| 1. |
- Abdelrahman, Islam, et al.
(author)
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Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.
- 2017
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 12:3
-
Journal article (peer-reviewed)abstract
- Patients and Methods: Surgically managed burn patients admitted between 2010-14 were included. Operative stay was defined as the time from admission until the last operation, postoperative stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative stay. Multivariable regression was used to assess factors associated with operative stay and postoperative stay.less thanbr /greater thanResults: Operative stay/TBSA% showed less variation than total duration/TBSA% (F test = 2.38, pless than0.01). The size of the burn, and the number of operations, were the independent factors that influenced operative stay (R2 0.65). Except for the size of the burn other factors were associated with duration of postoperative stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean) 12 and 17 days (pless than0.001, R2 0.51).less thanbr /greater thanConclusion: Adjusted operative stay showed less variation than total hospital stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure.
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| 2. |
- Björkskog, Anni, et al.
(author)
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Framtiden är redan byggd : 12 perspektiv
- 2023
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Reports (other academic/artistic)abstract
- POST-ACCELERATION – framtiden är redan byggd har varit temat för kursen Byggnadskonst vid Kungl. Konsthögskolan 2022–2023. Att byggsektorn står för en betydande del av klimatpåverkan både gällande förbrukning av naturresurser och energi, är ingen nyhet, det är också den sektor som efterlämnar mest avfall. Att i större utsträckning återbruka hela byggnader, anläggningar och miljöer, vet vi skulle snabbt ge positiv effekt på klimatet. Att utgå ifrån det som redan finns, istället för att bygga nytt, innebär en kraftfull minskning av ytterligare miljöpåverkan. Majoriteten av den byggda miljön i Sverige är uppförd under senare delen av 1900-talet, en tid, som brukar kallas den stora accelerationen, starkt präglad av sin framtidstro, folkhemsbygge och välfärdsutveckling. Det är ofta i dessa vardagsmiljöer och nära relation till dess arkitektur som vi växer upp, lever våra liv och formas som människor. Livsviktiga miljöer, men känsliga, eftersom de ofta tas för givet, inte pekas ut som värdefulla och därför ofta lider av brist på omsorg och långsiktigt underhåll. Exploateringarna går så snabbt att det är svårt att få tillräcklig tidsdistans för att kunna förstå och värdera vidden av miljöernas idé, betydelse och storhet. Denna publikation redovisar studenternas enskilda arbeten. Materialet har tillkommit inom ramen för läsårets tema ”Post-acceleration - framtiden är redan byggd”, men varje studie utgår ifrån studenternas egna val av ämne. POST-ACCELERATION ingår i den utbildningssatsning som KKH Restaureringskonst sedan 2020 kallar Perspektiv. Utbildningen är forskningsinriktad, där studenterna kritiskt analyserar olika, och ibland motstridiga, perspektiv som idag finns i byggsektorn och samhällets strävan mot en mer hållbar riktning.
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| 3. |
- Borgquist, Ola, et al.
(author)
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Central venous stenosis after subclavian versus internal jugular dialysis catheter insertion (CITES) in adults in need of a temporary central dialysis catheter : study protocol for a two-arm, parallel-group, non-inferiority randomised controlled trial
- 2023
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In: Trials. - 1745-6215. ; 24:1
-
Journal article (peer-reviewed)abstract
- Background: The right internal jugular vein is currently recommended for temporary central dialysis catheters (tCDC) based on results from previous studies showing a lower incidence of central vein stenosis compared to the subclavian vein. Data is however conflicting, and there are several advantages when the subclavian route is used for tCDCs. This prospective, controlled, randomised, non-inferiority study aims to compare the incidence of post-catheterisation central vein stenosis between the right subclavian and the right internal jugular routes. Methods: Adult patients needing a tCDC will be included from several hospitals and randomised to either subclavian or internal jugular vein catheterisation with a silicone tCDC. Inclusion continues until 50 patients in each group have undergone a follow-up CT venography. The primary outcome is the incidence of post-catheterisation central vein stenosis detected by a CT venography performed 1.5 to 3 months after removal of the tCDC. Secondary outcomes include between-group comparisons of (I) the patients’ experience of discomfort and pain, (II) any dysfunction of the tCDC during use, (III) catheterisation success rate and (IV) the number of mechanical complications. Furthermore, the ability to detect central vein stenosis by a focused ultrasound examination will be evaluated using the CT venography as golden standard. Discussion: The use of the subclavian route for tCDC placement has largely been abandoned due to older studies with various methodological issues. However, the subclavian route offers several advantages for the patient. This trial is designed to provide robust data on the incidence of central vein stenosis after silicone tCDC insertion in the era of ultrasound-guided catheterisations. Trial registration: Clinicaltrials.gov; NCT04871568. Prospectively registered on May 4, 2021.
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| 4. |
- Dogan, Sinan, et al.
(author)
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A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft
- 2022
-
In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1
-
Journal article (peer-reviewed)abstract
- To investigate if donor and recipient site morbidity (healing time and cosmesis) could be reduced by a novel, modified split-thickness skin grafting (STSG) technique using a dermal component in the STSG procedure (DG). The STSG technique has been used for 150 years in surgery with limited improvements. Its drawbacks are well known and relate to donor site morbidity and recipient site cosmetic shortcomings (especially mesh patterns, wound contracture, and scarring). The Dermal graft technique (DG) has emerged as an interesting alternative, which reduces donor site morbidity, increases graft yield, and has the potential to avoid the mesh procedure in the STSG procedure due to its elastic properties. A prospective, dual-centre, intra-individual controlled comparison study. Twenty-one patients received both an unmeshed dermis graft and a regular 1:1.5 meshed STSG. Aesthetic and scar assessments were done using The Patient and Observer Scar Assessment Scale (POSAS) and a Cutometer Dual MPA 580 on both donor and recipient sites. These were also examined histologically for remodelling and scar formation. Dermal graft donor sites and the STSG donor sites healed in 8 and 14 days, respectively (p < 0.005). Patient-reported POSAS showed better values for colour for all three measurements, i.e., 3, 6, and 12 months, and the observers rated both vascularity and pigmentation better on these occasions (p < 0.01). At the recipient site, (n = 21) the mesh patterns were avoided as the DG covered the donor site due to its elastic properties and rendered the meshing procedure unnecessary. Scar formation was seen at the dermal donor and recipient sites after 6 months as in the standard scar healing process. The dermis graft technique, besides potentially rendering a larger graft yield, reduced donor site morbidity, as it healed faster than the standard STSG. Due to its elastic properties, the DG procedure eliminated the meshing requirement (when compared to a 1:1.5 meshed STSG). This promising outcome presented for the DG technique needs to be further explored, especially regarding the elasticity of the dermal graft and its ability to reduce mesh patterns. Trial registration: ClinicalTrials.gov Identifier (NCT05189743) 12/01/2022. © 2022, The Author(s).
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| 5. |
- Elmasry, Moustafa, et al.
(author)
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Changes in patterns of treatment of burned children at the Linkoping Burn Centre, Sweden, 2009-2014
- 2017
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In: Burns. - : Pergamon Press. - 0305-4179 .- 1879-1409. ; 43:5, s. 1111-1119
-
Journal article (peer-reviewed)abstract
- Introduction: Children are a relatively large group among patients with burns in Sweden. We changed the management of childrens burns to a flexible, outpatient-based plan. The aim was to follow up the outpatient management for childrens burns during the period 20092014, and track it, to find out to what extent the patients had been treated flexibly as outpatients, and to clarify the reasons behind those who did not fit in the plan. Methods: Descriptive retrospective analysis dividing the patients into three groups: inpatients only, flexible management, and outpatients. Other variables recorded included: age, sex, percentage total body surface area burned (TBSA%), percentage full thickness burn (FTB%), cause of burn, county of residence, operations required, number of visits to the outpatient department, costs, and duration of overnight stay in the hospital. Results: The study group included 620 children: nine were managed strictly as inpatients, 204 as flexible outpatients, and 407 strictly as outpatients. Among the total there were 269 children who came from remote areas (43%), and of these 260 were treated as outpatients and flexible outpatients. Median TBSA% in the whole group was 1 (10th-90th centile 0-9) with the biggest median TBSA% 12 (5-38) in the inpatient group. The most common cause of injury was scalds (332/620,-54%). Costs/patient (US$) was lower in the flexible outpatient group than in the inpatient group (median 10 557 (3213-35802) and 35343 (7344-66554), respectively). Conclusion: Based on the results, we expect that the flexible outpatient treatment plan for children with minor to moderate burns can be expanded in the future. The results encourage us to continue the service and to further reduce duration of stay in hospital below the level already achieved (25% of the whole period of care). (C) 2017 Elsevier Ltd and ISBI. All rights reserved.
