| 1. |
- Leta, Tesfaye H., et al.
(författare)
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Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement
- 2024
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Ingår i: JAMA Network Open. - 2574-3805. ; 7:5, s. 2412898-2412898
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Despite increased use of antibiotic-loaded bone cement (ALBC) in joint arthroplasty over recent decades, current evidence for prophylactic use of ALBC to reduce risk of periprosthetic joint infection (PJI) is insufficient. Objective: To compare the rate of revision attributed to PJI following primary total knee arthroplasty (TKA) using ALBC vs plain bone cement. Design, Setting, and Participants: This international cohort study used data from 14 national or regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, New Zealand, Norway, Romania, Sweden, Switzerland, the Netherlands, the UK, and the US. The study included primary TKAs for osteoarthritis registered from January 1, 2010, to December 31, 2020, and followed-up until December 31, 2021. Data analysis was performed from April to September 2023. Exposure: Primary TKA with ALBC vs plain bone cement. Main Outcomes and Measures: The primary outcome was risk of 1-year revision for PJI. Using a distributed data network analysis method, data were harmonized, and a cumulative revision rate was calculated (1 - Kaplan-Meier), and Cox regression analyses were performed within the 10 registries using both cement types. A meta-analysis was then performed to combine all aggregated data and evaluate the risk of 1-year revision for PJI and all causes. Results: Among 2 168 924 TKAs included, 93% were performed with ALBC. Most TKAs were performed in female patients (59.5%) and patients aged 65 to 74 years (39.9%), fully cemented (92.2%), and in the 2015 to 2020 period (62.5%). All participating registries reported a cumulative 1-year revision rate for PJI of less than 1% following primary TKA with ALBC (range, 0.21%-0.80%) and with plain bone cement (range, 0.23%-0.70%). The meta-analyses based on adjusted Cox regression for 1 917 190 TKAs showed no statistically significant difference at 1 year in risk of revision for PJI (hazard rate ratio, 1.16; 95% CI, 0.89-1.52) or for all causes (hazard rate ratio, 1.12; 95% CI, 0.89-1.40) among TKAs performed with ALBC vs plain bone cement. Conclusions and Relevance: In this study, the risk of revision for PJI was similar between ALBC and plain bone cement following primary TKA. Any additional costs of ALBC and its relative value in reducing revision risk should be considered in the context of the overall health care delivery system.
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| 2. |
- Leta, Tesfaye H., et al.
(författare)
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The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania
- 2023
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Ingår i: Acta Orthopaedica. - 1745-3674 .- 1745-3682. ; 94, s. 416-425
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA). Patients and methods — This observational study is based on 2,971,357 primary TKAs reported in 2010–2020 to national/regional joint arthroplasty registries in Australia, Den-mark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries. Results — ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register). Conclusion — The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries.
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| 3. |
- Andersson, Anders, et al.
(författare)
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Describing fish passage in a river confluence with telemetry and CFD
- 2016
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Konferensbidrag (refereegranskat)abstract
- The confluence between hydropower tailrace and the old river bed in Stornorrfors in the river Umeälven in the northern part of Sweden has shown to be the largest obstacle for upstream migrating salmon and sea trout during the migrating season. Fish are attracted to the high flow rate from the tailrace and will not migrate upstream in the old river bed being the passage to the fishway leading past the hydropower dam. By triangulating the movements of radio tagged fish using eight antennas in the confluence, it is here possible to describe the individual fish tracks left by radio tagged fish during the migrating season. These tracks are then compared with three-dimensional Computational Fluid Dynamics (CFD) simulations of the confluence. By simulating the most common combinations of turbine flow and spill flow in the old river bed it is then possible to find correlations between individual fish movements and flow parameters such as velocity, turbulence intensity or vorticity for different flow combinations. It was previously assumed that fish had trouble locating the old river bed, the results of the triangulation however shows that most fish finds the old river bed within a few days but does not chose to migrate until several days (or weeks) later. The main issue to be solved is therefore not how to attract the fish to the old river bed but rather how to create favorable conditions in the old river bed so that migrating fish are more inclined to take that path upstream.
