| 1. |
- Gaber, Alexander, et al.
(författare)
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Effects of radiation therapy on tissue and serum concentrations of tumour associated trypsin inhibitor and their prognostic significance in rectal cancer patients
- 2011
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Ingår i: Radiation Oncology. - 1748-717X. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: We have previously demonstrated that elevated concentrations of tumour-associated trypsin inhibitor (TATI) in both tumour tissue (t-TATI) and in serum (s-TATI) are associated with a poor prognosis in colorectal cancer patients. It was also found that s-TATI concentrations were lower in patients with rectal cancer compared to patients with colon cancer. In this study, we investigated the effects of neoadjuvant radiotherapy (RT) on concentrations of t-TATI and s-TATI in patients with rectal cancer. Methods: TATI was analysed in serum, normal mucosa and tumour tissue collected at various time points in 53 rectal cancer patients enrolled in a case-control study where 12 patients received surgery alone, 20 patients 5 x 5 Gy (short-term) preoperative RT and 21 patients 25 x 2 Gy (long-term) preoperative RT. T-TATI was analysed by immunohistochemistry and s-TATI was determined by an immunofluorometric assay. Mann-Whitney U test and Wilcoxon Z (Z) test were used to assess t-TATI and s-TATI concentrations in relation to RT. Spearman's correlation (R) test was used to explore the associations between t-TATI, s-TATI and clinicopathological parameters. Overall survival (OS) according to high and low t-TATI and s-TATI concentrations was estimated by classification and regression tree analysis, Kaplan-Meier analysis and the log rank test. Results: RT did not affect concentrations of t-TATI or s-TATI. In patients receiving short-term but not long-term RT, s-TATI concentrations were significantly higher 4 weeks post surgery than in serum drawn prior to surgery (Z = -3.366, P < 0.001). T-TATI expression correlated with male gender (R = 0.406, P = 0.008). High t-TATI expression in surgical specimens was associated with a significantly shorter OS (P = 0.045). S-TATI concentrations in serum drawn at all time points were associated with an impaired OS (P = 0.035 before RT, P = 0.001 prior to surgery, P = 0.043 post surgery). At all time points, s-TATI correlated with higher age (P < 0.001-0.021) and with increased s-creatinine concentrations assessed prior to surgery (P = 0.041). Conclusions: The results presented here further validate the utility of t-TATI and s-TATI as prognostic biomarkers in patients with rectal cancer, independent of neoadjuvant RT.
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| 2. |
- Hakansson, A, et al.
(författare)
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Rose Hip and Lactobacillus plantarum DSM 9843 Reduce Ischemia/Reperfusion Injury in the Mouse Colon.
- 2006
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Ingår i: Digestive Diseases and Sciences. - : Springer Science and Business Media LLC. - 1573-2568 .- 0163-2116. ; 51:11, s. 2094-2101
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Tidskriftsartikel (refereegranskat)abstract
- schaemia/reperfusion (I/R) of the colon is an inflammatory condition that leads to tissue injury where reactive oxygen species play a central role. Rose hip is rich in biologically active polyphenols with antioxidative properties, which may be important in prevention of lipid peroxidation. L. plantarum DSM 9843 possesses enzymatic activity towards polyphenols. The objective of this study was to define the effect of oral administration of L. plantarum and rose hip in I/R injury. Administration of rose hip and L. plantarum significantly decreased MDA levels in caecum tissue and Enterobacteriaceae counts in caecum stool. A positive correlation between MDA levels and Enterobacteriaceae counts was found. The results support a synergistic/additive role of rose hip and L. plantarum in reducing lipid peroxidation. Therefore rose hip and L. plantarum may be used as a pretreatment to tissue injuries, e.g. colonic surgery, organ transplantation and vascular surgery.
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| 3. |
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| 4. |
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| 5. |
- Hurtsén, Anna Stene, 1992-, et al.
