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  • 1. Abbas, Sascha
    et al.
    Linseisen, Jakob
    Rohrmann, Sabine
    Chang-Claude, Jenny
    Peeters, Petra H
    Engel, Pierre
    Brustad, Magritt
    Lund, Eiliv
    Skeie, Guri
    Olsen, Anja
    Tjønneland, Anne
    Overvad, Kim
    Boutron-Ruault, Marie-Christine
    Clavel-Chapelon, Francoise
    Fagherazzi, Guy
    Kaaks, Rudolf
    Boeing, Heiner
    Buijsse, Brian
    Adarakis, George
    Ouranos, Vassilis
    Trichopoulou, Antonia
    Masala, Giovanna
    Krogh, Vittorio
    Mattiello, Amalia
    Tumino, Rosario
    Sacerdote, Carlotta
    Buckland, Genevieve
    Suárez, Marcial Vicente Argüelles
    Sánchez, Maria-José
    Chirlaque, Maria-Dolores
    Barricarte, Aurelio
    Amiano, Pilar
    Manjer, Jonas
    Wirfält, Elisabet
    Lenner, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Bueno-de-Mesquita, H B
    van Duijnhoven, Fränzel J B
    Khaw, Kay-Tee
    Wareham, Nick
    Key, Timothy J
    Fedirko, Veronika
    Romieu, Isabelle
    Gallo, Valentina
    Norat, Teresa
    Wark, Petra A
    Riboli, Elio
    Dietary intake of vitamin D and calcium and breast cancer risk in the European prospective investigation into cancer and nutrition2013In: Nutrition and Cancer, ISSN 0163-5581, E-ISSN 1532-7914, Vol. 65, no 2, p. 178-187Article in journal (Refereed)
    Abstract [en]

    Studies assessing the effects of vitamin D or calcium intake on breast cancer risk have been inconclusive. Furthermore, few studies have evaluated them jointly. This study is the largest so far examining the association of dietary vitamin D and calcium intake with breast cancer risk in the European Prospective Investigation into Cancer and Nutrition. During a mean follow-up of 8.8 yr, 7760 incident invasive breast cancer cases were identified among 319,985 women. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for pre- and postmenopausal breast cancer risk. Comparing the highest with the lowest quintile of vitamin D intake, HR and 95% CI were 1.07 (0.87-1.32) and 1.02 (0.90-1.16) for pre- and postmenopausal women, respectively. The corresponding HR and 95% CIs for calcium intake were 0.98 (0.80-1.19) and 0.90 (0.79-1.02), respectively. For calcium intake in postmenopausal women, the test for trend was borderline statistically significant (P(trend) = 0.05). There was no significant interaction between vitamin D and calcium intake and cancer risk (P(interaction) = 0.57 and 0.22 in pre- and postmenopausal women, respectively). In this large prospective cohort, we found no evidence for an association between dietary vitamin D or calcium intake and breast cancer risk.

  • 2.
    Abdelmalek, George
    et al.
    Rutgers New Jersey Medical School, NJ, Newark, United States.
    Mina, George Ehab
    Rutgers New Jersey Medical School, NJ, Newark, United States.
    Pant, Krittika
    Rutgers New Jersey Medical School, NJ, Newark, United States.
    Zheng, Zheshi
    Department of Statistics, Rutgers University, NJ, Piscataway, United States.
    Mahajan, Jasmine
    Rutgers New Jersey Medical School, NJ, Newark, United States.
    Srinivasan, Nivetha
    Rutgers New Jersey Medical School, NJ, Newark, United States.
    Gupta, Shivani
    Rutgers New Jersey Medical School, NJ, Newark, United States.
    Shafei, Jasmine
    Rutgers New Jersey Medical School, NJ, Newark, United States.
    Levidy, Michael F.
    Rutgers New Jersey Medical School, NJ, Newark, United States.
    McGrath, Aleksandra M
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Department of Hand Surgery, Norrland’s University Hospital, Umeå, Sweden.
    Chu, Alice
    Division of Pediatric Orthopedics, Department of Orthopedic Surgery, Rutgers New Jersey Medical School, NJ, Newark, United States.
    Intercostal nerve transfer for biceps reinnervation in obstetrical brachial plexus palsy: a preferred reporting items for systematic reviews and meta-analysis for individual patient data systematic review using individualized fusion and comparison to supraclavicular exploration and nerve grafting2024In: Journal of Children's Orthopaedics, ISSN 1863-2521, E-ISSN 1863-2548, Vol. 18, no 1, p. 54-63Article, review/survey (Refereed)
    Abstract [en]

    Introduction: The objective of this study was to search existing literature on nerve reconstruction surgery in patients with obstetric brachial plexus palsy to determine whether treatment with supraclavicular exploration and nerve grafting produced better elbow flexion outcomes compared to intercostal nerve transfer.

    Methods: This study was a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Individual Patient Data guidelines. A systematic search was conducted using multiple databases. An ordinal regression model was used to analyze the effect of using supraclavicular exploration and nerve grafting or intercostal nerve on elbow flexion with the two scores measured: elbow flexion Medical Research Council scores and Toronto active movements scale scores for elbow flexion.

    Results: A final patient database from 6 published articles consisted of 83 supraclavicular exploration and nerve grafting patients (73 patients with Medical Research Council and 10 patients with Toronto score) and 7 published articles which consisted of 131 intercostal nerve patients (84 patients with Medical Research Council and 47 patients with Toronto scores). Patients who underwent supraclavicular exploration and nerve grafting presented with an average Medical Research Council score of 3.9 ± 0.72 and an average Toronto score of 6.2 ± 2.2. Patients who underwent intercostal nerve transfer presented with an average Medical Research Council score of 3.9 ± 0.71 and an average Toronto score of 6.4 ± 1.2. There was no statistical difference between supraclavicular exploration and nerve grafting and intercostal nerve transfer when utilizing Medical Research Council elbow flexion scores (ordinal regression: 0.3821, standard error: 0.4590, p = 0.2551) or Toronto Active Movement Scale score for elbow flexion (ordinal regression: 0.7154, standard error: 0.8487, p = 0.2188).

    Conclusion: Regardless of surgical intervention utilized (supraclavicular exploration and nerve grafting or intercostal nerve transfers), patients had excellent outcomes for elbow flexion following obstetric brachial plexus palsy when utilizing Medical Research Council or Toronto scores for elbow flexion. The difference between these scores was not statistically significant.

    Type of study/Level of evidence: Therapeutic Study: Investigating the Result of Treatment/level III.

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  • 3.
    Abrahamsson, Pernilla
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Johansson, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Åberg, Anna-Maja
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Winsö, Ola
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Blind, Per Jonas
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Outcome of microdialysis sampling on liver surface and parenchyma2016In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 200, no 2, p. 480-487Article in journal (Refereed)
    Abstract [en]

    Background: To investigate whether surface microdialysis (μD) sampling in probes covered by a plastic film, as compared to noncovered and to intraparenchymatous probes, would increase the technique's sensitivity for pathophysiologic events occurring in a liver ischemia-reperfusion model. Placement of μD probes in the parenchyma of an organ, as is conventionally done, may cause adverse effects, e.g., bleeding, possibly influencing outcome.

    Methods: A transient ischemia-reperfusion model of the liver was used in six anesthetized normoventilated pigs. μD probes were placed in the parenchyma and on the liver surface. Surface probes were either left uncovered or were covered by plastic film.

    Results: Lactate and glucose levels were significantly higher in plastic film covered probes than in uncovered surface probes throughout the ischemic period. Glycerol levels were significantly higher in plastic film covered probes than in uncovered surface probes at 30 and 45 min into ischemia.

    Conclusions: Covering the μD probe increases the sensibility of the μD–technique in monitoring an ischemic insult and reperfusion in the liver. These findings confirm that the principle of surface μD works, possibly replacing need of intraparenchymatous placement of μD probes. Surface μD seemingly allows, noninvasively from an organ's surface, via the extracellular compartment, assessment of intracellular metabolic events. The finding that covered surface μD probes allows detection of local metabolic changes earlier than do intraparenchymatous probes, merit further investigation focusing on μD probe design.

  • 4. Abul-Kasim, Kasim
    et al.
    Backman, Clas
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery.
    Björkman, Anders
    Dahlin, Lars B
    Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries2010In: Journal of Brachial Plexus and Peripheral Nerve Injury, E-ISSN 1749-7221, Vol. 5, p. 14-Article in journal (Refereed)
    Abstract [en]

    Background

    As neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries.

    Methods

    Seven consecutive male patients (median age 33; range 15-61) with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI), computed tomography myelography (CT-M) or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (К-value). Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical findings and the radiological findings were estimated.

    Results

    The diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (К = 0.76) compared with only fair (К = 0.34) for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87).

    Conclusions

    The advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.

  • 5. Achouiti, A.
    et al.
    Vogl, T.
    Urban, Constantin
    Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS).
    Hommes, T. J.
    van Zoelen, M. A.
    Florquin, S.
    Roth, J.
    van 't Veer, C.
    de Vos, A. F.
    van der Poll, T.
    Myeloid related protein (mrp) 8/14 contributes to an antibacterial host response against klebsiella (k.) pneumoniae2012In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 37, no S1, p. 56-56Article in journal (Other academic)
  • 6.
    Adamo, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sandblom, Gabriel
    Brännström, Fredrik
    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.
    Prevalence and recurrence rate of perianal abscess -a population-based study, Sweden 1997-20092016In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 31, no 3, p. 669-673Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The aim of this study was to assess the impact of diabetes mellitus, Crohn's disease, HIV/aids, and obesity on the prevalence and readmission rate of perianal abscess.

    METHODS: The study cohort was based on the Swedish National Patient Register and included all patients treated for perianal abscess in Sweden 1997-2009. The prevalence and risk for readmission were assessed in association with four comorbidity diagnoses: diabetes mellitus, Crohn's disease, HIV, and/or AIDS and obesity.

    RESULTS: A total of 18,877 patients were admitted during the study period including 11,138 men and 4557 women (2.4:1). Crohn's disease, diabetes, and obesity were associated with a significantly higher prevalence of perianal abscess than an age- and gender-matched background population (p < 0.05). In univariate analysis, neither age nor gender had any significant impact on the risk for readmission. In a multivariate Cox proportional hazard analysis, Crohns disease was the only significant risk factor for readmission of perianal abscess.

    CONCLUSION: Crohn's disease, diabetes, and obesity increase the risk for perianal abscess. Of these, Crohn's and HIV has an impact on readmission. The pathogenesis and the influence of diabetes and obesity need further research if we are to understand why these diseases increase the risk for perianal abscess but not its recurrence.

