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  • 751.
    Sandzén, Birger
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Haapamäki, Markku M.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Nilsson, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Öman, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Surgery for acute gallbladder disease in Sweden 1989-2006: A register study2013Inngår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 48, nr 4, s. 480-486Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. Since early 1970s, prospective randomized controlled trials have emphasized the advantages of early cholecystectomy in patients with acute cholecystitis, compared to elective delayed cholecystectomy. The aim of this investigation was to study surgery for acute gallbladder disease in Sweden during a 15-year period when open cholecystectomy was replaced by a laparoscopic procedure. Material and methods. Data from the Swedish National Patient Register and the Cause of Death Register 1988-2006 comprising hospital stays with a primary diagnosis of gallbladder/gallstone disease in Sweden were retrieved. Patients were analyzed with reference to timing of cholecystectomy, length of hospital stay, and mortality. Results. Emergency cholecystectomy at index (first) admission or at readmission within 2 years of index admission was performed in 32.2% and 6.1% of patients, respectively. Elective cholecystectomy within 2 years of index admission was performed in 20.3% patients, whereas 41.3% of all patients did not undergo cholecystectomy within 2 years. Standardized mortality ratio did not significantly change during the audit period. Total hospital stay (days at index stay and subsequent stay(s) for biliary diagnoses within 2 years) was shorter for patients who had emergency cholecystectomy at first admission compared to patients with later or no cholecystectomy within 2 years. Conclusions. Around 30% of patients with acute gallbladder disease were operated with cholecystectomy during the first admission with no time trend from 1990 through 2004. A total of 40% of patients with acute gallbladder disease were not cholecystectomized within 2 years. Analysis of outcome of long-term conservative treatment is warranted.

  • 752.
    Sandzén, Birger
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rosenmüller, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Haapamäki, Markku M
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Nilsson, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stenlund, Hans C
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Öman, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    First attack of acute pancreatitis in Sweden 1988 - 2003: incidence, aetiological classification, procedures and mortality - a register study2009Inngår i: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 9, s. 18-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Population-based studies suggest that the incidence of first attack of acute pancreatitis (FAAP) is increasing and that old age is associated with increased mortality. Because nationwide data are limited and information on standardized mortality ratio (SMR) versus age is lacking, we wanted to describe incidence and mortality of first attack acute pancreatitis (FAAP) in Sweden.

    METHODS: Hospital discharge data concerning diagnoses and surgical procedures and death certificate data were linked for patients with FAAP in Sweden. Mortality was calculated as case fatality rate (CFR), i.e. deaths per 1000 patients and SMR using age-, gender- and calendar year-specific expected survival estimates, and is given as mean with 95% confidence intervals. Data are presented as median values with 25% and 75% percentiles, means and standard deviations, or proportions. Proportions have been compared using the chi square test, Poisson-regression test or Fisher exact test. Location of two groups of ratio scale variables were compared using independent samples t-test or Mann-Whitney U-test.

    RESULTS: From 1988 through 2003, 43415 patients (23801 men and 19614 women) were admitted for FAAP. Age adjusted incidence rose from 27.0 to 32.0 per 100000 individuals and year. Incidence increased with age for both men and women. At index stay 19.7% of men and 35.4% of women had biliary diagnoses, and 7.1% of men and 2.1% of women alcohol-related diagnoses. Of 10072 patients who underwent cholecystectomy, 7521 (74.7%) did so after index stay within the audit period. With increasing age CFR increased and SMR decreased. For the whole period studied SMR was 11.75 (11.34-12.17) within 90 days of index admission and 2.03 (1.93-2.13) from 91 to 365 days. Alcohol-related diagnoses and young age was associated with increased SMR. Length of stay and SMR decreased significantly during the audit period.

    CONCLUSION: Incidence of FAAP increased slightly from 1988 to 2003. Incidence increased and SMR declined with increasing patient age. Although the prognosis for patients with FAAP has improved it remains an important health problem. Aetiological classification at index stay and timing of cholecystectomy should be improved.

  • 753.
    Saveman, Britt-Inger
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Unintentional injuries among older adults in northern Sweden: a one-year population-based study2011Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, nr 1, s. 185-193Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Scand J Caring Sci; 2011; 25; 185-193 Unintentional injuries among older adults in northern Sweden - a one-year population-based study Aim:  To study the epidemiology of unintentional injuries in a population of 21 000 Swedish older adults (65+) and to compare the injury incidence with similar data collected two decades earlier. Method:  This is a retrospective epidemiologic cross-sectional study based on a 1-year data set of all the 1753 registered injury events from a well-defined population. Result:  The injury rate per 1000 individuals was three times higher in the 85+ age group than in the 65-74 age group. The rate was also higher in women than in men aged 75 and older. Fractures, especially on lower and upper extremities, were the most common injuries. Falls in residential care facilities caused the most serious injuries. In transport areas, pedestrian falls and bicyclist crashes were much more common than car crashes. Of the 1753 people injured, 42% were treated as inpatients for a total of 11 569 days; 86% of these days were caused by injury events in the home (57%) or in residential care facilities (29%). Our 65+ age group occupied 69% of all hospital bed-days for trauma in all ages (0-102 years). Conclusion:  Over the last two decades, the injury and fracture rate per 1000 individuals has increased by 40-50%, especially in the older age groups. During this time, the nursing strategy for older adults has changed in Sweden. As a result, more people live in their homes nowadays. This increase is distressing especially when we consider the current knowledge of preventive measures. The high number and proportion (>2/3) of inpatient trauma days for these age groups are a heavy burden for the medical sector. These facts call for more effective preventive measures, especially in the home and in residential care facilities, to minimize the negative health effects and the rising health costs.

  • 754.
    Schaakxs, Dominique
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Plastic and Reconstructive Surgery (CHUV), University Hospital of Lausanne, Lausanne, Switzerland.
    Raffoul, Wassim
    Plastic and Reconstructive Surgery (CHUV), University Hospital of Lausanne, Lausanne, Switzerland.
    Wiberg, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Kingham, Paul
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Kalbermatten, Daniel
    Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Switzerland.
    A comparison of an artificial nerve repair construct and nerve grafting when used in combination with intramuscular injections of stem cells for reduction of muscle atrophyManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Peripheral nerve injuries represent a clinical challenge, especially when they are accompanied by loss of neural tissue. We tried to attain a better outcome after a peripheral nerve injury (in a rat sciatic nerve experimental model) by both repairing the nerve lesion and treating the denervated muscle at the same time.  We compared artificial nerve constructs made from strips of poly-3-hydroxybutyrate (PHB), seeded with or without Schwann cell-like differentiated adipose stem cells (dASC), and autografts (reverse sciatic nerve grafts) in combination with stem cell injections in the gastrocnemius muscle. dASC expressed Schwann cell markers (GFAP, S100B and p75-NTR) and secreted a range of nerve, angiogenic and muscle growth factors. Six weeks after nerve injury, the effects of the stem cells on nerve regeneration and reduction of muscle atrophy were assessed. PHB strips showed a high number of βIII-tubulin positive axons entering the distal stump and abundant endothelial cells. Animals treated with PHB strips without cells in combination with control growth medium intramuscular injections showed significantly more atrophy than the other groups.  Best results were obtained in the autograft group combined with intramuscular stem cell injections. This bioengineering research is a promising approach to treat nerve lesions and associated muscle atrophy.

  • 755.
    Schaakxs, Dominique
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Plastic and Reconstructive Surgery (CHUV), University Hospital of Lausanne, Lausanne, Switzerland.
    Vermeille, Matthieu
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Switzerland.
    Kalbermatten, Daniel
    Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Switzerland.
    Raffoul, Wassim
    Plastic and Reconstructive Surgery (CHUV), University Hospital of Lausanne, Switzerland.
    Wiberg, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Kingham, Paul
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Mechanisms of adipose stem cell interactions with muscle cells and Schwann cellsManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Peripheral nerve injury leads to muscle atrophy due to prolonged denervation. In a previous study, we showed the benefits of injecting Schwann cell and Schwann cell-like differentiated adipose stem cells (dASC) into the muscle to help nerve regeneration and prevent muscle atrophy. In this in vitro study, we have analyzed the possible mechanisms of how adipose stem cells interact with muscle cells and Schwann cells. Myoblast cell lines (C2C12 and L6) or rat primary Schwann cells treated with conditioned media prepared from either undifferentiated adipose stem cells or dASC proliferated more than control cultures. Stem cell mediated proliferation of myoblasts and Schwann cells was blocked by the inhibition of MAP kinase signaling (using U0126 drug) whereas the PKA pathway (inhibited with H89 drug) was only involved in myoblast proliferation. In order to assess the direct interaction of the stem cells with the muscle, we established direct in vitro co-culture of L6 myoblasts and stem cells for 2 weeks.  Under these conditions a small fraction of cells fused together forming multi-nucleated elongated structures, characteristic of myotubes.  These structures stained positive for fast type myosin heavy chain protein and myogenin. These effects were most pronounced in the dASC-myoblast co-cultures. ELISA analysis of the co-cultures showed high levels of secreted vascular endothelial growth factor-A (VEGF-A) and insulin like growth factor 1 proteins. Western blot analysis of denervated rat muscle tissue also showed elevated levels of VEGF-A expression in animals treated with stem cell injections. In conclusion, this study provides evidence of possible mechanisms how stem cells might influence cells of the neuromuscular system and supports the beneficial effect of using these cells for future clinical application in treatment of peripheral nerve injuries.

  • 756. Scheiman, Simeon
    et al.
    Moghaddas, Hossein S
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Bylund, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Bicycle injury events among older adults in Northern Sweden: A 10-year population based study.2010Inngår i: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 42, nr 2, s. 758-763Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Bicycles are a common mode of transportation and injured bicyclists cause a substantial burden on the medical sector. In Sweden, about half of fatally injured bicyclists are 65 years or older. This study analyzes the injury mechanisms, injuries, and consequences among bicyclists 65 years or older and compare with younger bicyclists (</=64) and older adults as passenger car drivers, to give a basis for an injury preventive discussion for this age group. Umeå University Hospital's primary catchments area had 142,000 inhabitants in 2006. Nearly all injured road users in the well-defined geographic area are treated at this hospital and a 10-year data set (N=456) of injured bicyclists aged 65+ from the hospital's continuous injury registration (1997-2006) was analyzed. The results show that the annual injury incidence was 2.4 and 2.2 per 1000 men and women, respectively, aged 65 or older. For men the incidence rate was constant in the three age groups 65-74, 75-84 and 85+, while it decreased strongly for women. The incidence rate for old adults as passenger car drivers and younger bicyclists was 1.0 and 4.6, respectively. Most frequent injury mechanisms were falls when getting on or off a bicycle (20%) and by potholes or irregularities on the ground, edge of a sidewalk, or similar (13%). Only 6% were hit by cars, trucks, or buses. Half of the injured suffered fractures or dislocations, and 10% suffered concussion or more serious intracranial injuries. Getting on or off the bicycle caused most fractures (especially a high fraction of the hip and femur fractures) and resulted in 27% of all inpatient days in hospital. Three individuals died. One-third of the injured were treated as inpatients for a total of 1413 days (on average 9 days), with 69% of the days being caused by fractures. The cost for out- and inpatient acute treatment was approximately USD 4700 (SEK 33,000) per injured. The results merit an interest for this target group; bicycle injuries among older adults are costly both for the individual and the medical sector. Injury mitigation strategies focused on the needs of this group are probably as well motivated as those focused on older car drivers.

