122
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim was to describe the microbiology of surgically treated infective native (mycotic) aortic aneurysms (INAAs), and associated survival and development of infection-related complications (IRCs). Methods: Data were pooled from 2 nationwide studies on surgically treated patients with INAAs in Sweden, between 1994 - 2016. Patients were grouped and analyzed according to culture results: 1) Staphylococcus aureus, 2) Streptococcus species (sp.), 3) Salmonella sp., 4) Enterococcus sp., 5) Gram-negative intestinal bacteria, 6) Other sp. (all other species found in culture), and 7) Negative cultures. Results: A sum of 182 patients were included, mean age 71 years (standard deviation; SD: 8.9). The median follow-up was 50.3 months (range 0 - 360). 128 (70.3%) patients had positive blood and/or tissue culture; Staphylococcus aureus n = 38 (20.9%), Streptococcus sp. n = 37 (20.3%), Salmonella sp. n = 19 (10.4%), Enterococcus sp. n = 16 (8.8%), Gram-negative intestinal bacteria n = 6, (3.3%), Other sp. n = 12 (6.6%) and Negative cultures n = 54 (29.7%). The estimated survival for the largest groups at 2-years after surgery was: Staphylococcus aureus 62% (95% Confidence interval 53.9 - 70.1), Streptococcus sp. 74.7% (67.4 - 82.0), Salmonella sp. 73.7% (63.6 - 83.8), Enterococcus sp. 61.9% (49.6 - 74.2), and Negative cultures 89.8% (85.5 - 94.1), P =.051. There were 37 IRCs (20.3%), and 19 (51.4%) were fatal, the frequency was insignificant between the groups. The majority of IRCs, 30/37 (81%), developed during the first postoperative year. Conclusion: In this assessment of microbiological findings of INAAs in Sweden, 50% of the pathogens were Staphylococcus aureus, Streptococcus sp., or Salmonella sp.. The overall 20%-frequency of IRCs, and its association with high mortality, motivates long-term antibiotic treatment regardless of microbial findings.
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| 14. |
- Wanhainen, Anders, et al.
(författare)
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The effect of ticagrelor on growth of small abdominal aortic aneurysms-a randomized controlled trial
- 2020
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Ingår i: Cardiovascular Research. - : Oxford University Press (OUP). - 0008-6363 .- 1755-3245. ; 116:2, s. 450-456
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To evaluate if ticagrelor, an effective platelet inhibitor without known non-responders, could inhibit growth of small abdominal aortic aneurysms (AAAs). Methods and results: In this multi-centre randomized controlled trial, double-blinded for ticagrelor and placebo, acetylic salicylic acid naive patients with AAA and with a maximum aortic diameter 35-49mm were included. The primary outcome was mean reduction in log-transformed AAA volume growth rate (%) measured with magnetic resonance imaging (MRI) at 12months compared with baseline. Secondary outcomes include AAA-diameter growth rate and intraluminal thrombus (ILT) volume enlargement rate. A total of 144 patients from eight Swedish centres were randomized (72 in each group). MRI AAA volume increase was 9.1% for the ticagrelor group and 7.5% for the placebo group (P=0.205) based on intention-to-treat analysis, and 8.5% vs. 7.4% in a per-protocol analysis (P=0.372). MRI diameter change was 2.5mm vs. 1.8mm (P=0.113), US diameter change 2.3mm vs. 2.2mm (P=0.778), and ILT volume change 12.9% vs. 10.4% (P=0.590). Conclusion: In this RCT, platelet inhibition with ticagrelor did not reduce growth of small AAAs. Whether the ILT has an important pathophysiological role for AAA growth cannot be determined based on this study due to the observed lack of thrombus modulating effect of ticagrelor.
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| 15. |
- Eriksson, H., et al.
