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Hansson, L., Lind, T., Öhlund, I., Wiklund, U. & Rydberg, A. (2020). Increased abdominal fat mass and high fat consumption in young school children with congenital heart disease: results from a case-control study. Journal of human nutrition and dietetics (Print)
Open this publication in new window or tab >>Increased abdominal fat mass and high fat consumption in young school children with congenital heart disease: results from a case-control study
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2020 (English)In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Background We have previously found that infants with complex congenital heart disease (CHD) experience growth failure despite high-energy dietary supplementation. This is a follow-up and comparison with healthy controls at 9 years of age regarding body composition and macronutrient intake, especially in relationship to the diet provided during infancy. Methods Anthropometric changes in 10 children with CHD at 12 months and at 4 and 9 years of age were analysed as Z-scores. To assess body composition and food intake at 9 years of age, a dual-energy X-ray absorptiometry scan and a 3-day food diary were completed and compared with age- and gender-matched controls using Wilcoxon's signed-rank test for matched pairs. Results Growth changes from 12 months to 9 years, converted to Z-scores for weight for height and height for age, were significantly different within the group of children with complex CHD, although no growth differences were seen in comparison with healthy controls at 9 years of age. However, the children with CHD had statistically higher abdominal fat mass index and higher daily intake of fat, particularly from saturated fatty acid in g kg(-1) compared to controls. Conclusions At 9 years of age, children with complex CHD with growth failure and high fat intake in infancy have normalised growth but increased abdominal fat mass and higher intake of saturated fatty acid compared to their peers. Nutritional monitoring in early childhood may detect unhealthy diet quality and prevent later health risks in this group.

Place, publisher, year, edition, pages
WILEY, 2020
Keywords
children, congenital heart disease, dietary fatty acid, dual-energy X-ray absorptiometry, growth, macronutrient intake
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-168120 (URN)10.1111/jhn.12739 (DOI)000511230800001 ()32026539 (PubMedID)
Available from: 2020-02-21 Created: 2020-02-21 Last updated: 2020-02-21
Tossavainen, E., Wikström, G., Henein, M. Y., Lundqvist, M., Wiklund, U. & Lindqvist, P. (2020). Passive leg-lifting in heart failure patients predicts exercise-induced rise in left ventricular filling pressures. Clinical Research in Cardiology, 109(4), 498-507
Open this publication in new window or tab >>Passive leg-lifting in heart failure patients predicts exercise-induced rise in left ventricular filling pressures
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2020 (English)In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 109, no 4, p. 498-507Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to assess PCWP with passive leg-lifting (PLL) and exercise, in two groups of patients presenting with normal left ventricular ejection fraction (LVEF); one group with elevated NT-proBNP (eBNP), and one with normal NT-proBNP (nBNP) plasma concentration.

Methods and results: Fifty-one patients with eBNP (NT-proBNP ≥ 125 ng/l) and LVEF > 50%, were investigated and compared with 34 patients with nBNP (NT-proBNP < 125 ng/l) and LVEF > 50%. Both groups underwent right heart catheterization (RHC) at rest, PLL and exercise. From RHC, mean pulmonary arterial pressure (mPAP), cardiac output (CO), and PCWP were measured. All nBNP patients had PCWP < 15 mmHg at rest, and a PCWP of < 25 mmHg with PLL and during exercise. Patients with eBNP had higher (p < 0.01) resting mPAP, PCWP, and mPAP/CO. These values increased with exercise; however, CO increased less in comparison with nBNP patients (p = 0.001). 20% of patients with eBNP had a PCWP > 15 mmHg at rest, this percentage increased to 47% with PLL and 41% had a PCWP > 25 mmHg during exercise. Of those with PCWP > 25 mmHg during exercise, 91% had a PCWP > 15 mmHg with PLL. A PCWP > 15 mmHg on PLL had a 91% sensitivity and 92% specificity in predicting exercise-induced PCWP of > 25 mmHg.

