umu.sePublications
Change search
Refine search result
3456789 251 - 300 of 775
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 251.
    Holgersson, Annelie
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Preparedness for mass-casualty attacks on public transportation2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Public transportation constitutes a vulnerable sector in modern day society with a high probability of generating mass casualties if attacked. By preparing for mass-casualty attacks (MCAs), response can become more effective and public transportation can become a less rewarding target. However, preparedness for attacks, much like response, implies resource constraints, and this dissertation pinpoints some major dilemmas that inhibit achieving preparedness for MCAs on public transportation in Sweden.

    Aim: The aim of this dissertation was to investigate preparedness for mass-casualty attacks on public transportation. This allowed for identification of major challenges for preparedness and response with a particular focus on the Swedish context.

    Methods: Study I included 477 MCAs identified through searches of the Global Terrorism Database, journals, newspapers and websites, which were examined with descriptive statistics. Study II thematically analyzed 105 articles attained by systematic searches of the PubMed and Scopus databases. Study III and IV statistically analyzed data from 864 responses to a purposive-designed questionnaire, from operational personnel of the Swedish emergency organizations. Study V entailed validation of a finite element (FE) simulation model of a bombing in a train carriage compared to the bombings in Madrid 2004.

    Results: International trends of MCAs (≥ 10 fatally injured and/or ≥ 100 non-fatally injured) on public transportation, during the years 1970-2009 (I) showed that the average number of injured increased considerably, despite a quite stable incidence rate since the 1980s. High numbers of injured people were connected to attacks on terminal buildings, multiple targets and complex tactical approaches. Few MCAs occurred in Europe, but the average number of fatalities per incident and injured per incident were the second highest among regions. The literature study (II) of previous on-scene management showed that commonly encountered challenges during unintentional incidents were added to during MCAs, implying specific issues for safety, assessment, triage and treatment, which require collaborative planning and specific training. The study regarding the Swedish emergency organizations’ perceptions of terrorist attacks (III) showed significant differences on perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence in knowledge of tasks to be performed on scene. The police respondents stood out; e.g., fewer police personnel had high estimates of their organizations’ management capability and knowledge of tasks on-scene compared to the other organizations. The study of factors that influence responders’ perceptions of preparedness for terrorism (IV) showed that these were influenced by the responders’ sex, work experience, organizational affiliation, various training arrangements and access to personal protective equipment (PPE). Investing in amenable factors, such as terrorism-related management training and provision of PPE, could improve responders’ perceptions of preparedness for terrorism. A finite-element (FE) model of an explosion in a train carriage (V) was developed and showed that FE modeling techniques could effectively model damage and injuries for explosions with applicability for preparedness and injury mitigation efforts, but, also, there was room for improvement of the model in terms of injuries.

    Conclusion: Achieving preparedness for MCAs on public transportation is a multiple choice balancing act between ostensible dilemmas regarding investments, disaster plans, training, response strategies, collaboration and inventions.

  • 252.
    Holmdahl, Viktor
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Properties of full-thickness skin - Mechanical properties and application of full-thickness skin grafts in parastomal hernia repair2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 253.
    Holmdahl, Viktor
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stark, Birgit
    Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden..
    Clay, Leonard
    Department of Clinical Science and Education, Karolinska Institute, Solna, Sweden..
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft: a randomised controlled trial2019In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 23, no 2, p. 355-361Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Repair of giant incisional hernia often requires complex surgery and the results of conventional methods using synthetic mesh as reinforcement are unsatisfactory, with high recurrence and complication rates. Our hypothesis was that full-thickness skin graft (FTSG) provides an alternative reinforcement material for giant incisional hernia repair and that outcome is improved. The aim of this study was to compare FTSG with conventional materials currently used as reinforcement in the repair of giant incisional hernia.

    METHODS: A prospective randomised controlled trial was conducted, comparing FTSG with synthetic mesh as reinforcement in the repair of giant (> 10 cm minimum width) incisional hernia. One-year follow-up included a blinded clinical examination by a surgeon and objective measurements of abdominal muscle strength using the Biodex-4 system.

    RESULTS: 52 patients were enrolled in the study: 24 received FTSG and 28 synthetic mesh. Four recurrences (7.7%) were found at 1-year follow-up, two in each group. There were no significant differences regarding pain, patient satisfaction or aesthetic outcome between the groups. Strength in the abdominal wall was not generally improved in the study population and there was no significant difference between the groups.

    CONCLUSION: The outcome of repair of giant incisional hernia using FTSG as reinforcement is comparable with repair using synthetic mesh. This suggests that FTSG may have a future place in giant incisional hernia repair.

  • 254.
    Holmgren, Klas
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Haapamäki, Markku M.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Matthiessen, Peter
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rutegård, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Anterior resection for rectal cancer in Sweden: validation of a registry-based method to determine long-term stoma outcome2018In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 57, no 12, p. 1631-1638Article in journal (Refereed)
    Abstract [en]

    Background: A permanent stoma after anterior resection for rectal cancer is common. Nationwide registries provide sufficient power to evaluate factors influencing this phenomenon, but validation is required to ensure the quality of registry-based stoma outcomes.

    Methods: Patients who underwent anterior resection for rectal cancer in the Northern healthcare region of Sweden between 1 January 2007 and 31 December 2013 were reviewed by medical records and followed until 31 December 2014 with regard to stoma outcome. A registry-based method to determine nationwide long-term stoma outcomes, using data from the National Patient Registry and the Swedish Colorectal Cancer Registry, was developed and internally validated using the chart reviewed reference cohort. Accuracy was evaluated with positive and negative predictive values and Kappa values. Following validation, the stoma outcome in all patients treated with an anterior resection for rectal cancer in Sweden during the study period was estimated. Possible regional differences in determined stoma outcomes between the six Swedish healthcare regions were subsequently evaluated with the χ2 test.

    Results: With 312 chart reviewed patients as reference, stoma outcome was accurately predicted through the registry-based method in 299 cases (95.8%), with a positive predictive value of 85.1% (95% CI 75.8%-91.8%), and a negative predictive value of 100.0% (95% CI 98.4%-100.0%), while the Kappa value was 0.89 (95% CI 0.82-0.95). In Sweden, 4768 patients underwent anterior resection during the study period, of which 942 (19.8%) were determined to have a permanent stoma. The stoma rate varied regionally between 17.8-29.2%, to a statistically significant degree (p = .001).

    Conclusion: Using data from two national registries to determine long-term stoma outcome after anterior resection for rectal cancer proved to be reliable in comparison to chart review. Permanent stoma prevalence after such surgery remains at a significant level, while stoma outcomes vary substantially between different healthcare regions in Sweden.

  • 255.
    Holmgren, Klas
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Kverneng Hultberg, Daniel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Haapamäki, Markku M.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Matthiessen, P.
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rutegård, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study2017In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 19, no 12, p. 1067-1075Article in journal (Refereed)
    Abstract [en]

    AIM: Fashioning a defunctioning stoma is common when performing an anterior resection for rectal cancer in order to avoid and mitigate the consequences of an anastomotic leakage. We investigated the permanent stoma prevalence, factors influencing stoma outcome and complication rates following stoma reversal surgery.

    METHOD: Patients who had undergone an anterior resection for rectal cancer between 2007 and 2013 in the northern healthcare region were identified using the Swedish Colorectal Cancer Registry and were followed until the end of 2014 regarding stoma outcome. Data were retrieved by a review of medical records. Multiple logistic regression was used to evaluate predefined risk factors for stoma permanence. Risk factors for non-reversal of a defunctioning stoma were also analysed, using Cox proportional-hazards regression.

    RESULTS: A total of 316 patients who underwent anterior resection were included, of whom 274 (87%) were defunctioned primarily. At the end of the follow-up period 24% had a permanent stoma, and 9% of patients who underwent reversal of a stoma experienced major complications requiring a return to theatre, need for intensive care or mortality. Anastomotic leakage and tumour Stage IV were significant risk factors for stoma permanence. In this series, partial mesorectal excision correlated with a stoma-free outcome. Non-reversal was considerably more prevalent among patients with leakage and Stage IV; Stage III patients at first had a decreased reversal rate, which increased after the initial year of surgery.

    CONCLUSION: Stoma permanence is common after anterior resection, while anastomotic leakage and advanced tumour stage decrease the chances of a stoma-free outcome. Stoma reversal surgery entails a significant risk of major complications.

  • 256.
    Holmgren, Klas
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Kverneng Hultberg, Daniel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Haapamäki, Markku M
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Matthiessen, P
    Rutegård, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Reply to: 'High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population‐based multicentre study'2018In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 20, no 4, p. 342-343Article in journal (Refereed)
  • 257. Holmquist, Per
    et al.
    Dasmah, Amir
    Sennerby, Lars
    Hallman, Mats
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery. Clinic for Oral & Maxillofacial Surgery, Gävle Hospital, Gävle, Sweden.
    A new technique for reconstruction of the atrophied narrow alveolar crest in the maxilla using morselized impacted bone allograft and later placement of dental implants2008In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 10, no 2, p. 86-92Article in journal (Refereed)
    Abstract [en]

    Background: In cases when the alveolar crest is too narrow to host an implant, lateral augmentation is required. The use of autogenous bone blocks harvested from the iliac crest is often demanded. One disadvantage is the associated patient morbidity.

    Purpose: The purpose of this study was to clinically and histologically evaluate the use of morselized impacted bone allograft, a novel technique for reconstruction of the narrow alveolar crest.

    Materials and methods: Two patients with completely edentulous maxillae and one partially edentulous, with a mean age of 77 years (range 76-79 years) were included in the study. The alveolar crest width was < 3 mm without possibility to place any implant. Bone grafts were taken from a bone bank in Gavle Hospital. Bone from the neck of femur heads was milled to produce bone chips. The milled bone was partially defatted by rinsing in 37 degrees C saline solution. After compression of the graft pieces with a size of 15 mm (height), 30 mm (length), and 6 mm (width), they were then fit to adapt to the buccal surface of the atrophied alveolar crest. One piece was placed to the right and one to the left side of the midline. On both sides fibrin glue was used (Tisseel (R), Baxter AG, Vienna, Austria) to stabilize the graft. After 6 months of graft healing, dental implants were placed, simultaneously biopsies were harvested and in one patient two oxidized microimplants were placed. At the time of abutment connection, microimplants were retrieved with surrounding bone for histology. Fixed screw-retained bridges were fabricated in mean of 7 months after implant surgery. Radiographs were taken before and after implant surgery and after 1 year of loading.

    Results: Sixteen implants with an oxidized surface were placed (TiUnite (R), Nobel Biocare AB, Goteborg, Sweden). After 1 year of functional loading, all implants were clinically stable. The marginal bone loss was 1.4 mm (SD 0.3) after 1 year of loading. The histological examination showed resorption and subsequent bone formation on the allograft particles. There were no signs of inflammatory cell infiltration in conjunction with the allograft. The two microimplants showed bone formation directly on the implant surface.

