| 1. |
- Chew, Michelle S., et al.
(författare)
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Identification of myocardial injury using perioperative troponin surveillance in major noncardiac surgery and net benefit over the Revised Cardiac Risk Index
- 2022
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Ingår i: British Journal of Anaesthesia. - : Elsevier. - 0007-0912 .- 1471-6771. ; 128:1, s. 26-36
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with perioperative myocardial injury are at risk of death and major adverse cardiovascular and cerebrovascular events (MACCE). The primary aim of this study was to determine optimal thresholds of preoperative and perioperative changes in high-sensitivity cardiac troponin T (hs-cTnT) to predict MACCE and mortality.METHODS: Prospective, observational, cohort study in patients ≥50 yr of age undergoing elective major noncardiac surgery at seven hospitals in Sweden. The exposures were hs-cTnT measured before and days 0-3 after surgery. Two previously published thresholds for myocardial injury and two thresholds identified using receiver operating characteristic analyses were evaluated using multivariable logistic regression models and externally validated. The weighted comparison net benefit method was applied to determine the additional value of hs-cTnT thresholds when compared with the Revised Cardiac Risk Index (RCRI). The primary outcome was a composite of 30-day all-cause mortality and MACCE.RESULTS: We included 1291 patients between April 2017 and December 2020. The primary outcome occurred in 124 patients (9.6%). Perioperative increase in hs-cTnT ≥14 ng L-1 above preoperative values provided statistically optimal model performance and was associated with the highest risk for the primary outcome (adjusted odds ratio 2.9, 95% confidence interval 1.8-4.7). Validation in an independent, external cohort confirmed these findings. A net benefit over RCRI was demonstrated across a range of clinical thresholds.CONCLUSIONS: Perioperative increases in hsTnT ≥14 ng L-1 above baseline values identifies acute perioperative myocardial injury and provides a net prognostic benefit when added to RCRI for the identification of patients at high risk of death and MACCE.CLINICAL TRIAL REGISTRATION: NCT03436238.
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| 2. |
- Di Saverio, Salomone, et al.
(författare)
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Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines
- 2020
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Ingår i: World Journal of Emergency Surgery. - : BMC. - 1749-7922. ; 15:1
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Forskningsöversikt (refereegranskat)abstract
- Background and aims Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. Conclusions The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
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| 3. |
- Di Saverio, Salomone, et al.
(författare)
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WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis
- 2016
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Ingår i: World Journal of Emergency Surgery. - : BIOMED CENTRAL LTD. - 1749-7922. ; 11:34
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Forskningsöversikt (refereegranskat)abstract
- Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.
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| 4. |
- Krebs, Frederik C, et al.
(författare)
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A round robin study of flexible large-area roll-to-roll processed polymer solar cell modules
- 2009
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Ingår i: SOLAR ENERGY MATERIALS AND SOLAR CELLS. - : Elsevier BV. - 0927-0248. ; 93:11, s. 1968-1977
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Tidskriftsartikel (refereegranskat)abstract
- A round robin for the performance of roll-to-roll coated flexible large-area polymer solar-cell modules involving 18 different laboratories in Northern America, Europe and Middle East is presented. The study involved the performance measurement of the devices at one location (Riso DTU) followed by transportation to a participating laboratory for performance measurement and return to the starting location (Riso DTU) for re-measurement of the performance. It was found possible to package polymer solar-cell modules using a flexible plastic barrier material in such a manner that degradation of the devices played a relatively small role in the experiment that has taken place over 4 months. The method of transportation followed both air-mail and surface-mail paths.
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| 5. |
- Nielsen, Niklas, et al.
(författare)
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Target temperature management after out-of-hospital cardiac arrest-a randomized, parallel-group, assessor-blinded clinical trial-rationale and design
- 2012
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Ingår i: American Heart Journal. - : Elsevier. - 0002-8703 .- 1097-6744. ; 163:4, s. 541-548
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Tidskriftsartikel (refereegranskat)abstract
- Background Experimental animal studies and previous randomized trials suggest an improvement in mortality and neurologic function with induced hypothermia after cardiac arrest. International guidelines advocate the use of a target temperature management of 32 degrees C to 34 degrees C for 12 to 24 hours after resuscitation from out-of-hospital cardiac arrest. A systematic review indicates that the evidence for recommending this intervention is inconclusive, and the GRADE level of evidence is low. Previous trials were small, with high risk of bias, evaluated select populations, and did not treat hyperthermia in the control groups. The optimal target temperature management strategy is not known. less thanbrgreater than less thanbrgreater thanMethods The TTM trial is an investigator-initiated, international, randomized, parallel-group, and assessor-blinded clinical trial designed to enroll at least 850 adult, unconscious patients resuscitated after out-of-hospital cardiac arrest of a presumed cardiac cause. The patients will be randomized to a target temperature management of either 33 degrees C or 36 degrees C after return of spontaneous circulation. In both groups, the intervention will last 36 hours. The primary outcome is all-cause mortality at maximal follow-up. The main secondary outcomes are the composite outcome of all-cause mortality and poor neurologic function (cerebral performance categories 3 and 4) at hospital discharge and at 180 days, cognitive status and quality of life at 180 days, assessment of safety and harm. less thanbrgreater than less thanbrgreater thanDiscussion The TTM trial will investigate potential benefit and harm of 2 target temperature strategies, both avoiding hyperthermia in a large proportion of the out-of-hospital cardiac arrest population.
