| 1. |
- Brodin, Daniel, et al.
(författare)
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Inhaled ciclesonide in adults hospitalised with COVID-19 : a randomised controlled open-label trial (HALT COVID-19)
- 2023
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the efficacy of inhaled ciclesonide in reducing the duration of oxygen therapy (an indicator of time to clinical improvement) among adults hospitalised with COVID-19.DESIGN: Multicentre, randomised, controlled, open-label trial.SETTING: 9 hospitals (3 academic hospitals and 6 non-academic hospitals) in Sweden between 1 June 2020 and 17 May 2021.PARTICIPANTS: Adults hospitalised with COVID-19 and receiving oxygen therapy.INTERVENTION: Inhaled ciclesonide 320 µg two times a day for 14 days versus standard care.MAIN OUTCOME MEASURES: Primary outcome was duration of oxygen therapy, an indicator of time to clinical improvement. Key secondary outcome was a composite of invasive mechanical ventilation/death.RESULTS: Data from 98 participants were analysed (48 receiving ciclesonide and 50 receiving standard care; median (IQR) age, 59.5 (49-67) years; 67 (68%) men). Median (IQR) duration of oxygen therapy was 5.5 (3-9) days in the ciclesonide group and 4 (2-7) days in the standard care group (HR for termination of oxygen therapy 0.73 (95% CI 0.47 to 1.11), with the upper 95% CI being compatible with a 10% relative reduction in oxygen therapy duration, corresponding to a <1 day absolute reduction in a post-hoc calculation). Three participants in each group died/received invasive mechanical ventilation (HR 0.90 (95% CI 0.15 to 5.32)). The trial was discontinued early due to slow enrolment.CONCLUSIONS: In patients hospitalised with COVID-19 receiving oxygen therapy, this trial ruled out, with 0.95 confidence, a treatment effect of ciclesonide corresponding to more than a 1 day reduction in duration of oxygen therapy. Ciclesonide is unlikely to improve this outcome meaningfully.TRIAL REGISTRATION NUMBER: NCT04381364.
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| 2. |
- Hellesen, Carl, 1980-, et al.
(författare)
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Nuclear Spent Fuel Parameter Determination using Multivariate Analysis of Fission Product Gamma Spectra
- 2017
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Ingår i: Annals of Nuclear Energy. - : Elsevier BV. - 0306-4549 .- 1873-2100. ; 110, s. 886-895
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we investigate the application of multivariate data analysis methods to the analysis of gamma spectroscopy measurements of spent nuclear fuel (SNF). Using a simulated irradiation and cooling of nuclear fuel over a wide range of cooling times (CT), total burnup at discharge (BU) and initial enrichments (IE) we investigate the possibilities of using a multivariate data analysis of the gamma ray emission signatures from the fuel to determine these fuel parameters. This is accomplished by training a multivariate analysis method on simulated data and then applying the method to simulated, but perturbed, data.We find that for SNF with CT less than about 20 years, a single gamma spectrum from a high resolution gamma spectrometer, such as a high-purity germanium spectrometer, allows for the determination of the above mentioned fuel parameters.Further, using measured gamma spectra from real SNF from Swedish pressurized light water reactors we were able to confirm the operator declared fuel parameters. In this case, a multivariate analysis trained on simulated data and applied to real data was used.
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| 3. |
- Senis, Lorenzo, et al.
