| 1. |
- Cavefors, Oscar, et al.
(author)
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Isolated diastolic dysfunction is associated with increased mortality in critically ill patients.
- 2023
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In: Journal of critical care. - : Elsevier BV. - 1557-8615 .- 0883-9441. ; 76
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Journal article (peer-reviewed)abstract
- Left ventricular (LV) diastolic dysfunction is important in critically ill patients, but prevalence and impact on mortality is not well studied. We classified intensive care patients with normal left ventricular function according to current diastolic guidelines and explored associations with mortality.Echocardiography was performed within 24h of intensive care admission. Patients with reduced LV ejection fraction, regional wall motion abnormality, or a history of cardiac disease were excluded. Patients were classified according to the 2016 EACVI guidelines, Recommendations for the Evaluation of LV Diastolic Function by Echocardiography.Out of 218 patients, 162 (74%) had normal diastolic function, 21 (10%) had diastolic dysfunction, and 35 (17%) had indeterminate diastolic function. Diastolic dysfunction were more common in female patients, older patients and associated with sepsis, respiratory and cardiovascular comorbidity as well as higher SAPS Score. In a risk-adjusted logistic regression model, patients with indeterminate diastolic dysfunction (OR 4.3 [1.6-11.4], p=0.004) or diastolic dysfunction (OR 5.1 [1.6-16.5], p=0.006) had an increased risk of death at 90days compared to patients with normal diastolic function.Isolated diastolic dysfunction, assessed by a multi-parameter approach, is common in critically ill patients and is associated with mortality.Secondary analysis of data from a single-center prospective observational study focused on systolic dysfunction in intensive care unit patients (Clinical Trials ID: NCT03787810.
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| 2. |
- Cavefors, Oscar, et al.
(author)
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Regional left ventricular systolic dysfunction associated with critical illness: incidence and effect on outcome
- 2021
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In: Esc Heart Failure. - : Wiley. - 2055-5822. ; 8:6, s. 5415-5423
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Journal article (peer-reviewed)abstract
- Aims Left ventricular (LV) dysfunction can be triggered by non-cardiac disease, such as sepsis, hypoxia, major haemorrhage, or severe stress (Takotsubo syndrome), but its clinical importance is not established. In this study, we evaluate the incidence and impact on mortality of LV dysfunction associated with critical illness. Methods and results In this single-centre, observational study, consecutive patients underwent an echocardiographic examination within 24 h of intensive care unit (ICU) admission. LV systolic dysfunction was defined as an ejection fraction (EF) < 50% and/or regional wall motion abnormalities (RWMA). A cardiologist assessed patients with LV dysfunction for the presence of an acute or chronic cardiac disease, and coronary angiography was performed in high-risk patients. Of the 411 patients included, 100 patients (24%) had LV dysfunction and in 52 (13%) of these patients, LV dysfunction was not attributed to a cardiac disease. Patients with LV dysfunction and non-cardiac disease had higher mortality risk score (Simplified Acute Physiologic Score 3 score), heart rate, noradrenaline doses, and lactate levels as well as decreased EF, stroke volume, and cardiac output compared with patients with normal LV function. Diagnoses most commonly associated with LV dysfunction and non-cardiac disease were sepsis, respiratory insufficiency, major haemorrhage, and neurological disorders. RWMA (n = 40) with or without low EF was more common than global hypokinesia (n = 12) and was reversible in the majority of cases. Twelve patients had a circumferential pattern of RWMA in concordance with Takotsubo syndrome. Crude 30 day mortality was higher in patients with LV dysfunction and non-cardiac disease compared with patients with normal LV function (33% vs. 18%, P = 0.023), but not after risk adjustment (primary outcome) {odds ratio [OR] 1.56 [confidence interval (CI) 0.75-3.39], P = 0.225}. At 90 days, crude mortality was 44% and 22% (P = 0.002), respectively, in these groups. This difference was also significant after risk adjustment [OR 2.40 (CI 1.18-4.88), P = 0.016]. Conclusions Left ventricular systolic dysfunction is commonly triggered by critical illness, is frequently seen as regional hypokinesia, and is linked to an increased risk of death. The prognostic importance of LV dysfunction in critical illness might be underestimated.
