| 1. |
- Andersson, Håkan, et al.
(author)
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Interaktiv rättsvetenskap : En antologi
- 2006
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Book (other academic/artistic)abstract
- I antologin ”Interaktiv rättsvetenskap” avhandlas rättsvetenskapens möten med andra vetenskapliga kunskapsområden. I nio artiklar diskuteras och analyseras problem och möjligheter som kan uppstå vid sådana möten och hur de kan hanteras med bibehållen rättsvetenskaplig integritet. Författarna är erfarna forskare inom allmän rättslära, civilrätt, konstitutionell rätt, lagstiftningsforskning, miljörätt och rättshistoria. Boken är i första hand avsedd för forskare och forskarstuderande med intresse för metodutveckling inom ramen för sina forskningsprojekt, men den har även en vidare betydelse för juridikens utveckling. Antologin har skrivits inom ramen för ett samarbetsprojekt mellan juridiska fakulteterna i Uppsala och Åbo.
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| 2. |
- Bartha, Erzsebet, et al.
(author)
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ASA classification and surgical severity grading used to identify a high-risk population, a multicenter prospective cohort study in Swedish tertiary hospitals
- 2021
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In: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 65:9, s. 1168-1177
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Journal article (peer-reviewed)abstract
- Background: Identification of surgical populations at high risk for negative outcomes is needed for clinical and research purposes. We hypothesized that combining two classification systems, ASA (American Society of Anesthesiology physical status) and surgical severity, we could identify a high-risk population before surgery. We aimed to describe postoperative outcomes in a population selected by these two classifications system.Methods: Data were collected in a Swedish multicentre, time-interrupted prospective, consecutive cohort study. Eligibility criteria were age >= 18 years, ASA >= 3, elective or emergent, major to Xmajor/complex (Specialist Procedure Codes used in United Kingdom), gastrointestinal, urogenital or orthopaedic procedures. Postoperative morbidity was identified by the Postoperative Morbidity Survey on postoperative days 3 +/- 1, 7 +/- 1, 10 + 5 and graded for severity by the Clavien-Dindo system. Mortality was assessed at 30, 180 and 360 days.Results: Postoperative morbidity was 78/48/47 per cent on postoperative days 3/7/10. Majority of morbidities (67.5 per cent) were graded as >1 by Clavien-Dindo. Any type of postoperative morbidity graded >1 was associated with increased risk for death up to one year. The mortality was 5.7 per cent (61/1063) at 30 days, 13.3 per cent (142/1063) at 6 months and 19.1 per cent (160/1063) at 12 months.Conclusion: Severity classification as major to Xmajor/complex and ASA >= 3 could be used to identify a high-risk surgical population concerning postoperative morbidity and mortality before surgery. Combining the two systems future electronic data extraction is possible of a high-risk population in tertiary hospitals.
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| 3. |
- Bartha, Erzsebet, et al.
(author)
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Combining functional dependency and ASA III classification for risk stratification-predictors, risk factors, and outcomes following major surgery study (NCT02626546)
- 2017
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In: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 61:8, s. 1011-1011
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Journal article (other academic/artistic)abstract
- Background: In elderly reclassification of ASA3 class by functional dependency improved prediction of postoperative mortality. We hypothesized that such a reclassification could improve the risk prediction of adverse outcomes also following high risk surgery.Method: We analyzed data collected by the PROFS study in four Swedish academic hospitals. The inclusion criteria were: adults, ASA≥3, major or xmajor/complex surgery (UK surgical severity coding). ASA 3 patients were reclassified into ASA 3a (functionally independent) and 3b (functionally dependent). The adverse outcomes were postoperative complications (yes/no) screened by Postoperative Morbidity Survey (days 3, 7, 10) and mortality (30-day). Complications graded ≥2 by Clavien-Dindo classification were considered. The predictive value of reclassification was analyzed by logistic regression models.Results: Between 2015 Nov2th and 2016 Feb19th 1089 patients were include; 13 were excluded (violation of inclusion criteria), 3 were lost to follow-up and 1073 were analyzed. ASA 3b (vs ASA 3a) patients had higher risk for mortality and for postoperative complications at days 7 and 10. ASA 4 (vs ASA 3) patients had higher risk of all adverse outcomes (Table 1). When age was added in the regression model ASA 3b patients still had higher risk for postoperative complications at day 10, but the significance disappeared when also urgency was added.Conclusion: The loss of significance by adding urgency in the model might be attributed to the dominance of urgent procedures in ASA3b and ASA4 groups. Reclassification of ASA 3 patients by dependency is recommended, as it may predict adverse outcomes and support clinical judgment.