(författare)
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A computational methodology for estimating the detected energy spectra of the gamma-ray flux from irradiated nuclear fuel
- 2022
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Ingår i: IEEE Transactions on Nuclear Science. - : Institute of Electrical and Electronics Engineers (IEEE). - 0018-9499 .- 1558-1578. ; 69:4, s. 703-713
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Tidskriftsartikel (refereegranskat)abstract
- Gamma-ray spectrometry using collimated detectors is a well-established examination method for irradiated nuclear fuel. However, the feasibility of examining a particular nuclide of interest is subject to constraints; the peak must be statistically determinable with the desired precision and the total spectrum count rate in the detector should not cause throughput issues. Methods were assembled for gamma spectrum prediction to optimize instruments for gamma emission tomography and to enable a priori feasibility evaluation of determination of single peaks of irradiated nuclear fuel. The aim was to find reliable results (~10% accuracy) regarding total spectrum and peak count rates with faster computation time than a full-Monte Carlo approach. For this purpose, the method is based on depletion calculations with SERPENT2, a point-source kernel method for the collimator response, a rig response matrix and a detector response matrix, both computed with MCNP6. The computational methodology uses as input the fuel properties (dimensions, materials, power history, and cooling time), and the instrumental setup (collimator and detector dimensions and materials). The prediction method was validated using measured data from a high-burnup, short-cooled test fuel rodlet from the Halden reactor. Absolute count rates and ratios of characteristic peaks were compared between predicted and measured spectra, showing a total count rate overestimation of 7% and discrepancies between 2-20% for the single peaks (same order of magnitude of the uncertainty). This level of agreement is deemed sufficient for measurement campaigns planning, and the optimization of spectroscopic instruments for use in gamma scanning and tomography of nuclear fuel.
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| 4. |
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| 5. |
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| 6. |
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| 7. |
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| 8. |
- Axelsson, Karin, et al.
(författare)
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Hög tid att ta ansvar för samverkan
- 2011
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Ingår i: En vitbok i färg. - Västerås : Mälardalens högskola.
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Bokkapitel (populärvet., debatt m.m.)
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| 9. |
- Backström, Niclas, et al.
(författare)
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A high-density scan of the Z chromosome in ficedula flycatchers reveals candidate loci for diversifying selection
- 2010
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Ingår i: Evolution. - : Wiley. - 0014-3820 .- 1558-5646. ; 64:12, s. 3461-3475
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Tidskriftsartikel (refereegranskat)abstract
- Theoretical and empirical data suggest that genes located on sex chromosomes may play an important role both for sexually selected traits and for traits involved in the build-up of hybrid incompatibilities. We investigated patterns of genetic variation in 73 genes located on the Z chromosomes of two species of the flycatcher genus Ficedula, the pied flycatcher and the collared flycatcher. Sequence data were evaluated for signs of selection potentially related to genomic differentiation in these young sister species, which hybridize despite reduced fitness of hybrids. Seven loci were significantly more divergent between the two species than expected under neutrality and they also displayed reduced nucleotide diversity, consistent with having been influenced by directional selection. Two of the detected candidate regions contain genes that are associated with plumage coloration in birds. Plumage characteristics play an important role in species recognition in these flycatchers suggesting that the detected genes may have been involved in the evolution of sexual isolation between the species.
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| 10. |
- Björnsson, Bergthor, et al.
(författare)
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Segment 4 occlusion in portal vein embolization increase future liver remnant hypertrophy : A Scandinavian cohort study
- 2020
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Ingår i: International Journal of Surgery. - : ELSEVIER. - 1743-9191 .- 1743-9159. ; 75, s. 60-65
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Tidskriftsartikel (refereegranskat)abstract
- Background: The additional value of including segment 4 (S4) portal branches in right portal vein embolization (rPVE) is debated. The aim of the study was to explore this in a large multicenter cohort.Material and methods: A retrospective cohort study consisting of all patients subjected to rPVE from August 2012 to May 2017 at six Scandinavian university hospitals. PVE technique was essentially the same in all centers, except for the selection of main embolizing agent (particles or glue). All centers used coils or particles to embolize S4 branches. A subgroup analysis was performed after excluding patients with parts of or whole S4 included in the future liver remnant (FLR).Results: 232 patients were included in the study, of which 36 received embolization of the portal branches to S4 in addition to rPVE. The two groups (rPVE vs rPVE + S4) were similar (gender, age, co-morbidity, diagnosis, neoadjuvant chemotherapy, bilirubin levels prior to PVE and embolizing material), except for diabetes mellitus which was more frequent in the rPVE + S4 group (p = 0.02). Pre-PVE FLR was smaller in the S4 group (333 vs 380 ml, p = 0.01). rPVE + S4 resulted in a greater percentage increase of the FLR size compared to rPVE alone (47 vs 38%, p = 0.02). A subgroup analysis, excluding all patients with S4 included in the FLR, was done. There was no longer a difference in pre-PVE FLR between groups (333 vs 325 ml, p = 0.9), but still a greater percentage increase and also absolute increase of the FLR in the rPVE + S4 group (48 vs 38% and 155 vs 112 ml, p = 0.01 and 0.02).Conclusion: In this large multicenter cohort study, additional embolization of S4 did demonstrate superior growth of the FLR compared to standard right PVE.
