| 1. |
- Chew, Michelle S., et al.
(author)
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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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In: British Journal of Anaesthesia. - : Elsevier. - 0007-0912 .- 1471-6771. ; 128:1, s. 26-36
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Journal article (peer-reviewed)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. |
- Dahlin, Anna M., 1979-, et al.
(author)
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A genome-wide association study on medulloblastoma
- 2020
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In: Journal of Neuro-Oncology. - : Springer. - 0167-594X .- 1573-7373. ; 147:2, s. 309-315
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Journal article (peer-reviewed)abstract
- Introduction: Medulloblastoma is a malignant embryonal tumor of the cerebellum that occurs predominantly in children. To find germline genetic variants associated with medulloblastoma risk, we conducted a genome-wide association study (GWAS) including 244 medulloblastoma cases and 247 control subjects from Sweden and Denmark.Methods: Genotyping was performed using Illumina BeadChips, and untyped variants were imputed using IMPUTE2.Results: Fifty-nine variants in 11 loci were associated with increased medulloblastoma risk (p < 1 × 10–5), but none were statistically significant after adjusting for multiple testing (p < 5 × 10–8). Thirteen of these variants were genotyped, whereas 46 were imputed. Genotyped variants were further investigated in a validation study comprising 249 medulloblastoma cases and 629 control subjects. In the validation study, rs78021424 (18p11.23, PTPRM) was associated with medulloblastoma risk with OR in the same direction as in the discovery cohort (ORT = 1.59, pvalidation = 0.02). We also selected seven medulloblastoma predisposition genes for investigation using a candidate gene approach: APC, BRCA2, PALB2, PTCH1, SUFU, TP53, and GPR161. The strongest evidence for association was found for rs201458864 (PALB2, ORT = 3.76, p = 3.2 × 10–4) and rs79036813 (PTCH1, ORA = 0.42, p = 2.6 × 10–3).Conclusion: The results of this study, including a novel potential medulloblastoma risk loci at 18p11.23, are suggestive but need further validation in independent cohorts.
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| 3. |
- Di Saverio, Salomone, et al.
(author)
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Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines
- 2020
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In: World Journal of Emergency Surgery. - : BMC. - 1749-7922. ; 15:1
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Research review (peer-reviewed)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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| 4. |
- Farrell, Edward D. D., et al.
(author)
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A baseline for the genetic stock identification of Atlantic herring, Clupea harengus, in ICES Divisions 6.a, 7.b-c
- 2022
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In: Royal Society Open Science. - : The Royal Society. - 2054-5703. ; 9:9
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Journal article (peer-reviewed)abstract
- Atlantic herring in International Council for Exploration of the Sea (ICES) Divisions 6.a, 7.b-c comprises at least three populations, distinguished by temporal and spatial differences in spawning, which have until recently been managed as two stocks defined by geographical delineators. Outside of spawning the populations form mixed aggregations, which are the subject of acoustic surveys. The inability to distinguish the populations has prevented the development of separate survey indices and separate stock assessments. A panel of 45 single-nucleotide polymorphisms, derived from whole-genome sequencing, were used to genotype 3480 baseline spawning samples (2014-2021). A temporally stable baseline comprising 2316 herring from populations known to inhabit Division 6.a was used to develop a genetic assignment method, with a self-assignment accuracy greater than 90%. The long-term temporal stability of the assignment model was validated by assigning archive (2003-2004) baseline samples (270 individuals) with a high level of accuracy. Assignment of non-baseline samples (1514 individuals) from Divisions 6.a, 7.b-c indicated previously unrecognized levels of mixing of populations outside of the spawning season. The genetic markers and assignment models presented constitute a 'toolbox' that can be used for the assignment of herring caught in mixed survey and commercial catches in Division 6.a into their population of origin with a high level of accuracy.
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| 5. |
- Fazey, Ioan, et al.
(author)
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Transforming knowledge systems for life on Earth : Visions of future systems and how to get there
- 2020
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In: Energy Research & Social Science. - : Elsevier. - 2214-6296 .- 2214-6326. ; 70
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Journal article (peer-reviewed)abstract
- Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent.
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| 6. |
- Forslund, Sofia K., et al.