  • 757. Schlesinger, S
    et al.
    Aleksandrova, K
    Pischon, T
    Jenab, M
    Fedirko, V
    Trepo, E
    Overvad, K
    Roswall, N
    Tjønneland, A
    Boutron-Ruault, M C
    Fagherazzi, G
    Racine, A
    Kaaks, R
    Grote, V A
    Boeing, H
    Trichopoulou, A
    Pantzalis, M
    Kritikou, M
    Mattiello, A
    Sieri, S
    Sacerdote, C
    Palli, D
    Tumino, R
    Peeters, P H
    Bueno-de-Mesquita, H B
    Weiderpass, E
    Quirós, J R
    Zamora-Ros, R
    Sánchez, M J
    Arriola, L
    Ardanaz, E
    Tormo, M J
    Nilsson, P
    Lindkvist, B
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rolandsson, Olov
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Khaw, K T
    Wareham, N
    Travis, R C
    Riboli, E
    Nöthlings, U
    Diabetes mellitus, insulin treatment, diabetes duration, and risk of biliary tract cancer and hepatocellular carcinoma in a European cohort2013Inngår i: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 24, nr 9, s. 2449-2455Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Evidence on associations between self-reported diabetes mellitus, diabetes duration, age at diabetes diagnosis, insulin treatment, and risk of biliary tract cancer (BTC) and hepatocellular carcinoma (HCC), independent of general and abdominal obesity is scarce. PATIENTS AND METHODS: We conducted a prospective analysis in the EPIC-cohort study among 363 426 participants with self-reported diabetes data. Multivariable adjusted relative risks and 95% confidence intervals were estimated from Cox regression models. In a nested case-control subset, analyses were carried out in HCV/HBV-negative individuals. RESULTS: During 8.5 years of follow-up, 204 BTC cases [including 75 gallbladder cancer (GBC) cases], and 176 HCC cases were identified. Independent of body mass index and waist-to-height ratio diabetes status was associated with higher risk of BTC and HCC [1.77 (1.00-3.13) and 2.17 (1.36-3.47)]. For BTC, the risk seemed to be higher in participants with shorter diabetes duration and those not treated with insulin. Regarding cancer subsites, diabetes was only associated with GBC [2.72 (1.17-6.31)]. The risk for HCC was particularly higher in participants treated with insulin. The results were not appreciably different in HCV/HBV-negative individuals. CONCLUSION(S): This study supports the hypothesis that diabetes is a risk factor for BTC (particularly GBC) and HCC. Further research is required to establish whether diabetes treatment or duration is associated with these cancers.

  • 758. Schlesinger, Sabrina
    et al.
    Aleksandrova, Krasimira
    Pischon, Tobias
    Fedirko, Veronika
    Jenab, Mazda
    Trepo, Elisabeth
    Boffetta, Paolo
    Dahm, Christina C
    Overvad, Kim
    Tjønneland, Anne
    Halkjaer, Jytte
    Fagherazzi, Guy
    Boutron-Ruault, Marie-Christine
    Carbonnel, Franck
    Kaaks, Rudolf
    Lukanova, Annekatrin
    Boeing, Heiner
    Trichopoulou, Antonia
    Bamia, Christina
    Lagiou, Pagona
    Palli, Domenico
    Grioni, Sara
    Panico, Salvatore
    Tumino, Rosario
    Vineis, Paolo
    Bueno-de-Mesquita, HB
    van den Berg, Saskia
    Peeters, Petra HM
    Braaten, Tonje
    Weiderpass, Elisabete
    Quirós, J Ramón
    Travier, Noémie
    Sánchez, María-José
    Navarro, Carmen
    Barricarte, Aurelio
    Dorronsoro, Miren
    Lindkvist, Björn
    Regner, Sara
    Werner, Mårten
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Khaw, Kay-Tee
    Wareham, Nicholas
    Travis, Ruth C
    Norat, Teresa
    Wark, Petra A
    Riboli, Elio
    Nöthlings, Ute
    Abdominal obesity, weight gain during adulthood and risk of liver and biliary tract cancer in a European cohort2013Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 132, nr 3, s. 645-657Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    General obesity has been positively associated with risk of liver and probably with biliary tract cancer, but little is known about abdominal obesity or weight gain during adulthood. We used multivariable Cox proportional hazard models to investigate associations between weight, body mass index, waist and hip circumference, waist-to-hip and waist-to-height ratio (WHtR), weight change during adulthood and risk of hepatocellular carcinoma (HCC), intrahepatic (IBDC) and extrahepatic bile duct system cancer [EBDSC including gallbladder cancer (GBC)] among 359,525 men and women in the European Prospective Investigation into Cancer and Nutrition study. Hepatitis B and C virus status was measured in a nested case-control subset. During a mean follow-up of 8.6 years, 177 cases of HCC, 58 cases of IBDC and 210 cases of EBDSC, including 76 cases of GBC, occurred. All anthropometric measures were positively associated with risk of HCC and GBC. WHtR showed the strongest association with HCC [relative risk (RR) comparing extreme tertiles 3.51, 95% confidence interval (95% CI): 2.09-5.87; p(trend) < 0.0001] and with GBC (RR: 1.56, 95% CI: 1.12-2.16 for an increment of one unit in WHtR). Weight gain during adulthood was also positively associated with HCC when comparing extreme tertiles (RR: 2.48, 95% CI: 1.49-4.13; <0.001). No statistically significant association was observed between obesity and risk of IBDC and EBDSC. Our results provide evidence of an association between obesity, particularly abdominal obesity, and risk of HCC and GBC. Our findings support public health recommendations to reduce the prevalence of obesity and weight gain in adulthood for HCC and GBC prevention in Western populations.

  • 759. Schmidt, Julie A
    et al.
    Allen, Naomi E
    Almquist, Martin
    Franceschi, Silvia
    Rinaldi, Sabina
    Tipper, Sarah J
    Tsilidis, Konstantinos K
    Weiderpass, Elisabete
    Overvad, Kim
    Tjønneland, Anne
    Boutron-Ruault, Marie-Christine
    Dossus, Laure
    Mesrine, Sylvie
    Kaaks, Rudolf
    Lukanova, Annekatrin
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Boeing, Heiner
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Trichopoulou, Antonia
    Palli, Domenico
    Krogh, Vittorio
    Panico, Salvatore
    Tumino, Rosario
    Zanetti, Roberto
    Bueno-de-Mesquita, H Bas
    Peeters, Petra H M
    Lund, Eiliv
    Menéndez, Virginia
    Agudo, Antonio
    Sanchez, Maria-Jose
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Larranaga, Nerea
    Hennings, Joakim
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sandström, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Khaw, Kay-Tee
    Wareham, Nicholas
    Romieu, Isabelle
    Gunter, Marc J
    Riboli, Elio
    Key, Timothy J
    Travis, Ruth C
    Insulin-like growth factor-I and risk of differentiated thyroid carcinoma in the European Prospective Investigation into Cancer and Nutrition2014Inngår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 23, nr 6, s. 976-985Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Little is known about the causes of thyroid cancer, but insulin-like growth factor-I (IGF-I) might play an important role in its development due to its mitogenic and anti-apoptotic properties. Methods: This study prospectively investigated the association between serum IGF-I concentrations and risk of differentiated thyroid carcinoma in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition. 345 incident cases of differentiated thyroid carcinoma were individually matched to 735 controls by study centre, sex, and age, date, time, and fasting status at blood collection, follow-up duration, and for women menopausal status, use of exogenous hormones, and phase of menstrual cycle at blood collection. Serum IGF-I concentrations were measured by immunoassay, and risk of differentiated thyroid cancer in relation to IGF-I concentration was estimated using conditional logistic regression. Results: There was a positive association between IGF-I concentrations and risk of differentiated thyroid carcinoma: the odds ratio for a doubling in IGF-I concentration was 1.48 (95% confidence interval: 1.06 - 2.08; ptrend = 0.02). The positive association with IGF-I was stable over time between blood collection and cancer diagnosis. Conclusion: These findings suggest that IGF-I concentrations may be positively associated with risk of differentiated thyroid carcinoma. Impact: This study provides the first prospective evidence of a potential association between circulating IGF-I concentrations and risk of differentiated thyroid carcinoma and may prompt the further investigations needed to confirm the association.

  • 760. Schober, Marvin
    et al.
    Javed, Muhammad A.
    Beyer, G.
    Le, Nha
    Vinci, Alessio
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Neesse, Albrecht
    Krug, Sebastian
    New Advances in the Treatment of Metastatic Pancreatic Cancer2015Inngår i: Digestion, ISSN 0012-2823, E-ISSN 1421-9867, Vol. 92, nr 3, s. 175-184Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Pancreatic ductal adenocarcinoma (PDAC) is characterised by an extremely poor overall survival (OS) compared to other solid tumours. As the incidence of the disease is rising and the treatment options are limited, PDAC is projected to be the 2nd leading cause of cancer-related deaths in the United States by 2030. A majority of patients are not eligible for curative resection at the time of diagnosis, and those that are resected will often relapse within the first few years after surgery. Summary: Until recently, the nucleoside analogue gemcitabine has been the standard of care for patients with non-resectable PDAC with only marginal effects on OS. In 2011, the gemcitabine-free FOLFIRINOX regimen (folinic acid, fluorouracil, irinotecan and oxaliplatin) showed a significant survival advantage for patients with metastatic PDAC in a phase III trial. In 2013, the Metastatic Pancreatic Adenocarcinoma Trial phase III trial with nano-formulated albumin-bound paclitaxel (nab-paclitaxel) in combination with gemcitabine also resulted in a significant survival extension compared to gemcitabine monotherapy. However, both intensified therapy regimens show a broad spectrum of side effects and patients need to be carefully selected for the most appropriate protocol. Key Message: In this study, recent advances in the chemotherapeutic options available to treat metastatic PDAC and their implications for today's treatment choices are reviewed.

  • 761.
    Schollin-Borg, Maria
    et al.
    Department of Anesthesiology and Intensive Care, Östersund Hospital, 83183 Östersund, Sweden.
    Nordin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Zetterström, Henrik
    Department of Surgical Sciences, Anesthesiology and Critical Care Medicine, Uppsala University, 75185 Uppsala, Sweden.
    Johansson, Joakim
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård. Department of Anesthesiology and Intensive Care, Östersund Hospital, 83183 Östersund, Sweden.
    Blood Lactate Is a Useful Indicator for the Medical Emergency Team2016Inngår i: Critical Care Research and Practice, ISSN 2090-1305, E-ISSN 2090-1313, artikkel-id 5765202Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Lactate has been thoroughly studied and found useful for stratification of patients with sepsis, in the Intensive Care Unit, and trauma care. However, little is known about lactate as a risk-stratification marker in the Medical Emergency Team-(MET-) call setting. We aimed to determine whether the arterial blood lactate level at the time of a MET-call is associated with increased 30-day mortality. This is an observational study on a prospectively gathered cohort at a regional secondary referral hospital. All MET-calls during the two-year study period were eligible. Beside blood lactate, age and vital signs were registered at the call. Among the 211 calls included, there were 64 deaths (30.3%). Median lactate concentration at the time of the MET-call was 1.82 mmol/L (IQR 1.16-2.7). We found differences between survivors and nonsurvivors for lactate and oxygen saturation, a trend for age, but no significant correlations between mortality and systolic blood pressure, respiratory rate, and heart rate. As compared to normal lactate (<2.44 mmol/L), OR for 30-day mortality was 3.54 (p < 0.0006) for lactate 2.44-5.0 mmol/L and 4.45 (p < 0.0016) for lactate >5.0 mmol/L. The present results support that immediate measurement of blood lactate in MET call patients is a useful tool in the judgment of illness severity.