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| 4. |
- Björne, Håkan
(author)
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Nitrite ion : its role in vasoregulation and host defenses
- 2005
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Doctoral thesis (other academic/artistic)abstract
- Nitrite and nitrate are distributed throughout the human body, with especially high levels being present in saliva. Until recently, these anions were considered merely to be inert end-products of the oxidation of endogenous nitric oxide (NO). This thesis is part of a rapidly growing field of research which now reveals, surprisingly, that the nitrite ion can be reduced chemically to NO in both blood and tissues. Such NO may play an important role, e.g., in vasoregulation and host defenses against bacteria, similar to that played by NO formed from L-arginine via the action of NO synthases. A major aim here has been to characterize the reduction of nitrite to NO and other nitrogen oxides in the stomach, as well as the actions of nitrite in the gastric environment, where the levels of this anion are exceptionally high, due to reduction of nitrate by symbiotic bacteria in the oral cavity. First, however, we explored the possibility that very low levels of nitrite, similar to those present in blood and tissues, can be converted into vasodilatory levels of NO. In experiments employing rings of rat aortic tissue, we demonstrated that when the pH of the buffer solution is lowered to resemble a situation of metabolic acidosis or ischemia, nitrite is reduced to NO with concomitant vasorelaxation. Next, we found that when delivered into the acidic stomach of rats, human saliva containing nitrite causes rapid mucosal vasodilatation and enhances the generation of mucus. These effects are dependent on cyclic guanosine monophosphate (cGMP) and, again, paralleled by formation of NO. Moreover, we demonstrated that the high levels of NO and other nitrogen oxides generated by a mixture of human saliva and gastric juice are bactericidal towards a laboratory strain of Escherichia coli . Similar results are obtained when NO itself is delivered via diffusion through a silicone balloon attached to a gastric tube. In the final study on human subjects we showed that continuous delivery of nitrite-containing saliva is required to maintain high intragastric levels of NO. Indeed, in intubated, critically ill patients, who do not swallow their saliva, gastric NO is virtually absent. However, upon intragastric administration of nitrite, a normal level of gastric NO is rapidly restored in these individuals. Together, these observations clearly illustrate the physiological relevance of the newly discovered pathway for the generation of NO by chemical reduction of nitrite. In the local gastric environment NO may have important protective roles to play through stimulating gastric mucosal blood flow and mucus production, as well as by killing ingested pathogens. Critically ill patients have extremely low gastric levels of NO, because they cannot swallow their saliva. These patients are prone to develop stress ulcers and their stomachs are rapidly colonized by bacteria, which may result in serious infections, including pneumonia. Future studies will reveal whether the simple procedure for restoring intragastric NO described here can be used to reduce the incidence of these serious complications in such patients. Under conditions of ischemia and metabolic stress, reduction of nitrite to vasodilatory levels of NO can also occur systemically. We propose that a continuous intake of nitrate-containing food, e.g., vegetables may help to maintain tissue levels of nitrite and NO at adequate levels even when endogenous enzymatic synthesis of NO is disturbed. If true, these considerations could have a profound impact on our view of the role of diet and commensal bacteria in the regulation of normal physiological processes and prevention of cardiovascular disease.
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| 5. |
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| 6. |
- Jacobsson, Martin, 1976-, et al.
