| 1. |
- Ahle, Margareta, 1966-, et al.
(författare)
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Maternal, fetal and perinatal factors associated with necrotizing enterocolitis in Sweden. A national case-control study
- 2018
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Ingår i: Plos One. - San Francisco, United States : Public Library of Science (PLoS). - 1932-6203. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective To analyze associations of maternal, fetal, gestational, and perinatal factors with necrotizing enterocolitis in a matched case-control study based on routinely collected, nationwide register data. Study design All infants born in 1987 through 2009 with a diagnosis of necrotizing enterocolitis in any of the Swedish national health care registers were identified. For each case up to 6 controls, matched for birth year and gestational age, were selected. The resulting study population consisted of 720 cases and 3,567 controls. Information on socioeconomic data about the mother, maternal morbidity, pregnancy related diagnoses, perinatal diagnoses of the infant, and procedures in the perinatal period, was obtained for all cases and controls and analyzed with univariable and multivariable logistic regressions for the whole study population as well as for subgroups according to gestational age. Results In the study population as a whole, we found independent positive associations with necrotizing enterocolitis for isoimmunization, fetal distress, cesarean section, neonatal bacterial infection including sepsis, erythrocyte transfusion, persistent ductus arteriosus, cardiac malformation, gastrointestinal malformation, and chromosomal abnormality. Negative associations were found for maternal weight, preeclampsia, maternal urinary infection, premature rupture of the membranes, and birthweight. Different patterns of associations were seen in the subgroups of different gestational age. Conclusion With some interesting exceptions, especially in negative associations, the results of this large, population based study, are in keeping with earlier studies. Although restrained by the limitations of register data, the findings mirror conceivable pathophysiological processes and underline that NEC is a multifactorial disease. © 2018 Ahle et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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| 2. |
- Ahle, Margareta, 1966-
(författare)
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Necrotising Enterocolitis : epidemiology and imaging
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Necrotising enterocolitis (NEC) is a potentially devastating intestinal inflammation of multifactorial aetiology in premature or otherwise vulnerable neonates. Because of the broad spectrum of presentations, diagnosis and timing of surgical intervention may be challenging, and imaging needs to be an integrated part of management.The first four studies included in this thesis used routinely collected, nationwide register data to describe the incidence of NEC in Sweden 1987‒2009, its variation with time, seasonality, space-time clustering, and associations with maternal, gestational, and perinatal factors, and the risk of intestinal failure in the aftermath of the disease.Early infant survival increased dramatically during the study period. The incidence rate of NEC was 0.34 per 1,000 live births, rising from 0.26 per 1,000 live births in the first six years of the study period to 0.57 in the last five. The incidence rates in the lowest birth weights were 100‒160 times those of the entire birth cohort. Seasonal variation was found, as well as space-time clustering in association with delivery hospitals but not with maternal residential municipalities.Comparing NEC cases with matched controls, some factors, positively associated with NEC, were isoimmunisation, fetal distress, caesarean section, persistent ductus arteriosus, cardiac and gastrointestinal malformations, and chromosomal abnormalities. Negative associations included maternal pre-eclampsia, maternal urinary infection, and premature rupture of the membranes. Intestinal failure occurred in 6% of NEC cases and 0.4% of controls, with the highest incidence towards the end of the study period.The last study investigated current practices and perceptions of imaging in the management of NEC, as reported by involved specialists. There was great consensus on most issues. Areas in need of further study seem mainly related to imaging routines, the use of ultrasound, and indications for surgery.Developing alongside the progress of neonatal care, NEC is a complex, multifactorial disease, with shifting patterns of predisposing and precipitating causes, and potentially serious long-term complications. The findings of seasonal variation, spacetime clustering, and negative associations with antenatal exposure to infectious agents, fit into the growing understanding of the central role of bacteria and immunological processes in normal maturation of the intestinal canal as well as in the pathogenesis of NEC. Imaging in the management of NEC may be developed through future studies combining multiple diagnostic parameters in relation to clinical outcome.
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| 3. |
- Andersson, Peder, et al.