    Conclusions: This study shows that morselized impacted bone allograft can be used to increase the width of the atrophied narrow alveolar crest as a good alternative to autogenous bone grafts in elderly patients. The histological examination of biopsies revealed a normal incorporation process and no signs of an immunological reaction. Further studies with larger samples are of important to be able to conclude if equal results can be obtained using morselized impacted bone allograft as for autogenous bone graft.

  • 258.
    Holsti, Mari
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Vascular remodelling and circulating basement membrane fragments in abdominal aortic aneurysm2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    An abdominal aortic aneurysm (AAA) is a degenerative disease, characterized by advanced inflammation and extracellular matrix (ECM) remodelling. Enhanced protease activity mediated by cytokines results in the degradation of ECM proteins, leading to the generation of different bioactive fragments. Some of these generated fragments are released from the vascular basement membrane (VBM), a highly specialized ECM. VBM provides mechanical and structural stability and regulates many important cellular functions of the vascular system. Type IV and XVIII collagens are two structural proteins in VBM, with crucial roles in maintaining of the VBM integrity and vascular architecture. Circulating levels of type IV and XVIII collagen fragments are found physiologically, but have also been associated with many diseases. Remodelling of VBM and expression of its components has not been as well studied in AAA as that of the interstitial ECM.

    Here we investigate these VBM collagens, their expression and possible association with aortic diameter and expansion rate in individuals with an AAA in comparison with different control groups. Further we study whether there is a link between the circulating VBM collagen fragments and several inflammatory markers, all highly involved in AAA pathogenesis. Lastly, we study the impact of surgical intervention on plasma levels of VBM collagens in patients treated by either open surgical repair (OSR) or endovascular aortic aneurysm repair (EVAR).

    Methods: Circulating levels of type IV and XVIII collagen fragments were analysed in individuals with an AAA and compared with healthy controls and patients with peripheral artery disease (paper I). A possible association between VBM collagen fragments and the aortic diameter and expansion was studied in a large population-based cohort of 615 men stratified into three aortic diameter groups based on initial maximum aortic diameter (paper II). Furthermore, 159 individuals were followed up over time with repeated measurements of aortic diameter and blood samples. The follow up cohort were divided into two subgroups based on expansion rate of AAA. Moreover, the location of VBM collagens in tissue from aortic wall in individuals with an AAA was characterized and the expression pattern was compared with normal aorta (paper II). In paper III, the association between the plasma levels of VBM collagens and inflammatory markers; IL-1 (IL-1α and IL-1β), IL-6, IL-8, TNF-α INF-γ and hs-CRP were studied in same cohort as paper II. Finally, the effect of surgical intervention on circulating levels of VBM collagen fragments was investigated in AAA patients who had undegone either OSR or EVAR by comparison of plasma levels before and after AAA repair.

    Ultrasound technique was used for measurements of aortic diameter (paper I, II, III and IV). Analysis of circulating VBM collagens and inflammatory markers were performed by ELISA-assay (Paper I, II, III and IV) and Multiplex-assays, respectively (paper III). Aortic wall tissues were analysed by haematoxylin and eosin (H&E) and immunofluorescence staining (Paper II).

    Results: There were significantly increased plasma levels of VBM collagen fragments in individuals with an AAA, compared with healthy controls and individulas with a peripheral artery disease (PAD), (Paper I). The levels of type IV collagen in AAA patients did not differ from the group with PAD, and there were no significant differences between the control groups regarding plasma levels of both VBM collagen fragments (Paper I). The increased levels of VBM collagen fragments were significantly associated with aortic diameter with highest levels in the group with an AAA (Paper II). Altered expression of the VBM collagens and fragmentation of elastic fibres were observed in tissue from AAA patients (Paper II). A significant association between the levels of pro-inflammatory cytokines IL-6 and IL-8, and VBM collagens was found. Additionally, there were a significant association between the plasma levels of IL-8, TNF-α and hs-CRP and an AAA (Paper III). Aneurysms with faster expansion rate had significantly higher levels of IL-6, IL-1β, and type XVIII/endostatin collagen. Additionally, IL-6, type XVIII/endostatin collagen and baseline-aortic diameter were significantly associated with expansion rate (Paper III). AAA repair was associated with changes in plasma levels of VBM collagens (Paper IV).

    Conclusion: Circulating levels of VBM collagens were increased in patients with an AAA, and significantly associated with aortic diameter and expansion rate. The expression of VBM collagens was altered in AAA tissue compared with normal aorta. In addition, plasma levels of several inflammatory markers were associated as with VBM collagens, aortic diameter and expansion rate. The levels of both VBM collagens were altered at short and long time after AAA repair. 

  • 259.
    Holsti, Mari
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wanhainen, Anders
    Lundin, Christina
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björck, Martin
    Tegler, Gustaf
    Svensson, Johan
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Circulating Vascular Basement Membrane Fragments are Associated with the Diameter of the Abdominal Aorta and Their Expression Pattern is Altered in AAA Tissue2018In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 56, no 1, p. 110-118Article in journal (Refereed)
    Abstract [en]

    Objective: Abdominal aortic aneurysm (AAA) is characterised by enhanced proteolytic activity, and extracellular matrix (ECM) remodelling in the vascular wall. Type IV and XVIII collagen/endostatin are structural proteins in vascular basement membrane (VBM), a specialised ECM structure. Here the association between plasma levels of these collagens with the aortic diameter and expansion rate is studied, and their expression in aortic tissue characterised. Methods: This was a retrospective population based cohort study. Type IV and XVIII collagen/endostatin were analysed in plasma by ELISA assay in 615 men, divided into three groups based on the aortic diameter: 1) normal aorta <= 25 mm, 2) sub-aneurysmal aorta (SAA) 26-29 mm, and 3) AAA >= 30 mm. Follow up data were available for 159 men. The association between collagen levels and aortic diameter at baseline, and with the expansion rate at follow up were analysed in ordinal logistic regression and linear regression models, controlling for common confounding factors. Tissue expression of the collagens was analysed in normal aorta (n = 6) and AAA (n = 6) by immunofluorescence. Results: Plasma levels of type XVIII collagen/endostatin (136 ng/mL [SD 29] in individuals with a normal aorta diameter, 154 ng/ml [SD 45] in SAA, and 162 ng/ml [SD 46] in AAA; p = .001) and type IV collagen (105 ng/mL [SD 42] normal aorta, 124 ng/ml [SD 46] SAA, and 127 ng/ml [SD 47] AAA; p = .037) were associated with a larger aortic diameter. A significant association was found between the baseline levels of type XVIII/endostatin and the aortic expansion rate (p = .035), but in the multivariable model, only the initial aortic diameter remained significantly associated with expansion (p = .005). Altered expression patterns of both collagens were observed in AAA tissue. Conclusion: Plasma levels of circulating type IV and XVIII collagen/endostatin increase with AAA diameter. The expression pattern of VBM proteins is altered in the aneurysm wall.

  • 260.
    Holsti, Mari
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wanhainen, Anders
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala Universitet.
    Lundin, Christina
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Mani, Kevin
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala Universitet.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Svensson, Johan
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Effect of aortic aneurysm treatment on circulating levels of vascular basement membrane fragments: a pilot studyManuscript (preprint) (Other academic)
  • 261.
    Holsti, Mari
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wanhainen, Anders
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala Universitet.
    Lundin, Christina
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Svensson, Johan
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Björck, Martin
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala Universitet.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Association of inflammatory cytokines to vascular wall remodelling and the aortic diameterManuscript (preprint) (Other academic)
  • 262. Honda, Kazufumi
    et al.
    Katzke, Verena A.
    Hüsing, Anika
    Okaya, Shinobu
    Shoji, Hirokazu
    Onidani, Kaoru
    Olsen, Anja
    Tjønneland, Anne
    Overvad, Kim
    Weiderpass, Elisabete
    Vineis, Paolo
    Muller, David
    Tsilidis, Kostas
    Palli, Domenico
    Pala, Valeria
    Tumino, Rosario
    Naccarati, Alessio
    Panico, Salvatore
    Aleksandrova, Krasimira
    Boeing, Heiner
    Bueno-de-Mesquita, H. Bas
    Peeters, Petra H.
    Trichopoulou, Antonia
    Lagiou, Pagona
    Khaw, Kay-Tee
    Wareham, Nick
    Travis, Ruth C.
    Merino, Susana
    Duell, Eric J.
    Rodríguez-Barranco, Miguel
    Chirlaque, María Dolores
    Barricarte, Aurelio
    Rebours, Vinciane
    Boutron-Ruault, Marie-Chiristine
    Romana Mancini, Francesca
    Brennan, Paul
    Scelo, Ghislaine
    Manjer, Jonas
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Öhlund, Daniel
    Canzian, Federico
    Kaaks, Rudolf
    CA19-9 and apolipoprotein-A2 isoforms as detection markers for pancreatic cancer: a prospective evaluation2019In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 144, no 8, p. 1877-1887Article in journal (Refereed)
    Abstract [en]

    Recently, we identified unique processing patterns of apolipoprotein A2 (ApoA2) in patients with pancreatic cancer. Our study provides a first prospective evaluation of an ApoA2 isoform ("ApoA2-ATQ/AT"), alone and in combination with carbohydrate antigen 19-9 (CA19-9), as an early detection biomarker for pancreatic cancer. We performed ELISA measurements of CA19-9 and ApoA2-ATQ/AT in 156 patients with pancreatic cancer and 217 matched controls within the European EPIC cohort, using plasma samples collected up to 60 months prior to diagnosis. The detection discrimination statistics were calculated for risk scores by strata of lag-time. For CA19-9, in univariate marker analyses, C-statistics to distinguish future pancreatic cancer patients from cancer-free individuals were 0.80 for plasma taken ≤6 months before diagnosis, and 0.71 for >6-18 months; for ApoA2-ATQ/AT, C-statistics were 0.62, and 0.65, respectively. Joint models based on ApoA2-ATQ/AT plus CA19-9 significantly improved discrimination within >6-18 months (C = 0.74 vs. 0.71 for CA19-9 alone, p = 0.022) and ≤ 18 months (C = 0.75 vs. 0.74, p = 0.022). At 98% specificity, and for lag times of ≤6, >6-18 or ≤ 18 months, sensitivities were 57%, 36% and 43% for CA19-9 combined with ApoA2-ATQ/AT, respectively, vs. 50%, 29% and 36% for CA19-9 alone. Compared to CA19-9 alone, the combination of CA19-9 and ApoA2-ATQ/AT may improve detection of pancreatic cancer up to 18 months prior to diagnosis under usual care, and may provide a useful first measure for pancreatic cancer detection prior to imaging.