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| 6. |
- Elmasry, Moustafa, et al.
(author)
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Staged excisions of moderate-sized burns compared with total excision with immediate autograft : an evaluation of two strategies.
- 2017
-
In: International journal of burns and trauma. - : E-Century Publishing Corporation. - 2160-2026. ; 7:1, s. 6-11
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Different surgical techniques have evolved since excision and autografting became the treatment of choice for deep burns in the 1970s. The treatment plan at the Burn Center, Linköping University Hospital, Sweden, has shifted from single-stage excision and immediate autografting to staged excisions and temporary cover with xenografts before autografting. The aim of this study was to find out if the change in policy resulted in extended duration of hospital stay/total body surface area burned (LOS/TBSA%).METHODS: Retrospective clinical cohort including surgically-managed patients with burns of 15%-60% TBSA% within each treatment group. The first had early full excisions of deep dermal and full thickness burns and immediate autografts (1997-98), excision and immediate autograft group) and the second had staged excisions before final autografts using xenografts for temporary cover (2010-11, staged excision group).RESULTS: The study included 57 patients with deep dermal and full-thickness burns, 28 of whom had excision and immediate autografting, and 29 of whom had staged excisions with xenografting before final autografting. Adjusted (LOS/TBSA%) was close to 1, and did not differ between groups. Mean operating time for the staged excision group was shorter and the excised area/operation was smaller. The total operating time/TBSA% did not differ between groups.CONCLUSION: Staged excisions with temporary cover did not affect adjusted LOS/TBSA% or total operating time. Staged excisions may be thought to be more expensive because of the cost of covering the wound between stages, but this needs to be further investigated as do the factors that predict long term outcome.
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| 7. |
- Elmasry, Moustafa, et al.
(author)
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Temporary coverage of burns with a xenograft and sequential excision, compared with total early excision and autograft
- 2016
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In: Annals of burns and fire disasters. - : Mediterranean Council for Burns and Fire Disasters. - 1592-9558. ; 29:3, s. 196-201
-
Journal article (peer-reviewed)abstract
- During the 80s and 90s, early and total excision of full thickness burns followed by immediate autograft was the most common treatment, with repeated excision and grafting, mostly for failed grafts. It was hypothesized, therefore, that delayed coverage with an autograft preceded by a temporary xenograft after early and sequential smaller excisions would lead to a better wound bed with fewer failed grafts, a smaller donor site, and possibly also a shorter duration of stay in hospital. We carried out a case control study with retrospective analysis from our National Burn Centre registry for the period 1997-2011. Patients who had been managed with early total excision and autograft were compared with those who had had sequential smaller excisions covered with temporary xenografts until the burn was ready for the final autograft. The sequential excision and xenograft group (n=42) required one-third fewer autografts than patients in the total excision and autograft group (n=45), who needed more than one operation (p<0.001). We could not detect any differences in duration of stay in hospital / total body surface area burned% (duration of stay/TBSA%) (2.0 and 1.8) (p=0.83). The two groups showed no major differences in terms of adjusted duration of stay, but our findings suggest that doing early, smaller, sequential excisions using a xenograft for temporary cover can result in shorter operating times, saving us the trouble of making big excisions. However, costs tended to be higher when the burns were > 25% TBSA.
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| 8. |
- Frieberg, Petter, et al.
(author)
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Computational Fluid Dynamics Support for Fontan Planning in Minutes, Not Hours : The Next Step in Clinical Pre-Interventional Simulations
- 2022
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In: Journal of Cardiovascular Translational Research. - : Springer Science and Business Media LLC. - 1937-5395 .- 1937-5387. ; 15:4, s. 708-720
-
Journal article (peer-reviewed)abstract
- Computational fluid dynamics (CFD) modeling may aid in planning of invasive interventions in Fontan patients. Clinical application of current CFD techniques is however limited by complexity and long computation times. Therefore, we validated a "lean" CFD method to magnetic resonance imaging (MRI) and an "established" CFD method, ultimately aiming to reduce complexity to enable predictive CFD during ongoing interventions. Fifteen Fontan patients underwent MRI for CFD modeling. The differences between lean and established approach, in hepatic and total flow percentage to the left pulmonary artery (%LPA), power loss and relative wall shear stress area were 1.5 ± 4.0%, -0.17 ± 1.1%, -0.055 ± 0.092 mW and 1.1 ± 1.4%. Compared with MRI, the lean and established method showed a bias in %LPA of -1.9 ± 3.4% and -1.8 ± 3.1%. Computation time was for the lean and established approach 3.0 ± 2.0 min and 7.0 ± 3.4 h, respectively. We conclude that the proposed lean method provides fast and reliable results for future CFD support during interventions.
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| 9. |
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| 10. |
- Frieberg, Petter, et al.
(author)
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In vivo hepatic flow distribution by computational fluid dynamics can predict pulmonary flow distribution in patients with Fontan circulation
- 2023
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In: Scientific Reports. - 2045-2322. ; 13:1
-
Journal article (peer-reviewed)abstract
- In Fontan patients, a lung deprived of hepatic blood may develop pulmonary arterio-venous malformations (PAVMs) resulting in shunting, reduced pulmonary vascular resistance (PVR) and decreased oxygenation. To provide guidance for corrective invasive interventions, we aimed to non-invasively determine how the hepatic to pulmonary blood flow balance correlates with pulmonary flow, PVR, and with oxygen saturation. Magnetic resonance imaging (MRI) data from eighteen Fontan patients (eight females, age 3–14 years) was used to construct patient-specific computational fluid dynamics (CFD) models to calculate the hepatic to pulmonary blood flow. This was correlated with pulmonary vein flow, simulated PVR and oxygen saturation. Clinical applicability of the findings was demonstrated with an interventional patient case. The hepatic to pulmonary blood flow balance correlated with right/left pulmonary vein flow (R2 = 0.50), left/right simulated PVR (R2 = 0.47), and oxygen saturation at rest (R2 = 0.56). In the interventional patient, CFD predictions agreed with post-interventional MRI measurements and with regressions in the cohort. The balance of hepatic blood to the lungs has a continuous effect on PVR and oxygen saturation, even without PAVM diagnosis. MRI combined with CFD may help in planning of surgical and interventional designs affecting the hepatic to pulmonary blood flow balance in Fontan patients.
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| 11. |
- Frieberg, Petter, et al.