(författare)
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High-sensitivity troponin T is an important independent predictor in addition to the Simplified Acute Physiology Score for short-term ICU mortality, particularly in patients with sepsis
- 2019
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Ingår i: Journal of Critical Care. - : Elsevier BV. - 0883-9441. ; 53, s. 218-222
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Elevated cardiac troponin levels have been shown to be associated with a poor prognosis under some intensive care conditions. This study investigated whether inclusion of high-sensitivity troponin T (hsTnT) increased the prognostic accuracy of the Simplified Acute Physiology Score (SAPS 3) for general intensive care unit (ICU) patients, cardiac arrest patients, or patients with a non-cardiac arrest diagnosis. Materials and methods: We performed a single-center cohort study of ICU patients with an hsTnT measurement on ICU admission at a tertiary university hospital between February 2010 and June 2017. Results: Of 4185 first-time admissions, 856 patients (20.5%) had hsTnT evaluated at ICU admission. Factoring in ICU admission hsTnT values increased the ability of SAPS 3 to accurately predict 30-day mortality (odds ratio 1.27, 95% confidence interval: 1.15–1.41, p < 0.001). Elevated hsTnT levels were not independently associated with 30-day mortality in cardiac arrest patients. In sepsis patients, hsTnT evaluation in addition to SAPS 3 evaluation improved the area under the receiver operating characteristic curve by >10%. Conclusion: Addition of hsTnT evaluation to SAPS 3 enhances the predictive capability of this model in relation to mortality. In sepsis, the hsTnT level may be an important prognostic marker.
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| 4. |
- Andersson, Sven, 1968, et al.
(författare)
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Sulphur recirculation for high temperature corrosion and dioxin abatement in Waste-to-Energy boilers
- 2018
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Ingår i: Sulphur 2018 + Sulphuric Acid. ; , s. 315-320
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Konferensbidrag (refereegranskat)abstract
- Sulphur Recirculation is a new patented technology for reducing high temperature boiler corrosion and dioxin formation in Waste-to-Energy plants. SO2 is separated from a tail end wet scrubber using H2O2, producing a 15-25wt% H2SO4 solution, which is injected into the boiler producing SO2, thus creating a sulphur loop. The recirculated sulphur will increase the gas concentration of SO2 in the boiler and decrease the Cl/S ratio of the deposits and ashes, thus producing a less corrosive environment for the superheaters. Furthermore, the lower chlorine content of the boiler deposits also significantly decreased the dioxin formation rates as well as dioxin emissions. Sulphur Recirculation was initially demonstrated in pilot plant tests as well as full-scale tests at a Waste to Energy plant in Göteborg (Sweden) during nearly two months of operation. Babcock & Wilcox Vølund AB in Sweden has installed their Sulphur Recirculation technology in one of the two Waste-to Energy lines at Maabjerg Energy Center (MEC) in Denmark in order to combat high temperature corrosion and dioxin formation. This is the first commercial installation and it has been operating since mid-October 2016. Sulphur Recirculation decreased the high temperature corrosion rates of the superheaters in this full-scale installation by approximately 50%, which may increase green electricity production from combustion of biomass and waste in the future. Furthermore, the dioxin gas concentrations decreased by 72%. Sulphur Recirculation almost entirely decreased the need for costly road transports of effluent sulphate water for the Sulphur Recirculation line, since most sulphur from the waste now ends up in the ashes instead of creating a surplus dilute Na2SO4 solution. The sulphur content of the waste varies with time, which may create periods of sulphur surplus and deficit respectively. Most of these variations are being evened out by a storage vessel for H2SO4. These variations may facilitate a small market of waste sulphuric acid between plants in the future.
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| 5. |
- Holmgren, Gustav, et al.
(författare)
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Artificial neural networks improve and simplify intensive care mortality prognostication: a national cohort study of 217,289 first-time intensive care unit admissions
- 2019
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Ingår i: Journal of Intensive Care. - : Springer Science and Business Media LLC. - 2052-0492. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Purpose We investigated if early intensive care unit (ICU) scoring with the Simplified Acute Physiology Score (SAPS 3) could be improved using artificial neural networks (ANNs). Methods All first-time adult intensive care admissions in Sweden during 2009-2017 were included. A test set was set aside for validation. We trained ANNs with two hidden layers with random hyper-parameters and retained the best ANN, determined using cross-validation. The ANNs were constructed using the same parameters as in the SAPS 3 model. The performance was assessed with the area under the receiver operating characteristic curve (AUC) and Brier score. Results A total of 217,289 admissions were included. The developed ANN (AUC 0.89 and Brier score 0.096) was found to be superior (p textless10-15 for AUC and p textless10-5 for Brier score) in early prediction of 30-day mortality for intensive care patients when compared with SAPS 3 (AUC 0.85 and Brier score 0.109). In addition, a simple, eight-parameter ANN model was found to perform just as well as SAPS 3, but with better calibration (AUC 0.85 and and Brier score 0.106, p textless10-5). Furthermore, the ANN model was superior in correcting mortality for age. Conclusion ANNs can outperform the SAPS 3 model for early prediction of 30-day mortality for intensive care patients.
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| 6. |
- Johansson Frigyesi, E., et al.