  • 263. Hovelius, Lennart
    et al.
    Olofsson, Anders
    Department of Orthopedics, Gävle Hospital.
    Sandström, Björn
    Department of Orthopedics, Gävle Hospital.
    Augustini, Bengt-Göran
    Läkargruppen AB, Örebro.
    Krantz, Lars
    Orthopedic Department, Högalidssjukhuset, Eksjö.
    Fredin, Hans
    Läkargruppen St Petri, Malmö.
    Tillander, Bo
    Department of Orthopedics, University Hospital, Linköping.
    Skoglund, Ulf
    Department of Orthopedics, Karlstad Hospital.
    Salomonsson, Björn
    Department of Orthopedics, Danderyd Hospital.
    Nowak, Jan
    Department of Orthopedics, Samariterhemmet, Uppsala.
    Sennerby, Ulf
    Department of Orthopedics, Nordfjord Hospital, Norway .
    Non-operative treatment of primary anterior shoulder dislocation in patients forty years of age and younger: a prospective twenty-five-year follow-up2008In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 90, no 5, p. 945-952Article in journal (Refereed)
    Abstract [en]

    Background: During 1978 and 1979, we initiated a prospective multicenter study to evaluate the results of nonoperative treatment of primary anterior shoulder dislocation. In the current report, we present the outcome after twenty-five years.

    Methods: Two hundred and fifty-five patients (257 shoulders) with an age of twelve to forty years who had a primary anterior shoulder dislocation were managed with immobilization (achieved by tying the arm to the torso with use of a bandage) or without immobilization. All 227 living patients (229 shoulders) completed the follow-up questionnaire, and 214 patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

    Results: Ninety-nine (43%) of 229 shoulders had not redislocated, and seventeen (7%) redislocated once. Thirty-three recurrent dislocations had become stable over time (14.4%), and eighteen were considered to be still recurrent (7.9%). Sixty-two shoulders (27%) had undergone surgery for the treatment of recurrent instability. Immobilization after the primary dislocation did not change the prognosis. Only two of twenty-four shoulders with a fracture of the greater tuberosity at the time of the primary dislocation redislocated (p < 0.001). When shoulders with a fracture of the greater tuberosity were excluded, forty-four (38%) of 115 shoulders in patients who had been twelve to twenty-five years of age at the time of the original dislocation and sixteen (18%) of ninety shoulders in patients who had been twenty-six to forty years of age had undergone surgical stabilization. At twenty-five years, fourteen (23%) of sixty-two shoulders that had undergone surgical stabilization were in patients who subsequently had a contralateral dislocation, compared with seven (7%) of ninety-nine shoulders in patients in whom the index dislocation had been classified as solitary (p = 0.01). Gender and athletic activity did not appear to affect the redislocation rate; however, women had worse DASH scores than men did (p = 0.006).

    Conclusions: After twenty-five years, half of the primary anterior shoulder dislocations that had been treated nonoperatively in patients with an age of twelve to twenty-five years had not recurred or had become stable over time.

    Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

  • 264.
    Hovelius, Lennart
    et al.
    Orthopedic Department, Gävle Hospital, Gävle, Sweden.
    Saeboe, Modolv
    Radiologic Department, Bollnäs Hospital, Bollnäs.
    Neer Award 2008: Arthropathy after primary anterior shoulder dislocation: 223 shoulders prospectively followed up for twenty-five years2009In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 18, no 3, p. 339-347Article in journal (Refereed)
  • 265.
    Hovelius, Lennart
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sandström, Björn
    Olofsson, Anders
    Svensson, Olle
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Rahme, Hans
    The effect of capsular repair, bone block healing, and position on the results of the Bristow-Laterjet procedure (study III): long-term follow-up in 319 shoulders2012In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 21, no 5, p. 647-660Article in journal (Refereed)
    Abstract [en]

    Background We evaluated the results of the May modification of the Bristow-Latarjet procedure (“coracoid in standing position”) in 319 shoulders with respect to (1) coracoid healing and position and (2) surgical treatment of the joint capsule.

    Methods From 1980 until 2004, all shoulders with a Bristow-Latarjet repair were registered at our hospital. This study consists of 3 different cohorts with respect to follow-up. Series 1, 118 shoulders operated on during 1980 through 1985, had 15 years’ radiographic and clinical follow-up. Series 2, 167 shoulders that had surgery during 1986 through 1999, underwent retrospective follow-up by a questionnaire and scores—Western Ontario Shoulder Instability Index; Disabilities of the Arm, Shoulder and Hand; and Subjective Shoulder Value—after 10 to 23 years. Series 3, 34 shoulders treated during 2000 through 2004, with an added modified Bankart repair (“capsulopexy”) in 33 shoulders, were prospectively followed up for 5 to 8 years with the same questionnaire and scores as series 2.

    Results Of 319 shoulders, 16 (5%) had 1 or more redislocations and 3 of these (1%) had revision surgery because of remaining instability. One or more subluxations were reported in 41 shoulders (13%). The worst scores were found in 16 shoulders with 2 or more subluxations (P < .001). Radiographs showed bony healing in 246 of 297 shoulders (83%), fibrous union in 34 (13%), migration by 0.5 cm or more in 14 (5%), and no visualization in 3 (1%). Five of six shoulders that had the transplant positioned 1 cm or more medial to the glenoid rim had redislocations (83%, P = .001). Shoulders with migrated transplants did not differ from those with bony or fibrous healing with respect to redislocations and subluxations. When just a horizontal capsular shift was added to the transfer, the recurrence rate (redislocations or subluxations) decreased, with 2 of 53 (4%)compared with 37 of 208 (18%) with just anatomic closure of the capsule (P = .005), and the Western Ontario Shoulder Instability Index score improved (92 vs 85.6, P = .048). In total, for 307 of 319 shoulders (96%), patients were satisfied or very satisfied at final follow-up.

    Conclusion The open Bristow-Latarjet procedure yields good and consistent results, with bony fusion of the coracoid in 83%. A position of the coracoid 1 cm or more medial to the rim meant significantly more recurrences. The rate of recurrences decreased and subjective results improved when a horizontal capsular shift was added to the coracoid transfer.

  • 266. Hultman, Bo
    et al.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Nygren, Peter
    Sundbom, Magnus
    Glimelius, Bengt
    Mahteme, Haile
    Prognostic factors in patients with loco-regionally advanced gastric cancer2017In: World Journal of Surgical Oncology, ISSN 1477-7819, E-ISSN 1477-7819, Vol. 15, article id 172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to investigate epidemiologic and prognostic factors relevant to the treatment of loco-regionally advanced gastric cancer (GC).

    METHODS: Two hundred and fifty-five patients with GC were identified in Uppsala County between 2000 and 2009. Patient records were analyzed for loco-regionally advanced GC defined as tumor with peritoneal involvement, excluding serosal invasion from the primary tumor only, at primary diagnosis or during follow-up. The presence or not of distant metastasis (DM), including hematogenous metastases (e.g., liver, lung, and bone) and/or distant lymph node metastases, was also analyzed. The Cox proportional hazard model was used for multivariate analysis of factors influencing survival.

    RESULTS: One hundred and twenty patients (47% of all patients with GC; median age 70.5 years) had loco-regionally advanced disease, corresponding to an incidence of 3.8 per 100,000 person-years. Forty-one percent of these also had DM. Median overall survival (mOS) from the time of the diagnosis of loco-regionally advanced disease was 4.8 months for the total patient cohort, 5.1 months for the subgroup of patients without DM, and 4.7 months for the subgroup with DM. There was no significant difference in mOS between the subgroups with synchronous versus metachronous loco-regionally advanced GC: 4.8 months (range 0.0-67.4) versus 4.7 months (range 0.0-28.3). Using multivariate Cox analysis, positive prognostic factors for survival were good performance status at diagnosis and treatment with palliative chemotherapy and/or radiotherapy. Synchronous DM was a negative prognostic factor. The mOS did not differ when comparing the time period 2000-2004 (5.1 months, range 0-67.4) with the period 2005-2009 (4.0 months, range 0.0-28.3).

    CONCLUSION: Peritoneal involvement occurred in almost half of the patients with GC in this study and was associated with short life expectancy. New treatment strategies are warranted.

  • 267. Huotarinen, Antti
    et al.
    Kivisaari, Riku
    Hariz, Marwan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Unit of Functional Neurosurgery, University College London – Institute of Neurology, London, United Kingdom.
    Laitinen's Subgenual Cingulotomy: Anatomical Location and Case Report2018In: Stereotactic and Functional Neurosurgery, ISSN 1011-6125, E-ISSN 1423-0372, Vol. 96, no 5, p. 342-346Article in journal (Refereed)
    Abstract [en]

    Background: The widespread use of deep brain stimulation (DBS) for movement disorders has renewed the interest in DBS for psychiatric disorders. Lauri Laitinen was a pioneer of stereotactic psychosurgery in the 1950s to 1970s, especially by introducing the subgenual cingulotomy. Our aim here was to verify the anatomical target used by Laitinen, to report on a patient who underwent this procedure, and to review the literature. Materials and Methods: The records of Helsinki University Hospital were searched for psychosurgical cases performed between 1970 and 1974. Alive consenting patients were interviewed and underwent a brain MRI. Results: We found 1 patient alive who underwent subgenual cingulotomy in 1971 for obsessive thoughts, anxiety, and compulsions, diagnosed at that time as "schizophrenia psychoneurotica." MRI showed bilateral subgenual cingulotomy lesions (254 and 160 mm(3), respectively). The coordinates of the center of the lesions in relation to the midcommissural point for the right and left, respectively, were: 7.1 and 7.9 mm lateral; 0.2 mm inferior and 1.4 mm superior, and 33.0 and 33.9 anterior, confirming correct subgenual targeting. The patient reported retrospective satisfactory results. Conclusions: The lesion in this patient was found to be in the expected location, which gives some verification of the correct placement of Laitinen's subgenus cingulotomy target.

  • 268.
    Hurtig, Jennie
    et al.
    Sunderby sjukhus - Allmänkirurgi Luleå, Sweden Sunderby sjukhus - Allmänkirurgi Lulea, Sweden..
    Gkekas, Ioannis
    Sunderby sjukhus - Allmänkirurgi Luleå, Sweden Sunderby sjukhus - Allmänkirurgi Lulea, Sweden..
    Näsvall, Pia
    Sunderby sjukhus - Allmänkirurgi Luleå, Sweden Sunderby sjukhus - Allmänkirurgi Lulea, Sweden..
    Vandrande mjälte – ovanlig men viktig differentialdiagnos vid akut buksmärta hos barn2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, no 47, article id FA9ZArticle in journal (Other academic)
    Abstract [en]

    Wandering spleen is a rare reason for acute abdominal pain in pediatric patients caused by laxity of the splenic ligaments. It can be complicated by torsion of the pedicle, leading to ischemia, a situation that in most cases results in acute abdominal surgery. To prevent ischemia of a mobile spleen caused by a total occlusion of the pedicle, splenopexy can be considered. We present an unusual case where changes in the position of the operating table during diagnostic laparoscopy might have caused a total occlusion of the pedicle.