(författare)
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A randomized porcine study of hemorrhagic shock comparing end-tidal carbon dioxide targeted and proximal systolic blood pressure targeted partial resuscitative endovascular balloon occlusion of the aorta in the mitigation of metabolic injury
- 2023
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Ingår i: Intensive Care Medicine Experimental. - : Springer. - 2197-425X. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The definition of partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) is not yet determined and clinical markers of the degree of occlusion, metabolic effects and end-organ injury that are clinically monitored in real time are lacking. The aim of the study was to test the hypothesis that end-tidal carbon dioxide (ETCO2) targeted pREBOA causes less metabolic disturbance compared to proximal systolic blood pressure (SBP) targeted pREBOA in a porcine model of hemorrhagic shock.MATERIALS AND METHODS: Twenty anesthetized pigs (26-35 kg) were randomized to 45 min of either ETCO2 targeted pREBOA (pREBOAETCO2, ETCO2 90-110% of values before start of occlusion, n = 10) or proximal SBP targeted pREBOA (pREBOASBP, SBP 80-100 mmHg, n = 10), during controlled grade IV hemorrhagic shock. Autotransfusion and reperfusion over 3 h followed. Hemodynamic and respiratory parameters, blood samples and jejunal specimens were analyzed.RESULTS: ETCO2 was significantly higher in the pREBOAETCO2 group during the occlusion compared to the pREBOASBP group, whereas SBP, femoral arterial mean pressure and abdominal aortic blood flow were similar. During reperfusion, arterial and mesenteric lactate, plasma creatinine and plasma troponin concentrations were higher in the pREBOASBP group.CONCLUSIONS: In a porcine model of hemorrhagic shock, ETCO2 targeted pREBOA caused less metabolic disturbance and end-organ damage compared to proximal SBP targeted pREBOA, with no disadvantageous hemodynamic impact. End-tidal CO2 should be investigated in clinical studies as a complementary clinical tool for mitigating ischemic-reperfusion injury when using pREBOA.
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| 6. |
- Johansson, Ulla M, et al.
(författare)
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Nutritional therapy in elderly care--a forgotten perspective. A questionnaire study shows clear shortages in the care of the elderly
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:40, s. 2538-2542
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Tidskriftsartikel (refereegranskat)abstract
- It has previously been demonstrated that the use of clinical nutrition in Swedish hospitals did not fulfill European standards. In the present study, a questionnaire-based investigation was performed among nurses working with elderly people living in sheltered housing. Overall, 765 (54.6%) responded. Nearly 90% of the nurses considered themselves responsible for nutritional assessment, although only 36% routinely registered energy intake on patients at risk of undernutrition. More than 60% stated that education regarding clinical nutrition was insufficient. Thus, despite a heavy responsibility in the nutrition care process for nurses, a lack of sufficient knowledge and education was evident. Special efforts should be aimed at a clarified organization as well as education.
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| 7. |
- Johansson, Ulla M, et al.
(författare)
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Nutritionsbehandling i äldrevård - ett bortglömt perspektiv : Enkätstudie visar tydliga brister i omhändertagandet av äldre
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:40, s. 2538-2542
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Tidskriftsartikel (refereegranskat)abstract
- Sjukdomsrelaterad undernäring har beskrivits i Europa under flera decennier. Europarådet antog år 2003 en resolution med rekommendationer till medlemsländerna kring nutritionsbehandling på sjukhus. En tidigare studie visar att rekommendationerna inte efterlevs inom svensk slutenvård, där flertalet patienter är äldre. Den aktuella enkätstudien, riktad till sjuksköterskor inom särskilda boenden, påvisar sjuksköterskornas ansvar för utritionsprocessen men även brister i både kunskap och utbildning. Brister har även beskrivits i ansvarsfördelning mellan yrkesgrupper, riktlinjer för nutritionsbehandling och övergripande organisation. En förändrad struktur efterlyses inom hälso -och sjukvårdsorganisationen. Såväl läkare, dietister, sjuksköterskor som undersköterskor bör vara aktiva i nutritionsprocessen vid särskilda boenden.
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| 8. |
- Johansson, Ulla M, et al.
(författare)
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Nutritionsbehandling i äldrevård - ett bortglömt perspektiv : Enkätstudie visar tydliga brister i omhändertagandet av äldre
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:40, s. 2538-2542
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Tidskriftsartikel (refereegranskat)abstract
- It has previously been demonstrated that the use of clinical nutrition in Swedish hospitals did not fulfill European standards. In the present study, a questionnaire-based investigation was performed among nurses working with elderly people living in sheltered housing. Overall, 765 (54.6%) responded. Nearly 90% of the nurses considered themselves responsible for nutritional assessment, although only 36% routinely registered energy intake on patients at risk of undernutrition. More than 60% stated that education regarding clinical nutrition was insufficient. Thus, despite a heavy responsibility in the nutrition care process for nurses, a lack of sufficient knowledge and education was evident. Special efforts should be aimed at a clarified organization as well as education.
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| 11. |
- Johansson, Ulla, et al.
