| 1. |
- Ahn, Henrik Casimir, 1949-, et al.
(författare)
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A New Total Artificial Heart Concept Allowing Replacement or Support of the Native Heart
- 2018
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Ingår i: Journal of Clinical & Experimental Cardiology. - Los Angeles, United States : Omics Publishing Group. - 2155-9880. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- A total artificial heart (TAH) is typically used to bridge the time to heart transplantation. A device designed by Robert Jarvik has been improved through the years and under the name of Syncardia™ this has been the most successful commercially available TAH so far. Since 2008 the Carmat™ heart has been under development in Europe. The Scandinavian Real Heart™ is based on a unique physiological concept where the atrio-ventricular valve plane is of utmost importance in the pumping function of the heart. It consists of two identical parts driven separately by independent motors and in this first animal study we have used one part as a left ventricular assist device. This new concept makes the device flexible as it may be used not only as a TAH but also as a separate pump for left or right ventricular assist.
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| 2. |
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| 3. |
- Gaipov, Abduzhappar, et al.
(författare)
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Acute kidney injury following coronary revascularization procedures in patients with advanced CKD.
- 2019
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 34:11, s. 1894-1901
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies reported that compared with percutaneous coronary interventions (PCIs), coronary artery bypass grafting (CABG) is associated with a reduced risk of mortality and repeat revascularization in patients with mild to moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). Information about outcomes associated with CABG versus PCI in patients with advanced stages of CKD is limited. We evaluated the incidence and relative risk of acute kidney injury (AKI) associated with CABG versus PCI in patients with advanced CKD.Methods: We examined 730 US veterans with incident ESRD who underwent a first CABG or PCI up to 5 years prior to dialysis initiation. The association of CABG versus PCI with AKI was examined in multivariable adjusted logistic regression analyses.Results: A total of 466 patients underwent CABG and 264 patients underwent PCI. The mean age was 64 ± 8 years, 99% were male, 20% were African American and 84% were diabetic. The incidence of AKI in the CABG versus PCI group was 67% versus 31%, respectively (P < 0.001). The incidence of all stages of AKI were higher after CABG compared with PCI. CABG was associated with a 4.5-fold higher crude risk of AKI {odds ratio [OR] 4.53 [95% confidence interval (CI) 3.28-6.27]; P < 0.001}, which remained significant after multivariable adjustments [OR 3.50 (95% CI 2.03-6.02); P < 0.001].Conclusion: CABG was associated with a 4.5-fold higher risk of AKI compared with PCI in patients with advanced CKD. Despite other benefits of CABG over PCI, the extremely high risk of AKI associated with CABG should be considered in this vulnerable population when deciding on the optimal revascularization strategy.
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| 4. |
- Gaipov, Abduzhappar, et al.
(författare)
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Predialysis coronary revascularization and postdialysis mortality
- 2019
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : MOSBY-ELSEVIER. - 0022-5223 .- 1097-685X. ; 157:3, s. 976-
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Coronary artery bypass grafting (CABG) is associated with better survival than percutaneous coronary intervention (PCI) in patients with mild-to-moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, the optimal strategy for coronary artery revascularization in patients with advanced CKD who transition to ESRD is unclear. Methods: We examined a contemporary national cohort of 971 US veterans with incident ESRD who underwent first CABG or PCI up to 5 years before dialysis initiation. We examined the association of a history of CABG versus PCI with all-cause mortality following transition to dialysis using Cox proportional hazards models adjusted for time between procedure and dialysis initiation, sociodemographics, comorbidities, and medications. Results: In total, 582 patients underwent CABG and 389 patients underwent PCI. The mean age was 64 +/- 8 years, 99% of patients were male, 79% were white, 19% were African American, and 84% had diabetes. The all-cause post-dialysis mortality rates after CABG and PCI were 229 per 1000 patient-years (95% confidence interval [CI], 205-256) and 311 per 1000 patient years (95% CI, 272-356), respectively. Compared with PCI, patients who underwent CABG had 34% lower risk of death (multivariable adjusted hazard ratio, 0.66; 95% CI, 0.51-0.86, P = .002) after initiation of dialysis. Results were similar in all subgroups of patients stratified by age, race, type of intervention, presence/absence of myocardial infarction, congestive heart failure, and diabetes. Conclusions: CABG in patients with advanced CKD was associated lower risk of death after initiation of dialysis compared with PCI.
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| 5. |
- Grams, Morgan, et al.
(författare)
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Decline in Estimated Glomerular Filtration Rate After Acute Kidney Injury: A Surrogate Endpoint?