(author)
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Simulation of aortopulmonary collateral flow in Fontan patients for use in prediction of interventional outcomes
- 2018
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In: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-097X .- 1475-0961. ; 38:4, s. 622-629
-
Journal article (peer-reviewed)abstract
- Purpose: Patients with complex congenital heart disease may need to be converted to a Fontan circulation with systemic venous return surgically connected to the pulmonary circulation. These patients frequently form aortopulmonary collaterals (APC), that is arterial inflows to the pulmonary artery vascular tree. The aim of this study was to develop a method to calculate the effect of APC on the pulmonary flow distribution based on magnetic resonance imaging (MRI) measurements and computational fluid dynamics simulations in order to enable prediction of interventional outcomes in Fontan patients.Methods: Patient-specific models of 11 patients were constructed in a 3D-design software based on MRI segmentations. APC flow was quantified as the difference between pulmonary venous flow and pulmonary artery flow, measured by MRI. A method was developed to include the modulating effect of the APC flow by calculating the patient-specific relative pulmonary vascular resistance. Simulations, including interventions with a Y-graft replacement and a stent dilatation, were validated against MRI results.Results: The bias between simulated and MRI-measured fraction of blood to the left lung was 29 53%. Including the effects of the APC flow in the simulation (n = 6) reduced simulation error from 98 70% to 52 63%. Preliminary findings in two patients show that the effect of surgical and catheter interventions could be predicted using the demonstrated methods.Conclusions: The work demonstrates a novel method to include APC flow in predictive simulations of Fontan hemodynamics. APC flow was found to have a significant contribution to the pulmonary flow distribution in Fontan patients.
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| 12. |
- Guné, Henrik, et al.
(author)
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Right ventricular remodeling after conduit replacement in patients with corrected tetralogy of Fallot - Evaluation by cardiac magnetic resonance
- 2019
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In: Journal of Cardiothoracic Surgery. - : Springer Science and Business Media LLC. - 1749-8090. ; 14:1
-
Journal article (peer-reviewed)abstract
- Purpose: To evaluate the potential for right ventricular reverse remodelling after pulmonary valve replacement using cardiac magnetic resonance imaging, in adults with corrected tetralogy of Fallot and severe pulmonary insufficiency. Material and methods: Ten patients with previous correction of tetralogy of Fallot with severe pulmonary insufficiency accepted for pulmonary valve replacement were evaluated prospectively with cardiac magnetic resonance imaging preoperatively and re-evaluated 10 ± 5 months postoperatively. Follow up for survival was 100% complete with mean of 37 ± 12 months. Results: The preoperative mean indexed right ventricular end-diastolic volume was reduced from 161 ± 33 ml/m 2 to 120 ± 23 ml/m 2 postoperatively, p < 0.001. The preoperative mean indexed right ventricular stroke volume was reduced from 72 ± 20 ml/m 2 to 50 ± 6 ml/m 2 postoperatively, p = 0.002. After pulmonary valve replacement, the right ventricular ejection fraction did not change significantly (46% versus 42%, p = 0.337). Pulmonary insufficiency fraction decreased from 49% ± 11 to 1% ± 1 postoperatively, p < 0.001. Conclusions: Pulmonary valve replacement leads to a favourable early reverse remodelling with a reduction in RV volumes and improved function in all patients regardless of their preoperative indexed right ventricular volume.
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| 13. |
- Johansson, Martin, et al.
(author)
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Atrioventricular Area Difference Aids Diastolic Filling in Patients with Repaired Tetralogy of Fallot
- 2024
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In: Pediatric Cardiology. - 0172-0643.
-
Journal article (peer-reviewed)abstract
- A hydraulic force aids diastolic filling of the left ventricle (LV) and is proportional to the difference in short-axis area between the left ventricle and atrium; the atrioventricular area difference (AVAD). Patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) have reduced LV filling which could lead to a negative AVAD and a hydraulic force impeding diastolic filling. The aim was to assess AVAD and to determine whether the hydraulic force aids or impedes diastolic filling in patients with rToF and PR, compared to controls. Twelve children with rToF (11.5 [9–13] years), 12 pediatric controls (10.5 [9–13] years), 12 adults with rToF (21.5 [19–27] years) and 12 adult controls (24 [21–29] years) were retrospectively included. Cine short-axis images were acquired using cardiac magnetic resonance imaging. Atrioventricular area difference was calculated as the largest left ventricular short-axis area minus the largest left atrial short-axis area at beginning of diastole and end diastole and indexed to height (AVADi). Children and adults with rToF and PR had higher AVADi (0.3 cm2/m [− 1.3 to 0.8] and − 0.6 [− 1.5 to − 0.2]) at beginning of diastole compared to controls (− 2.7 cm2/m [− 4.9 to − 1.7], p = 0.015) and − 3.3 cm2/m [− 3.8 to − 2.8], p = 0.017). At end diastole AVADi did not differ between patients and controls. Children and adults with rToF and pulmonary regurgitation have an atrioventricular area difference that do not differ from controls and thus a net hydraulic force that contributes to left ventricular diastolic filling, despite a small underfilled left ventricle due to pulmonary regurgitation.
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| 14. |
- Karlsson, Matilda, et al.
(author)
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Biosynthetic cellulose compared to porcine xenograft in the treatment of partial-thickness burns : A randomised clinical trial.
- 2022
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In: Burns. - : Elsevier. - 0305-4179 .- 1879-1409. ; 48:5, s. 1236-1245
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Journal article (peer-reviewed)abstract
- AIM: The aim was to compare two dressing treatments for partial-thickness burns: biosynthetic cellulose dressing (BsC) (Epiprotect® S2Medical AB, Linköping, Sweden) and porcine xenograft (EZ Derm®, Mölnlycke Health Care, Gothenburg, Sweden).METHODS: Twenty-four adults with partial-thickness burns were included in this randomized clinical trial conducted at The Burn Centers in Linköping and Uppsala, Sweden between June 2016 and November 2018. Time to healing was the primary outcome. Secondary outcomes were wound infection, pain, impact on everyday life, length of hospital stay, cost, and burn scar outcome (evaluated with POSAS).RESULTS: We found no significant differences between the two dressing groups regarding time to healing, wound infection, pain, impact on everyday life, duration of hospital stay, cost, or burn scar outcome at the first follow up. Burn scar outcome at the 12-month follow up showed that the porcine xenograft group patients scored their scars higher on the POSAS items thickness (p = 0.048) and relief (p = 0.050). This difference was, however, not confirmed by the observer.CONCLUSIONS: The results showed the dressings performed similarly when used in adults with burns evaluated as partial thickness.
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| 15. |
- Karlsson, Matilda, 1981-, et al.
(author)
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Burn scar outcome at six and 12 months after injury in children with partial thickness scalds : Effects of dressing treatment.
- 2020
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In: Burns. - : Elsevier. - 0305-4179 .- 1879-1409. ; 46:3, s. 546-551
-
Journal article (peer-reviewed)abstract
- INTRODUCTION: In line with other researchers in the field of burns' care, we think that research investigating the long-term outcome of scars is largely lacking. As scarring is of the utmost importance to the patient, clinicians who treat burns must aim to find treatments that lead to a good end result. The aim of this study was to study scar outcomes at six and 12 months after injury. It is an extension of a previous randomised controlled trial (RCT) in which two dressings (porcine xenograft and silver foam dressing) were examined with respect to their ability to help heal partial thickness scalds.METHOD: Children aged six months - six years with acute partial thickness scalds, on the trunk, or extremities, or both, were included. In the previous study, the silver foam was found to have significantly shorter healing times than the xenograft. Children were assessed at six and 12 months after injury for this study, and photographs were taken of the burn site, and both the patient and observer scar assessment scale (POSAS) and the Vancouver scar scale (VSS) were completed and evaluated by blinded observers.RESULTS: Of the 58 children from the original RCT, 39 returned to the clinic for evaluation of their scars at six months, and 34 at 12 months after injury. There were no differences in POSAS, VSS total scores, or incidence of hypertrophic scarring between the different dressings. Fifteen children were assessed as having hypertrophic scarring, all of whom had healing times that had extended beyond 14 days.CONCLUSIONS: This study compared burn scarring after two different treatments for burns in children with partial-thickness scalds and the data suggested that neither dressing had a more favourable impact on scar outcome. The conclusion is, however, tempered by the non-return of all the patients to the follow up. However, as anticipated, regardless of the dressing used, longer healing times were associated with higher scar scores (more scarring) and hypertrophic scarring.
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| 16. |
- Karlsson, Matilda, et al.