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| 4. |
- Johansson, Martin, 1976-, et al.
(author)
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Spatial sexual dimorphism of X and Y homolog gene expression in the human central nervous system during early male development
- 2016
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In: Biology of Sex Differences. - : Springer Science and Business Media LLC. - 2042-6410. ; 7
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Journal article (peer-reviewed)abstract
- Background: Renewed attention has been directed to the functions of the Y chromosome in the central nervous system during early human male development, due to the recent proposed involvement in neurodevelopmental diseases. PCDH11Y and NLGN4Y are of special interest because they belong to gene families involved in cell fate determination and formation of dendrites and axon. Methods: We used RNA sequencing, immunocytochemistry and a padlock probing and rolling circle amplification strategy, to distinguish the expression of X and Y homologs in situ in the human brain for the first time. To minimize influence of androgens on the sex differences in the brain, we focused our investigation to human embryos at 8-11 weeks post-gestation. Results: We found that the X- and Y-encoded genes are expressed in specific and heterogeneous cellular sub-populations of both glial and neuronal origins. More importantly, we found differential distribution patterns of X and Y homologs in the male developing central nervous system. Conclusions: This study has visualized the spatial distribution of PCDH11X/Y and NLGN4X/Y in human developing nervous tissue. The observed spatial distribution patterns suggest the existence of an additional layer of complexity in the development of the male CNS.
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| 5. |
- Lannemyr, Lukas, 1974, et al.
(author)
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Renal tubular injury during cardiopulmonary bypass as assessed by urinary release of N-acetyl-ss-D-glucosaminidase
- 2017
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 61:9, s. 1075-1083
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Journal article (peer-reviewed)abstract
- BackgroundAcute kidney injury (AKI) is a common complication with a major impact on morbidity and mortality after cardiac surgery with cardiopulmonary bypass (CPB). The aim of the present study was to perform a detailed analysis on the release of the tubular injury biomarker N-acetyl-b-D-glucosaminidase (NAG) during and early after CPB and to describe independent predictors of maximal tubular injury. We hypothesized that renal tubular injury occurs early after the onset of CPB. MethodsIn this prospective observational study, we included 61 patients undergoing open cardiac surgery with an expected CPB duration exceeding 60min. The urinary NAG levels were measured at 30min intervals during CPB, as well as early (30min) after CPB and post-operatively. Independent predictors of tubular injury were identified using an Interquantile multivariate regression model. ResultsAlready 30min after the onset of CPB, NAG excretion was significantly increased (P<0.001), followed by a sixfold peak increase after discontinuation of CPB (P<0.001). In the multivariable regression model, CPB duration (P<0.05) and the degree of rewarming during CPB (P<0.05), were independent predictors of peak NAG excretion. ConclusionIn cardiac surgery, a renal tubular cell injury is seen early after onset of CPB with a peak biomarker increase early after end of CPB. The magnitude of this tubular injury is independently related to CPB duration and the degree of rewarming. Efforts made to decrease the CPB duration and to avoid hypothermia and the need for rewarming may decrease the risk for tubular injury.
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| 6. |
- Lindberg, Jonatan, et al.
(author)
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En spark i baken för ett aktivare liv
- 2011
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Reports (other academic/artistic)abstract
- Efter årtionden av inaktivitet fick några patienter i 60-årsåldern fysisk aktivitet på recept (FaR). Vår studie pekar på att det var ett bra sätt att hjälpa dem att finna motivation och att ta ett första steg mot ett aktivare liv.
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| 7. |
- Lundin, Andreas, et al.
(author)
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High-sensitivity troponin T for detection of culprit lesions in patients with out-of-hospital cardiac arrest
- 2024
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In: ACTA ANAESTHESIOLOGICA SCANDINAVICA. - 0001-5172 .- 1399-6576.