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| 11. |
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| 12. |
- Grape, Sophie, 1982-, et al.
(författare)
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New perspectives on nuclear power - Generation IV nuclear energy systems to strengthen nuclear non-proliferation and support nuclear disarmament
- 2014
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Ingår i: Energy Policy. - : Elsevier BV. - 0301-4215 .- 1873-6777. ; 73, s. 815-819
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Tidskriftsartikel (refereegranskat)abstract
- Recently, nuclear power has received support from environmental and climate researchers emphasizing the need to address factors of global importance such as climate change, peace and welfare. Here, we add to previous discussions on meeting future climate goals while securing safe supplies of energy by discussing future nuclear energy systems in the perspective of strengthening nuclear non-proliferation and aiding in the process of reducing stockpiles of nuclear weapons materials.New nuclear energy systems, currently under development within the Generation IV (Gen IV) framework, are being designed to offer passive safety and inherent means to mitigate consequences of nuclear accidents. Here, we describe how these systems may also be used to reduce or even eliminate stockpiles of civil and military plutonium—the former present in waste from today׳s reactors and the latter produced for weapons purposes. It is argued that large-scale implementation of Gen IV systems would impose needs for strong nuclear safeguards. The deployment of Safeguards-by-Design principles in the design and construction phases can avoid draining of IAEA resources by enabling more effective and cost-efficient nuclear safeguards, as compared to the current safeguards implementation, which was enforced decades after the first nuclear power plants started operation.
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| 13. |
- Hasselgren, Kristina, et al.
(författare)
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ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM Survival Analysis From the Randomized Controlled Trial LIGRO
- 2021
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 273:3, s. 442-448
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the oncological outcome for patients with colorectal liver metastases (CRLM) randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or 2-stage hepatectomy (TSH). Background: TSH with portal vein occlusion is an established method for patients with CRLM and a low volume of the future liver remnant (FLR). ALPPS is a less established method. The oncological outcome of these methods has not been previously compared in a randomized controlled trial. Methods: One hundred patients with CRLM and standardized FLR (sFLR) <30% were included and randomized to resection by ALPPS or TSH, with the option of rescue ALPPS in the TSH group, if the criteria for volume increase was not met. The first radiological follow-up was performed approximately 4 weeks postoperatively and then after 4, 8, 12, 18, and 24 months. At all the follow-ups, the remaining/recurrent tumor was noted. After the first follow-up, chemotherapy was administered, if indicated. Results: The resection rate, according to the intention-to-treat principle, was 92% (44 patients) for patients randomized to ALPPS compared with 80% (39 patients) for patients randomized to TSH (P = 0.091), including rescue ALPPS. At the first postoperative follow-up, 37 patients randomized to ALPPS were assessed as tumor free in the liver, and also 28 patients randomized to TSH (P = 0.028). The estimated median survival for patients randomized to ALPPS was 46 months compared with 26 months for patients randomized to TSH (P = 0.028). Conclusions: ALPPS seems to improve survival in patients with CRLM and sFLR <30% compared with TSH.
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| 14. |
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| 15. |
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| 16. |
- Hutchinson, Bevis, et al.
