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  • Dahlqvist, J. A., et al. (författare)
  • Pacemaker treatment after Fontan surgery-A Swedish national study
  • 2019
  • Ingår i: Congenital Heart Disease. - : Wiley-Blackwell. - 1747-079X .- 1747-0803. ; 14:4, s. 582-589
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveFontan surgery is performed in children with univentricular heart defects. Previous data regarding permanent pacemaker implantation frequency and indications in Fontan patients are limited and conflicting. We examined the prevalence of and risk factors for pacemaker treatment in a consecutive national cohort of patients after Fontan surgery in Sweden. MethodsWe retrospectively reviewed all Swedish patients who underwent Fontan surgery from 1982 to 2017 (n=599). ResultsAfter a mean follow-up of 12.2years, 13% (78/599) of the patients with Fontan circulation had received pacemakers. Patients operated with the extracardiac conduit (EC) type of total cavopulmonary connection had a significantly lower prevalence of pacemaker implantation (6%) than patients with lateral tunnel (LT; 17%). Mortality did not differ between patients with (8%) and without pacemaker (5%). The most common pacemaker indication was sinus node dysfunction (SND) (64%). Pacemaker implantation due to SND was less common among patients with EC. Pacemaker implantation was significantly more common in patients with mitral atresia (MA; 44%), double outlet right ventricle (DORV; 24%) and double inlet left ventricle (DILV; 20%). In contrast, patients with pulmonary atresia with intact ventricular septum and hypoplastic left heart syndrome were significantly less likely to receive a pacemaker (3% and 6%, respectively). ConclusionsThirteen percent of Fontan patients received a permanent pacemaker, most frequently due to SND. EC was associated with a significantly lower prevalence of pacemaker than LT. Permanent pacemaker was more common in patients with MA, DORV, and DILV.
  • Dahlqvist, J. A., et al. (författare)
  • Sinus node dysfunction in patients with Fontan circulation: could heart rate variability be a predictor for pacemaker implantation?
  • 2019
  • Ingår i: Pediatric Cardiology. - : Springer-Verlag New York. - 0172-0643 .- 1432-1971. ; 40:4, s. 685-693
  • Tidskriftsartikel (refereegranskat)abstract
    • Sinus node dysfunction (SND) causes significant morbidity in patients after Fontan surgery. Heart rate variability (HRV) reflects the autonomic regulation of the heart, and changes in HRV have been associated with SND in adults. We aimed to study whether changes in HRV could be detected in 24-h electrocardiographic (ECG) recordings in Fontan patients with SND. We compared HRV results from two patient groups; patients with Fontan circulation who later required a pacemaker due to severe SND (n = 12) and patients with Fontan circulation and SND, without indication for pacemaker treatment (n = 11), with two control groups; patients with Fontan circulation without SND (n = 90) and healthy controls (n = 66). The Poincare plot index SD2 (representing changes in heart rate over 24-h) and the very low-frequency (VLF) HRV component were significantly higher in both SND groups, both compared with healthy controls and patients with Fontan circulation without SND. In SND patients with pacemakers, SD2 and VLF were slightly reduced compared to SND patients without pacemaker (p = 0.06). In conclusion, in Fontan patients with SND the HRV is significantly higher compared to healthy controls and Fontan patients without SND. However, in patients with severe SND requiring pacemaker, SD2 and VLF tended to be lower than in patients with SND without pacemaker, which could indicate a reduced diurnal HRV in addition to the severe bradycardia. This is a small study, but our results indicate that HRV analysis might be a useful method in the follow-up of Fontan patients regarding development of SND.