(författare)
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Nutritionsbehandling inom slutenvården : Svenska sjukhus klarar inte Europarådets riktlinjer
- 2006
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 103:21-22, s. 1718-1724
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Tidskriftsartikel (refereegranskat)abstract
- Sjukdomsrelaterad undernäring har beskrivits i Europa sedan ett tiotal år. Problemet har föranlett Europarådet att 2003 anta en resolution med rekommendationer till medlemsländerna om nutritionsbehandling på sjukhus.I en enkätstudie genomförd bland svenska läkare, sjuksköterskor och dietister undersöktes attityder till och rutiner för nutritionsbehandling inom slutenvården – i relation till Europarådets rekommendationer.Totalt 1 656 personer (38 procent) svarade på enkäten. Av dessa ansåg 88 procent att nutritionsstatus ska screenas vid inläggning, medan endast 22 procent beskrev att så verkligen sker. Nästan hälften ansåg att utbildningen i klinisk nutrition för vårdpersonal var otillräcklig. En otydlighet i ansvarsfördelningen beskrevs av majoriteten av dem som svarat.Undersökningen visar att svensk slutenvård inte lever upp till Europarådets rekommendationer om nutritionsbehandling. Brister har också definierats vad gäller riktlinjer och organisation.För framtiden efterlyses en nationell handlingsplan för att implementera Europarådets resolution i svensk hälso- och sjukvård.
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| 12. |
- Polistena, Andrea, et al.
(författare)
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MMP7 Expression in Colorectal Tumours of Different Stages
- 2014
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Ingår i: In Vivo. - 0258-851X. ; 28:1, s. 105-110
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: Matrix metalloproteinases (MMPs) are involved in cancer biology. Expression of MMP7 (matrilysin) in colorectal cancer is associated with metastatic disease even though it is expressed in most tumour states. In the present study, our purpose was to analyze MMP7 in bowel and lymph nodes of different tumour stages and to evaluate its expression as a cancer biomarker. Patients and Methods: 28 patients surgically-treated for benign and malignant colorectal tumours were recruited and analyzed for MMP7 in tumoural tissue, lymph nodes and serum by histology, immunohistochemistry, ELISA and western blotting. Results: Immunohistochemistu showed prevalent expression of MMP7 in advanced cancer. A significant increase (p < 0.001) was evident in serum of stage III/IV cancers compared to both adenomas and non-metastatic disease. MMP7 was increased in cancer tissues with prevalence in stage I/II. Lymph nodes presented a significant increase of MMP7 (p < 0.05 adenoma vs. stage I/II and p < 0.001 vs. stage III/IV). Conclusion: MMP7 increases with dysplasia and cancer disease stage in tumour tissue as well as in the regional lymph nodes. It may be used as a complement in investigating suspected locally advanced cancer.
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| 13. |
- Stene, Christina, et al.
(författare)
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Administration of probiotics to healthy volunteers : effects on reactivity of intestinal mucosa and systemic leukocytes
- 2022
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Ingår i: BMC Gastroenterology. - : Springer Science and Business Media LLC. - 1471-230X. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Oral administration of health-promoting bacteria is increasingly used in clinical practise. These bacteria have anti-inflammatory characteristics and modulate the immune system without major reported side effects. The mechanisms of action are not yet fully defined. Our aim was to study systemic effects of probiotics by measurements of leukocytes as well as local effects on rectal mucosal biopsies after adding a standardized inflammatory stimulus in vitro. Methods: Fourteen healthy subjects were randomized to receive 1010 colony forming units/day orally of the probiotic strain Lactiplantibacillus plantarum 299 (Lp299), n = 7, or Bifidobacterium infantis CURE21 (CURE21), n = 7, for six weeks. Rectal biopsies were taken before and after ingestion of either probiotic strain product, for stimulation in vitro with tumour necrosis factor alpha (TNF-α) at 10 and 100 ng/ml respectively up to 8 h. Blood tests were sampled before and after treatment. Lactate dehydrogenase (LDH) confirmed viable tissue. Results: Composition of the intestinal microbiota was not changed. Systemic leukocytes decreased after administration of CURE21 (P<0.05) and Lp299 (P<0.01). Levels of the pro-inflammatory cytokine IL-6 in rectal mucosa after stimulation with TNF-α were attenuated after ingestion of Lp299. No effect was seen with CURE21. Conclusions: Administration of these probiotic strains to healthy humans show both a systemic and local reduction of inflammatory response by lowering leukocyte counts, and for Lp299 IL-6 levels in rectal mucosa. Probiotics may play an important role in the reduction of inflammatory responses expected after trauma during surgery or after pelvic irradiation. Trial registration Clinical Trials, registration number NCT01534572, retrospectively registered (http://www.clinicaltrials.gov).
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| 17. |
- Stene, Christina, et al.