(author)
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Deep Learning-Based Early Prediction of Intraoperative Hypotension
- 2021
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Conference paper (peer-reviewed)abstract
- This work focuses on predicting near-term onset of hypotension prior to onset using convolutional neural networks. Based solely on the arterial blood pressure curve, our initial attempt can predict an onset with 60% sensitivity and 80% specificity 5-15 minutes before onset.Clinical relevance Hypotension is common during large surgery. By identifying and treating hypotensive episodes early, preferably even before onset, hypotension and its associate post- surgery complications are reduced. Even a prediction with 80% sensitivity/specificity is valuable for the anesthesiologist.
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| 7. |
- Jansson, Emmelie A, et al.
(author)
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Protection from nonsteroidal anti-inflammatory drug (NSAID)-induced gastric ulcers by dietary nitrate
- 2007
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In: Free Radical Biology & Medicine. - : Elsevier BV. - 0891-5849 .- 1873-4596. ; 42:4, s. 510-518
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Journal article (peer-reviewed)abstract
- Nitrate is abundant in our diet with particularly high levels in many vegetables. Ingested nitrate is concentrated in saliva and reduced to nitrite by bacteria in the oral cavity. We recently reported that application of nitrite-containing saliva to the gastric mucosa increases superficial blood flow and mucus generation via acid-catalyzed formation of bioactive nitrogen oxides including nitric oxide. Here we studied if dietary supplementation with nitrate would protect against gastric damage caused by a nonsteroidal anti-inflammatory drug. Rats received sodium nitrate in the drinking water for 1 week in daily doses of 0.1 or 1 mmol kg− 1. Control rats received 1 mmol kg− 1 sodium chloride. Diclofenac (30 mg kg− 1) was then given orally and the animals were examined 4 h later. In separate experiments we studied the effects of dietary nitrate on intragastric NO levels and mucus formation. Luminal levels of NO gas were greatly increased in nitrate-fed animals. The thickness of the mucus layer increased after nitrate supplementation and gene expression of MUC6 was upregulated in the gastric mucosa. Nitrate pretreatment dose dependently and potently reduced diclofenac-induced gastric lesions. Inflammatory activity was reduced in the rats receiving nitrate as indicated by lower mucosal myeloperoxidase activity and expression of inducible NO synthase. We conclude that dietary nitrate protects against diclofenac-induced gastric ulcers likely via enhanced nitrite-dependent intragastric NO formation and concomitant stimulation of mucus formation. Future studies will reveal if a diet rich in nitrate can offer an additional nutritional approach to preventing and treating peptic ulcer disease.
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| 8. |
- Sander, Caroline Hällsjö, et al.
(author)
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Capnodynamic assessment of effective lung volume during cardiac output manipulations in a porcine model
- 2016
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In: Journal of clinical monitoring and computing. - : Springer Science and Business Media LLC. - 1387-1307 .- 1573-2614. ; 30:6, s. 761-769
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Journal article (peer-reviewed)abstract
- A capnodynamic calculation of effective pulmonary blood flow includes a lung volume factor (ELV) that has to be estimated to solve the mathematical equation. In previous studies ELV correlated to reference methods for functional residual capacity (FRC). The aim was to evaluate the stability of ELV during significant manipulations of cardiac output (CO) and assess the agreement for absolute values and trending capacity during PEEP changes at different lung conditions. Ten pigs were included. Alterations of alveolar carbon dioxide were induced by cyclic reoccurring inspiratory holds. The Sulphur hexafluoride technique for FRC measurements was used as reference. Cardiac output was altered by preload reduction and inotropic stimulation at PEEP 5 and 12 cmH(2)O both in normal lung conditions and after repeated lung lavages. ELV at baseline PEEP 5 was [mean (SD)], 810 (163) mL and decreased to 400 (42) mL after lavage. ELV was not significantly affected by CO alterations within the same PEEP level. In relation to FRC the overall bias (limits of agreement) was -35 (-271 to 201) mL, and percentage error 36 %. A small difference between ELV and FRC was seen at PEEP 5 cmH(2)O before lavage and at PEEP 12 cmH(2)O after lavage. ELV trending capability between PEEP steps, showed a concordance rate of 100 %. ELV was closely related to FRC and remained stable during significant changes in CO. The trending capability was excellent both before and after surfactant depletion.
