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1.	Bjällmark, Anna, et al. (författare) Differences in myocardial velocities during supine and upright exercise stress echocardiography in healthy adults 2009 Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 29:3, s. 216-223 Tidskriftsartikel (refereegranskat)abstract Tissue Velocity Imaging (TVI) is a method for quantitative analysis of longitudinal myocardial velocities, which can be used during exercise and pharmacological stress echocardiography. It is of interest to evaluate cardiac response to different types of stress tests and the differences between upright and supine bicycle exercise tests have not been fully investigated. Therefore, the aim of this study was to compare cardiac response during supine and upright exercise stress tests. Twenty young healthy individuals underwent supine and upright stress test. The initial workload was set to 30 W and was increased every minute by a further 30 W until physical exhaustion. Tissue Doppler data from the left ventricle were acquired at the end of every workload level using a GE Vivid7 Dimension system (> 200 frames s(-1)). In the off-line processing, isovolumic contraction velocity (IVCV), peak systolic velocity (PSV), isovolumic relaxation velocity (IVRV), peak early diastolic velocity (E') and peak late diastolic velocity (A') were identified at every workload level. No significant difference between the tests was found in PSV. On the contrary, E' was shown to be significantly higher (P < 0.001) during supine exercise than during upright exercise and IVRV was significantly lower (P < 0.001) during supine exercise compared to upright exercise. Upright and supine exercise stress echocardiography give a comparable increase in measured systolic velocities and significant differences in early diastolic velocities.
2.	Bjällmark, Anna, et al. (författare) Effects of hemodialysis on the cardiovascular system: Quantitative analysis using wave intensity wall analysis and tissue velocity imaging 2010 Ingår i: Heart and Vessels. - : Springer Science and Business Media LLC. - 0910-8327 .- 1615-2573. Tidskriftsartikel (refereegranskat)abstract Cardiovascular disease is the leading cause of death in patients with end stage renal disease (ESRD). The aim of this study was to investigate the changes in cardiovascular function induced by a single session of hemodialysis (HD) by the analysis of cardiovascular dynamics using wave intensity wall analysis (WIWA) and of systolic and diastolic myocardial function using tissue velocity imaging (TVI). Grey-scale cine loops of the left common carotid artery, conventional echocardiography and TVI images of the left ventricle were acquired before and after HD in 45 patients (17 women, mean age 54) with ESRD. The WIWA indexes, W1 preload-adjusted W1, W2 and preload-adjusted W2, and the TVI variables, isovolumic contraction velocity (IVCV), isovolumic contraction time (IVCT), peak systolic velocity (PSV), displacement, isovolumic relaxation velocity (IVRV), isovolumic relaxation time (IVRT), peak early diastolic velocity (E’) and peak late diastolic velocity (A’), were compared before and after HD. The WIWA measurements showed significant increases in W1 (p < 0.05) and preload-adjusted W1 (p < 0.01) after HD. W2 was significantly decreased (p < 0.05) after HD, whereas the change in preload-adjusted W2 was not significant. Systolic velocities, IVCV (p < 0.001) and PSV (p < 0.01), were increased after HD, whereas the AV-plane displacement were decreased (p < 0.01). For the measured diastolic variables, E’ was significantly decreased (p < 0.01) and IVRT was significantly prolonged (p < 0.05), after HD. A few correlations were found between WIWA and TVI variables. The WIWA and TVI measurements indicate that a single session of HD improves systolic function. The load dependency of the diastolic variables seems to be more pronounced than for the systolic variables. Preload-adjusted wave intensity indexes may contribute in the assessment of true LV contractility and relaxation.
3.	Bjällmark, Anna, et al. (författare) Ultrasonographic strain imaging is superior to conventional non-invasive measures of vascular stiffness in the detection of age-dependent differences in the mechanical properties of the common carotid artery 2010 Ingår i: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 11:7, s. 630-636 Tidskriftsartikel (refereegranskat)abstract Aims: Elastic properties of large arteries have been shown to deteriorate with age and in the presence of atherosclerotic vascular disease. In this study, the performance of ultrasonographic strain measurements was compared to conventional measures of vascular stiffness in the detection of age-dependent differences in the elastic properties of the common carotid artery.Methods and results: In 10 younger (25-28 years, 4 women) and 10 older (50-59 years, 4 women) healthy individuals, global and regional circumferential and radial strain variables were measured in the short-axis view of the right common carotid artery using ultrasonographic two-dimensional (2D) strain imaging with recently introduced speckle tracking technique. Conventional elasticity variables, elastic modulus (Ep) and β stiffness index, were calculated using M-mode sonography and non-invasive blood pressure measurements. Global and regional circumferential systolic strain and strain rate values were significantly higher (p < 0.001, p < 0.01 for regional late systolic strain rate) in the younger individuals, whereas the values of conventional elasticity variables in the same group were lower (p < 0.05). Among all strain and conventional elasticity variables, principal component analysis and its regression extension identified only circumferential systolic strain variables as contributing significantly to the observed discrimination between the younger and older age groups.Conclusion: Ultrasonographic 2D-strain imaging is a sensitive method for the assessment of elastic properties in the common carotid artery, being in this respect superior to conventional measures of vascular elasticity. The method has potential to become a valuable non-invasive tool in the detection of early atherosclerotic vascular changes.
4.	Bjällmark, Anna, et al. (författare) Velocity tracking - a novel method for quantitative analysis of longitudinal myocardial function 2007 Ingår i: Journal of the American Society of Echocardiography. - : Elsevier. - 0894-7317 .- 1097-6795. ; 20:7, s. 847-856 Tidskriftsartikel (refereegranskat)abstract Doppler tissue imaging is a method for quantitative analysis of longitudinal myocardial velocity. Commercially available ultrasound systems can only present velocity information using a color Dopplerbased overlapping continuous color scale. The analysis is time-consuming and does not allow for simultaneous analysis in different projections. We have developed a new method, velocity tracking, using a stepwise color coding of the regional longitudinal myocardial velocity. The velocity data from 3 apical projections are presented as static and dynamic bull's-eye plots to give a 3-dimensional understanding of the function of the left ventricle. The static bull's-eye plot can display peak systolic velocity, late diastofic tissue velocity, or the sum of peak systolic velocity and early diastolic tissue velocity. Conversely, the dynamic bull's-eye plot displays how the myocardial velocities change over one heart cycle. Velocity tracking allows for a fast, simple, and hituitive visual analysis of the regional longitudinal contraction pattern of the left ventricle with a great potential to identify characteristic pathologic patterns.
5.	Bydén, Stefan, 1951, et al. (författare) Mark - Människa -Miljö 2004 Bok (övrigt vetenskapligt/konstnärligt)abstract Boken handlar om hur marken formats och påverkats av spadar och grävskopor, mular och harvar, kemikalier och sura regndroppar. Den fjärde upplagan har reviderade texter som ingående behandlar marken ur alla aspekter: markegenskaper, kulturlandskapet, skogsbruk, exploatering, planering och lagar, naturvård, information m.m. Boken är rikligt illustrerad med foton, diagram, teckningar och kartor. Boken är ett samarbete mellan Stockholms och Göteborgs universitet. Författarna är verksamma inom högskolan eller annan utbildning.
6.	Cajander, Åsa, et al. (författare) Ekonomiadministratörernas IT-relaterade arbetsmiljö vid Uppsala universitet : En kortfattad rapport från KiA-projektet 2014 Rapport (övrigt vetenskapligt/konstnärligt)
7.	Carlsson, Lars, et al. (författare) Enhanced myocardial peak systolic capacity in elite endurace athletes during exercise 2009 Ingår i: Proceedings of the 14th Annual Congress of European College of Sports Science. - Oslo : Gamlebyen Grafiske AS. - 9788250204201 Konferensbidrag (refereegranskat)
8.	Carlsson, Lars, et al. (författare) Enhanced systolic myocardial function in elite endurance athletes during combined arm-and-leg exercise 2011 Ingår i: European Journal of Applied Physiology. - : Springer Science and Business Media LLC. - 1439-6319 .- 1439-6327. ; 111:6, s. 905-913 Tidskriftsartikel (refereegranskat)abstract The aim here was to employ color tissue velocity imaging (TVI), to test the hypothesis that highly trained endurance athletes exhibit enhanced systolic function of the left ventricular (LV) myocardium both at rest and during combined arm-and-leg exercise in comparison with untrained subjects. For each of the ten elite male (EG) and ten matched control participants (CG), LV dimensions and systolic function were assessed at rest using echocardiography. Subsequently, these subjects exercised continuously on a combined arm-and-leg cycle ergometer for 3 min each at 50, 60, 70, 80, 90 and 100% of VO2max. Oxygen uptake, heart rate, systolic blood pressure (SBP) and peak contraction systolic velocities of the LV myocardium (PSV) were recorded in the end of each level. At rest, the trained and untrained groups differed with respect to LV dimensions, but not systolic function. At 60–100% VO2max, the EG group demonstrated both higher PSV and SBP. The observation that the EG athletes had higher PSV than CG during exercise at 60–100% VO2max, but not at rest or at 50% of VO2max, suggested an enhanced systolic capacity. This improvement is likely to be due to an enhanced inotropic contractility, which only becomes apparent during exercise.