  • 7. Ademuyiwa, Adesoji O.
    et al.
    Arnaud, Alexis P.
    Drake, Thomas M.
    Fitzgerald, J. Edward F.
    Poenaru, Dan
    Bhangu, Aneel
    Harrison, Ewen M.
    Fergusson, Stuart
    Glasbey, James C.
    Khatri, Chetan
    Mohan, Midhun
    Nepogodiev, Dmitri
    Soreide, Kjetil
    Gobin, Neel
    Freitas, Ana Vega
    Hall, Nigel
    Kim, Sung-Hee
    Negeida, Ahmed
    Khairy, Hosni
    Jaffry, Zahra
    Chapman, Stephen J.
    Tabiri, Stephen
    Recinos, Gustavo
    Amandito, Radhian
    Shawki, Marwan
    Hanrahan, Michael
    Pata, Francesco
    Zilinskas, Justas
    Roslani, April Camilla
    Goh, Cheng Chun
    Irwin, Gareth
    Shu, Sebastian
    Luque, Laura
    Shiwani, Hunain
    Altamimi, Afnan
    Alsaggaf, Mohammed Ubaid
    Spence, Richard
    Rayne, Sarah
    Jeyakumar, Jenifa
    Cengiz, Yucel
    Raptis, Dmitri A.
    Fermani, Claudio
    Balmaceda, Ruben
    Marta Modolo, Maria
    Macdermid, Ewan
    Chenn, Roxanne
    Yong, Cheryl Ou
    Edye, Michael
    Jarmin, Martin
    D'amours, Scott K.
    Iyer, Dushyant
    Youssef, Daniel
    Phillips, Nicholas
    Brown, Jason
    Dickfos, Marilla
    Mitul, Ashrarur Rahman
    Mahmud, Khalid
    Oosterkamp, Antje
    Assouto, Pamphile A.
    Lawani, Ismail
    Souaibou, Yacoubou Imorou
    Devadasar, Giridhar H.
    Chong, Chean Leung
    Qadir, Muhammad Rashid Minhas
    Aung, Kyaw Phyo
    Yeo, Lee Shi
    Castillo, Vanessa Dina Palomino
    Munhoz, Monique Moron
    Moreira, Gisele
    Palomino Castillo, Vanessa Dina
    Barros De Castro Segundo, Luiz Carlos
    Khouri Ferreira, Salim Anderson
    Careta, Maira Cassa
    Araujo, Rafael
    Menegussi, Juliana
    Leal, Marisa
    Barroso de Lima, Caio Vinicius
    Tatagiba, Luiza Sarmento
    Leal, Antonio
    Nigo, Samuel
    Kabba, Juana
    Ngwa, Tagang Ebogo
    Brown, James
    King, Sebastian
    Zani, Augusto
    Azzie, Georges
    Firdouse, Mohammed
    Kushwaha, Sameer
    Agarwal, Arnav
    Bailey, Karen
    Cameron, Brian
    Livingston, Michael
    Horobjowsky, Alexandre
    Deckelbaum, Dan L.
    Razek, Tarek
    Montes, Irene
    Sierra, Sebastian
    Mendez, Manuela
    Isabel Villegas, Maria
    Mendoza Arango, Maria Clara
    Mendoza, Ivan
    Aristiza Ibal, Fred Alexander Naranjo
    Montoya Botero, Jaime Andres
    Quintero Riaza, Victor Manuel
    Restrepo, Jakeline
    Morales, Carlos
    Cruz, Herman
    Munera, Alejandro
    Karlo, Robert
    Domini, Edgar
    Mihanovic, Jakov
    Radic, Mihael
    Zamarin, Kresimir
    Pezelj, Nikica
    Khyrallh, Ahmed
    Hassan, Ahamed
    Shimy, Gamal
    Fahmy, Mohamed A. Baky
    Nabawi, Ayman
    Gohar, Muhammad Saad Ali Muhammad
    Elfil, Mohamed
    Ghoneem, Mohamed
    Gohar, Muhammad El-Saied Ahmad Muhammad
    Asal, Mohamed
    Abdelkader, Mostafa
    Gomah, Mahmoud
    Rashwan, Hayssam
    Karkeet, Mohamed
    Gomaa, Ahmed
    Hasan, Amr
    Elgebaly, Ahmed
    Saleh, Omar
    Fattah, Ahmad Abdel
    Gouda, Abdullah
    Elshafay, Abd Elrahman
    Gharib, Abdalla
    Hanafy, Mohammed
    Al-Mallah, Abdullah
    Abdulgawad, Mahmoud
    Baheeg, Mohamad
    Alhendy, Mohammed
    Fattah, Ibrahim Abdel
    Kenibar, Abdalla
    Osman, Omar
    Gemeah, Mostafa
    Mohammed, Ahmed
    Adel, Abdalrahman
    Mesreb, Ahmed Maher Menshawy
    Mohammed, Abdelrahman
    Sayed, Abdelrahman
    Abozaid, Mohamed
    Kotb, Ahmed Hafez El-Badri
    Ata, Ali Amin Ahmed
    Nasr, Mohammed
    Alkammash, Abdelrahman
    Saeed, Mohammed
    El Hamid, Nader Abd
    Attia, Attia Mohamed
    Abd El Galeel, Ahmed
    Elbanby, Eslam
    El-Dien, Khalid Salah
    Hantour, Usama
    Alahmady, Omar
    Mansour, Billal
    Elkorashy, Amr Muhammad
    Taha, Emad Mohamed Saeed
    Lasheen, Kholod Tarek
    Elkolaly, Salma Said
    Abdel-Wahab, Nehal Yosri Elsayed
    Abozyed, Mahmoud Ahmed Fathi
    Adel, Ahmed
    Saeed, Ahmed Moustafa
    El Sayed, Gehad Samir
    Youssif, Jehad Hassan
    Ahmed, Soliman Magdy
    El-Shahat, Nermeen Soubhy
    Khedr, Abd El-Rahman Hegazy
    Elsebaaye, Abdelrhman Osama
    Elzayat, Mohamed
    Abdelraheim, Mohamed
    Elzayat, Ibrahim
    Warda, Mahmoud
    El Deen, Khaled Naser
    Essam, Abdelrhman
    Salah, Omar
    Abbas, Mohamed
    Rashad, Mona
    Elzayyat, Ibrahim
    Hemeda, Dalia
    Tawfik, Gehad
    Salama, Mai
    Khaled, Hazem
    Seisa, Mohamed
    Elshaer, Kareem
    Hussein, Abdelfatah
    Elkhadrawi, Mahmoud
    Afifi, Ahmed Mohamed
    Ebrahim, Osama Saadeldeen
    Metwally, Mahmoud Mohamed
    Elmelegy, Rowida
    Elsawahly, Diaa Moustafa Elbendary
    Safa, Hisham
    Nofal, Eman
    Elbermawy, Mohamed
    Raya, Metwally Abo
    Ghazy, Ahmed Abdelmotaleb
    Samih, Hisham
    Abdelgelil, Asmaa
    Abdelghany, Sarah
    El Kholy, Ahmed
    Elkady, Fatma
    Salma, Mahmoud
    Samy, Sarah
    Fakher, Reem
    Aboarab, Aya
    Samir, Ahmed
    Sakr, Ahmed
    Haroun, Abdelrahman
    Al-Aarag, Asmaa Abdel-Rahman
    Elkholy, Ahmed
    Elshanwany, Sally
    Ghanem, Esraa
    Tammam, Ahmed
    Hammad, Ali Mohamed
    El Shoura, Yousra
    El Ashal, Gehad
    Antar, Sarah
    Mehrez, Sara
    Abdelshafy, Mahmoud
    Hamad, Maha Gamal Mohamad
    Hosh, Mona
    Abdallah, Emad
    Magdy, Basma
    Alzayat, Thuraya
    Gamaly, Elsayed
    Elfeki, Hossam
    Abouzahra, Amany
    Elsheikh, Shereen
    Elgendy, Fatimah I.
    Abd El-Salam, Fathia
    Seifelnasr, Osama
    Ammar, Mohamed
    Eysa, Athar
    Sadek, Aliaa
    Toeema, Aliaa Gamal
    Nasr, Aly
    Abuseif, Mohamed
    Zidan, Hagar
    Barakat, Sara Abd Elmageed
    Elsayed, Nadin
    Abd Elrasoul, Yasmin
    El-Kelany, Ahmed
    Ammar, Mohamed Sabry
    Mustafa, Mennat-Allah
    Makhlouf, Yasmin
    Etman, Mohamed
    Saad, Samar
    Alrahawy, Mahmoud
    Raslan, Ahmed
    Morsi, Mahmoud
    Sabry, Ahmed
    Elwakil, Hager
    Shaker, Heba
    Elkelany, Ahmed
    El-Kashef, Hussein
    Shaalan, Mohamed
    Tarek, Areej
    Elwan, Ayman
    Nayel, Ahmed Ragab
    Seif, Mostafa
    Shafik, Doaa Emadeldin
    Ghoname, Mohamed Ali
    Almallah, Ahmad
    Fouad, Ahmed
    Sayma, Eman Adel
    Elbatahgy, Ahmad
    El-Ma'doul, Angham Solaiman
    Mosad, Ahmed
    Tolba, Hager
    Elsorogy, Diaa Eldin Abdelazeem Amin
    Mostafa, Hassan Ali
    Omar, Amira Atef
    Abd El Hameed, Ola Sherief
    Lasheen, Ahmed
    Abd El Salam, Yasser
    Morsi, Ashraf
    Ismail, Mohammed
    Ahmed, Hager
    Amer, Mohamed A.
    El-Hamouly, Ahmed Sabry
    Attallah, Noura
    Mosalum, Omnia
    Afandy, Ahmed
    Mokhtar, Ahmed
    Abouelnasr, Alaa
    Ayad, Sara
    Shaker, Ramdan
    Sakr, Rokia
    Amreia, Mahmoud
    Elsobky, Soaad
    Mustafa, Mohamed
    El Magd, Ahmed Abo
    Marey, Abeer
    Tarek, Amr
    Fadel, Mohamed
    Mohamed, Mohamed Moamen
    Fadel, Amr
    Ahmed, Emad Ali
    Ali, Ahmad
    Alwafai, Mohammad Ghassan
    Alnawam, Ehab Abdulkader Hemida Ghazy
    Dwydar, Abdullah
    Kharsa, Sara
    Mamdouh, Ehab
    El-Sheemy, Hatem
    Alyoussef, Ibrahim
    Aly, Abouelatta Khairy
    Aldalaq, Ahmad
    Alnawam, Ehab
    Alkhabbaz, Dalia
    Saad, Mahmoud
    Hussein, Shady
    Elazayem, Ahmed Abo
    Meshref, Ahmed
    Elashmawy, Marwa
    Mousa, Mohammed
    Nashaat, Ahmad
    Ghanem, Sara
    Elsayed, Zaynab M.
    Elwaey, Aya
    Elkadsh, Iman
    Darweesh, Mariam
    Mohameden, Ahmed
    Hafez, Mennaallah
    Badr, Ahmed
    Badwy, Assmaa
    Abd El Slam, Mohamed
    Elazoul, Mohamed
    Al-Nahrawi, Safwat
    Eldamaty, Lotfy
    Nada, Fathee
    Ameen, Mohamed
    Hagar, Aya
    Elsehimy, Mohamed
    Abo-ryia, Mohammad
    Dawoud, Hossam
    El Mesery, Shorouk
    El Gendy, Abeer
    Abdelkareem, Ahmed
    Marey, Ahmed Safwan
    Allam, Mostafa
    Shehata, Sherif
    Abozeid, Khaled
    Elshobary, Marwa
    Fahiem, Ahmed
    Sarsik, Sameh
    Hashish, Amel
    Zidan, Mohamed
    Hashish, Mohamed
    Aql, Shaimaa
    Elhendawy, Abdelaziz Osman Abdelaziz
    Husseini, Mohamed
    Khater, Omar
    Kasem, Esraa Abdalmageed
    Gheith, Ahmed
    Elfouly, Yasmin
    Soliman, Ahmed Ragab
    Hani, Yasmein
    Elfouly, Nesma
    Fawzy, Ahmed
    Hassan, Ahmed
    Rashid, Mohammad
    Elsherbiny, Abdallah Salah
    Sieda, Basem
    Badwi, Nermin Mohamed
    Mohammed, Mohammed Mustafa Hassan
    Mohamed, Osama
    Habeeb, Mohammad Abdulkhalek
    Worku, Mengistu
    Starr, Nichole
    Desta, Semay
    Wondimu, Sahlu
    Abebe, Nebyou Seyoum
    Thomas, Efeson
    Asele, Frehun Ayele
    Dabessa, Daniel
    Abebe, Nebiyou Seyoum
    Zerihun, Abebe Bekele
    Scalabre, Aurelien
    Frade, Fernanda
    Irtan, Sabine
    Parent, Valentine
    Martin, Amandine
    Graffeille, Vivien
    Gaignard, Elodie
    Alimi, Quentin
    Abbo, Olivier
    Mouttalib, Sofia
    Bouali, Ourdia
    Hervieux, Erik
    Aigrain, Yves
    Botto, Nathalie
    Faure, Alice
    Fievet, Lucile
    Panait, Nicoleta
    Eyssartier, Emilie
    Schmitt, Francoise
    Podevin, Guillaume
    Muller, Cecile
    Bonnard, Arnaud
    Peycelon, Matthieu
    Abantanga, Francis
    Boakye-Yiadom, Kwaku
    Bukari, Mohammed
    Owusu, Frank
    Awuku-Asabre, Joseph
    Bray, Lemuel Davies
    Lytras, Dimitrios
    Psarianos, Kyriakos
    Bamicha, Anastasia
    Anthoulakis, Christos
    Nikoloudis, Nikolaos
    Mitroudis, Nikolaos
    Estupinian, Sergio
    Forno, Walter
    Guevara, Romeo
    Aguilera, Maria
    Mendez, Napoleon
    Mendizabal, Cesar Augusto Azmitia
    Ramazzini, Pablo
    Urquizu, Mario Contreras
    Rodriguez, Daniel Estuardo Marroquin
    Velsquez, Carlos Ivan Perez
    Merida, Sara Maria Contreras
    Regalado, Francisco
    Lopez, Mario
    Siguantay, Miguel
    Prasad, S. S.
    Kirishnan, Anand
    Gyanchandani, Nidhi
    Bhat, Sriram
    Sreedharan, Anjana
    Kinnera, S. V.
    Nadkami, Shravan
    Lakshmi, Harish Neelamraju
    Malik, Puneet
    Bin Mahamood, Abid
    Khajanchi, Monty
    Satoskar, Savni
    Satoskar, Rajeev
    Reddy, Yella
    Venugopal, Caranj
    Kumar, Sunil
    Sutanto, Eldaa Prisca Refianti
    Soeselo, Daniel Ardian
    Tedjaatmadja, Chintya
    Rahmawati, Fitriana Nur
    Mayasari, Maria
    Al-Hasani, Ruqaya Kadhim Mohammed Jawad
    Al-Hameedi, Hasan Ismael Ibraheem
    Al-Azraqi, Israa Abdullah Aziz
    Sabeeh, Lubna
    Kamil, Rahma
    Rasendran, Amoudtha
    Sheehan, Jacqueline
    Kerley, Robert
    Normile, Caoimhe
    Gilbert, Richard William
    Song, Jiheon
    Mauro, Linnea
    Dablouk, Mohammed Osman
    Kielty, Paul
    Marks, Eleanor
    Gosling, Simon
    Mccarthy, Michelle
    Mirghani, Diya
    Naqvi, Syed Altaf
    Wong, Chee Siong
    Gosling, Simon George
    Fahy, Ciara
    Cadogan, Diana Duarte
    Powell, Anna
    Gilbert, Richard
    Clifford, Caroline
    Driscoll, Aoife
    Paul, Stassen
    Lee, Chris
    Bowe, Ross
    Hutch, William
    Mohan, Helen
    O'Neill, Maeve
    Mealy, Kenneth
    Danelli, Piergiorgio
    Bondurri, Andrea
    Maffioli, Anna
    Bonavina, Luigi
    Macchitella, Yuri
    Ceriani, Chiara
    Veronese, Ezio
    Bortolasi, Luca
    Hasheminia, Alireza
    Benevento, Angelo
    Tessera, Gaetano
    Turati, Luca
    Sgroi, Giovanni
    Rausa, Emanuele
    Venskutonis, Donatas
    Bradulskis, Saulius
    Urbanavicius, Linas
    Austraite, Aiste
    Riauka, Romualdas
    Dambrauskas, Zilvinas
    Coomber, Ross
    Johnson, Kenneth
    Nowers, Jennifer
    Periasammy, Dineshwary
    Salleh, Afizah
    Das, Andre
    Tze, Reuben Goh Em
    Kumar, Milaksh Nirumal
    Abdullah, Nik Azim Nik
    Chong, Hoong Yin
    Agius, Marija
    Borg, Elaine
    Bezzina, Maureen
    Bugeja, Roberta
    Vella-Baldacchino, Martinique
    Spina, Andrew
    Psaila, Josephine
    Francois-Coridon, Helene
    Tolg, Cecilia
    Colombani, Jean-Francois
    Jacobe, Mario
    Mapasse, Domingos
    Snyder, Elizabeth
    Oumer, Ramadan
    Osman, Mohammed
    Mohammad, Aminu
    Anyanwu, Lofty-John
    Sheshe, Abdulrahman
    Adesina, Alaba
    Faturoti, Olubukola
    Taiwo, Ogechukwu
    Ibrahim, Muhammad Habib
    Nasir, Abdulrasheed A.
    Suleiman, Siyaka Itopa
    Adeniyi, Adewale
    Adesanya, Opeoluwa
    Adebanjo, Ademola
    Osuoji, Roland
    Atobatele, Kazeem
    Ogunyemi, Ayokunle
    Wiiliams, Omolara
    Oludara, Mobolaji
    Oshodi, Olabode
    Razzaq, Abdul
    Lawal, Oluwagbemiga