(author)
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Scarring At Donor Sites After Split-Thickness Skin Graft : A Prospective, Longitudinal, Randomized Trial
- 2018
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In: Advances in Skin & Wound Care. - : Lippincott Williams & Wilkins. - 1527-7941 .- 1538-8654. ; 3:4, s. 183-188
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The aim of this study was to evaluate scarring at split-thickness skin graft donor sites 8 years after surgery.METHODS: At surgery, 67 patients were randomized to hydrofiber, polyurethane foam, or porcine xenograft treatment. Scars were evaluated with the Patient and Observer Scar Assessment Scale.RESULTS: Results showed significant differences in observed scar outcomes at donor sites, leaving the polyurethane foam–treated and the porcine xenograft–treated patients with the least satisfying scars. Multivariable regression analysis showed that the group treated with the xenografts had worse scores for overall opinion of the scar than did the other groups (P = .03), the most important factor being pigmentation. There was no correlation between duration of healing time and quality of the scar.CONCLUSIONS: There were significant differences among the groups, with the hydrofiber group being the most satisfied with the appearance of their scar.
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| 17. |
- Karlsson, Matilda, et al.
(author)
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Scarring at Donor Sites after Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial
- 2020
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In: Advances in Skin & Wound Care. - : LIPPINCOTT WILLIAMS & WILKINS. - 1527-7941 .- 1538-8654. ; 33:12
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate if previous findings on the association between dressing treatments and subjective opinion on final donor site scar outcome using the Patient and Observer Scar Assessment Scale (POSAS) can be confirmed objectively. The previous study showed that patients dressed with hydrofiber covered with film were more satisfied with their donor site scars than patients receiving porcine xenograft or polyurethane foam dressings. METHODS: Scar outcome measurements were assessed by a blinded observer using POSAS and the Cutometer dual MPA 580 device to measure the viscoelasticity of skin. RESULTS: A total of 17 participants were included in this study, five of whom were treated with hydrofiber, six with polyurethane foam, and another six with porcine xenograft. There were no significant differences among groups in any of the POSAS items or in the viscoelasticity measurements made with the Cutometer. CONCLUSIONS: The investigators could not confirm previous associations between dressing treatment and long-term donor site scars. No associations between donor sites healing times and final scarring were found. Hypopigmentation was reported in 15 of 17 donor sites evaluated.
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| 18. |
- Karlsson, Matilda, 1981-, et al.
(author)
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Sprayed cultured autologous keratinocytes in the treatment of severe burns : a retrospective matched cohort study.
- 2020
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In: Annals of burns and fire disasters. - Palermo, Italy : Mediterranean Council for Burns and Fire Disasters. - 1592-9558. ; 33:2, s. 134-142
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Journal article (peer-reviewed)abstract
- The standard treatment of burns is early excision followed by autologous skin grafting. The closure of extensive deep burns poses a considerable challenge. Cultured autologous keratinocytes have been used since 1981 in an effort to improve healing. However, the time required to culture the cells and the lack of a dermal component limit the expectations of outcome. Our aim was to compare the duration of hospital stay between patients who were treated with autologous skin grafts and cultured autologous keratinocytes and those who were treated with autologous skin grafting without cultured autologous keratinocytes. In this retrospective study all patients treated with cultured autologous keratinocytes between 2012 and 2015 were matched by size and depth of burn with patients not treated with cultured autologous keratinocytes. Multivariable regression was used to analyse associations between duration of hospital stay and treatment adjusted for age, mortality, size and depth of the burn. Then, we investigated the possibility of differentiation of human bone marrow stem cell line to keratinocyte- like cells as a future direction. The regression analysis showed a coefficient of 17.36 (95% CI -17.69 to 52.40), p= 0.32, for hospital stay in the treatment group, compared with the matched group. Our results showed no difference in the duration of hospital stay between the two treatments. Autologous stem cells should be considered as a future modality of burn management, although further studies are needed.
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| 19. |
- Karlsson, Matilda, 1981-
(author)
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Studying the healing and long-term outcomes of two partial thickness wound models using different wound dressings
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Background: Safe and effective wound dressing treatments are important for proper wound healing. Such procedures therefore need to be evidence-based regarding the most important outcome measures such as healing time, less discomfort for the patient, duration of hospital care and, importantly, less scarring. As the relation between longer healing times and more severe scarring is known, it is important to find dressing treatments that reduces such complications by providing fast and proper wound healing. In this thesis, four established wound dressing treatments (hydrofibre covered with film; porcine xenografts and polyurethane foam, with and without silver), were evaluated for two types of acute, partial thickness wounds: split thickness skin graft (STSG) donor sites and partial thickness burn wounds in two randomised, controlled clinical trials (RCT) with longterm scar follow ups. The relations between factors thought to influence wound healing and scarring as sex, infection, wound extent and depth, healing time and skin grafting were also investigated in these two wound models.Methods: Data from these trials were collected on sex, infection rates, wound depth and extent, need of skin grafting, healing times and scarring frequency together with demographic data. Scars were evaluated at 8 years in Study II and III and at 6 and 12 months after injury in Study V.Results: Two dressing treatments; hydrofibre covered with film and porcine xenografts gave significantly faster healing of the STSG donor sites than the standard of care (SOC) dressing, the polyurethane foam. The hydrofibre was thereafter implemented as the new SOC at the department. The long-term scar follow up showed that the hydrofibre group was most satisfied with their donor site scar, providing further evidence for the implementation of this dressing strategy. From the observer’s perspective no differences were found between these treatment groups. For partial thickness burns the treatment with a silvercontaining foam dressing showed significantly shorter healing time, whereas for the scars, no difference between dressing groups could be detected. A number of factors were identified that affected healing time: for donor sites only male sex was associated with shorter healing time. Sex was also the only factor that influenced donor site scarring, where female patients, both subjectively and objectively, were rated with higher scores (worse outcome). For partial thickness burns a larger extent of the burn wound, presence of deep dermal burns, and the need of skin grafting, all had a negative impact on both healing time and final scar. The final scar was also significantly affected by longer wound healing times and infection.Conclusion: The results suggest that the use of hydrofibre dressings covered with film on donor sites resulted in positive short-term and long-term outcomes. Regarding partial thickness burns, silver foam dressing resulted in faster healing but as for the final scar, no difference could be seen. Several factors were associated with longer healing times and more severe scarring such as: female sex, larger burns, deep dermal burns, skin grafting, and infection. Longer healing times were related to more severe scarring.
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| 20. |
- Karlsson, Matilda, 1981-, et al.
(author)
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Superiority of silver-foam over porcine xenograft dressings for treatment of scalds in children: A prospective randomised controlled trial
- 2019
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In: Burns. - : ELSEVIER SCI LTD. - 0305-4179 .- 1879-1409. ; 45:6, s. 1401-1409
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Journal article (peer-reviewed)abstract
- Aim: Our aim was to compare two different regimens for the treatment of children with partial-thickness scalds. These were treated with either a porcine xenograft (EZderm (R), Molnlycke Health Care, Gothenburg, Sweden) or a silver-foam dressing (Mepilex (R) Ag, Molnlycke Health Care, Gothenburg, Sweden). Methods: We organised a prospective randomised clinical trial that included 58 children admitted between May 2015 and May 2018 with partial-thickness scalds to The Burn Centre in Linkoping, Sweden. The primary outcome was time to healing. Secondary outcomes were pain, need for operation, wound infection, duration of hospital stay, changes of dressings, and time taken. Results: The patients treated with silver-foam dressing had a significantly shorter healing time. The median time to 97% healing for this group was 9 (7-23) days compared to 15 (9-29) days in the porcine xenograft group (p = 0.004). The median time to complete healing for the silver-foam group was 15 (9-29) days and for the porcine xenograft group 20.5 (11-42) days (p = 0.010). Pain, wound infection, duration of hospital stay, and the proportion of operations were similar between the groups. Number of dressing changes and time for dressing changes were lower in the silver-foam dressing group (p = 0.03 for both variables). Conclusions: We compared two different treatments for children with partial-thickness scalds, and the data indicate that wound healing was faster, fewer dressing changes were needed, and dressing times were shorter in the silver-foam group. (C) 2019 Elsevier Ltd and ISBI. All rights reserved.
