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| 14. |
- Lilja, Gisela, et al.
(författare)
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Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest A Predefined Analysis of the TTM2 Randomized Clinical Trial
- 2023
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Ingår i: Jama Neurology. - 2168-6149 .- 2168-6157. ; 80:10, s. 1070-1079
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE The Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial reported no difference in mortality or poor functional outcome at 6 months after out-of-hospital cardiac arrest (OHCA). This predefined exploratory analysis provides more detailed estimation of brain dysfunction for the comparison of the 2 intervention regimens. OBJECTIVES To investigate the effects of targeted hypothermia vs targeted normothermia on functional outcome with focus on societal participation and cognitive function in survivors 6 months after OHCA. DESIGN, SETTING, AND PARTICIPANTS This study is a predefined analysis of an international multicenter, randomized clinical trial that took place from November 2017 to January 2020 and included participants at 61 hospitals in 14 countries. A structured follow-up for survivors performed at 6 months was by masked outcome assessors. The last follow-up took place in October 2020. Participants included 1861 adult (older than 18 years) patients with OHCA who were comatose at hospital admission. At 6 months, 939 of 1861 were alive and invited to a follow-up, of which 103 of 939 declined or were missing. INTERVENTIONS Randomization 1:1 to temperature control with targeted hypothermia at 33 degrees C or targeted normothermia and early treatment of fever (37.8 degrees C or higher). MAIN OUTCOMES AND MEASURES Functional outcome focusing on societal participation assessed by the Glasgow Outcome Scale Extended ([GOSE] 1 to 8) and cognitive function assessed by the Montreal Cognitive Assessment ([MoCA] 0 to 30) and the Symbol Digit Modalities Test ([SDMT] z scores). Higher scores represent better outcomes. RESULTS At 6 months, 836 of 939 survivors with a mean age of 60 (SD, 13) (range, 18 to 88) years (700 of 836 male [84%]) participated in the follow-up. There were no differences between the 2 intervention groups in functional outcome focusing on societal participation (GOSE score, odds ratio, 0.91; 95% CI, 0.71-1.17; P =.46) or in cognitive function by MoCA (mean difference, 0.36; 95% CI,-0.33 to 1.05; P =.37) and SDMT (mean difference, 0.06; 95% CI,-0.16 to 0.27; P =.62). Limitations in societal participation (GOSE score less than 7) were common regardless of intervention (hypothermia, 178 of 415 [43%]; normothermia, 168 of 419 [40%]). Cognitive impairment was identified in 353 of 599 survivors (59%). CONCLUSIONS In this predefined analysis of comatose patients after OHCA, hypothermia did not lead to better functional outcome assessed with a focus on societal participation and cognitive function than management with normothermia. At 6 months, many survivors had not regained their pre-arrest activities and roles, and mild cognitive dysfunction was common.
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| 17. |
- Rylander, L, et al.
(författare)
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Mortality and cancer incidence among women with a high consumption of fatty fish contaminated with persistent organochlorine compounds
- 1995
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 21:6, s. 26-419
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The purpose of this study was to assess cancer incidence and cardiovascular mortality among women with a high dietary intake of fatty fish from the Baltic Sea (on the Swedish east coast), contaminated with persistent organochlorine compounds.MATERIAL AND METHODS: Cohorts of fishermen's wives from the Swedish east (1989 subjects) and west (6605 subjects) coasts were established. The mortality and cancer incidence were studied in these cohorts, and comparisons were made with respective regional populations and between the cohorts. Dietary interviews were made with 200 randomly selected cohort women and equally many women from the general population. The interviewed east- and westcoast cohort women ate locally caught fatty fish at least twice as often as their referents.RESULTS: Compared with that of the regional population, the breast cancer incidence was higher than expected in the eastcoast cohort [standardized incidence ratio (SIR) 1.29, 95% confidence interval (95% CI) 0.96-1.71], whereas it was lower in the westcoast cohort (SIR 0.89; 95% CI 0.77-1.04). When a direct comparison was made between the two cohorts, the eastcoast women displayed an increased breast cancer incidence (incidence rate ratio 1.35, 95% CI 0.98-1.86). No obvious difference was seen between the two cohorts concerning cardiovascular mortality.CONCLUSIONS: The results support, but do not prove, the hypothesis of an association between exposure to a mixture of persistent organochlorine compounds through fish consumption and an increased risk for breast cancer.
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| 18. |
- Wallin, H, et al.