  • Coronel, E., et al. (författare)
  • The effect of carbon content on the microstructure of hydrogen-free physical vapour deposited titanium carbide films
  • 2009
  • Ingår i: Thin Solid Films. - P.O. Box 211, Amsterdam, 1000 AE, Netherlands. - 0040-6090 .- 1879-2731. ; 518:1, s. 71-76
  • Tidskriftsartikel (refereegranskat)abstract
    • Titanium carbide (TiC) coatings for tribological applications were deposited on high speed steel. Several coatings with different titanium to carbon ratio were deposited by means of physical vapour deposition in which titanium was evaporated and carbon was sputtered. The coatings were characterised using analytical electron microscopy. It was observed that the change in titanium to carbon ratio significantly changed the microstructure of the coatings. The low carbon containing coatings consisted of columnar grains exhibiting a preferred crystallographic orientation whereas the coating with highest carbon content consisted of randomly ordered TiC grains in an amorphous carbon matrix. Energy filtered transmission electron microscopy revealed a change in Ti/C ratio as the distance from the substrate increased. The titanium to carbon ratio was observed to increase with distance from the substrate until a stable level was reached. This is due to a variation in the titanium evaporation during the early stages of film growth. This change of the titanium to carbon ratio affected the columnar growth in the initial stage of coating growth for the coatings with low carbon content. (C) 2009 Elsevier B.V. All rights reserved.
  • Dahlqvist, J. A., et al. (författare)
  • Changes in Heart Rate and Heart Rate Variability During Surgical Stages to Completed Fontan Circulation
  • 2021
  • Ingår i: Pediatric Cardiology. - : Springer. - 0172-0643 .- 1432-1971.
  • Tidskriftsartikel (refereegranskat)abstract
    • Arrhythmia is related to heart rate variability (HRV), which reflects the autonomic nervous regulation of the heart. We hypothesized that autonomic nervous ganglia, located at the junction of the superior vena cava's entrance to the heart, may be affected during the bidirectional Glenn procedure (BDG), resulting in reduced HRV. We aimed to investigate changes in heart rate and HRV in a cohort of children with univentricular heart defects, undergoing stepwise surgery towards total cavopulmonary connection (TCPC), and compare these results with healthy controls. Twenty four hours Holter-ECG recordings were obtained before BDG (n = 47), after BDG (n = 47), and after total cavopulmonary connection (TCPC) (n = 45) in patients and in 38 healthy controls. HRV was analyzed by spectral and Poincare methods. Age-related z scores were calculated and compared using linear mixed effects modeling. Total HRV was significantly lower in patients before BDG when compared to healthy controls. The mean heart rate was significantly reduced in patients after BDG compared to before BDG. Compared to healthy controls, patients operated with BDG had significantly reduced heart rate and reduced total HRV. Patients with TCPC showed reduced heart rate and HRV compared with healthy controls. In patients after TCPC, total HRV was decreased compared to before TCPC. Heart rate was reduced after BDG procedure, and further reductions of HRV were seen post-TCPC. Our results indicate that autonomic regulation of cardiac rhythm is affected both after BDG and again after TCPC. This may be reflected as, and contribute to, postoperative arrhythmic events.
  • Dimberg, Lina Y., et al. (författare)
  • Stat1 activation attenuates IL-6 induced Stat3 activity but does not alter apoptosis sensitivity in multiple myeloma
  • 2012
  • Ingår i: BMC Cancer. - : BioMed Central (BMC). - 1471-2407 .- 1471-2407. ; 12, s. 318-
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Multiple myeloma (MM) is at present an incurable malignancy, characterized by apoptosis-resistant tumor cells. Interferon (IFN) treatment sensitizes MM cells to Fas-induced apoptosis and is associated with an increased activation of Signal transducer and activator of transcription (Stat)1. The role of Stat1 in MM has not been elucidated, but Stat1 has in several studies been ascribed a pro-apoptotic role. Conversely, IL-6 induction of Stat3 is known to confer resistance to apoptosis in MM. Methods: To delineate the role of Stat1 in IFN mediated sensitization to apoptosis, sub-lines of the U-266-1970 MM cell line with a stable expression of the active mutant Stat1C were utilized. The influence of Stat1C constitutive transcriptional activation on endogenous Stat3 expression and activation, and the expression of apoptosis-related genes were analyzed. To determine whether Stat1 alone would be an important determinant in sensitizing MM cells to apoptosis, the U-266-1970-Stat1C cell line and control cells were exposed to high throughput compound screening (HTS). Results: To explore the role of Stat1 in IFN mediated apoptosis sensitization of MM, we established sublines of the MM cell line U-266-1970 constitutively expressing the active mutant Stat1C. We found that constitutive nuclear localization and transcriptional activity of Stat1 was associated with an attenuation of IL-6-induced Stat3 activation and up-regulation of mRNA for the pro-apoptotic Bcl-2 protein family genes Harakiri, the short form of Mcl-1 and Noxa. However, Stat1 activation alone was not sufficient to sensitize cells to Fas-induced apoptosis. In a screening of > 3000 compounds including bortezomib, dexamethasone, etoposide, suberoylanilide hydroxamic acid (SAHA), geldanamycin (17-AAG), doxorubicin and thalidomide, we found that the drug response and IC50 in cells constitutively expressing active Stat1 was mainly unaltered. Conclusion: We conclude that Stat1 alters IL-6 induced Stat3 activity and the expression of pro-apoptotic genes. However, this shift alone is not sufficient to alter apoptosis sensitivity in MM cells, suggesting that Stat1 independent pathways are operative in IFN mediated apoptosis sensitization.