(författare)
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Boys have better short-term and long-term survival rates after intensive care admissions than girls
- 2017
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Ingår i: Acta Paediatrica, International Journal of Paediatrics. - : Wiley. - 0803-5253. ; 106:12, s. 1973-1978
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Tidskriftsartikel (refereegranskat)abstract
- Aim: We investigated possible gender differences in paediatric intensive care morbidity-adjusted mortality. Methods: In this study, data on all 21 972 paediatric intensive care admissions in Sweden between 2008 and 2015 were analysed regarding morbidity-adjusted survival, using Cox regression, with age, gender and estimated mortality ratio as dependent variables and using the standardised mortality ratio at 90 days after admission. The data were obtained from the Swedish Intensive Care Registry. Results: We found that boys had better overall survival than girls (hazard ratio 0.91 for boys, p = 0.035). In addition, the 90-day survival was also better for boys (standardised mortality ratio 0.85 for boys versus 1.02 for girls, p = 0.0014). The survival advantage was most evident in children less than a year old and for nonsurgical patients. The male advantage was also seen in children admitted with respiratory insufficiency and seizures and was furthermore independent of any concurrent cardiac condition. We did not find any gender difference in the intensity of care or length of stay when corrected for morbidity. Conclusion: This study showed that boys have better outcomes than girls after intensive care admissions. The difference does not seem to be based on inequality of care.
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| 7. |
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| 8. |
- Olofsson, Peder S., et al.
(författare)
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Blood pressure regulation by CD4+ lymphocytes expressing choline acetyltransferase
- 2016
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Ingår i: Nature Biotechnology. - : Nature Publishing Group. - 1087-0156 .- 1546-1696. ; 34:10, s. 1066-1071
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Tidskriftsartikel (refereegranskat)abstract
- Blood pressure regulation is known to be maintained by a neuro-endocrine circuit, but whether immune cells contribute to blood pressure homeostasis has not been determined. We previously showed that CD4(+) T lymphocytes that express choline acetyltransferase (ChAT), which catalyzes the synthesis of the vasorelaxant acetylcholine, relay neural signals(1). Here we show that these CD4(+)CD44(hi)CD62L(Io) T helper cells by gene expression are a distinct T-cell population defined by ChAT (CD4 T-ChAT). Mice lacking ChAT expression in CD4(+) cells have elevated arterial blood pressure, compared to littermate controls. Jurkat T cells overexpressing ChAT (JT(ChAT)) decreased blood pressure when infused into mice. Co-incubation of JT(ChAT) and endothelial cells increased endothelial cell levels of phosphorylated endothelial nitric oxide synthase, and of nitrates and nitrites in conditioned media, indicating increased release of the potent vasorelaxant nitric oxide. The isolation and characterization of CD4 T-ChAT cells will enable analysis of the role of these cells in hypotension and hypertension, and may suggest novel therapeutic strategies by targeting cell-mediated vasorelaxation.
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| 9. |
- Sommarlund, Petra, et al.
(författare)
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En personlig och digital vårdupplevelse - Framtidens primärvård : Full version
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Om 10 år kommer primärvården ha andra kontaktvägar och högre tillgänglighet än idag. Patientens första kontakt är digital och i många fall kan ett digitalt beslutsstödssystem, vid behov kompletterat med hemtester, vara tillräckligt för att ge patienten den vård hen behöver. De digitala möjligheterna kommer att leda till ökad kunskap och egenförmåga hos patienten att ta större ansvar för sin egen hälsa. Personanpassade tjänster där individens behov styr kommer att erbjudas både från vården och andra aktörer. Relevant hälsodata kommer att finnas tillgänglig för de aktörer som behöver den och digitala lösningar integreras i hela vårdkedjan. På så sätt frigörs vårdresurser till de personer som verkligen behöver den.Denna rapport illustrerar den nutida och framtida primärvården genom fem patientfall som tillsammans täcker in merparten av primärvårdens besök. Möt febrige femårige Arvid, Ahmed med risk för att utveckla livsstilsrelaterad kronisk sjukdom, deprimerade 14-åriga Sara, Erik som just haft en hjärtinfarkt och multisjuka Inga. Från nutid och 10 år framåt förväntas primärvårdens resurser förflyttas från fall av engångskaraktär som Arvid till att arbeta förebyggande med fall som Ahmed.För att detta ska realiseras behöver vården säkerställa att patient- och kostnadsansvar följer individen och inte organisatoriska gränssnitt. Ett tydligt syfte med digitaliseringen och den avsedda effekten på verksamheten behöver definieras och hinder som möjliggör samlad vårdinformation som flödar mellan kommun och landsting behöver undanröjas.
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