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| 4. |
- Andersson, Anders G., et al.
(författare)
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A numerical study of the location and function of the entrance of a fishway in a regulated river
- 2010
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Ingår i: 8th International Symposium on ECOHYDRAULICS. ; , s. 277-284
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Konferensbidrag (refereegranskat)abstract
- Simulation driven design with Computational Fluid Dynamics has been used to evaluate the flow downstream a hydropower plant with regards to upstream migrating fish. Field measurements with an Acoustic Doppler Current Profiler were performed and the measurements were used to validate the simulations. The measurements indicate a more unstable flow than the simulations and the tailrace jet from the turbines is stronger in the simulations. The simulations are however considered to capture the important features of the flow in a way that makes them viable for attraction water simulations. A fishway entrance was included in the simulations and the subsequent attraction water was evaluated for two positions and two angles of the entrance at different turbine discharges. Results show that both positions are viable and that a position where the flow from the fishway does not have to compete with the flow from the power plant will generate superior attraction water. Simulations were also performed further downstream where the flow from the turbines meets the old river bed which is the current fish passage for upstream migrating fish. A modification of the old river bed was made in the model as one scenario to generate better attraction water. This considerably increases the attraction water although it cannot compete with the flow from the tailrace tunnel.
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| 5. |
- Andersson, Anders G., et al.
(författare)
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A study of the location of the entrance of a fishway in a regulated river with CFD and ADCP
- 2012
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Ingår i: Modelling and Simulation in Engineering. - : Hindawi Limited. - 1687-5591 .- 1687-5605. ; 2012
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Tidskriftsartikel (refereegranskat)abstract
- Simulation-driven design with computational fluid dynamics has been used to evaluate the flow downstream of a hydropower plant with regards to upstream migrating fish. Field measurements with an Acoustic Doppler Current Profiler were performed, and the measurements were used to validate the simulations. The measurements indicate a more unstable flow than the simulations, and the tailrace jet from the turbines is stronger in the simulations. A fishway entrance was included in the simulations, and the subsequent attraction water was evaluated for two positions and two angles of the entrance at different turbine discharges. Results show that both positions are viable and that a position where the flow from the fishway does not have to compete with the flow from the power plant will generate superior attraction water. Simulations were also performed for further downstream where the flow from the turbines meets the old river bed which is the current fish passage for upstream migrating fish. A modification of the old river bed was made in the model as one scenario to generate better attraction water. This considerably increases the attraction water although it cannot compete with the flow from the tailrace tunnel.
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| 6. |
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| 7. |
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| 8. |
- Leonardsson, Kjell, et al.
(författare)
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Describing fish passage in a river confluence with telemetry and CFD
- 2016
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The confluence between a hydropower tailrace and the old river bed in Stornorrfors in the river Umealven in the northern part of Sweden has shown to be the largest obstacle for upstream migrating salmon and sea trout. Fish are attracted to the high flow rate from the tailrace and will not migrate upstream in the old river bed to the fishway leading past the hydropower dam. By using triangulation from eight antennas in the confluence, the tracks of radio tagged migrating fish can be determined. These tracks are then compared with three-dimensional Computational Fluid Dynamics (CFD) simulations of the confluence. By simulating the most common combinations of turbine flow and spill flow in the old river bed it is possible to find correlations between fish movements and the flow field. It was previously assumed that fish had trouble locating the old river bed, the results of the triangulation however shows that most fish find the old river bed within a few days but do not chose to migrate until several days or even weeks later. The main issue is therefore not how to attract the fish to the old river bed, but rather how to create favorable conditions in the old river bed so that migrating fish are more inclined to take that path upstream.