9.	Dahl, Ulrika, et al. (författare) Food quality effects on copepod growth and development : Implications for bioassays in ecotoxicological testing 2009 Ingår i: Ecotoxicology and Environmental Safety. - : Elsevier Inc. - 0147-6513 .- 1090-2414. ; 72:2, s. 351-357 Tidskriftsartikel (refereegranskat)abstract We evaluated effects of six algal species in 25 combinations on growth and reproduction of the harpacticoid copepod Nitocra spinipes. In the first lifecycle test, Rhodomonas salina, Phaeodactylum tricornutum, and Dunaliella tertiolecta were used. The results showed that R. salina was the best food, whereas P. tricornutum (0% development success) and D. tertiolecta (41.7% malformations) were poor food items. In the second lifecycle test, a mixture of R. salina, Tetraselmis suecica, and Thalassiosira weisflogii (selected from screening tests) was tested together with a mono-diet of R. salina. Also in this test, copepods fed R. salina performed better (i.e. had higher survival and reproductive success) compared with the other treatment. We conclude that R. salina is appropriate to use as food in toxicity testing with N. spinipes, whereas some of the algae commonly used as feed in ecotoxicological tests with other copepods had detrimental effects on the development, reproduction, and survival of N. spinipes.
10.	Eiken, Ola, et al. (författare) Lunar habitat simulation 2013 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
11.	Elmstedt, Nina, et al. (författare) Fetal cardiac muscle contractility decreases with gestational age : a color-coded tissue velocity imaging study 2012 Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; 10, s. 19- Tidskriftsartikel (refereegranskat)abstract Background: Present data regarding how the fetal heart works and develops throughout gestation is limited. However, the possibility to analyze the myocardial velocity profile provides new possibilities to gain further knowledge in this area. Thus, the objective of this study was to evaluate human fetal myocardial characteristics and deformation properties using color-coded tissue velocity imaging (TVI). Methods: TVI recordings from 55 healthy fetuses, at 18 to 42 weeks of gestation, were acquired at a frame rate of 201-273 frames/s for offline analysis using software enabling retrieval of the myocardial velocity curve and 2D anatomical information. The measurements were taken from an apical four-chamber view, and the acquired data was correlated using regression analysis. Results: Left ventricular length and width increased uniformly with gestational age. Atrioventricular plane displacement and the E'/A' ratio also increased with gestational age, while a longitudinal shortening was demonstrated. Conclusions: Fetal cardiac muscle contractility decreases with gestational age. As numerous fetal-and pregnancy-associated conditions directly influence the pumping function of the fetal heart, we believe that this new insight into the physiology of the human fetal cardiovascular system could contribute to make diagnosis and risk assessment easier and more accurate.
12.	Elmstedt, Nina, et al. (författare) Fetal heart contractile function and gestational age 2012 Ingår i: Cardiovascular Research. - 0008-6363 .- 1755-3245. ; 93, s. S108-S108 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
13.	Elmstedt, Nina (författare) Prenatal Tisse Velocity Imaging of the Heart : A new approach to assess fetal myocardial function 2013 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The general aim of this thesis has been to evaluate color‐coded tissue velocity imaging (TVI) as an approach to developing a new, non‐invasive assessment method for fetal myocardial function. Such a method could hypothetically give early indications of fetal pathology, as myocardial dysfunction is often the consequence when the circulation tries to adapt to deteriorating situations. This would be beneficial in clinical decision making when evaluating fetal well‐being in a wide range of pregnancy associated conditions, to facilitate risk assessment and to monitor the benefit of therapeutic interventions.TVI is an ultrasound technique that enables quantification of longitudinal myocardial motion with high temporal resolution, which is essential in the identification of fetal myocardial movements of short duration. Furthermore, the longitudinal motion is mainly determined by subendocardial fibers that usually become abnormal in the very early stages of cardiac dysfunction as they are sensitive to milder degrees of hypoxia. Thus, TVI has the potential to give early indications of impaired fetal myocardial function and hypothetically facilitate the detection of intrauterine hypoxia. Hypoxia is a common phenomenon of many pathological conditions in pregnancy, from which a substantial number of children either die or acquire permanent brain injury during delivery every year.After having established optimal sampling requirements and ensured an acceptable reproducibility for TVI measurements of the fetal myocardium, normal reference values were determined feasible and sensitive enough to provide insight into maturational changes in myocardial function. This provided a foundation that should enable further investigations and was partly accomplished using the cardiac state diagram (CSD) to accurately time the myocardial events during a cardiac cycle according to the motion shifts of the atrioventricular plane.The demonstrated results are promising and the general conclusion of this thesis is that TVI contributes to increasing the knowledge and understanding of fetal myocardial function and dysfunction. Used together with CSD this technique has great potential as an assessment method. However, further testing of the clinical potential is needed in larger study populations concerning the pathological or physiological questions at issue, and additional development of the method is required to render the method simple enough to be of potential aid in clinical practice.
14.	Elmstedt, Nina, et al. (författare) Reference values for fetal tissue velocity imaging and a new approach to evaluate fetal myocardial function 2013 Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; 11:1, s. 29- Tidskriftsartikel (refereegranskat)abstract Objectives: Myocardial function can be evaluated using color-coded tissue velocity imaging (TVI) to analyze the longitudinal myocardial velocity profile, and by expressing the motion of the atrioventricular plane during a cardiac cycle as coordinated events in the cardiac state diagram (CSD). The objective of this study was to establish gestational age specific reference values for fetal TVI measurements and to introduce the CSD as a potential aid in fetal myocardial evaluation. Methods: TVI recordings from 125 healthy fetuses, at 18 to 42 weeks of gestation, were performed with the transducer perpendicular to the apex to provide a four-chamber view. The myocardial velocity data was extracted from the basal segment of septum as well as the left and right ventricular free wall for subsequent offline analysis. Results: During a cardiac cycle the longitudinal peak velocities of septum increased with gestational age, as did the peak velocities of the left and right ventricular free wall, except for the peak velocity of post ejection. The duration of rapid filling and atrial contraction increased during pregnancy while the duration of post ejection decreased. The duration of pre ejection and ventricular ejection did not change significantly with gestational age. Conclusion: Evaluating fetal systolic and diastolic performance using TVI together with CSD could contribute to increase the knowledge and understanding of fetal myocardial function and dysfunction. The pre and post ejection phases are the variables most likely to indicate fetuses with abnormal myocardial function.
15.	Elmstedt, Nina, et al. (författare) Reproducibility and variability in the assessment of color-coded tissue velocity imaging of the fetal myocardium 2013 Ingår i: Journal of biomedical graphics and computing. - : Sciedu Press. - 1925-4008 .- 1925-4016. ; 3:2 Tidskriftsartikel (refereegranskat)abstract Objective: The introduction of color-coded tissue velocity imaging (TVI) in fetal medicine is quite recent, and as this method is presently evaluated and developed in regard to diagnostic precision it is of outmost importance to evaluate the reproducibility for adequate clinical use. In this study, reproducibility and intra- and inter-observer variability was assessed for offline analysis as well as echocardiography investigations. Also, we evaluated the importance of exact placement of the region of interest (ROI).Methods: TVI recordings from 21 fetuses, at a gestational age of 27 to 41 weeks, were acquired at 208-239 frames/s for subsequent offline analysis. All recordings were performed with the transducer positioned to provide an apical four-chamber view and the myocardial velocity data was obtained from basal inferoseptum. The data set was analyzed according to Bland-Altman and reproducibility was expressed as the standard error of a single determination, estimated from duplicate determinations in percentage of the total.Results: The variation of reproducibility for the echocardiography investigation ranged from 2.0% to 9.8%. The duration of left ventricular ejection, and the peak velocities of early diastolic filling and atrial contraction being the most robust events measured. The variation of inter-observer variability for the echocardiography investigation ranged from 1.5% to 8.4%, and the variation of intra- and inter-observer variability for the offline analysis ranged from 1.2% to 10.4%. Least robust were the events of shortest duration, including isovolumetric contraction and relaxation.Conclusion: We believe that TVI measurements of the fetal myocardium could be performed in the clinical routine with acceptable reproducibility.
16.	Elmstedt, Nina, et al. (författare) Temporal frequency requirements for tissue velocity imaging of the fetal heart 2011 Ingår i: Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692 .- 1469-0705. ; 38:4, s. 413-417 Tidskriftsartikel (refereegranskat)abstract Objectives The high velocity and short duration of myocardial motion requires a high sampling rate to obtain adequate temporal resolution; this issue becomes even more important when taking into consideration the high fetal heart rate. In this study we have established optimal sampling requirements for assessing the duration of various cardiac cycle events and myocardial velocities of the fetal heart using color-coded tissue velocity imaging (TVI). Methods Recordings from 30 fetuses were acquired at an initial frame rate of 180-273 frames/s. All TVI recordings were performed from an apical four-chamber view and stored as cineloops of five to 10 consecutive cardiac cycles for subsequent offline analysis using software enabling a reduction in frame rate. Different components of the myocardial velocity curve, obtained from the basal part of the ventricular septum, were measured at the initial frame rate and compared with their equivalents at gradually decreased frame rates. Results As acquisition frame rate was reduced, there was a marked increase in deviation from the initial values, resulting in an underestimation of all systolic and diastolic velocities. For the measured durations, there was a clear tendency to underestimate isovolumetric contraction and relaxation, and a clear tendency to overestimate ventricular ejection and diastolic E-wave and A-wave. An acceptable <= 5% deviation from the value obtained at the highest frame rate corresponded to measurements obtained at above 150-200 frames/s. Conclusions A high sampling rate of at least 200 frames/s is necessary for adequate reconstruction of TVI data for the fetal heart. Frame rates that are too low result in considerable loss of temporal and velocity information.