  • 269.
    Husberg, Britt
    et al.
    Karolinska University Hospital Huddinge, Department of Surgical Gastroenterology, Stockholm, Sweden.
    Malmborg, P
    Karolinska University Hospital Huddinge, Department of Surgical Gastroenterology, Stockholm, Sweden.
    Strigård, Karin
    Karolinska University Hospital Huddinge, Department of Surgical Gastroenterology, Stockholm, Sweden.
    Treatment with botulinum toxin in children with chronic anal fissure.2009In: European journal of pediatric surgery, ISSN 0939-7248, E-ISSN 1439-359X, Vol. 19, no 5, p. 290-292Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Chronic anal fissures with painful defecation and bloodstained stools can be seen in children of all ages. Constipation may precede or appear in connection with the symptoms. Adult patients with anal fissures have been treated successfully with the injection of botulinum toxin into both the internal and external sphincter. The effect of botulinum toxin is reversible and lasts for 3-4 months. This pilot study attempted to examine whether botulinum toxin is also effective in paediatric cases of anal fissure, a treatment which not yet has been reported in the literature.

    MATERIAL AND METHODS: Six boys and seven girls aged 1-10 years were treated with botulinum toxin (Botox ((R))) during 2002-2005 due to chronic anal fissure. Conventional treatment with laxatives and local anaesthetics had been unsuccessful in all cases. The treatment was given to five children under 2 years of age in a dosage of 1.25 Ux2. Eight children over 2 years of age were given 2.5 Ux2. The injections were given in the external sphincter on both sides of the fissure using EMG-stimulation for guidance and were performed under light anaesthetics (Diprivan ((R))). Follow-up was conducted at 1 and 3 months after treatment.

    RESULTS: Within one week, 11 of the children were free from pain and blood stained stools, according to their parent's observations. One 10-year old patient initially showed some improvement but soon experienced a recurrence. After another injection with a higher dosage 2 months later, the fissure healed. One 4-year old patient did not show any signs of improvement. The laxatives, which had been withdrawn after the injection treatment, were then reinstated. At the 3 month post-treatment examination the patient was finally symptom-free with no signs of a fissure. There were no negative side-effects detected in any of the cases. Seven recurrences were noted in 6 of the patients after 3-30 months, often in connection with an episode of constipation. Repeat injections were offered and accepted by four of these patients, once more producing good immediate results.

    CONCLUSION: Treatment with botulinum toxin in the external sphincter produces a quick and effective alleviation of pain with healing of chronic anal fissures in children. The treatment is not considered to carry any risks but requires light anaesthesia. Recurrences are common after the pharmacological effect has receded but can be cured with an additional injection.

  • 270. Hyam, Jonathan A
    et al.
    Akram, Harith
    Foltynie, Thomas
    Limousin, Patricia
    Hariz, Marwan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom.
    Zrinzo, Ludvic
    What You See Is What You Get: Lead Location Within Deep Brain Structures Is Accurately Depicted by Stereotactic Magnetic Resonance Imaging2015In: Operative Neurosurgery, ISSN 2332-4252, Vol. 11, no 3, p. 412-419Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Magnetic resonance imaging (MRI)-verified deep brain stimulation relies on the correct interpretation of stereotactic imaging documenting lead location in relation to visible anatomic target. However, it has been suggested that local signal distortion from the lead itself renders its depiction on MRI unreliable. OBJECTIVE: To compare lead location on stereotactic MRI with subsequent location of its brain track after removal. METHODS: Patients underwent deep brain stimulation with the use of MRI-guided and MRI-verified Leksell frame approach. Infection or suboptimal efficacy required lead removal and subsequent reimplantation by using the same technique. Postimplantation stereotactic MR images were analyzed. Lateral (x) and anteroposterior (y) distances from midcommissural point to center of the lead hypointensity were recorded at the anterior commissure-posterior commissure plane (pallidal electrode) or z = 24 (subthalamic electrode). Stereotactic MRI before the second procedure, x and y distances from the center of the visible lead track hypointensity to midcommissural point were independently recorded. Vectorial distance from center of the lead hypointensity to the center of its track was calculated. RESULTS: Sixteen electrode tracks were studied in 10 patients. Mean differences between lead artifact location and lead track location were: x coordinate 0.4 mm +/- 0.2; y coordinate 0.6 mm +/- 0.3. Mean vectorial distance was 0.7 mm +/- 0.2. CONCLUSION: Stereotactic distance between lead location and subsequent brain track location on MRI was small. The mean discrepancy was approximately half the deep brain stimulation lead width. This suggests that lead hypointensity seen on postimplantation MRI is indeed an accurate representation of its real location within deep brain structures.

  • 271. Hägg, Shadi Amid
    et al.
    Emilsson, Össur I.
    Franklin, Karl A.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Janson, Christer
    Lindberg, Eva
    Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women2019In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 53, p. 94-100Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Daytime sleepiness is common in women and has negative health effects. Nocturnal gastroesophageal reflux (nGER) and snoring are risk factors for daytime sleepiness, but the effect of their interaction remains unknown. The aim of this study was to examine how nGER and snoring combined affected daytime sleepiness and involuntary falling asleep in women.

    METHODS: A questionnaire was sent to randomly selected women in 2000 and 2010. Participants who answered questions regarding both nGER and snoring in both questionnaires were included (N = 4882). Daytime sleepiness was defined as severe or very severe problems with daytime sleepiness. Involuntary falling asleep was defined as sometimes, often or very often falling asleep involuntarily during the day. Respondents snoring loudly and disturbingly sometimes, often or very often were defined as snorers. Having nocturnal heartburn or acid reflux sometimes, often or very often was defined as having nGER.

    RESULTS: Daytime sleepiness was reported by 14% of the participants, involuntary falling asleep by 11%. After adjustment for age, smoking, physical activity, caffeine intake and alcohol dependency, increased odd ratios (ORs) for both daytime sleepiness (adjusted OR 4.2, 95% confidence interval (CI): 1.9-9.2) and involuntary falling asleep (adjusted OR 3.1, 95% CI: 1.5-6.4) were seen in women with the combination of nGER and snoring at both baseline and follow-up. The association with daytime sleepiness was also strong for those with only persistent nGER but not for those with only persistent snoring.

    CONCLUSION: Women with nGER were at increased risk of developing daytime sleepiness and snoring augmented this association. In addition, women with both nGER and snoring were also at increased risk of developing involuntary falling asleep.

  • 272.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Malmö University, Malmö.
    Rezvani, M.
    Department of Orofacial Pain and Jaw Function, Malmö University, Malmö.
    List, T.
    Department of Orofacial Pain and Jaw Function, Malmö University, Malmö and Department of Rehabilitation Medicine, Skåne University Hospital, Lund,.
    Prevalence of whiplash trauma in TMD patients: a systematic review2014In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 41, no 1, p. 59-68Article, review/survey (Refereed)
    Abstract [en]

    The purpose of this systematic review was to describe the prevalence of whiplash trauma in patients with temporomandibular disorders (TMDs) and to describe clinical signs and symptoms in comorbid TMD/whiplash compared with TMD localised to the facial region. A systematic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 31 December 2012. The systematic search identified 129 articles. After the initial screening of abstracts, 32 articles were reviewed in full text applying inclusion and exclusion criteria. Six studies on the prevalence of neck trauma in patients with TMD met the inclusion criteria and were included in the review. Two of the authors evaluated the methodological quality of the included studies. The reported prevalence of whiplash trauma ranged from 84% to 70% (median 35%) in TMD populations, compared with 17-13% in the non-TMD control groups. Compared with patients with TMD localised to the facial region, TMD patients with a history of whiplash trauma reported more TMD symptoms, such as limited jaw opening and more TMD pain, and also more headaches and stress symptoms. In conclusion, the prevalence of whiplash trauma is higher in patients with TMD compared with non-TMD controls. Furthermore, patients with comorbid TMD/whiplash present with more jaw pain and more severe jaw dysfunction compared with TMD patients without a history of head-neck trauma. These results suggest that whiplash trauma might be an initiating and/or aggravating factor as well as a comorbid condition for TMD.

  • 273.
    Högström, Gabriel
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Pietilä, Tom
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Body composition and performance: influence of sport and gender among adolescents2012In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 26, no 7, p. 1799-1804Article in journal (Refereed)
    Abstract [en]

    Body composition is well known to be associated with endurance performance amongst adult skiers, however the association among adolescent cross-country and alpine skiers is inadequately explored. The study sample was comprised of 145 male and female adolescent subjects (aged 15-17 years), including 48 cross-country skiers, 33 alpine skiers, and 68 control subjects. Body composition [%body fat, %lean mass, bone mineral density (g/cm2)] was measured with a dual-emission X-ray absorptiometer, and pulse and oxygen uptake were measured at three break points during incremental performance tests to determine physical fitness levels. Female cross-country and alpine skiers were found to have significantly higher %lean mass (mean difference = 7.7%, p < 0.001) and lower %body fat (mean difference = (8.1%, p < 0.001) than female control subjects. Male cross-country skiers were found to have lower %body fat (mean difference = 3.2%, p < 0.05) and higher %lean mass (mean difference = 3.3%, p < 0.01) than male alpine skiers and higher % lean mass (mean difference = 3.7%, p < 0.05) and % body fat (mean difference = 3.2%, p < 0.05) than controls. The present study found strong associations between %lean mass and the OBLA and VO2 max weight adjusted thresholds among both genders of the cross-country skiing cohort (r = 0.47-0.67, p < 0.05) and the female alpine skiing cohort (r = 0.77-0.79, p < 0.001 for all). The present study suggests that body composition is associated with physical performance already in adolescent athletes.

  • 274.
    Högström, Magnus
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
    Vitamins, fatty acids, physical activity and peak bone mass2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Osteoporosis is a disease characterized by low bone mineral density, deteriorated bone microstructure and increased fracture risk. About 50% of all women and 25% of all men will have an osteoporotic fracture. Given that there is no effective cure in established osteoporosis, prevention is of high importance. Bone mineral density (BMD) is accumulated during childhood and adolescence with a peak at about 20 years of age. Peak BMD has been suggested to explain at least half of the variation in BMD up to old age. Thus, to increase peak BMD could decrease the risk of later fractures. The purpose of the present thesis was to investigate the influence of physical activity, vitamins A and D, and fatty acids on peak bone mass in men.

    The influence of physical activity on bone accrual was studied in two cohorts. In the first cohort 46 ice hockey players, 18 badminton players and 27 controls, all 17 years of age at baseline, were followed for four years. During the follow up the badminton players gained more bone mass at the hip compared to both the ice hockey players and controls. In the second cohort the associations between physical activity and BMD were investigated in 62 female and 62 male young medical students. The estimated high impact activity per week was associated with bone mass at all sites in the male medical students (r=0.27-0.53, p<0.05). In the female cohort different estimates of physical activity were not related to bone mass at any site. In both males and females correlations between bone mass and body constitution parameters were observed.