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| 9. |
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| 10. |
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| 11. |
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| 12. |
- Lindberg, Dan-Erik
(författare)
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Flow preferences of upstream migrating Atlantic salmon (Salmo salar)
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- On their way from the sea to their spawning grounds in rivers, Atlantic salmon are often delayed or hindered by dams or other obstructions. Building a fishway can save a population that would otherwise go extinct. But even when there is a fishway present, sometimes the fish will have difficulties finding the entrance or navigating through the fishway. Understanding fish preferences during their upstream migration can help us improve fishway design so we can help the fish move upstream. The main goal of my studies was to find hydrodynamic preferences of salmon. We were able to show a preference for high turbulence intensity (I ~ 0.7). We also found a preference for lower water velocity. In my last study, I found most salmon near the highest available water velocity, which in light of previous results was interpreted as the salmon seeking out the turbulent areas in the boundary layer of the high velocity jet in the center of the river. There were several indications that Atlantic salmon prefer to save energy, and that they are able to utilize turbulent structures to save energy during their active migration. However, much of the proof was circumstantial and requires further investigation. As a main source of error, the instruments used to measure hydrodynamics were not precise enough. More focus should be put on developing better instruments, for example the newly invented artificial lateral lines.
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| 13. |
- Lindberg, Dan-Erik, et al.
(författare)
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Methods for locating the proper position of a planned fishway entrance near a hydropower tailrace
- 2013
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Ingår i: Limnologica. - : Elsevier BV. - 0075-9511 .- 1873-5851. ; 43:5, s. 339-347
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Tidskriftsartikel (refereegranskat)abstract
- The spatial distribution of upstream migrating Atlantic salmon (Salmo salar) spawners was studied in 2008 and 2009 in the surroundings of the tailrace from a hydropower station in the River Umeälven. This area is problematic because the fish have difficulties finding their way into the original riverbed, which prompted an investigation on the feasibility of adding a fishway in the area. Echo sounding was used in 2008 to investigate the spatial use of fish in the tailrace channel during the time of salmon migration. Presence of other fish species was so low that all echo sounding detections were assumed to be salmon. In 2009, data on wild radio-tagged salmon (n = 94) was collected in the same tailrace by an array of underwater antennas with a detection radius of approximately 10 m, to validate the results from the echo sounding. Both types of surveys showed aggregations of fish in one part of the tailrace. As a final step, Computational Fluid Dynamics (CFD) modeling was performed to analyze hydrodynamics. This CFD modeling showed a coincidence of fish detections in areas with turbulence intensities between 0.6 and 0.8, which may be an indication that the fish are holding in these areas to reduce energy expenditure during migration. A high proportion of the radio-tagged salmon were observed in the tailrace area (a median of 21 days between their first and last detection), indicating that the salmon are delayed in their upstream migration by the attraction to the tailrace in this area. The overall data on fish behavior in the tailrace led us to suggest a location for a new fishway where the fish aggregation was most pronounced. The number of detections from either technology had similar distributions over the tailrace, suggesting that the results are comparable. Thus, the split beam echo sounder can preferably be used to investigate which location is most appropriate for locations of entrances to new fishways since many more individual fishes are covered by this method compared to telemetry. Furthermore, there is no need to handle the fish in the echo sounding studies as is required in telemetry studies
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| 14. |
- Lindberg, Dan-Erik, et al.
(författare)
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Path Selection of Atlantic Salmon (Salmo salar) Migrating Through a Fishway
- 2016
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Ingår i: River Research and Applications. - : Wiley. - 1535-1459 .- 1535-1467. ; 32, s. 795-803
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Tidskriftsartikel (refereegranskat)abstract
- We constructed a model that predicted path selection of Atlantic salmon. Our basic assumption for the model was that Atlantic salmon optimize migration by selecting a path that minimizes water resistance. The model prediction was compared with observations in a fishway, and the results were within expectations. It appeared like the fishway design and flow configuration at our study site caused some problems for the fish to discover both of the available paths. Therefore, only 53% of female fish and 67% of male fish selected the optimal path in the beginning of the fishway, but 92% of female fish and 97% of male fish selected the optimal path at the end of the fishway. Velocity over ground was very low, which is likely because every weir in the fishway was an obstacle for the fish. This knowledge can be used to improve future fishway design, or improve flow configuration for existing fishways. Copyright © 2015 John Wiley & Sons, Ltd.