17.	Gunnes, S., et al. (författare) Analysis of the effect of temporal filtering in myocardial tissue velocity imaging 2004 Ingår i: Journal of the American Society of Echocardiography. - : Mosby Inc. - 0894-7317 .- 1097-6795. ; 17:11, s. 1138-1145 Tidskriftsartikel (refereegranskat)abstract Signal filtering to reduce random noise may compromise the reliability of tissue velocity measurements. This study evaluates the influence of temporal filters on time and velocity variables derived from myocardial tissue velocity images acquired in 15 healthy individuals at a high frame rate (142-184 Hz). Different time and velocity variables from the basal septum were analyzed offline before and after temporal filtering from 20 to 60 milliseconds in 10-millisecond steps using software enabling retrieval of myocardial Doppler velocity and 2-dimensional information from different cardiac locations during the same cardiac cycle. Filtering affected the results by increasing variability of time and by underestimation of velocity variables, the rapid isovolumic events being particularly filter sensitive. In addition, at a certain range of sampling rate, ambiguity of filtering effect was observed. This ought to be considered if an optimal, high-fidelity tissue Doppler velocity signal is to be obtained.
18.	Hayashi, Shirley Yumi, et al. (författare) A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease : A pilot tissue synchronization imaging study 2008 Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 23:11, s. 3622-3628 Tidskriftsartikel (refereegranskat)abstract Background. Mechanical left ventricular (LV) dyssynchrony impairs cardiac function in patients with heart failure and LV hypertrophy (LVH) and may be a factor contributing to the high incidence of cardiac deaths in patients with end-stage renal disease (ESRD). Objectives. To evaluate the possible presence of LV dyssynchrony in ESRD patients, and acute effect of haemodialysis (HD) on LV synchronicity using a tailored echocardiographic modality, tissue synchronization imaging (TSI). Methods. In 13 clinically stable ESRD patients (7 men; 65 +/- 10 years) with LVH, echocardiography data were acquired before and after a single HD session for subsequent off-line TSI analysis enabling the retrieval of regional intraventricular systolic delay data. Six basal and six midventricular LV segments were evaluated. Dyssynchrony was defined as a regional difference in time to peak systolic velocity > 105 ms. Results. Before HD, all patients had at least one dyssynchronous LV segment. The percentage of delayed segments correlated positively to LV end-diastolic diameter (r = 0.68, P < 0.05). HD induced a substantial decrease in the percentage of delayed segments from 36 +/- 25% to 19 +/- 14% (P < 0.01), reduced average maximal mechanical systolic LV delay from 300 +/- 89 to 225 +/- 116 ms (P < 0.05) and completely normalized LV synchronicity in three patients (23%). Conclusions. LV dyssynchrony appears to be present frequently in ESRD patients with LVH. The severity of LV dyssynchrony correlates with LV end-diastolic diameter and decreases after a single session of HD suggesting a mechanistic relevance of volume overload and possibly other toxins accumulating in HD patients.
19.	Hayashi, Shirley Yumi, et al. (författare) Acute effects of low and high intravenous doses of furosemide on myocardial function in anuric haemodialysis patients : a tissue Doppler study 2008 Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 23:4, s. 1355-1361 Tidskriftsartikel (refereegranskat)abstract Background. In patients with pulmonary oedema and preserved renal function, furosemide has not only a renal, but also a vascular effect, causing a rapid fall in left ventricular filling pressure accompanied by an increase in venous compliance. Previous studies have shown conflicting findings regarding the vascular effects of furosemide in patients with end-stage renal disease (ESRD). The objective of our study was to investigate whether furosemide induces changes in central cardiac haemodynamics in anuric ESRD patients, using conventional echocardiography and colour tissue Doppler velocity imaging (TVI), a new quantitative and sensitive method. Methods. Repeated low doses (40 mg followed by an additional dose of 40 mg after 30 min) of i.v. furosemide were administered to 12 (61.6 +/- 16 years, 7 men) and a high dose (250 mg) of i.v. furosemide to 6 (64.1 +/- 3.6 years, 5 men) clinically stable anuric haemodialysis (HD) patients. Conventional two-dimensional echocardiography and colour TVI images were recorded immediately before (0 min) the furosemide infusion in both groups, and in the group receiving the repeated low-dose infusion (at 0 and 30 min), 10, 20, 30, 40, 50 and 70 min after the administration of the first infusion. In the group receiving the single high dose of furosemide the ultrasound investigation was repeated 10, 20, 30 and 40 min after the infusion. The myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVC), peak systole (PS), early (E') and late (A') myocardial diastolic filling velocities were measured in the left ventricle (LV) at six sites (infero-septal, antero-lateral, inferior, anterior, infero-lateral and antero-septal walls) at the basal region. IVC time (IVCT), IV relaxation time (IVRT), PS time (PSt), RR interval, mitral annulus motion (MAM), strain rate (SR), left ventricular filling pressure (E/E') and cardiac output were also measured. The average of the different walls was used to evaluate global function. Right ventricle (RV) dynamics was evaluated from measurements of IVC velocity (IVCv), peak systolic velocity (PSv), E' and A' from the RV free wall. Results. No significant changes in cardiac output, IVCv, PSv, SR, MAM, E', A', E'/A', IVRT and LV filling pressure were observed, indicating that neither 40 mg (plus additional 40 mg after 30 min) nor 250 mg of furosemide had any measurable effects on LV filling pressure and LV and RV systolic and diastolic function. Conclusions. In anuric HD patients, low and high doses of furosemide had no significant effects on central cardiac haemodynamics. Therefore, the use of furosemide infusion in anuric ESRD patients with acute pulmonary oedema is not supported by the results of this study.
20.	Hayashi, Shirley Yumi, et al. (författare) Analysis of mitral annulus motion measurements derived from M-mode, anatomic M-mode, tissue Doppler displacement, and 2-dimensional strain imaging 2006 Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 19:9, s. 1092-1101 Tidskriftsartikel (refereegranskat)abstract Background: Left ventricular longitudinal shortening plays an important role in cardiac contraction and can be measured by the mitral annulus motion (MAM) toward the cardiac apex. MAM can be evaluated by conventional M-mode, anatomic M-mode (AM-mode), tissue Doppler displacement (TDD), and 2-dimensional strain imaging (2DSI). Objective: The aim of the study was to compare these 4 different methods for measuring MAM. Methods: MAM was evaluated in 25 patients by M-mode, AM-mode, TDD, and 2DSI. Two walls (septal and lateral) in apical 4-chamber view were analyzed. Results. The angle correction between M-mode and AM-mode was significantly higher in the lateral wall (septum 2.2+/-1.6 vs lateral 4.1+/-1.6 degrees, P<0.01). However, with angle correction up to 8 degrees, the measurements obtained were not significantly different from those obtained by M-mode. No significant differences were found among 2DSI. M-mode, and AM-mode either, although all of them were significantly higher in comparison with TDD measurements in both septal (M-mode [11.0 +/- 2.4 nun], AM-mode [11.8 +/- 2.4 mm], 2DSI [11.0 +/- 3.4 mm] vs TDD [9.2 +/- 3.3 mm], P<.01) and lateral (M-mode [11.9 +/- 2.3 min], AM-mode [12.4 +/- 2.8 mm], 2DSI [10.4 +/- 3.9 mm] vs TDD [8.9 +/- 3.0 mm], P<.05) walls. The +/- 2SD variation from the mean difference in septal and lateral walls were, respectively, between: M-mode and TDD, -2.4 to 5.9 and -2.2 to 8.2 mm; M-mode and 2DSI, -5.7 to 5.7 and -5.8 to 8.7; AM-mode and TDD, -2.5 to 5.6 and -2.7 to 9.6; AM-mode and 2DSI, -5.7 to 5.87 and -5.9 to 9.8 and TDD and 2DSI, -3.2 to 6.6 and -5.3 to 8.4. Conclusions: AM-mode and M-mode measurements did not differ significantly. Despite the good correlation among all methods they were not interchangeable. TDD measurements were significantly lower than M-mode, AM-mode, and 2DSI measurements. M-mode and AM-mode are angle dependent and can, therefore, underestimate or overestimate MAM. The new method of 2DSI is promising because it tracks natural acoustic markers and is not angle dependent and, therefore, measures the true local tissue motion.