  • 762. Sen, Abhijit
    et al.
    Tsilidis, Konstantinos K.
    Allen, Naomi E.
    Rinaldi, Sabina
    Appleby, Paul N.
    Almquist, Martin
    Schmidt, Julie A.
    Dahm, Christina C.
    Overvad, Kim
    Tjonneland, Anne
    Rostgaard-Hansen, Agnetha L.
    Clavel-Chapelon, Francoise
    Baglietto, Laura
    Boutron-Ruault, Marie-Christine
    Kuehn, Tilman
    Katze, Verena A.
    Boeing, Heiner
    Trichopoulou, Antonia
    Tsironis, Christos
    Lagiou, Pagona
    Palli, Domenico
    Pala, Valeria
    Panico, Salvatore
    Tumino, Rosario
    Vineis, Paolo
    Bueno-de-Mesquita, H. B. (as)
    Peeters, Petra H.
    Hjartaker, Anette
    Lund, Eiliv
    Weiderpass, Elisabete
    Ramon Quiros, J.
    Agudo, Antonio
    Sanchez, Maria-Jose
    Arriola, Larraitz
    Gavrila, Diana
    Barricarte Gurrea, Aurelio
    Tosovic, Ada
    Hennings, Joakim
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sandström, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Romieu, Isabelle
    Ferrari, Pietro
    Zamora-Ros, Raul
    Khaw, Kay-Tee
    Wareham, Nicholas J.
    Riboli, Elio
    Gunter, Marc
    Franceschi, Silvia
    Baseline and lifetime alcohol consumption and risk of differentiated thyroid carcinoma in the EPIC study2015Inngår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 113, nr 5, s. 840-847Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Results from several cohort and case-control studies suggest a protective association between current alcohol intake and risk of thyroid carcinoma, but the epidemiological evidence is not completely consistent and several questions remain unanswered.

    Methods: The association between alcohol consumption at recruitment and over the lifetime and risk of differentiated thyroid carcinoma was examined in the European Prospective Investigation into Cancer and Nutrition. Among 477 263 eligible participants (70% women), 556 (90% women) were diagnosed with differentiated thyroid carcinoma over a mean follow-up of 11 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards models.

    Results: Compared with participants consuming 0.1-4.9 g of alcohol per day at recruitment, participants consuming 15 or more grams (approximately 1-1.5 drinks) had a 23% lower risk of differentiated thyroid carcinoma (HR = 0.77; 95% CI = 0.60-0.98). These findings did not differ greatly when analyses were conducted for lifetime alcohol consumption, although the risk estimates were attenuated and not statistically significant anymore. Similar results were observed by type of alcoholic beverage, by differentiated thyroid carcinoma histology or according to age, sex, smoking status, body mass index and diabetes.

    Conclusions: Our study provides some support to the hypothesis that moderate alcohol consumption may be associated with a lower risk of papillary and follicular thyroid carcinomas.

  • 763.
    Sevonius, D
    et al.
    Department of Surgery, Lund University Hospital, Lund, Sweden.
    Gunnarsson, Ulf
    CLINTEC, Karolinska Institute, Stockholm, Sweden.
    Nordin, Pär
    Nilsson, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sandblom, G
    CLINTEC, Karolinska Institute, Stockholm, Sweden.
    Recurrent groin hernia surgery2011Inngår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 98, nr 10, s. 1489-1494Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The reoperation rate after recurrent groin hernia surgery is more than twice that recorded for primary groin hernia procedures. The aim was to define the outcome from routine redo hernia surgery by analysing a large population-based cohort from a national hernia register.

    Methods: All recurrent groin hernia operations registered in the Swedish Hernia Register from 1992 to 2008 were analysed using multivariable analysis with stratification for preceding repair.

    Results: Altogether 174 527 hernia operations were recorded in the Swedish Hernia Register between 1992 and 2008, including 19 582 reoperations. The preceding repair was included in the register for 5565 of these recurrent repairs. With laparoscopic repair as reference standard, the hazard ratio for recurrence was 2.55 (95 per cent confidence interval 1.66 to 3.93) after sutured repair, 1.53 (1.20 to 1.95) after Lichtenstein repair, 2.31 (1.76 to 3.03) after plug repair, 1.36 (0.95 to 1.94) after open preperitoneal mesh and 3.08 (2.22 to 4.29) after other repairs. Laparoscopic and open preperitoneal repair were associated with a lower risk of reoperation following a preceding open repair (P < 0.001), but no technique differed significantly from the others following a preceding preperitoneal repair.

    Conclusion: The laparoscopic and the open preperitoneal mesh methods of repair for recurrent groin hernias were associated with the lowest risk of reoperation. Although the method of repair in previous surgery must be considered, these techniques are the preferred methods for recurrent groin hernia surgery.

  • 764.
    Sevonius, Dan
    et al.
    Department of Surgery, University Hospital of Lund, Lund, Sweden.
    Gunnarsson, Ulf
    CLINTEC, Division of Surgery, Karolinska Institute, Stockholm, Sweden.
    Nordin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Nilsson, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sandblom, Gabriel
    Department of Surgery, University Hospital of Lund, Lund, Sweden.
    Repeated groin hernia recurrences.2009Inngår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 249, nr 3, s. 516-518Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe the characteristics of patients undergoing multiple groin hernia repairs and to identify strategies that prevent further recurrence. SUMMARY BACKGROUND DATA: Although relatively infrequent, recurrent groin hernias where several repairs have previously been undertaken constitutes a major problem in hernia surgery. Low numbers and heterogeneity have made it difficult to perform large prospective studies on this group. METHODS: The study was designed as an observational population-based register study. All repairs for recurrent hernia recorded in the Swedish Hernia Register (SHR) 1992-2006 were identified. Risk for reoperation by number of previous repairs, with adjustment for gender and age, and risk for reoperation by unit responsible for previous repair were determined using Cox proportional hazard analysis. RESULTS: There were 12,104 cases of hernia repaired once, 2 repairs in 4199 cases, 3 repairs in 310 cases, 4 repairs in 32 cases, and 5 repairs in 3 cases. The risk for further reoperation increased with the number of previous repairs (P < 0.001). The hazard ratios for reoperation following open preperitoneal mesh repair and laparoscopic repair decreased; whereas, the hazard ratio for sutured repair increased with the number of previous repairs. The difference between Lichtenstein repair and laparoscopic repair was significant for the first 2 repairs (P < 0.05). CONCLUSION: Laparoscopic preperitoneal repair provides the best surgical outcome in repeated groin hernia recurrence.

  • 765.
    Shah, Farhan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Franklin, Karl A
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Holmlund, Thorbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Levring Jäghagen, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Berggren, Diana
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Forsgren, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Stål, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Desmin and dystrophin abnormalities in upper airway muscles of snorers and patients with sleep apnea2019Inngår i: Respiratory Research, ISSN 1465-993X, Vol. 20, artikkel-id 31Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The pathophysiology of obstruction and swallowing dysfunction in snores and sleep apnea patients remains unclear. Neuropathy and to some extent myopathy have been suggested as contributing causes. Recently we reported an absence and an abnormal isoform of two cytoskeletal proteins, desmin, and dystrophin, in upper airway muscles of healthy humans. These cytoskeletal proteins are considered vital for muscle function. We aimed to investigate for muscle cytoskeletal abnormalities in upper airways and its association with swallowing dysfunction and severity of sleep apnea. Cytoskeletal proteins desmin and dystrophin were morphologically evaluated in the uvula muscle of 22 patients undergoing soft palate surgery due to snoring and sleep apnea and in 10 healthy controls. The muscles were analysed with immunohistochemical methods, and swallowing function was assessed using videoradiography. Desmin displayed a disorganized pattern in 21 +/- 13% of the muscle fibres in patients, while these fibers were not present in controls. Muscle fibres lacking desmin were present in both patients and controls, but the proportion was higher in patients (25 +/- 12% vs. 14 +/- 7%, p = 0.009). The overall desmin abnormalities were significantly more frequent in patients than in controls (46 +/- 18% vs. 14 +/- 7%, p < 0.001). In patients, the C-terminus of the dystrophin molecule was absent in 19 +/- 18% of the desmin-abnormal muscle fibres. Patients with swallowing dysfunction had 55 +/- 10% desmin-abnormal muscle fibres vs. 22 +/- 6% in patients without swallowing dysfunction, p = 0.002. Cytoskeletal abnormalities in soft palate muscles most likely contribute to pharyngeal dysfunction in snorers and sleep apnea patients. Plausible causes for the presence of these abnormalities is traumatic snoring vibrations, tissue stretch or muscle overload.

  • 766.
    Shah, Farhan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Holmlund, Thorbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Levring Jäghagen, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Berggren, Diana
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Franklin, Karl A
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Forsgren, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Stål, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Axon and Schwann Cell Degeneration in Nerves of Upper Airway Relates to Pharyngeal Dysfunction in Snorers and Patients With Sleep Apnea2018Inngår i: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 154, nr 5, s. 1091-1098Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The pathophysiologic mechanism of nocturnal obstruction and swallowing dysfunction commonly occurring in patients with sleep apnea is unclear. The goal of this study was to investigate whether nerve injuries in the upper airways of snorers and patients with sleep apnea are associated with pharyngeal dysfunction and severity of sleep apnea.

    METHODS: Twenty-two patients undergoing palatal surgery due to snoring and sleep apnea were investigated for a swallowing dysfunction by using videoradiography. Twelve healthy nonsnoring subjects were included as control subjects. Tissue samples from the soft palate at the base of the uvula were obtained in all patients and control subjects. Nerves and muscle were analyzed with immunohistochemical and morphologic methods, and the findings were correlated with swallowing function and degree of sleep apnea.

    RESULTS: In the soft palate of patients, nerve fascicles exhibited a significantly lower density of axons (5.4 vs 17.9 x 10(-3) axons/mu m(2); P = .02), a smaller percentage area occupied by Schwann cells (17.5% vs 45.2%; P = .001) and a larger number of circular shaped Schwann cells lacking central axons (43.0% vs 12.7%; P < 0.001) compared with control subjects. The low density of axons was significantly related to degree of swallowing dysfunction (r = 0.5; P = .03) and apnea-hypopnea index > 5 (P = .03). Regenerating axons were frequently observed in patients compared with control subjects (11.3 +/- 4.2% vs 4.8 +/- 2.4%; P = .02).

    CONCLUSIONS: Axon degeneration in preterminal nerves of the soft palate is associated with pharyngeal dysfunction in snorers and patients with sleep apnea. The most likely cause for the nerve injuries is traumatic snoring vibrations and tissue stretch, leading to swallowing dysfunction and increased risk for upper airway obstruction during sleep.

  • 767.
    Sharma, Rajiv
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Axelsson, H.
    Öberg, Åke
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Jansson, Erica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Clergue, F.
    Johansson, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Reiz, Sebastian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Diaphragmatic activity after laparoscopic cholecystectomy1999Inngår i: Anesthesiology, Vol. 91, nr 2, s. 406-13Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Laparoscopic cholecystectomy is presumed to induce a reduction in diaphragmatic activity. Indirect indices of diaphragmatic function based on tidal changes in pressures and cross-section area measurements can be unreliable in the postoperative phase. The present study evaluates diaphragmatic activity by directly recording diaphragmatic EMG (EMGdia) data, along with indirect indices. METHODS: Thirteen adult patients (American Society of Anesthesiologists physical status I or II) undergoing laparoscopic cholecystectomy were examined preoperatively for inspiratory tidal changes in gastric (Pgas-insp) and esophageal (Peso-insp) pressures, and tidal changes in ribcage (Vthor) and abdominal (Vabd) cross-section areas and then again at 1, 6, and 24 h postoperatively combined with EMGdia recordings. Variations in inspiratory gastric (deltaPgas-insp) and inspiratory transdiaphragmatic (deltaPdi-insp) pressures were derived from the above. RESULTS: Laparoscopic cholecystectomy induced a significant reduction in mean deltaPgas-insp, mean deltaPdi-insp, and mean Vabd indicating a reduction of diaphragmatic activity postoperatively. DeltaPdi-insp decreased from 11.8+/-4.0 cm H2O preoperatively to 5.7+/-5.7 cm H2O at 1 h and 6.6+/-5.1 cm H2O at 6 h postoperatively (mean +/- SD; P < 0.05). Vabd decreased from 327.0+/-113.0 ml preoperatively to 174.0+/-65.0 ml at 1 h and 175.0+/-98.0 ml at 6 h postoperatively (mean +/- SD; P < 0.05). These values had partially recovered at 24 h. CONCLUSION: The direct and indirect indices of diaphragmatic activity taken together confirm the presence of reduction in diaphragmatic activity after laparoscopic cholecystectomy followed by its partial recovery at 24 h.