    Alakaloko, Felix
    Elebute, Olumide
    Osinowo, Adedapo
    Bode, Christopher
    Adesuyi, Abidemi
    Tade, Adesoji
    Adekoya, Adeleke
    Nwokoro, Collins
    Ayandipo, Omobolaji O.
    Lawal, Taiwo Akeem
    Ajao, Akinlabi E.
    Ali, Samuel Sani
    Odeyemi, Babatunde
    Olori, Samson
    Popoola, Ademola
    Adeyeye, Ademola
    Adeniran, James
    Lossius, William J.
    Havemann, Ingemar
    Thorsen, Kenneth
    Narvestad, Jon Kristian
    Wold, Trude Beate
    Nymo, Linn
    Elsiddig, Mohammed
    Dar, Manzoor
    Bhopal, Kamran Faisal
    Iftikhar, Zainab
    Furqan, Muhammad Mohsin
    Nighat, Bakhtiar
    Jawaid, Masood
    Khalique, Abdul
    Zil-E-Ali, Ahsan
    Rashid, Anam
    Aguilar, Wendy Leslie Messa
    Chiong, Jose Antonio Cabala
    Cecilia, Ana
    Bautista, Manchego
    Huaman, Eduardo
    Zegarra, Sergio
    Camacho, Rony
    Vergara Celis, Jose Maria
    Romani Pozo, Diego Alonso
    Hamasaki, Jose
    Temoche, Edilberto
    Herrera-Matta, Jaime
    Garcia Torres, Carla Pierina
    Alvarez Barreda, Luis Miguel
    Barrionuevo Ojeda, Ronald Renato
    Garaycochea, Octavio
    Mollo, Melanie Castro
    Delgado, Mitchelle Solange De Fa Tima Linares
    Fujii, Francisco
    Manchego Bautista, Ana Cecilia
    Messa Aguilar, Wendy Leslie
    Cabala Chiong, Jose Antonio
    Aranzabal Durand, Susana Yrma
    Arroyo Basto, Carlos Alejandro
    Urbina Rojas, Nelson Manuel
    Shu Yip, Sebastian Bernardo
    Contreras Vergara, Ana Lucia
    Rosas Moran, Andrea Echevarria
    Borda Luque, Giuliano
    Rodriguez Castro, Manuel
    Alvarado Jaramillo, Ramon
    Sila, George Manrique
    Lopez, Crislee Elizabeth
    De Leon, Mardelangel Zapata Ponze
    Machaca, Massiell
    Coasaca Huaraya, Ronald
    Arenas, Andy
    Herrera Puma, Clara Milagros
    Pino, Wilfredo
    Hinojosa, Christian
    Ponze De Leon, Melanie Zapata
    Limache, Susan
    Manrrique Sila, George
    Mercado Rodriguez, Layza-Alejandra
    Sauvat, Frederique
    Vida, Lucian Corneliu
    Muntean, Liviu Iuliu
    Mironescu, Aurel Sandu
    Alomar, Ibrahim N.
    Alnuqaydan, Saleh A.
    Altwigry, Abdulrahman M.
    Othman, Moayad
    Osman, Nohad
    Alqahtani, Enas
    Alzahrani, Mohammed
    Alyami, Rifan
    Aljohani, Emad
    Alhabli, Ibrahim
    Mikwar, Zaher
    Almuallem, Sultan
    Nawawi, Abrar
    Bakhaidar, Mohamad
    Maghrabi, Ashraf A.
    Alsaggaf, Mohammed
    Aljiffry, Murad
    Altaf, Abdulmalik
    Khoja, Ahmad
    Habeebullah, Alaa
    Akeel, Nouf
    Ghandora, Nashat
    Almoflihi, Abdullah
    Huwait, Abdulmalik
    Al-Shammari, Abeer
    Al-Mousa, Mashael
    Alghamdi, Masood
    Adham, Walid
    Albeladi, Bandar
    Alfarsi, Muayad Ahmed
    Mahdi, Atif
    Al Awwad, Saad
    Nouh, Thamer
    Hassanain, Mazen
    Aldhafeeri, Salman
    Sadig, Nawal
    Algohary, Osama
    Aledrisy, Mohannad
    Gudal, Ahmad
    Alrifaie, Ahmad
    AlRowais, Mohammed
    Althwainy, Amani
    Shabkah, Alaa
    Alamoudi, Uthman
    Alrajraji, Mawaddah
    Alghamdi, Basim
    Aljohani, Saud
    Daqeeq, Abdullah
    Al-Faifi, Jubran J.
    Jennings, Vicky
    Ngayu, Nyawira
    Moore, Rachel
    Kong, Victor
    Sampson, Colleen
    Panieri, Eugenio
    Tun, Myint
    Mphatsoe, Albert Mohale
    Carreira, Jo-Anne
    Teasdale, Ella
    Wagener, Mark
    Botes, Stefan
    Du Plessis, Danelo
    Pagnozzi, Janet
    Quezada, Jimy Harold Jara
    Rodicio, Jose Luis
    Minguez, German
    Rodriguez-Uria, Raquel
    Ugalde, Paul
    Lopez-Arevalo, Camilo
    Barneo, Luis
    Gonzales Stuva, Jessica Patricia
    Aguilar-Jimenez, Jose
    Andres Garcia-Marin, Jose
    Ortega-Vazquez, Irene
    Rodriguez, Lorena
    Herrera, Norberto
    Arachchi, Prasad Pitigala
    Jan, Wanigasekara Senanayake Mudiyanselage Kithsiri
    Arachchige, Lalith Asanka Jayasooriya Jayasooriya
    Sivaganesh, Sivasuriya
    Samaraweera, Dulan Irusha
    Thanusan, Vimalakanthan
    Musa, Ahmed Elgaili Khalid
    Balila, Reem Mohammed Hassan
    Mohamed, Mohamed Awad Elkarim Hamad
    Ali, Hussein
    Elabdin, Hagir Zain
    Hassan, Alaa
    Mahdi, Sefeldin
    Ahmed, Hala
    Idris, Sahar Abdoun Ishag
    Elsayed, Makki
    Elsayed, Mohammed
    Mahmoud, Mohamed
    Thorarinsdottir, Hildur
    Utter, Maria
    Sundstrom, Sami Martin
    Wredberg, Cecilia
    Kjellin, Ann
    Nyberg, Johanna
    Frisk, Bjorn
    Ahlqvist, Sandra
    Bjorklund, Ida
    Hjertberg, Maria
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Andersson, Linda
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Royson, Hanna
    Weber, Per
    Schmid, Roger
    Schivo, Debora
    Despotidis, Vasileios
    Breitenstein, Stefan
    Staerkle, Ralph F.
    Schadde, Erik
    Deichsel, Fabian
    Gerosa, Alexandra
    Nocito, Antonio
    Raptis, Dimitri Aristotle
    Mijuskovic, Barbara
    Zuber, Markus
    Eisner, Lukas
    Kruspi, Swantje
    Reinisch, Katharina Beate
    Schoewe, Christin
    Novak, Allan
    Palma, Adrian F.
    Teufelberger, Gerfried
    Balkan, Ali Zeynel Abidin
    Gumar, Mehmet
    Yavuz, Mehmet Ali
    Karabacak, Ufuk
    Lap, Gokhan
    Ozkan, Bahar Busra
    Adams, Ryan
    Morton, Robert
    Henderson, Liam
    Gratton, Ruth
    Clement, Keiran David
    Chang, Kate Yu-Ching
    McNish, David
    McIntosh, Ryan
    Milligan, William
    Skelly, Brendan
    Anderson-Knight, Hannah
    Lawther, Roger
    Onimowo, Jemina
    Shatkar, Veereanna
    Tharmalingam, Shivanee
    Woin, Evelina
    Fautz, Tessa
    Ziff, Oliver
    Dindyal, Shiva
    Arman, Sam
    Talukder, Shagorika
    Gadhvi, Vijay
    Chew, Luen Shaun
    Heath, Jonathan
    Mannu, Gurdeep Singh
    Zachariades, Dimitris-Christos
    Snaith, Ailsa Claire
    Hettiarachchi, Thusitha Sampath
    Nesaratnam, Arjun
    Wheeler, James
    Sykes, Mark
    Behar, Nebil
    Jordan, Harriet
    Arulampalam, Tan
    Shah, Apar
    Brown, Damien
    Blower, Emma
    Sutton, Paul
    Gasteratos, Konstantinos
    Vimalachandran, Dale
    Magee, Cathy
    Mcguigan, Andrew
    Mcaleer, Stephen
    Morgan, Clare
    Braungart, Sarah
    Lafferty, Kirsten
    Labib, Peter
    Tanase, Andrei
    Mangan, Clodagh
    Reza, Lillian
    Woodward, Helen
    Gouldthorpe, Craig
    Turner, Megan
    Wild, Jonathan R. L.
    Malik, Tom Am
    Proctor, Victoria K.
    Hewage, Kalon
    Davies, James
    Dubois, Andre
    Sarwary, Sayed
    Zardab, Ali
    Grant, Alan
    Mcintyre, Robert
    Tewari, Shirish
    Humm, Gemma
    Farinella, Eriberto
    Parthiban, Sunil
    Hall, Nigel J.
    Wright, Naomi J.
    Major, Christina P.
    Xerri, Thelma
    De Bono, Phoebe
    Amin, Jasim
    Farhad, Mustafa
    Camilleri-Brennan, John F.
    Robertson, Andrew G. N.
    Swann, Joanna
    Richards, James
    Jabbar, Aijaz
    Attard, Myranda
    Burns, Hannah
    Macdonald, Euan
    Baldacchino, Matthew
    Skehan, Jennifer
    Camilleri-Brennan, Julian
    Hall, Tom Falconer
    Gimzewska, Madelaine
    Mclachlan, Greta
    Shah, Jamie
    Giles, James
    Hassan, Maleeha
    Beasley, William
    Vlachogiorgos, Apostolos
    Dias, Stephen
    Maharaj, Geta
    McDonald, Rosie
    Cross, Kate
    Rees, Clare M.
    Van Duren, Bernard
    Upchurch, Emma
    Karandikar, Sharad
    Bowley, Doug
    Karim, Ahmed
    Chachulski, Witold
    Richardson, Liam
    Dawnay, Giles
    Thompson, Ben
    Mistry, Ajayesh
    Ghetia, Millika
    Roy, Sudipta
    Al-Obaedi, Ossama
    Das, Kaustuv
    Prabhudesai, Ash
    Cocker, D. M.
    Tan, Jessica Juliana
    Vivekanantham, Sayinthen
    Gillespie, Michael
    Gudlaugsdottir, Katrin
    Pezas, Theodore
    Currow, Chelise
    Kim, Matthew Young-Han
    Salama, Yahya
    Shah, Rohi
    Ibrahem, Ahmad Aboelkassem
    Ebdewi, Hamdi
    Gravante, Gianpiero
    El-Rabaa, Saleem
    Chan, Zoe
    Hassan, Zaffar
    Makinde, Misty
    Hemingway, David
    Dean, Ramzana
    Boddy, Alexander
    Aber, Ahmed
    Patel, Vijay
    Kotecha, Deevia
    Ubhi, Harmony Kaur
    Hosein, Simon-Peter
    Ward, Simon
    Malik, Kamran
    Jennings, Leifa
    Newton, Tom
    Alkhouri, Mirna
    Kang, Min Kyu
    Houlden, Christopher
    Barry, Jonathan
    Wilson, Michael S. J.
    Neo, Yan Ning
    Ibrahim, Ibrahim
    Chan, Emily
    Peck, Fraser S.
    Lim, Pei J.
    North, Alexander S.
    Blundell, Rebecca
    Williamson, Adam
    Fouad, Dina
    Minocha, Ashish
    Mccarthy, Kathryn
    Court, Emma
    Chambers, Alice
    Yee, Jenna
    Tham, Ji Chung
    Beaton, Ceri
    Walsh, Una
    Lockey, Joseph
    Bokhari, Salman
    Howells, Lara
    Griffiths, Megan
    Yallop, Laura
    Singh, Shailinder
    Nasher, Omar
    Jackson, Paul
    Ramzi, Saed
    Zeidan, Shady
    Doughty, Jennifer
    Sinha, Sidhartha
    Davenport, Ross
    Lewis, Jason
    Duffy, Leo
    Mcaleer, Elizabeth
    Williams, Eleanor
    Obute, Rhalumi Daniel
    Glover, Thomas E.
    Clark, David J.
    Boshnaq, Mohamed
    Akhtar, Mansoor
    Capleton, Pascale
    Doughan, Samer
    Rabie, Mohamed
    Mohamed, Ismail
    Samuel, Duncan
    Dickson, Lauren
    Kennedy, Matthew
    Dempster, Eleanor
    Brown, Emma
    Maple, Natalie
    Monaghan, Eimear
    Wolf, Bernhard
    Garland, Alicia
    Lund, Jonathan
    Boereboom, Catherine
    Murphy, Jennifer
    Tierney, Gillian
    Tou, Samson
    Zimmermann, Eleanor Franziska
    Smart, Neil James
    Warwick, Andrea Marie
    Stasinou, Theodora
    Daniels, Ian
    Findlay-Cooper, Kim
    Mitrasinovic, Stefan
    Ray, Swayamjyoti
    Varcada, Massimo
    D'souza, Rovan
    Omara, Sharif
    Boyce, Tamsin
    Whewell, Harriet
    Jones, Elin
    Ma, Jennifer
    Abington, Emily
    Ramcharn, Meera
    Williams, Gethin
    Winstanley, Joseph
    Kennedy, Ewan D.
    Yeung, Emily N. W.
    Fergusson, Stuart J.
    Jones, Catrin
    O'neill, Stephen
    Lim, Shujing Jane
    Liew, Ignatius
    Nair, Hari
    Fairfield, Cameron
    Oh, Julia
    Koh, Samantha
    Wilson, Andrew
    Fairfield, Catherine
    Th'ng, Francesca
    Robertson, Nichola
    Anandkumar, Delran
    Kirupagaran, Ashok
    Jones, Timothy F.
    Torrance, Hew D.
    Fowler, Alexander J.
    Chandrakumar, Charmilie
    Patel, Priyank
    Ashraf, Syed Faaz
    Lakhani, Sonam M.
    Mclean, Aaron Lawson
    Basson, Sonia
    Batt, Jeremy
    Bowman, Catriona
    Stoddart, Michael
    Benons, Natasha
    Barker, Tom
    Summerour, Virginia
    Harper, Edward
    Smith, Caroline
    Hampton, Matthew
    Mckechnie, Doug
    Farah, Ayaan
    Chun, Anita
    Pereira, Bernadette
    Nemeth, Kristof
    Decker, Emily
    Giuliani, Stefano
    Shalaby, Aly
    Szczap, Aleksandra
    Chidambaram, Swathikan
    Chen, Chee Yang
    Kulasabanathan, Kavian
    Chhabra, Srishti
    Kostov, Elisabeth
    Harbord, Philippe
    Barnacle, James
    Palliyil, Madan Mohan
    Zikry, Mina
    Porter, Johnathan
    Raslan, Charef
    Hafiz, Shazia
    Soltani, Niksa
    Baillie, Katie
    Mirza, Ahmad
    Saeed, Haroon
    Galloway, Simon
    Elena, Gia
    Afzal, Mohammad
    Zakir, Mohamed
    Sodde, Peter
    Hand, Charles
    Sriram, Aiesha
    Clark, Tamsyn
    Holton, Patrick
    Livesey, Amy
    Sinha, Yashashwi
    Iqbal, Fahad Mujtaba
    Bharj, Indervir Singh
    Rotundo, Adriana
    Jenvey, Cara
    Slade, Robert
    Golding, David
    Haines, Samuel
    Abdullah, Ali Adel Ne'ma
    Tilston, Thomas W.
    Loughran, Dafydd
    Donoghue, Danielle
    Giacci, Lorenzo
    Sherif, Mohamed Ashur
    Harrison, Peter
    Tang, Alethea
    Elshaer, Mohamed
    Urbonas, Tomas
    Riaz, Amjid
    Chapman, Annie
    Acharya, Parisha
    Shalhoub, Joseph
    Grossart, Cathleen
    McMorran, David
    Mlotshwa, Makhosini
    Hawkins, William
    Loizides, Sofronis
    Thomson, Peter
    Khan, Shahab
    Taylor, Fiona
    Shukla, Jalak
    Howie, Emma Elizabeth
    Macdonald, Linda
    Komolafe, Olusegun
    Mcintyre, Neil
    Cragg, James
    Parker, Jody
    Stewart, Duncan
    Lintin, Luke
    Tracy, Julia
    Farooq, Tahir
    Sion, Melanie
    Weinstein, Michael S.
    Punja, Viren
    Bugaev, Nikolay
    Goodstein, Monica
    Razmdjou, Shadi
    Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries2016In: BMJ Global Health, E-ISSN 2059-7908, Vol. 1, no 4, article id e000091Article in journal (Refereed)
    Abstract [en]

    Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.

    Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.

    Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.

    Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.

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  • 8. Adnan, Ali
    et al.
    Högmo, Anders
    Sjödin, Helena
    Gebre-Medhin, Maria
    Laurell, Göran
    Reizenstein, Johan
    Farnebo, Lovisa
    Norberg-Spaak, Lena
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Notstam, Isak
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Holmberg, Erik
    Cange, Hedda H.
    Hammerlid, Eva
    Health-related quality of life among tonsillar carcinoma patients in Sweden in relation to treatment and comparison with quality of life among the population2020In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 42, no 5, p. 860-872Article in journal (Refereed)
    Abstract [en]

    Background: The health-related quality of life (HRQOL) of tonsillar carcinoma survivors was explored to investigate any HRQOL differences associated with tumor stage and treatment. The survivors' HRQOL was also compared to reference scores from the population.

    Methods: In this exploratory cross-sectional study patients were invited 15 months after their diagnosis and asked to answer two quality of life questionnaires (EORTC QLQ- C30, EORTC QLQ- HN35), 405 participated.

    Results: HRQOL was associated with gender, with males scoring better than females on a few scales. Patients' HRQOL was more associated with treatment than tumor stage. Patients' HRQOL was worse than that in an age- and sex-matched reference group from the normal population, the largest differences were found for problems with dry mouth followed by problems with sticky saliva, senses, swallowing and appetite loss.

    Conclusions: The tonsillar carcinoma patients had a worse HRQOL compared to the general population one year after treatment.

  • 9. Agudo, Antonio
    et al.
    Bonet, Catalina
    Sala, Núria
    Muñoz, Xavier
    Aranda, Núria
    Fonseca-Nunes, Ana
    Clavel-Chapelon, Françoise
    Boutron-Ruault, Marie Christine
    Vineis, Paolo
    Panico, Salvatore
    Palli, Domenico
    Tumino, Rosario
    Grioni, Sara
    Quirós, J Ramón
    Molina, Esther
    Navarro, Carmen
    Barricarte, Aurelio
    Chamosa, Saioa
    Allen, Naomi E
    Khaw, Kay-Tee
    Bueno-de-Mesquita, H Bas
    Siersema, Peter D
    Numans, Mattijs E
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Kaaks, Rudof
    Canzian, Federico
    Boeing, Heiner
    Meidtner, Karina
    Johansson, Mattias
    Umeå University, Faculty of Medicine. WHO, IARC, Lyon, France.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Manjer, Jonas
    Overvad, Kim
    Tjonneland, Anne
    Lund, Eiliv
    Weiderpass, Elisabete
    Jenab, Mazda
    Fedirko, Veronika
    Offerhaus, G Johan A
    Riboli, Elio
    González, Carlos A
    Jakszyn, Paula
    Hemochromatosis (HFE) gene mutations and risk of gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) study2013In: Carcinogenesis, ISSN 0143-3334, E-ISSN 1460-2180, Vol. 34, no 6, p. 1244-1250Article in journal (Refereed)
    Abstract [en]

    Hereditary hemochromatosis (HH) is a strong risk factor for hepatocellular cancer, and mutations in the HFE gene associated with HH and iron overload may be related to other tumors, but no studies have been reported for gastric cancer (GC). A nested case-control study was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC), including 365 incident gastric adenocarcinoma and 1284 controls matched by center, sex, age and date of blood collection. Genotype analysis was performed for two functional polymorphisms (C282Y/rs1800562 and H63D/rs1799945) and seven tagSNPs of the HFE genomic region. Association with all gastric adenocarcinoma, and according to anatomical localization and histological subtype, was assessed by means of the odds ratio (OR) and 95% confidence interval (CI) estimated by unconditional logistic regression adjusted for the matching variables. We observed a significant association for H63D with OR (per rare allele) of 1.32 (CI = 1.03-1.69). In subgroup analyses, the association was stronger for non-cardia anatomical subsite (OR = 1.60, CI = 1.16-2.21) and intestinal histological subtype (OR = 1.82, CI = 1.27-2.62). Among intestinal cases, two tagSNPs (rs1572982 and rs6918586) also showed a significant association that disappeared after adjustment for H63D. No association with tumors located in the cardia or with diffuse subtype was found for any of the nine SNPs analyzed. Our results suggest that H63D variant in HFE gene seems to be associated with GC risk of the non-cardia region and intestinal type, possibly due to its association with iron overload although a role for other mechanisms cannot be entirely ruled out.

  • 10.
    Ahlberg, Hans
    et al.
    Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Östersund).
    Wallgren, Daniel
    Department of Surgical and € Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sunderbyn).
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Department of Surgical and € Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sunderbyn).
    Johansson, Joakim
    Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Östersund).
    Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery: A randomised controlled trial2023In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 40, no 9, p. 636-642Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Surgery for breast cancer is common, and intravenous opioids are often used to control postoperative pain. Recently, pectoralis-2 (PECS-2) block has emerged as a promising regional anaesthetic alternative. With nomenclature recently proposed, this block is termed combined PSP/IPP-block (pectoserratus plane block/interpectoral plane block).

    OBJECTIVE: We aimed to compare the need for postoperative rescue morphine between the intervention group that received a pre-operative combined PSP/IPP-block and a control group that received peri-operative long-acting opioids for postoperative analgesia.

    DESIGN: A randomised controlled study.

    SETTING: Operating theatres of two Swedish hospitals. The patients were recruited between May 2017 and October 2020.

    PATIENTS: Among the 199 women scheduled to undergo breast cancer surgery (sector resection or radical mastectomy) who were enrolled in the study, 185 were available for follow up.

    INTERVENTION: All patients received general anaesthesia. The intervention group received a combined PSP/IPP-block before surgery. The control group received intravenous morphine 30 min before emergence from anaesthesia.

    MAIN OUTCOME MEASURE: The primary endpoint was the cumulative need for intravenous rescue morphine to reach a predefined level of pain control (visual analogue scale score <40 mm) during the first 48 h after surgery.

    RESULTS: Data from 92 and 93 patients in the intervention and control groups, respectively, were analysed. The amount of rescue morphine administered in the 48 h after surgery was significantly lower in the intervention group than in the control group (median: 2.25 vs 3.0 mg, P  = 0.021). The first measured pain score was lower in the intervention group than in the control group (35 vs. 40 mm, P  = 0.035). There was no significant difference in the incidence of nausea between the groups (8.7 vs. 12.9%, P  = 0.357).

    CONCLUSION: The use of a combined PSP/IPP-block block before breast cancer surgery reduces the need for postoperative rescue morphine, even when compared with the use of intra-operative morphine.

    TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03117894.

  • 11. Ahlborg, Liv
    et al.
    Hedman, Leif
    Nisell, Henry
    Felländer-Tsai, Li
    Enochsson, Lars
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden; Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Simulator training and non-technical factors improve laparoscopic performance among OBGYN trainees2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 10, p. 1194-1201Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate how simulator training and non-technical factors affect laparoscopic performance among residents in obstetrics and gynecology. DESIGN: In this prospective study, trainees were randomized into three groups. The first group was allocated to proficiency-based training in the LapSimGyn(®) virtual reality simulator. The second group received additional structured mentorship during subsequent laparoscopies. The third group served as control group. At baseline an operation was performed and visuospatial ability, flow and self-efficacy were assessed. All groups subsequently performed three tubal occlusions. Self-efficacy and flow were assessed before and/or after each operation. SETTING: Simulator training was conducted at the Center for Advanced Medical Simulation and Training, Karolinska University Hospital. Sterilizations were performed at each trainee's home clinic. POPULATION: Twenty-eight trainees/residents from 21 hospitals in Sweden were included. METHODS/MAIN OUTCOME MEASURES: Visuospatial ability was tested by the Mental Rotation Test-A. Flow and self-efficacy were assessed by validated scales and questionnaires. Laparoscopic performance was measured as the duration of surgery. Visuospatial ability, self-efficacy and flow were correlated to the laparoscopic performance using Spearman's correlations. Differences between groups were analyzed by the Mann-Whitney U-test. RESULTS: No differences across groups were detected at baseline. Self-efficacy scores before and flow scores after the third operation were significantly higher in the trained groups. Duration of surgery was significantly shorter in the trained groups. Flow and self-efficacy correlate positively with laparoscopic performance. CONCLUSIONS: Simulator training and non-technical factors appear to improve the laparoscopic performance among trainees/residents in obstetrics and gynecology.

  • 12. Ahlborg, Liv
    et al.
    Weurlander, Maria
    Hedman, Leif
    Nisel, Henry
    Lindqvist, Pelle G
    Felländer-Tsai, Li
    Enochsson, Lars
    Individualized feedback during simulated laparoscopic training: a mixed methods study.2015In: International Journal of Medical Education, E-ISSN 2042-6372, Vol. 6, p. 93-100Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study aimed to explore the value of individualized feedback on performance, flow and self-efficacy during simulated laparoscopy. Furthermore, we wished to explore attitudes towards feedback and simulator training among medical students.

    METHODS: Sixteen medical students were included in the study and randomized to laparoscopic simulator training with or without feedback. A teacher provided individualized feedback continuously throughout the procedures to the target group. Validated questionnaires and scales were used to evaluate self-efficacy and flow. The Mann-Whitney U test was used to evaluate differences between groups regarding laparoscopic performance (instrument path length), self-efficacy and flow. Qualitative data was collected by group interviews and interpreted using inductive thematic analyses.

    RESULTS: Sixteen students completed the simulator training and questionnaires. Instrument path length was shorter in the feedback group (median 3.9 m; IQR: 3.3-4.9) as compared to the control group (median 5.9 m; IQR: 5.0-8.1), p<0.05. Self-efficacy improved in both groups. Eleven students participated in the focus interviews. Participants in the control group expressed that they had fun, whereas participants in the feedback group were more concentrated on the task and also more anxious. Both groups had high ambitions to succeed and also expressed the importance of getting feedback. The authenticity of the training scenario was important for the learning process.

    CONCLUSIONS: This study highlights the importance of individualized feedback during simulated laparoscopy training. The next step is to further optimize feedback and to transfer standardized and individualized feedback from the simulated setting to the operating room.