(author)
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Combinatorial, additive and dose-dependent drug–microbiome associations
- 2021
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In: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 600:7889, s. 500-505
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Journal article (peer-reviewed)abstract
- During the transition from a healthy state to cardiometabolic disease, patients become heavily medicated, which leads to an increasingly aberrant gut microbiome and serum metabolome, and complicates biomarker discovery1–5. Here, through integrated multi-omics analyses of 2,173 European residents from the MetaCardis cohort, we show that the explanatory power of drugs for the variability in both host and gut microbiome features exceeds that of disease. We quantify inferred effects of single medications, their combinations as well as additive effects, and show that the latter shift the metabolome and microbiome towards a healthier state, exemplified in synergistic reduction in serum atherogenic lipoproteins by statins combined with aspirin, or enrichment of intestinal Roseburia by diuretic agents combined with beta-blockers. Several antibiotics exhibit a quantitative relationship between the number of courses prescribed and progression towards a microbiome state that is associated with the severity of cardiometabolic disease. We also report a relationship between cardiometabolic drug dosage, improvement in clinical markers and microbiome composition, supporting direct drug effects. Taken together, our computational framework and resulting resources enable the disentanglement of the effects of drugs and disease on host and microbiome features in multimedicated individuals. Furthermore, the robust signatures identified using our framework provide new hypotheses for drug–host–microbiome interactions in cardiometabolic disease.
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| 7. |
- Hambäck, Peter A., et al.
(author)
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Insekter och spindlar i anlagda våtmarker : Intressanta fynd från en systematisk undersökning i Uppland och södra Halland
- 2022
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In: Entomologisk tidskrift. - 0013-886X. ; 143:1-2, s. 47-66
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Journal article (peer-reviewed)abstract
- Wetland area has decreased dramatically compared with preindustrial times, and in manyagricultural areas almost all wetlands have been drained to gain cropland. The trend hasin recent years been reversed because society has realized the many benefits of wetlandfunctions, such as for nutrient retention and flood control. In this study we inventoried 75 wetlands in Uppland and Halland for insects and spiders with Malaise traps, pitfall traps andsuction sampling. Most included wetlands are constructed, because the main purpose was toexamine if these wetlands also can be good for arthropod diversity, but we also included somemore natural wetlands as comparison. In total, we identified more than 25,000 individualsof more than 900 species of Coleoptera, Araneae, Diptera and Heteroptera. We found onenew species for Sweden, Hilara manicata Meigen 1822, and 37 new regional records. Alarge number of species found are considered threatened or else rare. Some wetlands closeto Mälaren were particularly interesting, with three species (Hypsosinga heri (Hahn 1831),Rhaphium antennatum (Charlier 1835) and Bagous robustus Brisout de Barneville 1863)that have no records nearby during recent times. These and other species found in the studyshow that constructed wetlands can provide good habitats for arthropod biodiversity andrare species, particularly if wetland shores are grazed and trampled by cattle.
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| 8. |
- Martin, David, et al.
(author)
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Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members
- 2020
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 44:7, s. 2211-2219
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Journal article (peer-reviewed)abstract
- © 2020, Société Internationale de Chirurgie. Background: Major surgery is a term frequently used but poorly defined. The aim of the present study was to reach a consensus in the definition of major surgery within a panel of expert surgeons from the European Surgical Association (ESA). Methods: A 3-round Delphi process was performed. All ESA members were invited to participate in the expert panel. In round 1, experts were inquired by open- and closed-ended questions on potential criteria to define major surgery. Results were analyzed and presented back anonymously to the panel within next rounds. Closed-ended questions in round 2 and 3 were either binary or statements to be rated on a Likert scale ranging from 1 (strong disagreement) to 5 (strong agreement). Participants were sent 3 reminders at 2-week intervals for each round. 70% of agreement was considered to indicate consensus. Results: Out of 305 ESA members, 67 (22%) answered all the 3 rounds. Significant comorbidities were the only preoperative factor retained to define major surgery (78%). Vascular clampage or organ ischemia (92%), high intraoperative blood loss (90%), high noradrenalin requirements (77%), long operative time (73%) and perioperative blood transfusion (70%) were procedure-related factors that reached consensus. Regarding postoperative factors, systemic inflammatory response (76%) and the need for intensive or intermediate care (88%) reached consensus. Consequences of major surgery were high morbidity (>30% overall) and mortality (>2%). Conclusion: ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.