  • 768.
    Sharp, Nicholas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Does the location of bile duct stones influence the intra- and postop outcome of cholecystectomy?2018Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 769. Shetye, Jayant D
    et al.
    Liljefors, Maria L
    Emdin, Stefan
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Frödin, Jan-Erik
    Strigård, Karin
    Mellstedt, Håkan T
    Porwit, Anja
    Spectrum of cytokeratin-positive cells in the bone marrows of colorectal carcinoma patients.2004Inngår i: Anticancer Res, ISSN 0250-7005, Vol. 24, nr 4, s. 2375-83Artikkel i tidsskrift (Fagfellevurdert)
  • 770. Siddiq, Afshan
    et al.
    Couch, Fergus J.
    Chen, Gary K.
    Lindstrom, Sara
    Eccles, Diana
    Millikan, Robert C.
    Michailidou, Kyriaki
    Stram, Daniel O.
    Beckmann, Lars
    Rhie, Suhn Kyong
    Ambrosone, Christine B.
    Aittomaki, Kristiina
    Amiano, Pilar
    Apicella, Carmel
    Baglietto, Laura
    Bandera, Elisa V.
    Beckmann, Matthias W.
    Berg, Christine D.
    Bernstein, Leslie
    Blomqvist, Carl
    Brauch, Hiltrud
    Brinton, Louise
    Bui, Quang M.
    Buring, Julie E.
    Buys, Saundra S.
    Campa, Daniele
    Carpenter, Jane E.
    Chasman, Daniel I.
    Chang-Claude, Jenny
    Chen, Constance
    Clavel-Chapelon, Francoise
    Cox, Angela
    Cross, Simon S.
    Czene, Kamila
    Deming, Sandra L.
    Diasio, Robert B.
    Diver, W. Ryan
    Dunning, Alison M.
    Durcan, Lorraine
    Ekici, Arif B.
    Fasching, Peter A.
    Feigelson, Heather Spencer
    Fejerman, Laura
    Figueroa, Jonine D.
    Fletcher, Olivia
    Flesch-Janys, Dieter
    Gaudet, Mia M.
    Gerty, Susan M.
    Rodriguez-Gil, Jorge L.
    Giles, Graham G.
    van Gils, Carla H.
    Godwin, Andrew K.
    Graham, Nikki
    Greco, Dario
    Hall, Per
    Hankinson, Susan E.
    Hartmann, Arndt
    Hein, Rebecca
    Heinz, Judith
    Hoover, Robert N.
    Hopper, John L.
    Hu, Jennifer J.
    Huntsman, Scott
    Ingles, Sue A.
    Irwanto, Astrid
    Isaacs, Claudine
    Jacobs, Kevin B.
    John, Esther M.
    Justenhoven, Christina
    Kaaks, Rudolf
    Kolonel, Laurence N.
    Coetzee, Gerhard A.
    Lathrop, Mark
    Le Marchand, Loic
    Lee, Adam M.
    Lee, I-Min
    Lesnick, Timothy
    Lichtner, Peter
    Liu, Jianjun
    Lund, Eiliv
    Makalic, Enes
    Martin, Nicholas G.
    McLean, Catriona A.
    Meijers-Heijboer, Hanne
    Meindl, Alfons
    Miron, Penelope
    Monroe, Kristine R.
    Montgomery, Grant W.
    Mueller-Myhsok, Bertram
    Nickels, Stefan
    Nyante, Sarah J.
    Olswold, Curtis
    Overvad, Kim
    Palli, Domenico
    Park, Daniel J.
    Palmer, Julie R.
    Pathak, Harsh
    Peto, Julian
    Pharoah, Paul
    Rahman, Nazneen
    Rivadeneira, Fernando
    Schmidt, Daniel F.
    Schmutzler, Rita K.
    Slager, Susan
    Southey, Melissa C.
    Stevens, Kristen N.
    Sinn, Hans-Peter
    Press, Michael F.
    Ross, Eric
    Riboli, Elio
    Ridker, Paul M.
    Schumacher, Fredrick R.
    Severi, Gianluca
    Silva, Isabel dos Santos
    Stone, Jennifer
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Tapper, William J.
    Thun, Michael J.
    Travis, Ruth C.
    Turnbull, Clare
    Uitterlinden, Andre G.
    Waisfisz, Quinten
    Wang, Xianshu
    Wang, Zhaoming
    Weaver, JoEllen
    Schulz-Wendtland, Ruediger
    Wilkens, Lynne R.
    Van Den Berg, David
    Zheng, Wei
    Ziegler, Regina G.
    Ziv, Elad
    Nevanlinna, Heli
    Easton, Douglas F.
    Hunter, David J.
    Henderson, Brian E.
    Chanock, Stephen J.
    Garcia-Closas, Montserrat
    Kraft, Peter
    Haiman, Christopher A.
    Vachon, Celine M.
    A meta-analysis of genome-wide association studies of breast cancer identifies two novel susceptibility loci at 6q14 and 20q112012Inngår i: Human Molecular Genetics, ISSN 0964-6906, E-ISSN 1460-2083, Vol. 21, nr 24, s. 5373-5384Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Genome-wide association studies (GWAS) of breast cancer defined by hormone receptor status have revealed loci contributing to susceptibility of estrogen receptor (ER)-negative subtypes. To identify additional genetic variants for ER-negative breast cancer, we conducted the largest meta-analysis of ER-negative disease to date, comprising 4754 ER-negative cases and 31 663 controls from three GWAS: NCI Breast and Prostate Cancer Cohort Consortium (BPC3) (2188 ER-negative cases; 25 519 controls of European ancestry), Triple Negative Breast Cancer Consortium (TNBCC) (1562 triple negative cases; 3399 controls of European ancestry) and African American Breast Cancer Consortium (AABC) (1004 ER-negative cases; 2745 controls). We performed in silico replication of 86 SNPs at P 1 10(-5) in an additional 11 209 breast cancer cases (946 with ER-negative disease) and 16 057 controls of Japanese, Latino and European ancestry. We identified two novel loci for breast cancer at 20q11 and 6q14. SNP rs2284378 at 20q11 was associated with ER-negative breast cancer (combined two-stage OR 1.16; P 1.1 10(8)) but showed a weaker association with overall breast cancer (OR 1.08, P 1.3 10(6)) based on 17 869 cases and 43 745 controls and no association with ER-positive disease (OR 1.01, P 0.67) based on 9965 cases and 22 902 controls. Similarly, rs17530068 at 6q14 was associated with breast cancer (OR 1.12; P 1.1 10(9)), and with both ER-positive (OR 1.09; P 1.5 10(5)) and ER-negative (OR 1.16, P 2.5 10(7)) disease. We also confirmed three known loci associated with ER-negative (19p13) and both ER-negative and ER-positive breast cancer (6q25 and 12p11). Our results highlight the value of large-scale collaborative studies to identify novel breast cancer risk loci.

  • 771. Sieri, Sabina
    et al.
    Chiodini, Paolo
    Agnoli, Claudia
    Pala, Valeria
    Berrino, Franco
    Trichopoulou, Antonia
    Benetou, Vassiliki
    Vasilopoulou, Effie
    Sánchez, María-José
    Chirlaque, Maria-Dolores
    Amiano, Pilar
    Quirós, J Ramón
    Ardanaz, Eva
    Buckland, Genevieve
    Masala, Giovanna
    Panico, Salvatore
    Grioni, Sara
    Sacerdote, Carlotta
    Tumino, Rosario
    Boutron-Ruault, Marie-Christine
    Clavel-Chapelon, Françoise
    Fagherazzi, Guy
    Peeters, Petra H M
    van Gils, Carla H
    Bueno-de-Mesquita, H Bas
    van Kranen, Henk J
    Key, Timothy J
    Travis, Ruth C
    Khaw, Kay Tee
    Wareham, Nicholas J
    Kaaks, Rudolf
    Lukanova, Annekatrin
    Boeing, Heiner
    Schütze, Madlen
    Sonestedt, Emily
    Wirfält, Elisabeth
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Andersson, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Chajes, Veronique
    Rinaldi, Sabina
    Romieu, Isabelle
    Weiderpass, Elisabete
    Skeie, Guri
    Dagrun, Engeset
    Tjønneland, Anne
    Halkjær, Jytte
    Overvard, Kim
    Merritt, Melissa A
    Cox, David
    Riboli, Elio
    Krogh, Vittorio
    Dietary fat intake and development of specific breast cancer subtypes2014Inngår i: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 106, nr 5, s. dju068-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We prospectively evaluated fat intake as predictor of developing breast cancer (BC) subtypes defined by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 receptor (HER2), in a large (n = 337327) heterogeneous cohort of women, with 10062 BC case patients after 11.5 years, estimating BC hazard ratios (HRs) by Cox proportional hazard modeling. High total and saturated fat were associated with greater risk of ER(+)PR(+) disease (HR = 1.20, 95% confidence interval [CI] = 1.00 to 1.45; HR = 1.28, 95% CI = 1.09 to 1.52; highest vs lowest quintiles) but not ER(-)PR(-) disease. High saturated fat was statistically significantly associated with greater risk of HER2(-) disease. High saturated fat intake particularly increases risk of receptor-positive disease, suggesting saturated fat involvement in the etiology of this BC subtype.

  • 772.
    Simm, Maja
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Subtle clinical symptoms of pancreatic cancer  – a study in an early detection cohort.2014Independent thesis Advanced level (professional degree), 20 poäng / 30 hpOppgave
  • 773. Simons, M P
    et al.
    Aufenacker, T
    Bay-Nielsen, M
    Bouillot, J L
    Campanelli, G
    Conze, J
    de Lange, D
    Fortelny, R
    Heikkinen, T
    Kingsnorth, A
    Kukleta, J
    Morales-Conde, S
    Nordin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Schumpelick, V
    Smedberg, S
    Smietanski, M
    Weber, G
    Miserez, M
    European Hernia Society guidelines on the treatment of inguinal hernia in adult patients.2009Inngår i: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 13, nr 4, s. 343-403Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The European Hernia Society (EHS) is proud to present the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS. They are evidence-based and, when necessary, a consensus was reached among all members. The Guidelines have been reviewed by a Steering Committee. Before finalisation, feedback from different national hernia societies was obtained. The Appraisal of Guidelines for REsearch and Evaluation (AGREE) instrument was used by the Cochrane Association to validate the Guidelines. The Guidelines can be used to adjust local protocols, for training purposes and quality control. They will be revised in 2012 in order to keep them updated. In between revisions, it is the intention of the Working Group to provide every year, during the EHS annual congress, a short update of new high-level evidence (randomised controlled trials [RCTs] and meta-analyses). Developing guidelines leads to questions that remain to be answered by specific research. Therefore, we provide recommendations for further research that can be performed to raise the level of evidence concerning certain aspects of inguinal hernia treatment. In addition, a short summary, specifically for the general practitioner, is given. In order to increase the practical use of the Guidelines by consultants and residents, more details on the most important surgical techniques, local infiltration anaesthesia and a patient information sheet is provided. The most important challenge now will be the implementation of the Guidelines in daily surgical practice. This remains an important task for the EHS. The establishment of an EHS school for teaching inguinal hernia repair surgical techniques, including tips and tricks from experts to overcome the learning curve (especially in endoscopic repair), will be the next step. Working together on this project was a great learning experience, and it was worthwhile and fun. Cultural differences between members were easily overcome by educating each other, respecting different views and always coming back to the principles of evidence-based medicine. The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project.