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| 21. |
- Karlsson, Matilda, et al.
(author)
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Three Years Experience of a Novel Biosynthetic Cellulose Dressing in Burns
- 2019
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In: ADVANCES IN WOUND CARE. - : MARY ANN LIEBERT. - 2162-1918 .- 2162-1934. ; 8:2, s. 71-76
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Journal article (peer-reviewed)abstract
- Objective: The use of porcine xenograft (PX) is widely spread in burn care. However, it may cause immunologic responses and other ethical and cultural considerations in different cultures. Therefore, there is a need for alternatives. The aim of this work is to test a novel biosynthetic cellulose dressing (Epiprotect((R))) on burn patients. Approach: Charts from 38 patients with superficial burns (SBs) (n=18) or excised burns (n=20) that got biosynthetic cellulose dressing instead of PX at a national burn center during 3 years were reviewed. Time to healing, length of stay, and wound infection were extracted from the medical records. Results: SBs hospitalization time was 11 days comparable to PXs reported by others. In the excised group, median duration of hospital stay was 35 days. Time to healing was 28 days. Seven wound infections were confirmed in the superficial group (39%) and 11 infections in the excised group (61%). Patients with superficial wounds reported pain relief on application. Innovation: A dressing (17x21cm) consisting of biosynthetic cellulose replacing PX. Conclusion: Outcome of treatment of SBs or temporary coverage of excised deep burns with biosynthetic cellulose is comparable to treatment with PX. However, biosynthetic cellulose has benefits such as providing pain relief on application and ethical or cultural issues with the material is nonexistent.
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| 22. |
- Liefke, Jonas, et al.
(author)
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Higher blood pressure in adolescent boys after very preterm birth and fetal growth restriction
- 2023
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In: Pediatric Research. - : Springer Science and Business Media LLC. - 1530-0447 .- 0031-3998. ; 93:7, s. 2019-2027
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Journal article (peer-reviewed)abstract
- BackgroundAlthough preterm birth predisposes for cardiovascular disease, recent studies in children indicate normal blood pressure and arterial stiffness. This prospective cohort study therefore assessed blood pressure and arterial stiffness in adolescents born very preterm due to verified fetal growth restriction (FGR).MethodsAdolescents (14 (13–17) years; 52% girls) born very preterm with FGR (preterm FGR; n = 24) and two control groups born with appropriate birth weight (AGA), one in similar gestation (preterm AGA; n = 27) and one at term (term AGA; n = 28) were included. 24-hour ambulatory blood pressure and aortic pulse wave velocity (PWV) and distensibility by magnetic resonance imaging were acquired.ResultsThere were no group differences in prevalence of hypertension or in arterial stiffness (all p ≥ 0.1). In boys, diastolic and mean arterial blood pressures increased from term AGA to preterm AGA to preterm FGR with higher daytime and 24-hour mean arterial blood pressures in the preterm FGR as compared to the term AGA group. In girls, no group differences were observed (all p ≥ 0.1).ConclusionsVery preterm birth due to FGR is associated with higher, yet normal blood pressure in adolescent boys, suggesting an existing but limited impact of very preterm birth on cardiovascular risk in adolescence, enhanced by male sex and FGR.ImpactVery preterm birth due to fetal growth restriction was associated with higher, yet normal blood pressure in adolescent boys.In adolescence, very preterm birth due to fetal growth restriction was not associated with increased thoracic aortic stiffness.In adolescence, very preterm birth in itself showed an existing but limited effect on blood pressure and thoracic aortic stiffness.Male sex and fetal growth restriction enhanced the effect of preterm birth on blood pressure in adolescence.Male sex and fetal growth restriction should be considered as additional risk factors to that of preterm birth in cardiovascular risk stratification.
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| 23. |
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| 24. |
- Shahin, Hady, et al.
(author)
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MicroRNA-155 mediates multiple gene regulations pertinent to the role of human adipose-derived mesenchymal stem cells in skin regeneration
- 2024
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In: Frontiers in Bioengineering and Biotechnology. - : FRONTIERS MEDIA SA. - 2296-4185. ; 12
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Journal article (peer-reviewed)abstract
- Introduction: The role of Adipose-derived mesenchymal stem cells (AD-MSCs) in skin wound healing remains to be fully characterized. This study aims to evaluate the regenerative potential of autologous AD-MSCs in a non-healing porcine wound model, in addition to elucidate key miRNA-mediated epigenetic regulations that underlie the regenerative potential of AD-MSCs in wounds.Methods: The regenerative potential of autologous AD-MSCs was evaluated in porcine model using histopathology and spatial frequency domain imaging. Then, the correlations between miRNAs and proteins of AD-MSCs were evaluated using an integration analysis in primary human AD-MSCs in comparison to primary human keratinocytes. Transfection study of AD-MSCs was conducted to validate the bioinformatics data.Results: Autologous porcine AD-MSCs improved wound epithelialization and skin properties in comparison to control wounds. We identified 26 proteins upregulated in human AD-MSCs, including growth and angiogenic factors, chemokines and inflammatory cytokines. Pathway enrichment analysis highlighted cell signalling-associated pathways and immunomodulatory pathways. miRNA-target modelling revealed regulations related to genes encoding for 16 upregulated proteins. miR-155-5p was predicted to regulate Fibroblast growth factor 2 and 7, C-C motif chemokine ligand 2 and Vascular cell adhesion molecule 1. Transfecting human AD-MSCs cell line with anti-miR-155 showed transient gene silencing of the four proteins at 24 h post-transfection.Discussion: This study proposes a positive miR-155-mediated gene regulation of key factors involved in wound healing. The study represents a promising approach for miRNA-based and cell-free regenerative treatment for difficult-to-heal wounds. The therapeutic potential of miR-155 and its identified targets should be further explored in-vivo.
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| 25. |
- Sjöberg, Carina, et al.
(author)
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How to Achieve Highly Professional Care in the Postoperative Ward : The Care of Infants and Toddlers
- 2024
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In: Journal of Perianesthesia Nursing. - : Elsevier. - 1089-9472 .- 1532-8473.
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Journal article (peer-reviewed)abstract
- PURPOSE: The purpose of this study was to describe the experiences of critical care nurses (CCNs) and registered nurse anesthetists (RNAs) when monitoring and observing infants and toddlers recovering from anesthesia. DESIGN: A qualitative design with a critical incident approach.METHODS: Semistructured individual interviews were conducted with a purposeful sample of CCNs and RNAs (n = 17) from postanesthesia care units at two hospitals. The critical incident technique approach was used to guide the interviews, and data were analyzed inductively using thematic analysis.FINDINGS: The main finding was the CCNs' and RNAs' description of how they "watch over the children and stay close" to provide emotional and physical safety. CCNs' and RNAs' experiences of observing and managing the children's small, immature airways were reflected in the theme "using situation awareness of the small, immature airways." The theme "understanding emergence agitation" describes the challenge that arises when children are anxious, feel insecure, and have pain, and the theme "having parents nearby" shows the necessity and value of involving parents in their children's care.CONCLUSIONS: Findings from this study suggest that caring for infants and toddlers recovering from anesthesia requires experience and both technical and nontechnical skills. These are prerequisites for achieving readiness for planning, setting priorities, and adapting one's behavior if an adverse event occurs. Alertness and the ability to solve acute problems and make quick decisions are essential because of the risks associated with children's small, immature airways, as is the ability to understand and respond to emergence agitation. Having parents nearby is equally important for creating the conditions for compassionate child- and family-centered care.
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| 26. |
- Sjöberg, Pia, et al.
(author)
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Altered biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and right ventricular volume overload because of pulmonary regurgitation
- 2018
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In: American Journal of Physiology - Heart and Circulatory Physiology. - : American Physiological Society. - 1522-1539 .- 0363-6135. ; 315:6, s. 1691-1702
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Journal article (peer-reviewed)abstract
- Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in repaired tetralogy of Fallot (rToF) patients to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and PR>20% (n=18) and healthy controls (n=15) underwent magnetic resonance imaging (MRI) including 4D-flow. A subset of patients (n=8) underwent PVR and MRI after surgery. Time-resolved hemodynamic forces were quantified using 4D-flow data and indexed to ventricular volume. Patients had higher systolic and diastolic left ventricular (LV) hemodynamic forces compared to controls in the lateral-septal/LVOT (p=0.011; p=0.0031) and inferior-anterior (p<0.0001; p<0.0001) directions, which are forces not aligned with blood flow. Forces did not change after PVR. Patients had higher RV diastolic forces compared to controls in the diaphragm-RVOT (p<0.001) and apical-basal (p=0.0017) directions. After PVR RV systolic forces in the diaphragm-RVOT direction decreased (p=0.039) to lower levels than in controls (p=0.0064). RV diastolic forces decreased in all directions (p=0.0078; p=0.0078; p=0.039) but were still higher than in controls in diaphragm-RVOT direction (p=0.046). In conclusion, patients with rToF and PR had LV hemodynamic forces less aligned with the intraventricular blood flow compared to controls and higher diastolic RV forces along the regurgitant flow direction in the RVOT and that of tricuspid inflow. Remaining force differences in LV and RV after PVR suggest that biventricular pumping does not normalize after surgery.
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| 27. |
- Sjöberg, Pia, et al.
(author)
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Atrial septal defect closure in children at young age is beneficial for left ventricular function.
- 2024
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In: European Heart Journal Imaging Methods & Practice. - 2755-9637. ; 2:1, s. 1-8
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Journal article (peer-reviewed)abstract
- AimsAtrial septal defects (ASDs) lead to volume-loaded right ventricles (RVs). ASD closure does not always alleviate symptoms or improve exercise capacity, which is possibly explained by impaired left ventricular (LV) haemodynamics. This study evaluated the effect of ASD closure in children using non-invasive LV pressure–volume (PV) loops derived from cardiac magnetic resonance (CMR) imaging and brachial blood pressure, compared with controls.Methods and resultsTwenty-three children with ASD underwent CMR, and 17 of them were re-examined 7 (6–9) months after ASD closure. Twelve controls were included. Haemodynamic variables were derived from PV loops by time-resolved LV volumes and brachial blood pressure. After ASD closure, LV volume increased [76 (70–86) vs. 63 (57–70) mL/m2, P = 0.0001]; however, it was still smaller than in controls [76 (70–86) vs. 82 (78–89) mL/m2, P = 0.048]. Compared with controls, children with ASD had higher contractility [2.6 (2.1–3.3) vs. 1.7 (1.5–2.2) mmHg/mL, P = 0.0076] and arterial elastance [2.1 (1.4–3.1) vs. 1.4 (1.2–2.0) mmHg/mL, P = 0.034]. After ASD closure, both contractility [2.0 (1.4–2.5) mmHg/mL, P = 0.0001] and arterial elastance [1.4 (1.3–2.0) mmHg/mL, P = 0.0002] decreased.ConclusionDespite the left-to-right atrial shunt that leads to low LV filling and RV enlargement, the LV remains efficient and there is no evidence of impaired LV haemodynamics in children. Closure of ASD at young age while the ventricle is compliant is thus beneficial for LV function. LV volumes, however, remain small after ASD closure, which may impact long-term cardiovascular risk and exercise performance.
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| 28. |
- Sjöberg, Pia, et al.
(author)
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Changes in left and right ventricular longitudinal function after pulmonary valve replacement in patients with Tetralogy of Fallot
- 2020
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In: American Journal of Physiology - Heart and Circulatory Physiology. - : American Physiological Society. - 1522-1539 .- 0363-6135. ; 318:2, s. 345-353
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Journal article (peer-reviewed)abstract
- Timing and indication for pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) are uncertain. To improve understanding of pumping mechanics, we investigated atrioventricular coupling before and after surgical PVR. Cardiovascular magnetic resonance (CMR) were performed in patients (n=12) with rToF and PR>35% before and after PVR and in healthy controls (n=15). Atrioventricular plane displacement (AVPD), global longitudinal peak systolic strain (GLS), atrial and ventricular volumes and caval blood flows were analysed. Right ventricular (RV) AVPD and RV free wall GLS were lower in patients before PVR compared to controls (p<0.0001; p<0.01) and decreased after PVR (both p<0.0001 for both). Left ventricular (LV) AVPD was lower in patients before PVR compared to controls (p<0.05) and decreased after PVR (p<0.01). Left ventricular GLS did not differ between patients and controls (p>0.05). Right atrial reservoir volume and RV stroke volume (SV) generated by AVPD correlated in controls (r=0.93; p<0.0001) and patients before PVR (r=0.88; p<0.001) but not after PVR. In conclusion, there is a clear atrioventricular coupling in patients before PVR that is lost after PVR, possibly due to loss of pericardial integrity. Impaired atrioventricular coupling complicates assessment of ventricular function after surgery using measurements of longitudinal function. Changes in atrioventricular coupling seen in patients with rToF may be energetically unfavourable and long-term effects of surgery on atrioventricular coupling is therefore of interest. Also, AVPD and GLS cannot be used interchangeably to assess longitudinal function in rToF.
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| 29. |
- Sjöberg, Pia, et al.
(author)
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Comparison of 2D and 4D Flow MRI in Neonates Without General Anesthesia
- 2023
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In: Journal of Magnetic Resonance Imaging. - : Wiley. - 1522-2586 .- 1053-1807. ; 57:1, s. 71-82
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Journal article (peer-reviewed)abstract
- BackgroundNeonates with critical congenital heart disease require early intervention. Four-dimensional (4D) flow may facilitate surgical planning and improve outcome, but accuracy and precision in neonates are unknown.PurposeTo 1) validate two-dimensional (2D) and 4D flow MRI in a phantom and investigate the effect of spatial and temporal resolution; 2) investigate accuracy and precision of 4D flow and internal consistency of 2D and 4D flow in neonates; and 3) compare scan time of 4D flow to multiple 2D flows.Study TypePhantom and prospective patients.PopulationA total of 17 neonates with surgically corrected aortic coarctation (age 18 days [IQR 11–20]) and a three-dimensional printed neonatal aorta phantom.Field Strength/SequenceA 5 T, 2D flow and 4D flow.AssessmentIn the phantom, 2D and 4D flow volumes (ascending and descending aorta, and aortic arch vessels) with different resolutions were compared to high-resolution reference 2D flow. In neonates, 4D flow was compared to 2D flow volumes at each vessel. Internal consistency was computed as the flow volume in the ascending aorta minus the sum of flow volumes in the aortic arch vessels and descending aorta, divided by ascending aortic flow.Statistical testsBland–Altman plots, Pearson correlation coefficient (r), and Student's t-tests.ResultsIn the phantom, 2D flow differed by 0.01 ± 0.02 liter/min with 1.5 mm spatial resolution and −0.01 ± 0.02 liter/min with 0.8 mm resolution; 4D flow differed by −0.05 ± 0.02 liter/min with 2.4 mm spatial and 42 msec temporal resolution, −0.01 ± 0.02 liter/min with 1.5 mm, 42 msec resolution and −0.01 ± 0.02 liter/min with 1.5 mm, 21 msec resolution. In patients, 4D flow and 2D flow differed by −0.06 ± 0.08 liter/min. Internal consistency in patients was −11% ± 17% for 2D flow and 5% ± 13% for 4D flow. Scan time was 17.1 minutes [IQR 15.5–18.5] for 2D flow and 6.2 minutes [IQR 5.3–6.9] for 4D flow, P < 0.0001.Data ConclusionNeonatal 4D flow MRI is time efficient and can be acquired with good internal consistency without contrast agents or general anesthesia, thus potentially expanding 4D flow use to the youngest and smallest patients.Evidence Level1Technical EfficacyStage 2
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| 30. |
- Sjöberg, Pia, et al.
(author)
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Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging
- 2017
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In: Pediatric Cardiology. - : Springer Science and Business Media LLC. - 0172-0643 .- 1432-1971. ; 38:4, s. 669-680
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Journal article (peer-reviewed)abstract
- Four-dimensional (4D) flow magnetic resonance imaging (MRI) enables quantification of kinetic energy (KE) in intraventricular blood flow. This provides a novel way to understand the cardiovascular physiology of the Fontan circulation. In this study, we aimed to quantify the KE in functional single ventricles. 4D flow MRI was acquired in eleven patients with Fontan circulation (median age 12 years, range 3–29) and eight healthy volunteers (median age 26 years, range 23–36). Follow-up MRI after surgical or percutaneous intervention was performed in 3 patients. Intraventricular KE was calculated throughout the cardiac cycle and indexed to stroke volume (SV). The systolic/diastolic ratio of KE in Fontan patients was similar to the ratio of the controls’ left ventricle (LV) or right ventricle (RV) depending on the patients’ ventricular morphology (Cohen´s κ = 1.0). Peak systolic KE/SV did not differ in patients compared to the LV in controls (0.016 ± 0.006 mJ/ml vs 0.020 ± 0.004 mJ/ml, p = 0.09). Peak diastolic KE/SV in Fontan patients was lower than in the LV of the control group (0.028 ± 0.010 mJ/ml vs 0.057 ± 0.011 mJ/ml, p < 0.0001). The KE during diastole showed a plateau in patients with aortopulmonary collaterals. This is to our knowledge the first study that quantifies the intraventricular KE of Fontan patients. KE is dependent on the morphology of the ventricle, and diastolic KE indexed to SV in patients is decreased compared to controls. The lower KE in Fontan patients may be a result of impaired ventricular filling.
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| 31. |
- Sjöberg, Pia, et al.
(author)
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Disturbed left and right ventricular kinetic energy in patients with repaired tetralogy of Fallot : pathophysiological insights using 4D-flow MRI
- 2018
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In: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 28:10, s. 4066-4076
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Journal article (peer-reviewed)abstract
- Objectives: Indications for pulmonary valve replacement (PVR) in patients with pulmonary regurgitation (PR) after repaired tetralogy of Fallot (rToF) are debated. We aimed to compare right (RV) and left ventricular (LV) kinetic energy (KE) measured by 4D-flow magnetic resonance imaging (MRI) in patients to controls, to further understand the pathophysiological effects of PR. Methods: Fifteen patients with rToF with PR > 20% and 14 controls underwent MRI. Ventricular volumes and KE were quantified from cine MRI and 4D-flow, respectively. Lagrangian coherent structures were used to discriminate KE in the PR. Restrictive RV physiology was defined as end-diastolic forward flow. Results: LV systolic peak KE was lower in rToF, 2.8 ± 1.1 mJ, compared to healthy volunteers, 4.8 ± 1.1 mJ, p < 0.0001. RV diastolic peak KE was higher in rToF (7.7 ± 4.3 mJ vs 3.1 ± 1.3 mJ, p = 0.0001) and the difference most pronounced in patients with non-restrictive RV physiology. KE was primarily located in the PR volume at the time of diastolic peak KE, 64 ± 17%. Conclusion: This is the first study showing disturbed KE in patients with rToF and PR, in both the RV and LV. The role of KE as a potential early marker of ventricular dysfunction to guide intervention needs to be addressed in future studies. Key Points: • Kinetic energy (KE) reflects ventricular performance• KE is a potential marker of ventricular dysfunction in Fallot patients• KE is disturbed in both ventricles in patients with tetralogy of Fallot• KE contributes to the understanding of the pathophysiology of pulmonary regurgitation• Lagrangian coherent structures enable differentiation of ventricular inflows
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| 32. |
- Sjöberg, Pia, et al.
(author)
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Haemodynamic left-ventricular changes during dobutamine stress in patients with atrial septal defect assessed with magnetic resonance imaging-based pressure–volume loops
- 2022
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In: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 42:6, s. 422-429
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Journal article (peer-reviewed)abstract
- Background: Atrial septal defect (ASD) results in a left-to-right shunt causing right-ventricular (RV) volume overload and decreased cardiac output from the left ventricle. Pressure–volume (PV) loops enable comprehensive assessment of ventricular function and might increase understanding of the pathophysiology of ASD. The aim of this study was to investigate if left-ventricular (LV) haemodynamic response to stress in patients with ASD differs from controls. Material and Methods: Patients with ASD (n = 18, age 51 ± 18) and healthy controls (n = 16, age 35 ± 13) underwent cardiac magnetic resonance (CMR) and brachial cuff pressure measurements at rest and during dobutamine stress. An in-house, validated method was used to compute PV loops. Results: Patients had lower stroke work, potential energy and external power at rest than controls (p < 0.001; p < 0.05; p < 0.05). Stroke work and external power increased and potential energy decreased during stress in patients (p < 0.05; p < 0.0001; p < 0.01) and controls (p < 0.0001; p < 0.001; p < 0.01). Contractility and arterial elastance at rest were higher in patients than controls (p < 0.01; p < 0.01). Contractility increased during stress in both groups (p < 0.0001; p < 0.001). There was no difference between patients and controls in arterio-ventricular coupling. Conclusion: LV haemodynamic response to stress can be assessed using noninvasive PV loops derived from CMR and brachial blood pressure. Patients with ASD had normal LV energy efficiency, in contrast to other patient groups with decreased cardiac output. Data suggest that patients with ASD had an increased inotropic level at rest with high contractility and heart rate but were able to respond with a further increase during stress, albeit to not as high a cardiac output as controls.
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| 33. |
- Sjöberg, Pia
(author)
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Hemodynamic assessment in patients with congenital heart disease using magnetic resonance imaging
- 2019
-
Doctoral thesis (other academic/artistic)abstract
- Around 1000 children are born with a heart disease in Sweden every year and today most of these children survive and reach adult age. There are around 2.3 million grownups with congenital heart disease in Europe today, a number that is expected to continue to increase. Further, the prevalence of patients with complex malformations has been growing significantly the last 10 years. There is thus a need to increase knowledge of the pathophysiology of these diseases to avoid and treat heart failure and complications, which could lead to great suffering for the patients but also great economic costs for the health care system. This thesis therefore aims to assess the cardiac function with new magnetic resonance techniques in order to increase knowledge of the pathophysiology and to better individualize treatment and optimize the timing of intervention. The first study of this thesis investigated the ventricular kinetic energy in patients with Fontan circulation. The results showed that kinetic energy is dependent on the morphology of the heart and seems to be very specific for each individual. In study II, III and IV the cardiac pumping in patients with Tetralogy of Fallot and pulmonary regurgitation was explored by quantifying the intraventricular kinetic energy and hemodynamic forces, as well as the atrioventricular coupling. Kinetic energy was affected in both the right and left ventricle, even if left ventricular ejection fraction was normal. Patients with pulmonary regurgitation had higher right ventricular hemodynamic forces than controls, but also affected left ventricular forces, with less alignment of force and blood flow which has been suggested to lead to pathological cardiac remodelling. Further, pulmonary regurgitation resulted in decreased right ventricular longitudinal function, decreased left ventricular preload and lower left ventricular stroke volumes. Before pulmonary valve replacement patients, similar to controls, had a clear atrioventricular coupling with a strong correlation between atrial inflow and ventricular longitudinal function. After operation however this coupling was lost, possibly because the loss of pericardial integrity.After pulmonary valve replacement patients still had disturbed hemodynamic forces, pumping mechanics and loss of atrioventricular coupling, which is energetically unfavourable. Further studies will tell if these changes will normalize in time.The potential role of kinetic energy and hemodynamic forces for treatment evaluation and decision making in patients with Tetralogy of Fallot can be the aim for future studies.