21.	Hayashi, Shirley Yumi, et al. (författare) Improvement of cardiac function after haemodialysis : Quantitative evaluation by colour tissue velocity imaging 2004 Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 19:6, s. 1497-1506 Tidskriftsartikel (refereegranskat)abstract Background. Overhydration and accumulation of uraemic toxins may influence the myocardial function in haemodialysis (HD) patients. To evaluate cardiac function and the effects of fluid and solute removal during a single session of HD, colour tissue velocity imaging (TVI) was used. This new technique, which is less load dependent than conventional echocardiography, allows an objective quantitative assessment of myocardial contractility, contraction and relaxation. Methods. Conventional echocardiographic and TVI images were recorded before and after a single HD session in 13 clinically stable HD patients (62 +/- 10 years, six males) and in 13 sex- and age-matched healthy controls. Myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVC), peak systole (PS), early (E) and late (A') diastolic filling and strain rate (SR) were measured. Results. Left ventricular hypertrophy (LVH) was present in 12 patients. TVI gave additional information in comparison with conventional echocardiography. Before HD, PS (5.0 +/- 0.8 vs 6.0 +/- 1.2 cm/s, P < 0.05), E' (5.7 +/- 1.7 vs 7.3 +/- 2.0 cm/s, P < 0.05) and A' (6.6 +/- 1.7 vs. 8.3 +/- 2.9 cm/s, P < 0.05) velocities were lower in the patients than in the controls, indicating systolic and diastolic dysfunction. The HD session increased IVCv (4.0 +/- 1.7 to 5.5 +/- 1.9 cm/s; P < 0.001), PSv (5.0 +/- 0.8 to 5.7 +/- 0.8 cm/s; P < 0.05) and SR (0.7 +/- 0.2 to 0.9 +/- 0.2 1/s; P < 0.05) and decreased E/E' (16.7 +/- 7.7 to 12.2 +/- 4.0, P < 0.05), indicating improved systolic function and decreased LV filling pressure, respectively. Linear regression analysis demonstrated a dependency of systolic contraction (PSv) and contractility (IVCv) upon plasma levels of phosphate (r(2) = 0.70, P < 0.005, r(2) = 0.33, P < 0.01). Conclusions. Using TVI, HD patients demonstrate myocardial dysfunction, which is found less frequently when using conventional echocardiography. The systolic function seems to be impaired by high plasma levels of phosphate and an increased Ca x P product. One single session of HD improved systolic function as indicated by increases in IVCv, PSv and SR. Further studies are needed to clarify if this effect of HD is due to the acute removal of fluid, the removal of solutes or both.
22.	Hayashi, Shirley Yumi, et al. (författare) Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging 2006 Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 21:1, s. 125-132 Tidskriftsartikel (refereegranskat)abstract Background. Cardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients. Tissue Doppler velocity imaging (TVI) is a new objective method that accurately quantifies myocardial tissue velocities, deformation, time intervals and left ventricular (LV) filling pressure. In this study, TVI was compared with conventional echocardiography for the assessment of left ventricular (LV) function in pre-dialysis patients with different stages of CKD. The results obtained by TVI were used to analyse possible relationships between LV function and clinical factors such as hyperparathyroidism and hypertension that could influence LV function. Methods. Conventional echocardiography and TVI images were recorded in 40 patients (36 men and 4 women, mean age 60 +/- 14 years, range 28-80 years) and in 27 healthy controls (21 men and 6 women, mean age 58 +/- 17 years, range 28-82 years). Twenty-two patients had mild/moderate CKD (CCr > 29 ml/min; Group 1) and 18 patients had severe CKD (CCr <= 29 ml/min; Group 2). Using TVI, the myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVCv), peak systole (PSv), early (E') and late (A') diastolic filling velocities as well as strain rate (SR), mitral annulus displacement, isovolumetric relaxation time (IVRT) and LV filling pressure were estimated using TVI. The average of six LV wall measurements was used to evaluate LV global function. Results. Using TVI, we were able to identify significantly more patients with diastolic dysfunction than using conventional echocardiography (33 vs 26, P < 0.05). There was no difference in the prevalence of diastolic dysfunction between Group 1 and 2. However, using TVI, Group 2 CKD patients had lower E' velocities (6.2 +/- 1.9 vs 8.0 +/- 2.9 cm/s, P < 0.05) and higher IVRT (137.4 +/- 13 vs 88.2 +/- 26 ms, P < 0.001) in comparison with controls, indicating more accentuated diastolic dysfunction. Systolic blood pressure (SBP) was associated with E' velocities (rho = -0.68, P < 0.005) and E'/A' was strongly associated with SBP (rho = -0.60; P < 0.01) and PTH (rho = -0.64, P < 0.005) in Group 2. Using conventional echocardiography, there was no difference in the prevalence of systolic and diastolic dysfunction between patients with and without LVH. However, using TVI, patients with LVH had significantly lower IVCv (2.8 +/- 1.3 vs 3.8 +/- 1.5 and 3.8 +/- 1.5 cm/s, P < 0.05) and PSv (5.5 +/- 1.0 vs 6.3 +/- 1.2 and 6.4 +/- 1.3 cm/s, P < 0.05) compared with patients without LVH and controls, and they also had lower E' velocities (7.1 +/- 2.7 vs 8.0 +/- 2.9 cm/s, P < 0.05) compared with controls, indicating disturbances in systolic and diastolic left ventricular function. Conclusions. TVI provided additional information on left ventricular function in CKD patients. In patients with advanced renal failure, TVI revealed more accentuated diastolic dysfunction associated with increased systolic blood pressure (SBP) and increased levels of PTH. TVI also demonstrated disturbances in contractility and contraction in patients with LVH, which could not be detected by conventional echocardiography.
23.	Hayashi, Shirley Yumi, et al. (författare) Left ventricular mechanical dyssynchrony in patients with different stages of chronic kidney disease and the effects of hemodialysis 2013 Ingår i: Hemodialysis International. - : Wiley-Blackwell. - 1492-7535 .- 1542-4758. ; 17:3, s. 346-358 Tidskriftsartikel (refereegranskat)abstract Left ventricular (LV) dyssynchrony is a known cause of mortality in patients with heart failure and may possibly play a similar role in patients with chronic kidney disease (CKD) in whom sudden death is one of the most common and as yet not fully explained cause of death. LV synchronicity and its relationship with increased volume load and various biomarkers was analyzed in 145 patients including 53 patients with CKD stages 3 and 4 and in 92 CKD stage 5 patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) using color tissue Doppler imaging and tissue synchronization imaging. The HD patients were evaluated both before and after a single HD session. LV dyssynchrony was defined as a regional difference in time to peak systolic myocardial velocity, between 12 LV segments>105milliseconds. LV dyssynchrony was present in 54% of the patients with no difference between CKD 3 and 4 (58%), HD (48%), and PD (51%). LV dyssynchrony was independently associated with LV mass index and increased estimation of LV end-diastolic pressure. A single HD session resulted in significant changes in LV synchronicity variableswith improvement in 50% of the patientsespecially in patients with higher myocardial systolic velocities and lower LV mass index. Abnormalities in LV synchronicity are highly prevalent in CKD patients already prior to dialysis treatment and are associated with LV hypertrophy, LV dysfunction and load conditions, underlining the importance of volume status for LV synchronicity in CKD patients.
24.	Henareh, Loghman, et al. (författare) Disturbed glucose metabolism is associated with left ventricular dysfunction using tissue Doppler imaging in patients with myocardial infarction 2007 Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 27:1, s. 60-66 Tidskriftsartikel (refereegranskat)abstract Aims: To investigate the association between glucose abnormalities and left ventricular (LV) function assessed by tissue Doppler imaging (TDI) in patients with previous history of myocardial infarction and without known diabetes mellitus. Patients and methods: In a cross-sectional study, 123 patients, aged 31-80 years, with a history of previous myocardial infarction and without known diabetes mellitus were examined with TDI echocardiography. A standard oral glucose test (OGTT) with 75 g of glucose was performed. Results: Two-hour plasma glucose were significantly and negatively associated with TDI parameters such as LV ejection time; early diastolic filling velocity (E'-v); ratio of the early to late diastolic filling velocity (E'/A') and positively associated with regional myocardial performance index (MPI) (P < 0.05). Left ventricular ejection time and MPI were significantly higher; E'/A' and E'-v were significantly lower in patients with disturbed glucose metabolism compared with patients with normal glucose tolerance (P < 0.01). These differences remain significant also when the patients with DM were excluded. Conclusions: The present study demonstrates that disturbed glucose metabolism is associated with more pronounced LV dysfunction using TDI in patients with myocardial infarction. These abnormalities in LV function were more common not only in subjects with diabetes, but also in patients with prediabetic condition, impaired glucose intolerance.