Conclusion: In patients presenting with eBNP, PLL can predict which patients will develop elevated PCWP with exercise. These findings highlight the role of stress assessment.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
Passive leg-lifting, Exercise, Elevated filling pressures, Pulmonary hypertension, Heart failure
National Category
Respiratory Medicine and Allergy
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-158841 (URN)10.1007/s00392-019-01531-w (DOI)000521737100010 ()31368000 (PubMedID)2-s2.0-85069899028 (Scopus ID)
Note

Originally included in thesis in manuscript form with title: "Passive leg lifting in heart failure patients predicts exercise induced rise in left ventricular filling pressures"

Available from: 2019-05-10 Created: 2019-05-10 Last updated: 2020-05-14Bibliographically approved
Katsogiannos, P., Kamble, P. G., Wiklund, U., Sundbom, M., Espes, D., Hammar, U., . . . Eriksson, J. W. (2020). Rapid changes in neuroendocrine regulation may contribute to reversal of type 2 diabetes after gastric bypass surgery. Endocrine (Basingstoke), 67(2), 344-353
Open this publication in new window or tab >>Rapid changes in neuroendocrine regulation may contribute to reversal of type 2 diabetes after gastric bypass surgery
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2020 (English)In: Endocrine (Basingstoke), ISSN 1355-008X, E-ISSN 1559-0100, Vol. 67, no 2, p. 344-353Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the role of hormones and the autonomic nervous system in the rapid remission of diabetes after Roux-en-Y Gastric Bypass (RYGB).

Research design and methods: Nineteen obese patients with type 2 diabetes, 7 M/12 F, were randomized (2:1) to RYGB or standard-of-care medical treatment (control). At baseline and 4 and 24 weeks post surgery, fasting blood sampling, OGTT, intravenous arginine challenge, and heart-rate variability (HRV) assessments were performed.

Results: At both 4 and 24 weeks post-RYGB the following effects were found: arginine-stimulated insulin secretion was reduced. GLP-1, GIP, and glucagon rise during OGTT was enhanced. IGF-1 and GH levels increased. In addition, total HRV and spectral components PLF (power of low frequency) and PHF (power of high frequency) increased. At 4 weeks, morning cortisol was lower than baseline and 24 weeks. At 24 weeks, NEFA levels during OGTT, and the PLF/PHF ratio decreased. None of these changes were seen in the control group.

Conclusions: There were rapid changes within 4 weeks after RYGB: signs of enhanced parasympathetic nerve activity, reduced morning cortisol, and enhanced incretin and glucagon responses to glucose. The findings suggest that neurohormonal mechanisms can contribute to the rapid improvement of insulin resistance and glycemia following RYGB in type 2 diabetes.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
Roux-en-Y gastric bypass, Type 2 diabetes, Incretins, Adipokines, Heart rate variability
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-168897 (URN)10.1007/s12020-020-02203-w (DOI)000514540100009 ()31983031 (PubMedID)
Available from: 2020-03-17 Created: 2020-03-17 Last updated: 2020-03-17Bibliographically approved
Sundström, N., Brorsson, C., Karlsson, M., Wiklund, U. & Koskinen, L.-O. D. (2020). Refeeding syndrome: multimodal monitoring and clinical manifestation of an internal severe neurotrauma. Journal of clinical monitoring and computing
Open this publication in new window or tab >>Refeeding syndrome: multimodal monitoring and clinical manifestation of an internal severe neurotrauma
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2020 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614Article in journal (Refereed) Epub ahead of print
Abstract [en]