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| 34. |
- Sjöberg, Pia, et al.
(author)
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Left Ventricular Diastolic Function in Children with Atrial Septal Defects Improves After Closure by Means of Increased Hydraulic Force.
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In: Pediatric Cardiology. - 0172-0643.
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Journal article (peer-reviewed)abstract
- Hydraulic force aids diastolic filling of the left ventricle (LV) by facilitating basal movement of the atrioventricular plane. The short-axis atrioventricular area difference (AVAD) determines direction and magnitude of this force. Patients with atrial septal defect (ASD) have reduced LV filling due to the left-to-right shunt across the atrial septum and thus potentially altered hydraulic force. The aims were therefore to use cardiac magnetic resonance images to assess whether AVAD and thus the hydraulic force differ in children with ASD compared to healthy children, and if it improves after ASD closure. Twenty-two children with ASD underwent cardiac magnetic resonance before ASD closure. Of these 22 children, 17 of them repeated their examination also after ASD closure. Twelve controls were included. Left atrial and ventricular areas were delineated in short-axis images, and AVAD was defined as the largest ventricular area minus the largest atrial area at each time frame and normalized to body height (AVADi). At end diastole AVADi was positive in all participants, suggesting a force acting towards the atrium assisting the diastolic movement of the atrioventricular plane; however, lower in children both before (6.3 cm2/m [5.2–8.0]; p < 0.0001) and after ASD closure (8.7 cm2/m [6.6–8.5]; p = 0.0003) compared to controls (12.2 cm2/m [11.3–13.9]). Left ventricular diastolic function improves after ASD closure in children by means of improved hydraulic force assessed by AVAD. Although AVADi improved after ASD closure, it was still lower than in controls, indicating diastolic abnormality even after ASD closure. In patients where AVADi is low, ASD closure may help avoid diastolic function deterioration and improve outcome. This could likely be important also in patients with small shunt volumes, especially if they are younger, who currently do not undergo ASD closure. Changes in clinical routine may be considered pending larger outcome studies.
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| 35. |
- Sjöberg, Pia, et al.
(author)
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Non-invasive quantification of pressure-volume loops from cardiovascular magnetic resonance at rest and during dobutamine stress
- 2021
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In: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 41:5, s. 467-470
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Journal article (peer-reviewed)abstract
- Non-invasive quantification of pressure-volume (PV) loops from brachial pressure and cardiovascular magnetic resonance is a validated method but its application has been limited to resting heart rates. The aim of this study was to improve the previous method and validate it against invasive left-ventricular pressure measurements in an experimental porcine model, and further apply it to 16 healthy humans at rest and during dobutamine stress. In addition, the improved method calculates the arterial elastance which provides the computation of the ratio of effective arterial (Ea) to maximal ventricular elastance (Emax) representing the ventricular-arterial coupling. In the porcine model, the differences between the improved non-invasively derived PV loops and invasively measured PV loops were for stroke work (mean ± SD) 0.00 ± 0.03 J, ventricular efficiency −1.1 ± 0.4%, and contractility 1.1 ± 0.1 mmHg/ml. In human subjects during dobutamine stress, stroke work increased from 1.3 ± 0.3 to 1.7 ± 0.4 J, ventricular efficiency from 71 ± 4 to 82 ± 4%, contractility from 1.3 ± 0.2 to 2.3 ± 0.6 mmHg/ml, and the ratio of arterial to ventricular elastance decreased from 0.96 to 0.56. The improved method for non-invasive PV loops constitutes a more robust diagnostic tool for cardiac disease states in a wider range of study cohorts at both rest and during stress.
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| 36. |
- Sjöberg, Pia, et al.
(author)
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Non-invasive quantification of pressure–volume loops in patients with Fontan circulation
- 2022
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In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Pressure–volume (PV) loops provide comprehensive information of cardiac function, but commonly implies an invasive procedure under general anesthesia. A novel technique has made it possible to non-invasively estimate PV loops with cardiac magnetic resonance (CMR) and brachial pressure which would enable good volume estimation of often anatomically complex ventricles without the need of anesthesia in most cases. In this study we aimed to compare how hemodynamic parameters derived from PV loops in patients with Fontan circulation differ to controls. Methods: Patients with Fontan circulation (n = 17, median age 12 years, IQR 6–15) and healthy controls (n = 17, 14 years, IQR 13–22) were examined with CMR. Short axis balanced steady-state free-precession cine images covering the entire heart were acquired. PV loops were derived from left ventricular volumes in all timeframes and brachial blood pressure from cuff sphygmomanometry. Results: Fontan patients had lower stroke work, ventricular mechanical efficiency and external power compared to controls. Fontan patients with dominant right ventricle had higher potential energy indexed to body surface area but lower contractility (Ees) compared to controls. Fontan patients had higher arterial elastance (Ea) and Ea/Ees ratio than controls. Contractility showed no correlation with ejection fraction (EF) in Fontan patients irrespective of ventricular morphology. No difference was seen in energy per ejected volume between Fontan patients and controls. Conclusions: This non-invasive PV-loop method could be used in future studies to show the potential prognostic value of these measures and if changes in ventricular function over time can be detected earlier by this method compared to changes in ventricular volumes and EF. In contrast to patients with acquired heart failure, Fontan patients had similar energy per ejected volume as controls which suggests similar ventricular oxygen consumption to deliver the same volume in Fontan patients as in controls.
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| 37. |
- Sjöberg, Pia, et al.
(author)
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Patients with volume-loaded right ventricle - quantification of left ventricular hemodynamic response to intervention measured by noninvasive pressure-volume loops
- 2023
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In: Frontiers in Physiology. - 1664-042X. ; 14
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Journal article (peer-reviewed)abstract
- Volume loading of the right ventricle (RV) in patients with atrial septal defect (ASD) and patients with repaired Tetralogy of Fallot (rToF) affects the pumping mechanics of the left ventricle (LV). Intervention of the lesion will relieve the RV volume load however quantifiable impact on exercise capacity, arrhytmias or death are limited. A possible explanation could be remaining effects on the function of the LV. The aim of this study was therefore to investigate if hemodynamics of the LV differs between patients with RV volume load due to ASD or rToF and healthy controls and if they change after intervention. Eighteen patients with ASD, 17 patients with rToF and 16 healthy controls underwent cardiac magnetic resonance imaging (CMR) and maximal exercise test with continuous gas analysis. Reexamination was performed 13 ± 2 months after closure of the ASD in 13 of the patients and 10 ± 4 months after pulmonary valve replacement (PVR) in 9 of the patients with rToF. Non-invasive PV-loops from CMR and brachial pressures were analyzed. Stroke work (SW) and potential energy (PE) increased after ASD closure but not in ToF patients after valve repair. Patients with ASD or rToF had higher contractility and arterial elastance than controls. No major effects were seen in LV energetics or in peak VO2 after ASD closure or PVR. Peak VO2 correlated positively with SW and PE in patients with ASD (r = 0.54, p < 0.05; r = 0.61, p < 0.01) and controls (r = 0.72, p < 0.01; r = 0.53, p < 0.05) to approximately the same degree as peak VO2 and end-diastolic volume (EDV) or end-systolic volume (ESV). In ToF patients there was no correlation between PV loop parameters and peak VO2 even if correlation was found between peak VO2 and EDV or ESV. In conclusion, the LV seems to adapt its pumping according to anatomic circumstances without losing efficiency, however there are indications of persistent vascular dysfunction, expressed as high arterial elastance, which might have impact on exercise performance and prognosis. Future studies might elucidate if the duration of RV volume load and decreased LV filling have any impact on the ability of the vascular function to normalize after ASD closure or PVR.
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