  • 13.
    Ahlgren, Olof
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Kalciumbrist - osteoporos: parathyreoideaes roll vid adaptionen till lågt kalciumintag hos vuxna råttor1975Doctoral thesis, comprehensive summary (Other academic)
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    Kalciumbrist - osteoporos
  • 14.
    Ahlqvist, Sandra
    et al.
    Department of Anesthesia and Intensive care, Sundsvall Hospital, Sundsvall, Sweden.
    Björk, Dennis
    Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.
    Weisby, Lena
    Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.
    Israelsson, Leif
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Cengiz, Yucel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Trocar Site Hernia After Gastric Bypass2017In: Surgical technology international, ISSN 1090-3941, Vol. 30, p. 170-174Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The 5.2% rate of trocar site incisional hernia (TSIH) reported appears low in view of the proportion of TSIH repairs being performed. Detecting TSIH by clinical examination may be difficult in the obese. The correlation between clinical examination and a novel radiological examination for the detection of TSIH in obese patients was studied.

    MATERIALS AND METHODS: Twenty-six patients subjected to laparoscopic gastric bypass in 2010 underwent clinical and radiological examination by three independent assessors for each method, after a mean follow-up time of 33 months. The computed tomography was in the prone position upon a ring.

    RESULTS: At clinical examination, a TSIH was regarded to be present in six out of 26 patients and at CT scan in four. The Fleiss' Kappa for multiple raters was 0.40 (p = 0.184) with clinical examination and 1 (p <0.05) with CT scan. With CT scan, herniation was diagnosed in three of 26 umbilical trocar sites that had been closed at the index operation, and in one of the 130 other trocar sites that had not been closed.

    CONCLUSIONS: Clinical examination is not reliable when detecting TSIH in the obese. A CT scan in the prone position was extremely reliable and seems to have the potential of becoming the standard method for detecting TSIH in obese patients.

  • 15.
    Ahlqvist, Sandra
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Anesthesia and Intensive Care, Region Västernorrland, Härnösand, Sweden.
    Edling, Axel
    Granlo Health Center, Sundsvall, Sweden.
    Alm, Magnus
    Department of Radiology, Sundsvall Hospital, Sundsvall, Sweden.
    Dackhammar, Johan Blixt
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Cengiz, Yucel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Trocar site hernia after gastric sleeve2022In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 36, no 6, p. 4386-4391Article in journal (Refereed)
    Abstract [en]

    Background: Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position was found to be a reliable method for the detection of TSH following gastric bypass (LRYGB). In the present study, our aim was to examine the incidence of TSH after gastric sleeve, and further to investigate the proportion of symptomatic trocar site hernias.

    Methods: Seventy-nine patients subjected to laparoscopic gastric sleeve in 2011–2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey.

    Results: The incidence of trocar site hernia was 17 out of 79 (21.5%), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no significant correlation between patient symptoms and a TSH.

    Conclusions: The incidence of TSH is high after laparoscopic gastric sleeve, a finding in line with several recent studies as well as with our first trial on trocar site hernia after LRYGB. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of a trocar site hernia can be serious, the proportion of symptomatic TSH needs to be more clarified.

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  • 16. Ahmadi, Zainab
    et al.
    Bornefalk-Hermansson, Anna
    Franklin, Karl A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Midgren, Bengt
    Ekström, Magnus P
    Hypo- and hypercapnia predict mortality in oxygen-dependent chronic obstructive pulmonary disease: a population-based prospective study2014In: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 15, no 1, p. 30-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The prognostic role of the arterial blood gas tension of carbon dioxide (PaCO2) in severe Chronic Obstructive Pulmonary Disease (COPD) remains unknown. The aim of this study was to estimate the association between PaCO2 and mortality in oxygen-dependent COPD. METHODS: National prospective study of patients starting long-term oxygen therapy (LTOT) for COPD in Sweden between October 1, 2005 and June 30, 2009, with all-cause mortality as endpoint. The association between PaCO2 while breathing air, PaCO2 (air), and mortality was estimated using Cox regression adjusted for age, sex, arterial blood gas tension of oxygen (PaO2), World Health Organization performance status, body mass index, comorbidity, and medications. RESULTS: Of 2,249 patients included, 1,129 (50%) died during a median 1.1 years (IQR 0.6-2.0 years) of observation. No patient was lost to follow-up. PaCO2 (air) independently predicted adjusted mortality (p < 0.001). The association with mortality was U-shaped, with the lowest mortality at approximately PaCO2 (air) 6.5 kPa and increased mortality at PaCO2 (air) below 5.0 kPa and above 7.0 kPa. CONCLUSION: In oxygen-dependent COPD, PaCO2 (air) is an independent prognostic factor with a U-shaped association with mortality.

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  • 17.
    Ajiko, Mary Margaret
    et al.
    Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden; Soroti Regional Referral Hospital, Box 289, Soroti, Uganda.
    Weidman, Viking
    Uppsala University, Uppsala, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Wladis, Andreas
    Löfgren, Jenny
    Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden.
    Prevalence of Paediatric Surgical Conditions in Eastern Uganda: A Cross-Sectional Study2022In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, p. 701-708Article in journal (Refereed)
    Abstract [en]

    Background: The role of surgery in global health has gained greater attention in recent years. Approximately 1.8 billion children below 15 years live in low- and middle-income countries (LMIC). Many surgical conditions affect children. Therefore, paediatric surgery requires specific emphasis. Left unattended, the consequences can be dire. Despite this, there is a paucity of data regarding prevalence of surgical conditions in children in LMIC. The present objective was to investigate the prevalence of paediatric surgical conditions in children in a defined geographical area in Eastern Uganda.

    Method: A cross-sectional study was carried out in the Iganga-Mayuge Health and Demographic Surveillance Site located in Eastern Uganda. Through a two-stage, cluster-based sampling process, 490 households from 49 villages were randomly selected, generating a study population of 1581 children. The children’s caregivers were interviewed, and the children were physically examined by two medical doctors to identify any surgical conditions.

    Results: The interview was performed with 1581 children, and 1054 were physically examined. Among these, the overall prevalence of any surgical condition was 16.0 per cent (n = 169). Of these, 39 per cent had an unmet surgical need (66 of 169). This is equivalent to a 6.3 per cent prevalence of current unmet surgical need. The most common groups of surgical condition were congenital anomalies and trauma-related conditions.

    Conclusion: Surgical conditions in children are common in eastern Uganda. The unmet need for surgery is high. With a growing population, the need for paediatric surgical capacity will increase even further. The health care system must be reinforced to provide services for children with surgical conditions if United Nations Sustainability Development Goal 3 is to be achieved by 2030.

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  • 18.
    Al-Amiry, Bariq
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Karolinska Univ Hosp, Dept Radiol, Stockholm, Sweden.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Krupic, Ferid
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning?2017In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, no 9, p. 1125-1131, article id 0284185116684676Article in journal (Refereed)
    Abstract [en]

    Background: Restoration of femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA) as it improves functional outcome. Purpose: To analyze whether the problem of postoperative leg lengthening and FO reduction is related to the femoral stem or acetabular cup positioning or both. Material and Methods: Between September 2010 and April 2013, 172 patients with unilateral primary osteoarthritis treated with THA were included. Postoperative leg-length discrepancy (LLD) and global FO (summation of cup and FO) were measured by two observers using a standardized protocol for evaluation of antero-posterior plain hip radiographs. Patients with postoperative leg lengthening >= 10mm (n = 41) or with reduced global FO >5mm (n = 58) were further studied by comparing the stem and cup length of the operated side with the contralateral side in the lengthening group, and by comparing the stem and cup offset of the operated side with the contralateral side in the FO reduction group. We evaluated also the inter-observer and intra-observer reliability of the radiological measurements. Results: Both observers found that leg lengthening was related to the stem positioning while FO reduction was related to the positioning of both the femoral stem and acetabular cup. Both inter-observer reliability and intra-observer reproducibility were moderate to excellent (intra-class correlation co-efficient, ICC >= 0.69). Conclusion: Post THA leg lengthening was mainly caused by improper femoral stem positioning while global FO reduction resulted from improper positioning of both the femoral stem and the acetabular cup.

  • 19.
    Albertsson, Pontus
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
    Occupant casualties in bus and coach traffic: injury and crash mechanisms2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The relevance of conducting this thesis is evident by the fact that bus and coach casualties have been “stubbornly stable” in Europe recent years and a need for investigating if a similar trend could be found in Sweden is therefore obvious. It was also important to add new knowledge to the bus and coach research in Sweden, since many areas were scarcely addressed.

    Aims: To describe bus and coach occupants’ injuries, crash and injury mechanisms generated in a traffic environment based on data from the medical sector. Additional aims were to investigate the injury reducing effect of a 3-point belt, the effect of cross-winds, and crucial factors in the emergency- and rescue response.

    Material and methods: Injury data analyses were based on a complete ten-year medical data set from a catchment-area with about 130,000 inhabitants. A number of crash studies with the scope in different crash phases were conducted by applying and elaborating the Haddon matrix as a framework. An additional framework, Protocol for Major Incidents was used in order to investi-gate the emergency- and rescue response to a severe coach crash.

    Results: Between the first and second five-year period, the incidence of injured in non-crash in-cidents was increased by 24%. In non-crash incidents, 54% were injured; 2/3 while alighting from a bus or coach. The pre-crash factor cross-wind, in addition to vehicle design, vehicle speed and road friction, was investigated in ten crashes. It was confirmed that cross-wind, in relation to vehicle speed and slippery road conditions, needs more attention. The importance of goods load-ing and passengers’ position in the bus, was indicated by the fact that a displacement of the cen-tre of mass rearwards with 10% increased the necessary coefficient of friction with, on average 45%, which in many cases corresponded to dry road conditions. Three Swedish rollover crashes were analysed with regard to the injury outcome, mechanisms and the possible injury reduction for occupants using a safety belt. A considerable increase in safety for occupants belted with 3-point belts was shown through limiting interior contacts, occupant interaction and the possibility of ejection. Crucial post-crash factors in the emergency- and rescue response showed that ordi-nary ways of working and equipment are not always useful and proper equipment for lifting a coach body is essential in the case of a rollover. Finally, the communication between the hospitals is important, and the telephone systems may be overloaded by calls from worried relatives and media.

    Conclusions: In non-crash events: Non-crash events constitute a majority of all bus and coach casualties with a high proportion of elderly female occupants among the MAIS 2+ injury cases. Boarding and, especially alighting causes many injuries to the lower extremities.

    In the pre-crash phase: Cross-winds do affect the safety of buses and coaches and requires more at-tention. Seat belt usage among bus and coach occupants has to be increased.

    In the crash phase: Rollover and ejection are the major causes behind serious and fatal injuries to bus and coach occupants, consequently, retentive glazing, pillars or rails need more attention. An upgrade from 2-point seat belts to 3-point seat belts yields an increase in the estimated injury re-duction from approximately 50% up to 80% for the MAIS 2+ casualties in a rollover crash.

    In the post-crash phase: In order to be able to lift a coach body proper equipment originated from experience and development is essential in a rescue operation of a crashed bus or coach. Fur-thermore, to improve the emergency response inside crashed coaches proper methods originated from experience need to be developed.

    Euro NBAP: Based on the results and conclusions generated in this thesis, a European New Bus and Coach Assessment Programme is suggested, which would provide bus and coach occupants with a assessment programme similar to the Euro NCAP.

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  • 20. Alexandersson, Maria
    et al.
    Wang, Eugen Yuhui
    Eriksson, Staffan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Centre for Clinical Research Sörmland, Uppsala University, Kungsgatan 41, 631 88 Eskilstuna, Sweden; Department of Neuroscience, Physiotherapy, Uppsala University, Box 593, 751 24 Uppsala, Sweden.
    A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 4, p. 1035-1042Article in journal (Refereed)
    Abstract [en]

    Purpose: When a tourniquet is used during surgery on the extremities, the pressure applied to the muscles, nerves and blood vessels can cause neuromuscular damage that contributes to postoperative weakness. The hypothesis was that the rehabilitation-related results would be improved if total knee arthroplasty (TKA) is performed without the use of a tourniquet.

    Methods: 81 patients with osteoarthritis of the knee who underwent TKA surgery were randomized to surgery with or without tourniquet. Active flexion and extension of the knee, pain by visual analog scale (VAS), swelling by knee circumference, quadriceps function by straight leg raise, and timed up and go (TUG) test results were measured before and up to 3 months after surgery.

    Results: ANCOVA revealed no between-groups effect for flexion of the knee at day 3 postsurgery. Compared with the tourniquet group, the nontourniquet group experienced elevated pain at 24 h, with a mean difference of 16.6 mm, p = 0.005. The effect on mobility (TUG test) at 3 months was better in the nontourniquet group, with a mean difference of -1.1 s, p = 0.029.

    Conclusions: The hypothesis that the rehabilitation-related results would be improved without a tourniquet is not supported by the results. When the results in this study for surgery performed with and without tourniquet are compared, no clear benefit for either procedure was observed, as the more pain exhibited by the nontourniquet group was only evident for a short period and the improved mobility in this group was not at a clinically relevant level.

    Level of evidence: Inconsistent results, Level II.

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  • 21.
    Al-Faisal, Hanien
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Alkheder, Bayan
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    The Acute Maxillofacial Infection- a retrospective medical journals analysis of patients in inpatient care2022Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: An absolute majority of dental infections are treated without major complications. In exceptional situations dental infections can spread to surrounding structures such as the airways or even the brain leading to a life-threatening condition that requires hospitalization. According to literature, some qualified risk factors appear to be common in hospitalized patients.

    Aim: To outline factors typically seen in patients with acute maxillofacial infections with dental origin at Norrland University Hospital (NUS) and find possible association between these factors and the length of hospital stay. 

    Methods: A literature review using keywords associated with dental infections and acute throat and head infections was performed. Retrospective structured medical journal reviews of 58 patients suffering from acute maxillofacial infections which required hospitalization at NUS were analyzed. The results were analyzed using IBM SPSS Statistics software and Microsoft Office Excel.

    Results: The results indicated that overweight/obese people (Body Mass Index ⊵25) require longer care at the hospital due to their infection. Every other of the hospitalized patients had received dental treatment within 14 days prior to hospitalization. 

    Conclusions: In situations with acute maxillofacial infections of dental origin requiring hospitalization, BMI ⊵25 is eventually a risk factor. A group of patients received dental treatment for their infection, but the infection still exacerbated. How come? This requires deeper analysis with further studies.