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Journal article (peer-reviewed)abstract
- BackgroundPatients with an out-of-hospital cardiac arrest (OHCA) often undergo coronary angiography, although a culprit lesion is found in only 30%-40% of patients. The aim of this study was to investigate high-sensitivity troponin T (hsTnT) levels in post cardiac arrest patients with and without coronary culprit lesions; factors affecting hsTnT levels after return of spontaneous circulation (ROSC); and the diagnostic ability of hsTnT in identifying patients with culprit lesions. We hypothesized that peak hsTnT levels were higher during the initial 48 h after cardiac arrest in patients with a coronary culprit lesion.MethodsThis was a retrospective observational study, which included patients admitted to the Intensive Care Unit after an OHCA and who received a coronary angiography. Peak values and dynamic changes in hsTnT were analyzed in relation to the presence of a culprit lesion at coronary angiography.ResultsA total of 238 patients were studied, of whom 140 had a culprit lesion. HsTnT levels during the initial 48 h were higher in patients with culprit lesions, longer time to ROSC and an unwitnessed cardiac arrest. At 6 to 12 h after ROSC, a hsTnT cut-off level of 1690 ng/L had a sensitivity of 64% and specificity of 84% to identify a culprit lesion. In patients without ST-elevations, hsTnT measured between 6 and 12 h after ROSC had a specificity above 90%, with a sensitivity of 46%.ConclusionHsTnT levels after cardiac arrest are higher in patients with coronary culprit lesions. Presence of a culprit lesion, witnessed status and the duration of CPR are important factors affecting hsTnT levels. Repeated measurement of hsTnT within the first 12 h after admission improved diagnostic accuracy but the value of hsTnT as a predictor of culprit lesions early after OHCA is limited.
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| 8. |
- Lundin, Erik, et al.
(author)
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A weak C sink at high latitudes : support from an integrated terrestrial – aquatic C balance
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Other publication (other academic/artistic)abstract
- High latitude ecosystems have served as net sinks of atmospheric carbon (C) in the Holocene time perspective. However, the ongoing climate warming makes it questionable if high latitude landscapes still function as net C sinks. In this study we used multiyear high resolution C flux data to estimate an integrated terrestrial-aquatic C balance of a sub-arctic catchment. The results indicate large inter annual variability in C fluxes and suggest that the C sink function of this landscape is weak, especially when also accounting for the often neglected C losses from aquatic systems. In fact, our results suggest that it is more likely that the studied catchment serves as a net source of C rather than a net sink. These results highlight the importance of inland waters in the C cycle and that the strength of the C sequestering in the contemporary sub-arctic environment is much weaker than often assumed.
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| 9. |
- Lundin, Erik J, et al.
(author)
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Is the subarctic landscape still a carbon sink? : Evidence from a detailed catchment balance
- 2016
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In: Geophysical Research Letters. - : American Geophysical Union (AGU). - 0094-8276 .- 1944-8007. ; 43:5, s. 1988-1995
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Journal article (peer-reviewed)abstract
- Climate warming raises the question whether high-latitude landscape still function as net carbon (C) sinks. By compiling an integrated C balance for an intensely studied subarctic catchment, we show that this catchment's C balance is not likely to be a strong current sink of C, a commonly held assumption. In fact, it is more plausible (71% probability) that the studied catchment functions as a C source (-1120gCm(-2)yr(-1)). Analyses of individual fluxes indicate that soil and aquatic C losses offset C sequestering in other landscape components (e.g., peatlands and aboveground forest biomass). Our results stress the importance of fully integrated catchment C balance estimates and highlight the importance of upland soils and their interaction with the aquatic network for the catchment C balance.
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| 10. |
- Lundin, Erik J., et al.
(author)
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Large difference in carbon emission : burial balances between boreal and arctic lakes
- 2015
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In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 5
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Journal article (peer-reviewed)abstract
- Lakes play an important role in the global carbon (C) cycle by burying C in sediments and emitting CO2 and CH4 to the atmosphere. The strengths and control of these fundamentally different pathways are therefore of interest when assessing the continental C balance and its response to environmental change. In this study, based on new high-resolution estimates in combination with literature data, we show that annual emission: burial ratios are generally ten times higher in boreal compared to subarctic - arctic lakes. These results suggest major differences in lake C cycling between biomes, as lakes in warmer boreal regions emit more and store relatively less C than lakes in colder arctic regions. Such effects are of major importance for understanding climatic feedbacks on the continental C sink - source function at high latitudes. If predictions of global warming and northward expansion of the boreal biome are correct, it is likely that increasing C emissions from high latitude lakes will partly counteract the presumed increasing terrestrial C sink capacity at high latitudes.
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