(författare)
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Altered aromatic amine metabolism in epileptic patients treated with phenobarbital
- 1995
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Ingår i: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. - 1055-9965. ; 4:7, s. 3-771
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Tidskriftsartikel (refereegranskat)abstract
- The fate of carcinogens differs among individuals who have different activities of drug-metabolizing enzymes that are important in activating and detoxifying carcinogens. A drug that profoundly alters the metabolism of the drugs and carcinogens is the anticonvulsive agent phenobarbital. To investigate why epileptic patients appear to have a low risk of cancer of the urinary bladder, and on the basis of the observation that levels of aromatic amine-hemoglobin adducts are strongly associated with various risk factors for cancer at that site, we determined aromatic amine-hemoglobin adducts in 62 epileptic patients as a surrogate measure of the reaction of carcinogenic metabolites with DNA in target tissue. Although adducts were detected in all subjects, the levels were proportional to daily tobacco consumption. When the subjects were stratified into groups smoking 20 g tobacco/day or more, smoking <20 g/day, and not smoking, an effect of medication was detected. Epileptic patients treated chronically with phenobarbital or primidone, which is effectively metabolized to phenobarbital, were found to have lower levels of 4-aminobiphenyl adducts than patients on the other treatment (P = 0.02; ANOVA). In nonsmokers, no effect of medication could be demonstrated above background variation; however, an increasing effect was seen with tobacco consumption with only one-half the increase in adducts per g of tobacco smoked as epileptic patients on other treatment. The difference in the increases (slopes of regression lines) was highly significant statistically. This reduction in the level of hemoglobin-aromatic amine adducts is probably due to induction of detoxification enzymes in the patients treated with phenobarbital.
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| 19. |
- Arvidsson, Ida, et al.
(författare)
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Shiga toxin-induced complement-mediated hemolysis and release of complement-coated red blood cell-derived microvesicles in hemolytic uremic syndrome.
- 2015
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Ingår i: Journal of Immunology. - : The American Association of Immunologists. - 1550-6606 .- 0022-1767. ; 194:5, s. 2309-2318
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Tidskriftsartikel (refereegranskat)abstract
- Shiga toxin (Stx)-producing Escherichia coli (STEC) cause hemolytic uremic syndrome (HUS). This study investigated whether Stx2 induces hemolysis and whether complement is involved in the hemolytic process. RBCs and/or RBC-derived microvesicles from patients with STEC-HUS (n = 25) were investigated for the presence of C3 and C9 by flow cytometry. Patients exhibited increased C3 deposition on RBCs compared with controls (p < 0.001), as well as high levels of C3- and C9-bearing RBC-derived microvesicles during the acute phase, which decreased after recovery. Stx2 bound to P1 (k) and P2 (k) phenotype RBCs, expressing high levels of the P(k) Ag (globotriaosylceramide), the known Stx receptor. Stx2 induced the release of hemoglobin and lactate dehydrogenase in whole blood, indicating hemolysis. Stx2-induced hemolysis was not demonstrated in the absence of plasma and was inhibited by heat inactivation, as well as by the terminal complement pathway Ab eculizumab, the purinergic P2 receptor antagonist suramin, and EDTA. In the presence of whole blood or plasma/serum, Stx2 induced the release of RBC-derived microvesicles coated with C5b-9, a process that was inhibited by EDTA, in the absence of factor B, and by purinergic P2 receptor antagonists. Thus, complement-coated RBC-derived microvesicles are elevated in HUS patients and induced in vitro by incubation of RBCs with Stx2, which also induced hemolysis. The role of complement in Stx2-mediated hemolysis was demonstrated by its occurrence only in the presence of plasma and its abrogation by heat inactivation, EDTA, and eculizumab. Complement activation on RBCs could play a role in the hemolytic process occurring during STEC-HUS.
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| 20. |
- Axmon, Anna, et al.
(författare)
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Factors affecting time to pregnancy
- 2006
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 21:5, s. 1279-1284
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Both lifestyle factors and occupational and environmental factors have been suggested to affect the female reproductive system. In the present study, the separate and joint effects of several such factors are investigated. METHODS: Information on time to pregnancy (TTP) was available for 1578 women randomly selected from the general Swedish population. The information was collected retrospectively by using self-administered questionnaires. By means of logistic regression of survival data, fecundability odds ratios were determined for many factors. Multivariate models were used to determine which factors had the most impact on TTP. RESULTS: Several lifestyle factors were found to associate with TTP. However, only use of oral contraceptives prior to attempting to conceive, menstrual cycle length, age at conception and parity remained in the multivariate models. Together, these factors explained 14% of the variance in TTP. Excluding first and second month conceptions, only age at conception and menstrual cycle length remained in the multivariate models, together explaining only 8% of the variance in TTP. CONCLUSIONS: Although information on several factors was available, the multivariate model explained only a small fraction of the variation in the observed time to pregnancies. Furthermore, female biological factors seemed more important predictors of TTP than lifestyle factors.
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