- 2015
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Ingår i: ASN (American Society of Nephrology).
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Konferensbidrag (refereegranskat)abstract
- Background: Often a transient condition, acute kidney injury (AKI) is not currently accepted as an endpoint for drug registration trials by the US FDA. We sought to determine whether an intermediate-term change in eGFR after AKI has a sufficiently strong relationship with subsequent ESRD to serve as an alternative endpoint in clinical trials of AKI preventionand/or treatment.Methods: We evaluated 161,185 US veterans who underwent major surgery between2004-2011. Post-surgical AKI was defined by the KDIGO creatinine criteria;decline in eGFR was calculated from pre-hospitalization value to two time-points post-discharge (60-days, 90-days) and related to ESRD and mortality using Cox proportional hazards regression.Results: In-hospital mortality varied by AKI status, ranging from 1% for patients without AKI to 35% for those with dialysis-requiring AKI. An eGFR decline of ³30% at 60-days was relatively frequent: 2.5%, 9.7%, 17.2%, and 28.6% in those with no AKI, Stage 1 AKI, Stage 2 AKI, and Stage 3 AKI, respectively. There was a graded relationship between eGFR decline at 60-days and risk of ESRD in persons both with and without AKI (Figure). Compared to stable eGFR/no in-hospital AKI, the adjusted hazard ratio (HR) of ESRD associated with a 30% decline at 60-days after AKI was 6.42 (95% CI: 4.8-8.7). Risks for mortality associated with eGFR decline were smaller: the HR for 30% decline 60-days after in-hospital AKI was 1.59 (95% CI: 1.46-1.73). Risk relationships were similar at 90-days.Conclusions: A 30% decline in eGFR from pre-hospitalization baseline to 60-days or 90-days after an episode of AKI may be an acceptable surrogate endpoint in trials of AKI prevention and/or treatment.
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| 6. |
- Grams, Morgan E, et al.
(författare)
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Acute Kidney Injury After Major Surgery : A Retrospective Analysis of Veterans Health Administration Data.
- 2016
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Ingår i: American Journal of Kidney Diseases. - : Saunders Elsevier. - 0272-6386 .- 1523-6838. ; 67:6, s. 872-880
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Few trials of acute kidney injury (AKI) prevention after surgery have been conducted, and most observational studies focus on AKI following cardiac surgery. The frequency of, risk factors for, and outcomes after AKI following other types of major surgery have not been well characterized and may present additional opportunities for trials in AKI.STUDY DESIGN: Observational cohort study.SETTING & PARTICIPANTS: 3.6 million US veterans followed up from 2004 to 2011 for the receipt of major surgery (cardiac; general; ear, nose, and throat; thoracic; vascular; urologic; and orthopedic) and postoperative outcomes.FACTORS: Demographics, health characteristics, and type of surgery.OUTCOMES: Postoperative AKI defined by the KDIGO creatinine criteria, postoperative length of stay, end-stage renal disease, and mortality.RESULTS: Postoperative AKI occurred in 11.8% of the 161,185 major surgery hospitalizations (stage 1, 76%; stage 2, 15%, stage 3 [without dialysis], 7%; and AKI requiring dialysis, 2%). Cardiac surgery had the highest postoperative AKI risk (relative risk [RR], 1.22; 95% CI, 1.17-1.27), followed by general (reference), thoracic (RR, 0.92; 95% CI, 0.87-0.98), orthopedic (RR, 0.70; 95% CI, 0.67-0.73), vascular (RR, 0.68; 95% CI, 0.64-0.71), urologic (RR, 0.65; 95% CI, 0.61-0.69), and ear, nose, and throat (RR, 0.32; 95% CI, 0.28-0.37) surgery. Risk factors for postoperative AKI included older age, African American race, hypertension, diabetes mellitus, and, for estimated glomerular filtration rate < 90mL/min/1.73m(2), lower estimated glomerular filtration rate. Participants with postoperative AKI had longer lengths of stay (15.8 vs 8.6 days) and higher rates of 30-day hospital readmission (21% vs 13%), 1-year end-stage renal disease (0.94% vs 0.05%), and mortality (19% vs 8%), with similar associations by type of surgery and more severe stage of AKI relating to poorer outcomes.LIMITATIONS: Urine output was not available to classify AKI; cohort included mostly men.CONCLUSIONS: AKI was common after major surgery, with similar risk factor and outcome associations across surgery type. These results can inform the design of clinical trials in postoperative AKI to the noncardiac surgery setting.
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| 7. |
- Grams, Morgan E, et al.