  • 774.
    Sjögren, Harmeet
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Injuries among the elderly: study of fatal and non-fatal injury events1994Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    In view of the expected increase in the proportion of elderly in the population in most western countries, we studied injuries among the elderly (>60 years) by investigating hospital-treated injuries in inpatients and outpatients, and fatal injuries.

    One-year Hospital Injury Data - Even though the elderly made up only 15% of the injured in one year, they accounted for 42% of the total cost of trauma medical care, showing that injuries among the elderly place a disproportional burden on the health care system. The mean medical care cost increased significantly from the age of 60 years. Serious injuries (MAIS>3) in the elderly cost almost 2.5 times more than those in the younger group (<60 years).

    Study of 1,313 injury events in 1,268 elderly showed annual injury, fracture, and mortality rates per 1,000 elderly population of 57, 31, and 0.6, respectively. Almost half were injured in the home environment, and 23% in the traffic environment. Most of the severe and critical injuries (MAIS>4) occurred in the traffic environment. Injury rate, severity of injuries, fractures, and the duration of hospitalization increased with age. Almost half of the injuries were fractures; most common were wrist and hip fractures. Women had a higher injury rate, more severe injuries, and longer duration in hospitalization than men had.

    Study of 621 injury events in 600 elderly injured in the home environment, showed annual injury and fracture rates of 30 and 15 per 1,000 elderly home population, respectively. Injuries were grouped into fall injuries (76%) and non-fall injuries (24%). The fall injury incidence was higher in women than in men. Most falls occurred indoors. Environmental factors played a role in half of the fall injuries, and intrinsic factors in at least one fifth. Intrinsic factors in falls became increasingly important with advancing age. Non-fall injuries were mostly sustained in woodworking. Fall injuries were of a greater severity and accounted for 80% of the cost of medical care of elderly in the home environment.

    Study of 298 injury events in 297 elderly injured in the traffic environment, showed that pedestrian falls accounted for 52% of the injuries, and vehicle-related events for 44%. The main groups in the vehicle-related injury category were bicyclists (48%), car occupants (34%), and pedestrians (4%). Two thirds of the pedestrian falls involved slipping on ice/snow. Ice/snow-related injuries (all categories) accounted for 37% of the total cost of all injuries in the elderly in the traffic environment. Vehicle-related crashes resulted in the most severe and critical injuries and the most fatalities, and cost (total and mean) more than pedestrian falls.

    Fatal Injury Data from Northern Sweden - Study of 379 elderly injured in the traffic environment in a ten-year period, showed that the car occupants (43%) made up the largest category followed by pedestrians (28%), bicyclists (15%), and two-wheel-motor-vehicle riders (8%), but the risk of fatal injury per unit distance travelled was highest for pedestrians and bicyclists. Males had double the death rate as females. Most car occupants were killed in multivehicle crashes, mostly in the daylight, and at intersections. Ice/snow was the major (31%) precrash factor. One quarter of pedestrians were injured at pedestrian crossings, and half of them during darkness. One in six pedestrians was under the influence of alcohol. All pedestrians and bicyclists were injured in collisions with motor vehicles and most were injured at intersections. Pedestrians and bicyclists had more serious head injuries than chest injuries.

    Study of 514 car drivers (>18 years) injured in a 13-year-period, showed that fatalities per unit distance, and per licensed driver were highest for the >70-year-old and 18-19-year-old drivers. Elderly (>60 year old) and <25 year old drivers had similar fatality frequencies. The older drivers (>60 years) initiated the crash more often than younger (<60 years) ones. Fatal head injuries decreased whilst chest injuries increased with age. The older drivers were more likely to die from post-trauma complications than younger ones.

    In a study of role of disease in 480 fatally injured drivers (>18 years) who died within three days of the crash, a grading system was developed to assess the probability of contribution of medical intrinsic factors (MIF) to the crash. Almost one quarter of the drivers were found to have MIF. Drivers with MIF were more often at fault than those without. Medical intrinsic factors were probably an underlying cause in 1 of 17 fatal crashes in all ages, and 1 of 5 fatal crashes in the elderly; in 4% of the elderly the probability was strong.

    A "passive automatic" approach which does not require any action on the part of the elderly, is to be recommended when improving safety in the home and in the traffic environments. The elderly drivers can be regarded as the "miner's canary" to indicate which passive safety improvements are needed in the traffic environment. In view of the expected population trends, it is important that authorities and public health workers accept the challenge to continue and intensify the injury preventive work for the elderly.

  • 775.
    Sjöling, Mats
    et al.
    Research and Development Centre, County Council of Västernorrland.
    Westman, Anton
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Skydiving culture and its relation to injury risks and injury reportingManuskript (Annet (populærvitenskap, debatt, mm))
    Abstract [en]

    This article explores some aspects of the Swedish skydiving culture and its relation to injury risks and injury reporting. Seventeen skydivers were interviewed and the transcripts were analyzed with latent and manifest content analyses. The reference frame emerging from the narratives encompasses experiences of joy, passion and playfulness; and of injury, suffering and death. The risk of injury is viewed as an integrated element of the recreational activity, counterbalanced by its recreational value. From the text analysis we suggest that Swedish skydiving culture is carried by the local club; not the national association. Though the Swedish Parachute Association has far-reaching powers over the clubs, our findings imply that skydiving culture at the local drop zone and formal and informal hierarchical structures among skydivers are what really decide how rules are enforced, and if incidents and injuries are reported.

  • 776. Sjöström, Lars
    et al.
    Gummesson, Anders
    Sjöström, C David
    Narbro, Kristina
    Peltonen, Markku
    Wedel, Hans
    Bengtsson, Calle
    Bouchard, Claude
    Carlsson, Björn
    Dahlgren, Sven
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Jacobson, Peter
    Karason, Kristjan
    Karlsson, Jan
    Larsson, Bo
    Lindroos, Anna-Karin
    Lönroth, Hans
    Näslund, Ingmar
    Olbers, Torsten
    Stenlöf, Kaj
    Torgerson, Jarl
    Carlsson, Lena M S
    Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial2009Inngår i: The lancet oncology, ISSN 1474-5488, Vol. 10, nr 7, s. 653-662Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Obesity is a risk factor for cancer. Intentional weight loss in the obese might protect against malignancy, but evidence is limited. To our knowledge, the Swedish Obese Subjects (SOS) study is the first intervention trial in the obese population to provide prospective, controlled cancer-incidence data. METHODS: The SOS study started in 1987 and involved 2010 obese patients (body-mass index [BMI] >or=34 kg/m(2) in men, and >or=38 kg/m(2) in women) who underwent bariatric surgery and 2037 contemporaneously matched obese controls, who received conventional treatment. While the main endpoint of SOS was overall mortality, the main outcome of this exploratory report was cancer incidence until Dec 31, 2005. Cancer follow-up rate was 99.9% and the median follow-up time was 10.9 years (range 0-18.1 years). FINDINGS: Bariatric surgery resulted in a sustained mean weight reduction of 19.9 kg (SD 15.6 kg) over 10 years, whereas the mean weight change in controls was a gain of 1.3 kg (SD 13.7 kg). The number of first-time cancers after inclusion was lower in the surgery group (n=117) than in the control group (n=169; HR 0.67, 95% CI 0.53-0.85, p=0.0009). The sex-treatment interaction p value was 0.054. In women, the number of first-time cancers after inclusion was lower in the surgery group (n=79) than in the control group (n=130; HR 0.58, 0.44-0.77; p=0.0001), whereas there was no effect of surgery in men (38 in the surgery group vs 39 in the control group; HR 0.97, 0.62-1.52; p=0.90). Similar results were obtained after exclusion of all cancer cases during the first 3 years of the intervention. INTERPRETATION: Bariatric surgery was associated with reduced cancer incidence in obese women but not in obese men. FUNDING: Swedish Research Council, Swedish Foundation for Strategic Research, Swedish Federal Government under the LUA/ALF agreement, Hoffmann La Roche, Cederoths, AstraZeneca, Sanofi-Aventis, Ethicon Endosurgery.

  • 777. Skoglar, Andreas
    et al.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Falk, Peter
    Band adhesions not related to previous abdominal surgery: A retrospective cohort analysis of risk factors2018Inngår i: Annals of Medicine and Surgery, ISSN 2049-0801, Vol. 36, s. 185-190Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Postoperative intra-abdominal adhesion formation is a common cause of small bowel obstruction (SBO). Adhesions causing SBO are classed as either matted adhesions or solitary band adhesions. The aim of this study was to investigate the prevalence of previous abdominal surgery in a cohort of patients operated for bowel obstruction and to analyze the causes of obstruction discovered at surgery.

    Materials and methods: The study was performed at a county hospital with a catchment population of 120 000 inhabitants. Records of operations performed for bowel obstruction over a period of 70 months were retrieved.

    Results: Of the 196 surgical procedures for intestinal obstruction included, 108 (55%) were caused by adhesions. In this group, 42 (39%) were due to solitary band adhesions and 66 (61%) were due to matted adhesions. Ten of 18 male patients (56%) with a solitary obstructing band had not undergone previous abdominal surgery (p < 0.05). In the cohort as a whole, a significant number of surgical procedures were performed for solitary band adhesions in patients without prior history of surgery (p < 0.01).

    Conclusion: In male patients, not only previous abdominal surgery but also other factors appear to increase the risk for bowel obstruction due to a solitary band. For intestinal obstruction caused by matted adhesions, however, previous abdominal surgery is the main risk factor in both genders. Patients with signs of SBO but without previous abdominal surgery should be managed bearing in mind that solitary band adhesion and thereby strangulation may be present regardless of previous surgery or not.

  • 778. Skoglund, Johanna
    et al.
    Song, Bo
    Dalén, Johan
    Dedorson, Stefan
    Edler, David
    Hjern, Fredrik
    Holm, Jörn
    Lenander, Claes
    Lindforss, Ulrik
    Lundqvist, Nils
    Olivecrona, Hans
    Olsson, Louise
    Påhlman, Lars
    Rutegård, Jörgen
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Smedh, Kennet
    Törnqvist, Anders
    Houlston, Richard S
    Lindblom, Annika
    Lack of an association between the TGFBR1*6A variant and colorectal cancer risk.2007Inngår i: Clin Cancer Res, ISSN 1078-0432, Vol. 13, nr 12, s. 3748-52Artikkel i tidsskrift (Fagfellevurdert)
  • 779.
    Smulter, Nina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Delirium after cardiac surgery: risk factors, assessment methods and costs2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: Cardiac surgery is considered safe, but postoperative delirium (POD) remains frequently reported. Delirium is characterised by fluctuations in consciousness and cognition, and can be subdivided into disturbed psychomotoric activity (hyperactive and hypoactive) and psychiatric symptom profiles (psychotic and emotional). Delirium has an underlying cause that can be prevented and treated, provided the condition is detected. Undetected delirium could lead to serious consequences for the patient.

    Aim: This thesis aims to understand the underlying risk factors of delirium, to compare different assessment methods and documentation, and to understand its effects on hospitalisation costs after cardiac surgery.

