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- Broberg, Olof, et al.
(author)
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Characterization of Cardiac, Vascular, and Metabolic Changes in Young Childhood Cancer Survivors
- 2021
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In: Frontiers in Pediatrics. - : Frontiers Media SA. - 2296-2360. ; 9
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Journal article (peer-reviewed)abstract
- Background: Childhood cancer survivors (CCS) are at an increased risk for cardiovascular diseases (CVD). It was the primary aim of this study to determine different measures of cardiac, carotid, lipid, and apolipoprotein status in young adult CCS and in healthy controls. Methods: Cardiac and common carotid artery (CCA) structure and function were measured by ultrasonography. Lipids and apolipoproteins were measured in the blood. Peripheral arterial endothelial vasomotor function was assessed by measuring digital reactive hyperemia index (PAT-RHI) using the Endo-PAT 2000. Results: Fifty-three CCS (20-30 years, 35 men) and 53 sex-matched controls were studied. The CCS cohort was divided by the median dose of anthracyclines into a low anthracycline dose (LAD) group (50-197 mg/m2, n = 26) and a high anthracycline dose (HAD) group (200-486 mg/m2, n = 27). Carotid distensibility index (DI) and endothelial function determined by PAT-RHI were both lower in the CCS groups compared with controls (p < 0.05 and p = 0.02). There was no difference in carotid intima media thickness. Atherogenic apolipoprotein-B (Apo-B) and the ratio between Apo-B and Apoliprotein-A1 (Apo-A1) were higher in the HAD group compared with controls (p < 0.01). Apo-B/Apo-A1-ratio was over reference limit in 29.6% of the HAD group, in 15.4% of LAD group, and in 7.5% of controls (p = 0.03). Measured lipid markers (low density lipoprotein and total cholesterol and triglycerides) were higher in both CCS groups compared with controls (p < 0.05). Systolic and diastolic function were measurably decreased in the HAD group, as evidenced by lower EF (p < 0.001) and lower é-wave (p < 0.005) compared with controls. CCA DI correlated with Apo-B/Apo-A1-ratio and Apo-A1. Follow-up time after treatment correlated with decreased left ventricular ejection fraction (p = 0.001). Conclusion: Young asymptomatic CCS exhibit cardiac, vascular, lipid, and apolipoprotein changes that could account for increased risk for CVD later in life. These findings emphasize the importance of cardiometabolic monitoring even in young CCS.
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| 2. |
- Broberg, Olof, et al.
(author)
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Childhood Cancer Survivors Have Impaired Strain-Derived Myocardial Contractile Reserve by Dobutamine Stress Echocardiography
- 2023
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In: Journal of Clinical Medicine. - 2077-0383. ; 12:8, s. 1-14
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Journal article (peer-reviewed)abstract
- Abnormal left ventricular contractile reserve (LVCR) is associated with adverse cardiac outcomes in different patient cohorts and might be useful in the detection of cardiomyopathy in childhood cancer survivors (CCS) after cardiotoxic treatment. The aim of this study was to evaluate LVCR by dobutamine stress echocardiography (DSE) combined with measures of myocardial strain in CCS previously treated with anthracyclines (AC). Fifty-three CCS (age 25.34 ± 2.44 years, 35 male) and 53 healthy controls (age 24.40 ± 2.40 years, 32 male) were included. Subjects were examined with echocardiography at rest, at low-dose (5 micrograms/kg/min), and at high-dose (40 micrograms/kg/min) dobutamine infusion. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), strain rate (GSR), and early diastolic strain rate (GEDSR) at different DSE phases were used as measures of LVCR. The mean follow-up time among CCS was 15.8 ± 5.8 years. GLS, GSR, and LVEF were lower at rest in CCS compared to controls (p ≤ 0.03). LVEF was within the normal range in CCS. ΔGLS, ΔGSR, and ΔGEDSR but not ΔLVEF were lower in CCS compared to controls after both low- (p ≤ 0.048) and high-dose dobutamine infusion (p ≤ 0.023). We conclude that strain measures during low-dose DSE detect impaired myocardial contractile reserve in young CCS treated with AC at 15-year follow-up. Thus, DSE may help identify asymptomatic CCS at risk for heart failure and allows for tailored follow-up accordingly.
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| 3. |
- Broberg, Olof, et al.
(author)
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Circulating leptin is associated with adverse vascular changes in young adult survivors of childhood cancer
- 2024
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In: Cardiology in the Young. - 1047-9511 .- 1467-1107.