    Levels of vitamin D3, vitamin D2, retinol, retinol-binding-protein-4 (RBP-4) and fatty acids were measured in 78 young men with a mean age of 22.6 years. BMD at various sites were measured using Dual-Energy X-ray absorptiometry. Levels of vitamin D3 showed a significant positive association with all BMD sites and also lean body mass (r=0.23-0.35, p<0.05). Levels of vitamin D2, however, showed a significant negative correlation with BMD of the total body (r=-0.28, p=0.01) and spine (r=-0.27, p=0.02). There was also a significant negative relationship between levels of vitamin D3 and D2 (r=-0.31, p=0.006). Concentrations of n-3 (omega-3) fatty acids showed a positive association with BMD at the total body (r=0.27, p=0.02) and spine BMD (r=0.25, p=0.02). There was also a positive association between levels of n-3 fatty acids and changes in BMD of the spine between 16 and 22 years of age (r=0.26, p=0.02). The significant associations found seemed to be related mostly to the concentration of the n-3 fatty acid docosahexaenoic acid. Levels of retinol and RBP-4 were not related to BMD but to levels of osteocalcin, which is a marker of bone formation. This association disappeared when adjusting for the influence of abdominal fat mass.

    In summary, the present thesis suggests that many modifiable factors may influence the accumulation of peak bone mass in males, such as physical activity, vitamins, and fatty acids. Further studies are needed to investigate whether optimizing these factors in youth may decrease the risk of osteoporosis later in life.

  • 275.
    Iraeus, Johan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. ÅF Industry.
    Stochastic finite element simulations of real life frontal crashes: With emphasis on chest injury mechanisms in near-side oblique loading conditions2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction. Road traffic injuries are the eighth leading cause of death globally and the leading cause of death among young people aged 15-29. Of individuals killed or injured in road traffic injuries, a large group comprises occupants sustaining a thorax injury in frontal crashes. The elderly are particularly at risk, as they are more fragile. The evaluation of the frontal crash performance of new vehicles is normally based on barrier crash tests. Such tests are only representative of a small portion of real-life crashes, but it is not feasible to test vehicles in all real-life conditions. However, the rapid development of computers opens up possibilities for simulating whole populations of real-life crashes using so-called stochastic simulations. This opportunity leads to the aim of this thesis, which is to develop and validate a simplified, parameterized, stochastic vehicle simulation model for the evaluation of passive restraint systems in real-life frontal crashes with regard to rib fracture injuries.

    Methods. The work was divided into five phases. In phase one, the geometry and properties of a finite element (FE) generic vehicle buck model were developed based on data from 14 vehicles. In the second phase, a human FE model was validated for oblique frontal crashes. This human FE model was then used to represent the vehicle occupant. In the third phase, vehicle buck boundary conditions were derived based on real-life crash data from the National Automotive Sampling System (NASS) and crash test data from the Insurance Institute for Highway Safety. In phase four, a validation reference was developed by creating risk curves for rib fracture in NASS real-life crashes. Next, these risk curves were compared to the risk of rib fractures computed using the generic vehicle buck model. In the final phase, injury mechanisms in nearside oblique frontal crashes were evaluated.

    Results. In addition to an averaged geometry, parametric distributions for 27 vehicle and boundary condition parameters were developed as guiding properties for the stochastic model. Particular aspects of the boundary conditions such as pulse shape, pulse angle and pulse severity were analyzed in detail. The human FE model validation showed that the kinematics and rib fracture pattern in frontal oblique crashes were acceptable for this study. The validation of the complete FE generic vehicle buck model showed that the model overestimates the risk of rib fractures. However, if the reported under-prediction of rib fractures (50-70%) in the NASS data is accounted for using statistical simulations, the generic vehicle buck model accurately predicts injury risk for senior (70-year-old) occupants. The chest injury mechanisms in nearside oblique frontal crashes were found to be a combination of (I) belt and airbag loading and (II) the chest impacting the side structure. The debut of the second mechanism was found for pulse angles of about 30 degrees.

    Conclusion. A parameterized FE generic passenger vehicle buck model has been created and validated on a population of real life crashes in terms of rib fracture risk. With the current validation status, this model provides the possibility of developing and evaluating new passive safety systems for fragile senior occupants. Further, an injury mechanism responsible for the increased number of outboard rib fractures seen in small overlap and near-side oblique frontal impacts has been proposed and analyzed.

  • 276.
    Iraeus, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. ÅF Industry, Göteborg, Sweden.
    Lindquist, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Development and validation of a generic finite element vehicle buck model for the analysis of driver rib fractures in real life nearside oblique frontal crashes2016In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 95, p. 42-56Article in journal (Refereed)
    Abstract [en]

    Objective: Frontal crashes still account for approximately half of all fatalities in passenger cars, despite several decades of crash-related research. For serious injuries in this crash mode, several authors have listed the thorax as the most important. Computer simulation provides an effective tool to study crashes and evaluate injury mechanisms, and using stochastic input data, whole populations of crashes can be studied. The aim of this study was to develop a generic buck model and to validate this model on a population of real-life frontal crashes in terms of the risk of rib fracture.

    Method: The study was conducted in four phases. In the first phase, real-life validation data were derived by analyzing NASS/CDS data to find the relationship between injury risk and crash parameters. In addition, available statistical distributions for the parameters were collected. In the second phase, a generic parameterized finite element (FE) model of a vehicle interior was developed based on laser scans from the A2MAC1 database. In the third phase, model parameters that could not be found in the literature were estimated using reverse engineering based on NCAP tests. Finally, in the fourth phase, the stochastic FE model was used to simulate a population of real-life crashes, and the result was compared to the validation data from phase one.

    Results: The stochastic FE simulation model overestimates the risk of rib fracture, more for young occupants and less for senior occupants. However, if the effect of underestimation of rib fractures in the NASS/CDS material is accounted for using statistical simulations, the risk of rib fracture based on the stochastic FE model matches the risk based on the NASS/CDS data for senior occupants.

    Conclusion: The current version of the stochastic model can be used to evaluate new safety measures using a population of frontal crashes for senior occupants.

  • 277.
    Iraeus, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. ÅF Industry, Gothenburg, Sweden.
    Lindquist, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Influence of Vehicle Kinematic Components on Chest Injury in Frontal-Offset Impacts2014In: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 15, no Supplement 1, p. S88-S95Article in journal (Refereed)
    Abstract [en]

    Objective: Frontal crashes in which the vehicle has poor structural engagement, such as small-overlap and oblique crashes, account for a large number of fatalities. These crash modes are characterized by large intrusion and vehicle yaw rotation. Results from previous studies have shown mixed results regarding the importance and effects of these parameters. The aim of this study was to evaluate how vehicle yaw rotation, instrument panel intrusion, and the time history of the pulse angle influence chest injury outcomes.

    Method: This study was conducted using kinematic boundary conditions derived from physical crash tests, which were applied on a finite element simulation model of a vehicle interior including a finite element human model. By performing simulations with different levels of simplified boundary conditions and comparing the results to a simulation with a full set of boundary conditions, the influence of the simplifications was evaluated. The injury outcome measure compared between the simulations was the expected number of fractured ribs. The 3 simplifications simulated were (1) removal of vehicle yaw rotation, (2) removal of vehicle yaw rotation plus an assumption of a constant pulse angle between the x- and y-acceleration, and (3) removal of instrument panel intrusion.

    The kinematic boundary conditions were collected from 120 physical tests performed at the Insurance Institute of Highway Safety; 77 were small-overlap tests, and 43 were moderate overlap tests. For each test, the full set of boundary conditions plus the 3 simplifications were simulated. Thus, a total of 480 simulations were performed.

    Results: The yaw rotation influences occupant interaction with the frontal airbag. For the approximation without this kinematic boundary component, there was an average error in injury outcome of approximately 13% for the moderate overlap cases. Large instrument panel intrusion increases the risk of rib fracture in nearside small-overlap crashes. The mechanism underlying this increased fracture risk is a combination of increased airbag load and a more severe secondary impact to the side structure. Without the intrusion component, the injury risk was underestimated by 8% for the small-overlap crashes.

    Conclusion: The approximation with least error was version 2; that is, a model assuming a constant pulse angle, including instrument panel intrusion but no vehicle yaw rotation. This approximation simulates a sled test with a buck mounted at an oblique angle. The average error for this approximation was as low as 2–4%.

  • 278.
    Iraeus, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. ÅF Industry, Gothenburg, Sweden.
    Lindquist, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Pulse shape analysis and data reduction of real life crashes with modern passenger cars2015In: International Journal of Crashworthiness, ISSN 1358-8265, E-ISSN 1754-2111, Vol. 20, no 6, p. 535-546Article in journal (Refereed)
    Abstract [en]

    The increased use of computer simulations such as finite element modelling for evaluating passive safety applications has made it possible to simplify and parameterize complex physical processes. Crash pulses derived from laboratory tests have been used in many studies to evaluate and optimize passive safety systems such as airbags and seat belts. However, a laboratory crash pulse will only be representative of the acceleration time history of a specific car crashing into a barrier at a specified velocity. To be able to optimize passive safety systems for the wide variety of scenarios experienced during real-life crashes, there is a need to study and characterize this variation. In this study, crash pulses from real-life crashes as recorded by event data recorders were parameterized, and the influence of vehicle and crash variables was analysed. The pulse parameterization was carried out using eigenvalue analysis and the influence that vehicle and crash variables had on the pulse shape was determined with multiple linear regression. It was shown that the change in velocity, the subject vehicle mass, and the properties of the collision partner were the variables that had the greatest effect on the shape of the crash pulse. The results of this study can be used to create artificial real-life pulses with different crash parameters. This in turn can be used for stochastic computer simulation studies with the intention of optimizing passive safety systems that are robust to the wide variation in real-life crashes.

  • 279.
    Iraeus, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lindquist, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wistrand, Sofie
    Sibgård, Elin
    Pipkorn, Bengt
    Evaluation of chest injury mechanisms in nearside oblique frontal impacts2013In: Annals of advances in automotive medicine, ISSN 1943-2461, Vol. 57, p. 183-196Article in journal (Refereed)
    Abstract [en]

    Despite the use of seat belts and modern safety systems, many automobile occupants are still seriously injured or killed in car crashes. Common configurations in these crashes are oblique and small overlap frontal impacts that often lead to chest injuries.To evaluate the injury mechanism in these oblique impacts, an investigation was carried out using mathematical human body model simulations. A model of a simplified vehicle interior was developed and validated by means of mechanical sled tests with the Hybrid III dummy. The interior model was then combined with the human body model THUMS and validated by means of mechanical PMHS sled tests. Occupant kinematics as well as rib fracture patterns were predicted with reasonable accuracy.The final model was updated to conform to modern cars and a simulation matrix was run. In this matrix the boundary conditions, ΔV and PDOF, were varied and rib fracture risk as a function of the boundary conditions was evaluated using a statistical framework.In oblique frontal impacts, two injury producing mechanisms were found; (i) diagonal belt load and (ii) side structure impact. The second injury mechanism was found for PDOFs of 25°-35°, depending on ΔV. This means that for larger PDOFs, less ΔV is needed to cause a serious chest injury.