25.	Larsson, Matilda, et al. (författare) In-vivo assessment of radial and longitudinal strain in the carotid artery using speckle tracking 2010 Ingår i: 2010 IEEE International Ultrasonics Symposium Proceedings. - : IEEE. - 9781457703829 ; , s. 1328-1331 Konferensbidrag (refereegranskat)abstract Ultrasound-based algorithms are commonly used to assess mechanical properties of arterial walls in studies of arterial stiffness and atherosclerosis. Speckle tracking based techniques used for estimation of myocardial strain can be applied on vessels to estimate strain of the arterial wall. Previous elastography studies in vessels have mainly focused on radial strain measurements, whereas the longitudinal strain has been more or less ignored. However, recently we showed the feasibility of speckle tracking to assess longitudinal strain of the carotid artery in-silico. The aim of this study was to test this methodology in-vivo. Ultrasound images were obtained in seven healthy subjects with no known cardiovascular disease (39 ± 14 years old) and in seven patients with coronary artery disease (CAD), (69 ± 4 years old). Speckle tracking was performed on the envelope detected data using our previous developed algorithm. Radial and longitudinal strains were estimated throughout two cardiac cycles in a region of interest (ROI) positioned in the posterior vessel wall. The mean peak systolic radial and longitudinal strain values from the two heart cycles were compared between the groups using a student's t-test. The mean peak radial strain was -39.1 ± 15.1% for the healthy group and -20.4 ± 7.5% for the diseased group (p = 0.01), whereas the mean peak longitudinal strain was 4.8 ± 1.1% and 3.2 ± 1.6% (p = 0.05) for the healthy and diseased group, respectively. Both peak radial and longitudinal strain values were thus significantly reduced in the CAD patient group. This study shows the feasibility to estimate radial and longitudinal strain in-vivo using speckle tracking and indicates that the method can detect differences between groups of healthy and diseased (CAD) subjects.
26.	Larsson, Matilda, et al. (författare) Wave intensity wall analysis: a novel noninvasive method to measure wave inntensity 2009 Ingår i: Heart and Vessels. - : Springer Science and Business Media LLC. - 0910-8327 .- 1615-2573. ; 24, s. 357-365 Tidskriftsartikel (refereegranskat)abstract Wave intensity analysis is a concept providing information about the interaction of the heart and the vascular system. Originally, the technique was invasive. Since then new noninvasive methods have been developed. A recently developed ultrasound technique to estimate tissue motion and deformation is speckle-tracking echocardiography. Speckle tracking-based techniques allow for accurate measurement of movement and deformation variables in the arterial wall in both the radial and the longitudinal direction. The aim of this study was to test if speckle tracking-derived deformation data could be used as input for wave intensity calculations. The new concept was to approximate changes of flow and pressure by deformation changes of the arterial wall in longitudinal and radial directions. Flow changes (dU/dt) were approximated by strain rate (sr, 1/s) of the arterial wall in the longitudinal direction, whereas pressure changes (dP/dt) were approximated by sign reversed strain rate (1/s) in the arterial wall in the radial direction. To validate the new concept, a comparison between the newly developed Wave Intensity Wall Analysis (WIWA) algorithm and a commonly used and validated wave intensity system (SSD-5500, Aloka, Tokyo, Japan) was performed. The studied population consisted of ten healthy individuals (three women, seven men) and ten patients (all men) with coronary artery disease. The present validation study indicates that the mechanical properties of the arterial wall, as measured by a speckle tracking-based technique are a possible input for wave intensity calculations. The study demonstrates good visual agreement between the two systems and the time interval between the two positive peaks (W1-W2) measured by the Aloka system and the WIWA system correlated for the total group (r = 0.595, P < 0.001). The correlation for the diseased subgroup was r = 0.797, P < 0.001 and for the healthy subgroup no significant correlation was found (P > 0.05). The results of the study indicate that the mechanical properties of the arterial wall could be used as input for wave intensity calculations. The WIWA concept is a promising new method that potentially provides several advantages over earlier wave intensity methods, but it still has limitations and needs further refinement and larger studies to find the optimal clinical use.
27.	Lind, Anna-Britta, et al. (författare) Gene expression of cytochrome P450 1B1 and 2D6 in leukocytes in human pregnancy 2003 Ingår i: Pharmacology and Toxicology. - : Wiley. - 0901-9928 .- 1600-0773. ; 92:6, s. 295-9 Tidskriftsartikel (refereegranskat)abstract We investigated the influence of human pregnancy on gene expression of two cytochrome P450 enzymes in white blood cells. Cytochrome P450 1B1 (CYP1B1) catalyses oestradiol 4-hydroxylation, and may participate in the endocrine regulation of oestrogens. Cytochrome P450 2D6 (CYP2D6) metabolises many commonly used drugs, and previous studies have suggested that it is induced during pregnancy. CYP1B1 and CYP2D6 were therefore considered to be of interest in human pregnancy. As it is not ethically possible to take liver biopsies from healthy mothers during pregnancy, easily accessible cells that express the genes were used as a surrogate tissue. White blood cells were collected from eighteen pregnant women, and were used to measure CYP1B1 and CYP2D6 ribonucleic acid (RNA). The analysis was repeated after pregnancy, the women, thus, serving as their own controls. Real-time reverse transcriptase - polymerase chain reaction methods were used with 18S ribosomal RNA as an internal control. A slight, but not significant, increase in gene activity of CYP1B1 was detected during pregnancy. Expression of CYP2D6 in blood was extremely low, and induction of CYP2D6 during pregnancy could not be confirmed. In conclusion, gene expression of CYP1B1 and CYP2D6 in leukocytes was not significantly up-regulated in the third trimester of pregnancy, but a trend indicating an altered metabolism during pregnancy was detected.
28.	Lind, Anna-Britta, et al. (författare) Steady-state concentrations of mirtazapine, N-desmethylmirtazapine, 8-hydroxymirtazapine and their enantiomers in relation to cytochrome P450 2D6 genotype, age and smoking behaviour 2009 Ingår i: Clinical Pharmacokinetics. - : Springer Science and Business Media LLC. - 0312-5963 .- 1179-1926. ; 48:1, s. 63-70 Tidskriftsartikel (refereegranskat)abstract Background and objective: Mirtazapine is a tetracyclic antidepressant drug available as a racemic mixture of S(+)- and R(-)-mirtazapine. These enantiomers have different pharmacological properties, and both contribute to the clinical and adverse effects of the drug. Cytochrome P450 (CYP) 2D6 has been implicated in the metabolism of S(+)-mirtazapine. However, the effect of CYP2D6 on serum concentrations of the enantiomers of mirtazapine and its metabolites has not been assessed in patients on long-term treatment. The main objective of the study was to evaluate the effect of the CYP2D6 genotype on enantiomeric steady-state trough serum concentrations of mirtazapine and its metabolites N-desmethylmirtazapine and 8-hydroxymirtazapine. The effects of sex, age and smoking behaviour were also assessed. Subjects and methods: The study included 95 patients who had depression according to the Diagnostic and Statistical Manual of Mental Disorders - 4th Edition and were treated for 4 weeks with a daily dose of mirtazapine 30 mg. The serum concentrations of the enantiomers of mirtazapine and its metabolites were analysed by liquid chromatography-mass spectrometry, and the subjects were genotyped for CYP2D6 alleles3, 4,5 and6 and gene duplication. Results: Three subjects (3%) were classified as ultrarapid metabolizers (UMs), 56 (59%) as homozygous extensive metabolizers (EMs), 30 (32%) as heterozygous EMs and 6 (6%) as poor metabolizers (PMs) of CYP2D6. The median trough serum concentrations of S(+)-mirtazapine were higher in PMs (59 nmol/L, p = 0.016) and in heterozygous EMs (39 nmol/L, p = 0.013) than in homozygous EMs (28 nmol/L). PMs and heterozygous EMs also had higher mirtazapine S(+)/R(-) ratios (0.4) than homozygous EMs (0.3, p = 0.015 and 0.004, respectively). The S(+)-N-desmethylmirtazapine concentration was higher in PMs (16 nmol/L) than in homozygous EMs (7 nmol/L, p = 0.043). There was an association between the CYP2D6 genotype and the ratio between S(+)-8-hydroxymirtazapine and S(+)-mirtazapine, with a significantly higher ratio in homozygous EMs than in heterozygous EMs (0.11 vs 0.05, p = 0.007). The influence of the CYP2D6 genotype on S(+)-mirtazapine, the mirtazapine S(+)/R(-) ratio and S(+)-N- desmethylmirtazapine remained significant after correction for the influence of sex, age and smoking. Smokers had significantly lower concentrations of S(+)-mirtazapine (23 vs 39 nmol/L, p = 0.026) and R(-)-N-desmethylmirtazapine (39 vs 51 nmol/L, p = 0.036) and a significantly lower mirtazapine S(+)/R(-) ratio (0.28 vs 0.37, p = 0.014) than nonsmokers, and the effect of smoking remained significant after multivariate analysis. Conclusions: This study is the first to show the impact of the CYP2D6 genotype on steady-state serum concentrations of the enantiomers of mirtazapine and its metabolites. Our results also support the role of CYP1A2 in the metabolism of mirtazapine, with lower serum concentrations in smokers than in nonsmokers.