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| 15. |
- Link, Jenny, et al.
(författare)
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Clinical practice of analysis of anti-drug antibodies against interferon beta and natalizumab in multiple sclerosis patients in Europe : A descriptive study of test results
- 2017
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 12:2
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Tidskriftsartikel (refereegranskat)abstract
- Antibodies against biopharmaceuticals (anti-drug antibodies, ADA) have been a well-integrated part of the clinical care of multiple sclerosis (MS) in several European countries. ADA data generated in Europe during the more than 10 years of ADA monitoring in MS patients treated with interferon beta (IFN beta) and natalizumab have been pooled and characterized through collaboration within a European consortium. The aim of this study was to report on the clinical practice of ADA testing in Europe, considering the number of ADA tests performed and type of ADA assays used, and to determine the frequency of ADA testing against the different drug preparations in different countries. A common database platform (tranSMART) for querying, analyzing and storing retrospective data of MS cohorts was set up to harmonize the data and compare results of ADA tests between different countries. Retrospective data from six countries (Sweden, Austria, Spain, Switzerland, Germany and Denmark) on 20,695 patients and on 42,555 samples were loaded into tranSMART including data points of age, gender, treatment, samples, and ADA results. The previously observed immunogenic difference among the four IFN beta preparations was confirmed in this large dataset. Decreased usage of the more immunogenic preparations IFN beta-1a subcutaneous (s.c.) and IFN beta-1b s.c. in favor of the least immunogenic preparation IFN beta-1a intramuscular (i.m.) was observed. The median time from treatment start to first ADA test correlated with time to first positive test. Shorter times were observed for IFN beta-1b-Extavia s. c. (0.99 and 0.94 years) and natalizumab (0.25 and 0.23 years), which were introduced on the market when ADA testing was already available, as compared to IFN beta-1a i. m. (1.41 and 2.27 years), IFN beta-1b-Betaferon s. c. (2.51 and 1.96 years) and IFN beta-1a s. c. (2.11 and 2.09 years) which were available years before routine testing began. A higher rate of anti-IFN beta ADA was observed in test samples taken from older patients. Testing for ADA varies between different European countries and is highly dependent on the policy within each country. For drugs where routine monitoring of ADA is not in place, there is a risk that some patients remain on treatment for several years despite ADA positivity. For drugs where a strategy of ADA testing is introduced with the release of the drug, there is a reduced risk of having ADA positive patients and thus of less efficient treatment. This indicates that potential savings in health cost might be achieved by routine analysis of ADA.
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| 16. |
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| 17. |
- Pateraki, Irini, et al.
(författare)
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Total biosynthesis of the cyclic AMP booster for skolin from Coleus forskohlii
- 2017
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Ingår i: eLIFE. - : ELIFE SCIENCES PUBLICATIONS LTD. - 2050-084X. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Forskolin is a unique structurally complex labdane-type diterpenoid used in the treatment of glaucoma and heart failure based on its activity as a cyclic AMP booster. Commercial production of forskolin relies exclusively on extraction from its only known natural source, the plant Coleus forskohlii, in which forskolin accumulates in the root cork. Here, we report the discovery of five cytochrome P450s and two acetyltransferases which catalyze a cascade of reactions converting the forskolin precursor 13R-manoyl oxide into forskolin and a diverse array of additional labdane-type diterpenoids. A minimal set of three P450s in combination with a single acetyl transferase was identified that catalyzes the conversion of 13R-manoyl oxide into forskolin as demonstrated by transient expression in Nicotiana benthamiana. The entire pathway for forskolin production from glucose encompassing expression of nine genes was stably integrated into Saccharomyces cerevisiae and afforded forskolin titers of 40 mg/L.
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