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  • 22.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Reply to the letter from Dr. Karsten Knobloch regarding our article "Sclerosing injections to treat midportion Achilles tendinosis: a randomized controlled study evaluating two different concentrations of polidocanol"2009In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 17, no 1, p. 113-114Article in journal (Other academic)
  • 23.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Sports Medicine. Alfredson Tendon Clinic, Capio Ortho Center Skåne, Malmö, Sweden.
    Roberts, David
    Capio Ortho Center Skåne, Malmö, Sweden.
    Spang, Christoph
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Institute for Sports Science, Würzburg University, Würzburg, Germany; Private Orthopaedic Spine Center, Würzburg, Germany.
    Waldén, Markus
    Capio Ortho Center Skåne, Malmö, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Ultrasound- and doppler-Guided WALANT arthroscopic surgery for patellar tendinopathy with Partial Rupture in Elite Athletes: a 2-Year follow-up of a prospective case series2024In: Medicina, ISSN 1010-660X, E-ISSN 1648-9144, Vol. 60, no 4, article id 541Article in journal (Refereed)
    Abstract [en]

    Background and Objectives: Patellar tendinopathy is difficult to treat, and when combined with partial rupture, there are additional challenges. The aim of this study was to evaluate the subjective outcome and return-to-sport status after ultrasound (US)- and colour doppler (CD)-guided wide awake local anaesthetic no tourniquet (WALANT) arthroscopic shaving in elite athletes.

    Material and Methods: Thirty Swedish and international elite athletes (27 males) with a long duration (>1 year) of persistent painful patellar tendinopathy in 35 patellar tendons, not responding to non-surgical treatment, were included. All patients were treated with the same protocol of arthroscopic shaving, including bone removal and debridement of partial rupture, followed by at least 3 months of structured rehabilitation. The VISA-P score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation.

    Results: At the 2-year follow-up (mean 23, range 8–38 months), 25/30 patients (29/35 tendons) were satisfied with the treatment result and had returned to their pre-injury sport. The mean VISA-P score increased from 37 (range 7–69) before surgery to 80 (range 44–100) after surgery (p < 0.05). There was one drop-out (one tendon). There were no complications.

    Conclusions: US- and CD-guided WALANT arthroscopic shaving for persistent painful patellar tendinopathy, including bone removal and debridement of partial rupture, followed by structured rehabilitation showed good clinical results in the majority of the elite-level athletes.

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  • 24.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. ISEH, UCLH, London, UK; Pure Sports Medicine Clinic, London, UK.
    Spang, Christoph
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Dr Alfen, Orthopedic Spine Center, 97080 Würzburg, Germany.
    Clinical presentation and surgical management of chronic Achilles tendon disorders: a retrospective observation on a set of consecutive patients being operated by the same orthopedic surgeon2018In: Foot and Ankle Surgery, ISSN 1268-7731, E-ISSN 1460-9584, Vol. 24, no 6, p. 490-494Article in journal (Refereed)
    Abstract [en]

    Background: Non-invasive treatment is not always successful in patients with Achilles tendon disorders, and surgical treatment is instituted as the next step. There is sparse knowledge about the diagnoses, pain levels before surgery, surgically confirmed pathologies and postoperative complications in large patient groups.

    Aims: To study the diagnoses, pain scores before surgery, macroscopic surgical findings and postoperative complications in a series of patients treated for Achilles disorders.

    Material and methods: One surgeon operated on 771 Achilles tendons of 481 men and 290 women during a 10-year period. The clinically and ultrasound confirmed diagnoses, pre-operative pain and functional scores (Visual Analogue Scale, VAS, range 0-100; Victorian Institute Sports Tendon Assessment - Achilles questionnaire, VISA-A), macroscopic findings during surgery and postoperative complications, were retrospectively collected from a database.

    Results: Clinically, by ultrasound and during surgery midportion Achilles tendinopathy was confirmed in 519 (67%) patients, 41% of them had a thickened plantaris tendon located close the Achilles tendon. Partial midportion rupture was found in 31 (4%) patients, chronic midportion rupture in 12 (2%) patients and insertional Achilles tendinopathy, including superficial and retro-calcaneal bursitis, Haglund deformity, distal Achilles tendinopathy, plantaris tendon pathology, and bone spurs, in 209 (27%) patients. The mean pre-operative pain scores for midportion Achilles tendinopathy were 73 (VAS) and 45 (VISA-A), and for insertional Achilles tendinopathy 77 (VAS) and 39 (VISA-A). For midportion Achilles tendinopathy there were 14 (3%), and for insertional Achilles tendinopathy 10 (5%), postoperative complications.

    Conclusions: Patients presenting high pain scores from midportion Achilles tendinopathy were the most common. Plantaris tendon involvement is a frequent observation. For insertional Achilles tendinopathy the combination of pathology in the subcutaneous and retrocalcaneal bursa, a Haglund deformity and distal Achilles tendinopathy/tendinosis was most frequent. 

  • 25.
    Almkvist, Louise
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Agreement between LARS and Wexner score Two fecal incontinence scoring systems2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 26.
    Alpstål, Johan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gallium-Dotatoc-PET in GEP-NET and its correlation to hormonal biomarkers2019Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 27.
    Al-Shamkhi, Nasrin
    et al.
    Department of Internal Medicine, Örebro University Hospital and School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Endocrinology and Diabetology, Uppsala University Hospital, Uppsala, Sweden.
    Berinder, Katarina
    Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Borg, Henrik
    Department of Endocrinology, Skåne University Hospital, Lund University, Lund, Sweden.
    Burman, Pia
    Department of Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden.
    Dahlqvist, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Höybye, Charlotte
    Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Olsson, Daniel S.
    Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Ragnarsson, Oskar
    Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Göteborg, Sweden.
    Ekman, Bertil
    Departments of Endocrinology in Linköping and Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Engström, Britt Eden
    Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
    Pituitary function before and after surgery for nonfunctioning pituitary adenomas-data from the Swedish pituitary register2023In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 189, no 2, p. 217-224Article in journal (Refereed)
    Abstract [en]

    Objective: Data on pre- and postoperative pituitary function in nonfunctioning pituitary adenomas (NFPA) are not consistent. We aimed to investigate pituitary function before and up to 5 years after transsphenoidal surgery with emphasis on the hypothalamic-pituitary-adrenal axis (HPA).

    Design and methods: Data from the Swedish Pituitary Register was used to analyze anterior pituitary function in 838 patients with NFPA diagnosed between 1991 and 2014. Patients who were reoperated or had received radiotherapy were excluded.

    Results: Preoperative ACTH, TSH, LH/FSH, and GH deficiencies were reported in 31% (236/755), 39% (300/769), 51% (378/742), and 28% (170/604) of the patients, respectively. Preoperative median tumor volume was 5.0 (2.4-9.0) cm(3). Among patients with preoperative, 1 year and 5 years postoperative data on the HPA axis (n = 428), 125 (29%) were ACTH-deficient preoperatively. One year postoperatively, 26% (32/125) of them had recovered ACTH function while 23% (70/303) patients had developed new ACTH deficiency. Thus, 1 year postoperatively, 163 (38%) patients were ACTH-deficient (P < .001 vs. preoperatively). No further increase was seen 5 years postoperatively (36%, P = .096). At 1 year postoperatively, recoveries in the TSH and LH/FSH axes were reported in 14% (33/241) and 15% (46/310), respectively, and new deficiencies in 22% (88/403) and 29% (83/288), respectively.

    Conclusions: Adrenocorticotrophic hormone deficiency increased significantly at 1 year postoperatively. Even though not significant, some patients recovered from or developed new deficiency between 1 and 5 years postoperatively. This pattern was seen in all axes. Our study emphasizes that continuous individual evaluations are needed during longer follow-up of patients operated for NFPA.

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  • 28.
    Al-Taai, Nameer
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Persson, Maurits
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ransjö, Maria
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orthodontics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Westerlund, Anna
    Department of Orthodontics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dentoskeletal and soft tissue changes after treatment of crowding with premolar extractions: a 50-year follow-up2023In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 41, no 1, p. 79-87Article in journal (Refereed)
    Abstract [en]

    Background: The long-term effects on dentofacial morphology of interceptive treatment with premolar extractions, in the absence of subsequent orthodontic treatment, have not been fully explored.

    Objective: The aim was to investigate the effects of premolar extractions (without subsequent orthodontic treatment) on the dentoskeletal and soft tissue profile of patients aged between 12 and 62 years with Class I malocclusion with severe crowding, as compared to untreated controls.

    Materials and methods: The Extraction group (N = 30 with Class I crowding malocclusion) had their first premolars removed in early adolescence without subsequent orthodontic treatment. The Control group included 30 untreated subjects with Class I normal occlusion. Cephalograms were taken at 12 (T1), 15 (T2), 30 (T3), and 62 (T4) years of age. A superimposition-based cephalometric method was used to assess the dentoskeletal and soft tissue changes.

    Results: There were no significant differences between the Extraction and Control groups in terms of skeletal sagittal relation, incisor inclination, and protrusion, or most of the soft tissue parameters throughout the observation period. However, significant differences were observed between the groups with respect to the vertical relations in T2-T3, such that the Extraction group showed more-pronounced decreases in the ML/NSL, ML/NL, and Gonial angles and more-pronounced increases in facial heights.

    Conclusions and implications: Treatment for subjects with Class I malocclusion with severe crowding by the extraction of four premolars, without subsequent orthodontic treatment, does not affect the long-term dentoskeletal and soft tissue profile, as compared to an untreated Control group. The degree of crowding, rather than changes in dentofacial morphology, is crucial in deciding on extraction therapy.

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  • 29.
    Amin, Bawan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Yttre vändningsförsök: Är det säkert?2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 30. Aminoff, Hedvig
    et al.
    Meijer, Sebastiaan
    Arnelo, Urban
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
    Frennert, Susanne
    Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes2021In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 5, no 1, article id e20692Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption.

    OBJECTIVE: Our objective was to gain a deeper understanding of ERCP practitioners' attitudes toward teleguidance. These findings could inform the implementation process and future evaluations.

    METHODS: We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons' beliefs about teleguidance's contribution to performance and factors that might interact with implementation.

    RESULTS: Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard "Ease of Use" items for "Compatibility and Implementation Climate." In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64% (~9/14) among experts and 75% (~7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [~9/14], novices 69% [~6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P<.05).

    CONCLUSIONS: Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes.

  • 31.
    Aminoff, Hedvig
    et al.
    Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden.
    Meijer, Sebastiaan
    Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden.
    Groth, Kristina
    The Center for Innovation, Karolinska University Hospital, Stockholm, Sweden.
    Arnelo, Urban
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. CLINTEC Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service2021In: JMIR Human Factors, E-ISSN 2292-9495, Vol. 8, no 4, article id e30867Article in journal (Refereed)
    Abstract [en]

    Background:Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood.

    Objective:We were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology’s usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures.

    Methods:We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures.

    Results:In total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111 of 140 (79.3%) cases. Specific examples were that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11 referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance were generally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%).

    Conclusions:Users’ satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnical aspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes.

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  • 32.
    Andersson, Andreas
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Betydelsen av sjukhustyp och region för tidpunkten av kolecystektomi i Sverige2021Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 33.
    Andersson, Magnus N.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    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.
    Björkgren, Annika
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Wiberg, Rebecca
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery.
    Prophylactic mastectomy – Correlation between skin flap thickness and residual glandular tissue evaluated postoperatively by imaging2022In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 75, no 6, p. 1813-1819Article in journal (Refereed)
    Abstract [en]

    Background: Women with an increased hereditary risk of breast cancer can undergo risk-reducing prophylactic mastectomy. However, there is a balance between how much subcutaneous tissue should be resected to achieve maximal reduction of glandular tissue, while leaving viable skin flaps.

    Methods: Forty-five women previously operated with prophylactic mastectomy underwent magnetic resonance tomography (MRT) and ultrasound (US) to investigate the correlation between skin flap thickness and residual glandular tissue. Residual glandular tissue was documented as being present or not present, but not quantified, as the amount of residual glandular tissue in many cases was considered too small to make reliable volume quantifications with available tools. Since a mastectomy skin flap thickness of 5 mm is discussed as an oncologically safe thickness in the literature, this was used as a cut-off.

    Results: Following prophylactic mastectomy, residual glandular tissue was detected in 39.3% of all breasts and 27.9% of all the breast quadrants examined by MRT, and 44.1% of all breasts and 21.7% of all the breast quadrants examined by US. Residual glandular tissue was detected in 6.9% of the quadrants in skin flaps ≤ 5 mm and in 37.5% of the quadrants in skin flaps > 5 mm (OR 3.07; CI = 1.41–6.67; p = 0.005). Furthermore, residual glandular tissue increased significantly already when the skin flap thickness exceeded 7 mm.

    Conclusions: This study highlights that complete removal of glandular breast tissue during a mastectomy is difficult and suggests that this is an unattainable goal. We demonstrate that residual glandular tissue is significantly higher in skin flaps > 5 mm in comparison to skin flaps ≤ 5 mm, and that residual glandular tissue increases significantly already when the flap thickness exceeds 7 mm.

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  • 34.
    Andersson, Mattias
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sunderbyn Hospital, Sunderbyn, Sweden.
    Sandström, Charlotte
    Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University, of Gothenburg, Gothenburg, Sweden.
    Stackelberg, Otto
    Section of Vascular Surgery, Department of Clinical Science and Education, Karolinska, Institutet at Södersjukhuset, Stockholm, Sweden; Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
    Lundqvist, Robert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nordanstig, Joakim
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jonsson, Magnus
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Roy, Joy
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Andersson, Manne
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Hultgren, Rebecka
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Roos, Håkan
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Structured computed tomography analysis can identify the majority of patients at risk of post-endovascular aortic repair rupture2022In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 64, no 2-3, p. 166-174Article in journal (Refereed)
    Abstract [en]

    Objective: The main objective was to report mechanisms and precursors for post-endovascular aneurysm repair (EVAR) rupture. The second was to apply a structured protocol to explore whether these factors were identifiable on follow up computed tomography (CT) prior to rupture. The third objective was to study the incidence, treatment, and outcome of post-EVAR rupture.