(författare)
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Candidate Surrogate End Points for ESRD after AKI
- 2016
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Ingår i: Journal of the American Society of Nephrology. - : American Society of Nephrology. - 1046-6673 .- 1533-3450. ; 27:9, s. 2851-2859
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Tidskriftsartikel (refereegranskat)abstract
- AKI, a frequently transient condition, is not accepted by the US Food and Drug Association as an end point for drug registration trials. We assessed whether an intermediate-term change in eGFR after AKI has a sufficiently strong relationship with subsequent ESRD to serve as an alternative end point in trials of AKI prevention and/or treatment. Among 161,185 United States veterans undergoing major surgery between 2004 and 2011, we characterized in-hospital AKI by Kidney Disease Improving Global Outcomes creatinine criteria and decline in eGFR from prehospitalization to postdischarge time points and quantified associations of these values with ESRD and mortality over a median of 3.8 years. An eGFR decline of ≥30% at 30, 60, and 90 days after discharge occurred in 3.1%, 2.5%, and 2.6%, of survivors without AKI and 15.9%, 12.2%, and 11.7%, of survivors with AKI. For patients with in-hospital AKI compared with those with no AKI and stable eGFR, a 30% decline in eGFR at 30, 60, and 90 days after discharge demonstrated adjusted hazard ratios (95% confidence intervals) of ESRD of 5.60 (4.06 to 7.71), 6.42 (4.76 to 8.65), and 7.27 (5.14 to 10.27), with corresponding estimates for 40% decline in eGFR of 6.98 (5.21 to 9.35), 8.03 (6.11 to 10.56), and 10.95 (8.10 to 14.82). Risks for mortality were smaller but consistent in direction. A 30%-40% decline in eGFR after AKI could be a surrogate end point for ESRD in trials of AKI prevention and/or treatment, but additional trial evidence is needed.
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| 8. |
- Heldbjerg, Henning, et al.
(författare)
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Contrasting population trends of common starlings (Sturnus vulgaris) across Europe
- 2019
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Ingår i: Ornis Fennica. - 0030-5685. ; 96:4, s. 153-168
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Tidskriftsartikel (refereegranskat)abstract
- The greatest loss of biodiversity in the EU has occurred on agricultural land. The Common Starling (Sturnus vulgaris) is one of the many numerous and widespread European farmland breeding bird species showing major population declines linked to European agricultural intensification. Here we present results based on monitoring data collected since 1975 in 24 countries to examine the influence of changing extent of grassland and cattle abundance (based on results of earlier studies showing the importance of lowland cattle grazed grassland for the species), wintering provenance and temperature on national breeding population trends of Starlings across Europe. Positive Starling population trends in Central-East Europe contrast with negative trends in North and West Europe. Based on this indicative approach, we found some support for the importance of cattle stock and no support for grassland, temperature or wintering provenance to explain Starling population trends in Europe. However, we acknowledge such a European-wide analysis may conceal regional differences in responses and suggest that currently accessible national land use data might be insufficient to describe the detailed current changes in animal husbandry and grassland management that may be responsible for changes in food availability and hence breeding Starling abundance and their differences across Europe. Reviewing results from local studies relating Starling population trends to local agricultural change offer contradictory results, suggesting complex interacting processes at work. We recommend combining national datasets on demography, land-use/agricultural practices and from autecological research to better explain the reasons for contrasting Starling trends across Europe, to enable us to predict how changing agriculture will affect Starlings and potentially suggest mitigation measures to restore local populations where possible.
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| 9. |
- Holm, Jonas, 1971-, et al.
(författare)
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Copeptin Release in Cardiac Surgery : A New Biomarker to Identify Risk Patients?
- 2018
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Saunders Elsevier. - 1053-0770 .- 1532-8422. ; 32:1, s. 245-250
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the dynamics of copeptin in open cardiac surgery during the perioperative course.DESIGN: Prospective cohort study.SETTING: Single tertiary hospital.PARTICIPANTS: Twenty patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB).INTERVENTIONS: No intervention.MEASUREMENTS AND MAIN RESULTS: Copeptin concentrations were measured pre-, peri-, and postoperatively until day 6 after surgery. Patients were analyzed as a whole cohort (n = 20) and in a restricted "normal cohort" consisting of patients with normal preoperative copeptin concentration (<10 pmol/L) and perioperative uneventful course (n = 11). In the whole cohort, preoperative copeptin concentration was 7.0 pmol/L (interquartile range: 3.1-11 pmol/L). All patients had an early rise of copeptin, with 80% having peak copeptin concentration at weaning from CPB or upon arrival in the intensive care unit. Patients in the "normal cohort" had copeptin concentration at weaning from CPB of 194 pmol/L (98-275), postoperative day 1, 27 pmol/L (18-31); and day 3, 8.9 pmol/L (6.3-12).CONCLUSIONS: Regardless of cardiac surgical procedure and perioperative course, all patients had an early significant rise of copeptin concentrations, generally peaking at weaning from CBP or upon arrival in the intensive care unit. Among patients with normal copeptin concentration preoperatively and uneventful course, the postoperative copeptin concentrations decreased to normal values within 3-to-4 days after cardiac surgery. Furthermore, the restricted "normal cohort" generally tended to display lower levels of copeptin concentration postoperatively. Further studies may evaluate whether copeptin can be a tool in identifying risk patients in cardiac surgery.