  • 280.
    Israelsson, Leif
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Choose midline incision for the best access to the abdominal cavity2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 14, p. 1042-1045Article in journal (Refereed)
    Abstract [en]

    A midline incision or a wide transverse incision offers good access to the abdominal cavity. A midline incision should probably be preferred. Then no major nerve, muscle or vessel is severed and thereby subsequent neural or abdominal wall dysfunction may be avoided. Both incisions seem to be associated with similar pain, although a subcostal incision may be advantageous for gallbladder surgery. Respiratory function may be better with transverse incisions but there is no randomised study comparing incisions when a postoperative epidural is used. Wound dehiscence rates have not been proven to differ and the rate of incisional hernia is similar with both types of incision.

  • 281.
    Israelsson, Leif A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Abdominal incision closure: small but important bites2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10000, p. 1216-1218Article in journal (Other academic)
  • 282.
    Israelsson, Leif A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Parastomal hernia treatment with prosthetic mesh repair2010In: Der Chirurg, ISSN 0009-4722, E-ISSN 1433-0385, Vol. 81, no 3, p. 216-221Article in journal (Refereed)
    Abstract [de]

    After stoma formation, parastomal hernia develops in 30-50% of patients, with one-third of these require operative correction. Recurrence rates are very high after suture repair of parastomal hernias or relocation of the stoma. Open or laparoscopic mesh repairs have resulted in much lower recurrence rates. Long-term follow-up of the various techniques for parastomal hernia repair is lacking, as are randomized trials. A prophylactic prosthetic mesh placed in a sublay position at the index operation has reduced the rate of parastomal hernia in randomized trials. A prophylactic mesh in an onlay position, a sublay position, and an intraperitoneal onlay position has also been associated with low herniation rates in non-randomized studies. Although several questions within this field still have to be answered, it seems obvious that use of a mesh represents a suitable measure for the prevention of parastomal hernia as well as parastomal hernia repair.

  • 283.
    Israelsson, Leif A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Parastomal hernias2008In: Surgical Clinics of North America, ISSN 0039-6109, E-ISSN 1558-3171, Vol. 88, no 1, p. 113-125Article in journal (Refereed)
    Abstract [en]

    The incidence of parastomal hernias is probably 30% to 50%. Suture repair of a parastomal hernia or relocation of the stoma results in a high recurrence rate, whereas with mesh repair recurrence rates are lower. Several mesh repair techniques are used in open and laparoscopic surgery, but randomized trials comparing various techniques and with long-term follow-up are needed for better evidence.

  • 284.
    Israelsson, Leif A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Preventing and treating parastomal hernia2005In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 29, no 8, p. 1086-1089Article in journal (Refereed)
    Abstract [en]

    Parastomal hernia represents a major surgical challenge. There is no uniform definition of parastomal hernia, and the true rate is therefore difficult to establish, although it is probably higher than 30%. Many surgical techniques have been tried to prevent and treat parastomal hernia; but despite these efforts, herniation continues to be a problem. The only method that has reduced the rate of parastomal hernia in a randomized trial is the use of a prophylactic prosthetic mesh. A large-pore low-weight mesh with reduced polypropylene content and a high proportion of absorbable material placed in a sublay position at the primary operation significantly reduces the rate of parastomal hernia. Recurrence rates after surgical treatment of parastomal hernia are high unless mesh is used. Relocation of the stoma, with prophylactic mesh in a sublay position at the new site and sublay mesh repairing the incisional hernia at the primary site, is the standard method for treating parastomal hernia in our department.

  • 285.
    Israelsson, Leif A.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Millbourn, Daniel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.
    Closing midline abdominal incisions2012In: Langenbeck's archives of surgery (Print), ISSN 1435-2443, E-ISSN 1435-2451, Vol. 397, no 8, p. 1201-1207Article, review/survey (Refereed)
    Abstract [en]

    The most important wound complications are surgical site infection, wound dehiscence and incisional hernia. Experimental and clinical evidences support that the development of wound complications is closely related to the surgical technique at wound closure. The suture technique monitored through the suture length-to-wound length ratio is of major importance for the development of wound complications. The risk of wound dehiscence is low with a high ratio. The ratio must be higher than 4; otherwise, the risk of developing an incisional hernia is increased four times. With a ratio higher than 4, both the rate of wound infection and incisional hernia are significantly lower if closure is done with small stitches placed 5 to 8 mm from the wound edge than with larger stitches placed more than 10 mm from the wound edge. Midline incisions should be closed in one layer by a continuous suture technique. A monofilament suture material should be used and be tied with self-locking knots. Excessive tension should not be placed on the suture. Wounds must always be closed with a suture length-to-wound length ratio higher than 4. The only way to ascertain this is to measure, calculate and document the ratio at every wound closure. A high ratio should be accomplished with many small stitches placed 5 to 8 mm from the wound edge at very short intervals.

  • 286.
    Israelsson, Leif A.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sundsvall Hospital.
    Millbourn, Daniel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sundsvall Hospital.
    Prevention of Incisional Hernias How to Close a Midline Incision2013In: Surgical Clinics of North America, ISSN 0039-6109, E-ISSN 1558-3171, Vol. 93, no 5, p. 1027-+Article in journal (Refereed)
    Abstract [en]

    The development of wound complications is closely related to the surgical technique at wound closure. The risk of the suture technique affecting the development of wound dehiscence and incisional hernia can be monitored through the suture length to wound length ratio. Mid line incisions should be closed in one layer by a continuous-suture technique using a monofilament suture material tied with self-locking knots. Excessive tension should not be placed on the suture. Closure must always be with a suture length to wound length ratio higher than 4.

  • 287.
    Israelsson, Leif A
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Smedberg, Sam
    Montgomery, Agneta
    Nordin, Pär
    Spangen, L
    Incisional hernia repair in Sweden 20022006In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 10, no 3, p. 258-261Article in journal (Refereed)
    Abstract [en]

    Incisional hernia is a common problem after abdominal surgery. The complication and recurrence rates following the different repair techniques are a matter of great concern. Our aim was to study the results of incisional hernia repair in Sweden. A questionnaire was sent to all surgical departments in Sweden requesting data concerning incisional hernia repair performed during the year 2002. Eight hundred and sixty-nine incisional hernia repairs were reported from 40 hospitals. Specialist surgeons performed the repair in 782 (83.8%) patients. The incisional hernia was a recurrence in 148 (17.0%) patients. Thirty-three per cent of the hernias were subsequent to transverse, subcostal or muscle-splitting incisions or laparoscopic procedures. Suture repair was performed in 349 (40.2%) hernias. Onlay mesh repair was more common than a sublay technique. The rate of wound infection was 9.6% after suture repair and 8.1% after mesh repair. The recurrence rate was 29.1% with suture repair, 19.3% with onlay mesh repair, and 7.3% with sublay mesh repair. This survey revealed that there is room for improvement regarding the incisional hernia surgery in Sweden. Suture repair, with its unacceptable results, is common and mesh techniques employed may not be optimal. This study has led to the instigation of a national incisional hernia register.

  • 288. Jaafar, Gona
    et al.
    Hammarqvist, Folke
    Enochsson, Lars
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sandblom, Gabriel
    Patient-Related Risk Factors for Postoperative Infection After Cholecystectomy2017In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 41, no 9, p. 2240-2244Article in journal (Refereed)
    Abstract [en]

    Background: The impact of patient-related risk factors on the incidence of postoperative infection after cholecystectomy is relatively unknown.

    Aim: The aim of this study was to explore potential patient-related risk factors for surgical site infection (SSI) and septicaemia following cholecystectomy.

    Materials and methods: All cholecystectomies registered in the Swedish national population-based register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) 2006–2014 were identified. The study cohort was cross-matched with the Swedish National Patient Register in order to obtain data on patient history and postoperative infections. Simple and multiple logistic regression analyses were performed in order to assess the impact of various comorbidities on the risk for SSI and septicaemia.

    Results: A total of 94,557 procedures were registered. A SSI was seen following 5300 procedures (5.6%), and septicaemia following 661 procedures (0.7%). There was a significantly increased risk for SSI in patients with connective tissue disease (odds ratio [OR] 1.404, 95% confidence interval [CI] 1.208–1.633), complicated diabetes (OR 1.435, CI 1.205–1.708), uncomplicated diabetes (OR 1.391, CI 1.264–1.530), chronic kidney disease (OR 1.788, CI 1.458–2.192), cirrhosis (OR 1.764, CI 1.268–2.454) and obesity (OR 1.630, CI 1.475–1.802). There was a significantly higher risk for septicaemia in patients with chronic kidney disease (OR 3.065, CI 2.120–4.430) or cirrhosis (OR 5.016, CI 3.019–8.336).

    Conclusion and discussion: Certain comorbidities have an impact on the risk for postoperative infection after cholecystectomy, especially SSI. This should be taken into account when planning the procedure and when deciding on prophylactic antibiotic treatment.

  • 289. Janson, A R
    et al.
    Jänes, Arthur
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Israelsson, Leif A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Laparoscopic stoma formation with a prophylactic prosthetic mesh.2010In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 14, no 5, p. 495-498Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: One year after stoma formation with an open technique, the rate of parastomal hernia is almost 50%. The herniation rate can be reduced to 10% with the use of a prophylactic mesh in a sublay position. For stomas formed with a laparoscopic technique, a surgical method with the use of prophylactic mesh should be sought. METHODS: Patients with a sigmoidostomy created with a laparoscopic technique were provided with a prophylactic large-pore, low-weight mesh in a sublay position. Follow-up examination was carried out after at least 12 months. RESULTS: Between March 2003 and May 2007, a sigmoidostomy was created in 25 patients. The patients' mean age was 65 years (range 31-89), the mean body mass index was 26 (range 21-32) and 15 were female. One stoma necrosis and two minor wound infections occurred. Parastomal hernia was present in 3 of 20 patients (15%) available for follow-up examination after 11-31 months (mean 19). No fistulas or strictures had developed. No mesh infection was noted and no mesh was removed. CONCLUSION: In laparoscopic stoma formation, a prophylactic large-pore, low-weight mesh in a sublay position is an easy and safe procedure associated with a low rate of parastomal hernia.

