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- Blennow Nordström, Erik, et al.
(author)
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Neuropsychological outcome after cardiac arrest : results from a sub-study of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial
- 2023
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In: Critical Care. - : BioMed Central (BMC). - 1364-8535 .- 1466-609X. ; 27:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Cognitive impairment is common following out-of-hospital cardiac arrest (OHCA), but the nature of the impairment is poorly understood. Our objective was to describe cognitive impairment in OHCA survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA.METHODS: This was a prospective case-control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. At approximately 7 months post-event, we administered an extensive neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes.RESULTS: Of 184 eligible OHCA survivors, 108 were included, with 92 MI controls enrolled. Amongst OHCA survivors, 29% performed z-score ≤ - 1 (at least borderline-mild impairment) in ≥ 2 cognitive domains, 14% performed z-score ≤ - 2 (major impairment) in ≥ 1 cognitive domain while 54% performed without impairment in any domain. Impairment was most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = - 0.37, 95% confidence intervals [- 0.61, - 0.12]), verbal (MD = - 0.34 [- 0.62, - 0.07]), and visual/constructive functions (MD = - 0.26 [- 0.47, - 0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, executive functions (MD = - 0.44 [- 0.82, - 0.06]) were also worse following OHCA. Diabetes, symptoms of anxiety, depression, and fatigue were significantly associated with worse cognitive performance.CONCLUSIONS: In our study population, cognitive impairment was generally mild following OHCA. OHCA survivors performed worse than MI controls in 3 of 6 domains. These results support current guidelines that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue.TRIAL REGISTRATION: ClinicalTrials.gov, NCT03543371. Registered 1 June 2018.
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- Blennow Nordström, Erik, et al.
(author)
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Neuropsychological outcome after cardiac arrest : A prospective case control sub-study of the Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest trial (TTM2)
- 2020
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In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 20:1
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Journal article (peer-reviewed)abstract
- Background: This study is designed to provide detailed knowledge on cognitive impairment after out-of-hospital cardiac arrest (OHCA) and its relation to associated factors, and to validate the neurocognitive screening of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2-trial), assessing effectiveness of targeted temperature management after OHCA. Methods: This longitudinal multi-center clinical study is a sub-study of the TTM2-trial, in which a comprehensive neuropsychological examination is performed in addition to the main TTM2-trial neurocognitive screening. Approximately 7 and 24 months after OHCA, survivors at selected study sites are invited to a standardized assessment, including performance-based tests of cognition and questionnaires of emotional problems, fatigue, executive function and insomnia. At 1:1 ratio, a matched control group from a cohort of acute myocardial infarction (MI) patients is recruited to perform the same assessment. We aim to include 100 patients per group. Potential differences between the OHCA patients and the MI controls at 7 and 24 months will be analyzed with a linear regression, using composite z-scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions) as primary outcome measures. Results from OHCA survivors on the main TTM2-trial neurocognitive screening battery will be compared with neuropsychological test results at 7 months, using sensitivity and specificity analyses. Discussion: In this study we collect detailed information on cognitive impairment after OHCA and compare this to a control group of patients with acute MI. The validation of the TTM2 neurocognitive screening battery could justify its inclusion in routine follow-up. Our results may have a potential to impact on the design of future follow-up strategies and interventions after OHCA. Trial registration: ClinicalTrials.gov, NCT03543371. Registered 1 June 2018
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- Erkapers, Maria, et al.
(author)
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The influence of immediately loaded implant treatment in the atrophic edentulous maxilla on oral health related quality of life of edentulous patients : 3-year results of a prospective study
- 2017
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In: Head & Face Medicine. - : Springer Science and Business Media LLC. - 1746-160X. ; 13:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: To evaluate oral health related quality of life (OHQoL) in edentulous patients treated with immediately loaded implants in the maxilla.METHODS: Fifty-one edentulous patients in two centers received six maxillary implants each were loaded within 24 h with provisional restoration. Definitive restoration was delivered 20-24 weeks later. OHQoL was evaluated preoperatively with the Oral Health Impact Profile 49 questionnaire (OHIP-49) and on five subsequent occasions. OHIP-49 includes seven domains representing functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. A reduction in OHIP scores indicated an improved OHQoL.RESULTS: Forty-five patients reached the three-year follow up. OHQoL improved after treatment. A plateau of OHQoL improvement was observed at 12 months after surgery. The seven domains improved at different pace, 12 weeks to 12 months after treatment. OHIP showed continuously low scores with no significant changes at consecutive visits 12 months to three years after treatment. Dental status with removable prosthesis in the mandible had a negative impact on OHQoL prior to and during treatment, but did not affect OHQoL after permanent restoration was placed. Patients age or gender did not affect OHQoL.CONCLUSIONS: Patients with edentulous maxilla who received prosthetic rehabilitation on immediately loaded implants experienced the highest improved OHQoL 12 months after implant installation. Quality of life related to oral health continued to be high after three years. Edentulous patients with atrophy of the maxilla experience an improved OHQoL after implant treatment with immediate loading protocol.TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT00711022 .
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- Segerström, Susanna
(author)
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Carbon-graphite fiber-reinforced polymers for implant suprastructures
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Carbon-graphite fiber-reinforced polymers (CGFR) can be used as the core material for implant-retained prostheses as an alternative to metal frameworks. The purpose was to formulate and develop carbon-graphite fiber-reinforced polymers intended for implant suprastructures and to determine physicochemical, mechanical properties and possible cytotoxic effects. The adhesion strength between CGFR polymer to a titanium surface or CGFR polymer to opaquer layer/denture base polymer were evaluated. The resin mixtures, based on methyl methacrylate (MMA), poly(methyl methacrylate) and poly(vinyl chloride-co-vinyl acetate), were produced with two different cross-linking agent systems: 1,4-butanediol dimethacrylate and ethylene glycol dimethacrylate or diethylene glycol dimethacrylate. The matrix resins were reinforced with tubes of braided CG fibers, cleaned and treated with a size, with fiber loadings 24-58 wt%. Water uptake and water sorption/solubility was determined and dilatometric analysis was performed. Mechanical properties, adhesion, residual monomer and cytotoxicity were evaluated. Basic requirements regarding water sorption, water solubility, water uptake, residual MMA monomer, coefficient of linear thermal expansion were met and were similar for the two resin matrices. However, flexural properties and fracture toughness were higher for the matrix resin containing the cross linker diethylene glycol dimethacrylate, making it a more suitable resin binder. Flexural properties increased with fiber loadings up to and including 47 wt% (38 vol%) when tested in dry and wet condition. The combination of the described fiber surface treatment, the sizing resin and the developed resin matrix contributed to good adhesion between the carbongraphite fibers and the polymer matrix. Hydrothermal cycling did not decrease flexural strength of the CGFR polymers with 24 and 36 wt% fiber loadings, when compared to dry and water stored specimens. However, more porosity was observed with higher fiber loadings; flexural strength decreased after thermal cycling for fiber loadings of 47 wt% and 58 wt% in relation to composites tested in dry and wet condition. There was no evidence of cytotoxicity for the CGFR polymer and residual monomer content was within the international standard limits. Good adhesion with a cohesive fracture type was achieved between the layers of the silicatized titanium/CGFR polymer/ opaquer/denture base polymers. The combination of these materials in an implant-retained supraconstruction is promising for in vivo evaluation.
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