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| 10. |
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| 11. |
- Kolehmainen, Jari, et al.
(författare)
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Quadruple Helix, Innovation and the Knowledge-Based Development : Lessons from Remote, Rural and Less-Favoured Regions
- 2016
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Ingår i: Journal of the Knowledge Economy. - New York : Springer Science+Business Media B.V.. - 1868-7865 .- 1868-7873. ; 7:1, s. 23-42
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Tidskriftsartikel (refereegranskat)abstract
- This paper addresses the dynamics of knowledge-based development of remote, rural and less-favoured regions. Many of the regional strategies and policies aimed at developing innovation emanate from policymakers in centrally located urban conurbations and are assumed to be universally applicable. An example is the classical “triple helix” model and its successors for economic development based around the idea of universities, business and public sector organisations all coming together to foster innovation and economic prosperity. In many remote, rural and less-favoured localities, there may not be a university or other knowledge-intensive institution present which makes a difference from the point of view of local development agendas. In many regions, also the business community may be scattered and insufficiently developed in terms of innovation. And furthermore, this kind of region may also have a weak public sector to enhance innovativeness. In such regions, social and community groups may often play the dominant entrepreneurial role. The community may also play a significant role in remote, rural and less-favoured regions where the basic elements of “triple helix” model are present. In this respect the concept of a “quadruple helix” is highly beneficial. This is the case, because innovation processes are becoming increasingly open to different stakeholders. In this paper, four illustrative cases of knowledge-based development processes and policies in remote, rural and less-favoured regions are analysed by using a “double-coin model of knowledge-based regional development” which places the quadruple helix model at the very heart of knowledge-based regional development.
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| 12. |
- Leffler, Jonatan, et al.
(författare)
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Decreased Neutrophil Extracellular Trap Degradation in Shiga Toxin-Associated Haemolytic Uraemic Syndrome
- 2017
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Ingår i: Journal of Innate Immunity. - : S. Karger AG. - 1662-811X .- 1662-8128. ; 9:1, s. 12-21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Neutrophil extracellular traps (NETs) can stimulate thrombosis, and their degradation is decreased in several autoimmune disorders. It was recently reported that some patients with haemolytic uraemic syndrome (HUS) also fail to degrade NETs and that neutrophils from Shiga toxin-associated HUS are primed to form NETs. Method: We used a well-characterized cohort of 74 thrombotic microangiopathy (TMA) patients, with a subset also providing follow-up samples, and 112 age-matched controls to investigate NET degradation and serum nuclease activity in TMA before, during and after treatment. Results: We identified that in the cohort of TMA patients, 50% of patients with Shiga toxin-associated HUS displayed a decreased ability to degrade NETs. NET degradation correlated with serum nuclease activity, but not with autoantibodies against double-stranded DNA, which has been previously observed in some autoimmune disorders. Further, NET degradation negatively correlated with serum creatinine levels, suggesting that kidney function was negatively impacted by the low NET degradation ability. Conclusions: We revealed that decreased NET degradation is a common feature of Shiga toxin-associated HUS and that it is associated with decreased kidney function in these patients. It remains to be clarified whether improving NET degradation would be beneficial for the patient.
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| 13. |
- Molnar, Miklos Z, et al.