Refeeding syndrome (RFS) is a rare, potentially life-threatening, condition seen in malnourished patients starting refeeding. RFS may provoke seizures and acute encephalopathy and can be considered an internal severe neurotrauma in need of specific treatment. The objective was to describe course of disease, treatment and, for the first time, multimodal monitoring output in a comatose patient suffering RFS. After gastric-banding and severe weight loss, the patient initiated self-starving and was transferred to our intensive care unit (ICU) following rapid refeeding. At arrival, seizures, decrease in consciousness (GCS 7) and suspected acute encephalitis was presented. Serum albumin was 8 g/l. Intracranial pressure (ICP), invasive blood pressure and electrocardiography (ECG) were monitored. Pressure reactivity (PRx) and compliance (RAP) were calculated. The patient developed congestive heart failure, anuria and general oedema despite maximal neuro- and general ICU treatment. Global cerebral oedema and hypoperfusion areas with established ischemia were seen. ECG revealed massive cardiac arrhythmia and disturbed autonomic regulation. PRx indicated intact autoregulation (−0.06 ± 0.18, mean ± SD) and relatively normal compliance (RAP = 0.23 ± 0.13). After 15 days the clinical state was improved, and the patient returned to the primary hospital. RFS was associated with serious deviations in homeostasis, high ICP levels, ECG abnormalities, kidney and lung affections. It is of utmost importance to recognize this rare syndrome and to treat appropriately. Despite the severe clinical state, cerebral autoregulation and compensatory reserve were generally normal, questioning the applicability of indirect measurements such as PRx and RAP during neuro-intensive care treatment of RFS patients with cerebral engagement.

Keywords
Cerebral autoregulation, Compensatory reserve, Multimodal monitoring, Neurotrauma, Obesity surgery, Refeeding syndrome
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-170952 (URN)10.1007/s10877-020-00513-y (DOI)000530248600001 ()32363496 (PubMedID)2-s2.0-85084220416 (Scopus ID)
Available from: 2020-05-19 Created: 2020-05-19 Last updated: 2020-05-19
Kleyko, D., Osipov, E. & Wiklund, U. (2019). A Hyperdimensional Computing Framework for Analysis of Cardiorespiratory Synchronization During Paced Deep Breathing. IEEE Access, 7, 34403-34415
Open this publication in new window or tab >>A Hyperdimensional Computing Framework for Analysis of Cardiorespiratory Synchronization During Paced Deep Breathing
2019 (English)In: IEEE Access, E-ISSN 2169-3536, Vol. 7, p. 34403-34415Article in journal (Refereed) Published
Abstract [en]

Autonomic function during deep breathing (DB) is normally scored based on the assumption that the heart rate is synchronized with the breathing. We have observed individuals with subtle arrhythmias during DB, where an autonomic function cannot be evaluated. This paper presents a novel method for analyzing cardiorespiratory synchronization: feature-based analysis of the similarity between heart rate and respiration using the principles of hyperdimensional computing. Heart rate and respiration signals were modeled using Fourier series analysis. Three feature variables were derived and mapped to binary vectors in a high-dimensional space. Using both synthesized data and recordings from patients/healthy subjects, the similarity between the feature vectors was assessed using Hamming distance (high-dimensional space), Euclidean distance (original space), and with a coherence-based index. Methods were evaluated via the classification of the similarity indices into three groups. The distance-based methods achieved good separation of signals into classes with different degrees of cardiorespiratory synchronization, also providing identification of patients with low cardiorespiratory synchronization but high values of conventional DB scores. Moreover, binary high-dimensional vectors allowed an additional analysis of the obtained Hamming distance. Feature-based similarity analysis using hyperdimensional computing is capable of identifying signals with low cardiorespiratory synchronization during DB due to arrhythmias. Vector-based similarity analysis could be applied to other types of feature variables than based on spectral analysis. The proposed methods for robustly assessing cardiorespiratory synchronization during DB facilitate the identification of individuals where the evaluation of the autonomic function is problematic or even impossible, thus increasing the correctness of the conventional DB scores.