    Methods: This was a multicentre, retrospective study of patients treated with standard EVAR at five Swedish hospitals from 2008 to 2018. Patients were identified from the Swedvasc registry. Medical records were reviewed up to 2020. Index EVAR and follow up data were recorded. The primary endpoint was post-EVAR rupture. CT at follow up and at post-EVAR rupture were studied, using a structured protocol, to determine rupture mechanisms and identifiable precursors.

    Results: In 1 805 patients treated by EVAR, 45 post-EVAR ruptures occurred in 43 patients. The cumulative incidence was 2.5% over a mean follow up of 5.2 years. The incidence rate was 4.5/1 000 person years. Median time to post-EVAR rupture was 4.1 years. A further six cases of post-EVAR rupture in five patients found outside the main cohort were included in the analysis of rupture mechanisms only. The rupture mechanism was type IA in 20 of 51 cases (39%), IB in 20 of 51 (39%) and IIIA/B in 11 of 51 (22%). One of these had type IA + IB combined. One patient had an aortoduodenal fistula without another mechanism being identified. Precursors had been noted on CT follow up prior to post-EVAR rupture in 16 of 51 (31%). Retrospectively, using the structured protocol, precursors could be identified in 43 of 51 (84%). In 17 of 27 (63%) cases missed on follow up but retrospectively identifiable, the mechanisms were type IB/III. Overall, the 30 day mortality rate after post-EVAR rupture was 47% (n = 24/51) and the post-operative mortality rate was 21% (n = 7/33).

    Conclusions: Most precursors of post-EVAR rupture are underdiagnosed but identifiable before rupture using a structured follow up CT protocol. Precursors of type IB and III failures caused the majority of post-EVAR ruptures.

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  • 35. Andersson, Roland
    et al.
    Hellman, Per
    Johansson, Jan
    Lagergren, Jesper
    Martling, Anna
    Naredi, Peter
    Nilsson, Magnus
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Selektiv nivåstrukturering av svensk kirurgi behövs2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id E76EArticle in journal (Other (popular science, discussion, etc.))
  • 36.
    Andresen, Kristoffer
    et al.
    Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital – Herlev Hospital, Denmark.
    Kroon, Lovisa
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Öberg, Stina
    Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital – Herlev Hospital, Denmark.
    Rosenberg, Jacob
    Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital – Herlev Hospital, Denmark.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    de la Croix, Hanna
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital/Östra Hospital, Department of Surgery, Sweden.
    Collaboration between the Danish and Swedish hernia registers – a study protocol2022In: Danish Medical Journal, E-ISSN 2245-1919, Vol. 69, no 12, article id A06220408Article in journal (Refereed)
    Abstract [en]

    NTRODUCTION: The most common laparo-endoscopic groin hernia repair techniques are TEP (total extraperitoneal) and TAPP (transabdominal preperitoneal) repair. Despite geographic proximity, Swedish surgeons distinctively favour TEP, whereas Danish surgeons prefer TAPP. The aim of this study is to analyse the risk of reoperation for recurrence after TAPP, TEP and Lichtenstein repair using data from two nationwide registers. We also aim to discuss advantages of international collaboration between nationwide registers.

    METHODS: All groin hernia operations registered as TEP, TAPP or Lichtenstein repair in the Swedish Hernia Register and the Danish Hernia Database between January 2004 and December 2020 will be included. Cumulative hazard rate of reoperation for recurrence will be estimated using Cox-regression analyses adjusted for age and anatomy.

    CONCLUSION: Approximately 400,000 operations are estimated to have been registered prospectively in the inclusion period in the registers. The merging of two nationwide registers was made possible owing to close cooperation between the register steering committees and by obtaining the necessary approvals. This unique collaboration between nationwide registers will make it possible to compare the risk of reoperation for recurrence after TAPP, TEP and Lichtenstein repair on an international level. In future, similar collaboration may be established to explore other outcomes such as complication rates and chronic pain.

  • 37.
    Angelsten, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Predictive Factors for Recurrence Treatment in Papillary Thyroid Cancer - Pilot study at Östersund Hospital2020Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 38. Antona-Makoshi, Jacobo
    et al.
    Mikami, Koji
    Lindkvist, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Davidsson, Johan
    Schick, Sylvia
    Accident analysis to support the development of strategies for the prevention of brain injuries in car crashes2018In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 117, p. 98-105Article in journal (Refereed)
    Abstract [en]

    2+ injuries. Belted occupants were at lower risks than unbelted occupants for most brain injury categories, including concussions. After controlling for the effects of age and crash severity, belted female occupants involved in frontal crashes were estimated to be 1.5 times more likely to sustain a concussion than male occupants in similar conditions. Belted elderly occupants were found to be at 10.5 and 8 times higher risks for sub-dural haemorrhages than non-elderly belted occupants in frontal and side crashes, respectively. Adopted occupant protection strategies appear to be insufficient to achieve significant decreases in risk of both life-threatening brain injuries and concussions for all car occupants. Further effort to develop occupant and injury specific strategies for the prevention of brain injuries are needed. This study suggests that these strategies may consider prioritization of life-threatening brain vasculature injuries, particularly in elderly occupants, and concussion injuries, particularly in female occupants.

  • 39.
    Antona-Makoshi, Jacobo
    et al.
    Japan Automobile Research Insitute, Ibaraki, 2530 Karima, Tsukuba, Japan.
    Mikami, Koji
    Japan Automobile Research Insitute, Ibaraki, 2530 Karima, Tsukuba, Japan.
    Lindquist, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Davidsson, Johan
    Chalmers University of Technology, Gothenburg, Sweden.
    Analysis of Traumatic Brain Injuries Sustained by Occupants in Japanese Brand Car Crashes in the US2018In: International Journal of Automotive Engineering, E-ISSN 2185-0992, Vol. 9, no 3, p. 145-150Article in journal (Refereed)
    Abstract [en]

    This study estimates, by means of an analysis of accident data from the US, the incidence and risk of car crash related traumatic brain injuries for occupants in Japanese brand cars. The study incorporated crash type, crash severity, car model year, belt use and the victim's age and sex. Concussion risk was the highest among all brain injury categories for all crash types and severities; females were at higher risks than males. When concussions were excluded, Subdural Haemorrhages, Intracranial Haemorrhages and Sub-Arachnoid Haemorrhages comprised the most frequent injury categories. Elderly occupants were at considerably higher risks than non-elderly for these bleeding injuries

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  • 40.
    Antoniou, George A.
    et al.
    Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK .
    Bastos Gonçalves, Frederico
    Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; NOVA Medical School, Universidade NOVA de Lisboa, Portuga.
    Björck, Martin
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Chakfé, Nabil
    Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France.
    Coscas, Raphaël
    Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
    Dias, Nuno V.
    Vascular Centre, Skåne University Hospital, Malmö, Sweden.
    Dick, Florian
    Department of Vascular Surgery, Kantonsspital St. Gallen, University of Bern, Bern, Switzerland.
    Kakkos, Stavros K.
    Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
    Mees, Barend M.E.
    Department of Vascular Surgery, Maastricht University Medical Centre and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.
    Resch, Timothy
    Department of Vascular Surgery, Copenhagen University Hospital- Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Trimarchi, Santi
    Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
    Tulamo, Riikka
    Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
    Twine, Chris P.
    Department of Vascular Surgery, North Bristol NHS Trust, UK, Bristol, United Kingdom; Centre for Surgical Research, University of Bristol, UK, Bristol, United Kingdom.
    Vermassen, Frank
    Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
    Wanhainen, Anders
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Kolh, Philippe
    Department of Biomedical and Preclinical Sciences, University of Liège, Belgium; GIGA Cardiovascular Sciences, University of Liège, Belgium; Department of Information System Management, University Hospital of Liège, Belgium.
    European society for vascular surgery clinical practice guideline development scheme: an overview of evidence quality assessment methods, evidence to decision frameworks, and reporting standards in guideline development2022In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 63, no 6, p. 791-799Article, review/survey (Refereed)
    Abstract [en]

    Objective: A structured and transparent approach is instrumental in translating research evidence to health recommendations and evidence informed clinical decisions. The aim was to conduct an overview and analysis of principles and methodologies for health guideline development.

    Methods: A literature review on methodologies, strategies, and fundamental steps in the process of guideline development was performed. The clinical practice guideline development process and methodology adopted by the European Society for Vascular Surgery are also presented.

    Results: Sophisticated methodologies for health guideline development are being applied increasingly by national and international organisations. Their overarching principle is a systematic, structured, transparent, and iterative process that is aimed at making well informed healthcare choices. Critical steps in guideline development include the assessment of the certainty of the body of evidence; evidence to decision frameworks; and guideline reporting. The goal of strength of evidence assessments is to provide well reasoned judgements about the guideline developers’ confidence in study findings, and several evidence hierarchy schemes and evidence rating systems have been described for this purpose. Evidence to decision frameworks help guideline developers and users conceptualise and interpret the construct of the quality of the body of evidence. The most widely used evidence to decision frameworks are those developed by the GRADE Working Group and the WHO-INTEGRATE, and are structured into three distinct components: background; assessment; and conclusions. Health guideline reporting tools are employed to ensure methodological rigour and transparency in guideline development. Such reporting instruments include the AGREE II and RIGHT, with the former being used for guideline development and appraisal, as well as reporting.

    Conclusion: This guide will help guideline developers/expert panels enhance their methodology, and patients/clinicians/policymakers interpret guideline recommendations and put them in context. This document may be a useful methodological summary for health guideline development by other societies and organisations.

  • 41.
    Antoniou, Stavros A.
    et al.
    Surgical Department, Mediterranean Hospital of Cyprus, Limassol, Cyprus; Medical School, European University Cyprus, Nicosia, Cyprus.
    Mavridis, Dimitris
    Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece; Faculté de Médecine, Université Paris Descartes, Paris, France.
    Kontouli, Katerina Maria
    Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
    Drakopoulos, Vasileios
    1st Department of Surgery & Organ Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
    Gorter-Stam, Marguerite
    Department of Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Leone, Marc
    Department of Anesthesiology and Critical Care Medicine, Nord Hospital, Marseille, France.
    Pérez-Bocanegra, Maria Carmen
    Geriatrics Department, Hospital Universitari Vall D’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
    Smart, Neil J.
    Department of Surgery, Department of Surgery, Royal Devon & Exeter Hospital, Exeter, United Kingdom.
    Milone, Marco
    Department of Clinical Medicine and Surgery, University “Federico II” of Naples, Naples, Italy.
    Carrano, Francesco Maria
    PhD Program in Applied Medical-Surgical Sciences, University of Rome “Tor Vergata”, Rome, Italy; Department of Surgical Sciences, University of Rome “Tor Vergata”, Rome, Italy.
    Antoniou, George A.
    Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom.
    Vandvik, Per Olav
    Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
    EAES rapid guideline: appendicitis in the elderly2021In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 35, no 7, p. 3233-3243Article in journal (Refereed)
    Abstract [en]

    Background: There is a lack of trustworthy evidence-informed guidelines on the diagnosis and management of acute appendicitis in elderly patients.

    Methods: We developed a rapid guideline in accordance with GRADE and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of three general surgeons, an intensive care physician, a geriatrician and a patient advocate. We conducted systematic reviews and the results of evidence synthesis were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus.

    Results: This rapid guideline provides a weak recommendation against the use of clinical scoring systems to replace cross-sectional imaging in the diagnostic approach of suspected appendicitis in elderly patients. It provides a weak recommendation against the use of antibiotics alone over surgical treatment in patients who are deemed fit for surgery, and a weak recommendation for laparoscopic over open surgery. Furthermore, it provides a summary of surgery-associated risks in elderly patients. The guidelines, with recommendations, evidence summaries and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494.

    Conclusions: This rapid guideline provides evidence-informed trustworthy recommendations on the diagnosis and management of acute appendicitis in elderly patients.

  • 42.
    Appelgren, Matilda
    et al.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Sackey, Helena
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Solna, Sweden.
    Wengström, Yvonne
    Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Solna, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Johansson, Karin
    Department of Health Sciences, Lund University, Lund, Sweden.
    Ahlgren, Johan
    Department of Oncology, University Hospital, Örebro, Sweden; Regional Oncology Centre, Mid-Sweden Health Care Region, Uppsala, Sweden.
    Andersson, Yvette
    Department of Surgery, Västmanland County Hospital, Västerås, Sweden; Västmanland County Hospital, Center for Clinical Research, Uppsala University, Västerås, Sweden.
    Bergkvist, Leif
    Västmanland County Hospital, Center for Clinical Research, Uppsala University, Västerås, Sweden.
    Frisell, Jan
    Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Solna, Sweden.
    Lundstedt, Dan
    Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rydén, Lisa
    Division of Surgery, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Alkner, Sara
    Division of Oncology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden.
    Vrou Offersen, Birgitte
    Department of Experimental Clinical Oncology Aarhus University Hospital, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus University Hospital, Aarhus, Denmark.
    Filtenborg Tvedskov, Tove
    Department of Breast Surgery, Rigshospitalet, Copenhagen, Denmark.
    Christiansen, Peer
    Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus University Hospital, Aarhus, Denmark; Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark.
    de Boniface, Jana
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden.
    Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial2022In: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 63, p. 16-23Article in journal (Refereed)
    Abstract [en]

    Introduction: This report evaluates whether health related quality of life (HRQoL) and patient-reported arm morbidity one year after axillary surgery are affected by the omission of axillary lymph node dissection (ALND).

    Methods: The ongoing international non-inferiority SENOMAC trial randomizes clinically node-negative breast cancer patients (T1-T3) with 1–2 sentinel lymph node (SLN) macrometastases to completion ALND or no further axillary surgery. For this analysis, the first 1181 patients enrolled in Sweden and Denmark between March 2015, and June 2019, were eligible. Data extraction from the trial database was on November 2020. This report covers the secondary outcomes of the SENOMAC trial: HRQoL and patient-reported arm morbidity. The EORTC QLQ-C30, EORTC QLQ-BR23 and Lymph-ICF questionnaires were completed in the early postoperative phase and at one-year follow-up. Adjusted one-year mean scores and mean differences between the groups are presented corrected for multiple testing.