29.	Lind, Britta (författare) Evaluation of isovolumic myocardial motions in human subjects using tissue velocity echocardiography 2006 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Colour-coded tissue velocity imaging (TVE) with Echocardiography is an established method for evaluation of the global cardiac function and of the regional myocardial movements. The TVE-technique allows measurements of velocity and deformation variables from any discrete point in the myocardial wall during the cardiac cycle with high temporal and longitudinal spatial resolution. Even the rapid kinetic events during the isovolumic phases can be analysed which has been reported to be involved in the process of pre and postsystolic ventricular reshaping. However, the optimal sampling requirements for a proper rendering of the tissue velocity variables and the effect of different temporal smoothing filters incorporated in the WE software have not yet been established. The aims for current thesis were to establish optimal values for temporal resolution and also to study the effect of temporal filtering algorithms on colour-coded tissue derived duration and velocity variables registered at the base of left ventricle in apical views. After ensuring adequate sampling rate and temporal filter width for the myocardial velocity profiles the isovolumic periods were analysed in fortynine healthy subjects to describe normal reference values in the base of four different cardiac walls. The influence of gender and age were also studied for isovolumic time, velocity variables as well their respectively amplitude motion. The reproducibility for the longitudinal and radial myocardial velocity and displacement variables was studied and varied between 5-12% (CV). The temporal resolution should at least 100 frames/s for a proper rendering of the myocardial velocity variables during the entire cardiac cycle. Increased temporal filter width affected the results by decreased myocardial velocities and the effect was most pronounced during the rapid isovolumic events. The longitudinal motions of left ventricular wall showed biphasic patterns during the isovolumic contraction and relaxation periods and the segmental velocities and displacements differs among the four walls. The relative myocardial isovolumic displacement was most pronounced in anterior wall (5.0 of the total longitudinal myocardial shortening). Except prolonged duration of the TVE-IVRT in the older age group, no other larger gender and age differences occurred.
30.	Lind, Britta, et al. (författare) Left ventricular isovolumic velocity and duration variables calculated from colour-coded myocardial velocity images in normal individuals 2004 Ingår i: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 5:4, s. 284-293 Tidskriftsartikel (refereegranskat)abstract Aims: To describe the normal myocardial velocity profile during the isovolumic contraction and relaxation period at four different locations within left ventricular base and to establish normal age and gender related isovolumic time and velocity values. Methods and results: In 49 healthy individuals (26 women/23 men) in age groups 21-49 and 50-76 years, tissue velocity profiles and 2D-data were acquired at high temporal resolution (90-147 frames/s) for a subsequent off-line analysis using software enabling retrieval of myocardial Doppler velocity and 2D/anatomical M-mode information from different cardiac locations during the same cardiac cycle. The obtained velocity curves during the isovolumic contraction and relaxation period were usually biphasic and displayed clear regional differences in their respective positive and negative maximal velocities. Besides some gender related differences, mainly in the duration of the positive and negative velocity wave components during the isovolumic contraction period, a clear age-dependent increase in the duration of the isovolumic relaxation phase and its negative and positive velocity components was observed. Conclusion: Modern tissue Doppler imaging supplemented by anatomical M-mode images of the mitral and aortic valve movements allows a proper analysis of the rapid isovolumic myocardial movements. The presented normal isovolumic time and velocity values may prove useful for studies of myocardial function.
31.	Lind, Britta, et al. (författare) Longitudinal isovolumic displacement of the left ventricular myocardium assessed by tissue velocity echocardiography in healthy individuals 2006 Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 19:3, s. 255-265 Tidskriftsartikel (refereegranskat)abstract Rapid myocardial isovolumic motions are reportedly involved in the left ventricular reshaping process and may contribute to total systolic myocardial shortening. in this study, the qualitative and quantitative analysis of longitudinal myocardial isovolumic displacement was performed in 49 healthy individuals (23 men and 26 women) in age groups 21 to 49 and 50 to 76 years using tissue velocity echocardiography. The obtained isovolumic contraction and relaxation displacement curves were biphasic and displayed a significant regional heterogeneity most probably reflecting active presystolic and post-systolic reshaping of left ventricular cavity. Besides some sex difference in younger individuals, there was an age-dependent lengthening of the isovolumic relaxation time and their motion components. Even if being of short duration, the longitudinal myocardial isovolumic displacement may accounted for as much as 14% of the total longitudinal myocardial shortening, a fact which should be taken into consideration when assessing left ventricular systolic function.
32.	Lind, Ewa, 1968- (författare) Tephra horizons in the North Atlantic region during the Early Holocene 2014 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Uncertainties about the rate and magnitude of future climate change have drawn attention to the climate variability following the Late Glacial-Early Holocene transition, c. 12-8 ka BP. Tephrochronology is a method that uses volcanic ash as isochrons in order to link, date and synchronise geological and palaeoclimatic records which could provide a better understanding of short rapid climate shifts but also the timing of these.The main purpose of this thesis was to improve and refine the Late Younger Dryas-Early Holocene (c. 12-8 ka BP) tephrochronological framework with focus on dating and identification of new and previously known tephra horizons in the North Atlantic region. A special emphasis was to identify tephra horizons contemporary to short rapid climate events that occurred during the period; the Preboreal Oscillation (c. 11.3 ka BP), the Erdalen events (c. 10.0-9.8 ka BP), the 9.3 ka BP and the 8.2 ka BP events. Additional purposes have been to evaluate the potential of XRF ITRAX core-scanning to identify tephra in lake sediments but also as a tool in palaeoclimate studies.The potential of tephrochronology for linking climate archives across the North Atlantic region is a main outcome in this thesis. Specific results include five new tephra horizons; four identified on the Faroe Islands and one in Central Norway. Two previously known tephras, the Hässeldalen and Askja-S tephras, were identified on the Faroe Islands for the first time and at new locations in Sweden which confirmed their widespread distribution in NW Europe. Several of these tephras have the potential to become marker horizons for some of the short rapid climate events which occurred during the Late Younger Dryas-Early Holocene but their importance is yet to be determined. Further results show that the XRF core scanner can be used successfully to identify high concentrations of basaltic tephra but also to identify palaeoclimatic events in lake sediments.
33.	Lind, Ewa (författare) Towards an Early Holocene Tephrochronology for the Faroe Islands: Methodology and first results 2011 Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract The uncertainties regarding future climate change have put considerable notice to the climate variability following the Late Glacial-Holocene transition (ca. 13-9 ka BP) in the North Atlantic region as well as the forcing mechanisms behind climate changes. Much attention has focused on short climate events in order to understand the mechanisms that drove these changes but also to identify the leads and lags in the climate system. Chronological uncertainties for these events remain but an accurate chronological framework for the North Atlantic region would enhance possibilities to solve some of the chronological questions. Tephrochronology uses volcanic ash from a volcanic eruption which creates a marker horizon in marine and lake sediments, peat bogs and glacier ice as the ash is spread over large areas. These time-parallel markers allow precise correlations between archives. The purpose of this thesis is to improve and refine the Early Holocene tephrochronological framework with focus on dating and identification of new and previously known tephra horizons on the Faroe Islands, especially around the climatic events of the Preboreal Oscillation (11,300-11,100 cal. yr BP), the Erdalen events (10,100-10,050 and 10,000-9800 cal. yr BP) and the 9.3 ka BP event. A second goal is to develop the methodology of tephrochronology for finding cryptotephra (not visible by the eye) horizons in lacustrine sediments. The findings of eight tephra horizons spanning ca. 11,350 to 9700 cal yr BP where three are known from other locations in Europe show the potential of tephrochronology for linking records across the North Atlantic region. Refined ages for the Askja-S and Hässeldalen tephra were obtained from an age model built on eight AMS radiocarbon ages with the Saksunarvatn ash as a constrained age. The results from using XRF ITRAX core scanner to locate tephra in lacustrine sediments illustrate that high concentrations of basaltic tephra could be captured but not lower concentrations of rhyolitic shards.
34.	Mattsson, C. Mikael, et al. (författare) No evidence of cardiac fatigue in tissue velocity curves at rest after 6 days of ultra-endurance exercise 2010 Ingår i: European Heart Journal (2010) 31 (Abstract Supplement), 304-305. - : Oxford Journals. ; , s. 304-305 Konferensbidrag (refereegranskat)abstract Purpose: The aim of this study was to investigate if extreme workload would induce signs of cardiac fatigue similar to that in skeletal muscle, e.g. decreased velocity of contraction. Methods: The subjects were 12 men and 3 women who participated in the Adventure Racing World Championship, a 5-7 days non-stop competition open for mixed gender teams of four. All subjects were healthy, well-trained ultra-endurance athletes with experince from several years of training and competition at international elite level. Measurements of the heart's contraction velocities were conducted using tissue Doppler imaging (VIVID7) in a resting situation at baseline, immediately after the race, and after 24 hours of recovery. Results: Characteristics for the subjects were at baseline (mean ± SD, for men and women): age 30±3 and 27±4; interventricular septal thickness 10.5±0.7 and 8.0±0.0 mm; left ventricular end-diastolic diameter 54.4±3.4 and 45.0±3.0 mm; posterior wall thickness 10.4±0.9 and 8.0±1.0 mm; early to late diastolic filling velocity (E/A) 2.3±0.6 and 2.2±0.2. Exercise duration was approx. 150 hours, and the calculated average work intensity was 40% of respective VO2peak, including time for rest, change of equipment, and food intake. Values of contraction velocities are presented in the table. Conclusions: All athletes had normally sized hearts. Based on contraction velocities we found no evidence of cardiac fatigue after ultra-endurance exercise. A difference compared to studies that found cardiac fatigue in other sports (e.g. marathon, triathlon) is that even though our population exercised for an extreme duration the average intensity was low. This might point towards that exercise intensity, not duration, is the primary source for cardiac fatigue.