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| 9. |
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| 10. |
- Sjöberg, Per-Olof, et al.
(author)
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Sverige i halvledarvärlden – analys och förslag till strategi
- 2022
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Reports (other academic/artistic)abstract
- Den brist på halvledare som industrin upplevt under 2021 har satt den annars tämligen anonyma halvledarindustrin i rampljuset såväl i Sverige som i Europa, USA och globalt. Hur länge denna brist kommer att bestå är en viktig fråga för industrin, som dock är svår att svara på. Enligt internationella analytiker kommer industrin att uppleva halvledarbrist fram till sommaren 2022 och eventuellt in på nästa höst eller eventuellt längre, varefter det föreligger en risk för överproduktion då lager förmodligen byggts upp bland avnämare. Erfarenheterna från tidigare halvledarbrister är att de så småningom övergår i överskott. Men den nuvarande bristen kan sannolikt kräva längre tid för detta än tidigare brister. Främsta skälet är att de halvledarfabriker som för närvarande är under uppbyggnad för att råda bot på bristen lider av samma överhettade försörjningskedjor som övrig industri, med förseningar av allt från vitala utrustningar till förbrukningsmateriel, och att det därför troligen kommer att ta längre tid än planerat att få dem i drift. Detta kan i värsta fall innebära att det rentav kan ta ett eller flera år längre tid än analytikerna förutspått innan försörjningsläget är normalt. Sverige är en del av det globala halvledarekosystemet – ett komplext ekosystem som kännetecknas av hög grad av arbetsfördelning, hög kapitalintensitet, hög kunskapsintensitet, långa produktionstider, stark internationalisering och starka inlåsningseffekter. Sverige interagerar med detta globala ekosystem på två sätt - som leverantör av produkter och tjänster i ett antal nischer där vi uppvisar global spetskompetens samt som avnämare av halvledarprodukter för industriella behov. Båda dessa sidor behöver stärkas för att a) våra SMF och stora företag ska kunna få tillgång till de halvledare och system byggda på halvledare som krävs för den produktion av produkter och tjänster som bidrar till Sveriges välstånd, b) svenska industriföretag ska kunna säkra tillgång till den kompetens och de tjänster som krävs då industrins produkter innehåller allt större mängd halvledare, och c) för att maximera möjligheterna för svenska halvledar- och elektronikinnovationer att hävda sig på världsmarknaden, och på så sätt bidra till landets välstånd. Det övergripande målet för Sverige bör vara att använda vår nationella styrka inom innovation som hävstång, och fokusera de starka specialiserade kompetenserna som finns här i landet, jämte långsiktiga investeringar i forskning inom halvledarteknik, systemdesign och halvledarmaterial, i syfte att med samlad kraft nå följande strategiska mål: 1) Etablera Sverige som ett halvledarinnovationsland genom att stärka vårt innovationssystem för halvledare och halvledarmaterial. 2) Få utväxling på de svenska investeringarna i forsknings- och innovationsinfrastruktur för design och produktion av halvledare. 3) Säkra och vidmakthåll en roll för Sverige i halvledarindustrin, inte minst genom svensk representation i de organ och församlingar som beslutar om framtida europeiska investeringar. För att nå dessa mål krävs stark samverkan mellan industri, akademi, institut och offentlig sektor, och långsiktiga såväl publika som privata investeringar i utbildning, forskningsinfrastruktur, test- och demonstrationsanläggningar och i startup- och scaleup-bolag. RISE åsikt är att Sverige därtill bör ta aktiv del i EU-initiativ som den europeiska halvledaralliansen (Alliance on Processor and Semiconductor Technologies) och European Chips Act. Påpekas bör att dessa mål är långsiktiga och kräver kontinuerligt arbete och finansiering under många år framöver. De löser inte industrins kortsiktiga behov av halvledare, och det kommer att ta tid att säkra industrins behov av halvledarkompetens. Med en väl genomförd strategi skulle dock dessa behov i högre grad kunna tillgodoses samtidigt som vårt lands bidrag till det globala halvledarekosystemet skulle växa kraftigt, till fromma för vårt gemensamma välstånd.
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