    Results: Overall, 976 questionnaires (501 in the SLN biopsy only group and 475 in the completion ALND group) were analysed, corresponding to a response rate of 82.6%. No significant group differences in overall HRQoL were identified. Participants receiving SLN biopsy only, reported significantly lower symptom scores on the EORTC subscales of pain, arm symptoms and breast symptoms. The Lymph-ICF domain scores of physical function, mental function and mobility activities were significantly in favour of the SLN biopsy only group.

    Conclusion: One year after surgery, arm morbidity is significantly worse affected by ALND than by SLN biopsy only. The results underline the importance of ongoing attempts to safely de-escalate axillary surgery.

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  • 43. Archibugi, Livia
    et al.
    Graglia, Benedetta
    Valente, Roberto
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Digestive and Liver Disease Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Milan, Italy; Department of Surgery, Anschutz Medical Campus, University of Colorado, Denver, USA.
    Stigliano, Serena
    Roberto, Michela
    Capalbo, Carlo
    Marchetti, Paolo
    Nigri, Giuseppe
    Capurso, Gabriele
    Gynecological and reproductive factors and the risk of pancreatic cancer: A case-control study2020In: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 20, no 6, p. 1149-1154Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: /Objectives: Pancreatic ductal adenocarcinoma (PDAC) has a higher incidence in men compared to women, although the difference in known risk factors cannot explain this disparity completely. Reproductive and hormonal factors have been demonstrated in pre-clinical studies to influence pancreatic carcinogenesis, but the few published data on the topic are inconsistent. The aim was to investigate the role of reproductive and hormonal factors on PDAC occurrence in women.

    METHODS: We conducted a unicenter case-control study; PDAC cases were matched to controls by age with a 1:2 ratio. Risk factors were screened through questionnaires about gynecologic and medical history. Comparisons were made using Chi-square and Fisher's exact tests where appropriate for categorical variables and Student's t-test for continuous variables. Logistic regression was used to calculate Odds Ratios (ORs) and their 95% confidence intervals (CI). Multivariable logistic regression models were adjusted for potential confounders.

    RESULTS: 253 PDAC and 506 matched controls were enrolled. At logistic regression multivariable analysis adjusted for confounding factors, older age at menopause (OR:0.95 per year; 95% CI:0.91-0.98; p = 0.007), use of Oral Contraceptives (OR:0.52; 95% CI:0.30-0.89; p = 0.018), use of Hormonal Replacement Therapy (OR:0.31; 95% CI:0.15-0.64; p = 0.001), and having had two children (OR:0.57; 95% CI:0.38-0.84; p = 0.005) were significant, independent protective factors for the onset of PDAC.

    CONCLUSIONS: These data confirm some previous findings on menopause age and number of births while, to our knowledge, this is the first study to show a protective effect of HRT and OC use. The results collectively support the hypothesis that exposure to estrogens plays a protective role towards PDAC.

  • 44.
    Arnell, Kai
    et al.
    Department of Paediatric Surgery, University Hospital, Uppsala.
    Koskinen, Lars-Owe D
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurosurgery.
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurology.
    Eklund, Anders
    Evaluation of Strata NSC and Codman Hakim adjustable cerebrospinal fluid shunts and their corresponding antisiphon devices: laboratory investigation2009In: Journal of Neurosurgery: Pediatrics, ISSN 1933-0707, E-ISSN 1933-0715, Vol. 3, no 3, p. 166-172Article in journal (Refereed)
    Abstract [en]

    OBJECT: The authors investigated and compared the in vitro characteristics of 2 CSF shunts, the Strata NSC and the Codman Hakim, and their corresponding antisiphon devices (ASDs).

    METHODS: Six new CSF shunts and the corresponding ASDs for each model were tested in an automated, computerized experimental setup based on pressure regulation. Opening pressure accuracy, resistance, sensitivity to abdominal pressure, antisiphon effect, and the influence of different ASD positions were determined.

    RESULTS: In general the shunts performed according to the manufacturers' specifications. However, at the lowest setting, the opening pressure of the Strata NSC was close to 0, and in the Codman Hakim shunt, it was higher than specified. The resistance in the Codman Hakim shunt (5.4 mm Hg/ml/min) was much higher than that in the Strata NSC (3.6 mm Hg/ml/min). Abdominal pressure affected opening pressure in both valves. Positioning the Strata ASD above or below the ventricular catheter tip resulted in higher and lower opening pressures, respectively, than when it was placed in line with the catheter. The positioning of the Codman Hakim ASD did not influence the opening pressure.

    CONCLUSIONS: Both CSF shunts work properly, but at the lowest setting the opening pressure of the Strata NSC was near 0 and in the Codman Hakim it was twice the manufacturer's specifications. The resistance in the Strata NSC was below the normal physiological range, and in the Codman Hakim device it was in the lower range of normal. The ASD did not change the shunt characteristics in the lying position and therefore might not do so in children. If this is the case, then a shunt system with an integrated ASD could be implanted at the first shunt insertion, thus avoiding a second operation and the possibility of infection.

  • 45. Arnelo, Urban
    et al.
    Siiki, Antti
    Swahn, Fredrik
    Segersvärd, Ralf
    Enochsson, Lars
    del Chiaro, Marco
    Lundell, Lars
    Verbeke, Caroline S
    Löhr, J-Matthias
    Single-operator pancreatoscopy is helpful in the evaluation of suspected intraductal papillary mucinous neoplasms (IPMN)2014In: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 14, no 6, p. 510-514Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Even when advanced cross-sectional imaging modalities have been employed, endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMN) is often required in order to assess the final character and extent of lesions. The current study addresses the use of SpyGlass single-operator peroral pancreatoscopy in suspected IPMN.

    DESIGN: A prospective, non-randomized exploratory cohort study.

    SETTING: Single-center.

    PATIENTS AND INTERVENTION: A prospective study-cohort of 44 consecutive patients in a single tertiary referral center who underwent ERCP and peroral pancreatoscopy, was prospectively collected between July 2007 and March 2013 because of a radiological signs of IPMN. These IPMN-findings were discovered incidentally in 44% of the cases.

    MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy (specificity & sensitivity) and complications.

    RESULTS: The targeted region of the pancreatic duct was reached with the SpyGlass system in 41 patients (median age 65 years, 41% female). Three patients were excluded from analysis because of failed deep cannulation of the pancreatic duct. Brush cytology was taken in 88% and direct biopsies in 41%. IPMN with intermediate or high-grade dysplasia was the main final diagnosis (76%) in 22 patients who had surgery. Out of the 17 patients with a final diagnosis of MD-IPMN, 76% were correctly identified by pancreatoscopy. Of the 9 patients with a final diagnosis of BD-IPMN, the pancreatoscopy identified 78% of the cases correctly.The incidence of post-ERCP pancreatitis was 17%. Pancreatoscopy was found to have provided additional diagnostic information in the vast majority of the cases and to affect clinical decision-making in 76%.

    LIMITATIONS: Single-center study.

    CONCLUSIONS: Single-operator peroral pancreatoscopy contributed to the clinical evaluation of IPMN lesions and influenced decision-making concerning their clinical management. The problem of post-procedural pancreatitis needs further attention.

  • 46.
    Arnelo, Urban
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Valente, Roberto
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
    Scandavini, Chiara Maria
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Halimi, Asif
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Mucelli, Raffaella M.Pozzi
    Department of Radiology Huddinge, Karolinska University Hospital, O-huset 42, Stockholm, Sweden; Division of Radiology, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Rangelova, Elena
    Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Section for Upper Abdominal Surgery at Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    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, Surgery.
    Schulick, Richard D.
    Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States.
    Torphy, Robert J.
    Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States.
    Fagerström, Niklas
    Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Moro, Carlos Fernández
    Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Huddinge, Sweden; Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Huddinge, Sweden.
    Vujasinovic, Miroslav
    Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Matthias Löhr, Johannes
    Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Del Chiaro, Marco
    Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States.
    Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: a pilot study2023In: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 23, no 6, p. 704-711Article in journal (Refereed)
    Abstract [en]

    Objectives: Intraoperative pancreatoscopy is a promising procedure that might guide surgical resection for suspected main duct (MD) and mixed type (MT) intraductal papillary mucinous neoplasms (IPMNs). The aim of the present study was to assess the diagnostic yield and clinical impact of intraoperative pancreatoscopy in patients operated on for MD and MT-IPMNs.

    Methods: This is a retrospective cohort study. Patients undergoing surgery for suspected MD or MT-IPMN underwent intraoperative pancreatoscopy and frozen section analysis. In all patients who required extended resection due to pancreatoscopic findings, we compared the final histology with the results of the intraoperative frozen section analysis.

    Results: In total, 46 patients, 48% females, mean age (range) 67 years (45–82 years) underwent intraoperative pancreatoscopy. No mortality or procedure related complications were observed. Pancreatoscopy changed the operative course in 30 patients (65%), leading to extended resections in 20 patients (43%) and to parenchyma sparing procedures in 10 patients (22%). Analyzing the group of patients who underwent extended resections, 7 (35%) displayed lesions that needed further surgical treatment (six high grade dysplasia and one with G1 pancreatic neuroendocrine tumor) and among those 7, just 1 (14%) would have been detected exclusively with histological frozen section analysis of the transection margin. The combination of both pancreatoscopy and frozen section analysis lead to 86% sensitivity and 92% specificity for the detection of pathological tissue in the remnant pancreas.

    Conclusion: Intraoperative pancreatoscopy is a safe and feasible procedure and might allow the detection of skip lesions during surgery for suspect MD-involving IPMNs.

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  • 47.
    Arnerlöv, Conny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Söderström, Minette
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Öhberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Mobile kidney pain provocation ultrasonography before surgery for symptomatic mobile kidney: A prospective study of 43 consecutive patients2016In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, no 1, p. 61-64Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to evaluate whether mobile kidney pain provocation ultrasonography together with intravenous pyelography in supine and standing positions and a full medical history can confirm the diagnosis of the clinical condition of symptomatic mobile kidney and aid the selection of patients for surgical treatment.

    MATERIALS AND METHODS: In a consecutive study, 43 patients with the clinical picture of symptomatic mobile kidney, a positive mobile kidney pain provocation ultrasonography and a renal descent of at least 2 lumbar vertebral heights on intravenous pyelography in the standing position, were operated on with nephropexy. Patients' pain relief after nephropexy was evaluated by clinical follow-up, a questionnaire and visual analogue scale (VAS) scoring.

    RESULTS: Reduction of pain after nephropexy was associated with a significant decrease in VAS scoring from a median of 8 (range 4-10) preoperatively to a median of 0 (range 0-7) postoperatively (p < 0.001). Thirty-four patients (79%) were cured of their pain and seven patients (16%) experienced substantial relief from their pain symptoms. In two patients (5%) the symptoms were unchanged.

    CONCLUSION: The results indicate that mobile kidney pain provocation ultrasonography and intravenous pyelography in supine and standing positions can verify the diagnosis of symptomatic mobile kidney and aid the selection of patients who will benefit from nephropexy.

  • 48.
    Arnerlöv, Conny
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Öhberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Ghaffarpour, Ramin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Trippeldiagnostik säker vid symtomgivande rörlig njure: [Triple diagnostic can establish the diagnosis of symptomatic mobile kidney and nephropexy can give freedom of pain]2020In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117, no 37, article id 20025Article in journal (Refereed)
    Abstract [en]

    Symtomatic mobile kidney is a rare condition and diagnosis is difficult. Typical symptoms are position dependent back-flank-abdominal pain with increase of pain when walking, jogging and lifting or other physical activities which increase the descent of the kidney. Triple diagnostic with typical pain history, an intravenous pyelography with a renal descent of ≥ 2 lumbar vertebral heights in the erect position, and an ultrasound with a positive pain provocation can establish the diagnosis of symptomatic mobile kidney. In our study nephropexy gives freedom of pain for 75% of patients and substantial relief for 15% of patients with severe pain.

  • 49. Arver, Brita
    et al.
    Isaksson, Karin
    Atterhem, Hans
    Baan, Annika
    Bergkvist, Leif
    Brandberg, Yvonne
    Ehrencrona, Hans
    Emanuelsson, Monica
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Hellborg, Henrik
    Henriksson, Karin
    Karlsson, Per
    Loman, Niklas
    Lundberg, Jonas
    Ringberg, Anita
    Askmalm, Marie Stenmark
    Wickman, Marie
    Sandelin, Kerstin
    Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer: A National Survey2011In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 253, no 6, p. 1147-1154Article in journal (Refereed)
    Abstract [en]

    Background/Objective: This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences. Methods: Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. Results: A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low(3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1 unanticipated secondary operation.

  • 50.
    Arzola, Luis H.
    et al.
    Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.
    Mani, Kevin
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Zuccon, Gianmarco
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Ekberg, Tomas
    Department of Otorhinolaryngology-Head and Neck Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Wanhainen, Anders
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Viabahn-assisted sutureless anastomosis (VASA) repair of a complex internal carotid artery aneurysm2023In: Journal of Vascular Surgery Cases and Innovative Techniques, E-ISSN 2468-4287, Vol. 9, no 2, article id 101161Article in journal (Refereed)
    Abstract [en]

    Extracranial carotid artery aneurysms (CAAs) are extremely rare and often require surgical intervention to avoid complications such as local compression symptoms and thrombo-embolization. We present the case of a 63-year-old man with a history of hypertension, meningioma, and an incidental finding of a right saccular internal carotid artery aneurysm at the base of the skull. He underwent open surgical repair; nonetheless, end-to-end anastomosis was not feasible. As bailout, the internal carotid artery was successfully reconstructed with a novel Viabahn-assisted sutureless anastomosis technique (GORE, Viabahn). Postoperative clinical assessment revealed no complications, postoperative computed tomography angiography revealed a patent reconstruction, and the patient was discharged home uneventfully with 1-year clinical and computed tomography angiography follow-up without remarks. Hybrid procedure is a viable option for technically challenging carotid anastomoses near the skull base.

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