  • 290.
    Janunger, Karl-Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Benign and malignant gastric mucosal changes after partial gastrectomy1978Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The development of benign and malignant mucosal changes in the gastric remnant were studied early (1-3 years) postoperatively in 55 patients and late (10-24 years) postoperatively in 336 of 676 patients subjected to partial gastrectomy for ulcer disease.

    Chronic gastritis with atrophy, intestinal metaplasia and cystic dilatation of the gastric glands was found early postoperatively with the same prevalence in gastric and duodenal ulcer patients. Whereas the prevalence of atrophy, and of acute and chronic gastritis was the same both early and late postoperatively, the prevalence of intestinal metaplasia, cystic dilatation and lipid islands increased with time. The prevalence of inflammatory changes late postoperatively was not correlated to sex, age or type of anastomotic procedure.

    A significantly increased risk for stump carcinoma was found in male patients more than 12 years postoperatively. No difference correlated to type of ulcer disease or anastomotic procedure could be demonstrated. In duodenal ulcer patients the time interval between operation and diagnosis of carcinoma was independent of age at operation, while in gastric ulcer patients the interval was shorter with increasing age at operation.

    Gastric stump carcinomas were found in 12 of the 336 (3.6%) patients examined gastroscopically; four of these were early carcinomas. In four patients with stump carcinoma the correct diagnosis could not be established at the first examination.

    Gastric polyps and precancerous mucosal changes were the only macro- or microscopical findings in some cases with already existing non-visible carcinoma.

    The CEA immunohistochemical study of the gastric mucosa showed a positive reaction in 10 of 49 patients; 6 of the 10 had carcinoma, precancerous changes or adenomatous polyp. Three patients with diagnosed or later discovered carcinoma had CEA negative reactions. However, the results indicate that there is a correlation between demonstrated CEA content and increased risk for development of stump carcinoma. To evaluate whether this method can be used to identify patients at special risk for development of gastric carcinoma requires further study.

    Because of increased risk for stump carcinoma, gastric ulcer patients ought to be examined with gastroscopy from about 10 years after partial gastrectomy, and duodenal ulcer patients from about 15 years, irrespective of the type of anastomotic procedure. Re-examinations ought to be performed every two to four years. In patients with gastric polyps or precancerous mucosal changes re-examinations should be performed earlier, within 6-12 months.

  • 291. Javed, Muhammad Ahsan
    et al.
    Beyer, Georg
    Le, Nha
    Vinci, Alessio
    Wong, Helen
    Palmer, Daniel
    Morgan, Robert D
    Lamarca, Angela
    Hubner, Richard A
    Valle, Juan W
    Alam, Salma
    Chowdhury, Sumsur
    Ma, Yuk Ting
    Archibugi, Livia
    Capurso, Gabriele
    Maisonneuve, Patrick
    Neesse, Albrecht
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Schober, Marvin
    Krug, Sebastian
    Impact of intensified chemotherapy in metastatic pancreatic ductal adenocarcinoma (PDAC) in clinical routine in Europe2019In: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 19, no 1, p. 97-104Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is associated with poor prognosis. Gemcitabine is the standard chemotherapy for patients with metastatic pancreatic adenocarcinoma (MPA). Randomized clinical trials evaluating intensified chemotherapies including FOLFIRINOX and nab-paclitaxel plus gemcitabine (NAB+GEM) have shown improvement in survival. Here, we have evaluated the efficacy of intensified chemotherapy versus gemcitabine monotherapy in real-life settings across Europe.

    METHODS: A retrospective multi-center study including 1056 MPA patients, between 2012 and 2015, from nine centers in UK, Germany, Italy, Hungary and the Swedish registry was performed. Follow-up was at least 12 months. Cox proportional Harzards regression was used for uni- and multivariable evaluation of prognostic factors.

    RESULTS: Of 1056 MPA patients, 1030 (98.7%) were assessable for survival analysis. Gemcitabine monotherapy was the most commonly used regimen (41.3%), compared to FOLFIRINOX (n = 204, 19.3%), NAB+GEM (n = 81, 7.7%) and other gemcitabine- or 5-FU-based regimens (n = 335, 31.7%). The median overall survival (OS) was: FOLFIRINOX 9.9 months (95%CI 8.4-12.6), NAB+GEM 7.9 months (95%CI 6.2-10.0), other combinations 8.5 months (95%CI 7.7-9.3) and gemcitabine monotherapy 4.9 months (95%CI 4.4-5.6). Compared to gemcitabine monotherapy, any combination of chemotherapeutics improved the survival with no significant difference between the intensified regimens. Multivariable analysis showed an association between treatment center, male gender, inoperability at diagnosis and performance status (ECOG 1-3) with poor prognosis.

    CONCLUSION: Gemcitabine monotherapy was predominantly used in 2012-2015. Intensified chemotherapy improved OS in comparison to gemcitabine monotherapy. In real-life settings, the OS rates of different treatment approaches are lower than shown in randomized phase III trials.

  • 292.
    Jestin, Pia
    et al.
    Department of Surgical Sciences, University Hospital, Uppsala, SE 75185 Uppsala, .
    Heurgren, M
    Påhlman, L
    Glimelius, B
    Gunnarsson, Ulf
    Department of Surgical Sciences, University Hospital, Uppsala, Sweden.
    Elective surgery for colorectal cancer in a defined Swedish population.2004In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 30, no 1, p. 26-33Article in journal (Refereed)
    Abstract [en]

    AIMS: The aim of this study was to describe variability in compliance to clinical guidelines in colorectal cancer surgery related to hospital structure.

    METHODS: All patients registered in the databases of the Regional Oncologic Centre, operated upon electively for colon cancer between the start of the register in 1997 until 2000 (n=1771) and for rectal cancer between the start of the register in 1995 until 2000 (n=1841) were selected for analysis.

    RESULTS: There was no difference in 5-year survival rate between colon and rectal cancer (mean follow-up 2.6 and 3.0 years, respectively; p=0.22). There was a significant difference in frequency of preoperative liver scan depending on hospital category with an increase in colon cancer from 39 to 46% (p=0.02) and in rectal cancer from 42 to 64% (p<0.001). For colon cancer there was no difference, according to hospital category, in quotient sigmoid and high anterior resection to left-sided resection. Furthermore, high anterior resection was more common at university and general district hospitals (8%) compared with district hospitals (4%) (p=0.01). Sphincter-saving surgery was more common at university hospitals and district general hospitals than at district hospitals (low anterior/abdomino-perineal resection quotients 2.3, 2.4 and 1.6, respectively; p<0.001).

    CONCLUSIONS: Population-based audit forms an appropriate and valuable basis for quality assurance projects. In addition to describing compliance to guidelines and pointing to process steps that can be improved, such investigations may also indicate changes due to scientific development. Linked to case-costing data, such results may form an important basis for decisions about modifications in health care.

  • 293.
    Jestin, Pia
    et al.
    Department of Surgical Sciences, Federation of County Councils, Stockholm.
    Nilsson, J
    Heurgren, M
    Påhlman, L
    Glimelius, B
    Gunnarsson, Ulf
    Department of Surgical Sciences, University Hospital, Uppsala, Sweden.
    Emergency surgery for colonic cancer in a defined population.2005In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 92, no 1, p. 94-100Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to identify risk factors in emergency surgery for colonic cancer in a large population and to investigate the economic impact of such surgery.

    METHODS: Data from the colonic cancer registry (1997-2001) of the Uppsala/Orebro Regional Oncological Centre were analysed and classified by hospital category. Some 3259 patients were included; 806 had an emergency and 2453 an elective procedure. Data for calculating effects on health economy were derived from a national case-costing register.

    RESULTS: Patients who had emergency surgery had more advanced tumours and a lower survival rate than those who had an elective procedure (5-year survival rate 29.8 versus 52.4 per cent; P < 0.001). There was a stage-specific difference in survival, with poorer survival both for patients with stage I and II tumours and for those with stage III tumours after emergency compared with elective surgery (P < 0.001). Emergency surgery was associated with a longer hospital stay (mean 18.0 versus 10.0 days; P < 0.001) and higher costs (relative cost 1.5 (95 per cent confidence interval 1.4 to 1.6)) compared with elective surgery. The duration of hospital stay was the strongest determinant of cost (r(2) = 0.52, P < 0.001).

    CONCLUSION: Emergency surgery for colonic cancer is associated with a stage-specific increase in mortality rate.

  • 294.
    Jestin, Pia
    et al.
    Department of Surgical Sciences, University Hospital, Uppsala, Sweden.
    Påhlman, Lars
    rtment of Surgical Sciences, University Hospital, Uppsala, Sweden.
    Gunnarsson, Ulf
    rtment of Surgical Sciences, University Hospital, Uppsala, Sweden.
    Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study.2008In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 10, no 7, p. 715-21Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: With introduction of the total mesorectal excision technique and preoperative radiotherapy in rectal cancer surgery, the local recurrence rate has decreased and the overall survival has improved. One drawback, however, is the high anastomotic leakage rate of approximately 10-18%. Male gender and low anastomoses are known risk factors for such leakage. The aim of this study was to identify potentially modifiable risk factors.

    METHOD: In a case-control study, data from the Swedish Rectal Cancer Registry (1995-2000) were analysed. Cases were all patients with anastomotic leakage after an anterior resection (n = 134). Two controls were randomly selected for each case. The medical records (n = 402) were checked against a study protocol. Due to incorrect recording two cases and 28 controls were excluded from further analyses.

    RESULTS: In the multivariate analysis significant risk factors were American Society of Anesthesiologists score > 2 [OR = 1.40 (95% CI 1.05-1.83)], preoperative radiotherapy [OR = 1.34 (95% CI 1.06-1.69)], intraoperative adverse events [OR = 1.85 (95% CI 1.32-2.58)], level of anastomosis <or= 6 cm [OR = 1.39 (95% CI 1.01-1.90)] and severe bleeding [OR = 1.45 (95% CI 1.14-1.84)]. Diverting stoma protected from leakage [OR = 0.68 (95% CI 0.52-0.88)]. Male gender was a risk factor in the univariate but not in the multivariate analysis [OR = 1.30 (95% CI 1.04-1.63) and OR = 1.26 (95% CI 1.00-1.58), respectively]. Except for a protective stoma, none of the variables considered as possible targets for improvement, such as postoperative epidural anaesthesia, observation at intensive care unit for more than 24 h, and intraabdominal drainage, proved to be protective factors either in the univariate or in the multivariate analyses.

    CONCLUSION: The most important risk factors for leakage were adverse intraoperative events, low anastomoses and preoperative radiotherapy. A diverting stoma is protective and can reduce the consequences when leakage occurs. Further analyses with focus on the surgical technique and individual surgeon may be valuable in identifying targets for improvement.