(författare)
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Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans
- 2015
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Ingår i: Thorax. - : BMJ. - 0040-6376 .- 1468-3296. ; 70:9, s. 888-895
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE: There is a paucity of large cohort studies examining the association of obstructive sleep apnoea (OSA) with clinical outcomes including all-cause mortality, coronary heart disease (CHD), strokes and chronic kidney disease (CKD).OBJECTIVES: We hypothesised that a diagnosis of incident OSA is associated with higher risks of these adverse clinical outcomes.METHODS, MEASUREMENTS: In a nationally representative cohort of over 3 million (n=3 079 514) US veterans (93% male) with baseline estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m(2), we examined the association between the diagnosis of incident OSA, treated and untreated with CPAP, and: (1) all-cause mortality, (2) incident CHD, (3) incident strokes, (4)incident CKD defined as eGFR<60 mL/min/1.73 m(2), and (5) slopes of eGFR.MAIN RESULTS: Compared with OSA-negative patients, untreated and treated OSA was associated with 86% higher mortality risk, (adjusted HR and 95% CI 1.86 (1.81 to 1.91) and 35% (1.35 (1.21 to 1.51)), respectively. Similarly, untreated and treated OSA was associated with 3.5 times (3.54 (3.40 to 3.69)) and 3 times (3.06 (2.62 to 3.56)) higher risk of incident CHD; 3.5 times higher risk of incident strokes (3.48 (3.28 to 3.64) and 3.50 (2.92 to 4.19)) for untreated and treated OSA, respectively. The risk of incident CKD was also significantly higher in untreated (2.27 (2.19 to 2.36)) and treated (2.79 (2.48 to 3.13)) patients with OSA. The median (IQR) of the eGFR slope was -0.41 (-2.01 to 0.99), -0.61 (-2.69 to 0.93) and -0.87 (-3.00 to 0.70) mL/min/1.73 m(2) in OSA-negative patients, untreated OSA-positive patients and treated OSA-positive patients, respectively.CONCLUSIONS: In this large and contemporary cohort of more than 3 million US veterans, a diagnosis of incident OSA was associated with higher mortality, incident CHD, stroke and CKD and with faster kidney function decline.
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| 14. |
- Mueller, Katharina, et al.
(författare)
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Interdisciplinary Round-Robin Test on Molecular Spectroscopy of the U(VI) Acetate System
- 2019
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Ingår i: ACS Omega. - : American Chemical Society (ACS). - 2470-1343. ; 4:5, s. 8167-8177
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Tidskriftsartikel (refereegranskat)abstract
- A comprehensive molecular analysis of a simple aqueous complexing system. U(VI) acetate. selected to be independently investigated by various spectroscopic (vibrational, luminescence, X-ray absorption, and nuclear magnetic resonance spectroscopy) and quantum chemical methods was achieved by an international round-robin test (RRT). Twenty laboratories from six different countries with a focus on actinide or geochemical research participated and contributed to this scientific endeavor. The outcomes of this RRT were considered on two levels of complexity: first, within each technical discipline, conformities as well as discrepancies of the results and their sources were evaluated. The raw data from the different experimental approaches were found to be generally consistent. In particular, for complex setups such as accelerator-based X-ray absorption spectroscopy, the agreement between the raw data was high. By contrast, luminescence spectroscopic data turned out to be strongly related to the chosen acquisition parameters. Second, the potentials and limitations of coupling various spectroscopic and theoretical approaches for the comprehensive study of actinide molecular complexes were assessed. Previous spectroscopic data from the literature were revised and the benchmark data on the U(VI) acetate system provided an unambiguous molecular interpretation based on the correlation of spectroscopic and theoretical results. The multimethodologic approach and the conclusions drawn address not only important aspects of actinide spectroscopy but particularly general aspects of modern molecular analytical chemistry.
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| 15. |
- Nilsson, Andreas, et al.
(författare)
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Dual professional focus clinical case processed in an interprofessional postgraduate case seminar: Experiences from participants and the perceptions of a professional observer
- 2016
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Ingår i: MedEdPubish. - : MedEdPublish. - 2312-7996.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Inadequate communication between professionals in operating theaters results in impaired medical performance or even in critical events. Interprofessional case seminars, however, can enhance team communication by promoting a deeper understanding of complex situations. Our aim was to evaluate how an interprofessional case seminar using a dual professional focus case in anesthesiology was perceived by the participants. Method: A case seminar was held for 20 nurse anesthetists enrolled in a postgraduate course and for six anesthesiology residents. Transcripts of the case were distributed in advance for individual study and group discussion. The evaluation was based on the responses provided by participants who completed a semistructured questionnaire and from the perceptions of a professional observer. Results: Twenty participants completed the questionnaire; 53% of the respondents had previous experience with case methodology, and 89 different statements were obtained. Of these, 48% were positive and 11% were negative. The remaining 40% of the statements related to previous experiences with case methodology and to suggested improvements. The positive statements proposed that case methodologies are suitable for sensitive issues and beneficial for meetings and exchanges between different professionals. Negative statements focused instead on lack of time, overly large groups, too much speculation, and inadequate preparation or presentations by the participants. Conclusion: Interprofessional case seminars using a dual professional focus may be suitable for postgraduate education in anesthesia. This technique may improve interprofessional communication and may call attention to the importance of soft issues, such as ethics, communication, organization, and leadership in addition to that of the medical dimension.
