| 1. |
- Ederle, Joerg, et al.
(författare)
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Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial
- 2010
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Ingår i: The Lancet. - 1474-547X. ; 375:9719, s. 985-997
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Tidskriftsartikel (refereegranskat)abstract
- Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. Findings The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4.0%) events of disabling stroke or death in the stenting group compared with 27 (3.2%) events in the endarterectomy group (hazard ratio [HR] 1.28, 95% CI 0.77-2.11). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5.2% in the endarterectomy group (72 vs 44 events; HR 1.69, 1.16-2.45, p=0.006), Risks of any stroke (65 vs 35 events; HR 1.92, 1.27-2.89) and all-cause death (19 vs seven events; HR 2.76, 1.16-6.56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0.0197). Interpretation Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery.
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| 2. |
- Björn, Lars Olof, et al.
(författare)
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Effects of ozone depletion and increased ultraviolet-B radiation on northern vegetation
- 1999
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Ingår i: Polar Research. - : Norwegian Polar Institute. - 0800-0395 .- 1751-8369. ; 18:2, s. 331-337
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Tidskriftsartikel (refereegranskat)abstract
- The stratospheric ozone layer has been depleted at high and mid-latitudes as a consequence of man's pollution of the atmosphere, and this results in increasing ultraviolet-B radiation at ground level. We investigate the effects of further radiation increases on plants and ecosystems by irradiating natural sub-Arctic and Arctic vegetation with artificial W-B radiation in field experiments extending over several years. Our experimental sites are located at Abisko, in northern Sweden (68 degrees N), and Adventdalen, on the island of Spitsbergen (78 degrees N). Additional UV-B induced interspecific differences in plant response in terms of reduced (or, in one case, increased) growth, changed morphology and changed pigment content. In some cases effects seem to be accumulated from one year to another. Plant litter decomposition is retarded. We are also studying how UV-B enhancement may affect the interaction between species. In some experiments we combine UV-B enhancement with changes in other factors: carbon dioxide concentration, water availability, and temperature. In some cases the effect of radiation enhancement is modified, or even reversed, by such changes. Over a four year period we did not find any significant radiation induced change in species composition, but based on the effects on individual plant species, such changes can be expected to take place over a longer time.
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| 3. |
- Björn, Lars Olof, et al.
(författare)
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The problem of ozone depletion in northern Europe
- 1998
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Ingår i: Ambio: a Journal of Human Environment. - 0044-7447. ; 27:4, s. 275-279
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Tidskriftsartikel (refereegranskat)abstract
- Ozone in the atmosphere, mainly in the stratosphere, absorbs most of the ultraviolet-B (wavelength 280-315 nm) radiation from the sun, which can destroy DNA and other biologically important molecules and, thereby, damage living organisms. Due to the pollution of the atmosphere by humans, the ozone layer is presently being depleted, more rapidly at higher latitudes than at lower, and more rapidly over Scandinavia than over most geographical regions at corresponding latitudes. Ultraviolet-B radiation is generally more intense in mountain regions than at sea level. We have experiments in progress in which we simulate the effects of further ozone depletion on terrestrial ecosystems (mountain heaths, bogs, tundra) by irradiating them with artificial ultraviolet-B radiation. Effects on the growth of dwarf-shrubs and mosses and on plant litter decomposition are described.
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| 4. |
- Johanson, U, et al.
(författare)
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The effects of an enhanced UV-B radiation on a sub-arctic heath ecosystem
- 1995
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Ingår i: Ambio: a Journal of Human Environment. - 0044-7447. ; 24:2, s. 106-112
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the effects of increased UV-B radiation on a natural subarctic ecosystem a field irradiation experiment was established at Abisko, northern Sweden. The vegetation in the plots consists of a dwarf shrub layer with mosses and lichens beneath. Many response variables of the vegetation and soil are measured in these plots, e.g. photosynthesis, growth, phenology, changes in species composition and decomposition. This paper describes the methods used and some initial results. Decomposition was imparied by enhanced UV-B radiation. UV-B directly affected decomposition processes and also affected them indirectly by altering the tissue chemistry of leaves. The annual growth of the dwarf shrubs was lower under enhanced UV-B. This was more pronounced in evergreen than in deciduous species. Leaf thickness of the dwarf shrubs was changed by UV-B. The leaves of the evergreen Vaccinium vitis-idaea grew thicker, while those of the two deciduous species V. myrtillus and V. uliginosum grew thinner. In the moss Hylocomium splendens, the phenological development was accelerated under enhanced UV-B radiation. Its growth (number of primary branches, length and dry weight) also increased.