    Methods: Two cohorts of patients undergoing cardiac surgery at the Heart Centre, Umeå University Hospital, Sweden were analysed. Cohort-A (Studies I-IV) enrolled 142 patients, ≥70 years of age, scheduled in 2009 for surgery with cardiopulmonary bypass (CPB). POD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th ed, text rev (DSM-IV-TR), based on repetitive assessments with the Mini-Mental State Examination (MMSE) and the Organic Brain Syndrome (OBS) scale. This method was considered as reference. Predisposing and precipitating risk factors were explored (Study I), and a separate analysis was conducted with focus on CPB parameters (Study II). Patients were also assessed for POD with the Confusion Assessment Method (CAM), which was validated versus the reference method (Study III). Additionally in Study IV, data about how nurses assessed patients for POD symptoms using the Nursing Delirium Screening Scale (Nu-DESC) were analysed together with information extracted from the clinical database. Moreover, discharge summaries from both nurses and physicians were retrospectively reviewed for key words and expression associated with delirium. Cohort-B (Study V) included 1879 routine cardiac surgery patients (2014-2017) retrospectively extracted from the clinical database with concomitant Nu-DESC scoring. The association between the Nu-DESC and postoperative hospitalization costs was analysed.

    Results: In cohort-A, 54.9% (78/142) patients developed POD. Both predisposing and precipitating risk factors were significantly associated with POD, of which the ‘volume load during operation’ had the strongest predictive influence (Study I). Among CPB variables the ‘duration of mixed-venous oxygen saturation <75%’ predicted POD (Study II). Hypoactive was more common than hyperactive delirium. Those with hypoactive delirium were less likely to be detected by the CAM method (Study III), an observation also demonstrated from information found in the clinical database and in discharge summaries. Nu-DESC did not detect all patients with POD, but significantly increased the detection rate (Study IV). The major hospitalisation costs associated with Nu-DESC ≥2 occurred in the ICU and independently of the surgical procedure performed. There were no significant differences in costs among patients with Nu-DESC ≥2, between age groups (70-year cut-off) or genders (Study V).

    Conclusions: Both predisposing and precipitating risk factors contributed to POD and should be considered in future guidelines to prevent delirium after cardiac surgery. Hypoactive delirium was most common, but was the most difficult to detect without screening scales. Systematic assessment with Nu-DESC improved the detection rate of POD. Delirium after cardiac surgery has consequences on healthcare and is associated with increased costs.

  • 780.
    Smulter, Nina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Cardiothoracic Division, Department of Surgery and Perioperative Science, Umeå University.
    Claesson Lingehall, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Cardiothoracic Division, Department of Surgery and Perioperative Science, Umeå University.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Engström, Karl Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Cardiothoracic Division, Department of Surgery and Perioperative Science, Umeå University.
    Delirium after cardiac surgery: incidence and risk factors2013Inngår i: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 17, nr 5, s. 790-796Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Delirium after cardiac surgery is a problem with consequences for patients and healthcare. Preventive strategies from known risk factors may reduce the incidence and severity of delirium. The present aim was to explore risk factors behind delirium in older patients undergoing cardiac surgery with cardiopulmonary bypass.

    METHODS: Patients (≥70 years) scheduled for routine cardiac surgery were included (n = 142). The patients were assessed and monitored pre-/postoperatively, and delirium was diagnosed from repeated assessments with the Mini-Mental State Examination and the Organic Brain Syndrome Scale, using the DSM-IV-TR criteria. Variables were analysed by uni-/multivariable logistic regression, including both preoperative variables (predisposing) and those extracted during surgery and in the early postoperative period (precipitating).

    RESULTS: Delirium was diagnosed in 78 patients (54.9%). Delirium was independently associated with both predisposing and precipitating factors (P-value, odds ratio, upper/lower confidence interval): age (0.036, 1.1, 1.0/1.2), diabetes (0.032, 3.5, 1.1/11.0), gastritis/ulcer problems (0.050, 4.0, 1.0/16.1), volume load during operation (0.001, 2.8, 1.5/5.1), ventilator time in ICU (0.042, 1.2, 1.0/1.4), highest temperature recorded in ICU (0.044, 2.2, 1.0/4.8) and sodium concentration in ICU (0.038, 1.2, 1.0/1.4).

    CONCLUSIONS: Delirium was common among older patients undergoing cardiac surgery. Both predisposing and precipitating factors contributed to delirium. When combined, the predictive strength of the model improved. Preventive strategies may be considered, in particular among the precipitating factors. Of interest, delirium was strongly associated with an increased volume load during surgery.

  • 781.
    Smulter, Nina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Claesson Lingehall, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Engström, Karl Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    The use of a screening scale improves the recognition of delirium in older patients after cardiac surgery: a retrospective observational study2019Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, nr 11-12, s. 2309-2318Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS AND OBJECTIVES: This study analyzed postoperative delirium (POD) in clinical practice after cardiac surgery, how it is detected and documented and if the use of a screening scale improves the detection rate.

    BACKGROUND: Cardiac surgery is considered a routine procedure with few complications. However, POD remains a concern, although often being overlooked in clinical practice.

    DESIGN: Retrospective observational analysis.

    METHODS: Patients 70 years and older with POD (n=78) undergoing cardiac surgery were included in the study. Discharge summaries of both nurses and physicians were reviewed together with the clinical database for information about POD, to be compared with symptom screening using the Nursing Delirium Screening Scale (Nu-DESC). A quantitative content analysis was used for the review of discharge summaries, with a coding scheme adopted from the Nu-DESC method. The STROBE checklist was followed.

    RESULTS: In discharge summaries 41 of the 78 POD patients were correctly recognized, and 22 of these were identified in the clinical database. Screening by the Nu-DESC identified delirium at a measurably higher rate, 56/78 patients. The review of discharge summaries showed that patients expressing 'inappropriate behaviour' was the most easily identified sign for POD for both nurses and physicians.

    CONCLUSIONS: Healthcare professionals underdiagnose delirium after cardiac surgery, with a low detection rate described in both discharge summaries and in the clinical database. Recognition of delirium improved when Nu-DESC was used for systematic screening.

    RELEVANCE TO CLINICAL PRACTICE: This study emphasizes the need for better screening for the detection of delirium in daily clinical practice. This article is protected by copyright. All rights reserved.

  • 782.
    Smulter, Nina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Claesson Lingehall, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Engström, Karl Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Validation of the confusion assessment method in detecting postoperative delirium in cardiac surgery patients2015Inngår i: American Journal of Critical Care, ISSN 1062-3264, E-ISSN 1937-710X, Vol. 24, nr 6, s. 480-487Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Early detection, prevention, and treatment of delirium after cardiac surgery are important for quick postoperative recovery. The Confusion Assessment Method (CAM) may be an easy-to-use instrument for detecting delirium in clinical practice.

    Objectives: To compare the congruent validity of the CAM with the results from repeated assessments by using a combination of the Organic Brain Syndrome Scale and the Mini-Mental State Examination according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria for delirium.

    Methods: Patients aged 70 years or older undergoing cardiac surgery were assessed on postoperative days 1 and 4, and the 2 diagnostic methods were compared. The sensitivity and specificity of the CAM were examined. The reference method allowed categorization of delirium into subgroups of psychomotor activities and psychiatric symptom profiles, which were compared with the CAM results.

    Results: Postoperative delirium was diagnosed in 78 of 141 patients (55.3%). According to the CAM, 59 patients (41.8%) were categorized as delirious, 53 correctly. Thus, the sensitivity was 68% and the specificity was 90%, indicating false-negative rather than false-positive observations.

    Conclusion: Patients with psychomotor hyperactivity and mixed psychotic-emotional symptoms were more likely to have delirium detected via the CAM than were patients with less obvious clinical manifestations of delirium. Repetitive cognitive testing and psychogeriatric experience are probably necessary to improve the results obtained with the CAM.

  • 783.
    Smulter, Nina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Hentschel, Jan
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Engström, Karl Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    The association between delirium symptoms according to the Nursing Delirium Screening Scale and hospitalization costs after cardiac surgeryManuskript (preprint) (Annet vitenskapelig)
  • 784.
    Smulter, Nina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Cardiothoracic Surgery Division, Heart Center.
    Lingehall, Helena Claesson
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Engström, Karl Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Appelblad, Micael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Svenmarker, Staffan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Disturbances in Oxygen Balance During Cardiopulmonary Bypass: A Risk Factor for Postoperative Delirium2018Inngår i: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 32, nr 2, s. 684-690Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to determine risk factors for postoperative delirium after cardiac surgery, specifically associated with the conduct of cardiopulmonary bypass (CPB).

    Design: Prospective observational study.

    Setting: Heart Centre, University Hospital.

    Participants: The study included 142 patients aged 70 years and older scheduled for elective cardiac surgery with CPB.

    Interventions: Risk factor analysis comprised information collected from the hospital clinical and CPB dedicated databases in addition to the medical chart. Delirium was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criterion using the Mini Mental State Examination and the Organic Brain Syndrome scale.

    Measurements and Main Results: Assessments of delirium diagnosis were executed preoperatively and on the following first and fourth postoperative days. Delirium occurred in 55% (78/142) of the patients. Patients with delirium were identified with significantly higher body weight and body surface area preoperatively, accompanied with longer CPB time, higher positive fluid balance per CPB, and lower systemic pump flow related to body surface area. Furthermore, the duration of the mixed venous oxygen saturation (SvO2) below 75% was significantly longer during CPB. The result from the multivariable logistic regression analysis included the duration of SvO2 below 75%, fluid balance per CPB and patient age as independent risk factors for postoperative delirium.

    Conclusions: The influence of the SvO2 level during CPB, fluid balance, and patient age should be recognized as risk factors for postoperative delirium after cardiac surgery in patients 70 years and older.

  • 785. Soreide, K.
    et al.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Translational research in surgical oncology2017Inngår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 104, nr 5, s. 491-492Artikkel i tidsskrift (Fagfellevurdert)
  • 786.
    Spigset, Olav
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk farmakologi.
    Kristoffersson, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Mjörndal, Tom
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk farmakologi.
    Platelet serotonin 5-HT2A receptor binding in patients with carcinoid tumor2004Inngår i: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 64, nr 1, s. 3-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: As carcinoid tumors produce and secrete serotonin, various serotonin markers in blood, plasma and urine have been used as diagnostic tools, and quantification of the urinary excretion of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) is the method most frequently used.

    Methods: [ 3 H]lysergic acid diethylamide ([ 3 H]LSD) binding to the platelet serotonin 5-HT 2A receptor was investigated in nine patients with carcinoid tumors. The possible effect of serotonin-rich food on the receptor binding was also investigated.

    Results: B max for [ 3 H]LSD binding was significantly lower in the carcinoid group than in the control group (mean±SD: 17.6±1.3 vs. 23.9±5.2 fmol/mg protein; p=0.007). K d for [ 3 H]LSD binding was significantly higher in the carcinoid group than in the control group (median: 1.14 vs. 0.71 nmol/L; p=0.03). B max was inversely related to the urinary 5-HIAA excretion, but the correlation did not reach statistical significance (r s =-0.57; p=0.14). Intake of five bananas per day for one week had no effect on B max or K d in healthy volunteers.

    Conclusions: The results are consistent with a down-regulation of the 5-HT 2A receptor as a response to the high serotonin levels found in patients with carcinoid tumors. Intake of serotonin-rich food does not affect the receptor characteristics. Further studies are needed to determine whether the platelet 5-HT 2A receptor status can be used as a supplement to urinary 5-HIAA and other biochemical variables in carcinoid tumors.