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| 16. |
- Romanov, Roman A., et al.
(författare)
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Molecular interrogation of hypothalamic organization reveals distinct dopamine neuronal subtypes
- 2017
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Ingår i: Nature Neuroscience. - : Nature Publishing Group. - 1097-6256 .- 1546-1726. ; 20:2, s. 176-188
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Tidskriftsartikel (refereegranskat)abstract
- The hypothalamus contains the highest diversity of neurons in the brain. Many of these neurons can co-release neurotransmitters and neuropeptides in a use-dependent manner. Investigators have hitherto relied on candidate protein-based tools to correlate behavioral, endocrine and gender traits with hypothalamic neuron identity. Here we map neuronal identities in the hypothalamus by single-cell RNA sequencing. We distinguished 62 neuronal subtypes producing glutamatergic, dopaminergic or GABAergic markers for synaptic neurotransmission and harboring the ability to engage in task-dependent neurotransmitter switching. We identified dopamine neurons that uniquely coexpress the Onecut3 and Nmur2 genes, and placed these in the periventricular nucleus with many synaptic afferents arising from neuromedin S+ neurons of the suprachiasmatic nucleus. These neuroendocrine dopamine cells may contribute to the dopaminergic inhibition of prolactin secretion diurnally, as their neuromedin S+ inputs originate from neurons expressing Per2 and Per3 and their tyrosine hydroxylase phosphorylation is regulated in a circadian fashion. Overall, our catalog of neuronal subclasses provides new understanding of. hypothalamic organization and function.
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| 17. |
- Svensson, Anders S., et al.
(författare)
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Changes in serum cystatin C, creatinine, and C-reactive protein after cardiopulmonary bypass in patients with normal preoperative kidney function.
- 2016
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Ingår i: Nephrology (Carlton. Print). - : Wiley-Blackwell. - 1320-5358 .- 1440-1797. ; 21:6, s. 519-525
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The use of cardiopulmonary bypass (CPB) can cause changes in serum creatinine and cystatin C independent of glomerular filtration rate. We aimed to quantify the temporal changes of these biomarkers and C-reactive protein (CRP) after CPB.METHODS: This was a prospective study at an academic medical center between April and October 2013. We compared postoperative changes in serum creatinine and cystatin C in 38 patients with normal preoperative kidney function who underwent cardiac surgery using CPB and did not develop perioperative acute kidney injury (AKI). The effect of inflammation on intra-individual changes was examined in mixed effects regressions, using measurements of pre- and postoperative CRP.RESULTS: Both serum creatinine (79.9 ± 22.7 vs. 92.6 ± 21.4 µmol/L, p = 0.001) and cystatin C (1.16 ± 0.39 vs. 1.33 ± 0.37 mg/L, p = 0.012) decreased significantly in the first 8 hours postoperatively compared to preoperatively, as a result of hemodilution. Thereafter serum creatinine returned to preoperative levels, whereas serum cystatin C continued to rise and was significantly elevated at 72 hours post-CPB compared to preoperative levels (1.53 ± 0.48 vs. 1.33 ± 0.37 mg/L, p = 0.003). CRP levels increased significantly post-CPB and were significantly associated with increases in both serum creatinine and cystatin C.CONCLUSIONS: Serum creatinine and cystatin C appear not to be interchangeable biomarkers during and immediately after CPB. Processes unrelated to kidney function such as acute inflammation have a significant effect on post-CPB changes in these biomarkers, and may result in significant increases in serum cystatin C that could erroneously be interpreted as AKI. This article is protected by copyright. All rights reserved.
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| 18. |
- Szabó, Zoltán, et al.
(författare)
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Early Experience of Implantation of a New Pulsatile Total Artificial Heart (TAH) in the Pig
- 2017
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Ingår i: Journal of Clinical & Experimental Cardiology. - Los Angeles, United States : Omics Publishing Group. - 2155-9880. ; 8:3
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Tidskriftsartikel (refereegranskat)abstract
- The shortage of donor hearts and the physiological impact of pulsatile perfusion have driven technical innovation research efforts to create a positive displacement total artificial heart that can produce pulsatile flow and has a reasonable size for long-term assist in chronic heart failure. Such a product is the Scandinavian Real Heart 8 (SRH8); a new pulsatile total artificial heart. We here describe the basic principles of the surgical and anesthesiologic techniques we have developed for implantation of the latest prototype of this device.
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| 19. |
- Szabó, Zoltán, et al.
