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- Ranta, Susanna, et al.
(author)
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Extracorporeal Membrane Oxygenation Support in Children With Hematologic Malignancies in Sweden
- 2021
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In: Journal of Pediatric Hematology/Oncology. - : Wolters Kluwer. - 1077-4114 .- 1536-3678. ; 43:2, s. e272-e275
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Journal article (peer-reviewed)abstract
- Background: Extracorporeal membrane oxygenation (ECMO) is used in severe respiratory and/or circulatory failure when conventional critical care fails. Studies on patients with hematologic malignancies on ECMO have shown contradictory results; immunosuppression and coagulopathy are relative contraindications to ECMO.Observations: This nationwide Swedish retrospective chart review identified 958 children with hematologic malignancies of whom 12 (1.3%) required ECMO support. Eight patients survived ECMO, 7 the total intensive care period, and 6 survived the underlying malignancy.Conclusions: ECMO may be considered in children with hematologic malignancy. Short-term and long-term survival, in this limited group, was similar to that of children on ECMO at large.
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| 2. |
- Ranta, Susanna, et al.
(author)
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Icu admission in children with acute lymphoblastic leukemia in sweden: Prevalence, outcome, and risk factors
- 2021
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In: Pediatric Critical Care Medicine. - Philadelphia, PA, United States : Lippincott Williams & Wilkins. - 1529-7535 .- 1947-3893. ; 22:12, s. 1050-1060
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Research review (peer-reviewed)abstract
- OBJECTIVES: Despite progress in the treatment of childhood acute lymphoblastic leukemia, severe complications are common, and the need of supportive care is high. We explored the cumulative prevalence, clinical risk factors, and outcomes of children with acute lymphoblastic leukemia, on first-line leukemia treatment in the ICUs in Sweden.DESIGN: A nationwide prospective register and retrospective chart review study.SETTING: Children with acute lymphoblastic leukemia were identified,and demographic and clinical data were obtained from the Swedish Childhood Cancer Registry. Data on intensive care were collected from the Swedish Intensive Care Registry. Data on patients with registered ICU admission in the Swedish Childhood Cancer Registry were supplemented through questionnaires to the pediatric oncology centers.PATIENTS: All 637 children 0-17.9 years old with acute lymphoblastic leukemia diagnosed between June 2008 and December 2016 in Sweden were included.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Twenty-eight percent of the children (178/637) were admitted to an ICU at least once. The Swedish Intensive Care Registry data were available for 96% of admissions (241/252). An ICU admission was associated with poor overall survival (hazard ratio, 3.25; 95% CI, 1.97-5.36; p ≤ 0.0001). ICU admissions occurred often during early treatment; 48% (85/178) were admitted to the ICU before the end of the first month of acute lymphoblastic leukemia treatment (induction therapy). Children with T-cell acute lymphoblastic leukemia or CNS leukemia had a higher risk of being admitted to the ICU in multivariable analyses, both for early admissions before the end of induction therapy and for all admissions during the study period.CONCLUSIONS: The need for intensive care in children with acute lymphoblastic leukemia, especially for children with T cell acute lymphoblastic leukemia and CNS leukemia, is high with most admissions occurring during early treatment.
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| 5. |
- Berner, Jonas
(author)
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The role of substance P in respiratory control in the newborn : effects of morphine and nicotine
- 2008
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Doctoral thesis (other academic/artistic)abstract
- We breathe in order to maintain oxygen, carbon dioxide and pH levels within the physiological range in response to the metabolic demands of the body. To achieve this, the respiratory control system is dependent on input from peripheral and/ central chemosensitive areas and on participation of different neuromodulator systems. This thesis focuses on the role of one of the neurotransmitters, substance P, involved in the complex and finely tuned control of respiration. It also explores how prenatal nicotine exposure affects the substance P-ergic system and the effects of morphine when this system is non-functional. To investigate if endogenously released substance P is necessary for the hypoxic ventilatory response (HVR) in the intact newborn rat pup (postnatal day five, P5) we used a neurokinin 1-receptor antagonist (RP67580) injected intracerebroventricularly. We could demonstrate that RP67580-treated animals displayed an altered HVR but normal respiration during normal conditions, indicating that endogenously released substance P is necessary for an adequate response to hypoxic stress. Furthermore, in situ hybridisation demonstrated that c-fos mRNA expression, used as a marker for neuronal activation, was decreased in respiration related areas in the brainstem in RP67580-treated animals, indicating structures involved in the perturbed HVR. We also used a transgenic mouse model (Tac1 -/-), lacking substance P and neurokinin A (NKA), to investigate the respiratory response to intermittent hypoxia and hypercapnic stress at P2-3 and at P8-10 to identify developmental changes. In vivo experiments, using flow-plethysmography, displayed an attenuated increase in tidal volume during intermittent hypoxia in transgenic mice, P8-10, whereas the younger animals did not differ from controls except from an altered breathing pattern with fewer apneas and more augmented inspiratory breaths with a pause during intermittent hypoxia. Brain-stem spinal cord preparations of P2-mice revealed that intermittent hypoxia did not induce an increase in burst frequency, reflecting long-term facilitation, in Tac1 -/- mice as displayed in controls. This was also manifested in vivo as an impaired augmentation of ventilation during posthypoxic periods. Furthermore, transgenic mice displayed a more prominent posthypoxic frequency decline in vivo and posthypoxic neuronal arrests appeared more often in vitro. In line with previous studies the hypercapnic response did not differ between strains, confirming that substance P is not involved. Thus, our results show that a functional substance P/NKA system is essential to generate an adequate respiratory response and that it is also involved in the plasticity of respiratory network during early development. Human sudden infant death victims have elevated levels of substance P-like immunoreactivity (-LI) in the brainstem and nicotine increases the risk for sudden infant death syndrome (SIDS) by up to four-fold. We could demonstrate elevated substance P-LI levels in the brainstem and alterations of the substance P-precursor, preprotachykinin A mRNA expression in carotid body and petrosal/jugular ganglia following prenatal nicotine exposure in newborn rat (P1). This may offer a biochemical link between nicotine exposure and SIDS. We also show an increase in morphine analgesia and reduced main (respiratory depression) and other side-effects in Tac1 -/- mice. Since morphine is a widely used analgetic drug, also in neonates, with a narrow therapeutic window, our result offers the possibility to decrease the activity of substance P/NK- receptor signalling and thereby improve the pharmacological potential of morphine. In conclusion, this thesis demonstrates the involvement of substance P in the HVR and plasticity of the respiratory network. Prenatal nicotine exposure severely affects the substance Pergic system, a possible underlying mechanism for SIDS. Furthermore, it offers a correlation between the functionality of the substance P-ergic system and the breathing disturbances seen in Rett syndrome.