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| 9. |
- Sigmundsson, Thorir Svavar, et al.
(author)
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Performance of a capnodynamic method estimating effective pulmonary blood flow during transient and sustained hypercapnia
- 2018
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In: Journal of clinical monitoring and computing. - : SPRINGER HEIDELBERG. - 1387-1307 .- 1573-2614. ; 32:2, s. 311-319
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Journal article (peer-reviewed)abstract
- The capnodynamic method is a minimally invasive method continuously calculating effective pulmonary blood flow (COEPBF), equivalent to cardiac output when intra pulmonary shunt flow is low. The capnodynamic equation joined with a ventilator pattern containing cyclic reoccurring expiratory holds, provides breath to breath hemodynamic monitoring in the anesthetized patient. Its performance however, might be affected by changes in the mixed venous content of carbon dioxide (CvCO2). The aim of the current study was to evaluate COEPBF during rapid measurable changes in mixed venous carbon dioxide partial pressure (PvCO2) following ischemia-reperfusion and during sustained hypercapnia in a porcine model. Sixteen pigs were submitted to either ischemia-reperfusion (n = 8) after the release of an aortic balloon inflated during 30 min or to prolonged hypercapnia (n = 8) induced by adding an instrumental dead space. Reference cardiac output (CO) was measured by an ultrasonic flow probe placed around the pulmonary artery trunk (COTS). Hemodynamic measurements were obtained at baseline, end of ischemia and during the first 5 min of reperfusion as well as during prolonged hypercapnia at high and low CO states. Ischemia-reperfusion resulted in large changes in PvCO2, hemodynamics and lactate. Bias (limits of agreement) was 0.7 (-0.4 to 1.8) L/min with a mean error of 28% at baseline. COEPBF was impaired during reperfusion but agreement was restored within 5 min. During prolonged hypercapnia, agreement remained good during changes in CO. The mean polar angle was -4.19A degrees (-8.8A degrees to 0.42A degrees). Capnodynamic COEPBF is affected but recovers rapidly after transient large changes in PvCO2 and preserves good agreement and trending ability during states of prolonged hypercapnia at different levels of CO.
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| 10. |
- Öhman, Tomas, et al.
(author)
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Clinical and experimental validation of a capnodynamic method for end-expiratory lung volume assessment
- 2020
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In: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576. ; 64:5, s. 670-676
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Journal article (peer-reviewed)abstract
- Introduction Lung protective ventilation can decrease post-operative pulmonary complications. The aim of this study was to evaluate a capnodynamic method estimating effective lung volume (ELV) as a proxy for end-expiratory lung volume in response to PEEP changes in patients, healthy subjects and a porcine model. Methods Agreement and trending ability for ELV in anaesthetized patients and agreement in awake subjects were evaluated using nitrogen multiple breath wash-out/in and plethysmography as a reference respectively. Agreement and trending ability were evaluated in pigs during PEEP elevations with inert gas wash-out as reference. Results In anaesthetized patients bias (95% limits of agreement [LoA]) and percentage error (PE) at PEEP 0 cm H2O were 133 mL (-1049 to 1315) and 71%, at PEEP 5 cm H2O 161 mL (-1291 to 1613 mL) and 66%. In healthy subjects: 21 mL (-755 to 796 mL) and 26%. In porcines, at PEEP 5-20 cm H2O bias decreased from 223 mL to 136 mL LoA (34-412) to (-30 to 902) and PE 29%-49%. Trending abilities in anaesthetized patients and porcines were 100% concordant. Conclusion The ELV-method showed low bias but high PE in anaesthetized patients. Agreement was good in awake subjects. In porcines, agreement was good at lower PEEP levels. Concordance related to PEEP changes reached 100% in all settings. This method may become a useful trending tool for monitoring lung function during mechanical ventilation, if findings are confirmed in other clinical contexts.
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