(författare)
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How students perceive problem-based learning (PBL) group tutorials at a Swedish Medical College
- 2015
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Ingår i: Med Ed Publish. - : F1000 Research Ltd. - 2312-7996. ; 6:17
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: student perception of problem-based learning (PBL) group tutorials was investigated at a Swedish University Medical College 27 years after the introduction of PBL into the curriculum.Methods: a survey questionnaire comprising 43 questions answered on a Likert-type scale, together with one open question was used. The questionnaire was distributed to all 821 students taking part in the Linköping University medical program at the beginning of the Spring Term 2013. The results were subjected to explorative factor analysis, descriptive statistics and ANOVA. Responses to the open question where analyzed qualitatively by categorization.Results: 84 per cent of the 821 students completed the survey. Four factors describing student perception were identified: 1) PBL as a method of learning; 2) the tutor’s role; 3) PBL, stress and feelings of insecurity; and 4) traditional teaching methods within the PBL curriculum. The Cronbach´s alpha value was 0,788 overall. Two hundred and seventy-six students answered the open question declaring that they would appreciate more precise aims and objectives, smaller tutorial groups, and more formal lectures.Conclusions: the results of this study on PBL group tutorials, as seen from the student’s perspective, stress the importance of tutorial quality, tutor competence, tutorial group size and the quality and aims of the curriculum. Too much emphasis on the teacher’s research merits against the educational ones, and the inability to adapt to the needs and wishes of new generations of students seems a probable cause for the erosion of PBL.
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| 20. |
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| 21. |
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| 22. |
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| 23. |
- Szabó, Zoltán, et al.
(författare)
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Using a heart operation video with live comments to inspire students in pre-clinical studies - A pilot study
- 2017
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Ingår i: MedEdPublish. - : F1000 Research Ltd. - 2312-7996.
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Tidskriftsartikel (refereegranskat)abstract
- A simple moment of inspiration based on the American empiric psychologist Csíkszentmihalyi’s theory about optimal experience, internal motivation and flow was presented to medical students. The students, from the preclinical terms, were exposed to a movie showing a routine heart operation (coronary bypass) with comments during the film. The team presenting the film consisted of nurses in cardiothoracic and vascular anesthesia, a cardiothoracic surgeon, and a perfusionist. Questions from the students were answered by them. Thereafter, there was a panel discussion with junior specialists in cardiothoracic surgery and cardiology about the years after graduating.The moment was evaluated using Touchpoint® and one single question: What is your opinion about the inspiration moment? Of the 77 participating students 65 (84%) answered that the moment was “very good” and 12 (16%) answered “good”.These preliminary data suggest that the method may possibly be an adequate tool to increase internal motivation among preclinical semester medical students.
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| 24. |
- Theveau, Laure, et al.
(författare)
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Cofactor-Controlled Chirality of Tropoisomeric Ligand
- 2016
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Ingår i: Organometallics. - : American Chemical Society (ACS). - 0276-7333 .- 1520-6041. ; 35:11, s. 1956-1963
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Tidskriftsartikel (refereegranskat)abstract
- A new tropos ligand with an integrated anion receptor receptor site has been prepared. Chiral carboxylate and phosphate anions that bind in the anion receptor unit proved capable of stabilizing chiral conformations of the achiral flexible bidentate biaryl phosphite ligand, as shown by variable temperature H-1 and P-31 NMR spectroscopical studies of palladium(0) olefin complexes. Palladium allyl complexes of the supramolecular ligand-chiral cofactor assemblies catalyzed asymmetric allylic substitutions of rac-(E)-1,3-diphenyl-2-propenyl carbonate and rac-3-cyclohexenyl carbonate with malonate and benzylamine as nucleophiles to provide nonracemic products. Although moderate enantioselectivities were observed, (ee:s up to 66%), the results confirm the ability of the anionic guests to affect the conformation of the ligand.
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| 25. |
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| 26. |
- Zanonato, Pier Luigi, et al.