(författare)
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Plastic yielding in lath martensites – An alternative viewpoint
- 2018
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Ingår i: Acta Materialia. - : Elsevier BV. - 1359-6454 .- 1873-2453. ; 152, s. 239-247
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Tidskriftsartikel (refereegranskat)abstract
- In recent literature the gradual yielding of quenched martensitic steels has been attributed to either heterogeneous microstructures having different strength levels or to the presence of small scale, Type II, residual stresses. Using in-situ tensile testing in synchrotron diffraction experiments in combination with crystal plasticity finite element modelling (CPFEM) we show that the dominant influence on yielding derives from the residual stresses which are a product of the displacive transformation from austenite during quenching. As plastic straining proceeds, the measured diffraction peaks become narrower and asymmetric, as predicted by the CPFEM calculations. The model predictions are generally in good agreement with published results showing large variations in local strains in different microstructural elements.
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| 17. |
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| 18. |
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| 19. |
- Jakobsson, Peter, 1977-, et al.
(författare)
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A Neoliberal Media Welfare State? : The Swedish Media System in Transformation
- 2021
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Ingår i: Javnost - The Public. - : Taylor & Francis. - 1318-3222 .- 1854-8377. ; 28:4, s. 375-390
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Tidskriftsartikel (refereegranskat)abstract
- The concept of the Media Welfare State describes Nordic specificity in how media are organised and how they serve a lively and inclusive democracy. This article engages in a dialogue in regards to the contention that this media system has persisted in the midst of rapid social change. We synthesise previous research and documented changes in media policy in Sweden, covering the last three decades, to show the ways in which the Swedish media system has undergone significant transformations. Media use is becoming more polarised and connected to social class. The state is retreating from its involvement in media policy; consequently, the press and public service media are facing unprecedented challenges. Finally, the “consensual” relation between media companies and the state, which is said to be typical for the media welfare state, no longer characterises the media market. While some of the features of the media welfare state system remain in Sweden, the current media system is best characterised as a neoliberal media welfare state. The article discusses tensions and conflicts in the existing model and possible future developments.
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| 20. |
- Jakobsson, Peter, 1977-, et al.
(författare)
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Introduction : Class in/and the media: On the importance of class in media and communication studies
- 2021
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Ingår i: Nordicom Review. - : Walter de Gruyter GmbH. - 1403-1108 .- 2001-5119. ; 42:s3, s. 1-19
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Social class is one of the most enduring concepts in the social sciences and is associated with many of the key themes and topics across multiple disciplines. Thus, there are many uses to which the concept of social class in media and communication can be put. The ambition of this special issue is to offer a glimpse into the heterogeneity of its uses in the field. While attuned differently in relation to the various approaches and definitions of class, the eight contributions to this special issue collectively focus on the relationship between media and class. One of the ambitions of this special issue is to report on some of the current Nordic scholarship in this growing field of research and to highlight the particularities of the relationship between class, inequality and media in this region. While the special issue also includes contributions from other regions, the main focus is on social class in the Nordic countries.This introductory article begins with a discussion on the concept of social class and its analytical relevance in the contemporary social landscape. We detail the relationship between media and class as manifested in a growing body of research, followed by a brief presentation of the individual contributions to this special issue. Finally, we identify the road ahead and potential research areas for scholars of media and communication concerned about class and social inequality in the twenty-first century.
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| 21. |
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| 22. |
- Jakobsson, Peter, 1977-, et al.