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| 6. |
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| 7. |
- Aalberg, Laura, et al.
(författare)
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Development of a harmonised method for the profiling of amphetamines : I. Synthesis of standards and compilation of analytical data
- 2005
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Ingår i: Forensic Science International. - : Elsevier BV. - 0379-0738 .- 1872-6283. ; 149:2-3, s. 219-229
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Tidskriftsartikel (refereegranskat)abstract
- Reference material was synthesised for 21 substances that are frequently present as synthetic impurities, i.e. by-products, in illicitly produced amphetamine. Each of these substances is a typical by-product for at least one of the three approaches most often used to synthesise amphetamine, namely, the Leuckart, the reductive amination of benzyl methyl ketone, and the nitrostyrene routes. A large body of data on the substances was recorded, including the following: mass spectra, ultraviolet spectra, Fourier transform infrared spectra, infrared spectra in gas phase, and 1H NMR and 13C NMR spectra. © 2004 Elsevier Ireland Ltd. All rights reserved.
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| 8. |
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| 9. |
- Andersson, Anna, et al.
(författare)
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Molecular changes among non-volatile disinfection by-products between drinking water treatment and consumer taps
- 2021
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Ingår i: Environmental Science. - : Royal Society of Chemistry. - 2053-1400 .- 2053-1419. ; 7:12, s. 2335-2345
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Tidskriftsartikel (refereegranskat)abstract
- The formation of disinfection by-products (DBPs) during drinking water treatment has been associated with various health concerns but the total DBP exposure is still unknown. In this study, molecular level non-target analysis by Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) was used to study non-volatile DBPs, and how their composition changes during water distribution in four drinking water treatment plants (DWTPs) in Sweden using different types of raw water and disinfection processes. The largest portion of tap water DBP compositions were detected also at the DWTPs, highlighting that these DBP formulae were rather stable and contribute to human DBP exposure. Yet the number of detected DBPs decreased 14-48% between drinking water treatment and consumer taps in the three plants in which no mixing of water from other DWTPs in the distribution system occurred showing active DBP processing in the water distribution network. While considerable amounts of bromine-containing DBPs were detected upon chemical disinfection in some DWTPs, few of them were detected in the tap water samples, likely due to debromination by hydrolytic reactions. The overall fewer non-volatile DBPs detected in tap waters, along with changed distribution among chlorine and bromine DBPs, demonstrate that DBP mixtures are highly dynamic and that DBP measurements at DWTPs do not adequately reflect exposure at the point-of-use. Clearly, more knowledge about changes of DBP mixtures through the distribution system is needed to improve DBP exposure assessments.
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| 10. |
- Andersson, Anna, et al.
(författare)
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Selective removal of natural organic matter during drinking water production changes the composition of disinfection by-products
- 2020
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Ingår i: Environmental Science. - : ROYAL SOC CHEMISTRY. - 2053-1400 .- 2053-1419. ; 6:3, s. 779-794
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Tidskriftsartikel (refereegranskat)abstract
- Disinfection by-products (DBPs) are potentially toxic compounds formed upon chemical disinfection of drinking water. Controlling the levels and characteristics of dissolved organic matter (DOM) as precursor material for DBPs is a major target to reduce DBP formation. A pilot-scale treatment including suspended ion exchange (SIX (R)), a ceramic microfilter (CeraMac (R)) with in-line coagulation and optional pre-ozonation followed by granular activated carbon (GAC) filtration was compared with a conventional full-scale treatment based on DOM removal and DBP formation using Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS), rapid fractionation, liquid chromatography organic carbon detection (LC-OCD), adsorbable organic halogens (AOX) and trihalomethane (THM) analysis. The new treatment combination showed different selectivity for DOM removal, compared to the conventional, leading to changes in composition of the DBPs formed. SIX (R) and GAC had the largest impacts on reducing AOX and THM formation potentials but the high adsorptive capacity of GAC affected the diversity of detected DBPs most. Chlorination and chloramination of pilot treated water with doses normally used in Sweden produced low levels of AOX compared to the full-scale treatment, but FT-ICR MS revealed an abundance of brominated DBP species in contrast with the conventional treatment, which were dominated by chlorinated DBPs. This finding was largely linked to the high DOM removal by the pilot treatment, causing an increased Br-/C ratio and a higher formation of HOBr. Potential increases in Br-DBPs are important to consider in minimizing health risks associated with DBPs, because of the supposed higher toxicity of Br-DBPs compared to Cl-DBPs.
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