(författare)
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Alkali-metal ion coordination in uranyl(VI) poly-peroxide complexes in solution. Part 1 : the Li+, Na+ and K+ - peroxide-hydroxide systems
- 2015
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Ingår i: Dalton Transactions. - : Royal Society of Chemistry (RSC). - 1477-9226 .- 1477-9234. ; 44:4, s. 1549-1556
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Tidskriftsartikel (refereegranskat)abstract
- The alkali metal ions Li+, Na+ and K+ have a profound influence on the stoichiometry of the complexes formed in uranyl(VI)-peroxide-hydroxide systems, presumably as a result of a templating effect, resulting in the formation of two complexes, M[(UO2)(O-2)(OH)](2)(-) where the uranyl units are linked by one peroxide bridge, mu-eta(2)-eta(2), with the second peroxide coordinated "end-on", eta(2), to one of the uranyl groups, and M[(UO2)(O-2)(OH)](4)(3-), with a four-membered ring of uranyl ions linked by mu-eta(2)-eta(2) peroxide bridges. The stoichiometry and equilibrium constants for the reactions: M+ + 2UO(2)(2+) + 2HO(2)(-) + 2H(2)O -> M[(UO2)(O-2)(OH)] 2 - + 4H(+) (1) and M+ + 4UO(2)(2+) + 4HO(2)(-) + 4H(2)O -> M[(UO2)(O-2)(OH)](4)(3-) + 8H(+) (2) have been measured at 25 degrees C in 0.10 M (tetramethyl ammonium/M+)NO3 ionic media using reaction calorimetry. Both reactions are strongly enthalpy driven with large negative entropies of reaction; the observation that Delta H(2) approximate to 2 Delta H(1) suggests that the enthalpy of reaction is approximately the same when peroxide is added in bridging and "end-on" positions. The thermodynamic driving force in the reactions is the formation of strong peroxide bridges and the role of M+ cations is to provide a pathway with a low activation barrier between the reactants and in this way "guide" them to form peroxide bridged complexes; they play a similar role as in the synthesis of crown-ethers. Quantum chemical (QC) methods were used to determine the structure of the complexes, and to demonstrate how the size of the M+-ions affects their coordination geometry. There are several isomers of Na[(UO2)(O-2)(OH)](2)(-) and QC energy calculations show that the ones with a peroxide bridge are substantially more stable than the ones with hydroxide bridges. There are isomers with different coordination sites for Na+ and the one with coordination to the peroxide bridge and two uranyl oxygen atoms is the most stable one.
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| 27. |
- Zanonato, P.L., et al.
(författare)
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Alkali-metal ion coordination in uranyl(VI) poly-peroxo complexes in solution, inorganic analogues to crown-ethers. Part 2. Complex formation in the tetramethyl ammonium-, Li+-, Na+- and K+-uranyl(VI)-peroxide-carbonate systems
- 2015
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Ingår i: Dalton Transactions. - : Royal Society of Chemistry (RSC). - 1477-9226 .- 1477-9234. ; 44:37, s. 16565-16572
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Tidskriftsartikel (refereegranskat)abstract
- The constitution and equilibrium constants of ternary uranyl(VI) peroxide carbonate complexes [(UO2)(p)(O-2)(q)(CO3)(r)](2(p-q-r)) have been determined at 0 degrees C in 0.50 M MNO3, M = Li, K, and TMA (tetramethyl ammonium), ionic media using potentiometric and spectrophotometric data; O-17 NMR data were used to determine the number of complexes present. The formation of cyclic oligomers, "[(UO2)(O-2)(CO3)](n)", n = 4, 5, 6, with different stoichiometries depending on the ionic medium used, suggests that Li+, Na+, K+ and TMA ions act as templates for the formation of uranyl peroxide rings where the uranyl-units are linked by mu-eta(2)-eta(2) bridged peroxide-ions. The templating effect is due to the coordination of the M+-ions to the uranyl oxygen atoms, where the coordination of Li+ results in the formation of Li[(UO2)(O-2)(CO3)](4)(7-), Na+ and K+ in the formation of Na/K[(UO2)(O-2)(CO3)](5)(9-) complexes, while the large tetramethyl ammonium ion promotes the formation of two oligomers, TMA[(UO2)(O-2)(CO3)] 5 9-and TMA[(UO2)(O-2)(CO3)](6)(11-). The NMR spectra demonstrate that the coordination of Na+ in the five-and six-membered oligomers is significantly stronger than that of TMA(+); these observations suggest that the templating effect is similar to the one observed in the synthesis of crown-ethers. The NMR experiments also demonstrate that the exchange between TMA[(UO2)(O-2)(CO3)](5)(9-) and TMA[(UO2)(O-2)(CO3)](6)(11-) is slow on the O-17 chemical shift time-scale, while the exchange between TMA[(UO2)(O-2)(CO3)](6)(11-)and Na[(UO2)(O-2)(CO3)](6)(11-) is fast. There was no indication of the presence of large clusters of the type identified by Burns and Nyman (M. Nyman and P. C. Burns, Chem. Soc. Rev., 2012, 41, 7314-7367) and possible reasons for this and the implications for the synthesis of large clusters are briefly discussed.
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| 28. |
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