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| 6. |
- Berner, Karin, et al.
(author)
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Dose optimisation of double-contrast barium enema examinations.
- 2010
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In: Radiation protection dosimetry. - : Oxford University Press (OUP). - 1742-3406 .- 0144-8420. ; 139:1-3, s. 388-392
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Journal article (peer-reviewed)abstract
- The purpose of the present work was to optimise the filtration and dose setting for double-contrast barium enema examinations using a Philips MultiDiagnost Eleva FD system. A phantom study was performed prior to a patient study. A CDRAD phantom was used in a study where copper and aluminium filtration, different detector doses and tube potentials were examined. The image quality was evaluated using the software CDRAD Analyser and the phantom dose was determined using the Monte Carlo-based software PCXMC. The original setting [100 % detector dose (660 nGy air kerma) and a total filtration of 3.5 mm Al, at 81 kVp] and two other settings identified by the phantom study (100 % detector dose and additional filtration of 1 mm Al and 0.2 mm Cu as well as 80 % detector dose and added filtration of 1 mm Al and 0.2 mm Cu) were included in the patient study. The patient study included 60 patients and up to 8 images from each patient. Six radiologists performed a visual grading characteristics study to evaluate the image quality. A four-step scale was used to judge the fulfillment of three image quality criteria. No overall statistical significant difference in image quality was found between the three settings (P > 0.05). The decrease in the effective dose for the settings in the patient study was 15 % when filtration was added and 34 % when both filtrations was added and detector dose was reduced. The study indicates that additional filtration of 1 mm Al and 0.2 mm Cu and a decrease in detector dose by 20 % from the original setting can be used in colon examinations with Philips MultiDiagnost Eleva FD to reduce the patient dose by 30 % without significantly affecting the image quality. For 20 exposures, this corresponds to a decrease in the effective dose from 1.6 to 1.1 mSv.
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| 9. |
- Björkman, Anne, 1981, et al.
(author)
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Tundra Trait Team: A database of plant traits spanning the tundra biome
- 2018
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In: Global Ecology and Biogeography. - : Wiley. - 1466-822X .- 1466-8238. ; 27:12, s. 1402-1411
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Journal article (peer-reviewed)abstract
- © 2018 The Authors Global Ecology and Biogeography Published by John Wiley & Sons Ltd Motivation: The Tundra Trait Team (TTT) database includes field-based measurements of key traits related to plant form and function at multiple sites across the tundra biome. This dataset can be used to address theoretical questions about plant strategy and trade-offs, trait–environment relationships and environmental filtering, and trait variation across spatial scales, to validate satellite data, and to inform Earth system model parameters. Main types of variable contained: The database contains 91,970 measurements of 18 plant traits. The most frequently measured traits (>1,000 observations each) include plant height, leaf area, specific leaf area, leaf fresh and dry mass, leaf dry matter content, leaf nitrogen, carbon and phosphorus content, leaf C:N and N:P, seed mass, and stem specific density. Spatial location and grain: Measurements were collected in tundra habitats in both the Northern and Southern Hemispheres, including Arctic sites in Alaska, Canada, Greenland, Fennoscandia and Siberia, alpine sites in the European Alps, Colorado Rockies, Caucasus, Ural Mountains, Pyrenees, Australian Alps, and Central Otago Mountains (New Zealand), and sub-Antarctic Marion Island. More than 99% of observations are georeferenced. Time period and grain: All data were collected between 1964 and 2018. A small number of sites have repeated trait measurements at two or more time periods. Major taxa and level of measurement: Trait measurements were made on 978 terrestrial vascular plant species growing in tundra habitats. Most observations are on individuals (86%), while the remainder represent plot or site means or maximums per species. Software format: csv file and GitHub repository with data cleaning scripts in R; contribution to TRY plant trait database (www.try-db.org) to be included in the next version release.
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