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| 5. |
- Romner, Bertil, et al.
(författare)
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Late magnetic resonance imaging related to neurobehavioral functioning after aneurysmal subarachnoid hemorrhage
- 1989
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Ingår i: Neurosurgery. - 0148-396X. ; 25:3, s. 390-396
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Tidskriftsartikel (refereegranskat)abstract
- Twenty patients who underwent early aneurysm surgery--that is, surgery within 72 hours after rupture--underwent further follow-up examination including magnetic resonance imaging (MRI) of the brain and a comprehensive neuropsychological assessment. Significant statistical correlation between tissue loss as seen on a late MRI scan and neurobehavioral deficits could not be established. Among 9 patients with no tissue loss seen on MRI, 3 exhibited substantial cognitive dysfunction and 6 had mild impairment. Three patients showed minor but corresponding tissue loss and deficits. In 3 patients with pronounced pathological indications on MRI, evidence of cognitive dysfunction was absent in 2, and 1 patient showed substantial impairment. The remaining 5 individuals displayed moderate pathological indications on MRI, with no obvious correspondence to cognitive functioning. In 7 patients, small white matter lesions, probably silent infarcts not seen on computed tomographic scan, were discovered on MRI. There was a clear relationship between arterial hypertension prior to aneurysm rupture and the extent of tissue loss seen on MRI. Absence of pathological findings on MRI scan did not exclude cognitive malfunctioning, and vice-versa.
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| 6. |
- Sonesson, Björn C, et al.
(författare)
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UVB-induced inflammation gives increased d-dopachrome tautomerase activity in blister fluid which correlates with macrophage migration inhibitory factor.
- 2003
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Ingår i: Experimental Dermatology. - : Wiley. - 0906-6705. ; 12:3, s. 278-282
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Tidskriftsartikel (refereegranskat)abstract
- UVB light was used to induce an experimental inflammation in normal human skin in order to investigate its correlation with the activity of the newly described enzyme d-dopachrome tautomerase (DDT) in the fluid of experimental blisters. Macrophage migration inhibitory factor (MIF) activity was determined as a closely related marker of inflammation. DDT and MIF activities were demonstrated in blister fluids in all 10 healthy subjects. All but one of these subjects showed increased activity of DDT and MIF after three minimal erythemal doses (MED) of UVB. The mean activity of DDT increased approximately twofold and the mean activity of MIF also increased twofold after UVB in our experimental model. We found a strong correlation between DDT and MIF activities. The presence of DDT in epidermis and its increase at UV irradiation was confirmed by immunohistochemical studies. In this study, DDT is for the first time demonstrated in the skin. It is also the first time DDT can be related to inflammation, and its covariation with MIF strengthens this observation.
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| 7. |
- van der Riet, Claire, et al.
(författare)
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Supra-and Infra-Renal Aortic Neck Diameter Increase after Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm
- 2022
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Ingår i: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 11:5
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Tidskriftsartikel (refereegranskat)abstract
- Hypovolemia-induced hypotension may lead to an aortic diameter decrease in patients with a ruptured abdominal aortic aneurysm (rAAA). This study investigates the changes in supra-and infra-renal aortic neck diameters before and after endovascular aortic aneurysm repair (EVAR) for rAAA and the possible association with endograft apposition. A retrospective cohort study was conducted including 74 patients treated between 2010 and 2019 in two large European vascular centers. Outer-to-outer wall diameters were measured at +40, +10, 0, −10, and −20 mm relative to the lowest renal artery baseline on the last pre-and first post-EVAR computed tomography angiography (CTA) scan in a vascular workstation. Endograft apposition was determined on the first post-EVAR CTA scan. The post-operative diameter was significantly (p < 0.001) larger than the preoperative diameter at all aortic levels. The aortic diameter at +40 mm (supra-renal) and −10 mm (infra-renal) increased by 6.2 ± 7.3% and 12.6 ± 9.8%, respectively. The aortic diameter at +40 mm increased significantly more in patients with low preoperative systolic blood pressure (<90 mmHg; p = 0.005). A shorter apposition length was associated with a higher aortic diameter increase (R = −0.255; p = 0.032). Hypovolemic-induced hypotension results in a significant decrease in the aortic diameter in patients with an rAAA, which should be taken into account when oversizing the endograft.
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