  • Gerth, J., et al. (författare)
  • Reproducing wear mechanisms in gear hobbing : Evaluation of a single insert milling test
  • 2009
  • Ingår i: Wear. - : Elsevier. - 0043-1648 .- 1873-2577. ; 267:12, s. 2257-2268
  • Tidskriftsartikel (refereegranskat)abstract
    • Gear hobbing is a widely used method in industrial gear manufacturing. The most common type of hob is made of homogenous HSS and protected by a PVD coating. In order to increase the reliability and tool life of these milling tools, further developments of the tool surfaces and cutting edges are necessary. A single tooth milling test, using a HSS insert in a conventional milling machine, has been developed with the aim to reproduce the wear mechanisms seen on real HSS gear hobbing teeth. The benefits of such a test, compared to actual gear hobbing tests, are primarily accessibility and reduced costs for both design and production of test specimens (inserts). The main goal of this study was to verify that the wear mechanisms in the developed test correspond with the wear mechanisms obtained in real gear hobbing. Once this was verified, the influence of surfaces roughness on the performance of TiAlN coated HSS inserts was evaluated by using the tool as delivered or after polishing the tool surfaces. Parameters considered were tool wear, cutting forces and the quality of machined surfaces. The polished inserts, yielded less adhered work material and reduced flank wear but no significant difference in cutting forces as compared to the unpolished inserts.
  • Goel, S., et al. (författare)
  • Axial suspension plasma spraying of Al2O3 coatings for superior tribological properties
  • 2017
  • Ingår i: Surface & Coatings Technology. - : ELSEVIER SCIENCE SA. - 0257-8972 .- 1879-3347. ; 315, s. 80-87
  • Tidskriftsartikel (refereegranskat)abstract
    • Suspension plasma spray is a relatively new thermal spray technique which enables feeding of fine powder to produce advanced coatings for varied applications. This work investigates the difference in structure and performance of Al2O3 coatings manufactured using conventional micron-sized powder feedstock and a suspension of sub-micron to few micron sized powder. Axial injection was implemented for deposition in both cases. The effect of feedstock size and processing on the tribological performance of the two coatings was of specific interest. The coatings were characterized by Optical and Scanning Electron Microscopy, micro-hardness and scratch resistance testing, and their dry sliding wear performance evaluated. The suspension sprayed coatings yielded significantly higher scratch resistance, lower friction coefficient and reduced wear rate compared to conventional coatings. The improved tribological behaviour of the former is attributable to finer porosity, smaller splat sizes, and improved interlamellar bonding.