35.	Mattsson, C. Mikael, et al. (författare) No evidence of cardiac fatigue in tissue velocity curves at rest after 6 days of ultra-endurance exercise. 2011 Tidskriftsartikel (refereegranskat)
36.	Mattsson, C. M., et al. (författare) No evidence of cardiac fatigue in tissue velocity curves at rest after 6 days of ultra-endurance exercise 2010 Ingår i: European Heart Journal. - 0195-668X .- 1522-9645. ; 31, s. 304-305 Tidskriftsartikel (refereegranskat)
37.	Mekjavic, I.B., et al. (författare) Hypoxic bedrest : Implications for planetary habitats 2012 Konferensbidrag (refereegranskat)
38.	Quintana, Miguel, et al. (författare) Assessment of atrial regional and global electromechanical function by tissue velocity echocardiography : a feasibility study on healthy individuals 2005 Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; 3:18 February 2005 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The appropriate evaluation of atrial electrical function is only possible by means of invasive electrophysiology techniques, which are expensive and therefore not suitable for widespread use. Mechanical atrial function is mainly determined from atrial volumes and volume-derived indices that are load-dependent, time-consuming and difficult to reproduce because they are observer-dependent. AIMS: To assess the feasibility of tissue velocity echocardiography (TVE) to evaluate atrial electromechanical function in young, healthy volunteers. SUBJECTS AND METHODS: We studied 37 healthy individuals: 28 men and nine women with a mean age of 29 years (range 20-47). Standard two-dimensional (2-D) and Doppler echocardiograms with superimposed TVE images were performed. Standard echocardiographic images were digitized during three consecutive cardiac cycles in cine-loop format for off-line analysis. Several indices of regional atrial electrical and mechanical function were derived from both 2-D and TVE modalities. RESULTS: Some TVE-derived variables indirectly reflected the atrial electrical activation that follows the known activation process as revealed by invasive electrophysiology. Regionally, the atrium shows an upward movement of its walls at the region near the atrio-ventricular ring with a reduction of this movement towards the upper levels of the atrial walls. The atrial mechanical function as assessed by several TVE-derived indices was quite similar in all left atrium (LA) walls. However, all such indices were higher in the right (RA) than the LA. There were no correlations between the 2-D- and TVE-derived variables expressing atrial mechanical function. Values of measurement error and repeatability were good for atrial mechanical function, but only acceptable for atrial electrical function. CONCLUSION: TVE may provide a simple, easy to obtain, reproducible, repeatable and potentially clinically useful tool for quantifying atrial electromechanical function.
39.	Quintana, M., et al. (författare) Assessment of the longitudinal and circumferential left ventricular function at rest and during exercise in healthy elderly individuals by tissue-Doppler echocardiography : relationship with heart rate 2004 Ingår i: Clinical Science. - : Portland Press Ltd.. - 0143-5221 .- 1470-8736. ; 106:5, s. 451-457 Tidskriftsartikel (refereegranskat)abstract Tissue-Doppler echocardiography (TDE) has been introduced to quantify stress echocardiography by means of assessing the left ventricular (LV) segmental myocardial velocities and excursion. The interaction between LV long- and short-axis function during physical exercise has not been elucidated completely. The aim of the present study was to investigate long- and short-axis LV function, as assessed by myocardial velocities and excursions at rest and during exercise and its possible relationship with heart rate in healthy elderly individuals by TIDE Twenty-seven individuals underwent an exercise test in the supine position on a bicycle ergometer. The initial workload was 30 Watts, followed by 20-Watt increments every third minute. Standard echocardiographic images with super-imposed colour TDE were digitized at the end of each step. The following variables were studied in the LV long- and short-axis: myocardial peak systolic velocity (PSV) and excursion, isovolumic contraction and relaxation times, peak velocity at early diastole (E-wave) and peak velocity at late diastole (A'-wave) and the E'/A' ratio. Increments in myocardial peak systolic velocity and excursion in the LV long-axis were more pronounced during low workloads. The increase in those variables in the short-axis occurred mainly, at higher exercise loads. The improvement in LV long- and short-axis functions was closely related to the increase in the heart rate. Shortening of the isovolumic contraction and relaxation times occurred only at the initial stages of exercise. An increase in the long-axis E'/A' ratio occurred during exercise, whereas this ratio was unchanged in the short-axis. In conclusion, during exercise, the LV long- and short-axis functions behave differently, and increases in LV long- and short-axis functions are related to changes in heart rate. Therefore, in the interpretation of echocardiographic findings during exercise stress echocardiography, these facts have to be taken into account.
40.	Quintana, M., et al. (författare) Electromechanical coupling, uncoupling, and ventricular function in patients with bundle branch block : A tissue-doppler echocardiographic study 2004 Ingår i: Echocardiography. - : Wiley. - 0742-2822 .- 1540-8175. ; 21:8, s. 687-698 Tidskriftsartikel (refereegranskat)abstract Background: Left bundle branch block (LBBB) is associated with impaired left ventricular (LV) function and increased morbidity and mortality, especially in patients with structural heart diseases. The mechanisms are poorly understood. Subjects and Methods: Subjects with isolated LBBB (n = 20), right bundle branch block (RBBB, n = 20), and controls (C, n = 20) were studied with standard two-dimentional (2D), and color-encoded tissue-Doppler echocardiography (TDE). Inter- and intraventricular systolic and diastolic coordination were assessed from the TDE velocity profiles. LV function was assessed by 2D echocardiography, by TDE-derived peak systolic velocities, and the atrioventricular (AV) plane displacement. Results: Subjects with LBBB had longer electromechanical delays and longer isovolumic relaxation times than did the C and RBBB groups (P < 0.001). For the LBBB subjects compared with the RBBB and C groups, ejection times were shorter, peak systolic velocities and AV plane displacements were lower, they had larger LV end-systolic volumes and lower LV ejection fraction (all P < 0.001), and the atrial contribution to A-V plane displacement was higher (P < 0.01). There were no differences in diastolic or filling times among the groups. Conclusions: In patients with LBBB, delayed regional electromechanical coupling and uncoupling leads to generalized intra- and interventricular asynchrony, thereby explaining the depressed regional and global LV functions. Assessment of the electromechanical coupling and uncoupling processes and their consequences on cardiac function in patients with BBB and structural heart diseases may be possible using TDE.
41.	Saha, Samir, et al. (författare) Functional diagnosis of coronary stenosis using tissue tracking provides best sensitivity and specificity for left circumflex disease : experience from the MYDISE (myocardial Doppler in stress echocardiography) study. 2005 Ingår i: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 6:1, s. 54-63 Tidskriftsartikel (refereegranskat)abstract AIMS: To evaluate the diagnostic capacity of quantitative analysis of segmental longitudinal myocardial displacement images (tissue tracking, TT) during dobutamine stress echocardiography for the detection of patients with coronary artery disease (CAD). METHODS AND RESULTS: TT-generated colour-coded maps of systolic segmental longitudinal displacement were obtained by post-processing of echocardiographic data from 105 patients with CAD and 90 low risk individuals selected from MYDISE database. Quantitative analysis of the distribution pattern of segmental displacement during dobutamine stress was most successful when a ratio of basal (high amplitude) to apical (low amplitude) colour-coded displacement bands (B/A ratio) was employed. Applied in four different left ventricular sectors, the B/A ratio provided a significant discrimination of patients with CAD (p<0.05 in the anterior and p<0.001 in the inferior wall) as assessed by receiver operating characteristic analysis. The procedure was most sensitive when applied in inferior wall for the detection of left circumflex coronary artery disease, the B/A ratio of 0.8 giving the best combination of sensitivity (77+/-8%) and specificity (77+/-5%) values. CONCLUSION: Quantification of dobutamine stress echocardiography using TT is an efficient diagnostic approach and a valuable additional modality in functional cardiac imaging for the initial identification of patients suspected for CAD.
42.	Saha, S. K., et al. (författare) Myocardial velocities measured during adenosine, dobutamine and supine bicycle exercise : a tissue Doppler study in healthy volunteers 2004 Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 24:5, s. 281-288 Tidskriftsartikel (refereegranskat)abstract Background: Dobutamine stress echocardiography (DSE) quantified by tissue Doppler (TVI) have improved the diagnostic capacity of the procedure. Quantification of other stress modalities, e.g. adenosine stress echo (ASE) and exercise stress echocardiography (ESE) are necessary for assessing any pathophysiological differences in different forms of stress. Methods: Ten healthy individuals underwent ASE, DSE, and ESE during a span of 2-5 days. Left ventricular (LV) apical images at rest and peak stress (max) were postprocessed using TVI on a GE System FiVe equipment. ECG-derived QRS duration (QRSD, ms), heart rate (HR, bpm), TVI-estimated basal systolic velocities (S2V, cm s(-1)), ejection time (S2T, ms) and strain (S, %) were computed off-line and compared. Longitudinal displacement imaging, tissue tracking, was also made. Results: Data for ASE, DSE and ESE during peak stress were (HR: 84 +/- 12***, 142 +/- 19, 137 +/- 27; P0.05) response at a much lower HR indicates that adenosine has minor effects on contraction presumably secondary to vasodilatation. Powerful chronotropic response to DSE and ESE is probably prerequisite for strong velocity response at the expense of strain and displacement. TVI-assisted stress echocardiography thereby shows different LV systolic response in healthy individuals, depending on stress modality.