(författare)
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MMP7 modulation by short- and long-term radiotherapy in patients with rectal cancer
- 2018
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Ingår i: In Vivo. - : Anticancer Research USA Inc.. - 0258-851X .- 1791-7549. ; 32:1, s. 133-138
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: Matrix metalloproteinase 7 (MMP7) expression is highly associated with colorectal cancer and modulates tumour growth and invasion. Radiation injury induces inflammation with increases in MMP7 and in transforming growth factor beta (TGFβ). The aim of this study was to investigate the effect on MMP7 and TGFβ. expression in patients with rectal cancer undergoing different regimens of neoadjuvant radiotherapy (RT). Patients and Methods: We studied 53 patients in three RT treatment groups receiving RT of 25 Gy, long-term RT 50 Gy and controls receiving no RT. Three biopsies were obtained from each patient during the treatments: before RT, after RT and after surgery. Tissue samples were formalin fixed, paraffin embedded and tissue microarrays were constructed and stained for MMP7 and TGFβ. Mann–Whitney U-tests and Wilcoxon Z-tests were used to determine differences between patients before and after RT, and after surgery, as well as between the RT groups. Results: In all three patient groups, increases of MMP7 and TGFβ expression were observed after surgery. MMP7 expression was significantly increased in patients receiving short-term RT but TGFβ expression was not affected by RT. Conclusion: 50 Gy Irradiation of rectal cancer gives less tumour activation of MMP7, whilst it is up-regulated by 25 Gy and surgery regardless of RT.
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| 18. |
- Stene, Christina, et al.
(författare)
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The importance of enteral nutrition
- 2017
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Ingår i: Dysphagia. - Cham : Springer International Publishing. - 0942-5373 .- 2197-4187. ; , s. 793-811
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Bokkapitel (refereegranskat)abstract
- Many neurological diseases are followed by a disturbance of nutritional intake to some extent and thus constitute the most common indication for nutritional support and enteral access. Several studies have shown that malnutrition is a common condition, with as many as 40% of admitted patients being identified as undernourished and 78% of these further found to be deteriorated in their nutritional status during hospital stay (McWirtrer and Pennington, BMJ 308:945–948, 1994). Malnutrition, being a preventable disorder, is thus of great importance to identify patients at risk of malnutrition and prevent impairment of nutritional status. With adequate nutritional care, improved healing is augmented, resulting in better care and quality of life, lowered costs due to reduced length of hospital stay, fewer complications, and decreased mortality. Gut starvation hampers the immunological response. Even small amounts of enteral nutrition maintain gastrointestinal mucosal integrity and improve barrier function, thus minimizing immunological complications and enhancing clinical recovery.
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| 19. |
- Wikström, Maria B, 1972-, et al.
(författare)
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A randomized porcine study of the hemodynamic and metabolic effects of combined endovascular occlusion of the vena cava and the aorta in normovolemia and in hemorrhagic shock
- 2021
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Ingår i: Journal of Trauma and Acute Care Surgery. - : Lippincott Williams & Wilkins. - 2163-0755 .- 2163-0763. ; 90:5, s. 817-826
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mortality from traumatic retrohepatic venous injuries is high and methods for temporary circulatory stabilization are needed. We investigated survival, and hemodynamic and metabolic effects of resuscitative endovascular balloon occlusion of the aorta (REBOA) and vena cava inferior (REBOVC) in anesthetized pigs.METHODS: Twenty-five anesthetized pigs in normovolemia or severe hemorrhagic shock (controlled arterial bleeding in blood bags targeting systolic arterial pressure of 50 mmHg, corresponding to 40-50% of the blood volume) were randomized to REBOA zone 1 or REBOA+REBOVC zone 1 (n=6-7/group) for 45 minutes occlusion, followed by 3-hour resuscitation and reperfusion. Hemodynamic and metabolic variables and markers of end-organ damage were measured regularly.RESULTS: During occlusion, both the REBOA groups had higher systemic mean arterial pressure (MAP) and cardiac output (P<0.05) compared to the two REBOA+REBOVC groups. After 60 minutes reperfusion, there were no statistically significant differences between the two REBOA groups and the two REBOA+REBOVC groups in MAP and cardiac output. The two REBOA+REBOVC groups had higher arterial lactate and potassium concentrations during reperfusion, compared to the two REBOA groups (P<0.05). There was no major difference in end-organ damage markers between REBOA and REBOA+REBOVC. Survival after one-hour reperfusion was 86% and 100% respectively in the normovolemic REBOA and REBOA+REBOVC groups, and 67% and 83% respectively in the corresponding hemorrhagic shock REBOA and REBOA+REBOVC groups.CONCLUSION: Acceptable hemodynamic stability during occlusion and short-term survival can be achieved by REBOA+REBOVC with adequate resuscitation; however, the more severe hemodynamic and metabolic impacts of REBOA+REBOVC compared to REBOA must be considered.LEVEL OF EVIDENCE: Prospective, randomized, experimental animal study. Basic science study, therapeutic.
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