  • Granfeldt, H, et al. (författare)
  • Risk factor analysis of Swedish left ventricular assist device (LVAD) patients
  • 2003
  • Ingår i: Annals of Thoracic Surgery. - : Elsevier. - 1552-6259 .- 0003-4975. ; 76:6, s. 1993-1998
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. The use of left ventricular assist devices (LVADs) is established as a bridge to heart transplantation. Methods. All Swedish patients on the waiting list for heart transplantation, treated with LVAD since 1993 were retrospectively collected into a database and analyzed in regards to risk factors for mortality and morbidity. Results. Fifty-nine patients (46 men) with a median age of 49 years (range, 14 to 69 years), Higgins score median of 9 (range, 3 to 15), EuroScore median of 10 (range, 5 to 17) were investigated. Dominating diagnoses were dilated cardiomyopathy in 61% (n = 36) and ischemic cardiomyopathy in 18.6% (n = 11). The patients were supported with LVAD for a median time of 99.5 days (range, I to 873 days). Forty-five (76%) patients received transplants, and 3 (5.1%) patients were weaned from the device. Eleven patients (18.6%) died during LVAD treatment. Risk factor analysis for mortality before heart transplantation showed significance for a high total amount of autologous blood transfusions (p < 0.001), days on mechanical ventilation postoperatively (p < 0.001), prolonged postoperative intensive care unit stay (p = 0.007), and high central venous pressure 24 hours postoperatively and at the final measurement (p = 0.03 and 0.01, respectively). Mortality with LVAD treatment was 18.6% (n = 11). High C-reactive protein (p = 0.001), low mean arterial pressure (p = 0.03), and high cardiac index (p = 0.03) preoperatively were risk factors for development of right ventricular failure during LVAD treatment. Conclusions. The Swedish experience with LVAD as a bridge to heart transplantation was retrospectively collected into a database. This included data from transplant and nontransplant centers. Figures of mortality and morbidity in the database were comparable to international experience. Specific risk factors were difficult to define retrospectively as a result of different protocols for follow-up among participating centers. (C) 2003 by The Society of Thoracic Surgeons.
  • Grip, Helena, et al. (författare)
  • Classification of Neck Movement Patterns Related to Whiplash-Associated Disorders Using Neural Networks
  • 2003
  • Ingår i: IEEE transactions on information technology in biomedicine. - : IEEE. - 1089-7771 .- 1558-0032. ; 7:4, s. 412-418
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper presents a new method for classification of neck movement patterns related to Whiplash-associated disorders (WAD) using a resilient backpropagation neural network (BPNN). WAD are a common diagnosis after neck trauma, typically caused by rear-end car accidents. Since physical injuries seldom are found with present imaging techniques, the diagnosis can be difficult to make. The active range of the neck is often visually inspected in patients with neck pain, but this is a subjective measure, and a more objective decision support system, that gives a reliable and more detailed analysis of neck movement pattern, is needed. The objective of this study was to evaluate the predictive ability of a BPNN, using neck movement variables as input. Three-dimensional (3-D) neck movement data from 59 subjects with WAD and 56 control subjects were collected with a ProReflex system. Rotation angle and angle velocity were calculated using the instantaneous helical axis method and motion variables were extracted. A principal component analysis was performed in order to reduce data and improve the BPNN performance. BPNNs with six hidden nodes had a predictivity of 0.89, a sensitivity of 0.90 and a specificity of 0.88, which are very promising results. This shows that neck movement analysis combined with a neural network could build the basis of a decision support system for classifying suspected WAD, even though further evaluation of the method is needed.
  • Heinrichs, Jannica, et al. (författare)
  • Influence from surface roughness on steel transfer to PVD tool coatings in continuous and intermittent sliding contacts
  • 2012
  • Ingår i: Tribology International. - 0301-679X .- 1879-2464. ; 56, s. 9-18
  • Tidskriftsartikel (refereegranskat)abstract
    • A sliding test is used in order to evaluate the influence of tool surface roughness on the material transfer in intermittent and continuous sliding of PVD coated HSS against case hardening steel (20NiCrMo2). Two cutting tool coatings, TiN and AlCrN, and three different surface roughnesses are tested. For polished surfaces the same types of material transfer are obtained irrespective of sliding mode and coating type. If the surfaces are too rough, the tribofilms do not grow thick enough to separate the surfaces and the work material is abrasively worn in both sliding modes. With increased sliding distance, cracking of the TiN coating occurs while the AlCrN coating remains intact.
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