43.	Sahlén, Anders, et al. (författare) Magnitude, reproducibility, and association with baseline cardiac function of cardiac biomarker release in long-distance runners aged > or =55 years 2008 Ingår i: American Journal of Cardiology. - : Elsevier BV. - 0002-9149 .- 1879-1913. ; 102:2, s. 218-222 Tidskriftsartikel (refereegranskat)abstract Cardiac biomarker release after endurance exercise has been described in young athletes. Although older athletes are increasingly active in such sports, they have not previously been studied. Therefore, the aim of this study was to assess the magnitude and reproducibility of biomarker release in athletes aged > or =55 years. Forty-three healthy athletes (mean age 61 +/- 3.6 years) were assessed before and immediately after a 30-km cross-country race and studied with echocardiography at rest. The median N-terminal pro-brain natriuretic peptide (NT-proBNP; normal <194 ng/L) level was 42 ng/L (interquartile range 30 to 95) at baseline and 191 ng/L (interquartile range 114 to 308) after the race. Troponin T (normal <0.03 microg/L) was elevated in 19 subjects (44%) after the race. Twenty-two subjects had also been studied 3 years before at the same race, using an identical test protocol. Between the 2 races, strong correlations were seen for individual runners' postrace biomarker levels (NT-proBNP: r = 0.82, log transformed data; troponin T: Spearman's rho = 0.84; p <0.001 for both). The coefficient of variation for NT-proBNP release was 8.1%. Levels of NT-proBNP after the race were correlated with levels at baseline (r = 0.93, p <0.001) and with left ventricular mass index (r = 0.32, p = 0.03). Moreover, participants with elevated postrace NT-proBNP were significantly older (62.0 vs 59.8 years, p = 0.04). In conclusion, long-distance runners aged > or =55 years released NT-proBNP and troponin T in a reproducible fashion. The magnitude of NT-proBNP release during the race was correlated strongly with NT-proBNP baseline levels and was associated with left ventricular mass and age. These findings may suggest a potential adverse effect of long-distance running on cardiac function in certain participants in this age group.
44.	Shirley, Hayashi, et al. (författare) Improvement of Left Ventricular Synchronicity Assessed by Tissue Synchronization Imaging after a Single HD Session 2009 Ingår i: Blood Purification. - : KARGER. - 0253-5068 .- 1421-9735. ; 28:4, s. 306-306 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
45.	Storaa, C., et al. (författare) Distribution of left ventricular longitudinal peak systolic strain and impact of low frame rate 2004 Ingår i: Ultrasound in Medicine and Biology. - : Elsevier BV. - 0301-5629 .- 1879-291X. ; 30:8, s. 1049-1055 Tidskriftsartikel (refereegranskat)abstract The myocardium has complex 3-D motion that is frequently described using ultrasound (US) Doppler techniques that are limited to recording velocities in one dimension only. Studies using 3-D tagged magnetic resonance show that the myocardium has strain components with varying angles throughout the myocardium. Despite this, there seems to be a belief that the left ventricular longitudinal strain distribution should be homogeneous. When measuring myocardial strain, there are several parameters for the clinician to decide on, one of them being recording frame rate. The current study aims to further investigate the alleged homogeneity of the longitudinal myocardial strain distribution and to discover the impact that the frame rate has on these measurements. Myocardial strain was measured in 43 healthy individuals at different frame rates. Analysis of variance results clearly demonstrate that the strain is not uniformly distributed over the wall; there seems to be an increasing strain from apex toward the base. However, subjects exist with different distributions; thus, it is not possible to conclude that certain strain patterns are normal. Reduced frame rate had a highly significant impact on the measured strain results and it is seen that, at low frame rates, the strain values were reduced. (E-mail: Camilia.Storaa@labmed.ki.se)
46.	Storaa, Camilla, et al. (författare) Tissue motion imaging of the left ventricle--quantification of myocardial strain, velocity, acceleration and displacement in a single image 2004 Ingår i: European Journal of Echocardiography. - : Oxford University Press (OUP). - 1525-2167 .- 1532-2114. ; 5:5, s. 375-385 Tidskriftsartikel (refereegranskat)abstract AIMS: Several methods of parametric imaging of left ventricular function including tissue velocity imaging (TVI) and strain rate imaging (SRI) have previously been presented, however, they have the limitation that they can, respectively, portray only one physiological myocardial parameter. The aims of this pilot study were to implement and validate tissue motion imaging (TMI) for the first time, a visualization technique which permits acceleration, velocity, displacement and strain to be interpreted quantitatively or semi-quantitatively in a single image. METHODS AND RESULTS: TMI is achieved by the color coding of temporal tissue velocity integrals. The principles behind this technique are validated, and case examples demonstrating its use in the clinical setting are provided. Limitations of the method as well as future applications and improvements are discussed. CONCLUSION: As this method allows representation of a multitude of variables and is visually attractive, it may facilitate more widespread use of myocardial quantitation in everyday practice.
47.	Söderqvist, Emil, et al. (författare) Feasibility of creating estimates of left ventricular flow-volume dynamics using echocardiography 2006 Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; :4:40 Tidskriftsartikel (refereegranskat)abstract Background:This study explores the feasibility of non-invasive assessment of left ventricular volume and flow relationship throughout cardiac cycle employing echocardiographic methods.Methods:Nine healthy individuals and 3 patients with severe left-sided valvular abnormalities were subject to resting echocardiography with automated endocardial border detection allowing real-time estimation of left ventricular volume throughout the cardiac cycle. Global and regional (6 different left ventricular segments) estimates of flow-volume loops were subsequently constructed by plotting acquired instantaneous left ventricular 2-D area data (left ventricular volume) vs. their first derivatives (flow).Results:Flow-volume loop estimates were obtainable in 75% of all echocardiographic images and displayed in normal individuals some regional morphological variation with more pronounced isovolumic events in the paraseptal segments and significantly delayed maximal systolic flow paraapically. In patients with aortic stenosis, maximal systolic flow occurred at a lower estimated left ventricular systolic volume whereas in mitral stenosis, maximal diastolic flow was observed at a higher estimated left ventricular diastolic volume. Aortic regurgitation caused a complex alteration of the estimated flow-volume loop shape during diastole.Conclusion:Non-invasive assessment of left ventricular flow-volume relationship with echocardiography is technically feasible and reveals the existence of regional variation in flow-volume loop morphology. Valvular abnormalities cause a clear and specific alteration of the estimates of the normal systolic or diastolic flow-volume pattern, likely reflecting the underlying pathophysiology.
48.	Söderqvist, Emil, et al. (författare) Left ventricular pressure indicies help to evaluate loading conditions and contractility 2002 Ingår i: IFMBE proc. - 1680-0737. ; , s. 1014-5 Tidskriftsartikel (refereegranskat)
49.	Wagstrom, Elle, et al. (författare) The Cardiac State Diagram As A Novel Approach For The Evaluation Of Pre- And Post-Ejection Phases Of The Cardiac Cycle In Asphyxiated Fetal Lambs 2013 Ingår i: Ultrasound in Medicine and Biology. - : Elsevier BV. - 0301-5629 .- 1879-291X. ; 39:9, s. 1682-1687 Tidskriftsartikel (refereegranskat)abstract The aim of this study was to investigate myocardial wall motion using echocardiography and color-coded tissue velocity imaging and to generate a cardiac state diagram for evaluation of the duration of the pre- and post-ejection phases in asphyxiated fetal lambs. Six near-term lambs were partly exteriorized and brought to cardiac arrest through asphyxia. Echocardiography measurements were recorded simultaneously with arterial blood sampling for lactate and blood gases. All fetal lambs exhibited prolongation of the pre- and post-ejection phases at the time when the most pronounced changes in lactate concentration and pH occurred. The mean change in duration of the pre- and post-ejection phases for all fetal lambs was 36 +/- 7 ms (p < 0.002) and 77 +/- 17 ms (p < 0.019), respectively, and the percentage change was 50% (p < 0.001) and 38% (p < 0.049), respectively. As asphyxia progressed in fetal lambs, the duration of the pre- and post-ejection phases increased. The cardiac state diagram has the potential to be a comprehensible tool for detecting fetal asphyxia. (E-mail: elle.wagstrom@karolinska.se) (C) 2013 World Federation for Ultrasound in Medicine & Biology.
50.	Wågström, Elle, et al. (författare) The Cardiac State Diagram as a novel approach for evaluation of phases of the cardiac cycle in asfyxiated fetal lambs 2012 Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91, s. 144-144 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)

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