Place, publisher, year, edition, pages
Institute of Electrical and Electronics Engineers (IEEE), 2019
Keywords
Deep breathing test, deep breathing index, similarity analysis, heart rate variability, hyperdimensional computing
National Category
Computer Systems
Identifiers
urn:nbn:se:umu:diva-158768 (URN)10.1109/ACCESS.2019.2904311 (DOI)000463487400001 ()
Available from: 2019-05-08 Created: 2019-05-08 Last updated: 2019-05-08Bibliographically approved
Boles, U., Wiklund, U., David, S., Ahmed, K. & Henein, M. Y. (2019). Coronary artery ectasia carries a worse prognosis: a long-term follow-up study [Letter to the editor]. Polish Archives of Internal Medicine, 129(11), 833-835
Open this publication in new window or tab >>Coronary artery ectasia carries a worse prognosis: a long-term follow-up study
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2019 (English)In: Polish Archives of Internal Medicine, ISSN 0032-3772, E-ISSN 1897-9483, Vol. 129, no 11, p. 833-835Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Medycyna Praktyczna, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-163322 (URN)10.20452/pamw.14959 (DOI)000499691500017 ()31469119 (PubMedID)2-s2.0-85075814112 (Scopus ID)
Available from: 2019-09-16 Created: 2019-09-16 Last updated: 2020-05-11Bibliographically approved
Kleyko, D., Osipov, E., De Silva, D., Wiklund, U., Vyatkin, V. & Alahakoon, D. (2019). Distributed representation of n-gram statistics for boosting self-organizing maps with hyperdimensional computing. In: Nikolaj Bjørner, Irina Virbitskaite, Andrei Voronkov (Ed.), Perspectives of system informatics: . Paper presented at 12th International Andrei P. Ershov Informatics Conference, PSI 2019, Novosibirsk, Russia, July 2–5, 2019 (pp. 64-79). Cham: Springer
Open this publication in new window or tab >>Distributed representation of n-gram statistics for boosting self-organizing maps with hyperdimensional computing
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2019 (English)In: Perspectives of system informatics / [ed] Nikolaj Bjørner, Irina Virbitskaite, Andrei Voronkov, Cham: Springer, 2019, p. 64-79Conference paper, Published paper (Refereed)
Abstract [en]

This paper presents an approach for substantial reduction of the training and operating phases of Self-Organizing Maps in tasks of 2-D projection of multi-dimensional symbolic data for natural language processing such as language classification, topic extraction, and ontology development. The conventional approach for this type of problem is to use n-gram statistics as a fixed size representation for input of Self-Organizing Maps. The performance bottleneck with n-gram statistics is that the size of representation and as a result the computation time of Self-Organizing Maps grows exponentially with the size of n-grams. The presented approach is based on distributed representations of structured data using principles of hyperdimensional computing. The experiments performed on the European languages recognition task demonstrate that Self-Organizing Maps trained with distributed representations require less computations than the conventional n-gram statistics while well preserving the overall performance of Self-Organizing Maps.

Place, publisher, year, edition, pages
Cham: Springer, 2019
Series
Lecture Notes in Computer Science, ISSN 0302-9743, E-ISSN 1611-3349 ; 11964
Keywords
Self-organizing maps, n-gram statistics, Hyperdimensional computing, Symbol strings
National Category
Language Technology (Computational Linguistics)
Identifiers
urn:nbn:se:umu:diva-169610 (URN)10.1007/978-3-030-37487-7_6 (DOI)2-s2.0-85077499893 (Scopus ID)978-3-030-37486-0 (ISBN)978-3-030-37487-7 (ISBN)
Conference
12th International Andrei P. Ershov Informatics Conference, PSI 2019, Novosibirsk, Russia, July 2–5, 2019
Available from: 2020-04-09 Created: 2020-04-09 Last updated: 2020-04-09Bibliographically approved
Katsogiannos, P., Kamble, P. G., Hammar, U., Sundbom, M., Wiklund, U., Pereira, M. J. & Eriksson, J. W. (2019). Early effects of RYGB on hormone regulation and autonomic nerve activity in patients with obesity and type 2 diabetes. Paper presented at 55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), SEP 16-20, 2019, Barcelona, SPAIN. Diabetologia, 62, S274-S274
Open this publication in new window or tab >>Early effects of RYGB on hormone regulation and autonomic nerve activity in patients with obesity and type 2 diabetes
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2019 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 62, p. S274-S274Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Springer, 2019
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-164067 (URN)000485303802162 ()
Conference
55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), SEP 16-20, 2019, Barcelona, SPAIN
Note