  • 787.
    Spyckerelle, Iris
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Positive Expiratory Pressure Breathing after Abdominal Surgery - Effects on Ventilation and Respiration2018Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 788. Steffen, Annika
    et al.
    Huerta, José-Maria
    Weiderpass, Elisabete
    Bueno-de-Mesquita, H B As
    May, Anne M
    Siersema, Peter D
    Kaaks, Rudolf
    Neamat-Allah, Jasmine
    Pala, Valeria
    Panico, Salvatore
    Saieva, Calogero
    Tumino, Rosario
    Naccarati, Alessio
    Dorronsoro, Miren
    Sánchez-Cantalejo, Emilio
    Ardanaz, Eva
    Quirós, J Ramón
    Ohlsson, Bodil
    Johansson, Mattias
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. International Agency for Research on Cancer (IARC-WHO), Lyon, France.
    Wallner, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Overvad, Kim
    Halkjaer, Jytte
    Tjønneland, Anne
    Fagherazzi, Guy
    Racine, Antoine
    Clavel-Chapelon, Françoise
    Key, Tim J
    Khaw, Kay-Tee
    Wareham, Nick
    Lagiou, Pagona
    Bamia, Christina
    Trichopoulou, Antonia
    Ferrari, Pietro
    Freisling, Heinz
    Lu, Yunxia
    Riboli, Elio
    Cross, Amanda J
    Gonzalez, Carlos A
    Boeing, Heiner
    General and abdominal obesity and risk of esophageal and gastric adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition2015Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 137, nr 3, s. 646-657Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    General obesity, as reflected by BMI, is an established risk factor for esophageal adenocarcinoma (EAC), a suspected risk factor for gastric cardia adenocarcinoma (GCC) and appears unrelated to gastric non-cardia adenocarcinoma (GNCC). How abdominal obesity, as commonly measured by waist circumference (WC), relates to these cancers remains largely unexplored. Using measured anthropometric data from 391,456 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) study and 11 years of follow-up, we comprehensively assessed the association of anthropometric measures with risk of EAC, GCC and GNCC using multivariable proportional hazards regression. One hundred twenty-four incident EAC, 193 GCC and 224 GNCC were accrued. After mutual adjustment, BMI was unrelated to EAC, while WC showed a strong positive association (highest vs. lowest quintile HR = 1.19; 95% CI, 0.63-2.22 and HR = 3.76; 1.72-8.22, respectively). Hip circumference (HC) was inversely related to EAC after controlling for WC, while WC remained positively associated (HR = 0.35; 0.18-0.68, and HR=4.10; 1.94-8.63, respectively). BMI was not associated with GCC or GNCC. WC was related to higher risks of GCC after adjustment for BMI and more strongly after adjustment for HC (highest vs. lowest quintile HR = 1.91; 1.09-3.37, and HR = 2.23; 1.28-3.90, respectively). Our study demonstrates that abdominal, rather than general, obesity is an indisputable risk factor for EAC and also provides evidence for a protective effect of gluteofemoral (subcutaneous) adipose tissue in EAC. Our study further shows that general obesity is not a risk factor for GCC and GNCC, while the role of abdominal obesity in GCC needs further investigation.

  • 789.
    Stegmayr, Bernd G.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sperker, Wolfgang
    Nilsson, Christina H.
    Degerman, Christina
    Persson, Sven-Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stenbaek, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Arnerlöv, Conny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Few Outflow Problems With a Self-locating Catheter for Peritoneal Dialysis: A Randomized Trial2015Inngår i: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 94, nr 48, artikkel-id e2083Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We developed a technique for direct start of peritoneal dialysis. Using a coiled or straight Tenckhoff catheter often results in obstruction of flow. A self-locating Wolfram catheter is on the market. It is not clarified if this results in a benefit.The primary aim of this study was to perform a randomized investigation to clarify if the use of a self-locating peritoneal dialysis (PD) catheter would result in different flow problems than a straight Tenckhoff catheter.A total of 61 insertions were made who were randomized and received either a straight Tenckhoff (n = 32) or a self-locating Wolfram catheter (n = 29). A previously described operation technique allowed immediate postoperative start of dialysis. Seven straight Tenckhoff catheters had to be changed into self-locating catheters, and none vice versa, due to flow problems (P = 0.011). An early leakage resulted in temporarily postponed PD in 4 patients. This study showed that using the present operation technique the self-locating PD-catheter causes fewer obstruction episodes than a straight Tenckhoff catheter. This facilitates immediate postoperative start of PD.

  • 790.
    Stegmayr, Bernd
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin.
    Wikdahl, Ann Marie
    Bergström, Monica
    Nilsson, Christina
    Engman, Ulla
    Arnerlöv, Conny
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Petersen, Erling
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    A randomized clinical trial comparing the function of straight and coiled Tenckhoff catheters for peritoneal dialysis.2005Inngår i: Perit Dial Int, ISSN 0896-8608, Vol. 25, nr 1, s. 85-8Artikkel i tidsskrift (Fagfellevurdert)
  • 791. Steindorf, Karen
    et al.
    Ritte, Rebecca
    Eomois, Piia-Piret
    Lukanova, Annekatrin
    Tjonneland, Anne
    Johnsen, Nina Fons
    Overvad, Kim
    Ostergaard, Jane Nautrup
    Clavel-Chapelon, Francoise
    Fournier, Agnes
    Dossus, Laure
    Teucher, Birgit
    Rohrmann, Sabine
    Boeing, Heiner
    Wientzek, Angelika
    Trichopoulou, Antonia
    Karapetyan, Tina
    Trichopoulos, Dimitrios
    Masala, Giovanna
    Berrino, Franco
    Mattiello, Amalia
    Tumino, Rosario
    Ricceri, Fulvio
    Ramon Quiros, J.
    Travier, Noemie
    Sanchez, Maria-Jose
    Navarro, Carmen
    Ardanaz, Eva
    Amiano, Pilar
    Bueno-de-Mesquita, H. B. (as).
    van Duijnhoven, Franzel
    Monninkhof, Evelyn
    May, Anne M.
    Khaw, Kay-Tee
    Wareham, Nick
    Key, Tim J.
    Travis, Ruth C.
    Borch, Kristin Benjaminsen
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Andersson, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Fedirko, Veronika
    Rinaldi, Sabina
    Romieu, Isabelle
    Wahrendorf, Juergen
    Riboli, Elio
    Kaaks, Rudolf
    Physical activity and risk of breast cancer overall and by hormone receptor status: The European prospective investigation into cancer and nutrition2013Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 132, nr 7, s. 1667-1678Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Physical activity is associated with reduced risks of invasive breast cancer. However, whether this holds true for breast cancer subtypes defined by the estrogen receptor (ER) and the progesterone receptor (PR) status is controversial. The study included 257,805 women from the multinational EPIC-cohort study with detailed information on occupational, recreational and household physical activity and important cofactors assessed at baseline. During 11.6 years of median follow-up, 8,034 incident invasive breast cancer cases were identified. Data on ER, PR and combined ER/PR expression were available for 6,007 (67.6%), 4,814 (54.2%) and 4,798 (53.9%) cases, respectively. Adjusted hazard ratios (HR) were estimated by proportional hazards models. Breast cancer risk was inversely associated with moderate and high levels of total physical activity (HR = 0.92, 95% confidence interval (CI): 0.860.99, HR = 0.87, 95%-CI: 0.790.97, respectively; p-trend = 0.002), compared to the lowest quartile. Among women diagnosed with breast cancer after age 50, the largest risk reduction was found with highest activity (HR = 0.86, 95%-CI: 0.770.97), whereas for cancers diagnosed before age 50 strongest associations were found for moderate total physical activity (HR = 0.78, 95%-CI: 0.640.94). Analyses by hormone receptor status suggested differential associations for total physical activity (p-heterogeneity = 0.04), with a somewhat stronger inverse relationship for ER+/PR+ breast tumors, primarily driven by PR+ tumors (p-heterogeneity < 0.01). Household physical activity was inversely associated with ER/PR tumors. The results of this largest prospective study on the protective effects of physical activity indicate that moderate and high physical activity are associated with modest decreased breast cancer risk. Heterogeneities by receptor status indicate hormone-related mechanisms.

  • 792.
    Stenling, Roger
    et al.
    Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap, Patologi. Patologi.
    Lindberg, Jan
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Rutegård, Jörgen
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Palmqvist, Richard
    Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap, Patologi. Patologi.
    Altered expression of CK7 and CK20 in preneoplastic and neoplastic lesions in ulcerative colitis.2007Inngår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 115, nr 11, s. 1219-1226Artikkel i tidsskrift (Annet vitenskapelig)
  • 793. Stepien, Magdalena
    et al.
    Duarte-Salles, Talita
    Fedirko, Veronika
    Floegel, Anne
    Barupal, Dinesh Kumar
    Rinaldi, Sabina
    Achaintre, David
    Assi, Nada
    Tjønneland, Anne
    Overvad, Kim
    Bastide, Nadia
    Boutron-Ruault, Marie-Christine
    Severi, Gianluca
    Kühn, Tilman
    Kaaks, Rudolf
    Aleksandrova, Krasimira
    Boeing, Heiner
    Trichopoulou, Antonia
    Bamia, Christina
    Lagiou, Pagona
    Saieva, Calogero
    Agnoli, Claudia
    Panico, Salvatore
    Tumino, Rosario
    Naccarati, Alessio
    Bueno-de-Mesquita, H Bas
    Peeters, Petra H
    Weiderpass, Elisabete
    Quirós, J Ramón
    Agudo, Antonio
    Sánchez, María-José
    Dorronsoro, Miren
    Gavrila, Diana
    Barricarte, Aurelio
    Ohlsson, Bodil
    Sjöberg, Klas
    Werner, Mårten
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Wareham, Nick
    Khaw, Kay-Tee
    Travis, Ruth C
    Schmidt, Julie A
    Gunter, Marc
    Cross, Amanda
    Vineis, Paolo
    Romieu, Isabelle
    Scalbert, Augustin
    Jenab, Mazda
    Alteration of amino acid and biogenic amine metabolism in hepatobiliary cancers: findings from a prospective cohort study2016Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 138, nr 2, s. 348-360Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Perturbations in levels of amino acids (AA) and their derivatives are observed in hepatocellular carcinoma (HCC). Yet, it is unclear whether these alterations precede or are a consequence of the disease, nor whether they pertain to anatomically related cancers of the intrahepatic bile duct (IHBC), and gallbladder and extrahepatic biliary tract (GBTC). Circulating standard AA, biogenic amines and hexoses were measured (Biocrates AbsoluteIDQ-p180Kit) in a case-control study nested within a large prospective cohort (147 HCC, 43 IHBC and 134 GBTC cases). Liver function and hepatitis status biomarkers were determined separately. Multivariable conditional logistic regression was used to calculate odds ratios and 95% confidence intervals (OR; 95%CI) for log-transformed standardised (mean = 0, SD = 1) serum metabolite levels and relevant ratios in relation to HCC, IHBC or GBTC risk. Fourteen metabolites were significantly associated with HCC risk, of which seven metabolites and four ratios were the strongest predictors in continuous models. Leucine, lysine, glutamine and the ratio of branched chain to aromatic AA (Fischer's ratio) were inversely, while phenylalanine, tyrosine and their ratio, glutamate, glutamate/glutamine ratio, kynurenine and its ratio to tryptophan were positively associated with HCC risk. Confounding by hepatitis status and liver enzyme levels was observed. For the other cancers no significant associations were observed. In conclusion, imbalances of specific AA and biogenic amines may be involved in HCC development.

