| 1. |
- Al-Karkhi, Isam, et al.
(författare)
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Comparisons of automated blood pressures in a primary health care setting with self-measurements at the office and at home using the Omron i-C10 device
- 2015
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Ingår i: Blood Pressure Monitoring. - : Lippincott Williams & Wilkins. - 1359-5237 .- 1473-5725. ; 20:2, s. 98-103
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We aimed to compare blood pressure (BP) levels recorded using the semiautomatic oscillometric Omron i-C10 BP device in patients with or without hypertension in three different settings: (a) when used by a doctor or a nurse at the office (OBP); (b) when used for self-measurement by the patient at the office (SMOBP); and (c) when used for 7 consecutive days at home (HBP).MATERIALS AND METHODS: A total of 247 individuals were invited to participate, but 78 of these individuals declined and a further seven were excluded, leaving a final cohort of 162 participants.RESULTS: The mean OBP was higher than HBP (difference 8.1±14/3.1±8.8 mmHg, P<0.0001) and so was SMOBP compared with HBP (difference 7.0±13/4.2±7.3 mmHg, P<0.0001). Sixteen participants (9.9%) had at least 10 mmHg higher systolic SMOBP than OBP and 28 (17%) participants had at least 10 mmHg lower systolic SMOBP than OBP. Participants who were current smokers had a larger mean difference between systolic OBP and SMOBP than nonsmokers (OBP-SMOBP in smokers: 6.6±9.4 mmHg, OBP-SMOBP in nonsmokers: 0.5±9.2 mmHg, P=0.011 between groups).CONCLUSION: Self-measurement of BP in the office does not preclude an increase in BP when levels in the individual patients are compared with HBP using the same equipment. Thus, SMOBP with a semiautomatic device does not lead to a reduction in the white-coat effect in the same manner as fully automatic devices.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
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| 2. |
- Barmano, Neshro, 1980-
(författare)
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Structured management, Symptoms, Health-related Quality of Life and Alcohol in Patients with Atrial Fibrillation
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting at least 2.9 % of the Swedish population. Although AF is associated with increased risk of ischaemic stroke, there have been many reports on the underuse of oral anticoagulants (OAC) and non-adherence to guidelines in other areas as well. AF is also associated with disabling symptoms and decreased health-related quality of life (HRQoL), but some patients are asymptomatic. The reasons for the great variation of symptoms remain unclear. Furthermore, although research on AF has increased, studies have mainly focused on treatment, while studies on risk factors, such as alcohol consumption, have only recently gained attention.The aim of this thesis was to investigate whether structured care of patients with AF could improve guideline adherence and HRQoL compared to standard care, and to determine which factors affect symptoms and HRQoL prior to treatment with radiofrequency catheter ablation (RFA), as well as improvement after RFA. Furthermore, we aimed to examine the associations of alcohol consumption with cardiac biomarkers, the size of the left atrium (LA), and re-ablation.This thesis is based on two studies. In the ‘Structured Management and Coaching – Patients with Atrial Fibrillation’ (SMaC-PAF) study, 176 patients were recruited to the intervention group, receiving a structured follow-up programme, and 146 patients were recruited to the control group, receiving standard care. The two groups were compared in regard to adherence to guidelines and patient-reported outcome measures (PROMs) assessing symptoms and HRQoL.In the ‘Symptom burden, Metabolic profile, Ultrasound findings, Rhythm, neurohormonal activation, haemodynamics and health-related quality of life in patients with atrial Fibrillation’ (SMURF) study, 192 patients referred for their first RFA of AF were included. PROMs questionnaires were filled out, echocardiography was performed, and cardiac biomarkers were analysed. Alcohol consumption was assessed through interview and through analysis of ethyl glucuronide in hair (hEtG). AF recurrence and re-ablation within 12 months were examined.In the first study, after one year, 94% (n=112) and 74% (n=87) of patients with indication for OAC in the intervention and the control groups, respectively, actually received treatment with OAC (p <0.01). Both groups improved in anxiety and HRQoL scores over the year, but in the intervention group, arrhythmia-specific symptoms were less frequently experienced and the SF-36 scores were more similar to the norm population.In the second study, the most important predictors of arrhythmia-related symptoms and HRQoL prior to RFA were anxiety, depression and low-grade inflammation, while frequent AF attacks prior to RFA, freedom from AF recurrence after RFA, female gender, no enlarged LA, absence of diabetes, and the presence of heart failure were significant predictors of improvement in symptoms and HRQoL after RFA. Men with hEtG ≥7 pg/mg had higher levels of cardiac biomarkers, larger LA volumes and a higher re-ablation rate than men with hEtG <7 pg/mg, while no such findings were present in women.In conclusion, structured management was superior to standard care in patients with AF, emphasising the importance of structured care, adjusted to local requirements, in order to improve the care and well-being of patients with AF. Although the reasons for the great variety of symptoms in patients with AF still are not yet fully understood, it seems that psychological factors and inflammation play a role, and that improvement in symptoms and HRQoL after RFA is influenced by gender, diabetes, heart failure, LA size and the frequency of attacks before, as well as freedom from AF after, RFA. Finally, alcohol consumption corresponding to hEtG ≥7 pg/mg was associated with higher levels of cardiac biomarkers, larger LA size and a higher rate of re-ablation in men, implying that men with an hEtG-value ≥7 pg/mg have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.
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| 3. |
- Berglind, Niklas, et al.
(författare)
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Air Pollution Exposure : A Trigger for Myocardial Infarction?
- 2010
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 7:4, s. 1486-1499
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Tidskriftsartikel (refereegranskat)abstract
- The association between ambient air pollution exposure and hospitalization for cardiovascular events has been reported in several studies with conflicting results. A case-crossover design was used to investigate the effects of air pollution in 660 first-time myocardial infarction cases in Stockholm in 1993-1994, interviewed shortly after diagnosis using a standard protocol. Air pollution data came from central urban background monitors. No associations were observed between the risk for onset of myocardial infarction and two-hour or 24-hour air pollution exposure. No evidence of susceptible subgroups was found. This study provides no support that moderately elevated air pollution levels trigger first-time myocardial infarction.
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| 4. |
- Björk, Mats, 1960-, et al.
(författare)
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Methane emissions from macrophyte beach wrack on Baltic seashores
- 2023
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Ingår i: Ambio. - : Springer Nature. - 0044-7447 .- 1654-7209. ; 52:1, s. 171-181
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Tidskriftsartikel (refereegranskat)abstract
- Beach wrack of marine macrophytes is a natural component of many beaches. To test if such wrack emits the potent greenhouse gas methane, field measurements were made at different seasons on beach wrack depositions of different ages, exposure, and distance from the water. Methane emissions varied greatly, from 0 to 176 mg CH4-C m−2 day−1, with a clear positive correlation between emission and temperature. Dry wrack had lower emissions than wet. Using temperature data from 2016 to 2020, seasonal changes in fluxes were calculated for a natural wrack accumulation area. Such calculated average emissions were close to zero during winter, but peaked in summer, with very high emissions when daily temperatures exceeded 20 °C. We conclude that waterlogged beach wrack significantly contributes to greenhouse gas emissions and that emissions might drastically increase with increasing global temperatures. When beach wrack is collected into heaps away from the water, the emissions are however close to zero.
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| 5. |
- Dahlgren, David, et al.
(författare)
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Evaluation and validation of chemotherapy‐specific diarrhoea and histopathology in rats
- 2022
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Ingår i: Basic & Clinical Pharmacology & Toxicology. - : John Wiley & Sons. - 1742-7835 .- 1742-7843. ; 131:6, s. 536-546
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Tidskriftsartikel (refereegranskat)abstract
- Chemotherapy-induced mucositis is characterized by diarrhoea and villous atrophy. However, it is not well-understood why diarrhoea arises, why it only occurs with some chemotherapeutics and how it is related to villus atrophy. The objectives in this study were to determine (i) the relationship between chemotherapy-induced diarrhoea and villus atrophy and to (ii) establish and validate a rat diarrhoea model with clinically relevant endpoints. Male Wistar Han IGS rats were treated with saline, doxorubicin, idarubicin, methotrexate, 5-fluorouracil, irinotecan or 5-fluorouracil+irinotecan. After 72 h, jejunal tissue was taken for morphological, apoptotic and proliferative analyses, and faecal water content and change in body weight were determined. All treatments except methotrexate caused a similar reduction (≈42%) in villus height, but none of them altered mucosal crypt cell proliferation or apoptosis. Doxorubicin, idarubicin, irinotecan and 5-fluorouracil+irinotecan caused body weight reduction, but only irinotecan and idarubicin caused diarrhoea. No direct correlation between diarrhoea and villus height or body weight loss was observed. Therefore, studies of the mechanisms for chemotherapy-induced diarrhoea should focus on functional factors. Finally, the irinotecan and idarubicin diarrhoea models established in this study will be useful in developing supportive treatments of this common and serious adverse effect in patients undergoing chemotherapy.
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| 6. |
- Delsing, Jerker, et al.
(författare)
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Migration of industrial process control systems into service oriented architecture
- 2012
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Ingår i: 38th Annual Conference of the IEEE Industrial Electronics Society (IECON2012), 25-28 October 2012, Montreal, Canada. - Piscataway, NJ : IEEE Communications Society. - 9781467324205 ; , s. 5790-5796
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Konferensbidrag (refereegranskat)abstract
- The procedure of migrating SCADA and DCS func- tionality of the isa95 process automation architecture to a Service based automation architecture is discussed. Challenges in such migration are discussed and defined. From here the necessary migration technology and procedures are proposed. The critical migration technology is based on the mediator concept. The migration procedure is based on a functionality perspective and comprises four steps: initiation, configuration, data processing and control execution. Its argued that these steps are necessary for the successful migration of DCS and SCADA functionality in to the automation cloud.
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| 7. |
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| 8. |
- Fernemark, Hanna, et al.
(författare)
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A Randomized Cross-Over Trial of the Postprandial Effects of Three Different Diets in Patients with Type 2 Diabetes
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 8:11, s. e79324-
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the clinic setting both fasting levels of glucose and the area under the curve (AUC) of glucose, by determination of HbA1c levels, are used for risk assessments, in type 2 diabetes (NIDDM). However little is known about postprandial levels, and hence AUC, regarding other traditional risk factors such as insulin and blood-lipids and how this is affected by different diets. less thanbrgreater than less thanbrgreater thanObjective: To study postprandial effects of three diets, during a single day, in NIDDM. less thanbrgreater than less thanbrgreater thanMethods: A low-fat diet (45-56 energy-% from carbohydrates), and a low-carbohydrate diet (16-24 energy-% from carbohydrates) was compared with a Mediterranean-style diet (black coffee for breakfast and the same total-caloric intake as the other two diets for lunch with red wine, 32-35 energy-% from carbohydrates) in a randomized cross-over design. Total-caloric intake/test-day at the clinic from food was 1025-1080 kCal in men and 905-984 kCal in women. The test meals were consumed at a diabetes ward under supervision. less thanbrgreater than less thanbrgreater thanResults: Twenty-one participants were recruited and 19 completed the studies. The low-carbohydrate diet induced lower insulin and glucose excursions compared with the low-fat diet (pandlt;0.0005 for both AUC). The insulin-response following the single Mediterranean-style lunch-meal was more pronounced than during the low-fat diet lunch (insulin increase-ratio of the low-fat diet: 4.35 +/- 2.2, of Mediterranean-style diet: 8.12 +/- 5.2, p=0.001) while postprandial glucose levels were similar. The increase-ratio of insulin correlated with the elevation of the incretin glucose-dependent insulinotropic-polypeptide following the Mediterranean-style diet lunch (Spearman, r = 0.64, p = 0.003). less thanbrgreater than less thanbrgreater thanConclusions: The large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase. This suggests that accumulation of caloric intake from breakfast and lunch to a single large Mediterranean style lunch-meal in NIDDM might be advantageous from a metabolic perspective.
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| 9. |
- Ljungman, Petter L S, et al.
(författare)
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Rapid effects of air pollution on ventricular arrhythmias.
- 2008
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Ingår i: European heart journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 29:23, s. 2894-901
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Air pollution has been associated with ventricular arrhythmias in patients with implantable cardioverter defibrillators (ICDs) for exposure periods of 24-48 h. Only two studies have investigated exposure periods <24 h. We aimed to explore such effects during the 2 and 24 preceding hours as well as in relation to distance from the place of the event to the air pollution monitor. METHODS AND RESULTS: We used a case-crossover design to investigate the effects of particulate matter <10 microm in diameter (PM10) and nitrogen dioxide (NO2) in 211 patients with ICD devices in Gothenburg and Stockholm, Sweden. Events interpreted as ventricular arrhythmias were downloaded from the ICDs, and air pollution data were collected from urban background monitors. We found an association between 2 h moving averages of PM10 and ventricular arrhythmia [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.00-1.72], whereas the OR for 24 h moving averages was 1.24 (95% CI 0.87-1.76). Corresponding ORs for events occurring closest to the air pollution monitor were 1.76 (95% CI 1.18-2.61) and 1.74 (95% CI 1.07-2.84), respectively. Events occurring in Gothenburg showed stronger associations than in Stockholm. CONCLUSION: Moderate increases in air pollution appear to be associated with ventricular arrhythmias in ICD patients already after 2 h, although future studies including larger numbers of events are required to confirm these findings. Representative geographical exposure classification seems important in studies of these effects.
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| 10. |
- Löfgren, U B, et al.
(författare)
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Diabetes control in Swedish community dwelling elderly : More often tight than poor
- 2004
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 255:1, s. 96-101
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To determine glycaemic control in elderly patients with diabetes living in community dwelling. Design. Descriptive, cross-sectional and open. Prospective with regard to blood glucose. Setting. Community-dwelling in-patients. Subjects. From a total number of 351 patients in seven Swedish centres of community dwelling we identified and recruited all 45 patients with diabetes receiving treatment with insulin, and/or oral medication. Main outcome measures. Blood glucose was measured fasting, 2 h after breakfast, in the evening and at night, for three consecutive days. Results. Mean HbA1c was 5.9 ± 1.1% (range 3.6-8.6%). The patients were split in three HbA1c-groups for analysis: lower- (3.6-5.3%), middle-(5.4-6.3%) and higher-tertile (6.4-8.6%). The groups where similar with regard to age, time in community dwelling, ability to eat and move around independently, but body mass index was lower in the lower tertile (P < 0.003 and P < 0.04, compared with middle- and higher-tertiles). We recorded 14 episodes with blood glucose ≤4.0 mmol L-1 in eight patients. Blood glucose ≤4.0 mmol L-1 was mostly recorded during night (n = 8) or in the morning (n = 3). Conclusions. Swedish patients with diabetes in community dwelling are over- rather than undertreated and have low HbA1c levels. Despite very regular eating habits and near total compliance with medication, hypoglycaemias are frequent and possibly linked to malnutrition.
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| 11. |
- Rosenqvist, Fredrik, 1972, et al.
(författare)
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Controllability of direction dependent processes
- 2003
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Ingår i: 42nd IEEE Conference on Decision and Control, 9-12 Dec. 2003.. - 0191-2216. - 0780379241 ; 4
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Konferensbidrag (refereegranskat)abstract
- In a direction-dependent process, the dynamic response depends on the input or output direction. In this paper, controllability analysis of these processes investigates the ability to govern the output in any direction, even though the input signal is bounded. A sufficient condition for the controllability of single-input, single-output, direction-dependent processes is stated and proven.
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| 12. |
- Rosenqvist, Fredrik, 1972
(författare)
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Direction-dependent processes - Theory and application
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis, direction-dependent processes are described as processes whose responses differ in shape, strength and speed, depending on whether the input signal or output signal increases or decreases. The way in which these dynamics arise is discussed for three different applications; these applications are a thermomechanical pulp refiner, in which the motor load response to the hydraulic pressure is direction dependent, a paper machine, in which the calliper control in the calender section is direction dependent, and an electronic nose, in which the response to substrate concentration is direction dependent. In addition, it has been shown that direction-dependent dynamics originate not only from the process itself but sometimes also from sensors or actuators. Direction-dependent processes have been put into the framework of piecewise-linear dynamic systems, which consist of two linear time-invariant submodels. The sign of the rate of change of the input signal schedules the switching between the submodels. Parameter estimation methods have been derived, where the existing algorithms for parameter estimation in piecewise-linear processes have been extended in order to cope with direction-dependent dynamics. The dynamics in the above-mentioned industrial processes have been justified using direction-dependent parameter estimation methods. In these processes, the direction-dependent modelling approach has been compared with the standard-procedure linear time-invariant approach. Theoretical aspects, such as the realisation of the input/output form into the state-space form and the convergence of the time-averaged norm, have been considered. Even though a general piecewise-linear state-space model cannot be converted into input/output form, it has been shown that it is possible to find state-space models in two special cases. The convergence of the averaged mean-square error to its expected value, when the number of data points approaches infinity, has been proven for the direction-dependent parameter estimation method. Further, the control of direction-dependent processes is discussed in terms of a new concept called trend controllability. This concept deals with the ability to govern the output in any direction, even though the input signal is bounded. Finally, it can be concluded that direction-dependent models in general and the piecewise-linear ones presented here are suitable when it comes to identifying processes that exhibit direction dependence.
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| 13. |
- Rosenqvist, Fredrik, 1972, et al.
(författare)
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Direction-dependent system modeling approaches exemplified through an electronic nose system
- 2006
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Ingår i: IEEE Transactions on Control Systems Technology. - 1063-6536 .- 1558-0865. ; 14:3, s. 526-531
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Tidskriftsartikel (refereegranskat)abstract
- The modeling of processes exhibiting direction-dependent behavior is considered. Depending on the application, different models may be suitable. This brief is concerned with the use of Wiener models and piecewise-linear (PWL) models. These approaches are applied to data from an electronic nose system, for which knowledge of the physical principles is combined with system identification methods. Both models are found to provide close approximations to the behavior of the system itself. © 2006 IEEE.
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| 14. |
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| 15. |
- Rosenqvist, Fredrik, 1972, et al.
(författare)
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Modelling a thermomechanical wood-chip refiner
- 2001
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Ingår i: IASTED Conference. Modelling, Identification and Control, Innsbruck, Austria. ; II, s. 763 - 768
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Konferensbidrag (refereegranskat)
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| 16. |
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| 17. |
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| 18. |
- Rosenqvist, Fredrik, 1972, et al.
(författare)
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PiEcewise-Linear Output-Error Methods for Parameter Estimation in Direction-Dependent Processes
- 2004
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Ingår i: Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics). - Berlin, Heidelberg : Springer Berlin Heidelberg. - 1611-3349 .- 0302-9743. - 9783540212591 ; 2993, s. 493-507
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Konferensbidrag (refereegranskat)abstract
- In direction-dependent processes, the dynamic responses depend on the direction of the system input. The parameter estimation of these processes under noisy conditions can be somewhat problematic in terms of predictor choice and asymptotic behaviour. For parameter estimation, a convenient way to model direction dependence is to use a piecewise-linear model formulation, whose switching depends on the input direction. This paper analyses a prediction-error minimisation method for direction-dependent processes in terms of piecewise-linear dynamics. In particular, the asymptotic convergence properties are investigated and relevant conditions for the utilisation of the estimation method are given. Further, it is demonstrated that a piecewise-linear output-error predictor is preferable in situations where the impact of disturbances is predominant. The main reason for this is that it separates the disturbances from the process model.
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| 19. |
- Rosenqvist, Fredrik, 1972, et al.
(författare)
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Piecewise linear output-error models
- 2003
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Ingår i: IFAC Symposium on System Identification, Rotterdam, the Netherlands.
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Konferensbidrag (refereegranskat)
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| 20. |
- Rosenqvist, Fredrik, 1972, et al.
(författare)
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Realisation and estimation of piecewise-linear output-error models
- 2005
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Ingår i: Automatica. - : Elsevier BV. - 0005-1098. ; 41:3, s. 545-551
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Tidskriftsartikel (refereegranskat)abstract
- Piecewise-linear systems in input/output form can have different switching schedules. In this article, two categories, instant and delayed switching, are analysed. Even though a general piecewise-linear state-space model cannot be converted into input/output form, it is shown that it is possible to find state-space models representing instant and delayed switching. In addition, a prediction-error minimisation (PEM) method for piecewise-linear output-error predictors is derived and it is concluded that the instant-switching model candidate is not necessarily the most suitable for the parameter estimation procedure.
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| 21. |
- Rosenqvist, Fredrik, 1972, et al.
(författare)
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Time-variant modelling of TMP refining
- 2001
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Ingår i: IEEE IAS Workshop on Advanced Process Control. ; , s. 37-42
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Konferensbidrag (refereegranskat)
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| 22. |
- Rosenqvist, Kerstin, et al.
(författare)
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Endovascular treatment of acute and chronic portal vein thrombosis in patients with cirrhotic and non-cirrhotic liver
- 2016
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 57:5, s. 572-579
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Treatment of patients with portal vein thrombosis (PVT) differs due to different etiology and wide range of symptoms but certain patients seems to benefit from endovascular intervention.PURPOSE: To assess the safety and efficiency of endovascular treatment of acute and chronic PVT in patients with cirrhotic and non-cirrhotic liver.MATERIAL AND METHODS: Twenty-one patients with PVT treated with an endovascular procedure in 2002-2013 were studied retrospectively. Data on etiology, onset and extension of thrombus, presenting symptoms, methods of intervention, portal pressure gradients, complications, recurrence of symptoms, re-interventions, clinical status at latest follow-up, and survival were collected.RESULTS: Four non-cirrhotic patients with acute extensive PVT and bowel ischemia were treated with local thrombolysis, in three combined with placement of a transjugular intrahepatic portosystemic shunt (TIPS) placement. Three recovered and have survived more than 6 years. In six non-cirrhotic patients with chronic PVT and acute or threatening variceal bleeding recanalization and TIPS were successful in three and failed in three. Eleven cirrhotic patients with PVT and variceal bleeding or refractory ascites were successfully treated with recanalization and TIPS. Re-intervention was performed in five of these patients and five patients died, three within 12 months of intervention. Four cirrhotic patients had episodes of shunt-related encephalopathy and three had variceal re-bleeding.CONCLUSION: TIPS was found to be effective in reducing portal hypertension in patients with PVT. In patients with extensive PVT and bowel ischemia treatment with TIPS combined with thrombolysis should be considered.
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| 23. |
- Rosenqvist, Kerstin, et al.
(författare)
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Endovascular treatment of symptomatic Budd-Chiari syndrome - in favour of early transjugular intrahepatic portosystemic shunt.
- 2016
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Ingår i: European Journal of Gastroenterology and Hepathology. - 0954-691X .- 1473-5687. ; 28:6, s. 656-660
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Treatment of Budd-Chiari syndrome (BCS) has shifted from mainly medical treatment, with surgical shunt and orthotopic liver transplantation (OLT) as rescue, to medical treatment combined with an early endovascular intervention in the past two decades.PURPOSE: To assess the safety and efficiency of endovascular treatment of symptomatic patients with BCS and to compare mortality with symptomatic BCS patients in the same region treated with only sporadic endovascular techniques.METHODS: This was a retrospective review of clinical data, treatment and survival in 14 patients diagnosed with BCS and treated with endovascular methods from 2003 to 2015. A national epidemiology study of BCS from 1986 to 2003 was used for comparison.RESULTS: Thirteen of the 14 patients eventually had transjugular intrahepatic portosystemic shunt (TIPS), four after previous liver vein angioplasty. TIPS were performed with polytetrafluoroethylene-covered stents and technical success was 100%. Calculated preinterventional prognostic indices indicated a high risk of TIPS dysfunction, OLT and death. However, only one patient died and one had an OLT, and the 1- and 2-year primary TIPS-patency was 85 and 67%, respectively. Episodes of de-novo hepatic encephalopathy occurred in three patients. Overall 1- and 5-year transplantation-free survival was 100 and 93% compared with 47 and 28%, respectively, in 1986 to 2003.CONCLUSION: TIPS seems to be a safe and effective treatment for symptomatic BCS and there is an obvious improvement in transplantation-free survival compared with conservatory medical treatment. It should, therefore, be considered early, as first-line intervention, in patients with insufficient response to medical treatment.
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| 24. |
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| 25. |
- Rosenqvist, Kerstin
(författare)
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Transjugular intrahepatic portosystemic shunt in the treatment of symptomatic portal hypertension
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Portal hypertension (PHT) is a condition with serious complications, such as variceal bleeding, refractory ascites and bowel ischemia. The cause of PHT may be pre-, intra- or post-hepatic. Initial treatment is pressure-reducing drugs and the treatment of acute symptoms.Ten patients presented with severe abdominal pain and acute portomesenteric venous thrombosis. Their response to systemic anticoagulation was insufficient. Treatment with primary continuous thrombolysis by a transhepatic or transjugular approach in four patients resulted in major complications, incomplete recanalization and a 75% survival rate. Treatment with repeated transjugular thrombectomy (TT) combined with the creation of a transjugular intrahepatic portosystemic shunt (TIPS) achieved near complete recanalization, prompt symptom relief and 100% survival in five patients treated with this method as the primary intervention. In one patient, treated with TT and TIPS secondary to surgical thrombectomy and bowel resection, the outcome was fatal.Nineteen patients with portal vein thrombosis presented with acute or threatening variceal bleeding or refractory ascites. TIPS was feasible in 16 of the 18 patients in whom it was attempted and symptom relief was achieved in the majority of them.In 14 patients with Budd-Chiari syndrome, 13 patients were treated with TIPS, four of them after previous liver vein angioplasty. The 5-year transplantation-free survival rate was 100% in patients treated with primary TIPS.In 131 patients with variceal bleeding treated with TIPS, the survival at 12 months in patients with and without cirrhosis was 70% and 100% respectively and in accordance with previous studies. A high Child-Pugh score prior to TIPS and severe HE within 12 months after TIPS was related to an increased mortality. The occurrence of HE after TIPS did not correlate with the PSG after TIPS. Re-bleeding within 12 months after TIPS occurred in 10 patients and was associated with TIPS dysfunction.In conclusion, endovascular intervention, mainly TIPS, seems to be safe and effective for treating patients with complications of PHT, regardless of the underlying cause of disease and site of venous blood flow obstruction. HE may occur more frequently after TIPS than medical and endoscopic treatment, but is often mild and easily treated. In selected patients with PHT, TIPS may improve survival.
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| 26. |
- Rosenqvist, Kerstin, et al.
(författare)
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Transjugular intrahepatic portosystemic shunt treatment of variceal bleeding in an unselected patient population
- 2017
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 53:1, s. 70-75
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate transjugular intrahepatic portosystemic shunt (TIPS) in variceal bleeding in a clinical setting.Materials and methods: Retrospective review of 131 patients (116 with liver cirrhosis) treated with TIPS with covered stent grafts in a single centre from 2002 to 2016.Results: Survival at 1 and 2 years was 70% and 57% in patents with, and 100% at 2 years in patients without liver cirrhosis, respectively. A high Child-Pugh score and severe hepatic encephalopathy (HE) within 12 months post-TIPS were related to increased mortality. Re-bleeding occurred in 8% within 12 months and was related to TIPS dysfunction and a post-TIPS portosystemic gradient (PSG) of 5mmHg. The main cause of TIPS dysfunction was that the stent did not fully reach the inferior vena cava. There was no correlation between the PSG and the occurrence of HE.Conclusions: TIPS was safe and prevented re-bleeding in patients with variceal bleeding, with or without liver cirrhosis, regardless of Child-Pugh class and of how soon after bleeding onset, the TIPS procedure was performed. A post-TIPS PSG of 5mmHg was associated with an increased risk for re-bleeding and there was no correlation between the post-TIPS PSG and the occurrence of HE.
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| 27. |
- Rosenqvist, Kerstin, et al.
(författare)
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Treatment of acute portomesenteric venous thrombosis with thrombectomy through a transjugular intrahepatic portosystemic shunt : a single-center experience.
- 2018
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 59:8, s. 953-958
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Tidskriftsartikel (refereegranskat)abstract
- Background: Acute portomesenteric venous thrombosis (PMVT) is a potentially life-threatening condition and urgent treatment is required.Purpose: To retrospectively evaluate the efficacy and safety of treating acute PMVT by the creation of a transjugular intrahepatic portosystemic shunt (TIPS) followed by thrombectomy.Material and Methods: Six patients (all men, age range = 39-51 years) presenting with acute PMVT were treated with transjugular thrombectomy (TT) through a TIPS created in the same session. The intervention included iterated venography through the TIPS one to three times within the first week after diagnosis and repeated thrombectomy if needed (n = 5).Results: Recanalization was successful with persistent blood flow through the main superior mesenteric vein, portal vein, and TIPS in all six patients. Five patients were treated primarily with thrombectomy through a TIPS with clinical improvement. The final patient was initially treated with surgical thrombectomy and bowel resection. TIPS and TT was performed two days after surgery due to re-thrombosis but the patient deteriorated and died of multi-organ failure. Procedure-related complications were transient hematuria (n = 3) and transient encephalopathy (n = 2). In-hospital time was <14 days in four of the five patients with primary TIPS and TT. No sign of re-thrombosis was noted during follow-up (mean = 18 months, range = 8-28 months).Conclusion: Thrombectomy through a TIPS is feasible and can be effective in recanalization and symptom-relief in acute PMVT.
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| 28. |
- Sjöblom, Johanna, et al.
(författare)
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Clinical risk profile score predicts all cause mortality but not implantable cardioverter defibrillator intervention rate in a large unselected cohort of patients with congestive heart failure
- 2017
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Ingår i: Annals of Noninvasive Electrocardiology. - : Wiley. - 1082-720X. ; 22:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Primary prophylactic implantable cardioverter defibrillator (ICD) therapy is indicated for patients with reduced left ventricular ejection fraction (LVEF). We aimed to determine if preoperative clinical risk profiling can predict long-term benefit, and if clinical risk scores can be applied and improved in a patient cohort outside the clinical trial setting.METHODS: Using registry data, 789 patients with reduced LVEF who received ICDs for primary prevention during 2006-2011 were identified (age 64 ± 11 years, 82% men, 63% ischemic etiology, 52% cardiac resynchronization therapy with defibrillator). The patients were divided into three risk groups, based on the presence of baseline clinical risk factors (age >70, QRS duration >120 ms, New York Heart Association class III-IV, atrial fibrillation history, or creatinine >106 μmol/L). Endpoints were all-cause mortality and survival free of adequate ICD therapy.RESULTS: Mean follow-up was 39 ± 18 months. Annual mortality was 7.6%, and increased with risk group (p < .001). Rates of appropriate antitachycardia pacing and shock therapy were not statistically different between the groups, and ranged from 11%-16% and 6%-14%, respectively. By combining the previous risk score with data on diabetes, a better independent prediction of mortality was achieved; mortality rates then ranged from 11% (low-risk) to 46% (high-risk) (p < .0001).CONCLUSIONS: Implantable cardioverter defibrillator therapies occur across the spectrum of comorbidities in a population with systolic heart failure. However, all-cause mortality is considerably higher in the group of patients with accumulated risk factors, and using the proposed scoring system can be helpful for the evaluation and risk stratification of the patient prior to making a decision for a primary prophylactic ICD implantation.
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| 29. |
- Torisson, Gustav, et al.
(författare)
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Hospitalisations with infectious disease diagnoses in somatic healthcare between 1998 and 2019 : A nationwide, register-based study in Swedish adults
- 2022
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Ingår i: The Lancet Regional Health - Europe. - : Elsevier BV. - 2666-7762. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several studies indicate increasing hospitalisation rates for specific infectious diseases (IDs). Studies describing the entire ID spectrum are scarcer. Our aim was to describe hospital use with ID diagnoses in Swedish adults from 1998 to 2019. Methods: All four-position codes in ICD-10 were reclassified as ID or non-ID diagnoses. Using data from the National Patient Register, age-standardised hospitalisation rates and average length-of-stay (LOS) was determined for hospitalisations with ID vs non-ID diagnoses in the primary position at discharge. The 22-year study period was divided into five periods that were compared using standardised rate ratios (SRR). Findings: Annual hospitalisations with ID diagnoses increased from 115 thousand in 1998-2002 to 182 thousand in 2015-2019, for a rate increase from 17·4 to 23.0 per 1000 person-years, and a SRR (95%CI) of 1.32 (1.32-1.33). Concurrently, the hospitalisation rate with non-ID diagnoses decreased from 147 to 110, for a SRR of 0.75 (0.75-0.75). Average LOS decreased less for IDs than for non-IDs. Consequently, the proportion of hospital nights for which an ID was considered causing the hospitalisation increased from 11% to 21%. Persons aged 80+ years had the highest ID hospitalisation rate. Interpretation: The increased hospital use with ID diagnoses suggests an increasing incidence of severe IDs as well as a changing case-mix of hospitalised patients. Given the anticipated demographic change, this trend is likely to persist. Healthcare systems will need to address IDs in a comprehensive and standardised way. Funding: Governmental Funding of Research within the Clinical Sciences (ALF)
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| 30. |
- Wangsell, Fredrik, et al.
(författare)
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Investigation of alpha-phenylnorstatine and alpha-benzylnorstatine as transition state isostere motifs in the search for new BACE-1 inhibitors
- 2011
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Ingår i: Bioorganic & Medicinal Chemistry. - : Elsevier BV. - 0968-0896 .- 1464-3391. ; 19:1, s. 145-155
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Tidskriftsartikel (refereegranskat)abstract
- Inhibition of the BACE-1 protease enzyme has over the recent decade developed into a promising drug strategy for Alzheimer therapy. In this report, more than 20 new BACE-1 protease inhibitors based on alpha-phenylnorstatine, alpha-benzylnorstatine, iso-serine, and beta-alanine moieties have been prepared. The inhibitors were synthesized by applying Fmoc solid phase methodology and evaluated for their inhibitory properties. The most potent inhibitor, tert-alcohol containing (R)-12 (IC(50) = 0.19 mu M) was co-crystallized in the active site of the BACE-1 protease, furnishing a novel binding mode in which the N-terminal amine makes a hydrogen bond to one of the catalytic aspartic acids.
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| 31. |
- Westin, Fredrik, et al.
(författare)
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Heat losses from the turbine of a turbocharged SI-engine - Measurements and simulation
- 2004
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Ingår i: SAE Technical Paper Series. - 400 Commonwealth Drive, Warrendale, PA, United States : SAE International. - 0148-7191.
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Konferensbidrag (refereegranskat)abstract
- Traditionally, heat losses from the turbine are neglected in turbomatching calculations as well as in engine simulations [1]. On the SI-engine, with it's high exhaust temperatures, this assumption will lead to errors in the calculations. Significant amounts of heat are dissipated from the turbine through several mechanisms. This paper contains measurements of the different heat loss mechanisms from the turbine during full load operation on a 4-cylinder SI-engine. The largest loss components are convective and radiative. The heat losses to cooling water and lubrication oil were approximately 3-5% of the total heat loss from the turbine. In addition to heat losses to the surroundings, heat flux is also present internally in the turbocharger. Heat flux from the turbine to the compressor can deteriorate the efficiency of the compressor. Measurements and calculations were performed for several heat flux conditions and it could be concluded that little possibility exists for significant heat flux through the rotor, instead the major heat flux comes from conduction in the housings and external radiation. With the heat transfer included in the model the turbine outlet temperature could be simulated very close to measured. However, incorporation of the heat losses in the simulation did not do very much for the necessity of using correction factors for the turbine efficiency.
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| 32. |
- Zijlstra, Jolande A, et al.
(författare)
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Different defibrillation strategies in survivors after out-of-hospital cardiac arrest.
- 2018
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Ingår i: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 104:23, s. 1929-1936
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival.METHODS: We performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded.RESULTS: A total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm.CONCLUSION: Survivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.
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