(författare)
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The Proportion Cured of Patients with Resected Stage II-III Cutaneous Melanoma in Sweden
- 2021
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Ingår i: Cancers. - : MDPI AG. - 2072-6694. ; 13:10
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Tidskriftsartikel (refereegranskat)abstract
- Simple summary Patients diagnosed with stage II-III cutaneous melanoma (CM) are at high risk of recurrences, but the CM-specific survival ranges from approximately 40-70%. Here, the cure proportions and survival among uncured stage II-III CM patients were estimated. The 1- and 5-year relative survival ratios, cure proportions and the median survival times of uncured stage II-III CM patients in Sweden (n = 6466) were calculated based on data from the nationwide population-based Swedish Melanoma Register 2005-2013 with a follow-up through 2018. Proportions cured by surgery are low for sub-groups of stage II-III cutaneous melanoma showing that cure analyses can serve as a complement to established survival analyses. Background: Cure proportion represents the proportion of patients who experience the same mortality rate as the general population and can be estimated together with the survival of the proportion experiencing excess mortality (the uncured). The aim was to estimate the cure proportions and survival among uncured stage II-III cutaneous melanoma (CM) patients. Methods: 1- and 5-year relative survival ratios, cure proportions and the median survival times of uncured stage II-III CM patients in Sweden (n = 6466) were calculated based on data from the nationwide population-based Swedish Melanoma Register 2005-2013 with a follow-up through 2018. Results: Stages IIB and IIC showed significant differences in standardized cure proportions vs. stage IIA CM (0.80 (95% CI 0.77-0.83) stage IIA; 0.62 (95% CI 0.59-0.66) stage IIB; 0.42 (95% CI 0.37-0.46) for stage IIC). Significant differences in standardized cure proportions were found for stages IIIB and IIIC-D CM vs. stage IIIA (0.76 (95% CI 0.68-0.84) stage IIIA; 0.52 (95% CI 0.45-0.59) stage IIIB; 0.35 (95% CI 0.30-0.39) for stage IIIC-D). Conclusions: The results are emphasizing the poor prognosis with low proportions cured by surgery only for sub-groups of stage II-III CM, specifically within stages IIB-C CM.
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| 16. |
- Gillgren, Peter, et al.
(författare)
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2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial
- 2011
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Ingår i: The Lancet. - 1474-547X. ; 378:9803, s. 1635-1642
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Tidskriftsartikel (refereegranskat)abstract
- Background Optimum surgical resection margins for patients with clinical stage IIA-C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin. Methods We undertook a randomised controlled trial in nine European centres. Patients with cutaneous melanoma thicker than 2 mm, at clinical stage IIA-C, were allocated to have either a 2-cm or a 4-cm surgical resection margin. Patients were randomised in a 1:1 allocation to one of the two groups and stratified by geographic region. Randomisation was done by sealed envelope or by computer generated lists with permuted blocks. Our primary endpoint was overall survival. The trial was not masked at any stage. Analyses were by intention to treat. Adverse events were not systematically recorded. The study is registered with ClinicalTrials.gov, number NCT01183936. Findings 936 patients were enrolled from Jan 22, 1992, to May 19, 2004; 465 were randomly allocated to treatment with a 2-cm resection margin, and 471 to receive treatment with a 4-cm resection margin. One patient in each group was lost to follow-up but included in the analysis. After a median follow-up of 6.7 years (IQR 4.3-9.5) 181 patients in the 2-cm margin group and 177 in the 4-cm group had died (hazard ratio 1.05, 95% CI 0.85-1.29; p=0.64). 5-year overall survival was 65% (95% CI 60-69) in the 2-cm group and 65% (60-70) in the 4-cm group (p=0.69). Interpretation Our findings suggest that a 2-cm resection margin is sufficient and safe for patients with cutaneous melanoma thicker than 2 mm.
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| 23. |
- Gillgren, P, et al.
(författare)
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Pseudoxanthoma Elasticum and Isolated Iliac Artery Occlusion
- 2020
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Ingår i: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. - : Elsevier BV. - 1532-2165. ; 60:3, s. 409-409
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 24. |
- Gillgren, Thomas, et al.
(författare)
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Plasticization of zein : A thermomechanical, FTIR, and dielectric study
- 2009
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Ingår i: Biomacromolecules. - : American Chemical Society (ACS). - 1525-7797 .- 1526-4602. ; 10:5, s. 1135-1139
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Tidskriftsartikel (refereegranskat)abstract
- Zein, the main seed storage protein of maize, has been widely studied as a possible source of material for the production of biodegradable plastic films. Plasticization of zein is critical to make functional films. While there have been a number of publications which report the behavior of systems with a wide variety of plasticizers, there have been few which attempt to examine the interactions of protein and plasticizer at the molecular level. In this paper, we report on the plasticizing effects of water, glycerol, and 2-mercaptoethanol, which were examined by a combination of spectroscopy (FTIR and dielectric) and thermomechanical methods. The results suggest that both water and glycerol are adsorbed onto the protein and form hydrogen bonds with the amide groups. The plasticizer then builds up in patches on the protein surface. 2-Mercaptoethanol only exhibited a weak plasticizing effect due probably to disulfide bond breaking. © 2009 American Chemical Society.
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| 29. |
- Jonsson, M., et al.
(författare)
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Near Infrared Spectroscopy as a Predictor for Shunt Requirement During Carotid Endarterectomy
- 2017
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 53:6, s. 783-791
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Tidskriftsartikel (refereegranskat)abstract
- Objective/Background: Near infrared speCtroscopy (NIRS) continuously monitors regional cerebral oxygenation (rSO2) in the frontal lobes. This method may be used in patients during carotid endarterectomy to indicate the need for shunting. The aim of the study was to evaluate the value of NIRS in determining the need for selective shunting during CEA. A secondary aim was to compare NIRS with stump pressure.Methods: Between January 2013 and October 2016, 185 patients from two vascular units, undergoing CEA under local anaesthesia were prospectively included. All patients gave informed consent to participate; there were no exclusion criteria. A Foresight® oximeter was used for rSO2 measurement, which was compared with stump pressure. Receiver operating characteristic curve analysis was used to identify optimal cutoff points, and sensitivity, specificity, and positive and negative predictive values were calculated.Results: Twenty patients (10.8%) developed neurological symptoms during clamping. Mean stump pressure was lower in the group that developed neurological symptoms than in the group who did not (34 +/- 19 mmHg vs. 55 +/- 17 mmHg [p < . 01]). Corresponding NIRS results for the decrease in rSO2 on the ipsilateral side was 15 +/- 7% versus 4 +/- 6% (p < .01). Using stump pressure <= 50 mmHg as cutoff value for predicting symptoms, the sensitivity was 85% (95% confidence interval [CI] 64-95) and specificity 54% (95% CI 46-61). With a relative decrease in NIRS saturation (triangle rSO2) of 9%, sensitivity was 95% (95% CI 76-99), and specificity 81% (95% CI 74-86) to predict ischaemic symptoms during carotid clamping. Neurological deterioration during carotid clamping was detected in one patient with a relative decrease in rSO2 of <9% compared with three patients with a stump pressure >50 mmHg.Conclusion: NIRS allows continuous non-invasive monitoring of cerebral oxygenation during CEA, with high sensitivity and acceptable specificity in predicting cerebral ischaemia and the need for shupting, which makes it an attractive alternative to stump pressure.
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| 30. |
- Jonsson, M., et al.
(författare)
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Peri-procedural Risk with Urgent Carotid Artery Stenting : A Population based Swedvasc Study
- 2015
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 49:5, s. 506-512
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Current European Society for Vascular Surgery guidelines recommend that patients with a symptomatic carotid stenosis should be operated on within 14 days of onset of symptoms. Recent reports indicate that carotid endarterectomy (CEA) within 2 days of a neurological event may be associated with a higher. pen-procedural risk of stroke. Whether urgent carotid artery stenting (CAS) carries a similar high risk is unclear. The aim of this study was to analyze if urgent CAS increases the pen-procedural risks. Methods: Retrospective analysis of all CAS registered in Swedvasc, a validated nationwide registry, between January 1, 2005, and March 20, 2014. Only symptomatic patients treated for a stenosis of the internal carotid artery were included. Patients were categorized according to time from index event to surgery; 0-2 days, 3-7 days, 8-14 days, and 15-180 days. Primary outcome was 30 day combined stroke and death rate. Results: 323 patients underwent CAS for symptomatic carotid artery stenosis. The demographic and clinical data were similar in the groups. No procedure related complications or deaths were observed in the urgent CAS group. The 30 day combined stroke and death rate did not differ significantly between the groups; zero of 13 (0%; 95% Cl 0-26.6) in the group treated 0-2 days versus four of 85 (4.7%; 95% Cl 1.5-11.9), at 3-7 days, five of 80 (6.3%; 95% Cl 2.4-14.1) at 8-14 days, and six of 145 (4.1%; 95% Cl 1.7-8.9) for the patients treated at 15-180 days (p = .757). Stroke and death were not more frequent for patients treated within 1 week compared with after 1 week: 4 out of 98 (4.1%; 95% Cl 1.3-9.0) versus 11/225 (4.9%; 95% Cl 2.7-8.6) (p = .751). Conclusions: In this national registry study, CAS performed within 1 week of the onset of a neurologic event Was not associated with an additional risk of a pen-operative complication compared with those treated subsequently.
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| 31. |
- Koraen-Smith, L, et al.
(författare)
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Haemodialysis access thrombosis: Outcomes after surgical thrombectomy versus catheter-directed thrombolytic infusion
- 2018
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Ingår i: The journal of vascular access. - : SAGE Publications. - 1724-6032 .- 1129-7298. ; 19:6, s. 535-541
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Tidskriftsartikel (refereegranskat)abstract
- Thrombosis is one of the most common complications of dialysis vascular access and is a significant source of morbidity and healthcare-associated costs. In this retrospective study, outcomes for surgical thrombectomy and thrombolysis after access thrombosis in patients with arteriovenous fistulas or prosthetic grafts (arteriovenous grafts) were analysed. Methods: All patients with a primary episode of dialysis access thrombosis between 2005 and 2013 were included which yielded 131 patients with 149 episodes of access thrombosis (108 arteriovenous grafts; 41 arteriovenous fistulas). In all, 18 patients had two separate accesses during the study. Patient demographics, access anatomy, surgical and radiological procedural data were recorded. Kaplan–Meier estimates and Poisson regression were used for statistical analysis of access patency. Results: In total, 107 underwent surgical thrombectomy and 42 were treated with catheter-directed thrombolytic infusion. Technical success was 60% for surgical thrombectomy and 73% for thrombolysis (p = 0.18). There were no major complications and no deaths within 30 days of the procedure. More patients had adjunctive procedures in the thrombolysis group (65/107 vs 37/42; p = 0.002). There was an increasing risk of rethrombosis or a further access-related event for both arteriovenous fistulas and arteriovenous grafts after open thrombectomy compared with catheter-directed thrombolytic infusion, and arteriovenous fistulas exhibited a lower risk than arteriovenous grafts with an average increase in risk of 23.9% (95% confidence interval: 3.1–49) between each treatment group. Conclusion: Thrombolysis for thrombosis of native and prosthetic dialysis accesses appears to yield better assisted primary patency compared to surgical thrombectomy. Our results suggest that thrombolysis may be considered the first-choice method for treating the thrombosed dialysis access.
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| 37. |
- Perisic, L., et al.
(författare)
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Profiling of atherosclerotic lesions by gene and tissue microarrays reveals pcsk6 as a novel protease in unstable carotid atherosclerosis
- 2013
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Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - 1079-5642 .- 1524-4636. ; 33:10, s. 2432-2443
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE - : Carotid plaque instability is a major cause of ischemic stroke, but detailed knowledge about underlying molecular pathways is still lacking. Here, we evaluated large-scale transcriptomic and protein expression profiling in a biobank of carotid endarterectomies followed by characterization of identified candidates, as a platform for discovery of novel proteins differentially regulated in unstable carotid lesions. APPROACH AND RESULTS - : Genes highly upregulated in symptomatic versus asymptomatic plaques were selected from Affymetrix microarray analyses (n=127 plaques), and tissue microarrays constructed from 34 lesions were assayed for 21 corresponding proteins by immunohistochemistry. Quantification of stainings demonstrated differential expression of CD36, CD137, and DOCK7 (P<0.05) in unstable versus stable lesions and the most significant upregulation of a proprotein convertase, PCSK6 (P<0.0001). Increased expression of PCSK6 in symptomatic lesions was verified by quantitative real-time polymerase chain reaction (n=233), and the protein was localized to smooth muscle α-actin positive cells and extracellular matrix of the fibrous cap by immunohistochemistry. PCSK6 expression positively correlated to genes associated with inflammation, matrix degradation, and mitogens in microarrays. Stimulation of human carotid smooth muscle cells in vitro with cytokines caused rapid induction of PCSK6 mRNA. CONCLUSIONS - : Using a combination of transcriptomic and tissue microarray profiling, we demonstrate a novel approach to identify proteins differentially expressed in unstable carotid atherosclerosis. The proprotein convertase PCSK6 was detected at increased levels in the fibrous cap of symptomatic carotid plaques, possibly associated with key processes in plaque rupture such as inflammation and extracellular matrix remodeling. Further studies are needed to clarify the role of PCSK6 in atherosclerosis.
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| 44. |
- Sartipy, F, et al.
(författare)
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The Impact of Stent Graft Material on the Inflammatory Response After EVAR
- 2015
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Ingår i: Vascular and endovascular surgery. - : SAGE Publications. - 1938-9116 .- 1538-5744. ; 49:3-4, s. 79-83
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Tidskriftsartikel (refereegranskat)abstract
- Patients undergoing endovascular aneurysm repair (EVAR) due to abdominal aortic aneurysm often develop an inflammatory response, postimplantation syndrome (PIS) where fever and leukocytosis are common. Previous studies suggest that type of stent graft material (polyester or polytetrafluoroethylene [PTFE]) plays a role. Objectives: To investigate the effect of stent graft material on the inflammatory response and length of hospital stay in patients undergoing standard elective EVAR. Methods: Sixty-nine elective EVAR patients were included in this observational study. To avoid comparing patients with a different graft location and stent graft burden, 12 cases were excluded as well as cases with complication or simultaneous open surgical procedures, leaving 45 patients (32 with polyester and 13 with PTFE graft) for final analysis. Tympanic temperature, C-reactive protein (CRP), white blood cell (WBC), and procalcitonin (PCT) were measured on days −1 and +1 and +3. Duration of in-hospital stay and frequency of PIS were recorded. Results: The PIS was diagnosed in 9 (28.1%) of the 32 polyester cases and in 1 (7.7%) of the 13 cases in the PTFE group ( P = .24). Median (interquartile range) in-hospital stay was 5 (5-6) days in the polyester group and 4 (4-5) days in the PTFE group ( P = .009). On day +3, in the polyester group, mean CRP was 154 (95% confidence interval: 127-182) mg/L, WBC 9.5 (8.4-10.5) ×109/L, and PCT 0.17 (0.12-0.21) ng/mL. In the PTFE group, mean CRP was 70 (32-109) mg/L ( P = .001), WBC 8.8 (6.4-11.1) ×109/L ( P = .37), and PCT 0.09 (0.06-0.13) ng/mL ( P = .009) on day +3. Conclusion: Standard EVAR with polyester stent grafts appears to result in a trend toward a more pronounced inflammatory reaction than similar EVAR using PTFE and is associated with a longer in-hospital stay.
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| 48. |
- Utjés, Deborah, et al.
(författare)
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2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm : long-term follow-up of a multicentre, randomised trial
- 2019
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Ingår i: The Lancet. - 0140-6736. ; 394:10197, s. 471-477
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Tidskriftsartikel (refereegranskat)abstract
- Background: The optimal surgical excision margins are uncertain for patients with thick (>2 mm) localised cutaneous melanomas. In our previous report of this multicentre, randomised controlled trial, with a median follow-up of 6·7 years, we showed that a narrow excision margin (2 cm vs 4 cm) did not affect melanoma-specific nor overall survival. Here, we present extended follow-up of this cohort. Methods: In this open-label, multicentre randomised controlled trial, we recruited patients from 53 hospitals in Sweden, Denmark, Estonia, and Norway. We enrolled clinically staged patients aged 75 years or younger diagnosed with localised cutaneous melanoma thicker than 2 mm, and with primary site on the trunk or upper or lower extremities. Patients were randomly allocated (1:1) to treatment either with a 2-cm or a 4-cm excision margin. A physician enrolled the patients after histological confirmation of a cutaneous melanoma thicker than 2 mm. Some patients were enrolled by a physician acting as responsible for clinical care and as a trial investigator (follow-up, data collection, and manuscript writing). In other cases physicians not involved in running the trial enrolled patients. Randomisation was done by telephone call to a randomisation office, by sealed envelope, or by computer generated lists using permuted blocks. Patients were stratified according to geographical region. No part of the trial was masked. The primary outcome in this extended follow-up study was overall survival and the co-primary outcome was melanoma-specific survival. All analyses were done on an intention-to-treat basis. The study is registered with ClinicalTrials.gov, number NCT03638492. Findings: Between Jan 22, 1992, and May 19, 2004, 936 clinically staged patients were recruited and randomly assigned to a 4-cm excision margin (n=465) or a 2-cm excision margin (n=471). At a median overall follow-up of 19·6 years (235 months, IQR 200–260), 621 deaths were reported—304 (49%) in the 2-cm group and 317 (51%) in the 4-cm group (unadjusted HR 0·98, 95% CI 0·83–1·14; p=0·75). 397 deaths were attributed to cutaneous melanoma—192 (48%) in the 2-cm excision margin group and 205 (52%) in the 4-cm excision margin group (unadjusted HR 0·95, 95% CI 0·78–1·16, p=0·61). Interpretation: A 2-cm excision margin was safe for patients with thick (>2 mm) localised cutaneous melanoma at a follow-up of median 19·6 years. These findings support the use of 2-cm excision margins in current clinical practice. Funding: The Swedish Cancer Society, Stockholm Cancer Society, the Swedish Society for Medical Research, Radiumhemmet Research funds, Stockholm County Council, Wallström funds.
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