Supplement: 1 

Special Issue: SI 

Meeting Abstract: 567

Available from: 2019-10-16 Created: 2019-10-16 Last updated: 2019-10-16Bibliographically approved
Katsogiannos, P., Kamble, P. G., Hammar, U., Sundbom, M., Wiklund, U., Pereira, M. J. & Eriksson, J. W. (2019). Early effects of RYGB on hormone regulation and autonomic nerve activity in patients with obesity and type 2 diabetes. Paper presented at 55th Annual Meeting of the European-Association for the Study of Diabetes (EASD), Barcelona, SEP 16-20, 2019. Diabetologia, 62, S274-S274
Open this publication in new window or tab >>Early effects of RYGB on hormone regulation and autonomic nerve activity in patients with obesity and type 2 diabetes
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2019 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 62, p. S274-S274Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Springer, 2019
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-164147 (URN)000485303802162 ()
Conference
55th Annual Meeting of the European-Association for the Study of Diabetes (EASD), Barcelona, SEP 16-20, 2019
Note

Supplement 1, Special Issue. Meeting abstract 567.

Available from: 2019-10-17 Created: 2019-10-17 Last updated: 2019-10-17Bibliographically approved
Almby, K. E., Abrahamsson, N., Lundqvist, M. H., Hammara, U., Thombare, K., Panagiotou, A., . . . Eriksson, J. W. (2019). Effects of GLP-1 on counter-regulatory responses during hypoglycemia after GBP surgery. European Journal of Endocrinology, 181(2), 161-171
Open this publication in new window or tab >>Effects of GLP-1 on counter-regulatory responses during hypoglycemia after GBP surgery
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2019 (English)In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 181, no 2, p. 161-171Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of the study was to explore the role of GLP-1 receptor activation on the counter-regulation and symptoms of hypoglycemia in subjects who have undergone gastric bypass surgery (GBP).

Design: Experimental hyperinsulinemic–hypoglycemic clamp study.

Methods: Twelve post-GBP subjects participated in a randomized cross-over study with two hyperinsulinemic, hypoglycemic clamps (glucose nadir 2.7 mmol/L) performed on separate days with concomitant infusions of the GLP-1 analog exenatide or with saline, respectively. Continuous measurements of metabolites and counter-regulatory hormones as well as assessments of heart rate variability and symptoms of hypoglycemia were performed throughout the clamps.

Results: No effect of GLP-1 receptor activation on counter-regulatory hormones (glucagon, catecholamines, cortisol, GH) or glucose infusion rate was seen, but we found indications of a downregulation of the sympathetic relative to the parasympathetic nerve activity, as reflected in heart rate variability. No significant differences in symptom of hypoglycemia were observed.

Conclusions/interpretation: Short-term exposure to a GLP-1 receptor agonist does not seem to impact the counter-regulatory hormonal and metabolic responses in post-GBP subjects during hypoglycemic conditions, suggesting that the improvement in symptomatic hypoglycemia post-GBP seen following treatment with GLP-1 receptor agonists may be mediated by mechanism not directly involved in counter-regulation.

Place, publisher, year, edition, pages
Bioscientifica, 2019
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-161569 (URN)10.1530/EJE-19-0171 (DOI)000472835100013 ()31176298 (PubMedID)
Funder
Swedish Diabetes Association
Available from: 2019-07-25 Created: 2019-07-25 Last updated: 2019-07-25Bibliographically approved
Projects
State-space approach for analysis of the short-term interactions in systems with circular causality: Assessment of the autonomic control of heart rate and blood pressure variability [2008-03292_VR]; Umeå UniversityRealtime interactive cognitive architecture for prediction of autonomic cardiovascular dysregulation [2015-04677_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1313-0934

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