  • 794. Stepien, Magdalena
    et al.
    Fedirko, Veronika
    Duarte-Salles, Talita
    Ferrari, Pietro
    Freisling, Heinz
    Trepo, Elisabeth
    Trichopoulou, Antonia
    Bamia, Christina
    Weiderpass, Elisabete
    Olsen, Anja
    Tjonneland, Anne
    Overvad, Kim
    Boutron-Ruault, Marie-Christine
    Fagherazzi, Guy
    Racine, Antoine
    Kuehn, Tilman
    Kaaks, Rudolf
    Aleksandrova, Krasimira
    Boeing, Heiner
    Lagiou, Pagona
    Benetou, Vassiliki
    Trichopoulos, Dimitrios
    Palli, Domenico
    Grioni, Sara
    Tumino, Rosario
    Naccarati, Alessio
    Panico, Salvatore
    Bueno-de-Mesquita, H. Bas
    Peeters, Petra H.
    Lund, Eiliv
    Quiros, J. Ramon
    Napoles, Osmel Companioni
    Sanchez, Maria-Jose
    Dorronsoro, Miren
    Maria Huerta, Jose
    Ardanaz, Eva
    Ohlsson, Bodil
    Sjoberg, Klas
    Werner, Mårten
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Nyström, Hanna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Khaw, Kay-Tee
    Key, Timothy J.
    Gunter, Marc
    Cross, Amanda
    Riboli, Elio
    Romieu, Isabelle
    Jenab, Mazda
    Prospective association of liver function biomarkers with development of hepatobiliary cancers2016Inngår i: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 40, s. 179-187Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Serum liver biomarkers (gamma-glutamyl transferase, GGT; alanine aminotransferase, ALT; aspartate aminotransferase, AST; alkaline phosphatase, ALP; total bilirubin) are used as indicators of liver disease, but there is currently little data on their prospective association with risk of hepatobiliary cancers. Methods: A nested-case control study was conducted within the prospective EPIC cohort (>520,000 participants, 10 European countries). After a mean 7.5 mean years of follow-up, 121 hepatocellular carcinoma (HCC), 34 intrahepatic bile duct (IHBC) and 131 gallbladder and biliary tract (GBTC) cases were identified and matched to 2 controls each. Circulating biomarkers were measured in serum taken at recruitment into the cohort, prior to cancer diagnosis. Multivariable adjusted conditional logistic regression was used to calculate odds ratios and 95% confidence intervals (OR; 95% CI). Results: In multivariable models, 1SD increase of each log-transformed biomarker was positively associated with HCC risk (OR(GGT) = 4.23, 95% CI: 2.72-6.59; OR(ALP) = 3.43, 95% CI: 2.31-5.10; OR(AST) = 3.00, 95% CI: 2.04-4.42; OR(ALT) = 2.69, 95% CI: 1.89-3.84; OR(Bilirubin) = 2.25, 95% CI: 1.58-3.20). Each liver enzyme (OR(GGT) = 4.98; 95% CI: 1.75-14.17; OR(AST) = 3.10, 95% CI: 1.04-9.30; OR(ALT) = 2.86, 95% CI: 1.26-6.48, OR(ALP) = 2.31, 95% CI: 1.10-4.86) but not bilirubin (OR(Bilirubin) = 1.46,95% CI: 0.85-2.51) showed a significant association with IHBC. Only ALP was significantly associated with GBTC risk (OR (ALP) = 1.59, 95% CI: 1.20-2.09). Conclusion: This study shows positive associations between circulating liver biomarkers in sera collected prior to cancer diagnoses and the risks of developing HCC or IHBC, but not GBTC.

  • 795. Stigson, Helena
    et al.
    Gustafsson, Markus
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Sunnevang, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Krafft, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Kullgren, Anders
    Differences in Long-Term Medical Consequences Depending on Impact Direction Involving Passenger Cars2015Inngår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 16, s. S133-S139Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: There is limited knowledge of the long-term medical consequences for occupants injured in car crashes in various impact directions. Thus, the objective was to evaluate whether injuries leading to permanent medical impairment differ depending on impact direction. Methods: In total, 36,743 injured occupants in car crashes that occurred between 1995 and 2011 were included. All initial injuries (n = 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. Injured car occupants were followed for at least 3years to assess permanent medical impairment. The data were divided into different groups according to impact direction and levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to AIS. Results: It was found that almost 12% of all car occupants sustained a permanent medical impairment. Given an injury, car occupants involved in rollover crashes had the highest overall risk to sustain a permanent medical impairment. Half of the head injuries leading to long-term consequences occurred in frontal impacts. Far-side occupants had almost the same risk as near-side occupants. Occupants who sustained a permanent medical impairment from cervical spine injuries had similar risk in all impact directions (13%) except from rollover (17%). However, these injuries occurred more often in rear crashes. Most of the injuries leading to long-term consequences were classified as minor injuries by AIS for all impact directions. Conclusions: Studying crash data from a perspective of medical impairment is important to identify injuries that might not be prioritized only considering the AIS but might lead to lower quality of life for the occupant and also costs for society. These results can be used for road transport system strategies and for making priority decisions in vehicle design.

  • 796. Stigson, Helena
    et al.
    Hagberg, Jan
    Kullgren, Anders
    Krafft, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    A One Year Pay-as-You-Speed Trial With Economic Incentives for Not Speeding2014Inngår i: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 15, nr 6, s. 612-618Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The objective was to identify whether it was possible to change driver behavior by economic incentives and thereby reduce crash risk. Furthermore, the objective was to evaluate the participants' attitudes toward the pay-as-you-speed (PAYS) concept. Methods: A one-year PAYS trial with economic incentives for keeping speed limits using intelligent speed assistance (ISA) was conducted in Sweden during 2011-2012. The full incentive was a 30 percent discount off the insurance premium. The participants were private insurance customers and were randomized into a test group (initial n = 152, final n = 128) and a control group (initial n = 98, final n = 68). When driving, the drivers in the test group were informed and warned visually when the speed limit was exceeded. They could also follow their driving results on a personal website. The control group was not given any feedback at all. To reflect the impact of the PAYS concept the proportion of distance driven above the speed limit was compared between the 2 groups. Results: The introduction of a PAYS concept shows that the test group significantly reduced the proportion of distance driven above the speed limit. The proportion of driving at a speed exceeding 5 km/h over the speed limit was 6 percent for the test group and 14 percent for the control group. It also showed that the effect was higher the higher the violation of speed. The result remained constant over time. Conclusions: It was shown that a PAYS concept is an effective way to reduce speed violations. Hence, it has the possibility to reduce crash severity and thereby to save lives. This could be an important step toward a safer road transport system. The majority of the participants were in favor of the concept, which indicates the potential of a new insurance product in the future.

  • 797.
    Strandberg, Veronica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Statsvetenskapliga institutionen. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rail Bound Traffic: a Prime Target for Contemporary Terrorist Attacks?2013Inngår i: Journal of Transportation Security, ISSN 1938-7741, E-ISSN 1938-775X, Vol. 6, nr 3, s. 271-286Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The threat of terrorism is a worldwide concern, often discussed in the context of our constantly changing world with new complex threats, risks and crises. This article focuses on terrorist attacks targeting rail bound traffic because of its extreme vulnerability for terrorist attacks. The article provides an empirical overview of the frequency and characteristics of attacks on rail bound traffic. At least in recent years, attacks have been a growing phenomenon. The results are interpreted through the lens of a contemporary terrorism paradigm which revolves around in which way which terrorist organizations organize their activity and if there is an increased religiously motivated terrorism and a presumed shift towards more indiscriminate killing through the use of new tactics and weapons. This article identifies the 20 biggest large-scale attacks on rail bound traffic, and they do resemble contemporary terrorism.

  • 798.
    Strandh, Veronica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Statsvetenskapliga institutionen. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Preparing and responding to Mass Casualty Terrorist Attacks: a Comparative Analysis of Four Terrorist Attacks Targeting Rail Bound Traffic2015Inngår i: International Journal of Emergency Management, ISSN 1471-4825, E-ISSN 1741-5071, Vol. 11, nr 3, s. 262-281Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This paper addresses the challenging task of responding to terrorist attacks targeting rail bound traffic and provides a multi-level framework for analysis of such complex attacks. Major mass-casualty attacks are particularly challenging to emergency management and there is a knowledge gap concerning how to prepare for and respond to such extraordinary events. This paper categorises a rich empirical material from four major attacks on rail bound traffic and concludes that decisive components of the emergency management response in the four cases are related to ‘agent-generated demands’. Additional complicating factors emerge since each response is carried out in a specific terrorism context. Examples include sense-making difficulties, scene safety and terrorism-specific injuries. Another conclusion is that the development of knowledge and awareness about such challenges and the incorporation of such knowledge in training and response plans are pivotal to future emergency management.

  • 799.
    Strandh, Veronica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Statsvetenskapliga institutionen. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Responding to Terrorist Attacks on Rail Bound Traffic: Challenges for Inter-organizational Collaboration2015Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Contemporary terrorism is becoming increasingly indiscriminate, and rail bound traffic appears to be vulnerable and at high risk for terrorist attacks. An attack targeting a train or subway system can have enormous implications, both in terms of human suffering and long-term societal consequences. This dissertation aims to analyze how public and private organizations prepare for and respond to crises emanating from terrorism targeting rail bound traffic. It also examines different practices, networks and ideas related to interorganizational collaboration. Contemporary research emphasizes the importance and advantages of collaborative action in crisis management, and the idea of inter-organizational collaboration is also embedded in policy documents and has support among practitioners. Despite this, interorganizational collaboration often turns out to be difficult in practice, and it stands out as a critical factor in many crisis situations. Hence, it is crucial to identify and better understand the challenges associated with interorganizational collaboration in the context of terrorist-induced crises. This dissertation is a contribution to this endeavor. In order to capture the inherent complexity of the topic this dissertation combines and merges literature from three research fields: crisis management research, disaster medicine research and terrorism studies.

    The dissertation examines international experiences of terrorist attacks directed against rail bound traffic. It identifies the way in which attacks have changed over time and analyzes the main challenges of providing pre-hospital care following a mass-casualty attack. In addition, Sweden is used to provide empirical focus in an analysis of preparedness. Relying on scenario-based interviews with central crisis management actors and actors from rail bound traffic, current preparedness practices for responding to a multi-site terrorist attack on rail bound traffic in Sweden is analyzed. The research shows that both public and private organizations have developed risk awareness about terrorist-induced crises. However, their preparedness practices are characterized by significant variations and substantial uncertainty. Scare resources are a critical factor, and actors find it difficult to invest in preparedness for seldom-occurring crises. This difficulty is accentuated by the fact that no major mass-casualty attack has taken place in Sweden. A terrorist attack differs from a routine event and poses new and different challenges for inter-organizational collaboration. A large number of organizations are supposed to work together under severe time constraints, and their work can be delayed by particular security concerns. It is assumed that rail bound traffic actors engage in collaborative crisis management; however, there appear to be few mechanisms to prepare them, in a systematic way, for managing this particular type of crisis. Among actors, inter-organizational collaboration is understood primarily from a normative view rather than from the point of view of its practical meaning. As a consequence, it is difficult to turn risk awareness and a commitment to working together into actual practical action. In addition, collaboration between different levels in the crisis management system is particularly challenging. This dissertation also identifies a tension between viewing crisis management as an example of policy-as-usual or from a crises-as-exceptions perspective.

  • 800.
    Strandh, Veronica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Statsvetenskapliga institutionen. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sweden's capacity to prepare and respond to a terrorist attack on rail-bound traffic: promising practices and obstacles to inter-organizational collaboration2015Inngår i: Journal of risk analysis and crisis response, ISSN 2210-8491, Vol. 5, nr 4, s. 215-225Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article takes an interest in evolving collaborative practices in crises caused by terrorism targeting rail-bound traffic. Sweden provides the empirical focus, by examining current preparedness processes, this article offers an important perspective on inter-organizational collaboration; that is, the perspective of the involved actors themselves. This study relies on 20 interviews with key actors in the response system and rail bound traffic actors.This article combines insights from the literature on governance with the research on disasters and crises. Promising practices and obstacles to inter-organizational collaboration are identified and analyzed.

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