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Proteomics may help discover novel biomarkers and underlying mechanisms for cardiovascular disease. This could be useful for childhood cancer survivors as they show an increased risk of cardiovascular disease. The aim of this study was to investigate circulating cardiovascular proteins in young adult survivors of childhood cancer and their relationship to previously reported subclinical cardiovascular disease.METHODS: Ninety-two cardiovascular proteins were measured in 57 childhood cancer survivors and in 52 controls. For proteins that were significantly different between childhood cancer survivors and controls, we performed correlations between protein levels and measures of peripheral arterial stiffness (carotid distensibility and stiffness index, and augmentation index) and endothelial dysfunction (reactive hyperemia index).RESULTS: Leptin was significantly higher in childhood cancer survivors compared to controls (normalized protein expression units: childhood cancer survivors 6.4 (1.5) versus 5.1 (1.7), p < 0.0000001) after taking multiple tests into account. Kidney injury molecule-1, MER proto-oncogene tyrosine kinase, selectin P ligand, decorin, alpha-1-microglobulin/bikunin precursor protein, and pentraxin 3 showed a trend towards group differences (p < 0.05). Among childhood cancer survivors, leptin was associated with anthracycline treatment after adjustment for age, sex, and body mass index (p < 0.0001). Higher leptin correlated with lower carotid distensibility after adjustment for age, sex, body mass index, and treatments with radiotherapy and anthracyclines (p = 0.005).CONCLUSION: This proteomics approach identified that leptin is higher in young asymptomatic adult survivors of childhood cancer than in healthy controls and is associated with adverse vascular changes. This could indicate a role for leptin in driving the cardiovascular disease burden in this population.
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| 6. |
- Gertsson, Nellie, 1992-
(author)
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The auditor : Creating a concept of the auditor through auditors' own perceptions and understandings of their work in relation to boundary-setting forces
- 2021
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Licentiate thesis (other academic/artistic)abstract
- The overall purpose of this licentiate dissertation is to advance our understanding of the auditor by creating a concept of the auditor through focusing on auditors' own perceptions and understandings of their work in relation to boundary-setting forces. The audit profession, the audit firm, the client, society, regulations, and the market are all boundary-setting forces that influence the work of auditors and how auditors perceive and understand their work. The concept of the auditor consists of who the auditor is and what the auditor does; this concept is shaped interactively by the boundary-setting forces, that exist in the auditors’ environment and by the auditors themselves, through the view auditors have of themselves and their environment. The boundary-setting forces have in recent decades undergone significant and rapid changes; for example, increased commercialization as well as significant regulatory changes, which are expected to have influenced the concept of the auditor. The concept of the auditor therefor needs to be explored to understand who today’s auditor is and what today's auditor does.This licentiate dissertation consists of three appended papers and a comprehensive summary. The appended papers constitute the basis for discussing who the auditor is and what the auditor does, thereby contributing to the concept of the auditor. This dissertation uses boundaries in exploring the concept of the auditor, since it is when the auditor encounters the boundaries of being an auditor that the auditor’s conception of an auditor becomes clear. This dissertation has a mixed-methods design based on survey and interview data.The results of this dissertation show that there are several characteristics that define who the auditor is. The auditor:is highly driven by professional valuesis less driven by business valuesis genuinely interested in auditor workis resistant to stress, heavy workload, and work–life balance issuesis admiring the audit profession and perceiving it as highly professionalis perceiving professional values in adding value to the client, i.e., in the business activitiesis enjoying adding value to the clientis more motivated by contributing to the client than to societyhas high social skills and broad knowledgeThe results of this dissertation also show that the work of the auditor in the "grey area" between auditing and consulting comprises several activities. The auditor:adds value to the client by being available and engaged, by providing mental support and family mediation, by informing and discussing, by giving tips, advice, and suggestions, by explaining, answering questions, raising questions, and questioning, and by customizing, operating, developing, and contributing expertise to the clientconducts a wide range of services, also related to the private and personal matters of the clienthas counselling, pedagogical, coaching and/or developmental roles
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| 7. |
- Mohlkert, Lilly-Ann, et al.
(author)
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Right Heart Structure, Geometry and Function Assessed by Echocardiography in 6-Year-Old Children Born Extremely Preterm-A Population-Based Cohort Study
- 2021
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In: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:1
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Journal article (peer-reviewed)abstract
- Preterm birth has been associated with altered cardiac phenotype in adults. Our aim was to test the hypothesis that children surviving extremely preterm birth have important structural or functional changes of the right heart or pulmonary circulation. We also examined relations between birth size, gestational age, neonatal diagnoses of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) with cardiac outcomes. We assessed a population-based cohort of children born in Sweden before 27 weeks of gestation with echocardiography at 6.5 years of age (n = 176). Each preterm child was matched to a healthy control child born at term. Children born preterm had significantly smaller right atria, right ventricles with smaller widths, higher relative wall thickness and higher estimated pulmonary vascular resistance (PVR) than controls. In preterm children, PVR and right ventricular myocardial performance index (RVmpi') were significantly higher in those with a PDA as neonates than in those without PDA, but no such associations were found with BPD. In conclusion, children born extremely preterm exhibit higher estimated PVR, altered right heart structure and function compared with children born at term.
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