(författare)
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Media policy attitudes and political attitudes : the politization of media policy and the support for the 'media welfare state'
- 2023
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Ingår i: The International Journal of Cultural Policy. - : Routledge. - 1028-6632 .- 1477-2833. ; 29:4, s. 431-448
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Tidskriftsartikel (refereegranskat)abstract
- Previous research has neglected media audiences’ and citizens’ opinions on how the media should be organized, how they should function in society and what individual, corporate and state responsibilities should be in regard to these questions. In an attempt to understand the relationship between citizens’ broader political attitudes and their attitudes on media-related politics and responsibilities, this study uses a survey (n = 2003) of the adult Swedish population to investigate the distribution of a range of media political attitudes in the contemporary space of political positions. The results reveal overlaps between the space of media political attitudes and the broader political space, where support for a Nordic ‘media welfare state’ corresponds to leftist and GAL-oriented values, while TAN-oriented and right-wing attitudes link to scepticism towards state interventionism in the media landscape. A small but highly opinionated right-wing and TAN-oriented segment displays laissez-faire views on media policy that are reflected in current policy propositions from right-wing political parties in parliament.
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| 23. |
- Jakobsson, Peter, 1977-, et al.
(författare)
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Normative foundations of media welfare : Perspectives from the Nordic countries
- 2023
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Ingår i: Media Culture and Society. - : Sage Publications. - 0163-4437 .- 1460-3675. ; 45:2, s. 305-322
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Tidskriftsartikel (refereegranskat)abstract
- What does media welfare mean from a normative perspective? The notion of media welfare and “the media welfare state” has mainly been used descriptively, to depict the particular way in which the media are organized in the Nordic welfare states. In this article, we explore media welfare from a normative perspective. Our intention is to open up a discussion about the normative and political implications of the notion of media welfare and to bring the concept into the contemporary discussion on normative perspectives regarding the media.
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| 24. |
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| 25. |
- Jakobsson, Peter, 1977-, et al.
(författare)
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Vad tycker medborgarna om public service?
- 2022
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Ingår i: Public service. - Göteborg : Nordicom. - 9789188855633 - 9789188855640 ; , s. 92-111
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 26. |
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| 27. |
- Lindell, Eva, 1974-
(författare)
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Företagsekonomistudentens studieval. : Mannen, individualisten och altruisten.
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Business administration is one of Sweden's largest educational subjects, even so we know little about who applies to these study programs and why they do it. Through language we build representations of reality and through language this reality gets meaning. Interpretative repertoires can be described as locally produced discourse or locally available linguistic constructions. We use interpretative repertoires for positioning, which means linguistic construction of identity. Through language we can both construct positions, adopt positions, and resist adopting positions in a given social context. The aim of the thesis is to describe the business administration study choice as a socially constructed action - and thereby gain a greater understanding of business administration as education.In this thesis I discuss how interpretative repertoires are used to explain business administration as a study choice and thereby how the businessman is positioned. Two empirical materials are presented: previous research on business administration as a study choice, and interviews with students at Mälardalen University and Stockholm School of Economics.In previous research personality, career, making money and family are used as interpretative repertoires. In the interview material masculinity, management and leadership, building a family, personal finance, making money, profits and usefulness are used as interpretative repertoires. In relation to business administration as a study choice, the use of these interpretative repertoires create an ideological dilemma that needs handling by the business student. This is done by positioning the business economist as a man, an individualist and an altruist.The thesis concludes with a discussion about the positions as man and individualist as reproductions of already known structures, and how these positions are challenged in the material by the position as altruist.
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| 28. |
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| 29. |
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| 30. |
- Lindell, Johan, 1985-, et al.
(författare)
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The field of television production : Genesis, structure and positiontakings
- 2020
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Ingår i: Poetics (Amsterdam. Print). - : Elsevier. - 0304-422X .- 1872-7514. ; 80, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- As a leading scholar of the social conditions of cultural production, Pierre Bourdieu had little to say about large-scale media production. This study, however, brings the theoretical-empirical program that underpins studies of fields of cultural production within the Bourdieusian tradition to bear upon the Swedish field of television production. Two research questions are posed. First, what is the structure of the field of television production—what are the main hierarchies that divide agents in the field? Second, how do positions in the field correspond to agents’ ways of orienting themselves—how are various position-takings distributed in the field? These questions are answered with a multiple correspondence analysis with agents in the Swedish field of television production (n = 378). The field of television production is structured, first, along an incumbent-challenger axis; and second, according to an axis separating public service broadcasters and journalists rich on cultural capital from commercial broadcasters involved in drama and entertainment production. These dynamics, along with the position-takings assumed by agents in the field, are discussed.
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| 31. |
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| 32. |
- Lindell, Johan, 1985-, et al.
(författare)
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The media welfare state : A citizen perspective
- 2022
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Ingår i: European Journal of Communication. - : SAGE Publications. - 0267-3231 .- 1460-3705. ; 37:3, s. 330-349
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Tidskriftsartikel (refereegranskat)abstract
- During the last decades the Nordic media model has been challenged by neoliberal policy and welfare retrenchment. This study asks about the extent to which the values, functions and institutions of the “media welfare state” are supported by the adult Swedish citizenry, despite political mobilization against it. Drawing on a national survey (n = 2003) this study shows that the media welfare state is generally well-supported by the population. Using exploratory statistical analysis, we identify a media welfare state of mind. While widespread in the population, this attitudinal constellation is more common in older segments of the population, in the working-class, and by those who frequently use and trust public service media. The main conclusion is that support for the media welfare state primarily can be explained by political attitudes, where left-leaning and GAL-oriented individuals are more positive than people holding right-wing and TAN-attitudes.
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| 33. |
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| 34. |
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| 35. |
- Ottosson, Peter, et al.
(författare)
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Fingertip Model for Analysis of High-Frequency Vibrations
- 2023
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Ingår i: Proceedings. - : MDPI. - 2504-3900. ; 88:1
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Tidskriftsartikel (refereegranskat)abstract
- High-frequency shock-type vibrations (HFVs) from, e.g., impact wrenches with a frequency content mainly above 1250 Hz have long been suspected to cause a significant number of vibration injuries, HAVS. These vibrations are unregulated in the current standard for risk estimation, ISO 5349-1; thereby, the risk of injury is suspected to be underestimated. The objective of this study was to investigate the effects on finger tissue subjected to HFVs similar to those from impact wrenches by using a 2D finite element model of a fingertip. The model was validated through experiments. Using the input acceleration from the experiments, the model predicted high pressure variation and particular negative pressures at levels close to 0.1 MPa (1 Bar) or more, which are levels where cavitation in liquid can occur, with a detrimental effect on biological systems.
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| 36. |
- Quintana, Miguel, et al.
(författare)
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Assessment of atrial regional and global electromechanical function by tissue velocity echocardiography : a feasibility study on healthy individuals
- 2005
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Ingår i: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; 3:18 February 2005
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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.
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| 37. |
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| 38. |
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| 39. |
- Sandström, Per, et al.
(författare)
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ALPPS Improves Resectability Compared with Conventional Two-stage Hepatectomy in Patients with Advanced Colorectal Liver Metastasis : Results from a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial)
- 2018
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Ingår i: Annals of Surgery. - : LIPPINCOTT WILLIAMS & WILKINS. - 0003-4932 .- 1528-1140. ; 267:5, s. 833-840
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the study was to evaluate if associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could increase resection rates (RRs) compared with two-stage hepatectomy (TSH) in a randomized controlled trial (RCT). Background: Radical liver metastasis resection offers the only chance of a cure for patients with metastatic colorectal cancer. Patients with colorectal liver metastasis (CRLM) and an insufficient future liver remnant (FLR) volume are traditionally treated with chemotherapy with portal vein embolization or ligation followed by hepatectomy (TSH). This treatment sometimes fails due to insufficient liver growth or tumor progression. Methods: A prospective, multicenter RCT was conducted between June 2014 and August 2016. It included 97 patients with CRLM and a standardized FLR (sFLR) of less than 30%. Primary outcome - RRs were measured as the percentages of patients completing both stages of the treatment. Secondary outcomes were complications, radicality, and 90-day mortality measured from the final intervention. Results: Baseline characteristics, besides body mass index, did not differ between the groups. The RR was 92% [95% confidence interval (CI) 84%-100%] (44/48) in the ALPPS arm compared with 57% (95% CI 43%-72%) (28/49) in the TSH arm [rate ratio 8.25 (95% CI 2.6-26.6); P < 0.0001]. No differences in complications (Clavien-Dindo ≥3a) [43% (19/44) vs 43% (12/28)] [1.01 (95% CI 0.4-2.6); P = 0.99], 90-day mortality [8.3% (4/48) vs 6.1% (3/49)] [1.39 [95% CI 0.3-6.6]; P = 0.68] or R0 RRs [77% (34/44) vs 57% (16/28)] [2.55 [95% CI 0.9-7.1]; P = 0.11)] were observed. Of the patients in the TSH arm that failed to reach an sFLR of 30%, 12 were successfully treated with ALPPS. Conclusion: ALPPS is superior to TSH in terms of RR, with comparable surgical margins, complications, and short-term mortality.
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| 40. |
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| 41. |
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| 42. |
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| 43. |
- Sparrelid, Ernesto, et al.
(författare)
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How should liver hypertrophy be stimulated? A comparison of upfront associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and portal vein embolization (PVE) with rescue possibility
- 2021
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Ingår i: Hepatobiliary surgery and nutrition. - : AME Publishing Company. - 2304-3881 .- 2304-389X. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in comparison to portal vein embolization (PVE) is debated. The aim of this study was to compare successful resection rates (RR) with upfront ALPPS vs. PVE with rescue ALPPS on demand and to compare the hypertrophy of the liver between ALPPS and PVE plus subsequent rescue ALPPS. Methods: A retrospective analysis of all patients treated with PVE for colorectal liver metastasis (CRLM) or ALPPS (any diagnosis, rescue ALPPS included) at five Scandinavian university hospitals during the years 2013-2016 was conducted. A Chi-square test and a Mann-Whitney U test were used to assess the difference between the groups. A successful RR was defined as liver resection without a 90-day mortality. Results: A total of 189 patients were included. Successful RR was in 84.5% of the patients with ALPPS upfront and in 73.3% of the patients with PVE and rescue ALPPS on demand (P=0.080). The hypertrophy of the future liver remnants (FLRs) with ALPPS upfront was 71% (48-97%) compared to 96% (82-113%) after PVE and rescue ALPPS (P=0.010). Conclusions: Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on demand. The sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.
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| 44. |
- Sternby Eilard, Malin, 1974, et al.
(författare)
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Survival and prognostic factors after transplantation, resection and ablation in a national cohort of early hepatocellular carcinoma
- 2021
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Ingår i: HPB. - : Elsevier BV. - 1365-182X .- 1477-2574. ; 23:3, s. 394-403
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 International Hepato-Pancreato-Biliary Association Inc. Background: In patients with early hepatocellular cancer (HCC) and preserved liver function, the choice between transplantation, resection and ablation and which factors to consider is not obvious and guidelines differ. In this national cohort study, we aimed to compare posttreatment survival in patients fulfilling predefined criteria, and to analyse preoperative risk factors that could influence decision. Methods: We used data from HCC-patients registered with primary transplantation, resection or ablation 2008–2016 in the SweLiv-registry. In Child A-subgroups, 18–75 years, we compared survival after transplantation or resection, with different tumour criteria; either corresponding to our transplantation criteria (N = 257) or stricter with single tumours ≤50 mm (N = 159). A subgroup with single tumours ≤30 mm, compared all three treatments (N = 193). Results: We included 1022 HCC-patients; transplantation n = 223, resection n = 438, ablation n = 361. In the transplant criteria subgroup, differences in five-year survival, adjusted for age and gender, were not significant, with 71.2% (CI 62.3–81.3) after transplantation (n = 109) and 63.5% (CI 54.9–73.5) after resection (n = 148). Good liver function (Child 5 vs. 6, Albumin ≥36), increased the risk after transplantation, but decreased the risk after resection and ablation. Conclusion: Even within Child A, detailed liver function assessment is important before treatment decision, and for stratifying survival comparisons.
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- Strandberg Holka, Peter, et al.
(författare)
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Significance of poor performance status after resection of colorectal liver metastases
- 2018
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Ingår i: World Journal of Surgical Oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Performance status (PS) is known as one of the strongest prognostic factors for survival in metastatic colorectal cancer patients. The aim of the present study was to analyze factors associated with poor PS assessed after resection for colorectal liver metastases and the impact on survival.METHODS: All patients undergoing curative resection for colorectal liver metastases between 2010 and 2015 in a single center were reviewed retrospectively.RESULTS: A total of 284 patients were included, out of whom 74 patients (26%) presented with a postoperative PS WHO > 2 precluding administration of adjuvant chemotherapy. These patients had a shorter recurrence-free survival (P = 0.002) and shorter overall survival (P < 0.001). Multivariable analysis showed that patients with PS > 2 after surgery had higher preoperative ASA score, had a higher frequency of major complications after surgery, and had more frequently synchronous liver and lung metastases. PS was found to be the strongest independent factor predicting survival (hazard ratio 0.45). When patients with postoperative PS > 2 developed recurrent disease (54 of 74), 43 (80%) received tumor specific treatment.CONCLUSIONS: Patients with postoperative PS > 2 who did not receive adjuvant chemotherapy had decreased recurrence-free and overall survival after liver resection for colorectal liver metastases. After recurrence, a large majority of these patients had had improvement in PS allowing for administration of tumor specific treatment.
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- Westergren Jakobsson, Amanda, et al.
(författare)
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Iron Chelator VLX600 Inhibits Mitochondrial Respiration and Promotes Sensitization of Neuroblastoma Cells in Nutrition-Restricted Conditions
- 2022
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Ingår i: Cancers. - : MDPI AG. - 2072-6694. ; 14:13
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Tidskriftsartikel (refereegranskat)abstract
- MYC proteins are essential regulators which could affect more than 15% of all genes through an interaction with other transcription factors. High-risk neuroblastoma associated with treatment failure is characterized by amplification of the MYCN proto-oncogene. Here, we show for the first time that the iron chelator VLX600 inhibits mitochondrial activity and induces cell death, regardless of MYCN status in neuroblastoma cells. Blocking glucose uptake enhances the effect of VLX600, indicating that targeting pathways or cellular activities related to energy supply/metabolism may help to find better therapeutic strategy for neuroblastoma.Neuroblastoma, the most common solid tumor in children, is characterized by amplification of the MYCN proto-oncogene, a high-risk aggressive clinical marker associated with treatment failure. MYCN plays an important role in cell growth, proliferation, metabolism, and chemoresistance. Here, we show for the first time that in neuroblastoma, iron chelator VLX600 inhibits mitochondrial respiration, decreases expression levels of MYCN/LMO1, and induces an efficient cell death regardless of MYCN status in both 2D and 3D culture conditions. Moreover, insufficient induction of autophagy was observed in cells treated with VLX600, which is essential as a protective response in the event of ATP synthesis disruption. Further inhibition of glucose uptake using DRB18, a pan-GLUT (glucose transporter) inhibitor, synergized the effect of VLX600 and no significant cell death was found in immortalized epithelial cells under this combination treatment. Our results demonstrate that inhibition of mitochondrial respiration by iron chelator VLX600 accompanied by autophagy deficiency promotes sensitivity of neuroblastoma cells in a nutrition-restricted microenvironment regardless of MYCN status, indicating that MYCN expression level is an essential clinical marker but might not be a necessary target for the treatment of neuroblastoma which warrants further investigation. VLX600 has been studied in Phase I clinical trials; combining VLX600 with conventional chemotherapy could be an innovative therapeutic strategy for neuroblastoma.
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