  • 295.
    Jiang, G X
    et al.
    Division of Neurology, Department of Clinical Neuroscience and Family Medicine, Huddinge University Hospital, Huddinge, Sweden.
    de Pedro-Cuesta, J
    Division of Neurology, Department of Clinical Neuroscience and Family Medicine, Huddinge University Hospital, Huddinge, Sweden. Department of Applied Epidemiology, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
    Strigård, Karin
    Department of Surgery, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Olsson, T
    Division of Neurology, Department of Clinical Neuroscience and Family Medicine, Huddinge University Hospital, Huddinge, Sweden.
    Link, H
    Division of Neurology, Department of Clinical Neuroscience and Family Medicine, Huddinge University Hospital, Huddinge, Sweden.
    Pregnancy and Guillain-Barré syndrome: a nationwide register cohort study.1996In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 15, no 4, p. 192-200Article in journal (Refereed)
    Abstract [en]

    In this study, we determined the relationship between Guillain-Barré syndrome (GBS) and pregnancy. By taking advantage of several nationwide registers and the availability of personal identification numbers, we calculated person-years for Swedish females aged 15-49 years in the following categories: (1) neither pregnant nor postpartum; (2) pregnant; (3) in the first month postpartum, or (4) in the first 3 months postpartum during 1973-1983. For these women, we determined the corresponding exposure status of hospital-registered GBS cases. Medical records were examined for GBS cases hospitalized during the 2-week period postpartum and 1-month period after the last menstruation. Poisson regression analysis yielded age-adjusted relative risks (RRs) of 0.86 (95% CI 0.40-1.84) for pregnant women, and 1.47 (0.54-3.99) and 2.21 (0.55-8.94) for females during the 3-month and the 30-day period after delivery. The risk for GBS seems to be lower during pregnancy and increases after delivery.

  • 296.
    Johagen, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Svenmarker, Staffan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    The scientific evidence of arterial line filtration in cardiopulmonary bypass2016In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 31, no 6, p. 446-457Article in journal (Refereed)
    Abstract [en]

    Background: The indication for arterial line filtration (ALF) is to inhibit embolisation during cardiopulmonary bypass. Filtration methods have developed from depth filters to screen filters and from a stand-alone component to an integral part of the oxygenator. For many years, ALF has been a standard adopted by a majority of cardiac centres worldwide. The following review aims to summarize the available evidence in support for ALF and report on its current practice in Europe. Method: The principles and application of ALF in Europe was investigated using a survey conducted in 2014. The scientific evidence for ALF was examined by performing a systematic literature search in six different databases, using the following search terms: Cardiopulmonary bypass AND filters AND arterial. The primary endpoint was protection against cerebral injury verified by the degree of cerebral embolisation or cognitive tests. The secondary endpoint was improvement of the clinical outcome verified elsewise. Only randomised clinical trials were considered. Results: The response rate was 31% (n=112). The great majority (88.5%) of respondents were using ALF, following more than 10 years of experience. Integrated arterial filtration was used by 55%. Of respondents not using ALF, fifty-four percent considered starting using integrated arterial filtration. The systematic literature database search returned 180 unique publications where 82 were specifically addressing ALF in cardiopulmonary bypass. Only four out of the 82 identified publications fulfilled our inclusion criteria. Of these, three were more than 20 years old and based on the use of bubble oxygenation. Conclusion: ALF is a standard implemented in a majority of cardiopulmonary bypass procedures in Europe. The level of scientific evidence available in support of current arterial line filtration methods in cardiopulmonary bypass is, however, poor. Large, well-designed, randomised trials are warranted.

  • 297.
    Johannesson, Gauti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Hallberg, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Eklund, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Koskela, Timo
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Linden, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Change in intraocular pressure measurement 2 years after myopic laser-assisted subepithelial keratectomy2012In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 38, no 9, p. 1637-1642Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate intraocular pressure (IOP) measurements 24 months after laser-assisted subepithelial keratectomy (LASEK) with 3 tonometry methods-Goldmann applanation tonometry (DCT), Pascal dynamic contour tonometry (DCT), and applanation resonance tonometry (ART)-and to compare them with measurements taken preoperatively and 3 and 6 months postoperatively. SETTING: Department of Ophthalmology, Umea University, lima Sweden. DESIGN: Prospective randomized single-center. METHODS: One randomized eye per person from myopic healthy individuals who had LASEK was included. Visual acuity, central corneal thickness (CCT), corneal curvature, and IOP were measured at all time points. Six IOP measurements were performed per method, with a 5-minute lapse between methods. RESULTS: The study evaluated 38 eyes. Two years after LASEK, dynamic ART was the only method that did not measure significantly lower IOP than before LASEK (mean -0.2 mm Hg +/- 1.6 [SD]). The greatest difference was with GAT (mean -1.9 +/- 1.7 mm Hg) followed by static ART (mean -1.2 +/- 1.6 mm Hg) and then DCT (mean -0.9 +/- 1.3 mm Hg). All methods measured significantly lower IOP at 3 months and 6 months. CONCLUSIONS: Dynamic ART, which analyses IOP measurement during indentation, showed no significant difference in measured IOP after 24 months. The convex tip of the ART device and the continuous sampling of data during corneal indentation seem to be factors in why dynamic ART was less affected by corneal properties and therefore more suitable for IOP measurement in LASEK-treated eyes, although this must be confirmed in larger trials.

  • 298.
    Johansson, Bengt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Holmgren, Anders
    Hedström, Magnus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Engström-Laurent, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Engström, Karl Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Evaluation of hyaluronan and calcifications in stenotic and regurgitant aortic valves.2011In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 39, no 1, p. 27-32Article in journal (Refereed)
    Abstract [en]

    Objective: Hyaluronan (HA) is a major component of the interstitium and has been observed in normal heart valves. The function of HA in heart valves is unknown but contribution to biomechanical function has been proposed. The purpose of this investigation was to study the distribution of HA in relation to calcifications in diseased human aortic valves. Methods: Human aortic valves were collected at aortic valve replacement, of whom nine patients had regurgitation and 13 stenotic disease. The valves were decalcified and stained for the visualisation of HA. The specimens were macroscopically evaluated for magnitude of calcification using image analysis. The microscopic amount and distribution of HA and calcifications were semiquantitatively evaluated using histochemistry. Results: The overall HA staining showed an inverse relationship against the magnitude of observed valve calcifications (p<0.001) and type of disease (p=0.014). Multiple-group comparison revealed regionally reduced HA staining in diffuse and heavy calcified regions inside the valve (both p<0.001) compared with normal-structured parts of the valve. HA was concentrated on the ventricular side of the valve (p=0.002). Conclusions: The content of HA was reduced in calcified aortic valves and had a heterogeneous distribution, potentially contributing to poor valve function. HA may also be involved in the pathophysiological process in degenerative aortic stenosis.

  • 299.
    Johansson, Christer
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Elite sprinters, ice hockey players, orienteers and marathon runners: isokinetic leg muscle performance in relation to muscle structure and training1987Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In male athletes from different sports, isokinetic knee extensor, and in orienteers also plantar flexor peak torque (PT), contractional work (CW) and integrated surface electromyograms (iEMG) were analysed.

    Single contraction PT, CW and iEMG in sprinters and marathon runners were signi­ficantly correlated to the cross-sectional area (CSA) of m. quadriceps, and to the Type II fibre area of m. vastus lateralis. When correcting PT, CW and iEMG for CSA of m. quadriceps, such correlations were found only for Type IIA fibre area at 180° s~1. Elec- tromyographically, m. vastus lateralis (biopsied muscle) was representative for m. quadriceps. Calculated optimal mean power (CW s~1) and electrical efficacy (CW/iEMG) approximated for sprinters 450° s-1 and for marathon runners 270° s~1, i.e. velocities at or above the upper limit of the dynamometers. In orienteers, plantar flexor PT increased during winter training, but decreased during competitive season. Knee extensor PT increased over the whole year. At 30 and 60° s~1 only knee extensor PT was negatively associated with the running velocity at onset of blood lactate accu­mulation (VOBLA)- Changes in VOBLA during winter period were negatively associated with changes in knee extensor PT at 180° s~1. During competitive season, changes in Vobla were negatively associated with the ratio quality : quantity running. In ice hockey players PT varied non-systematically with training and games.

    The biopsy specimens of marathon runners showed irregular fibre shapes, an in­creased amount of connective tissue and central fibre nuclei, indicating an early strain disease or functional adaptation to extreme demands.

    During repetitive contractions in sprinters and marathon runners, fatigue, i.e. slope of decline in CW, was significantly associated with the Type II fibre area of m. vastus lateralis. For knee extensors of sprinters, ice hockey players and orienteers, a steep de­crease in CW/iEMG was observed. In contrast, knee extensors of marathon runners and plantar flexors of orienteers showed an almost unaltered CW/iEMG throughout the test. The knee extensor endurance level (CW/iEMG) was significantly correlated to the maximal oxygen uptake. In orienteers, an increase in endurance level of both tested muscle groups during winter training parallelled an increase in VOBLA and V02obla- In hockey players, fatigue and endurance pattern (CW and CW/iEMG) changed non-systematically with training and games.

    In conclusion, isokinetic measurements and iEMG reflect the structural properties of the knee extensor muscles in sprinters and marathon runners. The demonstrated characteristics and changes in leg muscle function in different groups of athletes apparently reflect varying demands from different sports activities.

  • 300.
    Johansson, Joakim
    et al.
    Department of Perioperative Medicine, Faculty of Health Sciences, Linköping University Hospital, Linköping, Sweden.
    Sjögren, Florence
    Bodelsson, Mikael
    Sjöberg, Folke
    Dynamics of leukocyte receptors after severe burns: an exploratory study2011In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 37, no 2, p. 227-233Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with burns are susceptible to organ failure, and there is indirect evidence that leukocytes may contribute to this process. They may change the expression of cell-surface receptors after certain stimuli, for example, the burn. We therefore aimed to assess the changes induced by the burn in the expression of leukocyte cell-surface receptors CD11b, CD14, CD16, and CD62L on the surface of PMNs and monocytes. We also wanted to examine the dynamics of this activation during the first week after the burn, and to relate it to the size of the injury.

    METHODS: Ten patients with burns of >15% (TBSA) were included in the study. Blood samples were collected on arrival and every consecutive morning during the first week. Healthy volunteers acted as controls.

    RESULTS: PMN CD11b expression was increased. The extent of PMN CD11b expression correlated negatively to the size of the full thickness burn. Monocyte CD14 expression increased initially but there was no relation to the size of the burn. PMN CD16 expression decreased initially during the first days and the decrease was related to burn size. CD62L did not vary depending on the burn in either PMN or monocytes during the first week after the burn.

    CONCLUSION: This study showed that specific receptors on the surface of leukocytes (PMN CD11b, monocyte CD14 and PMN CD16) are affected by the burn. Expression of PMN CD11b and CD16 are related to burn size. Burn-induced effects on the expression of PMN receptors, such as PMN CD11b and CD16, may contribute to burn-induced infection susceptibility.

3456789 251 - 300 of 775
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf