| 1. |
- Adler, Sara, et al.
(författare)
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Symptoms and risk factors of Cryptosporidium hominis infection in children : data from a large waterborne outbreak in Sweden
- 2017
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Ingår i: Parasitology Research. - : Springer Berlin/Heidelberg. - 0932-0113 .- 1432-1955. ; 116:10, s. 2613-2618
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Tidskriftsartikel (refereegranskat)abstract
- Cryptosporidium is a major cause of diarrheal disease worldwide. In developing countries, this infection is endemic and in children, associated with growth faltering and cognitive function deficits, with the most severe impact on those aged <2 years. Little has been reported about symptoms and risk factors for children in industrialized countries, although the disease incidence is increasing in such regions. In November 2010, a large waterborne outbreak of C. hominis occurred in the city of Östersund in Sweden. Approximately 27,000 of the 60,000 inhabitants were symptomatic. We aimed to describe duration of symptoms and the risk factors for infection with C. hominis in children aged <15 years in a Western setting. Within 2 months after a boil water advisory, a questionnaire was sent to randomly selected inhabitants of all ages, including 753 children aged <15 years. Those with ≥3 loose stools/day were defined as cases of diarrhoea. The response rate was 70.3%, and 211 children (39.9%) fulfilled the case definition. Mean duration of diarrhoea was 7.5 days (median 6, range 1-80 days). Recurrence, defined as a new episode of diarrhoea after ≥2 days of normal stools, occurred in 52.5% of the cases. Significant risk factors for infection, besides living within the distribution area of the contaminated water plant, included a high level of water consumption, male sex, and a previous history of loose stools. The outbreak was characterized by high attack and recurrence rates, emphasizing the necessity of water surveillance to prevent future outbreaks.
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| 2. |
- Bakri, Sherif, 1980, et al.
(författare)
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Height of the palatal vault after two different surgical procedures: Study of the difference in patients with complete unilateral cleft lip and palate.
- 2012
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Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 46:3-4, s. 155-158
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Tidskriftsartikel (refereegranskat)abstract
- Abstract The present study compared the height of the palatal vault in dental casts from 320 10-year-old children with unilateral cleft lip and palate (UCLP) operated on with the push-back technique according to Wardill-Kilner (W-K) with patients operated on with delayed hard palate closure (DHPC). The palatal height in patients operated on with the DHPC technique was found to be significantly higher than in patients operated on with the W-K technique. This coincides with better maxillary growth and better speech in the DHPC group.
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| 3. |
- Bakri, Sherif, et al.
(författare)
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Vertical Maxillary Growth After Two Different Surgical Protocols in Unilateral Cleft Lip and Palate Patients.
- 2014
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Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 51:6, s. 645-650
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the present study was to compare vertical maxillofacial growth in patients born with unilateral cleft lip and palate (UCLP) who were treated using two different surgical protocols. Design: A retrospective cohort study. Subjects: We studied 92 patients with complete UCLP (61 male and 31 female) treated at Sahlgrenska University Hospital in Gothenburg, Sweden: 46 consecutive patients born between 1965 and 1974 who were operated according to the Wardill-Kilner (W-K) protocol and 46 consecutive patients born between 1982 and 1989 who were operated according to the Gothenburg delayed hard palate closure (DHPC) protocol. Methods: We analyzed lateral cephalograms obtained at 10 years of age. Results: Patients treated according to the Gothenburg DHPC protocol had significantly greater anterior upper facial height, anterior maxillary height, overbite, and inclination of the maxilla than those treated with the W-K protocol. Both techniques led to similar posterior upper facial height. Conclusion: The Gothenburg DHPC protocol in patients with complete UCLP results in more normal anterior maxillary vertical growth and overbite and therefore increased maxillary inclination at 10 years of age.
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| 4. |
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| 5. |
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| 6. |
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| 7. |
- Didriksson, Ingrid, et al.
(författare)
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Intensive care unit burden is associated with increased mortality in critically ill COVID-19 patients
- 2023
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 67:3, s. 329-338
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Traditional models to predict intensive care outcomes do not perform well in COVID-19. We undertook a comprehensive study of factors affecting mortality and functional outcome after severe COVID-19.METHODS: In this prospective multicentre cohort study, we enrolled laboratory-confirmed, critically ill COVID-19 patients at six ICUs in the Skåne Region, Sweden, between May 11, 2020, and May 10, 2021. Demographics and clinical data were collected. ICU burden was defined as the total number of ICU-treated COVID-19 patients in the region on admission. Surviving patients had a follow-up at 90 days for assessment of functional outcome using the Glasgow Outcome Scale-Extended (GOSE), an ordinal scale (1-8) with GOSE ≥5 representing a favourable outcome. The primary outcome was 90-day mortality; the secondary outcome was functional outcome at 90 days.RESULTS: Among 498 included patients, 74% were male with a median age of 66 years and a median body mass index (BMI) of 30 kg/m 2 . Invasive mechanical ventilation was employed in 72%. Mortality in the ICU, in-hospital and at 90 days was 30%, 38% and 39%, respectively. Mortality increased markedly at age 60 and older. Increasing ICU burden was independently associated with a two-fold increase in mortality. Higher BMI was not associated with increased mortality. Besides age and ICU burden, smoking status, cortisone use, P a CO 2 >7 kPa, and inflammatory markers on admission were independent factors of 90-day mortality. Lower GOSE at 90 days was associated with a longer stay in the ICU. CONCLUSION: In critically ill COVID-19 patients, the 90-day mortality was 39% and increased considerably at age 60 or older. The ICU burden was associated with mortality, whereas a high BMI was not. A longer stay in the ICU was associated with unfavourable functional outcomes at 90 days.
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| 8. |
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| 9. |
- Eriksson, Mikael, et al.
(författare)
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MAX-IV Design: Pushing the Envelope
- 2007
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Ingår i: 2007 IEEE Particle Accelerator Conference, vols 1-11. - 9781424409167 ; , s. 1277-1279
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Konferensbidrag (refereegranskat)abstract
- The proposed MAX IV facility is meant as a successor to the existing MAX-lab. The accelerator part will consist of three storage rings, two new ones operated at 3 and 1.5 GeV respectively and the existing 700 MeV MAX III ring. The two new rings have identical lattices and are placed on top of each other. Both these rings have a very small emittance, 0.86 and 0.4 nm rad respectively, and offer synchrotron radiation of very high mean brilliance. As an injector, a 3 GeV linear accelerator is planned. The design philosophy and the special technical solutions called for are presented in this paper.
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| 10. |
- Eriksson, Mikael, et al.
(författare)
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The MAX IV Facility
- 2013
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Ingår i: 11th International Conference on Synchrotron Radiation Instrumentation (SRI 2012). - : IOP Publishing. - 1742-6588 .- 1742-6596. ; 425
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Konferensbidrag (refereegranskat)abstract
- The MAX IV synchrotron radiation facility is currently being constructed in Lund, Sweden. The accelerator park consists of a 3 GeV linac injector and 2 storage rings operated at 1.5 and 3 GeV respectively. The linac injector will also be used for the generation of short Xray pulses. Close to 30 straight sections will be available for IDs at the rings. The three machines mentioned above are described below with some emphasis on the effort to create a very small emittance in the 3 GeV ring. Some unconventional technical solutions imposed by the emittance minimisation are discussed.
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| 11. |
- Eriksson, Mikael, et al.
(författare)
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The MAX IV Synchrotron Light Source
- 2011
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Ingår i: [Host publication title missing]. - 9789290833666 ; , s. 3026-3028
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Konferensbidrag (refereegranskat)abstract
- The MAX IV synchrotron radiation facility is currently being constructed in Lund, Sweden. It consists of a 3 GeV linac injector and 2 storage rings operated at 1.5 and 3 GeV respectively. The linac injector will also be used for the generation of short X-ray pulses. The three machines mentioned above are described with some emphasis on the effort to create a very small emittance in the 3 GeV ring. Some unconventional technical solutions will also be presented.
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| 12. |
- Hultgren, Malin, et al.
(författare)
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Prolonged Fatigue and Mental Health Challenges in Critical COVID-19 Survivors
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Ingår i: Journal of Intensive Care Medicine. - 0885-0666.
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to investigate the development of fatigue and mental illness between 3 and 12 months after critical COVID-19 and explore risk factors for long-lasting symptoms. Study Design and Methods: A prospective, multicenter COVID-19 study in southern Sweden, including adult patients (≥18 years) with rtPCR-confirmed COVID-19 requiring intensive care. Survivors were invited to a follow-up at 3 and 12 months, where patient-reported symptoms were assessed using the Modified Fatigue Impact Scale (MFIS), the Hospital Anxiety and Depression Scale (HADS) and the Posttraumatic Stress Disorder Checklist version 5 (PCL-5). The development between 3 and 12 months was described by changes in relation to statistical significance and suggested values for a minimally important difference (MID). Potential risk factors for long-lasting symptoms were analyzed by multivariable logistic regression. Results: At the 3-month follow-up, 262 survivors (87%) participated, 215 (72%) returned at 12 months. Fatigue was reported by 50% versus 40%, with a significant improvement at 12 months (MFIS; median 38 vs. 33, P < .001, MID ≥4). There were no significant differences in symptoms of mental illness between 3 and 12 months, with anxiety present in 33% versus 28%, depression in 30% versus 22%, and posttraumatic stress disorder in 17% versus 13%. A worse functional outcome and less sleep compared to before COVID-19 were risk factors for fatigue and mental illness at 12 months. Conclusions: Fatigue improved between 3 and 12 months but was still common. Symptoms of mental illness remained unchanged with anxiety being the most reported. A worse functional outcome and less sleep compared to before COVID-19 were identified as risk factors for reporting long-lasting symptoms.
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| 13. |
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| 14. |
- Lilja, Erika, et al.
(författare)
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The association between dietary intake, lifestyle and incident symptomatic peripheral arterial disease among individuals with diabetes mellitus : insights from the Malmö Diet and Cancer study
- 2019
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Ingår i: Therapeutic Advances in Endocrinology and Metabolism. - : SAGE Publications. - 2042-0188 .- 2042-0196. ; 10, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- With the rising prevalence of both diabetes mellitus (DM) and peripheral arterial disease (PAD), the aim of this project was to examine the association between dietary intake and lifestyle on the risk of developing PAD among individuals with DM. The Malmö Diet and Cancer study was a prospective cohort study with baseline examinations carried out between 1991 and 1996 in Malmö, Sweden (n = 30,446). Individuals with prevalent PAD and cardiovascular disease (prior stroke or myocardial infarction) were excluded from the study, resulting in a total study population of 1112 patients with prevalent DM. The diagnosis of incident PAD was validated and confirmed in 98% of patients. Of the 1112 individuals, 136 (12.2%) were diagnosed with PAD during a median follow up of 19.7 years (interquartile range 12.9–22.4). Kaplan–Meier analysis showed that men with DM more often developed incident PAD compared with women (cumulative incidences 15.5% and 8.9%, respectively, p = 0.012). In Cox multivariable regression analysis, smoking (hazard ratio of 1.96, 95% confidence interval of 1.28–3.00) was associated with increased risk of PAD, and there was a trend that a higher intake of fish and shellfish (hazard ratio per additional gram per week of 0.99, 95% confidence interval of 0.99–1.00; p = 0.051) was associated with a decreased risk of PAD. In conclusion, the present study demonstrated a trend towards a protective effect of higher intake of fish and shellfish upon incident symptomatic PAD among individuals with DM.
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| 15. |
- Lilja, Johan, et al.
(författare)
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Prevalence of atrial fibrillation and reasons for undertreatment with oral anticoagulants
- 2024
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Ingår i: Journal of Thrombosis and Thrombolysis. - : Springer Nature. - 0929-5305 .- 1573-742X. ; 57, s. 101-106
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the prevalence of atrial fibrillation (AF), the proportion of AF patients not receiving oral anticoagulation (OAC) and reasons for abstaining from OAC treatment.Methods: A retrospective cross-sectional study of patients aged 18 years or older with an AF diagnosis on June 1st 2020 in Västernorrland County, Sweden. AF diagnosis was retrieved using the ICD10 code I.48, and medical records were reviewed for comorbidities and documented reasons to abstain OAC treatment.Results: Of 197 274 residents in Västernorrland County, 4.7% (9 304/197 274) had a documented AF diagnosis. Of these, 19% (1 768/9 304) had no OAC treatment, including 4.2% (393/9 304) with no indication, 2.5% (233/9 304) with a questionable and 2.5% (231/9 304) with a documented clear contraindication for OAC. In total 9.8% (911/9 304) were not treated with OAC despite indication and no reasonable documented contraindication, thus 90.8% (8 447/9 304) of all AF-patients were eligible for OAC treatment. Common reasons for abstaining treatment without reasonable contraindication were present sinus rhythm in 13.7% (125/911), perceived not an OAC candidate in 10.6% (97/911) and anemia in the past in 4.3% (39/911).Conclusions: In the population of Västernorrland County, a very high AF prevalence of 4.7% was found, of which just over 90% would theoretically benefit from OAC treatment. This is higher than previously reported and stresses the importance of stroke prevention in this large patient group.
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| 16. |
- Lilja, Linus, et al.
(författare)
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Application of a standardized EEG pattern classification in the assessment of neurological prognosis after cardiac arrest: A retrospective analysis
- 2021
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572. ; 165, s. 38-44
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Electroencephalogram (EEG) is used in the neurological prognostication after cardiac arrest. “Highly malignant” EEG patterns classified according to Westhall have a high specificity for poor neurological outcome when applied within protocols of recent studies. However, their predictive performance when applied in everyday clinical practice has not been investigated. We studied the prognostic accuracy and the interrater agreement when standardized EEG patterns were analysed and compared to neurological outcome in a patient cohort at a tertiary centre not involved in the original study of the standardized EEG pattern classification. Methods: Comatose patients treated for out-of-hospital cardiac arrest were included. Poor outcome was defined as Cerebral Performance Category 3–5. Two senior consultants and one resident in clinical neurophysiology, blinded to clinical data and outcome, independently reviewed their EEG registrations and categorised the pattern as “highly malignant”, “malignant” or “benign”. These categories were compared to neurological outcome at hospital discharge. Interrater agreement was assessed using Cohen's Kappa. Results: In total, 62 patients were included. The median (IQR) time to EEG was 59 (42–91) h after return of spontaneous circulation. Poor outcome was found in 52 (84%) patients. In 21 patients at least one of the raters considered the EEG to contain a “highly malignant” pattern, all with poor outcome (42% sensitivity, 100% specificity). The interrater agreement varied from kappa 0.62 to 0.29. Conclusion: “Highly malignant” patterns predict poor neurological outcome with a high specificity in everyday practice. However, interrater agreement may vary substantially even between experienced EEG interpreters. © 2021
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| 17. |
- Lilja, Linus, et al.
(författare)
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Assessing neurological prognosis in post-cardiac arrest patients from short vs plain text EEG reports : A survey among intensive care clinicians
- 2021
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Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 159, s. 7-12
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Tidskriftsartikel (refereegranskat)abstract
- bElectroencephalography (EEG) patterns are predictive of neurological prognosis in comatose survivors from cardiac arrest but intensive care clinicians are dependent of neurophysiologist reports to identify specific patterns. We hypothesized that the proportion of correct assessment of neurological prognosis would be higher from short statements confirming specific EEG patterns compared with descriptive plain text reports.Methods: Volunteering intensive care clinicians at two university hospitals were asked to assess the neurological prognosis of a fictional patient with high neuron specific enolase. They were presented with 17 authentic plain text reports and three short statements, confirming whether a “highly malignant”, “malignant” or “benign” EEG pattern was present. Primary outcome was the proportion of clinicians who correctly identified poor neurological prognosis from reports consistent with highly malignant EEG patterns. Secondary outcomes were how the prognosis was assessed from reports consistent with malignant and benign patterns.Results: Out of 57 participants, poor prognosis was correctly identified by 61% from plain text reports and by 93% from the short statement “highly malignant” EEG patterns. Unaffected prognosis was correctly identified by 28% from plain text reports and by 40% from the short statement “malignant” patterns. Good prognosis was correctly identified by 64% from plain text reports and by 93% from the short statement “benign” pattern.Conclusion: Standardized short statement, “highly malignant EEG pattern present”, as compared to plain text EEG descriptions in neurophysiologist reports, is associated with more accurate identification of poor neurological prognosis in comatose survivors of cardiac arrest. © 2020 The Authors
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| 18. |
- Lilja, Linus, et al.
(författare)
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The capacity of neurological pupil index to predict absence of somatosensory evoked potentials after cardiac arrest—A study protocol
- 2021
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 65:6, s. 852-858
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Tidskriftsartikel (refereegranskat)abstract
- Background: Anoxic-ischemic brain injury is the most common cause of death after cardiac arrest (CA). Robust methods to detect severe injury with a low false positive rate (FPR) for poor neurological outcome include the pupillary light reflex (PLR) and somatosensory evoked potentials (SSEP). The PLR can be assessed manually or with automated pupillometry which provides the neurological pupil index (NPi). We aim to describe the interrelation between NPi values and the absence of SSEP cortical response and to evaluate the capacity of NPi to predict the absence of cortical SSEP response in comatose patients after CA.Methods: A total of 50 patients will be included in an explorative, prospective, observational study of adult (>18 years) comatose survivors of CA admitted to intensive care in a university hospital. NPi assessed with a hand-held pupillometer will be compared to SSEP signals recorded >48 hours after CA. Primary outcomes are sensitivity, specificity, and odds ratio for NPi to predict bilateral absence of the SSEP N20 signal, with NPi values corresponding to <5% FPRs of SSEP absence. Secondary outcomes are the PLR and SSEP sensitivity, specificity, and odds ratio for poor neurological outcome at hospital discharge and death at 30 days.Discussion: The PLR and SSEP may have a systematic interrelation, and a certain NPi threshold could potentially predict the absence of cortical SSEP response. If this can be concluded from the present study, SSEP testing could be excluded in certain patients to save resources in the multimodal prognostication after CA.Editorial comment The interrelation between loss of the pupillary light reflex (PLR) and the loss of cortical response to a somatosensory evoked potential (SSEP) in comatose cardiac arrest patients is not known. This exploratory prospective study is designed to evaluate whether a specific degree of attenuated PLR, as measured by semiautomated pupillometry, can predict the bilateral loss of cortical SSEP response in severe anoxic/ischemic brain injury. Such an interrelation between the two methods would enable the use of pupillometry rather than the more resource demanding SSEP for neurologic prognostication in post cardiac arrest patients.Trial registration: ClinicalTrials.gov, NCT04720482, Registered 21 January 2021, retrospectively registered.
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| 19. |
- Lilja, Sara, 1979-
(författare)
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Gender-Related Terms in English Depositions, Examinations and Journals, 1670–1720
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation focuses on gender-related terms as well as adjectives and demonstratives in connection with these terms used in texts from the period 1670–1720. The material in the study has been drawn from both English and American sources and comes from three text categories: depositions, examinations and journals. Two of these text categories represent authentic and speech-related language use (depositions and examinations), whereas the third (journals) is representative of a non-speech-related, non-fictional text category. While previous studies of gender-related terms have primarily investigated fictional material, this study focuses on text categories which have received little attention so far.The overarching research question addressed in this study concerns the use and distribution of gender-related terms, especially with regard to referent gender. Data analyses are both quantitative and qualitative, and several linguistic and extra-linguistic factors are taken into account, such as the semantic domain to which the individual gender-related term belongs, region of origin and referent gender. Adjectives and demonstratives collocating with the gender-related terms are also investigated, as previous research has shown that referent gender has an impact on the use of adjectives as well.The results show that the use of gender-related terms is influenced by both region of origin and referent gender. It is suggested that this is due in part to the difference in nature between Early Modern English society and the early American colonies, and in part due to the social roles which men and women had. Referent gender also has an impact on the type of adjectives used in connection with gender-related terms: adjectives collocating with gender-related terms denoting men have positive connotations to a larger extent than do adjectives collocating with their female counterparts; meanwhile, gender-related terms denoting women tend to collocate with negative adjectives.
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| 20. |
- Lilja, Veronica, 1989, et al.
(författare)
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Balancing between being the most valuable player (MVP) and passing the ball: a qualitative study of support when living with chronic pain in Sweden
- 2024
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Ingår i: BMJ open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aimed to elucidate the meaning of lived experiences of support from social networks and the healthcare sector in persons with chronic pain. DESIGN: A qualitative, phenomenological hermeneutic method was used to analyse interview data. SETTING: Participants were recruited from patient organisations in Sweden. PARTICIPANTS: Ten (seven women, two men and one non-binary) individuals with chronic musculoskeletal pain were included. FINDINGS: The meaning of lived experiences of support in persons with chronic pain involves balancing between being the most valuable player (MVP) and passing the ball, meaning balancing between being a capable person and accepting support to be that capable person. CONCLUSION: For participants who lived with chronic pain, support means balancing between being capable (the MVP) and willing to accept support (passing the ball), which aligns with the concept of person-centred care. Our findings may be useful for policy-makers, managers and clinical professionals when planning and performing care for persons with chronic pain. Future research should focus on how the healthcare sector can create support to enable persons with chronic pain to be the MVP while being able to pass the ball to their social networks and the healthcare sector.
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| 21. |
- Lilja Visén, Sara, 1979-
(författare)
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Old creatures and poor children. The use of non-gendered words for gendered individuals in historical speech-related material
- 2012
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Ingår i: Moderna Språk. - 0026-8577. ; 106:2, s. 85-101
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Tidskriftsartikel (refereegranskat)abstract
- Previous research has shown that non-gendered (epicene) words, such as creature, person and child are often used with a gender-bias, both today and in historical material. The present study, which is based on sections of my dissertation (Lilja 2007) looks into the use of these three words in historical texts, with a focus on speech-related material from the courtroom setting (examinations and depositions) in England and New England 1670–1720. The findings are contrasted with those from previous research, which has used fictional material (novels and plays) from the same period. With regard to creature and child, the present study finds that they are primarily used with female reference, which confirms the findings of previous research. However, with regard to person, which in previous research has been found to be used with primarily male reference, the results indicate a difference between the material from England and that from New England: in the English material person is mainly used with male reference, whereas it is mainly used with female reference in the American material. This might be due to the specific nature of the New England material, most of which comes from the Salem witch trials.
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| 22. |
- Lundqvist, Martin, et al.
(författare)
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The nanoparticle protein corona formed in human blood or human blood fractions
- 2017
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:4
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Tidskriftsartikel (refereegranskat)abstract
- The protein corona formed around nanoparticles in protein-rich fluids plays an important role for nanoparticle biocompatibility, as found in several studies during the last decade. Biological fluids have complex compositions and the molecular components interact and function together in intricate networks. Therefore, the process to isolate blood or the preparation of blood derivatives may lead to differences in the composition of the identified protein corona around nanoparticles. Here, we show distinct differences in the protein corona formed in whole blood, whole blood with EDTA, plasma, or serum. Furthermore, the ratio between particle surface area to protein concentration influences the detected corona. We also show that the nanoparticle size per se influences the formed protein corona due to curvature effects. These results emphasize the need of investigating the formation and biological importance of the protein corona in the same environment as the nanoparticles are intended for or released into.
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| 23. |
- Mutanen, Annika, et al.
(författare)
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A nordic multicenter study on contemporary outcomes of pediatric short bowel syndrome in 208 patients
- 2023
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Ingår i: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 42:7, s. 1095-1103
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims: Despite advances in the management of short bowel syndrome related intestinal failure (SBS-IF), large-scale contemporary pediatric studies are scarce. The aim of this multicenter study was to assess key outcomes and clinical prognostic factors in a recent Nordic pediatric SBS-IF population.Methods: Patients with SBS-IF treated during 2010-2019, whose parenteral support (PS) started at age <1 year and continued >60 consecutive days were included and retrospectively reviewed. All six participating centers followed multidisciplinary SBS-IF management. Risk factors for PS dependency, intestinal failure associated liver disease (IFALD) and mortality were assessed with Cox regression and Kaplan Meier analyses. IFALD was defined with serum liver biochemistry levels.Results: Among 208 patients, SBS-IF resulted from NEC in 49%, gastroschisis w/wo atresia in 14%, small bowel atresia in 12%, volvulus in 11%, and other diagnoses in 14%. Median age-adjusted small bowel length was 43% (IQR 21-80%). After median follow up of 4.4 years (IQR 2.5-6.9), enteral autonomy was reached by 76%, none had undergone intestinal transplantation, and overall survival was 96%. Half of deaths (4/8) were caused by septic complications. Although biochemical cholestasis occurred only in 3% at latest follow-up and none of deaths were directly caused by IFALD, elevated liver biochemistry (HR 0.136; P = 0.017) and shorter remaining small bowel (HR 0.941; P = 0.040) predicted mortality. Shorter remaining small bowel and colon, and presence of end-ostomy were the main predictors of PS dependency, but not IFALD. Patients with NEC reached enteral autonomy more efficiently and had decreased incidence of IFALD compared to other etiologies.Conclusions: Although with current multidisciplinary management, prognosis of pediatric SBS is encouraging, septic complications and IFALD still associated with the remaining low mortality rate.
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| 24. |
- Najar Chalien, Midia, 1978, et al.
(författare)
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Long-term Outcome for Two-Stage Palatal Closure With Different Timings for Hard Palate Surgery: Craniofacial Growth and Dental Arch Relation.
- 2023
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Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 60:9, s. 1140-1148
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to evaluate dental arch relation and craniofacial growth for individuals born with unilateral cleft lip and palate (UCLP), who had two-stage palatal surgery, with hard palate closure (HPC) at the ages of 3 or 8 years.Longitudinal cohort study.Ceft lip and palate team in Gothenburg, Sweden.The inclusion criteria were nonsyndromic individuals born with complete UCLP who were consecutively operated according to two different surgical protocols; soft palate closure at 6 months followed by hard palate closure at the age of 3 years (HPC3) or at the age of 8 years (HPC8). In this evaluation, 28 individuals had HPC3 and 59 individuals had HPC8.The main outcome, longitudinal series of dental casts and lateral radiographs from the ages of 5, 10, 16, and 19 years, were evaluated using GOSLON Yardstick and cephalometric analysis.At the age of 10 years, 78% of the individuals with HPC3 demonstrated GOSLON scores of 1 and 2 and 86% in HPC8. At the age of 19 years, 54% of the individuals exhibited GOSLON scores of 1or 2 when compared with 74% in HPC8. A statistical significant difference for SNA was observed at the age of 5 years (P=.004), with a lower SNA in HPC3, but not at the ages of 10, 16 and 19 years. At the final age, SNA was 75.2° for HPC3 and 76.8° for HPC8.The decrease in age for HPC did not have an adverse effect on long-term dental arch relationship or craniofacial growth.
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| 25. |
- Nicolas, Aude, et al.
(författare)
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Genome-wide Analyses Identify KIF5A as a Novel ALS Gene
- 2018
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Ingår i: Neuron. - : Cell Press. - 0896-6273 .- 1097-4199. ; 97:6, s. 1268-1283.e6
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Tidskriftsartikel (refereegranskat)abstract
- To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.
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| 26. |
- Pegelow, M., et al.
(författare)
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Reliability and Predictive Validity of Dental Arch Relationships Using the 5-Year-Olds’ Index and the GOSLON Yardstick to Determine Facial Growth
- 2021
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Ingår i: Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 58:5, s. 619-627
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To determine reliability and predictive validity of the 5-year-olds’(5YO) Index and GOSLON Yardstick in 119 patients born with unilateral cleft lip and palate at 5, 7/8, 10, 15/16, and 19 years. Methods: Five hundred thirty-four dental study models were appraised by 2 teams in 2 centers, twice in each center. Intrateam and interteam reliability in scoring the models was calculated using κ. Dental arch prediction rates were calculated as the proportion of models remaining in the same category (good–scores 1 and 2; fair–score 3; poor–scores 4 and 5) over time. Results: Intrateam and interteam κ statistics ranged from 0.74 to 0.89 and from 0.74 to 0.81, respectively. The 5YO Index and GOSLON Yardstick at 5 years produced almost identical results. The prediction rate of 19-year-old (n = 106) outcome was >80% for those in groups 1 and 2 at 5 years, while for those in groups 4 and 5 prediction was poor (<40%). Prediction of groups 4 and 5 remained poor until 10 years when it increased to 77%. At 15/16 years prediction rate was 93% for those in groups 4 and 5. Prediction of cases in group 3 was very poor at all ages. Conclusions: These results question the predictive value of “poor” dental arch relationships before 10 years of age. However, the predictive value of “good” dental arch relationship scores over time is good in all age groups. This has implications for audit policies to predict facial growth outcomes. © American Cleft Palate-Craniofacial Association. All rights reserved 2020.
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| 27. |
- Robba, Chiara, et al.
(författare)
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Oxygen targets and 6-month outcome after out of hospital cardiac arrest : a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial
- 2022
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 26, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients’ outcome. Methods: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). Conclusions: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration: clinicaltrials.gov NCT02908308, Registered September 20, 2016.
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| 28. |
- Robba, Chiara, et al.
(författare)
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Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients : a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial
- 2022
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 48:8, s. 1024-1038
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods: Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results: A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (VT) was 7 (Interquartile range, IQR = 6.2–8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5–9) cmH20, plateau pressure was 20 cmH20 (IQR = 17–23), driving pressure was 12 cmH20 (IQR = 10–15), mechanical power 16.2 J/min (IQR = 12.1–21.8), ventilatory ratio was 1.27 (IQR = 1.04–1.6), and respiratory rate was 17 breaths/minute (IQR = 14–20). Median partial pressure of oxygen was 87 mmHg (IQR = 75–105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36–45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003–1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001–1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions: Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.
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| 29. |
- Rydelius, Anna, et al.
(författare)
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Longitudinal study of cognitive function in glioma patients treated with modern radiotherapy techniques and standard chemotherapy
- 2020
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Ingår i: Acta Oncologica. - 0284-186X. ; 59:9, s. 1091-1097
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Cognitive function is an important outcome measure in patients with brain tumor, providing information about the patient’s clinical situation, treatment effects and possible progressive disease. The aim of this longitudinal study was to evaluate effects of the currently used radiation and chemotherapy treatment on cognitive function and to investigate associations between cognitive function at baseline and progression as well as overall survival. Methods: 32 patients newly diagnosed with malignant glioma were evaluated at baseline with CNS Vital Signs (CNS-VS), a computerized standardized neuropsychological test battery, prior to arc-based radiotherapy and concomitant chemotherapy with Temozolomide. CNS-VS measures the cognitive functions known to be affected in patients with brain tumor, covering nine cognitive domains. Follow-up cognitive evaluations were performed in 26 patients after 3.5 months and in 13 patients 1 year after treatment start. Results: Overall cognitive scores were lower in the studied patient cohort at baseline compared to standardized domain scores. At 3.5 months follow-up cognitive functioning was slightly decreased, but only in 1/9 cognitive domains–visual memory–where significant changes were found compared to baseline test results. Similarly, at 12 months follow-up no significant changes in cognitive test results were seen compared to baseline examination, except for a decrease in the visual memory domain. In relation to early progression, the most significant cognitive deficits were dysfunctional visual memory and low executive functioning at baseline. Low executive function at baseline correlated most significantly with shorter overall survival. Conclusion: The present study suggests that the currently used arc-based radiotherapy and chemotherapy might affect cognitive function less negatively than previously described during treatment and in the first year after treatment in malignant glioma patients. In general, a high cognitive test score at baseline was associated with longer time to progression and with longer survival.
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| 30. |
- Schäfer, Samuel, et al.
(författare)
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scDrugPrio: a framework for the analysis of single-cell transcriptomics to address multiple problems in precision medicine in immune-mediated inflammatory diseases
- 2024
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Ingår i: Genome Medicine. - : BMC. - 1756-994X. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Ineffective drug treatment is a major problem for many patients with immune-mediated inflammatory diseases (IMIDs). Important reasons are the lack of systematic solutions for drug prioritisation and repurposing based on characterisation of the complex and heterogeneous cellular and molecular changes in IMIDs.Methods Here, we propose a computational framework, scDrugPrio, which constructs network models of inflammatory disease based on single-cell RNA sequencing (scRNA-seq) data. scDrugPrio constructs detailed network models of inflammatory diseases that integrate information on cell type-specific expression changes, altered cellular crosstalk and pharmacological properties for the selection and ranking of thousands of drugs.Results scDrugPrio was developed using a mouse model of antigen-induced arthritis and validated by improved precision/recall for approved drugs, as well as extensive in vitro, in vivo, and in silico studies of drugs that were predicted, but not approved, for the studied diseases. Next, scDrugPrio was applied to multiple sclerosis, Crohn's disease, and psoriatic arthritis, further supporting scDrugPrio through prioritisation of relevant and approved drugs. However, in contrast to the mouse model of arthritis, great interindividual cellular and gene expression differences were found in patients with the same diagnosis. Such differences could explain why some patients did or did not respond to treatment. This explanation was supported by the application of scDrugPrio to scRNA-seq data from eleven individual Crohn's disease patients. The analysis showed great variations in drug predictions between patients, for example, assigning a high rank to anti-TNF treatment in a responder and a low rank in a nonresponder to that treatment.Conclusions We propose a computational framework, scDrugPrio, for drug prioritisation based on scRNA-seq of IMID disease. Application to individual patients indicates scDrugPrio's potential for personalised network-based drug screening on cellulome-, genome-, and drugome-wide scales. For this purpose, we made scDrugPrio into an easy-to-use R package (https://github.com/SDTC-CPMed/scDrugPrio).
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| 31. |
- Semb, Gunvor, et al.
(författare)
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A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management.
- 2017
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Taylor & Francis. - 2000-656X .- 2000-6764. ; 51:1, s. 2-13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project.METHOD: Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes.RESULTS: Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years.CONCLUSION: The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series.TRIAL REGISTRATION: ISRCTN29932826.
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| 32. |
- Stenman, Emelie, et al.
(författare)
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Increased monoaminergic neurotransmission improves compliance with physical activity recommendations in depressed patients with fatigue.
- 2012
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Ingår i: Medical Hypotheses. - : Elsevier BV. - 1532-2777 .- 0306-9877.
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Tidskriftsartikel (refereegranskat)abstract
- Clinical studies have shown that moderately intense physical activity effectively treats various types of depression. Beneficial effects have been reported in the acute phase of the disease as well as in a long-term perspective. In addition, epidemiological studies have shown that inactivity increases the risk of depression and that exercise prevents relapse. Depressed patients are often prescribed antidepressants, with or without psychotherapy. Some studies have, however, suggested that the most frequently used antidepressants, selective serotonin reuptake inhibitors (SSRIs), contribute to fatigue, which is a common residual symptom associated with depression and the target of the proposed study. Profound fatigue may in turn decrease the ability and motivation to perform the beneficial physical activity, e.g. via executive dysfunction. Fatigue and impaired executive function are commonly linked to disturbed cerebral dopaminergic and noradrenergic neurotransmission. This kind of dysfunction is hard to overcome, even when the major symptoms of depression are alleviated. Interestingly, physical activity has been suggested to improve the dopamine and norepinephrine neurotransmission. Furthermore, the favorable effects may be reciprocal; improved dopamine and norepinephrine transmission in the brain may hypothetically increase the ability and motivation to exercise, since some parts of the brain (e.g. the prefrontal cortex, striatum and cerebellum) that control movement and initiative receive dopaminergic and noradrenergic projections. Based on these findings and assumptions, our hypothesis is that increased dopaminergic and noradrenergic neurotransmission, via intake of a dopamine- and norepinephrine-enhancing agent, improves the compliance with prescribed physical activity in patients with depression and residual fatigue. We also believe that the increased physical activity can prevent relapse into depression, even after interruption of medication. Since increased physical activity also has been shown to improve executive cognitive function, we suggest that executive function should be examined as a secondary outcome together with other possibly related variables such as quality of life, sick leave and BMI.
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| 33. |
- Thuccani, Meena, et al.
(författare)
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The capacity of neurological pupil index to predict the absence of somatosensory evoked potentials after cardiac arrest : An observational study
- 2024
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Ingår i: Resuscitation Plus. - : Elsevier. - 2666-5204. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn neurologic prognostication of comatose survivors from cardiac arrest, two independent predictors of poor outcome are the loss of the Pupillary light reflex (PLR) and the loss of the N20 response from Somatosensory Evoked potentials (SSEP). The PLR can be quantitatively assessed by pupillometry. Both tests depend on the midbrain, in which a dysfunction reflects a severe hypoxic injury. We reasoned that a certain level of defective PLR would be predictive of a bilaterally absent SSEP N20 response.MethodNeurological Pupil index (NPi) from the pupillometry and the SSEP N20 response were registered >48 h after cardiac arrest in comatose survivors. Clinical data were retrospectively analyzed. A receiver operating characteristic curve was used to evaluate the capacity of NPi to predict bilaterally absent SSEP N20 response. An NPi threshold value resulting in <5% false positive rate (FPR) for bilaterally absent N20 response was identified.ResultsFrom February 2020 to August 2022, we included 54 patients out of which 49 had conclusive pupillometry and SSEP examinations. The NPi threshold value with FPR < 5% was 3.4, yielding 36% sensitivity (95% CI 18–55) and significantly discriminated between respective groups with preserved and bilaterally absent N20 response to SSEP (p-value <0.01).ConclusionIn this limited cohort, NPi < 3.4 in patients remaining comatose >48 hours after cardiac arrest predicted bilateral loss of the SSEP N20 response with a FPR < 5%. If validated in a larger cohort, an NPi threshold may be clinically applied in settings where SSEP is unavailable.
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| 34. |
- Turella, Sara, et al.
(författare)
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The predictive value of highly malignant EEG patterns after cardiac arrest : evaluation of the ERC-ESICM recommendations
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Ingår i: Intensive Care Medicine. - 0342-4642.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The 2021 guidelines endorsed by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) recommend using highly malignant electroencephalogram (EEG) patterns (HMEP; suppression or burst-suppression) at > 24 h after cardiac arrest (CA) in combination with at least one other concordant predictor to prognosticate poor neurological outcome. We evaluated the prognostic accuracy of HMEP in a large multicentre cohort and investigated the added value of absent EEG reactivity. Methods: This is a pre-planned prognostic substudy of the Targeted Temperature Management trial 2. The presence of HMEP and background reactivity to external stimuli on EEG recorded > 24 h after CA was prospectively reported. Poor outcome was measured at 6 months and defined as a modified Rankin Scale score of 4–6. Prognostication was multimodal, and withdrawal of life-sustaining therapy (WLST) was not allowed before 96 h after CA. Results: 845 patients at 59 sites were included. Of these, 579 (69%) had poor outcome, including 304 (36%) with WLST due to poor neurological prognosis. EEG was recorded at a median of 71 h (interquartile range [IQR] 52–93) after CA. HMEP at > 24 h from CA had 50% [95% confidence interval [CI] 46–54] sensitivity and 93% [90–96] specificity to predict poor outcome. Specificity was similar (93%) in 541 patients without WLST. When HMEP were unreactive, specificity improved to 97% [94–99] (p = 0.008). Conclusion: The specificity of the ERC-ESICM-recommended EEG patterns for predicting poor outcome after CA exceeds 90% but is lower than in previous studies, suggesting that large-scale implementation may reduce their accuracy. Combining HMEP with an unreactive EEG background significantly improved specificity. As in other prognostication studies, a self-fulfilling prophecy bias may have contributed to observed results.
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